bluuebunny/crossref_metadata_2025 huggingface dataset:
Early clinical management of severe burn patients using telemedicine: a pilot study protocol
Authors: Moreau Maxim , Paré Guy
Published: July 2020

Background

Emergency physicians are responsible for assessing the severity of a patient’s burns, which determines whether the patient needs to be transferred to a burn center. Such a proper assessment represents a daunting task because severe burn injuries are rare. Inaccurate estimates often result in unjustified and costly transfers and unneeded fluid resuscitation and assisted ventilation procedures. Telemedicine offers a solution to these challenges. The present pilot study aims to investigate the feasibility, acceptability, and potential value of a large telemedicine initiative at the University of Montreal Health Center’s burn center and its network of referring hospitals.

Methods

A three-stage study protocol is proposed to achieve this objective. First, a proof of concept phase will assess the technical feasibility of telemedicine at one referring hospital with a high volume of patient transfers. Second, the organizational and human feasibility of the project will be evaluated in four referring medical centers. All teleconsultation sessions will be analyzed using the WHO’s telemedicine implementation model. The third phase will consist of evaluating the potential impacts of telemedicine in a subset of 10 referring hospitals. The quality of communications between referring physicians and specialists will be assessed using semi-structured interviews. A pre-test/post-test with a comparison group design will be used to assess the effects of telemedicine on patient transfers, ventilation procedures, patient complications, mortality, length of ICU stay, and additional surgical procedures. The economic viability of telemedicine will be assessed using a cost-minimization approach.

Discussion

The telemedicine initiative is expected to yield positive and significant outcomes that are relevant to a wide range of medical centers that already use or are considering using a similar technology. The contribution of this pilot study lies in its ability to reveal technological, organizational, and human barriers and provide a preliminary assessment of the clinical and economic value of a large-scale telemedicine initiative in the context of burn medicine.
Apolipoprotein M and Risk of Type 2 Diabetes
Authors: Hajny Stefan , Christoffersen Mette , Dalila Nawar , Nielsen Lars B , Tybjærg-Hansen Anne , Christoffersen Christina
Published: July 2020

Context

Recent studies have discovered a role of apolipoprotein M (apoM) in energy metabolism, and observational analyses in humans suggest an association with type 2 diabetes. The causal relationship remains however elusive.

Objective

To investigate whether reduced plasma apoM concentrations are causally linked to increased risk of type 2 diabetes.

Design

Prospective study design analyzed by Mendelian randomization.

Setting and participants

Two cohorts reflecting the Danish general population: the Copenhagen City Heart Study (CCHS, n = 8589) and the Copenhagen General Population Study (CGPS; n = 93 857). Observational analyses included a subset of participants from the CCHS with available plasma apoM (n = 725). Genetic analyses included the complete cohorts (n = 102 446). During a median follow-up of 16 years (CCHS) and 8 years (CGPS), 563 and 2132 participants developed type 2 diabetes.

Main outcome measures

Plasma apoM concentration, genetic variants in APOM, and type 2 diabetes.

Results

First, we identified an inverse correlation between plasma apoM and risk of type 2 diabetes in a subset of participants from the CCHS (hazard ratio between highest vs lowest quartile (reference) = 0.32; 95% confidence interval = 0.1-1.01; P for trend = .02). Second, genotyping of specific single nucleotide polymorphisms in APOM further revealed a 10.8% (P = 6.2 × 10–5) reduced plasma apoM concentration in participants with variant rs1266078. Third, a meta-analysis including data from 599 451 individuals showed no association between rs1266078 and risk of type 2 diabetes.

Conclusions

The present study does not appear to support a causal association between plasma apoM and risk of type 2 diabetes.
The MelFo Study UK: Effects of a Reduced-Frequency, Stage-Adjusted Follow-Up Schedule for Cutaneous Melanoma 1B to 2C Patients After 3-Years
Authors: Moncrieff Marc D. , Underwood Beverly , Garioch Jennifer J. , Heaton Martin , Patel Nakul , Bastiaannet Esther , Hoekstra-Weebers Josette E. H. M. , Hoekstra Harald J.
Published: July 2020

Background

Evidence-based guidelines for follow-up treatment of American Joint Committee on Cancer (AJCC) stages 1B to 2C melanoma patients are lacking. The MELanoma FOllow-up study is an international phase 3 randomized trial, and the 3-year interim data were recently reported from the Netherlands. The study was undertaken concurrently with a British cohort for comparison and validation of the Dutch study.

Methods

The study enrolled and stratified 207 patients by AJCC stage. The conventional schedule group (CSG; n = 103) cohort was reviewed as per UK guidelines. The experimental schedule group (ESG; n = 104) cohort was reviewed in a reduced-frequency nurse-led, consultant-supervised clinic. Quality of life (QoL) was measured at baseline (T1), a 1 year (T2), and at 3 years (T3) using the State-Trait Anxiety Inventory, the Cancer Worry Scale, the Impact-of-Event Scale, and the Mental and Physical Component scales (PCS/MCS) of the RAND-36.

Results

Of the 207 QoL questionnaires, 170 (82.1%) were completed at T3. Both cohorts expressed high satisfaction (> 93%) with their regimens. At T3, no significant group effect was found on any patient-reported outcome measures scores, indicating no QoL difference between the follow-up protocols. Recurrence had developed in 33 patients Conventional follow-up (CFU), 16 [15.5%]; Experimental follow-up (EFU), 17 [16.3%]. Self-examination was the method of detection for 12 ESG patients (70.6%) and 11 CSG patients (68.8%). The melanoma-specific survival was identical.

