bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of marketing mix and service quality on tourist satisfaction and loyalty at Samosir
Authors: Azhar Muhammad Elfi , Jufrizen Jufrizen , Prayogi Muhammad Andi , Sari Maya
Published: October 2019

This study aims to investigate the effect of the marketing mix and service quality on tourist satisfaction and loyalty. The data collection techniques used in this study included interviews and questionnaires to the relevant parties. The technique of data analysis in this study was descriptive and Structural Equation Modelling (SEM). The results showed that the marketing mix had a positive and significant effect on tourists satisfaction. The service quality had a positive and significant effect on tourists satisfaction in the region of Samosir. Marketing mix had a positive and significant effect on tourists loyalty. The service quality had a positive and significant effect on tourists loyalty. Tourist satisfaction had a positive and significant effect on tourists loyalty in the region of Samosir. And the marketing mix and the service quality had a significant effect on tourists in the Samosir Region through tourist satisfaction.
Lactobacillus plantarum B7 attenuates Salmonella typhimurium infection in mice: preclinical study in vitro and in vivo
Authors: Wongsen Siwaporn , Werawatganon Duangporn , Tumwasorn Somying
Published: October 2019

Background

Salmonella typhimurium is a cause of gastroenteritis including diarrhea. Lactobacillus plantarum is a probiotic widely used to prevent and treat diarrhea.

Objectives

To determine the protective effects of L. plantarum B7 on diarrhea in mice induced by S. typhimurium.

Methods

Inhibition of S. typhimurium growth by L. plantarum B7 was determined using an agar spot method. Mice were divided into 3 groups (n = 8 each): a control group, an S group administered 3 × 109 CFU/mL S. typhimurium, and an S + LP group administered 1 × 109 CFU/mL L. plantarum B7 and 3 × 109 CFU/mL S. typhimurium daily for 3 days. Counts of S. typhimurium and percentage of fecal moisture content (%FMC) were determined from stool samples. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and CXCL1 were determined.

Results

L. plantarum B7 produced a clear zone on S. typhimurium. There were significantly less S. typhimurium in the feces from mice in the S+LP group than in the S group. Serum levels of TNF-α, IL-6, and CXCL1 in mice from the S group were significantly higher than levels in the S+LP and control groups. Feces from mice in the S group were soft and loose, whereas in the S+LP group they were hard and rod shaped. The %FMC in the S+LP group was significantly less than in the S group.

Conclusions

L. plantarum B7 can inhibit growth of S. typhimurium, decrease levels of proinflammatory cytokines, and attenuate symptoms of diarrhea induced in mice by S. typhimurium.
Evidence of growth hormone effect on plasma leptin in diet-induced obesity and diet-resistant rats
Authors: Likitnukul Sutharinee , Kalandakanond-Thongsong Sarinee , Thammacharoen Sumpun
Published: October 2019

Background

Plasma leptin is regulated by several factors, including growth hormone (GH), which influences the pathophysiology of obesity.

Objective

To demonstrate the short-term effect of GH on plasma leptin levels in 3 conditions in vivo with the different amount of body fat mass.

Methods

Adult male Wistar rats were fed with standard chow or hypercaloric diet (HC). The HC rats were demonstrated as HC-feeding obese (HC-O) and HC-feeding resistant (HC-R) rats. Then, they were treated with GH or saline for 3 days. Basal plasma leptin levels were measured at 24 and 32 h. For meal-induced condition, all rats were fed for 2 hand plasma leptin was measured. Further 16-h fasting period, plasma leptin, insulin, and insulin sensitivity indexes were determined.

Results

The short-term GH treatment decreased basal plasma leptin at 32 h after the first GH injection in HC-O rats. However, GH treatment had no effect on meal-induced plasma leptin in all rats. Furthermore, GH treatment attenuated fasting effect on plasma leptin in control and HC-R rats. The insulin resistance (IR) induced by the short-term GH treatment was demonstrated by higher fasting plasma insulin and the increased homeostasis model of IR in HC-R rats.

Conclusions

The study demonstrates the important role of greater fat mass in HC-O rats, which results in decreased basal plasma leptin after short-term GH treatment. For meal-induced condition, GH had no effect on plasma leptin in all rats. Interestingly, GH could attenuate fasting effect on plasma leptin in rats that have lower fat mass.
Elliptic operators and their symbols
Authors: Vasilyev Vladimir
Published: October 2019

We consider special elliptic operators in functional spaces on manifolds with a boundary which has some singular points. Such an operator can be represented by a sum of operators, and for a Fredholm property of an initial operator one needs a Fredholm property for each operator from this sum.
Generalized implicit viscosity approximation method for multivalued mappings in CAT(0) spaces
Authors: Abbas Mujahid , Iqbal Hira , de la Sen Manuel
Published: October 2019

We prove strong convergence of the sequence generated by implicit viscosity approximation method involving a multivalued nonexpansive mapping in framework of CAT(0) space. Under certain appropriate conditions on parameters, we show that such a sequence converges strongly to a fixed point of the mapping which solves a variational inequality. We also present some convergence results for the implicit viscosity approximation method in complete ℝ-trees without the endpoint condition.
Evaluation of Electrocoagulation and Activated Carbon Adsorption Techniques Used Separately or Coupled to Treat Wastewater from Industrial Dairy
Authors: Eulmi Amina , Hazourli Sabir , Abrane Rahma , Bendaia Marwa , Aitbara Adel , Touahria Soraya , Chérifi Mouna
Published: October 2019

