bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECT OF PROFESSIONAL BLEACHING ON THE HYGIENE OF THE ORAL CAVITY. A RANDOMIZED CONTROLLED STUDY
Authors: Vlasova Natalia N. , Turkina A. Yu. , Prokhorov N. I. , Makeeva M. K. , Danilina A. A. , Nikolashvili N. I.
Published: November 2019

Aim of the study. To evaluate the effect of professional teeth whitening on the level of oral hygiene. Material and methods. A randomized controlled, prospective clinical trial was conducted in 2 groups of 30 people, in each. In group 1, professional oral hygiene and professional teeth whitening were performed using 25% hydrogen peroxide. In group 2, only professional oral hygiene was performed. Evaluated the dynamics of the hygienic index of Quigley-Hein in the modification of S. Turesky, 2 weeks, 1 month and 6 months after the procedure. Results. 6 months after the start of the study in group 1, the average value of the Quigley-Heine index in the modification of S. Turesky was significantly lower than before the at start of the study (1.24 ± 0.11 and 2.34 ± 0.14 respectively). In group 2, the index value after 6 months exceeded 2.0 and almost returned to the initial level (2.05 ± 0.06 and 2.44 ± 0.08, respectively). During the entire observation period in patients underwent professional teeth whitening, the level of oral hygiene was significantly higher than in the control group. Conclusion. Professional teeth whitening has a positive effect on the level of oral hygiene and is a significant motivating factor in maintaining oral health.
Una técnica de clasificación con variables categóricas
Authors: Clavijo M. J. A. , Granada D. H. A.
Published: November 2019

Presenta un algoritmo de clasificación para elementos caracterizados por variables categóricas, usandok-modas, un algoritmo similar a k-medias. A la vez, se incluyen diagramas de flujo para la implementación del algoritmo en cualquier lenguaje de programación. También se presenta un ejemplo con datos reales que ilustra la propuesta
Dermatomiyozit ve malignite birlikteliği: bir olgu örneği
Authors: TANIGÖR Göksel , KOÇANAOĞULLARI Hayriye , YARGUCU ZİHNİ Figen , KARABULUT Gonca
Published: November 2019

Dermatomiyozit, hem kas, hem de derinin tutulduğu bir sistemik otoimmün hastalıktır. Hastaların önemli bir kısmında altta bir malignite varlığı tespit edilebilmektedir. Birliktelik genellikle solid organ tümörleri olmakla beraber birçok malign neoplazi ile ilişkili olabilir. Bu nedenle hastalarda sadece hastalık yönetiminin gerçekleştirilmesi değil, sistemik açıdan da detaylı bir şekilde taranması ve gelecekte de bu açıdan izlenmesi önemlidir. Sunulacak olgu bahsettiğimiz birlikteliğe bir örnek teşkil etmektedir
O direito à educação no ensino superior de pessoas com deficiências
Authors: Januário Geane de Oliveira
Published: November 2019

A educação direito de todos e dever do Estado está garantida na Carta Magna. No tocante ao ensino superior, presencia-se um movimento de mobilização da sociedade, para garantir que as pessoas com deficiências tenham acesso à educação superior. Nesse contexto, realizou-se uma revisão sistemática, com o intuito de levantar os trabalhos que abordam a temática, tomando como fontes de pesquisas o catálogo de teses e dissertações da Capes, a Biblioteca Digital Brasileira de Teses e Dissertações, os periódicos científicos nas bases Scielo e Capes, além da Revista Internacional de Educação Superior. A partir das análises, foi possível depreender que, nos últimos anos, vem ocorrendo um aumento no número de estudos voltados para a questão. Vale acentuar os avanços ocorridos com relação à promulgação de leis e a formulação de políticas educacionais que garantem o direito à educação superior para a pessoa com deficiência, por meio da reserva de um percentual das vagas de cada curso e turno das Instituições Federais de Ensino Superior.
cultura del gusto. La alimentación entre representaciones y conexiones
Authors: Cava Antonia
Published: November 2019

Este ensayo explora las reflexiones teóricas clásicas y los escenarios posmodernos en que se inserta el discurso en torno a la comida, centrando la atención sociológica en las características fundamentales de las ideologías y de las rutinas alimenticias contemporáneas. Trataremos la reconfiguración de las técnicas y artes culinarias a partir del momento en que éstas se introducen en el marco medial, con especial arreglo a los escenarios de la “gastromanía” 2.0.  Analizaremos por tanto el impacto social, cultural y económico de las redes sociales en nuestras elecciones alimenticias. Nuestra perspectiva interpretativa se basará en los temas de la disinformation: nuestra hipótesis es que el mayor espacio que tanto los nuevos medios de comunicación como los tradicionales le dedican al relato de la comida y del bienestar no se convierte en niveles de conocimiento más altos por lo que atañe a los temas de alimentación.
Impacto socioeconómico de la globalización: el caso de Fagor Ederlan Brasileira
Authors: Arzadun Paula
Published: November 2019

