bluuebunny/crossref_metadata_2025 huggingface dataset:
Untersuchung zur Genauigkeit einer automatischen EKG-Vermessung
Authors: Überla K. , Gaus W.
Published: March 2018

Zur Überprüfung der Genauigkeit einer automatischen EKG-Vermessung wurde gesunden Versuchspersonen das EKG nach. Einthoven, Goldberger und Wilson abgenommen und durch ein Computer-Programm vermessen. In einer dreifachen Varianzanalyse wurde der Einfluß, der durch die maschinelle Vermessung entsteht, mit anderen Fehlereinflüssen verglichen. Neben Aussagen darüber, welche Meßgroße in welcher EKG-Ableitung am zuverlässigsten ermittelt werden kann, wurden zwei FehlerKoeffizienten definiert, von denen der eine (FKJ nur den Vermessungsfehler selbst und der andere (FKj) die gesamte biologische und sonstige Variation zwischen Tagen und Tageszeiten sowie zwischen den Abnahmebedingungen (Elektrodenlage) enthält. FKt ist nur für wenige Meßgrößen 5% oder besser, FKj liegt häufig in der Größenordnung von 50%. An Hand dieser Ergebnisse wird die Problematik eines einzelnen EKG-Meßwerts und der automatischen EKG-Vermessung diskutiert. Es wird empfohlen, derartige Untersuchungen zur Qualitätskontrolle beim Routineeinsatz mitzuführen.
Basis-Dokumentation in der Pathologie
Authors: Jacob W.
Published: March 2018

Die Vielfältigkeit der Aufgaben einer Basisdokumentation in der Pathologie bedarf geeigneter Methoden, mit deren Hilfe eine genügende Verläßlichkeit der Dokumentation morphologischer Befunde im Rahmen der Eingangshistologie und Sektionsdiagnostik erreicht werden kann. Die Methode der »halbautomatischen Verschlüsselung«, das sog. »over-cross«-Verfahren, erlaubt eine uneingeschränkte Dokumentation aller in der Pathoanatomie zu dokumentierenden Befunde mit einem sehr reduzierten Arbeitsaufwand, zugleich einer technisch relativ einfachen Handhabung, welche zudem Fehlermöglichkeiten wesentlich einschränkt. Umständliches Verschlüsseln »von Hand« entfällt, die Fehlerkontrolle der Daten ist sehr vereinfacht. Das »over-cross«-Verfahren erlaubt eine maschinelle Herstellung der Lochkarten sowie die Verwendung eines Dualzahlenschlüssels, welcher die Kapazität der einzelnen Lochkarte erheblich steigert. Sortier- und Selektiervorgänge lassen sich wesentlich beschleunigen.
Ein neues Konzept computerunterstützter Schwerkrankenüberwachung: Göttinger Informationssystem für Intensivpflege »GISI«
Authors: Schillings H. , Scharnberg B. , Sabean Ruth M. , Ehlers C. Th.
Published: March 2018

Die Vorteile des routinemäßigen Einsatzes von Digitalrechnern in der Schwerkrankenüberwachung sind heute unbestritten. Dennoch dienen die meisten der auf diesem Sektor der medizinischen Anwendung betriebenen Computersysteme problemorientierten Forschungsvorhaben. Das Göttinger Informationssystem für Intensivpflege »GISI« wird für den klinischen Routinebetrieb der postoperativen Intensivpflege in zwei Kliniken mit vier Betten erprobt und soll im Endausbau die Intensivstationen von 12 Kliniken unterstützen. »GISI« unterstützt ein zentrales MUMPS -Datenbank-system, sowie, im Rahmen seiner Echtzeitfunktionen, ein Netzwerk von Mikrorechnern zur Patientenüberwachung.
The Need for “Complementary Information” in the Medical Computer File
Authors: Lahaye D. , Roosels D. , Viaene J.
Published: March 2018

The use by the physician of the possibility to add complementary information (C. I.) to each question of a computer file has been analysed using both »APL« and »batch« systems.

The analysis of the frequency of use of C.I. by APL leads to the following conclusions: There exist great differences between several physicians in the interpretation of some questions, the ratio of C. I. utilisation frequency reaching in some cases 2:1. This seems clue to the individual »intuitive« approach in each medical examination. The fact that the C. I. is not always filled in at the same place makes this information worthless for statistical analysis.

The analysis of the content of the C. I. using the »batch« system makes it possible to identify the questions for which a better instruction of the physician is needed on one hand, and those for which a correction of the question text is necessary on the other hand. The authors think that the complete exclusion of a C. I. possibility is not practicable.
The Determination of Sequential Strategies of Diagnostic Tests: Comparison of Different Methods by Simulation
Authors: Alpérovitch A. , Le Minor M. , Lellouch J.
Published: March 2018

Various heuristic processes for determining diagnostic test strategies were compared with the optimal sequential strategy on simulated patients. These heuristics consisted in limiting the depth and breadth of the search in the decision tree with regard to medically reasonable constraints. It appeared that some of these heuristics required a very small amount of computer time and provided solutions, the costs of which were very close to the cost of the optimal strategy.