This present study focuses on the evaluation of the effectiveness and the feasibility of a combined treatment between the electrocoagulation (EC) and the adsorption on an activated carbon in grains (GAC) in a continuous mode. The peculiarity of this work is that the experiments are conducted with real wastewater from an industrial dairy. This combined treatment first required an optimization of the EC followed by an adsorption. For each of these techniques, different influential operating parameters such as the current density, the reaction time, the GAC dose, the initial turbidity of water … etc., have been studied. The Turbidity and the COD have been continuously analyzed, while the phosphorus, the BOD5, TSS, nitrogen and the grease have been punctually analyzed, and this happened before and after the water treatment. The EC adsorption coupling results have shown that the addition of an appropriate dose of GAC (2 gL−1) in a separate column, increases the effectiveness of treatment; more than 98 % of reduction for the COD, the BOD5, the turbidity and the greases. A mechanism explaining the phenomena which are involved in this combined treatment is proposed. On the basis of these results of efficiency, speed, low operational cost (~ 3 $m−3of the treated water), and in comparison with the EC used alone, the EC coupling/the adsorption GAC, could be recommended as a treatment of separation for waters at a high load in organic pollutants.
Optimal Power Flow Management and Control of Grid Connected Photovoltaic-Battery System
Authors: Bhende Chandrashekhar N , Panda Swasti , Mishra Sukumar , Narayanan Arun , Kaipia Tero , Partanen Jarmo
Published: October 2019

This paper presents optimal power flow management in real time for grid connected photovoltaic (PV)–battery system. The objective is the real time, dynamic and optimal scheduling of battery storage which reduces grid power consumption and achieves the peak load shaving. For this purpose, two strategies are developed; one is rule-based and other is optimization algorithm based. Two strategies are compared, pros and cons of those strategies are established. Though rule-based technique is simple & easy to implement, the optimization technique provides more optimal regulation of battery which provides the lesser electricity cost. Forecasted PV/load powers are used to get optimal value of battery power. In order to handle uncertainties due to forecasted data, fuzzy-based corrective strategy is developed to modify the reference battery power as per the present values of PV/load powers. The proposed analysis is carried out for over one exemplary day. The simulations are presented using typical load/PV data of India and Finland as a part of research collaboration. Experimental results are also carried out using proposed scheme.
Language and creativity: a Construction Grammar approach to linguistic creativity
Authors: Hoffmann Thomas
Published: October 2019

Creativity is an important evolutionary adaptation that allows humans to think original thoughts, to find solutions to problems that have never been encountered before and to fundamentally change the way we live. One particular domain of human cognition that has received considerable attention is linguistic creativity. The present paper discusses how the leading cognitive linguistic theory, Construction Grammar, can provide an explanatory account of creativity that goes beyond the issue of linguistic productivity. At the same time, it also outlines how Construction Grammar can benefit from insights from Conceptual Blending.
Thermodynamic parameters for the complexation of Tc(IV) with bromide under aqueous conditions
Authors: Eiroa-Lledo Cecilia , Wall Donald E. , Wall Nathalie A.
Published: October 2019

Technetium-99 is a long-lived fission product present in nuclear wastes, found mainly as Tc(VII) and Tc(IV) in the environment. The quantification of the equilibrium constants for the formation of Tc(IV) aqueous complexes has been limited to carboxylate ligands and interactions with the halides is mostly unknown. This work reports equilibrium constants of the formation of the TcO(OH)+ complexes with Br−, in a 3 M NaClO4 solution of pcH 2 and varied temperature, using a liquid-liquid extraction system. Neutron activation confirmed the suitability of the extraction technique for this work. Under the working conditions, Br− forms a weak exothermic TcO(OH)Br complex, with a Gibbs free energy (ΔGr) of 3 ± 3 kJ · mol−1 at a temperature of 273.15 K. The values for ΔHr (−32 ± 3 kJ · mol−1) and ΔSr (106 ± 9 J · mol−1 · K−1) of the complexation reaction were quantified using a van’t Hoff analysis. This work also showed that bromide addition does not displace the hydroxide from TcO(OH)+, as the equilibrium constant of bromide addition is much weaker than the first hydrolysis constant of the metal.
Investigation of porosity effect on flexural analysis of doubly curved FGM conoids
Authors: Ansari Md Irfan , Kumar Ajay , Barnat-Hunek Danuta , Suchorab Zbigniew , Kwiatkowski Bartłomiej
Published: October 2019

The flexural analysis of doubly curved functionally graded porous conoids was performed in the present paper. The porosities inside functionally graded materials (FGMs) can occur during the fabrication and lead to the occurrence of micro-voids in the materials. The mathematical model includes expansion of Taylor’s series up to the third degree in thickness coordinate and normal curvatures in in-plane displacement fields. Since there is a parabolic variation in transverse shear strain deformation across the thickness coordinate, the shear correction factor is not necessary. The condition of zero-transverse shear strain at upper and lower surface of conoidal shell is implemented in the present model. The improvement in the 2D mathematical model enables to solve problems of moderately thick FGM porous conoids. The distinguishing feature of the present shell from the other shells is that maximum transverse deflection does not occur at its centre. The improved mathematical model was implemented in finite element code written in FORTRAN. The obtained numerical results were compared with the results available in the literature. Once validated, the current model was employed to study the effect of porosity, boundary condition, volume fraction index, loading pattern and others geometric parameters.
Absence of material exponence
Authors: Stolz Thomas , Levkovych Nataliya
Published: October 2019