MONDRAGON es el mayor grupo empresarial de la Economía Social española. Actualmente está conformado por 266 organizaciones, de las cuales 143 son filiales productivas, o experiencias de globalización del proceso productivo establecido – GPPE. El presente artículo forma parte de una investigación más amplia en la que se desarrolló una herramienta analítica de evaluación del impacto socioeconómico, y que se utilizó para evaluar el impacto de la GPPE de Mondragón en países en riesgo identificados como mercados objetivo. Para ello se combinaron dos medidas: el impacto económico a través de las Tablas Input – Output, y el grado en el que se alinean las políticas y prácticas económicas, ambientales y socialmente responsables con la estrategia empresarial. En concreto, aquí se presenta el caso de Fagor Ederlan Brasileira para lo cual se llevó a cabo un trabajo de campo in situ en Mina Gerais y Sao Paulo, Brasil.
redes entre actores a través del presupuesto: los casos de Alicante y Valencia
Authors: Pardo Beneyto Gonzalo , López María Ángeles Abellán
Published: November 2019

El presente artículo tiene como principal objetivo analizar la forma de provisión de bienes y servicios de los Ayuntamientos de Alicante y València (2005-2016). Para ello, llevaremos a cabo un análisis del presupuesto por capítulos para determinar el reparto de fondos entre los distintos actores que forman las redes de políticas públicas de cada consistorio. Entre las evidencias que hemos encontrado podemos destacar que dicho fenómeno se ha visto, ciertamente, afectado por la crisis económica que ha hecho variar las estrategias. Asimismo, hemos podido constatar el reparto de dinero público entre actores de distinta naturaleza lo que denota un escenario propio de la gobernanza urbana en la que miembros del tercer sector, empresas y otras instituciones son parte de las políticas públicas locales.
Quercetin Exerts Anti-Inflammatory Effects via Meanwhile Suppressing TLR2 Gene Expression and STAT3 Protein Phosphorylation in Activated Inflammatory Macrophages
Authors: Liao Yi-Ru , Lin Jin-Yuarn
Published: November 2019

Our previous studies demonstrated that quercetin (Q) could be ingested and metabolized by macrophages and exerted prophylactic immuno-stimulatory activity and therapeutic anti-inflammatory effects on lipopolysaccharide (LPS)-treated macrophages ex vivo. To further clarify its possible anti-inflammatory mechanism, Q was selected to treat mouse peritoneal macrophages that obtained from female BALB/c mice exposed to LPS i.p. for 12 h. Relative gene expression of pro-/anti-inflammatory (TNF-α/IL-10) cytokines and components of inflammation-related intracellular signaling pathways (TLR2, TLR4, NF-κB, JAK2 and STAT3) was analyzed using two-step reverse transcription (RT) and real-time quantitative polymerase chain reaction (qPCR). STAT3 protein phosphorylation was determined using an in-cell ELISA method. As a result, Q and its metabolite quercetin-3-O-β-D-glucuronide (Q3G) decreased TNF-α gene expression amounts and ratios of pro-/anti-inflammatory (TNF-α/IL-10) cytokine gene expressions, but increased IL-10 gene expression amounts in activated inflammatory macrophages, supporting a substantial anti-inflammatory potential of Q and Q3G treatments. However, Q3G had lower effects than those of Q. Importantly, Q inhibited TLR2 gene expression and phosphorylation of STAT3 protein in the inflamed cells. Our results are the first report to suggest that Q inhibits LPS-induced inflammation ex vivo through suppressing TLR2 gene expression and STAT3 protein phosphorylation in activated inflammatory macrophages. Q has potential to further apply for treating inflammation-associated diseases.
Cognitive autonomy differences among adolescents in Malaysia
Authors: Abderrahim Benlahcene  , Sana Anwar Lashar  , Anita Lubana
Published: November 2019

This research examined the relationship between five areas of cognitive autonomy and development among adolescents. Students from middle and high school in Keddah participated in this study. Ninety-four participants responded on the Cognitive Autonomy and Self-Evaluation (CASE) inventory, which examined the evaluative thinking, voicing opinions, comparative validation, decision making, and self-assessment.  Scores were compared based on gender and grade. Results highlighted that high school students scored significantly higher in two of the five areas of cognitive autonomy. Additionally, females in middle school rated themselves significantly higher in two areas of cognitive autonomy (evaluative thinking and decision making). Areas of academic grades, time watching TV, time spent reading, and using computer were also discussed.
The composition of practice teaching in special education: A preliminary study
Authors: Shamsul Rizal Khalil  , Abdul Rahim Razalli  , Mohd Faiz Mohd Yaakob
Published: November 2019

Teaching composition of the practice teaching among teachers is important. Indeed, strategic teaching is a way of making decisions about a course, an individual class, or even an entire curriculum, beginning with an analysis of key variables in the teaching situation. This study, a preliminary study about teaching composition among special education teachers. The strategic composition namely as Quality of Instruction; The Appropriate Level of Instruction, Incentive; Time; and Lesson Plans. The findings showed Quality of Instruction is the highest level and the lowest variable is Time. Discussions and recommendations are stated for authorities and academic contribution.
Fastering Humanistic Language Teaching
Authors: Jumadi
Published: November 2019