General conclusions were drawn from an analysis of the performance of these various heuristics for varying cost functions.
Adverse-Reactions Literature: A Bibliometric Analysis
Authors: Windsor D. A.
Published: March 2018

The adverse-reactions literature was examined for 5 different bibliometric traits, using the 3,040 papers reported in the FDA Clinical Experience Abstracts during 1972 and 1973. Most papers (71%) were written by 2 or more authors. Adverse-reaction words appeared in most (64%) of the titles. Almost all (99%) of the papers had drug-words in their titles. Most (62%) of the papers had 4 or fewer pages. The vast majority (91%) of papers had references; of these, the median was 11 references. A generalization was postulated: If the literature on a drug is being monitored by title searching only, most of the papers reporting adverse reactions to that drug will be obtained.
Analyse der Ablauforganisation in einem medizinischen Untersuchungszentrum mit Hilfe der Netzwerktechnik
Authors: Fleck H.
Published: March 2018

Die Anwendung der Netzwerktechnik zur Analyse von Untersuchungsabläufen in einem medizinischen Untersuchungszentrum wird beschrieben. Das behandelte Problem stellte sich im Rahmen einer EDVEinsatzplanung für dieses Untersuchungszentrum.

Im vorliegenden Anwendungsbeispiel ▪wird, im Gegensatz zur herkömmlichen Praxis, die Netzwerktechnik dazu verwendet, ein bereits bestehendes System im zeitlichen und organisatorischen Ablauf nachzubilden. Durch Variation der Eingabedaten in einem Netzwerk-Rechnerprogramm werden Istund EDV-Sollzustand der medizinischen und verwaltungstechnischen Ablauforganisation erfaßt.

Eine Gegenüberstellung der kritischen Wege im Netzwerk sowie der einzelnen Zeittabellen liefert Aussagen über den zeitlichen Einfluß von zukünftigen ED V-Maßnahmen im vorgegebenen medizinischen System.
How to Organize the Medical Data of Chronically Ill Patients in the Computer
Authors: Martín J. M. , Jabot F. , Marrel P.
Published: March 2018

The problems of aiding in the medical decision-making process are very important today, especially through the use of artificial intelligence methods. Before studying these problems, it is necessary to have an excellent availability of relevant medical patient health data as well as medical knowledge.

The computer is well adapted for the task of satisfying this essential condition; but in order to accomplish this goal, it is necessary to develop an efficient system of data organization.

The current system of sequential organization of medical histories is most likely not the best possible method of data filing. Furthermore, at the present time there are only a small number of relations (in the mathematical sense) between these health data. This situation is not favorable to the development of a relational data base.

This article proposes an organization of health data which is relative to the patient. The organization is based on the notion of a medical entity and on the three-dimensionality of health data.
Integration of Homeopathy and Complementary Medicine in the Tuscan Public Health System and the Experience of the Homeopathic Clinic of the Lucca Hospital
Authors: Di Stefano M. , Picchi M. , Panozzo M. , Noberasco C. , Nurra L. , Baccetti S. , Rossi E.
Published: March 2018

Introduction The healthcare programs of the Region of Tuscany (Italy) have started the process of integration of some types of complementary medicine (CM), including homeopathy, which began in 1996. The Homeopathic Clinic of Lucca was opened in 1998, followed by the Homeopathic Clinic for Women in 2003, and the Clinic for CM and Diet in Oncology in 2013.

Methods Observational longitudinal studies conducted on 5,877 patients (3,937 in the general clinic, 1,606 in the women's clinic and 334 in oncology) were consecutively examined from 2003 to 2016. The Outcome in Relation to Impact on Daily Living (ORIDL) was generally used to assess outcomes.

Results Comparing the clinical conditions before and after homeopathic treatment, improvement was observed in 88.8% of general medicine patients with follow-up (45.1%); in particular, 68.1% of the patients had a major improvement in or resolution (ORIDL +2, +3, +4) of their condition. In women, an improvement was obtained in 74.1% cases and a major improvement in 61.2%. In cancer patients with homeopathic and integrative treatment, a significant improvement was observed for all the symptoms during anti-cancer therapy, particularly for hot flashes, nausea, depression, asthenia, and anxiety.

Conclusions These results suggest that homeopathy can effectively be integrated with allopathic medicine and that the Tuscan experience could provide a useful reference for developing national and European regulations on the use of CM and homeopathy in public healthcare.
Biomedical and Health Informatics Research and Education at the University of Washington
Authors: Fuller S. , Kalet I. , Tarczy-Hornoch P.
Published: March 2018

Although an extensive medical informatics research program as well as courses and training experiences in biomedical informatics have existed at the University of Washington (UW) for many years, a formal home did not exist until 1997 when the Division of Biomedical Informatics was created in the Department of Medical Education, School of Medicine. Since that time the expansion of the research, service and teaching programs has been rapid with a key milestone being a university commitment to provide funding, space and faculty to support the development of a new graduate program in Biomedical and Health Informatics.