The paper argues in favor of considering the absence of material exponence (AOME) of grammatical category a morphological mismatch on a par with established categories such as suppletion and syncretism. It is shown that the phenomenon under review can be integrated into the taxonomy of deviations from canonical inflection as proposed within the framework of Canonical Morphology. Empirical evidence from eleven languages of different genetic, geographic and typological background is presented and discussed. Different kinds of AOME are identified. Their interaction with other non-canonical phenomena is discussed additionally.
Detection of Herpes Simplex Virus in Chronic Generalized Periodontitis via Polymerase Chain Reaction: A Pilot Study
Authors: Veliyaveetil Thomas George
Published: October 2019

Background. As bacterial etiology could not support and explain various aspects of periodontal disease, herpes virus is now proposed to be one of the factors responsible for the periodontal destruction. The aim of the present study was to detect the presence of Herpes simplex virus (HSV) in patients with chronic generalized periodontitis. Methods. Eleven patients were consecutively selected for the study, of which 3 were diagnosed with moderate chronic generalized periodontitis and 8 with severe chronic generalized periodontitis. Subgingival material was taken from the deepest pocket of the dentition from every study subject, before the commencement of any procedure and polymerase chain reaction (PCR) assay was used to detect the presence of HSV-1 and -2. Results. HSV-1 and -2 DNA was not detected in any of the samples. Conclusion. This study is in contrast with previous studies and questions the proposed pathogenic role and clinical relevance of herpes virus in periodontitis.
A Comparison of the Responsiveness of the Postural Assessment Scale for Stroke and the Berg Balance Scale in Patients With Severe Balance Deficits After Stroke
Authors: Huang Yi-Jing , Lin Gong-Hong , Lee Shih-Chieh , Hsieh Ching-Lin
Published: October 2019

Background and Purpose:

Previous evidence that the Postural Assessment Scale for Stroke (PASS) and the Berg Balance Scale (BBS) have similar responsiveness is doubtful. Compared with the BBS, the PASS has more items assessing basic balance abilities (such as postural transition during lying and sitting), so it should be more likely to detect changes in patients with severe balance deficits. We aimed to compare the responsiveness of the PASS and the BBS in patients with stroke who have severe balance deficits.

Methods:

The PASS and BBS scores of 49 patients with severe balance deficits at 14 and 30 days after stroke were retrieved. The group-level responsiveness was examined with the standardized response mean (SRM). The individual-level responsiveness was examined by the proportion of patients who achieved clinically significant improvements (ie, their pre-post change scores in the PASS/BBS exceeded the minimal detectable change with 95% confidence of each measure). The responsiveness of the 2 measures was compared using the bootstrap approach.

Results and Discussion:

The comparisons of responsiveness showed significant differences between the PASS and the BBS at both the group and individual levels. At the group level, the PASS indicated moderate changes in balance function (SRM = 0.79), but the BBS indicated only small changes (SRM = 0.39). At the individual level, the PASS showed that 42.9% of patients had clinically significant improvements, while the BBS showed that only 6.1% of patients had clinically significant improvements.

Conclusions:

Compared with the BBS, the PASS was better able to detect balance improvements in patients having severe balance deficits. The PASS is recommended as an outcome measure to detect change in balance in patients with stroke who have severe balance deficits.
A paradigm shift is necessary to relate running injury risk and footwear design – comment on Nigg et al.
Authors: Hamill Joseph , Boyer Katherine A. , Weir Gillian
Published: October 2019

In this commentary, we respond to suggestions that new paradigms are needed to relate running-related injury risk and footwear design. We concur with the authors of this paper that the previous paradigms on which footwear were designed are faulty. We also concur with the authors that new paradigms are indeed needed and that research must take into consideration more epidemiological studies and more prospective biomechanical studies. The authors suggest new paradigms including muscle tuning, the preferred movement path and functional groups. However, we do raise questions about each of these suggestions regarding how these paradigms can be developed in future research designs.
Muscle tuning and preferred movement path: do we need a paradigm shift or should we redefine the old? – comment on Nigg et al.
Authors: Vanwanseele Benedicte , Zhang Xianyi , Schütte Kurt
Published: October 2019

In the feature paper “Muscle tuning and preferred movement path – a paradigm shift“, Benno Nigg and colleagues discuss that the impact and pronation paradigm should be abandoned as there is not enough biomechanical and epidemiological evidence supporting these paradigms. We agree that the paradigms, as defined in the paper, are currently not supported by strong scientific evidence however we argue that the lack of evidence originates from shortcomings in the methodological approach to these paradigms. In our commentary, we argue for a redefinition of the paradigms rather than defining two ‘new’ paradigms. A better methodological approach and definitions of the paradigms based on the current evidence are needed rather than to abandon them.
Validity of the Actiheart step test for the estimation of maximum oxygen consumption in endurance athletes and healthy controls
Authors: Heydenreich Juliane , Schutz Yves , Melzer Katarina , Kayser Bengt
Published: October 2019