Language teaching systems (especially in Indonesia) are generally still dominative. Teachers still dominate teaching process, both regarding the communication pattern, material presentation, and evaluation system used. In fact, education experts, such as John Dewey and Paulo Freire, emphasize the importance of developing a humanistic teaching climate. In this teaching climate, teachers place students as human beings who prepare their future critically and creatively. Teachers’ domination means killing students' criticality and creativity. Humanization of language teaching can be represented in various aspects of teaching, including in the process of preparing teaching materials, processes, and evaluation.
Teaching Speaking English Strategies For Indonesian Labors
Authors: Sumihatul Ummah Siti
Published: November 2019

The objectives of this research were to describe teaching Speaking English strategies used by the instructor for Indonesian labors, to investigate the instructor’s obstacles in teaching Speaking English, to know the instructor’s efforts in overcoming the obstacles, and to know the Indonesian labors’ respons in learning Speaking English at PT. Assanatama Karya Mandiri Surabaya. The research method was qualitative descriptive. The data sources were from the instructor and Indonesian labors. There were three ways to collect the data namely oberservation, interview, and documentation. The result of the research showed that there were six teaching strategies of Speaking English used by the instructor namely grammar translation method, communicative approach, audio-lingual method, role play method, demonstration method, and lecturing method. While the obstacles usually faced by the instructor in teaching Speaking English were the differences of Indonesian labors background, Indonesian labors difficulty in memorizing materials, arrangement of time allotment, indisciplinary of Indonesian labors, and Indonesian labors had low spirit in learning Speaking English. From these obstacles, the instructor overcame them by adapting her teaching strategy appropriately with games and songs, giving drilling in conversation section, giving interesting medias, collaborating other strategies in teaching Speaking English, and giving reward and pedagogy punishment.
Sleep Quality Among Undergraduates During Pre-Examination Period
Authors: Aishah Ahad Nor
Published: November 2019

The purpose of the study is to examine the sleep quality of undergraduates during pre-examination period. In addition, the effect of examination stress and sleep quality on academic performance of the undergraduates is also of interest. Questionnaire is used to collect responses from 379 undergraduates regarding perceived stress and sleep quality on the first week of final examination. Pittsburgh Sleep Quality Index (PSQI) is the instruments used in investigating the perceived sleep quality of respondents one month before the test is taken. Perceived Stress Scale (PSS) is used to measure the perceived stress level of the subjects for the past one month. The data dissemination concludes that the overall sleep quality of the undergraduates is poor. Female undergraduates tend to have a slightly better sleep quality than the male undergraduates. The sleep quality shows a weak positive relationship with perceived stress. It is also discovered that sleep quality and perceived stress have no effect on academic performance. The university authority might need to look into the problem of poor sleep quality among undergraduates especially during pre-examination period.
Microbial structures and dinosaur trackways from a Cretaceous coastal environment (Dakota Group, Colorado, U.S.A.)
Authors: Noffke Nora , Hagadorn James , Bartlett Sam
Published: November 2019

Microbially induced sedimentary structures may help preserve unique glimpses of ancient shoreline habitats, but are little known from Mesozoic epicontinental settings. To help fill this knowledge gap, we describe a diverse suite of microbial structures from the Upper Cretaceous “J” Sandstone (South Platte Formation, Dakota Group) that are spectacularly exposed at Dinosaur Ridge in Morrison, Colorado, USA. Structures include “tattered” bed surfaces and ferruginous sand chips in supratidal flat facies. A large over-flip structure is preserved in a channel locally known as Crocodile Creek. In upper-intertidal facies, multidirectional ripple marks occur. Perhaps the most well-known microbial structures are exposed on extensive bedding surfaces known as “Slimy Beach,” where lower supratidal-flat facies are dominated by decimeter-scale erosional remnants and pockets. Morphologies and superposition of the structures allows identification of three generations of erosional pockets. Generation A of these erosional pockets exhibit size similarities to ornithomimid, sauropod, and ornithopod dinosaur tracks from adjacent bedding planes, raising the question of whether initial disturbance of the mat-bound surface could have been from track making. Generation B erosional pockets are older and record continuous erosion of the initial pockets until they were eventually overgrown and sealed by microbial mats. Generation C pockets are the oldest ones, exposing wide areas of barren sediment that could not be overgrown by microbial mats anymore. In concert, the microbial structures point to seasonally variable meteorological conditions along the coastline of the Western Interior Seaway and indicate that the “Slimy Beach” bedding plane represents a multi-year record of dinosaur locomotion.
Prevalence and associated factors of metabolic syndrome in adults: a population-based epidemiological survey in Jiangxi province, China
Authors: wu liting , SHEN YunFeng , HU Lei , Zhang MeiYing , LAI XiaoYang
Published: November 2019