Hallmarks of the biomedical and health informatics program at the University of Washington include:

- Strong shared belief that informatics research can contribute to the improvement of healthcare and health;

- Large, multidisciplinary faculty including faculty from computer science, library and information science as well as the health sciences schools (dentistry, medicine, nursing, pharmacy, and public health and community medicine);

- Comprehensive research and development partnership with the University of Washington Medical Centers information systems group and the UW Primary Care Network to move research from the laboratory to operational clinical systems;

- Extensive and diverse regional setting in which to study information needs and develop informatics solutions in primary care settings;

- Lack of barriers to interdisciplinary research and teaching.
Research at the Department of Medical Informatics, Statistics and Documentation of the University of Graz
Authors: Simonic K.-M. , Gell G. , Errath M.
Published: March 2018

The Department of Medical Informatics, Statistics and Documentation of the University of Graz has a double responsibility: research in medical informatics, and implementation and operation of information systems in the hospital. Research is therefore application oriented with emphasis on departmental information systems, image management, and information integration. Other topics include analysis of the preconditions for the acceptance and successful use of information systems in medicine, and the ethics and professional responsibility of medical informatics.
Section 7: Bioinformatics: Bioinformatics Linkage of Heterogeneous Clinical and Genomic Information in Support of Personalized Medicine
Authors: Maojo V. , Mitchell J. A. , Frey L. J.
Published: March 2018

Biomedical Informatics as a whole faces a difficult epistemological task, since there is no foundation to explain the complexities of modeling clinical medicine and the many relationships between genotype, phenotype, and environment. This paper discusses current efforts to investigate such relationships, intended to lead to better diagnostic and therapeutic procedures and the development of treatments that could make personalized medicine a reality.

To achieve this goal there are a number of issues to overcome. Primary are the rapidly growing numbers of heterogeneous data sources which must be integrated to support personalized medicine. Solutions involving the use of domain driven information models of heterogeneous data sources are described in conjunction with controlled ontologies and terminologies. A number of such applications are discussed.

Researchers have realized that many dimensions of biology and medicine aim to understand and model the informational mechanisms that support more precise clinical diagnostic, prognostic and therapeutic procedures. As long as data grows exponentially, novel Biomedical Informatics approaches and tools are needed to manage the data. Although researchers are typically able to manage this information within specific, usually narrow contexts of clinical investigation, novel approaches for both training and clinical usage must be developed.

After some preliminary overoptimistic expectations, it seems clear now that genetics alone cannot transform medicine. In order to achieve this, heterogeneous clinical and genomic data source must be integrated in scientifically meaningful and productive systems. This will include hypothesis-driven scientific research systems along with well understood information systems to support such research. These in turn will enable the faster advancement of personalized medicine.
Human Factors for Capacity Building. Lessons learned from the OpenMRS Implementers Network
Authors: Mamlin B. W. , Biondich P. G. , Fraser H. S. F. , Wolfe B. A. , Jazayeri D. , Miranda J. , Blaya J. , Sinha C. , Bailey C. T. , Kanter A. S. , Seebregts C. J.
Published: March 2018

Objectives:
Theoverallobjectiveofthisprojectwastoinvestigateways to strengthen the OpenMRS community by (i) developing capacity and implementing a network focusing specifically on the needs of OpenMRS implementers,(ii) strengthening community-driven aspects of OpenMRS and providing a dedicated forum for implementation-specific issues, and; (iii) providing regional support for OpenMRS implementations as well as mentorship and training.

Methods:
Themethodsusedincluded(i)face-to-facenetworkingusing meetings and workshops; (ii) online collaboration tools, peer support and mentorship programmes; (iii) capacity and community development programmes, and; (iv) community outreach programmes.

Results:
Thecommunity-driven approach,combined withafewsimple interventions,has been a key factor in the growth and success of the OpenMRS ImplementersNetwork.Ithascontributed toimplementations in at least twenty-three different countries using basic online tools; and provided mentorship and peer support through an annual meeting, workshops and an internshipprogram. The OpenMRS Implementers Network has formed collaborations with several other open source networks and is evolving regional OpenMRS Centres of Excellence to provide localized support for OpenMRS development and implementation. These initiativesare increasingthe range of functionalityand sustainability of open source software in the health domain, resulting in improvedadoption and enterprise-readiness.

Conclusions:
Socialorganizationandcapacitydevelopmentactivities are important in growing a successful community-driven open source softwaremodel.
Capacity Building in e-Health and Health Informatics: A Review of the Global Vision and Informatics Educational Initiatives of the American Medical Informatics Association
Authors: Detmer D. E.
Published: March 2018

Substantial global and national commitment will be required for current healthcare systems and health professional practices to become learning care systems utilizing information and communications technology (ICT) empowered by informatics. To engage this multifaceted challenge, a vision is required that shifts the emphasis from silos of activities toward integrated systems. Successful systems will include a set of essential elements, e.g., a sufficient ICT infrastructure, evolving health care processes based on evidence and harmonized to local cultures, a fresh view toward educational preparation, sound and sustained policy support, and ongoing applied research and development.

Increasingly, leaders are aware that ICT empowered by informatics must be an integral part of their national and regional visions. This paper sketches out the elements of what is needed in terms of objectives and some steps toward achieving them. It summarizes some of the progress that has been made to date by the American and International Medical Informatics Associations working separately as well as collaborating to conceptualize informatics capacity building in order to bring this vision to reality in low resource nations in particular.
Evidence-based Biomedical Informatics
Authors: Lovis C.
Published: March 2018

Objectives: An overview of current trends and achievements in building more evidence of using information sciences technologies in biomedical informatics.