Submaximal step tests are often used for estimation of maximum oxygen consumption (VO2max) in humans. The validity of the Actiheart step test for VO2max estimation was not fully studied yet. Therefore, purpose of the study was to estimate VO2max using the Actiheart step test and to compare the data with measured VO2max in endurance trained athletes (ATH) and healthy non-athletes (CON).68 ATH (54% men, 28.0±5.4 yrs, 20.9±1.7 kg∙m-2) and 63 CON (46% men, 27.6±5.1 yrs, 22.1±1.7 kg∙m-2) performed the Actiheart step test and a spiroergometry for assessment of VO2max. In addition, resting metabolic rate (RMR; indirect calorimetry), maximum heart rate (HRmax; heart rate monitoring system during spiroergometry), and sleeping heart rate (SHR; Actiheart 6-day long term measurement) were determined. Validity of two different Actiheart software entry modes was assessed: (1) AHraw (estimated RMR [Schofield] and HRmax [Tanaka], SHR = 70 bpm) and (2) AHcomplete (measured RMR, HRmax, and SHR). Validity was investigated using linear regression (R2 and standard error of the estimate (SEE)) and repeated-measures ANOVA with a Bonferroni post-hoc correction. The level of significance was set to α=0.05.VO2max estimated by AHraw was significant related to measured VO2max in women CON (R2=0.22; p<0.05), whereas when VO2max was estimated by AHcomplete the relation was significant in women ATH and CON, and in men CON (R2=0.17-0.24; p<0.05). AHraw significantly underestimated VO2max in the total sample by 8% (51.4±10.2 vs. 55.9±7.6 ml∙kg-1∙min-1; p<0.0001), whereas no significant difference between AHcomplete and the criterion method was found (57.0±11.1 vs. 55.9±7.6 ml∙kg-1∙min-1; p=0.26).The Actiheart step test is an acceptable tool for the estimation of VO2max if an error within 8% can be tolerated. However, accuracy of the VO2max prediction is much improved when entering measured variables, such as RMR, SHR, and HRmax, into the software.
Anaplastic thyroid carcinoma diagnosed after treatment of lenvatinib for papillary thyroid carcinoma
Authors: Yamazaki Haruhiko , Iwasaki Hiroyuki , Suganuma Nobuyasu , Toda Soji , Masudo Katsuhiko , Nakayama Hirotaka , Rino Yasushi , Masuda Munetaka
Published: October 2019

Anaplastic transformation of a primary thyroid tumor whose process can be followed is rare. The objective this study is to report a case of anaplastic transformation of locally advanced papillary thyroid carcinoma after treatment with lenvatinib. A 74-year-old woman consulted a local physician because of cough and bloody sputum. Thyroid cancer with tracheal invasion was suspected on computed tomography (CT) imaging, and she visited our hospital for treatment. We suspected anaplastic thyroid cancer (ATC) and core needle biopsy was performed. Histologic sections of the core needle biopsy showed that the tumor formed a papillary structure, and we diagnosed papillary thyroid carcinoma. Surgery would have been difficult, and we initiated lenvatinib at a low dose of 8 mg/day. CT on day 40 of lenvatinib treatment revealed that the thyroid tumor had shrunk remarkably. CT on day 111 revealed that tumor regrowth and tracheal invasion had been exacerbated. Core needle biopsy was performed, and histologic sections of the core needle biopsy that was performed after regrowth of the tumor showed that individual cancer cells had large, irregular nuclei, and necrosis was also observed. The immunohistochemical findings were negative for thyroglobulin, and only a few cells were positive for thyroid transcription factor 1, and we diagnosed ATC. Anaplastic transformation of the target lesion may be one of the causes of lenvatinib treatment failure in differentiated thyroid carcinoma.

Learning points:

Anaplastic transformation of a primary thyroid tumor whose process can be followed is rare.

The resistance mechanism of lenvatinib in treatment for differentiated thyroid carcinoma has not been clarified.

Anaplastic transformation of the target lesion may be one of the causes of lenvatinib treatment failure in differentiated thyroid carcinoma.
Endometrial stromal cell miR-29c-3p regulates uterine contraction
Authors: Xiao Lan , Zhang Qiong , Huang Xi , He Aihua , Xie Shi , Li Yanping
Published: October 2019