Background: Metabolic syndrome (MS) has abruptly increased in China in the past two decades, gradually representing an important public health threat over the years. Here, we firstly reported the prevalence and associated factors of metabolic syndrome in Jiangxi province, China. Methods: A population-based cross-sectional survey was performed in Jiangxi province, China, from April to August 2015. MS was diagnosed by International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS) criteria, respectively. Factors associated with MS were investigated by multivariate logistic regression. Results: A total of 2665 residents aged over 18 years were enrolled, and 2580 effectively participated. According to IDF and CDS criteria, age-standardized prevalence of MS were 21.1% and 15.2% in all participants, respectively; prevalence were 19.6% or 17.1% in men, and 22.7% or 13.0% in women, based on these respective criteria. Rural participants had a significantly higher prevalence than urban individuals, so did rural females. Prevalence in males did not differ between rural and urban participants. Factors independently associated with MS were low education level and menopausal state. Conclusions: MS is highly prevalent in adults in Jiangxi province, China. Low education level and menopausal state are independently associated with MS. Keywords: metabolic syndrome, prevalence, associated factors
Psychiatric morbidity and poor follow-up underlie suboptimal functional and survival outcomes in Huntington's disease
Authors: Ratna Nikhil , Kamble Nitish L , V Sowmya D , Purushottam Meera , Pal Pramod K , Jain Sanjeev
Published: November 2019

BACKGROUND: Huntington’s disease (HD), an inherited, often late-onset, neurodegenerative disorder, is considered to be a rare, orphan disease. Research into its genetic correlates and services for those affected are inadequate in most low-middle income countries, including India. The apparent ‘incurability’ often deters symptomatic and rehabilitative care, resulting in poor quality of life and sub-optimal outcomes. There are no studies assessing disease burden and outcomes from India.
METHODS: We attempted to evaluate individuals diagnosed to have HD at our tertiary-care center between 2013 and 2016 for clinical symptoms, functionality, mortality, follow up status through a structured interview, clinical data from medical records & UHDRS TFC scoring.
RESULTS: Of the 144 patients, 25% were untraceable, and another 17 (11.8%) had already died. Mean age at death and duration of illness at the time of death, were 53 years and 7 years respectively, perhaps due to suicides and other comorbidities at an early agewhich is much shorter than in Europe and USA. The patients who could be contacted (n=81) were assessed for morbid symptoms and total functional capacity (TFC). Mean CAG repeat length and TFC score were 44.2 and 7.5 respectively. Most individuals (66%) were in TFC stage I and II and could perhaps benefit from several interventions. The TFC score correlated inversely with duration of illness (p<0.0001). The vast majority were being taken care of at home, irrespective of the physical and mental disability. There was a high prevalence of psychiatric morbidity (91%) including suicidal tendency (22%). Three of the 17 who died had committed suicide, and many other families reported suicidal history in other family members. Only about half the patients (57%) maintained a regular clinical follow-up.
CONCLUSIONS: This study demonstrates the poor follow-up rates, significant suicidality & other psychiatric symptoms, suboptimal survival durations and functional outcomes highlighting the need for holistic care for the majority who appear to be amenable for interventions.
Does Case-based blended-learning expedite the transfer of declarative knowledge to procedural knowledge in practice?
Authors: Turk Bela Rui , Ertl Sebastian , Wong Guoruey , Wadowski Patricia P , Loeffler-Stastka Henriette
Published: November 2019

Background Case-Based Learning (CBL) has seen widespread implementation in undergraduate education since the early 1920s. Ample data has shown CBL to be an enjoyable and motivational didactic tool, and effective in assisting the expansion of declarative and procedural knowledge in academia. Although a plethora of studies apply multiple choice questions (MCQs) in their investigation, few studies measure CBL or case-based blended learning (CBBL)-mediated changes in students’ procedural knowledge in practice or employ comparison or control groups in isolating causal relationships. Methods Utilizing the flexibilities of an e-learning platform, a CBBL framework consisting of a) anonymized patient cases, b) case-related textbook material and online e-CBL modules, and c) simulated patient (SP) contact seminars, was developed and implemented in multiple medical fields for undergraduate medical education. Additionally, other fields saw a solo implementation of e-CBL in the same format. E- cases were constructed according to the criteria of Bloom’s taxonomy. In this study, Objective Structured Clinical Examination (OSCE) results from (n=619) medical students in 2013 before CBBL implementation, and after CBBL implementation in 2015 (n=624) and 2016 (n=643) were analyzed. Results A significant improvement (adjusted p=.002) of the mean OSCE score by 1.02 points was seen between 2013 and 2015 (min=0, max=25). Conclusion E-Case-Based Learning is an effective tool in increasing student satisfaction, improving performance outcomes and may provide a sustainable learning platform for many fields of medicine in future.
Variation of prevalence of malaria, parasite density and the multiplicity of Plasmodium falciparum infection throughout the year at three different health centers in Brazzaville, Republic of Congo
Authors: MAYENGUE - PEMBE ISSAMOU , Batsimba Dezi Kouhounina , Niama Roch Fabien , Ottia Reyna Ibara , Malonga-Massanga Alida , Fila-Fila Grâce Petula Urielle , Ahombo Gabriel , Kobawila Simon Charles , Parra Henri Joseph
Published: November 2019