Methods: Extensive search using PubMed for published papers in this field in 2012. A selection process organized in three steps: a) identification and first selection of papers; b) international peer-review by at least 4 reviewers for each paper; c) final selection of five papers by the editorial board of the Yearbook based on the international reviewing results and a balanced coverage of the topics.

Results: Synopsis of the articles selected for the IMIA Yearbook 2012 and an invited opinion paper written by leading scientists in this field.

Conclusion: Evidence based health informatics is an important and ubiquitous trend in biomedical informatics. However, this research field has to be enhanced even further and, more importantly, achievements have to be put in practice.
Botulinumtoxin bei Zerebralparese
Authors: Mall V. , Fietzek U.
Published: March 2018

Die Behandlung spastischer und dystoner Bewegungsstörungen mit BoNT/A bei Kindern mit Zerebralparese ist ein weltweit etabliertes interventionelles Therapieverfahren. Bei einer Vielzahl von Indikationen lassen sich Therapieerfolge auf Organebene (Tonussenkung) und zunehmend häufiger auch auf funktioneller Ebene (z. B. Verbesserung des Gangbildes und Handscores) erreichen. Idealerweise sollte die Versorgung in einem multidisziplinären Team erfolgen. Zur Therapieevaluation eignen sich individuelle Zielvereinbarungen und die Dokumentation mit Video. Während die Tonusreduktion bei Patienten mit spastischen Bewegungsstörungen mit hohem Evidenzgrad belegt ist, sind die funktionellen Langzeitauswirkungen weitgehend unklar und unzureichend verstanden.
Begründete Aussicht auf längeres und besseres Überleben
Authors: Riem Ludger
Published: March 2018

Niemals zuvor hatten Ärzte bei Patienten mit Chronisch Lymphatischer Leukämie (CLL) so viele Pfeile im Köcher wie heute. Wie bei vielen anderen Indikationen im hämatologisch-onkologischen Umfeld rückt auch bei der CLL die zielgerichtete molekulare Therapie mit Macht in den Vordergrund des Geschehens. Sowohl in der Rezidivtherapie als auch in der Primärtherapie von Patienten mit genetisch ungünstigen Varianten, beispielsweise p53-Dysfunktion, sind gezielt wirkende Substanzen wie Ibrutrinib, Idelalisib oder Venetoclax bereits heute unverzichtbarer Bestandteil der Therapie, berichtete der Kölner Hämatoonkologe Prof. Michael Hallek bei einer vom Kompetenznetz Maligne Lymphome veranstalteten Sitzung über “Neue Therapiekonzepte” im Rahmen des diesjährigen Internistenkongresses (DGIM). Letztlich wecken die neuen und kommenden Substanzen die Hoffnung, in absehbarer Zeit eine maligne Grunderkrankung durch nicht zytotoxische Substanzen kontrollierbar zu machen. Davon dürfen sich betroffene Patienten ein besseres und längeres Überleben erhoffen.
Vitamin D könnte das Überleben verlängern
Authors: Braitmaier Helmine
Published: March 2018

Vitamin D ist unter anderem wichtig für den Knochenaufbau. Einige Studien deuten darauf hin, dass es auch vor Brustkrebs schützen oder den Erkrankungsverlauf positiv beeinflussen könnte. Andere Untersuchungen konnten diese Effekte nicht bestätigen. Neue Argumente für eine positive Wirkung von Vitamin D auf das überleben von Brustkrebspatientinnen kommen nun von einer Kohortenstudie aus Kalifornien.
Gehirnmetastasen bei der Erstdiagnose
Authors: Krome Susanne
Published: March 2018

Die aktuellen Leitlinien sehen für das primäre Staging keine Bildgebung des Gehirns vor. Deshalb fehlen Daten zur Inzidenz zerebraler Metastasen bei neu entdeckten Mammakarzinomen. Die populationsbasierte Studie liefert jetzt Informationen zur Häufigkeit einer initialen Gehirnbeteiligung, zu assoziierten Tumorcharakteristika und zum Einfluss auf die Prognose.
Forschungs-Highlights von häufigen und seltenen Lungentumoren
Authors: Arnheim Katharina
Published: March 2018

Mit der wissenschaftlichen Sektion „Pneumologische Onkologie” hat die Krebsmedizin auch in der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) heute einen hohen Stellenwert. Auf dem 58. DGP-Kongress in Stuttgart wurden in Poster- und Vortragssitzungen neue onkologische Studiendaten aus der Forschung in Deutschland vorgetragen.
Biogas supported bi-level macro energy hub management system for residential customers
Authors: Raza Aamir , Malik Tahir Nadeem
Published: March 2018

