bluuebunny/crossref_metadata_2025 huggingface dataset:
Grouping the districts in Indonesia based on value of science subjects of National Exam using K-Means clustering method
Authors: Ferdhiana R , FAbidin T , Mardhiah A
Published: July 2019

Implementation of the National Examination (NE) for senior high schools for each district in Indonesia is done as one way to mapping the success of education in each the district. Mapping can be done by grouping districts based on attribute values obtained on the implementation of the NE, which in this study using the K-means clustering method. The attribute of NE values used are the values for the science majors, which consist of 6 subjects, where from 514 districts only 510 districts own it. The purpose of the study in addition to grouping districts, will also predict the group of 4 districts that have no NE values. Prediction is done by entering the value of the district Human Development Index (HDI) that has no UN value into 95% confidence interval of HDI from groups formed from k-means clustering. Once known where the district is in a group based on the HDI group then the value of its UN will follow the confidence interval of the UN value of the group. The results of this study indicate that the number of clusters (k) selected to classify districts in Indonesia as many as 5 clusters. Group prediction results show that one district belongs to the V cluster, while the other three districts are predicted to be members of the I cluster.
The potential of five therapeutic medicinal herbs for dental treatment : A review
Authors: Ningsih D S , Idroes R , Bachtiar B M , Khairan
Published: July 2019

Indonesia, especially in Aceh Province, has a huge biodiversity of natural resources in herbal medicine. Calotrophis gigantea (L), Acrostichum aureum (L), Plucheaindica (L), Cissus adnata and Abutilon indicum (L) are considered to have secondary metabolite that are potential for dental therapeutic treatments because the compounds have anti-inflammatory, antibacterial, antifungal, antioxidant, antiseptic and wound healing ability. The utilization of medicinal herbs in dentistry is still limited, thus in this study we provide valuable information of each five medicinal herbs for dental therapeutic treatments. The results indicated that all the five medicinal herbs have different abilities and potentials in treating diseases / abnormalities in the oral cavity. The selection and the use of appropriate medicinal herbs can give an effective therapeutic treatment to improve the health of oral cavity. The qualities of the five herbs are directly proportional to their ability as an alternative therapeutics in dentistry. To produce a good herbal medicines in dentistry, a lot of supporting researches are needed.
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Geochemistry of warm springs in the Ie Brôuk hydrothermal areas at Aceh Besar district
Authors: Idroes R , Yusuf M , Alatas M , Subhan  , Lala A , Muslem  , Suhendra R , Idroes G M , Suhendrayatna  , Marwan  , Riza M
Published: July 2019

Indonesia is a country with the largest geothermal potential resource in the world, estimated of 28,617 MW or equivalent to 40% of the world’s geothermal potential. Geothermal energy is environmentally friendly and quite economical compared to fossil energy. Seulawah Agam is one of Indonesia’s geothermal fields that has several manifestation zones, including Ie Brôuk (BH1 and BH2) manifestations. The analysis for this study was conducted by acid-base titration, UV-Vis Spectrophotometry and Atomic Absorption Spectroscopy (AAS). The data analysis of cations and anions were plotted in liquid chemistry worksheet plotting spreadsheet version 3 Powell geoscience September 2012 by Powell and Cumming. The type of manifestation fluid is bicarbonate, obtained from the geoindicator Cl-SO4-HCO3, while the water condition is immature based on Na-K-Mg ternary diagram. The Ie Brôuk reservoir temperature was 289 °C and 291 °C obtained from Na/K geothermometer Tonani (1980) and Na/K Giggenbach (1988) respectively. Therefore, the Ie Brôuk manifestation classified as a high-temperature geothermal system.
Antibacterial cream formulation of ethanolic Pliek U extracts and ethanolic residue hexane Pliek U extracts against Staphylococcus aureus
Authors: Rahmad R. , Earlia N , Nabila C , Inayati I , Amin M , Prakoeswa C R S , Khairan K , Idroes R
Published: July 2019

Indonesia as the largest archipelago country in the world is also known as a country with plenty of natural resources that can be used as traditional medicinal plants. Pliek U is a fermented crude coconut meat has been used as an ingredient in Aceh traditional food and also used as a traditional topical medicine in Aceh. Pliek U is potential as a source of free fatty acids (FFAs) such as lauric acid and monolauric acid which have antimicrobial properties. The aim of this study is to determine the activity ethanolic Pliek U extracts (EPUE) and ethanolic of residue hexane of Pliek U extracts (ERHPUE) and also the activities of their cream formulation against Staphylococcus aureus The antibacterial activity was determined by disc difussion method with clindamycin as a positive control. The antibacterial activity results showed that EPUE has antibacterial activity against Staphylococcus aureus with diameter inhibition zone of 8.66±0.57 mm, while ERHPUE and their cream have no activity against Staphylococcus aureus.
Isolation and identification of Endophytic Fungus Fusarium sp from Agarwood (Aquilaria sp) population originated from the forest of Aceh Tamiang district, Indonesia
Authors: Zulfendi  , Idroes Rinaldi , Khairan
Published: July 2019