Background: In the Republic of Congo, hot temperature and seasons distortions observed may impact the development of malaria parasites. We investigate the variation of malaria cases, parasite density and the multiplicity of Plasmodium falciparum infection throughout the year in Brazzaville.
Methods: From May 2015 to May 2016, suspected patients with uncomplicated malaria were enrolled at the Hôpital de Mfilou, CSI « Maman Mboualé», and the Laboratoire National de Santé Publique. For each patient, thick blood was examined and parasite density was calculated. After DNA isolation, MSP1 and MSP2 genes were genotyped.
Results:
A total of 416, 259 and 131 patients with suspected malaria were enrolled at the CSI «Maman Mboualé», Hôpital de Mfilou and the Laboratoire National de Santé Publique respectively. Proportion of malaria cases and geometric mean parasite density were higher at the CSI «Maman Mboualé» compared to over sites (P-value ˂0.001). However the multiplicity of infection was higher at the Hôpital de Mfilou (P-value ˂0.001).
At the Laboratoire National de Santé Publique, malaria cases and multiplicity of infection were not influenced by different seasons. However, variation of the mean parasite density was statistically significant (P-value ˂0.01).
Higher proportions of malaria cases were found at the end of main rainy season either the beginning of the main dry season at the Hôpital de Mfilou and the CSI «Maman Mboualé»; while, lowest proportions were observed in September and January and in September and March respectively. Higher mean parasite densities were found at the end of rainy seasons with persistence at the beginning of dry seasons. The lowest mean parasite densities were found during dry seasons, with persistence at the beginning of rainy seasons. Fluctuation of the multiplicity of infection throughout the year was observed without significance between seasons.
Conclusion:
The current study suggests that malaria transmission is still variable between the north and south parts of Brazzaville. Seasonal fluctuations of malaria cases and mean parasite densities were observed with some extension to different seasons. Thus, both meteorological and entomological studies are needed to update the season’s periods as well as malaria transmission intensity in Brazzaville.
Complications and mortality of venovenous extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure: a systematic review and meta-analysis
Authors: Xiong Jing , Zhang Li , Bao Lei
Published: November 2019

Background: Extracorporeal membrane oxygenation (ECMO) has been increasingly used for severe neonatal respiratory failure refractory to conventional treatments. To systematically evaluate the complications and mortality of venovenous ECMO in the treatment of neonatal respiratory failure, we performed a systematic review and meta-analysis of all the related studies. Methods: PubMed, Embase, and Cochrane Library were searched. The retrieval period was from the establishment of the database to February 2019. Two investigators independently screened articles according to the inclusion and exclusion criteria. The quality of article was assessed by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by Stata 15.0 software. Results: Four observational studies were included, with a total of 347 newborns. The overall mortality at hospital charge was 12% (5% - 18%) with a heterogeneity of I2 = 73.8% (p = 0.01). Two studies reported mortality during ECMO and after decannulation, with 10% (0.8% -19.2%) and 6.1% (2.6% - 9.6%) respectively. The most common complications associated with venovenous ECMO were: pneumothorax (20.6%), hypertension (20.4%), cannula dysfunction (20.2%), seizure (14.9%), renal failure requiring hemofiltration (14.7%), infectious complications (10.3%), thrombi (7.4%), intracranial hemorrhage or infarction (6.6%), hemolysis (5.3%), cannula site bleeding (4.4%), gastrointestinal bleeding (3.7%), oxygenator failure (2.8%), other bleeding events (2.8%), brain death (1.9%), and myocardial stun (0.9%). Conclusion: The overall mortality at discharge of venovenous ECMO in the treatment of neonatal respiratory failure was 12%. Although complications are frequent, the survival rate during hospitalization is still high. Further larger samples and higher quality of randomized controlled trials (RCT) are needed to clarify the efficacy and safety of this technique in the treatment of neonatal respiratory failure.
Feasibility of home-based HIV counselling and testing and linking to HIV services among women delivering at home in Geita, Tanzania: A household longitudinal survey
Authors: Adinan Juma , Adamou Bridgit , Amour Caroline , Shayo Aisa , Kidayi Paulo Lino , Msuya Levina
Published: November 2019