Uterine peristalsis plays a vital role in fertility and female reproductive health. Although uterine peristalsis is thought to be correlated with some hormones and uterine pathologies, the physiological mechanisms underlying uterine peristalsis remain not quite clear. This study aimed to identify changes in miRNA in the endometrium of patients with abnormally high-frequency (hyper-) and low-frequency (hypo-) peristalsis to clarify whether miRNAs regulate uterine peristalsis. We used a miRNA microarray and RT-qPCR to identify changes in miRNA in endometrial tissue, a collagen gel contraction assay on co-cultured human endometrial stromal cells (ESCs) to analyze how the altered regulation of miRNAs influences uterine smooth muscle (USM) contraction, Western blots and other assays to elucidate the potential mechanisms involved. We found that among several differentially regulated miRNAs, miR-29c-3p was overexpressed in endometrial samples from patients with hypoperistalsis; oxytocin receptor (OXTR) expression was low in endometrial samples from patients with hypoperistalsis. Bioinformatic analysis and luciferase assays indicated that OXTR is a target of miR-29c-3p, which attenuates its expression. Additionally, downregulation of miR-29c-3p in ESC cultures increased the expression of aldo-keto reductase family 1, member C3 (AKR1C3) and increased the release of prostaglandin F2 alpha (PGF2α). Co-cultured ESCs overexpressing miR-29c-3p reduced USM cell contractions; the opposite tendency was found when ESCs were transfected with a miR-29c-3p inhibitor. To conclude, miR-29c-3p in endometrial cells regulates uterine contractility by attenuating the expression of OXTR and reducing PGF2α release.
Natural Genetic Variation Screen inDrosophilaIdentifies Wnt Signaling, Mitochondrial Metabolism, and Redox Homeostasis Genes as Modifiers of Apoptosis
Authors: Palu Rebecca A S , Ong Elaine , Stevens Kaitlyn , Chung Shani , Owings Katie G , Goodman Alan G , Chow Clement Y
Published: October 2019

Apoptosis is the primary cause of degeneration in a number of neuronal, muscular, and metabolic disorders. These diseases are subject to a great deal of phenotypic heterogeneity in patient populations, primarily due to differences in genetic variation between individuals. This creates a barrier to effective diagnosis and treatment. Understanding how genetic variation influences apoptosis could lead to the development of new therapeutics and better personalized treatment approaches. In this study, we examine the impact of the natural genetic variation in the Drosophila Genetic Reference Panel (DGRP) on two models of apoptosis-induced retinal degeneration: overexpression of p53 or reaper (rpr). We identify a number of known apoptotic, neural, and developmental genes as candidate modifiers of degeneration. We also use Gene Set Enrichment Analysis (GSEA) to identify pathways that harbor genetic variation that impact these apoptosis models, including Wnt signaling, mitochondrial metabolism, and redox homeostasis. Finally, we demonstrate that many of these candidates have a functional effect on apoptosis and degeneration. These studies provide a number of avenues for modifying genes and pathways of apoptosis-related disease.
Combining data on military demand and supply for arms production estimates
Authors: Brzoska Michael
Published: October 2019

Currently there exist no data series comparing arms production values among countries. The article outlines three methods for generating such data series based largely on already available data series relevant to arms production, in particular series on arms imports and exports, procurement, and turnover figures from the world’s largest arms producing companies. All three methods have major shortcomings and limitations but with additional effort in data collection they can provide a basis for comparing arms production values among countries as well as for regional and global totals. Furthermore, as the three methods use different definitions of the scope of arms production, comparison of the data produced by them can provide additional insights.
Breve historia de la revista “Odontología Sanmarquina”
Authors: Moromi Nakata Hilda
Published: October 2019

La investigación en la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos (UNMSM), siempre ha sido una de las funciones importantes en el quehacer institucional; por ello, la publicación y difusión de los resultados, a través de la revista ha permitido ofrecer a la comunidad científica, el análisis y la discusión como contribución para la mejora del bienestar de la población.
Arco de intrusión de Burstone para la corrección de la mordida profunda. Reporte de caso
Authors: Sánchez-Tito Marco Antonio
Published: October 2019

La mordida profunda se define como una maloclusión vertical, donde existe un incremento del sobrepase vertical de los incisivos superiores sobre los incisivos inferiores, puede deberse a una supraerupción de los dientes anterosuperiores, incremento de la curva de Spee o una combinación de ambos. Se presenta un caso de una paciente de 23 años de edad, con perfil convexo, sobremordida aumentada y retroinclinación de los incisivos centrales superiores. Se empleó el arco de intrusión propuesto por Burstone para la corrección simultanea de la supraerupción y retroinclinación de los incisivos superiores, logrando una oclusión estable tras un seguimiento de dos años. Este caso permitió demostrar la aplicación de los conceptos biomecánicos propuestos por Burstone para el tratamiento de la mordida profunda.
¿La caries dental afecta la economía en el hogar?
Authors: Munayco Pantoja Evelyn Del Rosario , Cadillo Ibarra Marleny Marianela
Published: October 2019

Sr. Editor.

La caries dental es la enfermedad más prevalente entre la población infantil y es la principal causa de consulta en los establecimientos del Ministerio de Salud 1. Los costos de tratamiento pueden ser altos, especialmente para los casos más graves, que pueden requerir un tratamiento extenso bajo anestesia general. En el Instituto Nacional de Salud del Niño (INSN), el Seguro Integral de Salud (SIS) solo cubre el 59,89% de los costos de sala de operaciones por tratamiento dental, el restante es cubierto por las familias.
Career Motivators for Community Pediatric Hospitalists
Authors: Jackson Kelsey , Marek Rachel , Fromme H. Barrett
Published: October 2019

BACKGROUND AND OBJECTIVES:

Within the field of pediatric hospital medicine, physicians can choose to work at community-based or university-based centers. The factors that motivate pediatric hospitalists to work specifically at community sites have not yet been fully explored. Our objective with this study was to elucidate the motivators for pediatric hospitalists to begin and continue work at community sites.