Aquilaria sp is one of higher plant types that can produce agarwood. Agarwood is commonly stimulated by the biological response of endophytic fungal infection of Fusarium sp. This research aims to isolate and identify endophytic fungus Fusarium sp from Aquilaria sp populations originated from the forest of Aceh Tamiang District. The pure isolates of Fusarium sp derived from Aquilaria sp that reinfected on Aquilaria sp populations to stimulate agarwood formation. The endophytic fungal isolates of Fusarium sp were growth on a selective media of Sabouraud Dextrose Agar (SDA) containing antibiotics Streptomycin 10 µg/dl and Chloramphenicol 25µg/dl. Ten percent of infected Aquilaria sp from the population was taken aseptically. Isolation and identification of endophytic fungus Fusarium sp were conducted from June to August 2016. The results showed that within 10 infected Aquilaria sp, several microbe species were found such as three Fusarium sp, six Aspergillus sp, two Rhizopus sp, two Penicillium sp, one Bacillus sp, one Actinomyces sp and one Streptomyces sp species. The result of identification towards three species of endophytic fungus Fusarium sp that has been purified were srongly suspected to be Fusarium solani, Fusarium oxysporum, and Fusarium monyliformae.
The study on composites formation from HDPE and sawdust/rice husk as raw materials
Authors: Mulana F , Mariana M , Hadman M N , Hanipah S H
Published: July 2019

In this study, composites were prepared using compression molding method from cheap raw materials of high-density polyethylene (HDPE) as matrix and mixture of rice husk and sawdust as filler. The small amount of coupling agent was added during preparation of composites and for comparison composite without addition of coupling agent was also prepared. The coupling agent used in this study was maleic anhydride (MA). The aim of this study is to form composites with and without addition of coupling agent and to know the effect of coupling agent addition and different ratio of matrix and filler toward mechanical properties of produced composites. Composites that contained different ratio of matrix and filler were pressed and heated at temperature of 170°C. The composites were tested its mechanical properties (bending strength and tensile strength) and water absorption capacity. The results indicated that the bending strength of the composite increased with addition of 4 wt% of maleic anhydride and with increased the percentage of filler until 50%. As for the tensile strength, the addition of 4 wt% of maleic anhydride as coupling agent increased the tensile strength significantly. The highest bending strength value of 12.8 MPa was obtained from composite prepared from raw materials contained same amount of matrix and filler and addition of 4 wt% of maleic anhydride. While the highest tensile strength value of 6.1 MPa was obtained from composite prepared from raw materials contained ratio percentage of matrix and filler (40:60 of wt%) and addition of 4 wt% of maleic anhydride.
Characterization of adsorbent derived from Coconut Husk and Silica (SiO2)
Authors: Mariana M , Mulana F , Sofyana S , Dian N P , Lubis M R
Published: July 2019

Activated carbon is one of the most commonly used adsorbents because of its high adsorption effectiveness. However, an adsorbent with one type of activated carbon causes a lacking of adsorption efficiency. Therefore, in this study we prepared activated carbon from two types of raw materials. The type of raw material is a combination of coconut husk and silica with several products of activated carbon that contained coconut husk and silica with mass ratio of 70:30, coconut husk with and without activation and pure silica (SiO2). In this study, raw materials were physically heated at 800 °C for 2 hours and chemically activated with H2SO4 solution for 2 hours. FTIR analysis identified a chemical group of Si-O in adsorbent at 898,83 – 1442,74 cm-1. XRD analysis showed that the prepared activated carbon of combination coconut husk:silica; coconut husk with activation; coconut husk without activation and pure silica had silica (SiO2) composition of 83%; 75%; 62.4% and 63.2%, respectively. The water content in activated carbon of combination coconut:silica; coconut husk with activation; coconut husk without activation and pure silica (SiO2) was 4.41%; 3.87%; 3.21% and 2.71%, respectively and the ash content was 3.9%, 2.04%; 1.86% and 0.32% respectively. Both water content and ash content met Indonesian National Standard (SNI) No. 06-3730-1995 with the maximum of ash and water content was 10% and 15%.
Risk impact on cost and time from the factors of contractor’s managerial and operational
Authors: Husin S , Abdullah  , Riza M , Afifuddin M
Published: July 2019

Aceh Province over the last 20 years has experienced different events that can be divided into 3 (three) phases. 1st Phase is the phase of the conflict (2000-2004), 2nd Phase is the post-earthquake and tsunami rehabilitation and reconstruction phase of Aceh (2005-2009), and 3rd Phase is the post-rehabilitation and reconstruction phase (2010-present). Events that occurred during the last 20 years are certainly likely to provide risks to community activities in the province of Aceh. One of the activities affected by the event is the construction project work. The implementation of construction works affected by events in Aceh Province over the last 20 years is highly vulnerable to risks that impact on achieving project objectives such as cost and time. This study analyzes the impact of the contractor and operational managerial risk factors on the cost and timing of construction. Data were obtained from questionnaires distributed to 15 large qualification companies in Aceh Province. Testing data is done by using the validity test and reliability test. Data that has been valid and reliable then analyzed by using Severity Index (SI). The variables of a managerial risk factor with SI to the highest cost in 1st Phase are F5 (incompetent Engineer), 2nd Phase is F3 (lack of contractor experience), and 3rd Phase is F5 (incompetent Engineer). From the operational risk factor, the highest cost SI in each phase is the G3 variable (electrical disorder). The managerial risk factors with the highest time SI in 1st Phase are F6 (lack of top management support), 2nd Phase is F5 (incompetent engineer), and in 3rd Phase is F3 (lack of contractor experience ). From the operational risk factor, the highest time SI at each phase is G3 (electrical disorder).
Childhood activities adults utilizing for the Intervention Reminiscence-Based Screening
Authors: Tallutondok E B
Published: July 2019