Background Substantial number of women who deliver at home (WDH) are not captured in prevention of mother-to-child transmission (PMTCT) services. This delays HIV infection detection that negatively impacts endeavours to fight the HIV pandemic and the health of mothers and children. The study objective was to determine the feasibility of home-based HIV testing and linking to care for HIV services among WDH in Geita District Council, Tanzania.Methods A longitudinal household survey was conducted. The study involved all mentally-able women who delivered within two years (WDTY) preceding the survey and their children under the age of two. The study was conducted in Geita District Council in Geita Region, Tanzania from June to July 2017. Geita is among the region with high HIV prevalence and proportion of women delivering at home.Results Of the 993 women who participated in the study, 981 (98.8%) accepted household-based HIV counselling and testing (HBHCT) from the research team. HIV prevalence was 5.3% (52 women). HBHCT identified 26 (2.7%) new HIV infections; 23 (23.4%) were those tested negative at ANC and the remaining three (0.3%) were those who had no HIV test during the ANC visit. Among the 51 HIV+ women, 21 (40.4%) were enrolled in PMTCT services. Of the 32 HIV+ participants who delivered at home, eight (25.8%) were enrolled in the PMTCT compared to 100 percent (13/13) of the women who delivered at a health facility.Conclusion HBHCT uptake was high. HBHCT detected new HIV infection among WDH as well as seroconversion among women with previously negative HIV tests. The study findings emphasize the importance of extending re-testing to women who breastfeed. HBHCT is feasible and can be used to improve PMTCT services among WDH.
Ketogenic diet and fasting diet as Nutritional Approaches in Multiple Sclerosis (NAMS): protocol of a randomized controlled study
Authors: Bahr Lina Samira , Bock Markus , Liebscher Daniela , Bellmann-Strobl Judith , Franz Liane , Prüß Alexandra , Schumann Dania , Piper Sophie K. , Kessler Christian S. , Steckhan Nico , Michalsen Andreas , Paul Friedemann , Mähler Anja
Published: November 2019

Background: Multiple sclerosis (MS) is the most common inflammatory disease of the central nervous system in young adults that may lead to progressive disability. Since pharmacological treatments may have substantial side effects, there is a need for complementary treatment options such as specific dietary approaches. Ketone bodies that are produced during fasting (FD) and ketogenic diets (KD) are an alternative and presumably more efficient energy source for the brain. Studies on mice with experimental autoimmune encephalomyelitis showed beneficial effects of KD and FD on disease progression, disability, cognition and inflammatory markers. However, clinical evidence on these diets is scarce. In the clinical study protocol presented here, we investigate if a KD and a FD are superior to a standard diet (SD) in terms of therapeutic effects and disease progression. Methods: This study is a single-center, randomized, controlled, parallel-group study. One hundred and eleven patients with relapsing-remitting MS with current disease activity and stable immunomodulatory therapy or no disease-modifying therapy will be randomized to one of three 18-month dietary interventions. The dietary interventions are 1) a KD with a restricted carbohydrate intake of 20-40 g/day, 2) a FD with a 7 day fast every 6 months and 14 hours daily intermittent fasting in between, and 3) a fat-modified SD as recommended by the German Nutrition Society. The primary outcome measure is the number of new T2-weighted MRI lesions after 18 months. Secondary endpoints are safety, changes in relapse rate, disability progression, fatigue, depression, cognition, quality of life, changes of gut microbiome as well as markers of inflammation, oxidative stress and autophagy. Safety and feasibility will also be assessed. Discussion: Preclinical data suggest that KD and FD may modulate immunity, reduce disease severity and promote remyelination in the mouse model of MS. However, clinical evidence is lacking. This study is the first clinical study investigating the effects of a KD and FD on disease progression of MS. Trial Registration: ClinicalTrials.gov; NCT03508414; Registered 25 April 2018, retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT03508414
Simplified Molecular Classification of Lung Adenocarcinomas Based on EGFR, KRAS, and TP53 Mutations
Authors: Ruiz-Cordero Roberto , Ma Junsheng , Khanna Abha , Lyons Genevieve Ray , Rinsurongkawong Waree , Bassett Roland , Guo Ming , Routbort Mark J , Zhang Jianjun , Skoulidis Ferdinandos , Heymach John Victor , Roarty Emily B , Tang Zhenya , Medeiros L. Jeffrey , Patel Keyur P , Luthra Rajyalakshmi , Roy-Chowdhuri Sinchita
Published: November 2019

Background: Gene expression profiling has consistently identified three molecular subtypes of lung adenocarcinoma that have prognostic implications. To facilitate stratification of patients with this disease into similar molecular subtypes, we developed and validated a simple, mutually exclusive classification. Methods: Mutational status of EGFR, KRAS, and TP53 was used to define seven mutually exclusive molecular subtypes. A development cohort of 283 cytology specimens of lung adenocarcinoma was used to evaluate the associations between the proposed classification and clinicopathologic variables including demographic characteristics, smoking history, fluorescence in situ hybridization and molecular results. For validation and prognostic assessment, 63 of the 283 cytology specimens with available survival data were combined with a separate cohort of 428 surgical pathology specimens of lung adenocarcinoma. Results: The proposed classification yielded significant associations between these molecular subtypes and clinical and prognostic features. We found better overall survival in patients who underwent surgery and had tumors enriched for EGFR mutations. Worse overall survival was associated with older age, stage IV disease, and tumors with co-mutations in KRAS and TP53. Interestingly, neither chemotherapy nor radiation therapy showed benefit to overall survival. Conclusions: The mutational status of EGFR, KRAS, and TP53 can be used to easily classify lung adenocarcinoma patients into seven subtypes that show a relationship with prognosis, especially in patients who underwent surgery, and these subtypes are similar to classifications based on more complex genomic methods reported previously.
Mental health among immigrants in Germany – the impact of self-attribution and attribution by others as an immigrant
Authors: Nesterko Yuriy , Friedrich Michael , Brähler Elmar , Hinz Andreas , Glaesmer Heide
Published: November 2019