Conclusion

The UK 3-year data were consistent with the previous Dutch report. The reduced follow-up strategy was shown to be safe, with significant resource usage benefits for national cancer services. Patient anxiety levels were not increased by a less-intensive follow-up regimen, and acceptance was high. The study data indicate that patient self-examination is very effective for recurrence detection.
Little and large: methodological reflections from two qualitative longitudinal policy studies on welfare conditionality
Authors: Dwyer Peter , Patrick Ruth
Published: July 2020

This article brings together methodological insight from two policy-focused studies centrally concerned with understanding experiences of, and responses to, rapidly expanding welfare conditionality (that is, making claimants’ eligibility to social welfare rights dependent on engagement with mandatory behavioural responsibilities under threat of sanction for non-compliance), in the UK context. Qualitative longitudinal approaches are ideally suited to seeking a better understanding of the efficacy and consequences of welfare conditionality and enabling an exploration of how the policy assumptions underpinning this approach intersect with (and often contradict) lived experiences. In this article, we detail the approaches we have taken in employing qualitative longitudinal methodologies and explore the similarities and distinctive features of two policy studies with which the authors were involved (Patrick, 2017; WelCond, 2018). Drawing on data from our two studies, we highlight how a focus on time can deepen our understanding of policy changes and their impact on people’s past, present and future lives. We consider the difference in scale of the two studies and the respective possibilities and challenges in working with quite small and very large sample sizes, including the analytical challenge particular to qualitative longitudinal research. Further, we highlight the value of qualitative longitudinal methods for research that seeks to comprehend the varied effects of welfare conditionality on the lives and behaviour of social security benefit recipients over time. Finally, we reflect on the merits of qualitative longitudinal studies for social policy research more broadly.
Characterisation of width-dependent diffusion dynamics in rubidium-exchanged KTP waveguides
Authors: Padberg Laura , Santandrea Matteo , Rüsing Michael , Brockmeier Julian , Mackwitz Peter , Berth Gerhard , Zrenner Artur , Eigner Christof , Silberhorn Christine
Published: July 2020

Integrated χ(2) devices are a widespread tool for the generation and manipulation of light fields, since they exhibit high efficiency, a small footprint and the ability to interface them with fibre networks. Surprisingly, some commonly used material substrates are not yet fully understood, in particular potassium titanyl phosphate (KTP). A thorough understanding of the fabrication process of waveguides in this material and analysis of their properties is crucial for the realization and the engineering of high efficiency devices for quantum applications. In this paper we present our studies on rubidium-exchanged waveguides fabricated in KTP. Employing energy dispersive X-ray spectroscopy (EDX), we analysed a set of waveguides fabricated with different production parameters in terms of time and temperature. We find that the waveguide depth is dependent on their widths by reconstructing the waveguide depth profiles. Narrower waveguides are deeper, contrary to the theoretical model usually employed. Moreover, we found that the variation of the penetration depth with the waveguide width is stronger at higher temperatures and times. We attribute this behaviour to stress-induced variation in the diffusion process.
Textual meaning: Media messages of Bangladesh–China relation and its Themes
Authors: Akanda Muhammad Anisur Rahman
Published: July 2020

This study, within the framework of Critical Discourse Analysis (CDA), aims to explore how Bangladesh’s news agency BSS (1975–2016) represents Bangladesh–China relations. Following this framework, three methods are employed to collect data: (1) the 41-year media coverage, (2) questionnaires and (3) observations at the newsrooms. By examining 140 news reports and investigating linguistic features, this article shows how the BSS under government control represents China and Bangladesh–China relations. Utilizing Systemic Functional Grammar as a tool for CDA, this study focuses only on the analysis of the news headline, which is considered a ‘micro story’. The findings will show how social subjects are historically constructed through the BSS media discourse on the topic. The Theme as a driving force is located at the clause as a message with its own configuration. CDA promoted values and hidden ideologies in the news headlines of the diplomatic ties between Bangladesh and China in 1975. This article clearly explains how the media message reflects social practice, ideology and power relations in social structures at the time of reporting.
Thyroid scintigraphy in diagnosis of nodular and diffuse thyroid pathology
Authors: Rumyantsev Pavel O. , Degtyarev Mikhail V. , Dzeytova Dali S. , Trukhin Alexey A. , Slashchuk Konstantin Y. , Sheremeta Marina S. , Serzhenko Sergey S. , Yasuchenia Valentina S. , Sirota Yaroslav I.
Published: July 2020

Diagnosis of the causes of thyrotoxicosis (destruction or increased functional activity of the thyroid tissue in nodular and diffuse thyroid pathology) is a key point in determining the management of patients with this pathology. Scintigraphy is the method of choice in differential diagnosis of the causes of thyrotoxicosis assessing the functional state of the thyroid gland. According to variable medical interest, thyroid scintigraphy can be performed using 99mTc-pertechnetate or radioactive iodine isotopes (123I, 124I, 131I). For thyroid uptake evaluation used scintigraphy with 99mTc-pertechnetate radiopharmaceutical, which is not organificates and quickly excretes from thyroid tissue. In case of thyroid iodine pharmacokinetics investigation radiopharmaceuticals labeled by iodine isotopes (123I,131I, 124I) are used. The review includes original scintigrams, tables and diagrams. Article shows thyroid scintigraphy informativity analysis, evaluates the place and role of the thyroid scintigraphy examinations in modern diagnostic algorithms taking into account the history of the disease, laboratory tests, ultrasound (TIRADS) and result ofFNA (Bethesda). Additionally authors focused on existing clinical guidelines analysis. An optimized algorithm for the diagnosis and treatment of diffuse and/or nodular thyroid pathology associated with thyrotoxicosis is proposed.
Efficacy of clinical decision support systems: methods and estimates
Authors: Rebrova Olga Yu.
Published: July 2020