In energy distribution systems, micro hubs are concerned about cost, whereas utilities or macro energy hubs (MEHs) are sensitive to network load deviations. This paper investigates the nature of the customer-utility relationship using a two-step methodology. In the first step, a two-tier centralized MEH model is proposed for residential customers. In the second step, a mathematical model describing the nature of the cost-deviation relation is developed using the bi-variate regression analysis technique. The MEH model is solved using particle swarm optimization (PSO) and flower pollination algorithm (FPA) in MATLAB and proved that FPA is superior to both PSO and mixed integer linear programming. The analysis of the results shows that the cost-deviation relationship is complex, non-linear, and random in nature. Due to cost-deviation non-linearity, the deviation inflates while minimizing cost at the building level. Therefore, deviation minimization is necessary to ensure network stability. At the network level, when the deviation minimizes, the cost rises, proving that both stakes cannot be addressed simultaneously. To avoid this conflict, a community level biogas plant is introduced, which replaces natural gas during peak and mid-peak hours to bring the cost down. A reduction in cost establishes a fact that the presence of renewables is essential to simultaneously address the bipartite interest. The problem was later extended to 200 homes for a duration of 6 months. The results show large cost, emission and deviation reduction, as well as significant revenue generation, demonstrating that the proposed model could be adopted by distribution utilities for the optimal scheduling of appliances and the dispatch of energy sources.
Influence of pre-existing damages on the degradation behavior of crystalline silicon photovoltaic modules
Authors: Camus Christian , Adegbenro Ayodeji , Ermer Jakob , Suryaprakash Vignesh , Hauch Jens , Brabec Christoph J.
Published: March 2018

In this paper, the influence of pre-existing crystalline damage, such as cracked or broken cells or soldering failures, as they are frequently observed in operating photovoltaic (PV) plants, on the degradation behavior of mono- and polycrystalline silicon PV modules is investigated. In particular, it is analyzed if and to what extent pre-damage introduced prior to lamination propagates upon stress exposure. Therefore, the pre-damaged modules are exposed to various accelerated aging conditions in order to analyze the impact of the pre-damage on the degradation behavior under the respective aging scenario. In order to separate the influence of the pre-damage from composition-induced influences, the choice of materials used in the modules is varied. These investigations reveal that none of the accelerated aging tests causes any change in the pre-existing damage. In fact, the degradation behavior and rate rather depended on the choice of the module components than on the nature of the pre-damage. Finally, these results are compared with indoor and outdoor results obtained from other studies.
Facile bottom-up synthesis of partially oxidized black phosphorus nanosheets as metal-free photocatalyst for hydrogen evolution
Authors: Tian Bin , Tian Bining , Smith Bethany , Scott M. C. , Lei Qin , Hua Ruinian , Tian Yue , Liu Yi
Published: March 2018

Significance

Black phosphorus (BP) nanosheet is a “hot” class of 2D material having wide applications in optoelectronics, catalysis, biomedicine, etc. However, facile synthesis of BP nanosheets is not achieved by far. Currently, BP nanosheets are mainly prepared via solution-based exfoliation of bulk crystals, a process that is complicated, time-consuming, and costly. Moreover, the as-prepared BP nanosheets are not stable. Here, we developed a facile bottom-up protocol for preparing BP nanosheets in solution at low temperature. Our synthetic procedure is conceptually simple and can be performed in common chemical laboratories. The estimated synthesis cost is less than 1 US dollar per gram. Our work, therefore, offers the community an unlimited access to such 2D material.
Middle Powers' Crucial Peace Dividend: Networking Development
Authors: Hetou Ghaidaa
Published: March 2018

This research provides insights into regional middle powers’ postures and constraints, showing evidence of a gradually structured peace dividend resulting from networking economic development in the Middle East and North Africa (MENA). Using three case studies, Turkey/Israel, Iran/Pakistan, and Turkey/Iran, this research demonstrates that external regional constraints and internal capacity needs have facilitated strategic economic relations, including joint electricity, gas, and water projects, joint infrastructure and technology initiatives, and joint R&D and military industries. In turn, this strategic networking of economic development projects has restricted these states’ reactions to tension and conflict, prompting them to negotiate and engage in diplomacy to resolve bilateral disagreements so as to not compromise their mutual economic interests. This research contends that the security dilemma faced by middle power states in MENA is a motivator for economic integration even when there is no clearly expressed desire for peace. Economic integration increases their bargaining leverage with the West, while simultaneously resulting in bilateral conflict reduction behaviour patterns. This research further discusses the implications of categorising regional middle power states as regional stability facilitators, since economic integration can satisfy their security concerns, maintain their middle power statuses, and restrain the possibility of war.
The Role of Higher Education Institutions in Building a Culture of Peace: An Albanian Case
Authors: Shehi Reina Zenelaj , Ozcan Salih , Hagen Timothy
Published: March 2018

This study explores the status of peace education and its correlation to student perceptions of peace in social science curricula in Albanian universities. The study finds that social science programmes in Albania offer varying coverage of peace education topics. Using quantitative surveys of 460 social science university students, the study finds evidence for a positive understanding of peace. Employing a Pearson's correlation analysis, the study finds a lack of support for the hypothesis that the prevalence of peace topics in the curricula to which students are exposed significantly explains students’ perceptions of peace. The implications of the study are that Albanian curricula and students affirm a positive understanding of peace, yet more research is needed to understand what factors impact student perceptions of peace and how they may be leveraged to further peace education and overall peace dividends in Albania and beyond.
Inventory control of raw material using silver meal heuristic method in PR. Trubus Alami Malang
Authors: Ikasari D M , Lestari E R , Prastya E
Published: March 2018