METHODS:

A qualitative study was performed via phone-based focus groups. Physicians were included if they were able to attend 1 of the offered group sessions and they self-identified as spending the majority of their time working as community-based pediatric hospitalists. Data were analyzed through a constant comparative analysis.

RESULTS:

Five themes emerged regarding factors that motivate pediatricians to begin and continue their careers as hospitalists in the community. The themes were (1) professional impact, (2) scope of practice, (3) personal and professional satisfaction, (4) community involvement, and (5) job availability.

CONCLUSIONS:

This study reveals the key factors that motivate community pediatric hospitalists to begin and continue working in the community.
Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions
Authors: Collier Ai-ris Y. , Molina Rose L.
Published: October 2019

The rising trend in pregnancy-related deaths during the past 2 decades in the United States stands out among other high-income countries where pregnancy-related deaths are declining. Cardiomyopathy and other cardiovascular conditions, hemorrhage, and other chronic medical conditions are all important causes of death. Unintentional death from violence, overdose, and self-harm are emerging causes that require medical and public health attention. Significant racial/ethnic inequities exist in pregnancy care with non-Hispanic black women incurring 3 to 4 times higher rates of pregnancy-related death than non-Hispanic white women. Varied terminology and lack of standardized methods for identifying maternal deaths in the United States have resulted in nuanced data collection and interpretation challenges. State maternal mortality review committees are important mechanisms for capturing and interpreting data on cause, timing, and preventability of maternal deaths. Importantly, a thorough standardized review of each maternal death leads to recommendations to prevent future pregnancy-associated deaths. Key interventions to improve maternal health outcomes include 1) integrating multidisciplinary care for women with high-risk comorbidities during preconception care, pregnancy, postpartum, and beyond; 2) addressing structural racism and the social determinants of health; 3) implementing hospital-wide safety bundles with team training and simulation; 4) providing patient education on early warning signs for medical complications of pregnancy; and 5) regionalizing maternal levels of care so that women with risk factors are supported when delivering at facilities with specialized care teams.
Fetal Doppler Assessment in Neonatal Care: Analysis of Fetal Doppler Abnormalities and Neonatal Outcomes
Authors: Narendran Nadia , Yusuf Kamran
Published: October 2019

Fetal Doppler ultrasonography provides an effective and noninvasive approach to identify circulatory abnormalities in the maternal-fetal circulation. It is invaluable to assess the hemodynamic status of the fetus under a wide range of physiologic, infectious, and abnormal anatomic conditions. Findings from these studies are often used to make clinical decisions, including whether to proceed with urgent delivery of the fetus. In this review, we focus on key literature describing the main uses of Doppler ultrasonography in neonatal medicine, including how abnormal findings may be implicated in immediate and long-term outcomes. Our review highlights the importance of fetal Doppler examination as an effective intrauterine management strategy, and its full potential is more likely to be realized when considered in context with other available clinical information.
Using Visual Social Media in Language Learning to Investigate the Role of Social Presence
Authors: Fornara Fabrizio , Lomicka Lara
Published: October 2019

In this paper, we attempt to investigate the pedagogical value of visual social media platforms, specifically Instagram, for the development of the online social presence of language classes. Students in intermediate university-level French and Italian classes used Instagram for a six-week period to reply to a series of questions prompted by the instructor as a way to engage in interaction with their own classmates. This research examines how students establish a community of inquiry (CoI) and investigates the development of social presence in students’ posts. Using a mixed methods approach, we performed a content analysis of the transcripts of Instagram posts, coding for social presence. Given the visual nature of Instagram, we also conducted a visual analysis of representative posts to investigate the multimodal projection of social presence. Additionally, we administered voluntary pre-questionnaires to capture demographic data and students’ experience with Instagram. We analyzed the data using the social presence density calculation and performed basic statistical analyses. Findings indicate that students did build online social presence, which can promote the development of a CoI. Both language groups performed in similar ways, which may be a result of the tool rather than the language and context. This finding is consistent with the general use of visual social media as a tool for self-expression, self-identity, and community building.
Mango Languages
Authors: Kavun Nataliia
Published: October 2019

Mango Languages is an online language learning platform founded in 2007. It offers courses in over 70 languages. The courses are both available through the mobile application on Android and iOS and the website platform. This review will take a close look at the website version for its Russian course. There are four major units that include 10 chapters. In all, Mango Languages offers 390 language lessons, teaching different conversational and grammar topics.
The role of nitric oxide in improving endothelial function andcardiovascular health: focus on nebivolol
Authors: Bakris G. L. , Basile J. N. , Giles T. D. , Taylor A. A.
Published: October 2019

Although β-blockers have been endorsed by guidelines committees for the treatment of patients with hypertension, particularly those with significant CVD and high CVD risk, there are concerns about conventional β-blockers related to poorer clinical outcomes compared with other classes of antihypertensive agents, as well as deleterious effects on quality of life and lipid and carbohydrate metabolism. β-blockers comprise a heterogeneous group of antihypertensive agents, including nonselective agents, cardioselective, nonvasodilating agents, and vasodilating agents that either combine β-nonselectivity with β-blockade or possess cardioselectivity without β-blockade. The pharmacologic, mechanistic, and hemodynamic differences between conventional, nonvasodilating β-blockers and vasodilating β-blockers are discussed in this review, with a focus on the cardioselective vasodilating β-blocker nebivolol. These differences may have important clinical implications, particularly in the treatment of complicated hypertension, such as that associated with patients with diabetes or cardiometabolic syndrome, elderly patients, and African American patients, suggesting that mechanism of action may be an important consideration when choosing a β-blocker.
Ergometric principles of cardiovascular function assessment in arterial hypertension
Authors: Bursikov A. V. , Valiulina E. Sh. , Birtseva L. N.
Published: October 2019