Clinical decision support (CDS) systems are the medical technologies that go through their life cycle. Evaluation ofeffectiveness and safety should be carried out at its various stages at the development, in clinical trials, licensing, clinical and economic analysis, health technologies assessment. To date, the effectiveness and safety of CDS systems vary and are ambiguous there are both successes and failures. Hundreds of clinical trials are carried out, and more than a hundred of systematic reviews are published. When evaluating the efficacy and safety of CDS systems, two types of outcomes are usually estimated: indicators of medical care (volume, time, costs, etc.), and patient outcomes (clinical and surrogate). A slight increase in physicians adherence to clinical guidelines has been observed, but ithad very small influence on surrogate outcomes, and there is no effect on clinical patient outcomes. A slight increase in risk with respect to patient outcomes was found in only a few studies. However, the methodological quality of the evidence is very low. In this regard, a few products based on artificial intelligence have so far approached the licensing phase. The field of CDS systems is developing, but not yet sufficiently studied, and there is a long way to real successes ahead. Meanwhile, there is a wide gap between the postulated and empirically demonstrated benefits of CDS systems.
What prevents passing the law about prevention of iodine deficiency disorders in the country with iodine deficiency?
Authors: Melnichenko Galina A. , Gerasimov Gregory A. , Troshina Ekaterina A.
Published: July 2020

This time, the traditional column De Gustibus was prepared by three authors who began writing fragments of this article in late January early February this year, once again discussing position of various departments and individuals about the development and adoption of the federal law Prevention of iodine deficiency disorders in Russian Federation. The fate of this unfortunate and necessary law reveals the shortcomings of education, culture, the level of scientific research, the state of prevention of non-communicable diseases, the social responsibility of business and many other problems that exist in our society. Self-interest and absurdity can become a downfall in which once again this necessary law will disappear.
The Use of Silica Extracted from Kaolin as Catalyst Support for Esterification of 4-Hydroxybenzoic Acid with Sucrose
Authors: Abdullah Iman , Wibowo Widayanti , Kosela Soleh , Krisnandi Yuni Krisyuningsih
Published: July 2020

SiO2 was extracted from kaolin using concentrated HCl and HNO3 mixture and used as solid support for both Bronsted (HClO4 and H2SO4) and Lewis Acid (AlCl3 and ZnCl2). Before extraction, kaolin was calcined at 800°C for eight hours to form metastable kaolin. After the extraction procedure, silica was recovered in 51.6% yield. Silica and the resulting solid acids were then characterized using XRD, XRF, and FTIR. XRD pattern shows that silica synthesized from kaolin is in the mixture of amorphous and α-quartz silica. Immobilization of acids alters its structure becomes more crystalline. XRF analysis shows that the loading of AlCl3 and ZnCl2 was 9.5 and 24.8%, respectively. The acid catalysts were then used in the esterification reaction of 4-hydroxybenzoic acid with sucrose. The reactions were conducted in dimethyl sulfoxide (DMSO) solvent by varying reaction time and reaction temperature. The highest conversion of starting materials and selectivity towards ester was obtained over the AlCl3/SiO2 catalyst. DPPH radical scavenging test shows that the ester exhibits good antioxidant activity.
Bioplastic from Pectin of Dragon Fruit (Hylocereus polyrhizus) Peel
Authors: Listyarini Risnita Vicky , Susilawati Puspita Ratna , Nukung Esther Natalia , Yua Maria Anastasia Toyo
Published: July 2020

Plastic derived from petroleum is challenging to degrade and pollute the environment. There are alternatives to making biodegradable plastics to reduce the adverse effects of plastics on the environment. This study aims to utilize dragon fruit peel waste as a material for making bioplastic. Plastic characterization was carried out by FTIR analysis to determine the functional groups contained in bioplastics. The results showed that dragon fruit peel could be extracted by HCl solution, and the pectin yield is 11%. Extracted pectin was used to make bioplastics with and without the addition of ethylene glycol. The results showed that moisture content of bioplastics of dragon fruit peel pectin is 5.71–12%, while dragon fruit peel pectin and ethylene glycol are 2.86–5.71%. FT-IR spectra showed that the bioplastics from dragon fruit peels belong to the pectin group, which produces carbonyl absorption at 1636–1628 cm-1 and stretching C-O stretch at 1098–1101 cm‑1.
Utilization of Montmorillonite-Modified Earthenware from Bentonite-Ca as a Microbial Fuel Cell (MFC) Membrane Based on Tempe Liquid Waste as a Substrate
Authors: Sudarlin Sudarlin , Afrianto Andika Wahyu , Khoerunnisa Melly , Rahmadhani Dhea Wiegya , Nugroho Anggit
Published: July 2020

Modifications of the Microbial Fuel Cell (MFC) membrane need to be carried out to increase its electric potential energy. This research aims to determine the effect of montmorillonite from bentonite-Ca as a composite in modified earthenware (GT), which is then used as a membrane of the MFC-based on tempe wastewater as substrate. The results obtained were compared to MFC that used pure earthenware membrane (GM). The ratio of bentonite-Ca and clay in GT was 50:50, while GM used 100% of clay. Characterizations of GT dan GM were performed using FTIR, XRD, and SAA. MFC testing was carried out for 24 hours, where every 2 hours, measurements of potential difference (V), current (A), and power density (W/cm2) were carried out. FTIR and XRD data showed an increase in montmorillonite content in GT, while SAA data showed a decrease in pore volume in GT. The decrease in pore volume GT occurs due to an increase in the number of trivalent cations (Al3+, Fe3+) and bivalent (Mg2+). These cations help transfer protons from the anode to the cathode, which causes a decrease in the potential difference and an increase in the current strength and the MFC-GT power density. The average difference between the decrease in potential difference from MFC-GM to MFC-GT is 0.043 V, while the increase in current is 0.022 mA, and the increase in power density is 0.163 mW/cm2.
¿Es homogéneo el desempeño bioclimático de las mayores economías del mundo?
Authors: Umaña Quesada Álvaro
Published: July 2020