Ageing people is a vulnerable population, so it is a global public health concern among nations. Indonesia has tendency to be an ageing structure population on the future. At one public home care in Jakarta, there was an extremely data about decreasing number of healthy older adults in three consecutive years since 2016. Behind in this problem, the reminiscence screening about childhood activities has done in one public home care. It was utilizing by the basic principle of Intervention Reminiscence – Based Screening. the qualitative study with a mix-method design was used in this study via verbal, then data transformed for four stages namely decontextualization, recontextualization, categorization, and compilation. Data have written text and transform for content analysed by surface structure to identify meaning units follow by coding, categorize, and themes. Participants 22 with inclusion criteria such as healthy, over 60-year-old, pass on sensory and cognitive screening. There were found three themes of childhood activities, namely: physical activity, mental activation, and interactive communication relationship. Although the participants were very excited during survey, there was found one participant who has none idea. Therefore, it is a good idea to develop a media for optimizing cognitive function of elderly in Indonesia.
Living together: The phenomenon of house occupancy in Indonesia with particular reference to Balikpapan East Kalimantan
Authors: Hakim W I , Harjoko T Y
Published: July 2019

This study explores housing problem concerning the most widely perceived idea of housing needs that heavily influenced by the technical and macro-scale level as well as the units’ tenure and occupancy which is mainly perceived as owning and renting. On the other hand, the housing cannot be seen as such due to the existence of different context of the problem and the various aspirations of occupants. This research highlights the other kind of occupancy phenomenon among Indonesian who can get access to and live in a housing unit without owning or renting – by living and staying with their relatives. In particular reference to Balikpapan East Kalimantan, this study concerns the modus of this specific kind of house occupancy and aims to reveal the housing processes as well as aspirations of the house occupants who live and stay together.
Housing preferences and strategies of Javanese migrants in Jakarta
Authors: Theresia C , Gabe R T , Adianto J
Published: July 2019

As the center of development growth, Jakarta has been flooded with massive migration from all over the country, especially Java. With the limited skill to compete in the formal economy sector and soaring house price, living in limited size house becomes the plausible solution for the Javanese migrants. This reality bite serves a severe mismatch between the culture-based housing preferences and available rooms in the occupied house. In order to minimize the mismatch, the migrants deliver various meticulous strategies by utilizing the available resources. This paper examines the housing preferences of Javanese migrants in Jakarta and their strategy to minimize the mismatch between the housing preferences and the occupied houses. Qualitative method and means-end chain analysis are conducted to reveal the housing preferences based on Javanese culture, the delivered strategies, and their connections. The respondent selection encompasses low-cost apartment and high-density slum settlements to represent the common housing type of low-skilled migrants in Jakarta. The result demonstrates that the anchored spirit of togetherness in housing preferences takes form in their unique strategies beyond physical boundaries and materiality.
Shifting from place to non-place: A case study on the central market of Banda Aceh
Authors: Qismullah F I
Published: July 2019

The transformation of Banda Aceh, Indonesia, through the phases of political war and tsunami disaster leads to the alteration of the central urban areas. The impact of the temporary agglomeration is on the functions of public spaces. There has been a paradigmatic shift of culture transformation in this city from a place of local tradition to a multicultural environment opened to change. The complexity of this transformation was especially influential to its central market. By using the two-sided theories and framework of Jacobs and Alexander, and Auge and Koolhas, this study analyses the historical evolution and perspectives of the central market for urban space. Data collection was from field observations and interviews with the vendors and customers in the market. The results imply that without disregarding the importance of heritage and history, stakeholders that have the power to change the central market must be realistic and adjust the condition according to the current people’s needs as users of this place. Nevertheless, despite some of the vendors’ rejections towards the development of modern markets in the city, this realism of modern markets has been able to solve the problem of other cities by the concept of one-stop shopping for time efficiency and goods availability.
‘Lanting’ as a way of life: A legacy of riverine culture and architecture in the present urban life of Sintang City, West Kalimantan
Authors: Lubis M S , Harjoko T Y , Susanto D
Published: July 2019

The vast island of Borneo, in the heart of Southeast Asia, is an island famous for its large and powerful rivers. Along with their tributaries and numerous smaller rivers, they represent a key factor in communication and transportation. Sintang is one of the riverfront cities located in the middle stream of Kapuas river in West Kalimantan. In the midst of a rapid urbanization process,’lanting’or floating houses, the legacy of culture and architecture of past Sintang, are still present and needed by the community. This paper discussed the way of life of lanting community in the midst of vast urbanization of the city. Through the grounded-theory method, this study found that lanting has a significant role as a linkage between the rural and urban community. We elaborated the concept of linkage and depicted the transition process of rural-urban society and the role of river community in the urbanization process of Sintang city.
Numerical analysis of the stress leading to fatigue failure on a coil spring of the front suspension of a car
Authors: Putra T E , Husaini  , Ali N , Hasanuddin I , Hendrayana  , Bakhtiar A
Published: July 2019