The purpose of this study was to compare the total inventory cost calculated using the method applied by PR. Trubus Alami and Silver Meal Heuristic (SMH) method. The study was started by forecasting the cigarette demand from July 2016 to June 2017 (48 weeks) using additive decomposition forecasting method. The additive decomposition was used because it has the lowest value of Mean Abosolute Deviation (MAD) and Mean Squared Deviation (MSD) compared to other methods such as multiplicative decomposition, moving average, single exponential smoothing, and double exponential smoothing. The forcasting results was then converted as a raw material needs and further calculated using SMH method to obtain inventory cost. As expected, the result shows that the order frequency of using SMH methods was smaller than that of using the method applied by Trubus Alami. This affected the total inventory cost. The result suggests that using SMH method gave a 29.41% lower inventory cost, giving the cost different of IDR 21,290,622. The findings, is therefore, indicated that the PR. Trubus Alami should apply the SMH method if the company wants to reduce the total inventory cost.
Characteristic of physical, chemical, and microbiological kombucha from various varieties of apples
Authors: Zubaidah E , Yurista S , Rahmadani N R
Published: March 2018

Kombucha is a fermented tea beverage with the addition of kombucha starter also called SCOBY (Symbiotic Culture Of Bacteria and Yeast). The purpose of this research was to know the physical, chemical and microbiological characteristics of kombucha from various varieties of apple kombucha. The study used Randomized Block Design (RAK) with one factor of apple varieties (Anna, Fuji, Granny Smith, Manalagi, Red Delicious, Rome Beauty, Royal Gala). Each treatment was repeated three times. Data was analyzed with ANOVA (Analysis of Variance). The best treatment was selected using Multiple Attribute method. Data of hedonic test was analysed using Friedman Test. The best treatment was obtained on Fuji varieties of kombucha apple with the characteristics as follows: total acid 1.33%; pH 2.95; Total phenol 268.57 μg/ml GAE; Total sugar 6.74%; Antibacterial activity against S.aureus 21.30 mm; Antibacterial activity E.coli 21.20 mm; Antioxidant activity 35.62%; Organoleptic aroma 3.55, taste 3.3; Color 3.4 (on a scale of 1-5)
Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system
Authors: Whalen Kimberly , Lynch Emily , Moawad Iman , John Tanya , Lozowski Denise , Cummings Brian M
Published: March 2018

Objective

While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic.

Methods

Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme.

Results

After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards.

Conclusions

Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.
Scarring At Donor Sites After Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial
Authors: Karlsson Matilda , Elmasry Moustafa , Steinvall Ingrid , Sjöberg Folke , Olofsson Pia , Thorfinn Johan
Published: March 2018

OBJECTIVE:

The aim of this study was to evaluate scarring at split-thickness skin graft donor sites 8 years after surgery.

METHODS:

At surgery, 67 patients were randomized to hydrofiber, polyurethane foam, or porcine xenograft treatment. Scars were evaluated with the Patient and Observer Scar Assessment Scale.

RESULTS:

Results showed significant differences in observed scar outcomes at donor sites, leaving the polyurethane foam–treated and the porcine xenograft–treated patients with the least satisfying scars. Multivariable regression analysis showed that the group treated with the xenografts had worse scores for overall opinion of the scar than did the other groups (P = .03), the most important factor being pigmentation. There was no correlation between duration of healing time and quality of the scar.

CONCLUSIONS:

There were significant differences among the groups, with the hydrofiber group being the most satisfied with the appearance of their scar.
Endotypes in allergic diseases
Authors: Agache Ioana , Rogozea Liliana
Published: March 2018

Purpose of review

The precision medicine concept is both appealing and challenging. We review here the recent findings in the endotype-driven approach for major allergic diseases.

Recent findings

Stratified medicine for different allergic diseases can identify patients who are more likely to benefit or experience an adverse reaction in response to a given therapy and anticipate their long-term outcome and vital risk. In addition, this approach potentially facilitates drug development and prevention strategies.

The endotype-driven approach in allergic diseases has tremendous potential, but there are notable barriers in reaching the new world of precision medicine. Multidimensional endotyping integrating visible properties with multiple biomarkers is recommended for both type 2 and nontype 2 allergic diseases to provide evidence that a certain pathway is the key driver for a given patient. Significant healthcare system changes are required to achieve the expected targets.
A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes
Authors: Lim Grace , Facco Francesca L. , Nathan Naveen , Waters Jonathan H. , Wong Cynthia A. , Eltzschig Holger K.
Published: March 2018

Obstetric anesthesia has evolved over the course of its history to encompass comprehensive aspects of maternal care, ranging from cesarean delivery anesthesia and labor analgesia to maternal resuscitation and patient safety. Anesthesiologists are concerned with maternal and neonatal outcomes, and with preventing and managing complications that may present during childbirth. The current review will focus on recent advances in obstetric anesthesia, including labor anesthesia and analgesia, cesarean delivery anesthesia and analgesia, the effects of maternal anesthesia on breastfeeding and fever, and maternal safety. The impact of these advances on maternal and neonatal outcomes is discussed. Past and future progress in this field will continue to have significant implications on the health of women and children.
Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast Reconstruction
Authors: Blum Craig A. , DellaCroce Frank J. , Sullivan Scott K. , Trahan Chris , Wise M. Whitten
Published: March 2018

Background:

When a single perforator flap does not provide adequate volume or projection for satisfactory breast reconstruction, the addition of an implant may be considered at the time of second-stage revisions. Dissection of an implant pocket beneath the flap may lead to the inadvertent injury of the flap pedicle as the tissue planes have been obscured by tissue ingrowth. The authors present a technique in which the boundaries of the implant pocket are predetermined at the time of flap reconstruction allowing an implant to be inserted at the second stage in ideal position with greater ease of dissection and minimal risk to the flap pedicle.