Transparencia Climática (TC) es una asociación global de organizaciones de la mayoría de los países del G20, con la misión de incentivar acciones climáticas ambiciosas. Acá se presenta y se discute de manera resumida y contexualizada los principales hallazgos del Reporte Brown to Green 2019, donde se realiza un balance en cuanto a la posición de los países del G20 en términos de los indicadores de 1.5 °C y resalta oportunidades clave para mejorar la acción climática en diferentes sectores. Lamentablemente, durante el 2018, las emisiones mundiales volvieron a aumentar, lo cual indica una necesidad de grandes esfuerzos para reducirlas y frenar el calentamiento global a 1.5 °C. Considerando los efectos de la pandemia ocasionada por el coronavirus, en el 2020 por primera vez veremos un decrecimiento en las emisiones mundiales. La pregunta es ¿Continuaremos con el mismo estilo de crecimiento pre-pandemia, o habremos aprendido lecciones y cambiado nuestro comportamiento, para que conduzca a una sociedad de emisiones más bajas?
El cambio de uso de suelo y la utilidad del paisaje periurbano de la cuenca del río Guayllabamba en Ecuador
Authors: Abad-Auquilla Adriana
Published: July 2020

[Introducción]: La planificación territorial establece procesos que mejoran y ordenan la morfología del suelo, con la finalidad de lograr ciudades más compactas y menos difusas. No obstante, la expansión urbana ha incidido en el cambio de uso del suelo y en los ecosistemas terrestres, concibiendo problemas en las zonas periurbanas que se ubican en la interface urbana rural, por la llegada de nuevos habitantes y las actividades socioeconómicas que se desarrollan. A la vez disminuyendo la calidad y la fragilidad del paisaje. [Objetivo]: Este artículo analiza el cambio de cobertura del suelo y la influencia del servicio ecosistémico cultural de la belleza escénica en la cuenca del río Guayllabamba en Ecuador. [Metodología]: Para ello, se utilizarón las herramientas de teledetección y los sistemas de información geográfica, mediante la digitalización de imágenes satelitales y el análisis de bandas espectrales. [Resultados]: El crecimiento de las construcciones ha aumentado considerablemente en la zona de estudio, comprimiendo los bosques y las áreas seminaturales por los procesos de urbanización. Sin embargo, los territorios agrícolas mantienen sus actividades en la zona. [Conclusiones]: Este estudio, también verificó la utilidad de la valoración del paisaje como un proceso de conservación de los ecosistemas, dado que establece el grado de afectación al que está expuesto.
Reciclado de subproductos de origen animal: Composición y valor nutritivo del pelo bovino hidrolizado hidrotérmicamente
Authors: Mora-Maldonado Luz Elena , Maldonado-Santoyo María , Padilla-Rizo Beatriz , Estrada-Monje Anayansi , Sánchez-Olivares Guadalupe , Segoviano-Garfias José J. N.
Published: July 2020

[Introducción]: El pelo bovino, subproducto del proceso de trasformación de pieles, es rico en proteína queratina. Sin embargo, es poco aprovechado y su disposición final, generalmente, es el relleno sanitario. [Objetivo]: Este trabajo promueve su reciclado, a través de su transformación a un producto alimenticio para animales, aplicando un proceso de hidrólisis hidrotérmica. [Metodología]: Para ello, el pelo fue recolectado en una tenería local, lavado, molido (<0.84 mm) e hidrolizado (130 °C/2.0 atm/90 min). Después, se caracterizó en su análisis elemental, termogravimétrico, proximal y calidad microbiológica. La presencia de metales pesados y minerales, fue determinado mediante espectrometría de emisión atómica de plasma acoplado por inducción y el perfil de aminoácidos mediante cromatografía de líquidos de alta resolución. [Resultados]: Con el proceso propuesto, dicho material quedó libre de olor desagradable y textura suave y homogénea. Su estabilidad térmica fue menor a 170 °C. Presentó un contenido elemental de nitrógeno (13.80±0.61 %), carbono (46.23±1.18 %) y azufre (2.00±0.13 %). El análisis proximal reveló las siguientes composiciones (%): proteína bruta (85.2±2.5), digestible en pepsina (71.36±2.9), ceniza (2.20±0.1), extracto etéreo (4.90±0.4), extracto libre de nitrógeno (0.17±0.01) y humedad (7.53±0.2). Algunos minerales fueron encontrados (calcio, potasio, fósforo). Metales pesados y salmonella spp no fueron detectados. Se obtuvieron aminoácidos esenciales para la nutrición animal (lisina, metionina, treonina, arginina y valina), con recuperaciones mayores al 90 %. [Conclusiones]: Con base en esta información, el pelo bovino residual puede ser reciclado, a las condiciones propuestas, para su transformación a un producto alimenticio alternativo, que provee nutrientes para animales.
Estimación del valor recreativo de la vegetación de costa arenosa y daño causado por inundación costera en el Parque Nacional de Guanahacabibes, Cuba
Authors: Ordaz Laura Rivero , Gutiérrez Carlos Gómez , González Yoel Martínez
Published: July 2020

[Introducción]: La vegetación de costa arenosa ubicada en el Parque Nacional de Guanahacabibes en Cuba, ofrece diversos bienes y servicios ambientales, entre ellos la recreación. Este ecosistema forma parte de los senderos ecoturísticos comercializados en el área y ha sido dañado por inundaciones ocasionadas por eventos extremos, como el huracán Wilma en el 2005. [Objetivo]: Valorar el beneficio recreativo que ofrece la vegetación de costa arenosa y el daño causado por inundaciones costeras. [Metodología]: Se utilizó una aproximación del método costos de viaje zonal, sin equidistancia, en una muestra de los visitantes que practicaron la actividad del senderismo asociada a la vegetación de costa arenosa, en el año 2016. [Resultados]: El huracán Wilma produjo inundaciones de moderadas a fuertes que afectaron entre un 70 % a 80 % el área de vegetación de costa arenosa. El impacto negativo que provocó en el ecosistema, tiene alta importancia en la jerarquía de daños. El beneficio recreativo por observar la vegetación de costa arenosa asociada a los senderos ecoturísticos tuvo un valor aproximado de 63 996 USD, para el año 2016, a su vez el valor individual del bienestar fue 15 USD. [Conclusiones]: Se puede inferir que un huracán similar al Wilma producirá una afectación análoga en la vegetación de costa arenosa y a su vez una posible pérdida de la calidad ambiental, siendo un antecedente el procedimiento utilizado y el valor recreativo estimado para este ecosistema.
Evaluación de impactos ambientales en la cadena de producción de huevos agroecológicos con un enfoque de ciclo de vida
Authors: González-Velandia Krystle Danitza , Landázury-Correa Andrés , Chaparro Adriana María
Published: July 2020