This study discussed the failure of the coil spring of a vehicle using a numerical method. The component was fabricated using ASTM A227. The coil spring was analyzed under three types of conditions, namely, flawless, defect of 0.2 mm, and defect of 3.5 mm. The simulation results show that the maximum shear stress of 745.8 MPa occurs on the spring with a defect of 3.5 mm. This value is close to the allowed shear stress, which is 799 MPa, but exceeded the yield strength of 731 MPa. This results in plastic deformation and contributes to failure due to fatigue.
Generalization of learned preferences covaries with behavioral flexibility in red junglefowl chicks
Authors: Zidar Josefina , Balogh Alexandra C V , Leimar Olof , Løvlie Hanne
Published: July 2019

The relationship between animal cognition and consistent among-individual behavioral differences (i.e., behavioral types, animal personality, or coping styles), has recently received increased research attention. Focus has mainly been on linking different behavioral types to performance in learning tasks. It has been suggested that behavioral differences could influence also how individuals use previously learnt information to generalize about new stimuli with similar properties. Nonetheless, this has rarely been empirically tested. Here, we therefore explore the possibility that individual variation in generalization is related to variation in behavioral types in red junglefowl chicks (Gallus gallus). We show that more behaviorally flexible chicks have a stronger preference for a novel stimulus that is intermediate between 2 learnt positive stimuli compared to more inflexible chicks. Thus, more flexible and inflexible chicks differ in how they generalize. Further, behavioral flexibility correlates with fearfulness, suggesting a coping style, supporting that variation in generalization is related to variation in behavioral types. How individuals generalize affects decision making and responses to novel situations or objects, and can thus have a broad influence on the life of an individual. Our results add to the growing body of evidence linking cognition to consistent behavioral differences.
The Critical Role of Codon Composition on the Translation Efficiency Robustness of the Hepatitis A Virus Capsid
Authors: D’Andrea Lucía , Pérez-Rodríguez Francisco-Javier , de Castellarnau Montserrat , Guix Susana , Ribes Enric , Quer Josep , Gregori Josep , Bosch Albert , Pintó Rosa M
Published: July 2019

Hepatoviruses show an intriguing deviated codon usage, suggesting an evolutionary signature. Abundant and rare codons in the cellular genome are scarce in the human hepatitis A virus (HAV) genome, while intermediately abundant host codons are abundant in the virus. Genotype–phenotype maps, or fitness landscapes, are a means of representing a genotype position in sequence space and uncovering how genotype relates to phenotype and fitness. Using genotype–phenotype maps of the translation efficiency, we have shown the critical role of the HAV capsid codon composition in regulating translation and determining its robustness. Adaptation to an environmental perturbation such as the artificial induction of cellular shutoff—not naturally occurring in HAV infection—involved movements in the sequence space and dramatic changes of the translation efficiency. Capsid rare codons, including abundant and rare codons of the cellular genome, slowed down the translation efficiency in conditions of no cellular shutoff. In contrast, rare capsid codons that are abundant in the cellular genome were efficiently translated in conditions of shutoff. Capsid regions very rich in slowly translated codons adapt to shutoff through sequence space movements from positions with highly robust translation to others with diminished translation robustness. These movements paralleled decreases of the capsid physical and biological robustness, and resulted in the diversification of capsid phenotypes. The deviated codon usage of extant hepatoviruses compared with that of their hosts may suggest the occurrence of a virus ancestor with an optimized codon usage with respect to an unknown ancient host.
Interaction Between Vitamin D and Interleukin 6 on Slow Gait Speed: 6-Year Follow-up Data of Older Adults From InCHIANTI
Authors: Kositsawat Jatupol , Kuo Chia-Ling , Barry Lisa C , Melzer David , Bandinelli Stefania , Ferrucci Luigi , Wu Rong , Kuchel George A
Published: July 2019

Background

Whereas the independent effects of biomarkers, including 25-hydroxy vitamin D (25(OH)D), insulin-like growth factor 1, C-reactive protein, and interleukin 6 (IL-6), on gait speed in older adults have been evaluated, their joint effects on gait speed are not well understood.

Methods

Study subjects aged at least 65 at baseline (N = 970) were enrolled in the population-based Invecchiare in Chianti (InCHIANTI) study from 1998 to 2000 and were followed up at 3 and 6 years. All above biomarkers and gait speed data were measured at each of the three time points. Using a generalized estimating equation approach, we determined if slow gait speed (<0.8 m/s) was associated with the biomarkers. Further investigation was conducted for interactions between high IL-6 (≥.87 pg/mL) and other biomarkers focusing on low 25(OH)D (<20 ng/mL).

Results

After controlling for other biomarkers and potential confounders, IL-6 emerged as the only biomarker independently associated with gait speed. The association between high IL-6 and slow gait speed was enhanced by low 25(OH)D, with significant interaction between high IL-6 and low 25(OH)D (p = .038). The odds ratio of slow gait speed for low 25(OH)D and high IL-6 was 1.63 (95% confidence interval [CI]: 1.15, 2.32) compared with the reference groups with both biomarker levels at the other ends.