Methods:

Forty patients (80 bilateral perforator flap breast reconstructions) treated with the creation of central under flap pocket technique in anticipation of subsequent sub flap implant augmentation within an 18-month period were assessed retrospectively.

Results:

Sixty-eight patients with flaps (85%) went on to receive secondary augmentation with silicone implants. The average percentage increase in volume contributed by the implant was 41%. The undersurface of the acellular dermal matrix was readily identified, and its medial most extent safely determined, allowing the expeditious recreation of the predelineated central under-flap implant pocket. No flap pedicles were injured during the process, and the implants were placed in a favorable position providing maximum projection to the reconstruction. No subsequent development of fat necrosis was identified after augmentation.

Conclusion:

The creation of central under flap pocket technique allows for safe, effective, and expedient delayed implant augmentation of perforator flap breast reconstruction.
Optic Disc Features in Highly Myopic Eyes: The ZOC-BHVI High Myopia Cohort Study
Authors: Li Zhixi , Guo Xinxing , Xiao Ou , Lee Pei Ying , Liu Ran , Wang Decai , Sankaridurg Padmaja , He Mingguang
Published: March 2018

SIGNIFICANCE

Some studies reported that optic disc tilt and rotation might be risk factors for the susceptibility of high myopic eyes to develop glaucoma. However, data regarding optic disc manifestations in high myopia participants are few. It is crucial to characterize the features of optic disc manifestations among high myopes.

PURPOSE

To describe optic disc characteristics of Chinese highly myopic eyes and to investigate associated factors.

METHODS

This cross-sectional, observational study included 890 Chinese with bilateral high myopia (defined as ≤−6.00 diopters spherical power) in 2012. All subjects underwent cycloplegic autorefraction, ocular biometry, and fundus photography. The optic disc tilt ratio, degree of rotation, and β-zone peripapillary atrophy area were measured from the 45°optic disc-centered fundus photographs. Optic disc tilt was defined as optic disc tilt ratio, the ratio of maximum to minimum diameter of optic disc, exceeding 1.3. The definition of optic disc rotation was using optic disc rotation degree, the angle from long diameter and the vertical meridian, of >15°.

RESULTS

Among 890 participants, 2 were excluded by ungradable optic disc-centered fundus photographs. In the 888 studied right eyes, the mean spherical power was −9.36 ± 3.46 diopters with a mean axial length of 27.51 ± 1.63 mm. The proportion of optic disc tilting, rotation, and β-zone peripapillary atrophy were 81.2%, 48.3%, and 92.8%, respectively. The mean ratio of optic disc tilting and rotation degree was 1.78 ± 0.53 and 21.08 ± 19.91°; the mean area of β-zone peripapillary atrophy/optic disc head was 1.11 ± 1.22. A multiple linear regression showed that older age (P < .001), female (P = .02), and more myopic spherical equivalent (P = .005) were related to the greater optic disc tilting ratio.

CONCLUSIONS

Beta-zone peripapillary atrophy, optic disc tilting, and rotation are very common in highly myopic eyes in Chinese population. Older age, female, and more myopic spherical equivalent are risk factors of higher degree of optic disc tilting.
A Degenerative Form of Mixed Transcortical Aphasia
Authors: Saadatpour Leila , Tariq Usama , Parker Alicia , Doty Leilani , Heilman Kenneth M.
Published: March 2018

Mixed transcortical aphasia (MTA) is characterized by decreased spontaneous speech, impaired naming, and poor comprehension, but with intact repetition. MTA has been reported to be the sequela of left hemisphere watershed infarction that isolates Wernicke’s perisylvian arc. We report a 55-year-old right-handed woman who began having word-finding difficulty and then gradually developed impaired spontaneous speech, comprehension, and naming, but with intact repetition. Magnetic resonance imaging showed atrophy in the left frontal, parietal, and temporal lobes. This patient demonstrates that MTA can occur as a result of neurodegenerative disease. Further research is needed to learn whether progressive MTA is a late stage of primary progressive aphasia, examine the neuropathology associated with this syndrome, and identify treatment strategies.
Congenital Achiasma
Authors: Lecler Augustin , Attye Arnaud , Edelson Catherine
Published: March 2018

In evaluating a 3-month-old boy with horizontal nystagmus, brain MRI revealed absence of the optic chiasm. The remainder of the brain was normal in appearance. Achiasma was confirmed with diffusion tensor imaging and best visualized with optimized probabilistic-based tractography.
Quantifying the dilution effect for models in ecological epidemiology
Authors: Roberts M. G. , Heesterbeek J. A. P.
Published: March 2018