[Introducción]: Análisis de impactos ambientales en la producción de huevos, muestran diferencias significativas entre sistemas convencionales y orgánicos, relacionados con la alimentación, la eficiencia energética, la distribución y la gestión de residuos; sin embargo, se desconocen los impactos ambientales en sistemas agroecológicos para la producción de huevo. [Objetivo]: Evaluar los impactos ambientales de la producción agroecológica de huevos empleando un análisis de ciclo de vida. [Metodología]: La evaluación se realizó para 350 gallinas de raza Hy Line Brow de granjas agroecológicas en Cundinamarca, Colombia, contemplando toda la cadena de producción de 1 kg de huevos, es decir, desde la cuna hasta la tumba, siguiendo los lineamientos de la ISO 14040. La información se recolectó durante un año contemplando la elaboración de alimentos, la producción, la distribución, consumo y disposición final. Se consideraron cantidades de materiales, energía y residuos, para posteriormente, evaluar los impactos con la metodología CML-2001. [Resultados]: Los impactos ambientales de un huevo agroecológico son menores hasta en un 30 %, comparado con los de un huevo convencional, principalmente, por la alimentación, que en este caso es producida de forma agroecológica en la misma finca, al aprovechamiento de todos los residuos, el uso de energías alternativas y a que se reducen intermediarios en la cadena de comercialización. [Conclusiones]: Aunque, la producción de huevos agroecológicos tiene menores impactos, es necesario lograr una mayor eficiencia en la gestión del nitrógeno, buscar desinfectantes con menores impactos en el suelo, implementar sistemas de distribución más cortos y menos contaminantes y además propiciar una reutilización de los empaques.
Using Pharmacogenetic Testing to Tailor Warfarin Therapy: The Singapore Experience and What the Future Holds
Authors: Chang Grace Shu-wen , Tan Doreen Su-Yin
Published: July 2020

Genetic polymorphisms significantly affect individual responses to warfarin, contributing to unpredictability and challenges in managing anticoagulation. Although numerous studies have demonstrated that pharmacogenetic testing improves anticoagulation-related outcomes in the Caucasian population, its effect in the Asian population has not been well studied. This article discusses controversies surrounding tailoring warfarin therapy using pharmacogenetic testing and its role in clinical practice, with a focus on the Asian context. Using the Singapore experience as an example, the authors propose how pharmacogenetic testing can be a means to reduce dose titrations in select patient populations, and how it may be positioned as an enabler to reduce healthcare resources needed for anticoagulation management.
Antegrade Chronic Total Occlusion Strategies: A Technical Focus for 2020
Authors: Creaney Calum , Walsh Simon J
Published: July 2020

Chronic total occlusions (CTOs) are common in patients with ischaemic heart disease. In many countries, patients with CTOs are underserved by percutaneous coronary intervention (PCI). One of the barriers to CTO PCI is the technical challenges of these procedures. Improvements in technique and dedicated devices for CTO PCI, combined with advances in procedural strategy, have resulted in a dramatic increase in procedural success and outcomes. Antegrade wiring (AW) is the preferred initial strategy in short CTOs, where the proximal cap and course of the vessel is understood. For many longer, more complex occlusions, AW has a low probability of success. Dissection and re-entry techniques allow longer CTOs and those with ambiguous anatomy to be crossed safely and efficiently, and CTO operators must also be familiar with these strategies. The CrossBoss and Stingray system is currently the primary targeted re-entry device used during antegrade dissection and re-entry (ADR), and there continues to be an evolution in its use to increase procedural efficiency. In contrast to older ADR techniques, targeted re-entry allows preservation of important side-branches, and there is no difference in outcomes compared to intraplaque stenting.
Halaman Depan
Authors: Subandriyo, ST Joko
Published: July 2020

Halaman Depan
Adição de finos de rocha granítica e seus efeitos nas propriedades de argamassas autoadensáveis
Authors: Siqueira Thaís Pinto Lôbo , Andrade Neto José da Silva , Dias Cleber Marcos Ribeiro , Ribeiro Daniel Veras
Published: July 2020

Resumo O presente estudo avalia a utilização de finos de rocha granítica (FRG) em argamassas autoadensáveis, visando obter características reológicas adequadas sem incorporar aditivos modificadores de viscosidade. Para isso, realizaram-se ensaios de mini funil-V e mini-slump test e ensaios de caracterização físico-mecânica em argamassas de referência (sem FRG) e com teores de substituição de FRG iguais a 5%, 15% e 25% em relação ao volume de cimento. Avaliou-se a hidratação das pastas que compõem essas argamassas, por meio da técnica de calorimetria isotérmica. Posteriormente, foi analisada a porosidade teórica das pastas, por meio do ensaio de compacidade, visando obter o espaçamento entre partículas (IPS) das pastas. Ao incorporar FRG, a viscosidade da argamassa foi ajustada, com o aumento do tempo de escoamento em até 4,3 s, reduzindo-se o consumo de cimento em até 12% e, consequentemente, a liberação de calor durante a hidratação. Ademais, concluiu-se que a incorporação de FRG reduz a porosidade das argamassas em até 17,63% e aumenta a resistência à compressão em cerca de 11% como consequência da adição de 15% de FRG. No entanto, pelo fato de reduzir a distância entre as partículas da pasta, aumentou-se o consumo de teor de aditivo superplastificante para alcançar o espalhamento ideal.
A Mindfulness-Based Intervention as a Supportive Care Strategy for Patients with Metastatic Non-Small Cell Lung Cancer and Their Spouses: Results of a Three-Arm Pilot Randomized Controlled Trial
Authors: Milbury Kathrin , Li Yisheng , Durrani Sania , Liao Zhongxing , Tsao Anne S. , Carmack Cindy , Cohen Lorenzo , Bruera Eduardo
Published: July 2020