Conclusion

The association of low vitamin D with slow gait speed statistically interacts with high IL-6. Coexisting vitamin D insufficiency and inflammation may provide a better biomarker for identifying those at risk of developing impairments in gait speed than either factor alone.
The Relationship Between Depression Symptoms and Anxiety Symptoms During Acute ECT for Patients With Major Depressive Disorder
Authors: Huang Chun-Jen , Lin Ching-Hua , Wu Jyh-I , Yang Wei-Cheng
Published: July 2019

Background

We investigated the efficacy of electroconvulsive therapy in patients with major depressive disorder and concomitant anxiety symptoms and explored the relationships between depression symptoms and anxiety symptoms during acute electroconvulsive therapy.

Methods

Major depressive disorder inpatients (N = 130) requiring electroconvulsive therapy were recruited for a maximum of 12 treatments each. Depression symptoms, using the core factor subscale derived from the 17-item Hamilton Depression Rating Scale, and anxiety symptoms, using the anxiety/somatization subscale from the Hamilton Depression Rating Scale-17, were assessed before electroconvulsive therapy, after every 3 electroconvulsive therapy treatments, and after the final electroconvulsive therapy. Both core factor subscale and anxiety/somatization subscale scores were converted to T-score units to compare the degrees of changes between depression symptoms and anxiety symptoms after electroconvulsive therapy. The relationships between core factor subscale and anxiety/somatization subscale were analyzed using the cross-lagged longitudinal model during acute electroconvulsive therapy.

Results

A total 116 patients who completed at least the first 3 electroconvulsive therapy treatments were included in the analysis. Reduction of core factor scale T-scores was significantly greater than that of anxiety/somatization subscale T-scores. The model satisfied all indices of goodness-of-fit (chi-square = 30.204, df = 24, P = 0.178, Tucker-Lewis Index = 0.976, Comparative Fit Index = 0.989, Root Mean Square Error of Approximation = 0.047). Core factor subscale changes did not definitely predict subsequent anxiety/somatization subscale changes.

Conclusions

Electroconvulsive therapy is effective in the acute treatment of major depressive disorder patients associated with anxiety symptoms. Anxiety symptoms improved less than depression symptoms during acute electroconvulsive therapy. However, earlier reduction in depression symptoms does not definitely drive subsequent relief in anxiety symptoms.
Intranasal Vaccination With Multiple Virulence Factors Promotes Mucosal Clearance of Streptococcus suis Across Serotypes and Protects Against Meningitis in Mice
Authors: Xing Xinxin , Bi Shuai , Fan Xin , Jin Meilin , Liu Wenjun , Wang Beinan
Published: July 2019

Background

Streptococcus suis is an emerging zoonotic agent. Its natural habitat is the tonsils, which are the main portals of S. suis entry into the bloodstream of pigs. The remarkable variability of the bacteria and complex pathogenic mechanisms make the development of a vaccine a difficult task.

Method

Five conserved virulence factors involved in critical events of S. suis pathogenesis were combined and used as an intranasal vaccine (V5). The effect of V5 was investigated with intranasal and systemic challenge models.

Results

V5 induced antibody and T-cell responses at the mucosal site and systemically. The immunity promoted clearance of S. suis from the nasopharynx independent of S. suis serotypes and reduced lethality after systemic challenge with S. suis serotype 2. Moreover, mice that survived sepsis from intravenous infection developed meningitis, whereas none of these mice showed neuropathological symptoms after V5 receipt.

Conclusion

Intranasal immunization with multiple conserved virulence factors decreases S. suis colonization at the nasopharynx across serotypes and inhibits the dissemination of the bacteria in the host. The protective mucosal immunity effects would potentially reduce the S. suis reservoir and prevent S. suis disease in pigs.
Meta-analysis of the effect of CYP2B6, CYP2A6, UGT2B7 and CAR polymorphisms on efavirenz plasma concentrations
Authors: Ayuso Pedro , Neary Megan , Chiong Justin , Owen Andrew
Published: July 2019

Background

Efavirenz primary metabolism is catalysed by CYP2B6 with minor involvement of CYP2A6. Subsequently, phase I metabolites are conjugated by UGT2B7, and constitutive androstane receptor (CAR) has been shown to transcriptionally regulate many relevant enzymes and transporters. Several polymorphisms occurring in the genes coding for these proteins have been shown to impact efavirenz pharmacokinetics in some but not all studies.

Objectives

A meta-analysis was performed to assess the overall effect of CYP2B6 rs3745274, CYP2A6 (rs28399454, rs8192726 and rs28399433), UGT2B7 (rs28365062 and rs7439366) and NR1I3 (rs2307424 and rs3003596) polymorphisms on mid-dose efavirenz plasma concentrations.

Methods

Following a literature review, pharmacokinetic parameters were compiled and a meta-analysis for these variants was performed using Review Manager and OpenMetaAnalyst. A total of 28 studies were included.