Background: In Germany, the term ‘migration background' has been established to differentiate between immigrants and natives. In the present study post-traumatic stress disorder (PTSD), anxiety, and depression were analysed in immigrant populations in Germany by considering self-attribution as well as attribution by others on one’s own ‘migration background’.
Methods: In a population-based survey (N = 2317), socio-demographic characteristics, migration background (official statistics definition vs. self-attribution as well as the anticipated attribution by others), PTSD (PCL-5), and symptoms of anxiety and depression (PHQ-4) were assessed. Logistic regression models were applied to predict mental health outcomes by considering socio-demographic and immigration-related factors.
Results: A total of 10.7% of respondents (N = 248) had a ‘migration background’. Immigrants of the 2nd generation compared to 1st generation immigrants are less likely to see themselves as immigrants. Attribution as an immigrant (self and/or by others) was found as significant predictor for PTSD and depression, but not anxiety.
Conclusions: It seems useful to focus on immigration-related factors considering subjective perspectives and not only comparing immigrants and natives using a federal statistics definition. Our findings suggest that research on the association between immigration-related factors such as attribution as an immigrant and mental health outcomes might be a promising approach to better identify subgroups at higher risk of mental distress.
The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia: a cross-sectional study
Authors: Zewde Yared Zenebe , Mengesha Abenet Tafesse , Gebreyes Yeweyenhareg Feleke , Naess Halvor
Published: November 2019

Background: Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.Methods: A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 hours of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as >140mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.Results: A total of 103 first-ever acute stroke patients were included (mean age = 55.5+15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10-19) compared to normoglycemic patients 11 (IQR 8-15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99-6.19) more likely to be functionally impaired (mRS = 3-5) at 30-days compared to normoglycemic patients (p = 0.041).Older age (≥ 65 years) (p = 0.017) and stroke severity (NIHSS >14) (p = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among the patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.Conclusions: Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-days of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.
Influence of Selected Biomarkers on Stress and Alexithymia in Patients under Hemodialysis Treatment
Authors: Tayaz Esra , Koç Ayşegül
Published: November 2019

The authors have withdrawn the journal submission associated with this preprint and requested that the preprint also be withdrawn.
Modelling the evolution of cognitive styles
Authors: Liedtke Jannis , Fromhage Lutz
Published: November 2019

Individuals consistently differ in behaviour, exhibiting so-called personalities. In many species, individuals differ also in their cognitive abilities. When personalities and cognitive abilities occur in distinct combinations, they can be described as ‘cognitive styles’. Both empirical and theoretical investigations produced contradicting or mixed results regarding the complex interplay between cognitive styles and environmental conditions. Here we use individual-based simulations to show that, under just slightly different environmental conditions, different cognitive styles exist and under a variety of conditions, can also co-exist. Co-existences are based on individual specialization on different resources, or, more generally speaking, on individuals adopting different niches or microhabitats. The results presented here suggest that in many species, individuals of the same population may adopt different cognitive styles. Thereby the present study may help to explain the variety of styles described in previous studies and why different, sometimes contradicting, results have been found under similar conditions.
Progression of the smoking epidemic in high-income regions and its effects on male-female survival differences: A populations-based analysis
Authors: Wensink Maarten , Álvarez Jesús-Adrián , Rizzi Silvia , Janssen Fanny , Lindahl-Jacobsen Rune
Published: November 2019

BackgroundOf all lifestyle behaviours, smoking caused the most deaths in the last century. Because of the time lag between the act of smoking and dying from smoking, and because males generally take up smoking before females do, male and female smoking epidemiology often follows a typical double wave pattern dubbed the ‘smoking epidemic’. How are male and female deaths from this epidemic differentially progressing in high-income regions on a cohort-by-age basis? How have they affected male-female survival differences? MethodsWe used data for the period 1950-2015 from the WHO Mortality Database and the Human Mortality Database on three geographic regions that have progressed most into the smoking epidemic: high-income North America, high-income Europe and high-income Oceania. We examined changes in smoking-attributable mortality fractions as estimated by the Preston-Glei-Wilmoth method by age (ages 50-85) across birth cohorts 1870-1965. We used these to trace sex differences with and without smoking-attributable mortality in period life expectancy between ages 50 and 85. ResultsIn all three high-income regions, smoking explained up to 50% of sex differences in period life expectancy between ages 50 and 85 over the study period. These sex differences have declined since at least 1980, driven by smoking-attributable mortality, which tended to decline in males and increase in females overall. Thus, there was a convergence between sexes across recent cohorts. While smoking-attributable mortality was still increasing for older female cohorts, it was declining for females in the more recent cohorts in the US and Europe, as well as for males in all three regions.ConclusionsThe smoking epidemic contributed substantially to the male-female survival gap and to the recent narrowing of that gap in high-income North America, high-income Europe and high-income Oceania. The precipitous decline in smoking-attributable mortality in recent cohorts bodes somewhat hopeful. Yet, smoking-attributable mortality remains high, and therefore cause for concern.
Assessment of Knowledge, Attitude and Practice towards rabies and associated factors among household heads in Mekelle city, Ethiopia
Authors: Hagos Weldegerima Gebremedhin , Muchie Kindie Fentahun , Gebru Goyitom Gebremedhn , Mezgebe Gebreamlak Gebremariam , Reda Kebede Ambaye , Dachew Berihun Assefa
Published: November 2019