Background

Although mindfulness-based interventions have been widely examined in patients with nonmetastatic cancer, the feasibility and efficacy of these types of programs are largely unknown for those with advanced disease. We pilot-tested a couple-based meditation (CBM) relative to a supportive-expressive (SE) and a usual care (UC) arm targeting psychospiritual distress in patients with metastatic lung cancer and their spousal caregivers.

Patients and Methods

Seventy-five patient-caregiver dyads completed baseline self-report measures and were then randomized to one of the three arms. Couples in the CBM and SE groups attended four 60-minute sessions that were delivered via videoconference. All dyads were reassessed 1 and 3 months later.

Results

A priori feasibility benchmarks were met. Although attendance was high in both groups, dyads in the CBM group indicated greater benefit of the sessions than those in the SE group (patients, CBM mean = 2.63, SE mean = 2.20, p = .003; spouses, CBM mean = 2.71, SE mean = 2.00, p = .005). Compared with the UC group, patients in the CBM group reported significantly lower depressive symptoms (p = .05; d = 0.53) and marginally reduced cancer-related stress (p = .07; d = 0.68). Medium effect sizes in favor of the CBM compared with the SE group for depressive symptoms (d = 0.59) and cancer-related stress (d = 0.54) were found. Spouses in the CBM group reported significantly lower depressive symptoms (p < .01; d = 0.74) compared with those in the UC group.

Conclusion

It seems feasible and possibly efficacious to deliver dyadic interventions via videoconference to couples coping with metastatic lung cancer. Mindfulness-based interventions may be of value to managing psychological symptoms in the palliative care setting. Clinical trial identification number. NCT02596490

Implications for Practice

The current randomized controlled trial has established that a mindfulness approach to the management of patients’ and spouses’ psychospiritual concerns is acceptable and subjectively deemed more beneficial than a supportive-expressive treatment for patients with metastatic non-small cell lung cancer (NSCLC). We also revealed that videoconference delivery, here FaceTime, is an acceptable approach even for geriatric patients with metastatic NSCLC and that patients and their spousal caregivers prefer a dyadic delivery of this type of supportive care strategy. Lastly, this trial has laid the foundation for the role of mindfulness-based interventions in the palliative care setting supporting patients with advanced NSCLC and their spousal caregivers.
Sınıf Öğretmenlerinin Eleştirel Pedagoji İlkelerine Katılım Düzeyleri
Authors: BALCI Ali Tansu , KOCABAŞ Ayfer
Published: July 2020

Eleştirel Pedagoji, Frankfurt Okulunda temellenen eleştirel teorinin eğitime yansıması olarak değerlendirilmektedir. Temel olarak günümüz egemen eğitim sisteminin göz ardı ettiği eğiten ile eğitilen arasındaki her türlü baskıcı ve hiyerarşik ilişkiyi reddeden ve eğitimde nesne olarak tabileştirilen özneleri özgürleştirmeyi amaçlamaktadır. Bir entelektüel olarak öğretmen eğitimi de eleştirel pedagojinin temel alanlarından birini oluşturmaktadır. Bu araştırma nicel bir araştırma olup, tarama modellerinden betimsel tarama modelinde tasarlanmıştır. Araştırmada sınıf öğretmenlerinin eleştirel pedagoji ilkelerine katılım düzeyleri ortaya konularak bir değerlendirmesinin yapılması amaçlanmaktadır. Araştırmanın örneklemi, tesadüfi eleman örnekleme yöntemi ile belirlenen İzmir ili Buca, Bornova, Konak ve Karşıyaka İlçe Milli Eğitim Müdürlüklerine bağlı okullarda görev yapan 588 sınıf öğretmeninden oluşmaktadır. Veri toplama aracı olarak araştırmacı tarafından hazırlanan Kişisel Bilgi Formu ve Yılmaz (2009) tarafından geliştirilen Eleştirel Pedagoji İlkeleri Ölçeği kullanılmıştır. Araştırma sonuçlarına göre sınıf öğretmenlerinin Eğitim Sistemi, Okulun İşlevi ve Eleştirel Pedagoji İlkeleri toplam puanları orta düzeyde iken Özgürleşme alt boyutu yüksek düzeyde bulunmuştur. Ayrıca cinsiyet, okullarda öğrencilere eleştirel düşünme becerisi kazandırılmasına yönelik görüşleri ve mevcut ilkokul eğitim sistemine yönelik görüşlerine göre anlamlı farklılıklar bulunmuştur.
Modern Japon Eğitim Sisteminin Tarihi Temelleri Üzerine Değerlendirme: Meiji’den Shôwa’ya 1868-1950 Arası Döneme Bakış
Authors: ÖZŞEN Tolga
Published: July 2020