Aim. To investigate hemodynamic and ergometric parameters and their agreement with metabolic demand during veloergometry in patients with Stage I-II arterial hypertension (AH). Material and methods. In total, 80 18-59-year-old men, with Stage I-II AH were examined, together with 25 healthy men of comparable body weight. All participants underwent standard veloergometry, with achievement of sub-maximal heart rate (HR), or development of test-termination criteria, such as excess blood pressure (BP) elevation, dyspnoea, or fatigue. Results. A significant increase in myocardial oxygen consumption, disagreeing with metabolic demand, was observed both at rest and during veloergometry test. The qualitative criteria reflecting myocardial workload due to peripheral vascular resistance and functional myocardial remodelling were developed. These criteria differed at different AH stages, and included hemodynamic parameters (levels of systolic and diastolic BP) and ergometric characteristics (double product and its increase, pressure load index, and cardiac load index). Conclusion. In Stage I-II AH patients, myocardial oxygen consumption during standard veloergometry was significantly higher than in healthy individuals, disagreed with metabolic demand, and increased with AH progression.
Ivabradine therapy effectiveness in patients with chronic heart failure, Functional Class III
Authors: Kanorskiy S. G. , Tregubov V. G. , Pokrovskiy V. M.
Published: October 2019

Aim. To assess the effectiveness of ivabradine-including therapy, as well as the effects of ivabradine on regulatoryadaptive status (RAS), in patients with chronic heart failure (CHF), Functional Class (FC) III. Material and methods. The study included 100 patients with FC III CHF and coronary heart disease (CHD) and/ or Stage III arterial hypertension (AH). The participants were previously prescribed a complex treatment regime. After randomisation, Group I included 56 patients (mean age 62,9±1,8 years), who were additionally administered metoprolol succinate extended-release (mean dose 59,1±4,5 mg/day). Group II (n=44; mean age 59,4±1,3 years) was additionally administered an If channel inhibitor ivabradine, when beta-adrenoblocker (BAB) therapy was not possible. At baseline and 6 months later, participants underwent treadmill test (with VO2max assessment), echocardiography, 24-hour blood pressure monitoring, and the measurement of plasma levels of N-terminal probrain natriuretic peptide (NT-proBNP). RAS status was qualitatively assessed in a cardio-respiratory synchronism test. Results. Ivabradine-including therapy improved myocardial structure and function, increased exercise capacity, and demonstrated positive effects on plasma NT-proBNP levels, VO2мах during treadmill test, and RAS status.

Conclusion. Ivabradine could be an alternative medication when BAB therapy is not possible in patients with FC III CHF and CHD and/or Stage III AH.
Importance of early diagnostics of chronic obstructive pulmonary disease in patients with coronary heart disease
Authors: Kuznetsov A. N. , Grigoryeva N. Yu. , Sharabrinv E. G.
Published: October 2019

Aim. To study the specific clinical features in patients with coronary heart disease, CHD (stable effort angina, SEA) and chronic obstructive pulmonary disease (COPD), in order to improve early diagnostics of this combined pathology. Material and methods. The study was a retrospective analysis of 958 medical histories. Co-existing COPD was registered in 251 patients (26,3 %). Therefore, Group I included 251 patients with SEA and COPD (26,3 %), while Group II included 707 SEA patients without COPD (73,7 %). Results. In Group I, there were more men than women, by 5,7 % (р<0,05). No significant differences in age and angina functional class were observed between Groups I and II. In patients with SEA and COPD, the prevalence of arterial hypertension and myocardial infarction was higher than in Group II (р<0,05). In addition, Group I was characterised by higher prevalence of dyspnoea, palpitation, C-reactive protein elevation, and lipid metabolism disturbances. Conclusion. Among chronic CHD patients hospitalized to the cardiology unit, co-existing COPD was registered in 26,3 %. The combination with COPD aggravated the clinical course of CHD. The study results support the use of lung function assessment in smoking CHD patients, to diagnose co-existing COPD.
Hemostasis effects of various glucose-lowering medications and angiopathy prevention
Authors: Petrik G. G. , Pavlishchuk S. A.
Published: October 2019