Results

Unsurprisingly, the analysis confirmed that individuals homozygous for the T allele for CYP2B6 rs3745274 had significantly higher efavirenz concentrations than those homozygous for the G allele [weighted standard mean difference (WSMD) = 2.98; 95% CI 2.19–3.76; P < 0.00001]. A subgroup analysis confirmed ethnic differences in frequency but with a similar effect size in each ethnic group (P = 0.96). Associations with CYP2A6 and UGT2B7 variants were not statistically significant, but T homozygosity for CAR rs2307424 was associated with significantly lower efavirenz concentrations than in C homozygotes (WSMD = −0.32; 95% CI −0.59 to −0.06; P = 0.02).

Conclusions

This meta-analysis provides the overall effect size for the impact of CYP2B6 rs3745274 and NR1I3 rs2307424 on efavirenz pharmacokinetics. The analysis also indicates that some previous associations were not significant when interrogated across studies.
The complementary nature of query-based and directed health information exchange in primary care practice
Authors: Vest Joshua R , Unruh Mark A , Casalino Lawrence P , Shapiro Jason S
Published: July 2019

Objective

Many policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations’ interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE.

Materials and Methods

System user log files from a regional HIE organization and electronic health record system were combined to model the usage of HIE associated with a patient visit at 3 federally qualified health centers in New York. Regression models tested the hypothesis that directed HIE usage was associated with query-based usage and adjusted for factors reflective of the FITT (Fit between Individuals, Task & Technology) framework. Follow-up interviews with 8 key informants helped interpret findings.

Results

Usage of query-based HIE occurred in 3.1% of encounters and directed HIE in 23.5%. Query-based usage was 0.6 percentage points higher when directed HIE provided imaging information, and 4.8 percentage points higher when directed HIE provided clinical documents. The probability of query-based HIE was lower for specialist visits, higher for postdischarge visits, and higher for encounters with nurse practitioners. Informants used query-based HIE after directed HIE to obtain additional information, support transitions of care, or in cases of abnormal results.

Discussion

The complementary nature of directed and query-based HIE indicates that both HIE functionalities should be incorporated into EHR Certification Criteria.

Conclusions

Quantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings.
Indirect Effects of a Cognitive-Behavioral Intervention on Adolescent Weight and Insulin Resistance Through Decreasing Depression in a Randomized Controlled Trial
Authors: Gulley Lauren D , Shomaker Lauren B , Kelly Nichole R , Chen Kong Y , Stice Eric , Olsen Cara H , Tanofsky-Kraff Marian , Yanovski Jack A
Published: July 2019

Objective

Depression is linked to excess weight, insulin resistance, and type 2 diabetes (T2D). We previously reported that in adolescent girls at-risk for T2D with moderately elevated depression, randomization to cognitive-behavioral therapy (CBT) produced greater decreases in depression at post-treament and greater decreases in fasting/2-h insulin at 1 year, compared to health education (HE). The current study is a secondary analysis of this parallel-group randomized controlled trial. We examined whether decreasing depression explained intervention effects on body composition and insulin outcomes. We hypothesized that decreases in depression would be an explanatory mediator and that indirect effects would be strongest at higher levels of baseline depression.

Methods

Participants were 12–17 years girls with overweight/obesity and family history of T2D randomized to 6-week group CBT (n = 58) or HE (n = 61). Procedures took place at an outpatient pediatric clinic. At baseline, post-treatment, and 1 year, adolescents completed the Center for Epidemiologic Studies-Depression Scale to assess depression symptoms; body mass index (BMI [kg/m2]) was measured from height/fasting weight; insulin resistance was derived from 2-h oral glucose testing. Adiposity was assessed with dual-energy X-ray absorptiometry at baseline and 1 year. Indirect effects of intervention were tested on 1-year changes in BMI, adiposity, and insulin through decreases in depression. Baseline depression was tested as a moderator of mediation.

Results

There was an indirect effect of CBT on decreased 1-year fasting insulin via decreases in depression during treatment, among adolescents with more elevated baseline depression.

Conclusions

Decreasing elevated depression may be one mechanism in the targeted prevention of T2D in at-risk adolescents.
Oh What an Unholy Mesh! Diamond v Royal Devon & Exeter NHS Foundation Trust [2019] EWCA Civ 585
Authors: Manning Joanna M
Published: July 2019

In Diamond v Royal Devon and Exeter NHS Foundation Trust [2019] EWCA Civ 585, the Court of Appeal mistakenly applied the wrong test to the issue of the causal link between the surgeon’s failure to disclose material information and her physical injury. Even had that test been correct, its application to the facts was open to question and arguably unsympathetic. The decision is also of note for adding to a line of previous Court of Appeal decisions, which have held that breach of the duty of disclosure does not create a stand-alone right to damages for loss of autonomy.
Sex-Ratio Meiotic Drive Shapes the Evolution of the Y Chromosome in Drosophila simulans
Authors: Helleu Quentin , Courret Cécile , Ogereau David , Burnham Katie L , Chaminade Nicole , Chakir Mohamed , Aulard Sylvie , Montchamp-Moreau Catherine
Published: July 2019