Japonya’nın 19. yüzyılın son çeyreğinden itibaren tecrübe etmeye başladığı modernleşme ülkemiz de dâhil olmak üzere dünyadaki Japonya çalışmalarında farklı boyutlarıyla ilgi görmektedir. Türkiye’de bu sürece ilişkin ilgi gören boyutlardan bir tanesi de Japon eğitim sistemidir. Ülkemizdeki Japon eğitim sistemine ilişkin akademik birikim nicel olarak az sayıya, kapsam ve içerik olarak ise sınırlı bir çerçeveye sahiptir. Bu birikim, ağırlıklı olarak günümüz örgün eğitim sisteminin kurumsal yapısına, fiziksel altyapısına ve öğretim programlarına odaklanmaktadır. Japonya’ya özgü sosyokültürel, tarihsel, siyasal dinamikler, tarihsel gelişimi çoğunlukla değerlendirilmemiştir. Bu bağlamda, bugünün Japon eğitim sisteminin zeminini oluşturan Meiji döneminden İkinci Dünya Savaşı sonrasına kadar olan döneme (1868-1950) odaklanılması, söz konusu süreçte bugünkü Japon eğitim sisteminin temellerinin nasıl atıldığı, eğitim sistemine ilişkin politika ve yaklaşımlarda hangi sosyopolitik, sosyokültürel, jeopolitik dinamiklerin etkili olduğunun ortaya konulması Japon eğitim sisteminin köklerine ilişkin genel bir perspektif oluşturulmasında etkili olacaktır. Tüm bunlardan hareketle bu çalışma, 19. yüzyıl son çeyreğinden İkinci Dünya Savaşı sonrasındaki sürece odaklanarak, Japon eğitim sisteminin tarihsel zeminini dönemin sosyal, kültürel, siyasal ve jeopolitik dinamikleri çerçevesinde ve Japonya’nın sosyokültürel kodları üzerinden irdeleyecektir. Çalışmada, ilgili tarihsel döneme ilişkin veri kaynağı olarak özellikle Japon Eğitim-Kültür-Spor-Bilim ve Teknoloji Bakanlığı (MEXT) web sayfası üzerinde yayımlanan açık arşiv kaynaklardan ve alana ilişkin Japonca basılı kaynaklardan yararlanılmıştır. Bu çalışma ile, ülkemizdeki Japon eğitim sistemine ilişkin alan yazına tarihsel bir perspektif kazandırılması; Japon toplumsal düşün sistemi, tarihsel ve siyasal arka plan ve sosyoekonomik çerçeve bağlamında Japonya’nın o dönemine ilişkin genel okuyucuya bir çerçeve çizilmesi beklenmektedir.
Dose-dependent effects of adalimumab in neonatal rats with hypoxia/reoxygenation-induced intestinal damage
Authors: Kocamaz Halil , Özdemir Özmert MA , Türk Nilay Şen , Enli Yaşar , Şahin Barbaros , Ergin Hacer
Published: July 2020

Tumor necrosis factor-alpha (TNF-α) has an important role in hypoxia/reoxygenation (H/R)-induced intestinal damage. It was shown that blocking TNF-α with infliximab has beneficial effects on experimental necrotizing enterocolitis and hypoxic intestinal injury. However, there is no data about the effect of adalimumab on H/R-induced intestinal damage. Therefore, we aimed to determine potential dose-dependent benefits of adalimumab in such damage in neonatal rats. Wistar albino rat pups were assigned to one of the four groups: control group, hypoxia group, low-dose adalimumab (5 mg/kg/day) treated group (LDAT), and high-dose adalimumab (50 mg/kg/day) treated group (HDAT). On the fourth day of the experiment, all rats except for the control group were exposed to H/R followed by euthanasia. Malondialdehyde (MDA), myeloperoxidase (MPO), TNF-α, total antioxidant capacity (TAC), and total oxidant capacity (TOC) were measured in intestinal tissue. TAC and TOC values were used to calculate the oxidative stress index (OSI). Histopathological injury scores (HIS) were also evaluated in the tissue samples. MDA levels were significantly lower in the LDAT and HDAT groups (p < 0.001). TNF-α levels were significantly lower in the LDAT group (p < 0.001). OSI was significantly higher in the H/R group than in the control and LDAT groups (p < 0.001). Mean HIS values in the LDAT group were significantly lower than those in the H/R and HDAT groups (p < 0.001). This experimental study showed that low-dose adalimumab appears to have a beneficial effect on intestinal injury induced with H/R in neonatal rats.
Eighth-grades students’ mental models in solving a number pattern problem
Authors: PRAYEKTİ Novi , NUSANTARA Toto , SUDİRMAN Sudirman , SUSANTO Hery
Published: July 2020

This study aims to explore all the types of students' mental models of number patterns. The study used a qualitative approach with an explorative type. The subjects used to characterize the student's mental models in this study were 46 eighth grade students in Indonesia. To reveal the subjects’ mental model, they were asked to solve the number pattern problem and were interviewed. For ensuring the validity and reliability of the research results, triangulation technique was used by comparing the results of video recording interviews and written test results. The study showed that in solving the problem of number patterns given, there were 4 types of mental models. They were formal direct mental model, formal indirect mental model, synthetic direct mental model, and synthetic indirect mental model. What we found in this study shows that some students have different mental models to solve the problem. Hence, in future teachers must introduce various strategies to solve the problem and conduct learning that can enrich students' mental models.
Participación social, un factor a considerar en la evaluación clínica del adulto mayor: una revisión narrativa
Authors: Sepúlveda-Loyola Walter , Dos Santos Lopes Rosielma , Pires Tricanico Maciel Renata , Suziane Probst Vanessa
Published: July 2020