Aim. To assess hemostasis effects of various glucose-lowering medications (GLM), such as sulphanilamides, biguanides, and insulin, in regard to micro- and microangiopathy progression over 5 years in patients with Type 2 diabetes mellitus (DM-2). Material and methods. The study included 72 patients with DM-2 (47 women, 25 men; median age 54,0 years (49,0-59,0 years); mean DM-2 duration 4,0 years (0,5-8,0 years)), receiving one of the following GLMs for 5 years: glibenclamide, gliclazide, metformin, insulin, or the combination of glibenclamide and metformin. Results. Various GLMs had different effects on platelet activity. In the gliclazide group, aggregant activity was decreased, compared to the glibenclamide and insulin groups. In the metformin group, aggregant activity and platelet disaggregation were similar to that in the gliclazide group. The microangiopathy progression over 5 years was related to GLM therapy, being minimal in the DM-2 patients receiving metformin, and maximal among participants administered glibenclamide. The microangiopathy progression was minimal in the metformin and gliclazide groups, and maximal — in the glibenclamide group. Conclusion. Carbohydrate and lipid metabolism compensation is not the only condition of angiopathy prevention. The latter should be based on the complex intervention, aimed at the complete metabolic compensation and hemostasis balance. The need for taking pleiotropic activity of specific agents into consideration when choosing GLM therapy is emphasized by protective effects of metformin (micro- and microangiopathy prevention) and gliclazide (microangiopathy prevention), but not glibenclamide.
ORIENTIR Study: design and results
Authors: Martsevich S. Yu. , Lukina Yu. V. , Bondareva I. B.
Published: October 2019

The paper summarizes the specific features of post-marketing studies, which are performed after the medication registration, in the settings close to the real-world clinical practice. In particular, the authors discuss the design and results of the Russian post-marketing study of nifedipine CR (controlled release) — ORIENTIR Study. The aim of the study was to assess antihypertensive effectiveness and tolerability of nifedipine CR in patients with arterial hypertension (AH). Results. The study included 38 doctors from 24 clinical centres in 16 Russian cities, as well as 3179 patients with AH. Mean blood pressure (BP) reduction reached 22,9±6,75/16,56±8,74 mm Hg. Target BP levels were achieved in 94,9 % of AH patients without diabetes mellitus (DM), and in 72,1 % patients with a combination of AH and DM. At the last visit, 98 % of the participants continued taking the study medication. Adverse effects were registered in 1,5 % of the participants. Doctor-assessed effectiveness, tolerability, and therapy compliance for nifedipine CR were “excellent” or “good” in 95,8 %, 96,4 %, and 97,7 % of the patients, respectively. Conclusion. The results of this study are consistent with the data from other post-marketing studies of nifedipine CR, confirming its antihypertensive effectiveness and good tolerability.
Venous thromboembolism in patients with heart failure
Authors: Averkov O. V. , Shevchenko I. V. , Mirilashvili T. Sh. , Kobalava Zh. D.
Published: October 2019

This review is focussed on the problem of venous thromboembolism in patients with heart failure (HF). The results of the major clinical trials of antithrombotic therapy in HF patients are presented. The authors discuss comparative effectiveness, safety, and tolerability of unfractionated heparins, low molecular weight heparins, and fondaparinux. The results of the two trials, MAGELLAN and ADOPT, are expected to clarify the clinical potential of such oral anticoagulants as rivaroxaban and apixaban (Factor Xa inhibitors). The problem of low rates e of preventive antithrombotic administration is emphasized.
Cardiovascular risk factors in women and the role of sex hormones
Authors: Yureneva S. V. , Mychka V. B. , Ilyina L. M. , Tolstov S. N.
Published: October 2019

Despite certain success in the recent years, the problem of cardiovascular disease (CVD) in women remains one of the greatest challenges of the 21st century. Its social and economic burden will continue to increase, due to increasing proportion of older women in the population. Recently, cardiologists have been focusing on menopause as a specific CVD risk factor in women. At the same time, other conditions, also increasing CVD risk, such as certain pregnancy complications and premature menopause, have not received enough attention. Hormone replacement therapy (HRT) remains the first-line treatment and the most effective strategy in young women with estrogen deficiency and postmenopausal women with menopausal symptoms. HRT effectiveness and safety is based on its timely start, low dose, and individually appropriate combination of estrogens and progestins. Interdisciplinary approach is essential for early identification of high-risk women, since lifestyle modification recommendations, diagnostic procedures, and, if needed, an active therapeutic intervention could reduce future CVD incidence in these women.
Direct renin inhibitor aliskiren in women with menopausal metabolic syndrome and arterial hypertension
Authors: Zhernakova Yu. V. , Mychka V. B. , Ponomarev Yu. A. , Tolstov S. N. , Tishina E. V. , Ivanov K. P. , Chazova I. E.
Published: October 2019

Aim. To study the effectiveness of a direct renin inhibitor, aliskiren, in patients with menopausal metabolic syndrome (MMS), and to assess aliskiren effects on blood pressure (BP), carbohydrate and lipid metabolism parameters, microalbuminuria, and arterial stiffness. Material and methods. The study included 23 women with MMS, to whom aliskiren monotherapy (150-300 mg/d) was administered. At baseline and in the end of the study, anthropometry, carbohydrate and lipid metabolism parameters assessment, 24-hour BP monitoring, and arterial stiffness assessment by volume sphygmography were performed. Results. By the end of the study, most parameters of circadian BP profile significantly decreased. Target levels of systolic and diastolic BP were achieved in 80 % of the patients. There was a significant reduction in postprandial glucose levels. According to the volume sphygmography results, a decrease in arterial stiffness was accompanied by a significant reduction in pulse wave velocity and augmentation index, with normalization of the former parameter. Conclusion. Aliskiren therapy demonstrated not only high antihypertensive effectiveness in MMS patients, but also a reduction in postprandial glucose levels and arterial stiffness.