The recent emergence and spread of X-linked segregation distorters—called “Paris” system—in the worldwide species Drosophila simulans has elicited the selection of drive-resistant Y chromosomes. Here, we investigate the evolutionary history of 386 Y chromosomes originating from 29 population samples collected over a period of 20 years, showing a wide continuum of phenotypes when tested against the Paris distorters, from high sensitivity to complete resistance (males sire ∼95% to ∼40% female progeny). Analyzing around 13 kb of Y-linked gene sequences in a representative subset of nine Y chromosomes, we identified only three polymorphic sites resulting in three haplotypes. Remarkably, one of the haplotypes is associated with resistance. This haplotype is fixed in all samples from Sub-Saharan Africa, the region of origin of the drivers. Exceptionally, with the spread of the drivers in Egypt and Morocco, we were able to record the replacement of the sensitive lineage by the resistant haplotype in real time, within only a few years. In addition, we performed in situ hybridization, using satellite DNA probes, on a subset of 21 Y chromosomes from six locations. In contrast to the low molecular polymorphism, this revealed extensive structural variation suggestive of rapid evolution, either neutral or adaptive. Moreover, our results show that intragenomic conflicts can drive astonishingly rapid replacement of Y chromosomes and suggest that the emergence of Paris segregation distorters in East Africa occurred less than half a century ago.
Trends in Direct Hospital Payments to Anesthesia Groups
Authors: O’Connell Chloe , Dexter Franklin , Mauler David J. , Sun Eric C.
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

In addition to payments for services, anesthesia groups in the United States often receive revenue from direct hospital payments. Understanding the magnitude of these payments and their association with the hospitals’ payer mixes has important policy implications.

Methods

Using a dataset of financial reports from 240 nonacademic California hospitals between 2002 and 2014, the authors characterized the prevalence and magnitude of direct hospital payments to anesthesia groups, and analyzed the association between these payments and the fraction of anesthesia revenue derived from public payers (e.g., Medicaid).

Results

Of hospitals analyzed, 69% (124 of 180) made direct payments to an anesthesia group in 2014, compared to 52% (76 of 147) in 2002; the median payment increased from $242,351 (mean, $578,322; interquartile range, $72,753 to $523,861; all dollar values in 2018 U.S. dollars) to $765,128 (mean, $1,295,369; interquartile range, $267,006 to $1,503,163) during this time period. After adjusting for relevant covariates, hospitals where public insurers accounted for a larger fraction of anesthesia revenues were more likely to make direct payments to anesthesia groups (β = 0.45; 95% CI, 0.10 to 0.81; P = 0.013), so that a 10–percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 4.5–percentage point increase in the probability of receiving any payment. Among hospitals making payments, our results (β = 2.10; 95% CI, 0.74 to 3.45; P = 0.003) suggest that a 1–percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 2% relative increase in the amount paid.

Conclusions

Direct payments from hospitals are becoming a larger financial consideration for anesthesia groups in California serving nonacademic hospitals, and are larger for groups working at hospitals serving publicly insured patients.
Superior Trunk Block
Authors: Kim David H. , Lin Yi , Beathe Jonathan C. , Liu Jiabin , Oxendine Joseph A. , Haskins Stephen C. , Ho Michael C. , Wetmore Douglas S. , Allen Answorth A. , Wilson Lauren , Garnett Christopher , Memtsoudis Stavros G.
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Interscalene nerve blockade remains one of the most commonly used anesthetic and analgesic approaches for shoulder surgery. The high incidence of hemidiaphragmatic paralysis associated with the block, however, precludes its use among patients with compromised pulmonary function. To address this issue, recent studies have investigated phrenic-sparing alternatives that provide analgesia. None, however, have been able to reliably demonstrate surgical anesthesia without significant risk for hemidiaphragmatic paralysis. The utility of the superior trunk block has yet to be studied. The hypothesis was that compared with the interscalene block, the superior trunk block will provide noninferior surgical anesthesia and analgesia while sparing the phrenic nerve.

Methods

This randomized controlled trial included 126 patients undergoing arthroscopic ambulatory shoulder surgery. Patients either received a superior trunk block (n = 63) or an interscalene block (n = 63). The primary outcomes were the incidence of hemidiaphragmatic paralysis and worst pain score in the recovery room. Ultrasound was used to assess for hemidiaphragmatic paralysis. Secondary outcomes included noninvasively measured parameters of respiratory function, opioid consumption, handgrip strength, adverse effects, and patient satisfaction.

Results

The superior trunk group had a significantly lower incidence of hemidiaphragmatic paralysis compared with the interscalene group (3 of 62 [4.8%] vs. 45 of 63 [71.4%]; P < 0.001, adjusted odds ratio 0.02 [95% CI, 0.01, 0.07]), whereas the worst pain scores in the recovery room were noninferior (0 [0, 2] vs. 0 [0, 3]; P = 0.951). The superior trunk group were more satisfied, had unaffected respiratory parameters, and had a lower incidence of hoarseness. No difference in handgrip strength or opioid consumption were detected. Superior trunk block was associated with lower worst pain scores on postoperative day 1.