The
dilution effect
, where an increase in biodiversity results in a reduction in the prevalence of an infectious disease, has been the subject of speculation and controversy. Conversely, an
amplification effect
occurs when increased biodiversity is related to an increase in prevalence. We explore the conditions under which these effects arise, using multi species compartmental models that integrate ecological and epidemiological interactions. We introduce three potential metrics for quantifying dilution and amplification, one based on infection prevalence in a focal host species, one based on the size of the infected subpopulation of that species and one based on the basic reproduction number. We introduce our approach in the simplest epidemiological setting with two species, and show that the existence and strength of a dilution effect is influenced strongly by the choices made to describe the system and the metric used to gauge the effect. We show that our method can be generalized to any number of species and to more complicated ecological and epidemiological dynamics. Our method allows a rigorous analysis of ecological systems where dilution effects have been postulated, and contributes to future progress in understanding the phenomenon of dilution in the context of infectious disease dynamics and infection risk.
Conflict and convention in dynamic networks
Authors: Foley Michael , Forber Patrick , Smead Rory , Riedl Christoph
Published: March 2018

An important way to resolve games of conflict (snowdrift, hawk–dove, chicken) involves adopting a convention: a correlated equilibrium that avoids any conflict between aggressive strategies. Dynamic networks allow individuals to resolve conflict via their network connections rather than changing their strategy. Exploring how behavioural strategies coevolve with social networks reveals new dynamics that can help explain the origins and robustness of conventions. Here, we model the emergence of conventions as correlated equilibria in dynamic networks. Our results show that networks have the tendency to break the symmetry between the two conventional solutions in a strongly biased way. Rather than the correlated equilibrium associated with ownership norms (play aggressive at home, not away), we usually see the opposite host–guest norm (play aggressive away, not at home) evolve on dynamic networks, a phenomenon common to human interaction. We also show that learning to avoid conflict can produce realistic network structures in a way different than preferential attachment models.
Clonal interference can cause wavelet-like oscillations of multilocus linkage disequilibrium
Authors: Garcia Victor , Glassberg Emily C. , Harpak Arbel , Feldman Marcus W.
Published: March 2018

Within-host adaptation of pathogens such as human immunodeficiency virus (HIV) often occurs at more than two loci. Multiple beneficial mutations may arise simultaneously on different genetic backgrounds and interfere, affecting each other's fixation trajectories. Here, we explore how these evolutionary dynamics are mirrored in multilocus linkage disequilibrium (MLD), a measure of multi-way associations between alleles. In the parameter regime corresponding to HIV, we show that deterministic early infection models induce MLD to oscillate over time in a wavelet-like fashion. We find that the frequency of these oscillations is proportional to the rate of adaptation. This signature is robust to drift, but can be eroded by high variation in fitness effects of beneficial mutations. Our findings suggest that MLD oscillations could be used as a signature of interference among multiple equally advantageous mutations and may aid the interpretation of MLD in data.
Regional protein expression in human Alzheimer’s brain correlates with disease severity
Authors: Xu Jingshu , Patassini Stefano , Rustogi Nitin , Riba-Garcia Isabel , Hale Benjamin D. , Phillips Alexander M , Waldvogel Henry , Haines Robert , Bradbury Phil , Stevens Adam , Faull Richard L. M. , Dowsey Andrew W. , Cooper Garth J. S. , Unwin Richard D.
Published: March 2018

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that currently affects 36 million people worldwide with no effective treatment available. Development of AD follows a distinctive pattern in the brain and is poorly modelled in animals. Therefore, it is vital to widen both the spatial scope of the study of AD and prioritise the study of human brains. Here we show that functionally distinct human brain regions show varying and region-specific changes in protein expression. These changes provide novel insights into the progression of disease, novel AD-related pathways, the presence of a ‘gradient’ of protein expression change from less to more affected regions, and the presence of a ‘protective’ protein expression profile in the cerebellum. This spatial proteomics analysis provides a framework which can underpin current research and opens new avenues of interest to enhance our understanding of molecular pathophysiology of AD, provides new targets for intervention and broadens the conceptual frameworks for future AD research.
Differential encoding of predator fear in the ventromedial hypothalamus and periaqueductal grey
Authors: Masferrer Maria Esteban , Silva Bianca A. , Nomoto Kensaku , Lima Susana Q. , Gross Cornelius T.
Published: March 2018

The ventromedial hypothalamus is a central node of the mammalian predator defense network. Stimulation of this structure in rodents and primates elicits abrupt defensive responses, including flight, freezing, sympathetic activation, and panic, while inhibition reduces defensive responses to predators. The major efferent target of the ventromedial hypothalamus is the dorsal periaqueductal grey, and stimulation of this structure also elicits flight, freezing, and sympathetic activation. However, reversible inhibition experiments suggest that the ventromedial hypothalamus and periaqueductal grey play distinct roles in the control of defensive behavior, with the former proposed to encode an internal state necessary for the motivation of defensive responses, while the latter serves as a motor pattern initiator. Here we used electrophysiological recordings of single units in behaving mice exposed to a rat to investigate the encoding of predator fear in the dorsomedial division of the ventromedial hypothalamus and the dorsal periaqueductal grey. Distinct correlates of threat intensity and motor responses were found in both structures, suggesting a distributed encoding of sensory and motor features in the medial hypothalamic-brainstem instinctive network.