Background: Rabies has a worldwide distribution in continental regions of Africa, Asia and the Latin America. Globally, the case fatality rate is 100% once a clinical sign is developed. Poor public awareness towards rabies is one of the major obstacles in any prevention and control scheme of the diseases. The aim of this study was to assess knowledge, attitude and practice (KAP) about rabies and associated factors among household heads in Mekelle city, Northern Ethiopia, 2016.
Methods: A community based cross sectional study was conducted from October to November 2016 with a total of 633 study participants. Data were collected using a pre-tested structured questionnaire in Enderta district, Tigray regional state, Ethiopia. Data was entered to EPI-Info 3.5.4 and coded, cleaned and analyzed using SPSS version 20 software. Bivariable and multivariable analysis was done to identify factors associated with knowledge, attitude and practice about rabies. Variables having p< 0.05 was considered as statistically significant at 95%CI.
Results: Of 633 study participants, 357 (56.4%) were females and 239 (37.8%) were 18-35 years old. Among the study participants, 56.1% (95%CI=52.2, 59.9), 56.2% (95%CI=52.4, 60.1) and 61.3% (95%CI=57.5, 65.1) had good level of knowledge, attitude and practice on the prevention and control of rabies respectively. Being female (AOR=1.50, 95%CI=1.05, 2.13), dog owner (AOR=1.68, 95%CI=1.17, 2.41) and participants who had training on rabies (AOR=2.22, 95%CI=1.53, 3.21) were found to have good knowledge. Married participants (AOR=2.19, 95%CI=1.16, 4.16), participants who owned dog (AOR=2.64, 95%CI=1.80, 3.86) and those encountered dog bite (AOR=2.24, 95%CI=1.23, 4.10) were found to have positive attitude towards rabies. Similarly dog ownership (AOR=11.85, 95%CI=7.16, 19.6) was found to be associated with good practice.
Conclusion: This study showed that more than half of the respondents had good knowledge, attitude and practice about the prevention and control of rabies.
Key words: Attitude, Knowledge, Practice, House hold, Rabies
A qualitative analysis of junior doctors’ journeys to preparedness in acute care
Authors: Burridge Samuel , Shanmugalingam Thurkaa , Nawrozzadeh Fatima , Leedham-Green Kathleen , Sharif Amar
Published: November 2019

Background New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors’ first experiences with unwell patients and how they developed preparedness over time. Methods We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness and first experiences of genuine preparedness. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise. Results Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences. Conclusions Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. As preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. Our findings suggest that undergraduates lack sufficient opportunities for scaffolded decision making in acute care, and that increasing the intensity of clinical shadowing may improve preparedness and should inform future educational interventions.
Attention/Memory Complaint is Correlated with Motor Speech Disorder in Parkinson’s Disease
Authors: Liu Ying , Gui Yuchang , Hu Jincui , Liang Shanshan , Mo Sixia , Zhou Yuanfang , Li Yujian , Zhou Fengkun , xu jianwen
Published: November 2019

Background The mechanisms underlying the online modulation of motor speech in Parkinson’s disease (PD) have not been determined. Moreover, medical and rehabilitation interventions for PD-associated motor speech disorder (MSD) have a poor long-term prognosis.
Methods To compare risk factors in PD patients with MSD to those without MSD (non-MSD) and determine predictive independent risk factors correlated with the MSD phenotype, we enrolled 314 PD patients, including 250 with and 64 without MSD. We compared demographic, characteristic data, as well as PD-associated evaluations between the MSD group and non-MSD group.
Results Univariate analysis showed that demographic characteristics, including occupation, educational level, monthly income and speaking background; clinical characteristics, including lesions in the frontal and temporal lobes, and concurrent dysphagia; and PD-associated evaluations, including the activity of daily living (ADL) score, non-motor symptoms scale (NMSS) domain 4 score (perceptual problem), and NMSS domain 5 score (attention/memory) were all significantly different between the MSD and non-MSD group (all P < 0.05). Multivariate logistic regression analysis showed that educational level, frontal lesions, and NMSS domain 5 score (attention/memory) were independent risk factors for PD-associated MSD (all P < 0.005).
Conclusions We determined an association between MSD phenotype and cognitive impairment, reflected by low-level education and related clinical profiles. Moreover, attention and memory dysfunction may play key roles in the progression of MSD in PD patients. Further studies are required to detail the mechanism underlying abnormal speech motor modulation in PD patients. Early cognitive intervention may enhance rehabilitation management and motor speech function in patients with PD-associated MSD.