Conclusions

Compared with the interscalene block, the superior trunk block provides noninferior surgical anesthesia while preserving diaphragmatic function. The superior trunk block may therefore be considered an alternative to traditional interscalene block for shoulder surgery.
Hernio-abdominoplasty with or without Scarpa’s Fascia Preservation for Ventral Hernia and Abdominal Wall Deformity
Authors: Eltantawy Mahmoud , Elshobaky Ayman , Thabet Waleed , Emile Sameh , El-Said Mohammed , Elshobaky Mohamed Taher , Mahmoud Sabry Ahmed
Published: July 2019

Background:

Scarpa’s fascia preservation plays a great role in decreasing the volume of wound drainage and reducing seroma after abdominoplasty. This study aimed to assess the role of Scarpa’s fascia preservation in patients with ventral hernias associated with abdominal wall deformity who underwent concomitant hernio-abdominoplasty in terms of early and late postoperative outcome and quality of life.

Methods:

Patients with ventral hernia and abdominal wall deformity underwent combined hernio-abdominoplasty. Patients were randomly allocated to 1 of 2 equal groups: group I underwent Scarpa’s fascia preserving hernio-abdominoplasty and group II underwent hernio-abdominoplasty with removal of Scarpa’s fascia. Volume of drainage, time to remove drains, return to work, and complications were recorded.

Results:

Fifty patients (49 female) were included to the study. Both groups had comparable operation time, pain score, and complication rate (24% versus 40%, P = 0.36). The mean total volume of postoperative drainage was significantly lower in group I than group II (686 ± 183.5 versus 1410.8 ± 371.6 ml; P < 0.0001). Group I had earlier drain removal (11.6 ± 1.9 versus 20.5 ± 4.2 days, P < 0.0001) and earlier return to work (16.4 ± 2.3 versus 23.3 ± 3.8 days, P < 0.0001) than group II. There were no recorded cases of hematoma or hernia recurrence after repair.

Conclusion:

Scarpa’s fascia preservation in combined ventral hernia repair and abdominoplasty was associated with significantly lower volume of postoperative drainage, earlier removal of drains, and similar recurrence rate to hernio-abdominoplasty with removal of Scarpa’s fascia.
The Effect of Nonpharmacological Interventions on Managing Symptom Clusters Among Cancer Patients
Authors: So Winnie K. W. , Law Bernard M. H. , Chan Dorothy N. S. , Xing Weijie , Chan Carmen W. H. , McCarthy Alexandra L.
Published: July 2019

Background

Cancer patients often experience multiple concurrent and related symptoms, or symptom clusters. Research increasingly indicates that targeting a symptom cluster as an overall entity instead of individual symptoms could be more effective and efficient in improving patients’ quality of life. Various nonpharmacological interventions are used to manage symptom clusters in cancer patients during and after treatment, but the effect of such interventions is uncertain.

Objective

To provide a summary of such interventions and evaluate their effects in terms of symptom cluster severity, quality of life, and functional ability of patients with cancer.

Methods

A comprehensive literature search of 5 English and 2 Chinese electronic databases (PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, CNKI, and Wanfang) was combined with hand searching, to identify eligible research studies from 2001 to January 2018. Two reviewers carried out data selection, data extraction, and quality appraisal independently. A narrative approach was used to summarize data.

Results

Thirteen randomized controlled trials, involving 1490 patients, were included in the review. The methodological quality of the studies was generally fair. Nonpharmacological interventions can reduce the severity of symptom clusters, especially the pain–fatigue–sleep disturbance, cognitive, and gastrointestinal clusters, and improve both quality of life and functional ability.

Conclusions

While symptom cluster interventions are potentially useful in cancer care, further well-designed research is needed to test them rigorously on various types of cancer symptom clusters.

Implications for Practice

Nonpharmacological interventions are shown to be effective in managing cancer-associated symptom clusters and could be considered as part of the existing healthcare services for cancer patients.
Review of Mixed-Methods Research in Nursing
Authors: Younas Ahtisham , Pedersen Maria , Tayaben Jude Laoagan
Published: July 2019

Background

Inadequate justification for using mixed-methods and inadequate data integration compromises the rigor of mixed-methods studies, and data integration remains a challenge for nurse researchers.

Objectives

The aim of the study was to determine the 5-year prevalence of mixed-methods research in nursing journals and to determine the extent of integration of qualitative and quantitative findings.

Methods

Ten journals were hand-searched, and additional search was conducted within three databases. Prevalence was calculated by counting the number of published mixed-methods studies divided by the number of published studies over 5 years. Three reviewers independently performed methodological assessment using a checklist based on guidelines by expert methodologists.

Results

Prevalence of mixed-methods studies was 1.89%. Concerning methodological assessment, of 175 studies, 29% did not provide an explicit label of the study design and four studies incorrectly labeled the design. In total, 31% of the studies did not justify using mixed methods, 95% did not identify the research paradigm, and 78% did not state the weight given to individual phases. The extent of data integration was 73%, but 83% of studies integrated data using narrative summaries with integration occurring at the interpretation (69.8%). Few studies used joint displays (10.9%), transformation (3.1%), and triangulation (1.6%) for data integration.

Discussion

Mixed-methods research is still in its infancy in nursing, and researchers encounter challenges during its conduct, analysis, and reporting. There is a need to determine researchers’ attitudes and challenges toward using mixed methods and educate them about advanced mixed methods. Emphasis should be placed on use of advanced data integration methods so that the rigor and quality of mixed research can be enhanced in nursing research.