La participación social es definida como la integración de las personas a actividades de la comunidad en grupos sociales voluntarios u obligatorios, formales e informales, lo cual podría tener consecuencias en la salud de la población adulta mayor. Fue realizada una búsqueda en Pubmed, Scielo, Scopus y Google Scholar. Para esta revisión se analizaron 16 artículos que estudiaban el impacto de la participación social en adultos mayores, incluyendo un total de 73 698 096 individuos de Norteamérica, Asia, Europa, y América latina. La participación social es considerada como un factor protector para la salud mental y física de los adultos mayores, la cual ha sido asociada a disminuciones de la discapacidad, comorbilidades y mortalidad. Por esta razón, se sugiere que debe ser evaluada en la práctica clínica. Esto permitiría orientar y derivar a los adultos mayores a participar de determinadas organizaciones comunitarias, principalmente aquellos que no tienen redes de apoyo, que no están vinculados a grupos comunitarios, que tienen síntomas de depresión o que están iniciando un cuadro de deterioro físico o cognitivo. De este modo, la salud pública podría aumentar sus acciones de prevención y promoción de la salud por medio de las organizaciones comunitarias. Por otro lado, la falta de instrumentos y consensos para evaluar la participación social fue discutida en esta revisión donde se ha propuesto un cuestionario de evaluación de la participación social del adulto mayor que debe ser validado y estudiado en el futuro.
Enfermedad pulmonar por Mycobacterium intracellulare en una paciente inmunocompetente: reporte de un caso en el Perú
Authors: Accinelli Roberto Alfonso , Camposano Alfredo
Published: July 2020

Presentamos una paciente inmunocompetente cuya enfermedad comenzó a los 49 años con tos, seguida de esputo purulento y hemoptoico, por lo que se diagnosticó bronquiectasias. Tres años después, luego de hemoptisis, le practicaron segmentectomía medial del lóbulo medio y quedó asintomática por meses. Al encontrarse tuberculosis en el informe de patología fue tratada con 4HREZ2R2H2. Cinco años después su BK fue 2+ recibiendo un nuevo esquema de 4HREZ2R2H2, con lo que no logro negativizar declarándose el fracaso al tratamiento. Al hallar en la genotipificación de su cultivo Mycobacterium intracellulare, la paciente recibió azitromicina, moxifloxacina y etambutol, hubo mejoría, pero abandonó el tratamiento a los ocho meses; lo reinició 18 meses después, junto con tratamiento para la depresión y el reflujo gastroesofágico. Al mes la paciente estuvo asintomática, pero hizo reacción dérmica a la moxifloxacina y se la reemplazó por amikacina. Salió de alta y al año estuvo curada, a los 64 años de edad.
Tipificación del cassette cromosómico estafilocócico de Staphylococcus aureus resistentes al meticilino en el estado de Aragua, Venezuela
Authors: Bastidas Betsi , Méndez María V. , Vásquez Ysvette , Requena Dayana
Published: July 2020

Objetivos: Tipificar el casette SCCmec en cepas de Staphylococcus aureus resistentes a meticilino (SARM) en aislados clínicos de centros de salud del Estado Aragua-Venezuela y comparar la presencia de los genotipos SCCmec entre los centros de salud del estado y según el tipo de infección. Materiales y métodos: Durante enero y agosto de 2015 se estudiaron 81 cepas SARM de cuatro centros de salud del estado de Aragua en Venezuela. La resistencia al meticilino se midió con el método de Kirby-Bauer con discos de oxacilina (1 μgr) y cefoxitina (30 μgr). El gen mecA y el SCCmec se analizaron por la técnica de reacción en cadena de polimerasa múltiple. Resultados: 55 aislados (67,9%) amplificaron el gen mecA, y 24 cepas (43,6%) amplificaron el SCCmec. El SCCmec I fue el más frecuente, seguido de SCCmec IV y SCCmec III, representaron el 62,5%, 25% y 12,5%, respectivamente. El SCCmec I fue predominante en el centro de salud A (80%), mientras que el SCCmec IV se encontró en el centro de salud B (60%) y C (100%). En el centro de salud D, 50% resultó ser SCCmec I y 50% SCCmec IVd. Se encontró relación entre el SCCmec y el centro de salud con significancia estadística. En infecciones de piel y tejidos blandos y en las respiratorias predominó el SCCmec I con 63,2% y 50% respectivamente. Conclusiones: La frecuencia de SCCmec I y IV permitirá establecer nuevas medidas en el uso y control de la resistencia a los antibióticos.
Actividad antitumoral de biopolímeros aislados de Vibrio sp. en cáncer de mama inducido en ratas
Authors: Flores-Cortez Daisy , Villalobos-Pacheco Eduardo , Chávez-Rojas Danilo , Rodriguez-Tafur Dávila Juan , Palomino-Yamamoto Manuel
Published: July 2020

Objetivo. Evaluar la actividad antitumoral del extracto crudo de biopolímeros aislados de la bacteria marina Vibrio sp. en cáncer de mama inducido por N-Methyl-N-nitrosourea (MNU) en ratas. Materiales y métodos. Se cultivó la bacteria marina Vibrio sp. durante siete días, luego se filtró, precipitó y concentró el sobrenadante crudo. Se administró una dosis única de MNU 50 mg/kg a 39 ratas Holtzman y fueron tratadas diariamente durante nueve semanas por vía oral: G1 (n = 13): suero fisiológico 0,1 mL/100 g; G2 (n = 13): extracto crudo de biopolímeros de Vibrio sp. 20 mg/kg; G3 (n = 13): tamoxifeno 100 mg/kg. El G4 (n = 11) solo recibió suero fisiológico 0,1 mL/100 g. Se valoró semanalmente el peso corporal y la aparición de tumores mamarios identificados mediante palpación; así como el examen histopatológico al final del tratamiento. Resultados. El 77% de las ratas del grupo G1 desarrollaron tumores a partir de la séptima semana en un promedio de 2,2 tumores por cada animal; en contraste al grupo tratado con el extracto crudo de biopolímeros y tamoxifeno; donde solo una rata (8%) en cada grupo desarrolló tumores y posterior a la semana nueve de la inducción (p = 0,001). Los resultados histopatológicos sostienen que todos los tumores extirpados corresponden a adenocarcinoma ductal de mama con distintos patrones: sólido, papilar y quístico. Asimismo, se evidenciaron focos necróticos en el 30% de los tumores del grupo G1. Conclusión. El extracto crudo de biopolímeros aislados de Vibrio sp. presentan efecto antitumoral en cáncer de mama inducido en ratas.