bluuebunny/crossref_metadata_2025 huggingface dataset:
O ensino de inglês permeado pela proposta de sala de aula invertida
Authors: Conserva Dilma Prata , Costa Marco Antonio Margarido
Published: May 2020

As contínuas mudanças sociais e epistemológicas ocasionadas pela globalização têm resultado em uma pluralidade de conceitos para denominar a sociedade pós-moderna – invadida pelos avanços tecnológicos e científicos com uma rapidez incontrolável. Por conseguinte, essa realidade reflete no contexto educacional que urge por mudanças, agregações e transformações nas práticas docentes, e o ensino de inglês não se exclui dessa realidade. As metodologias ativas, mais especificamente o modelo de flipped classroom, têm cooperado para que essas inovações ocorram. O presente relato versa sobre as contribuições das metodologias ativas e as experiências da sala de aula invertida como uma modalidade do ensino híbrido, destacando a sua aplicação no ensino de inglês. Apresenta as experiências desenvolvidas em uma escola de idiomas com alunos do nível pré-intermediário na cidade de Patos-PB. De modo central, objetivou-se nesta pesquisa identificar as contribuições trazidas pela proposta de sala de aula invertida, para a aprendizagem da língua inglesa e conhecer os possíveis desafios para a implementação dessa metodologia. A ancoragem teórica que fundamenta o entendimento das contribuições das tecnologias digitais e da proposta de sala de aula invertida encontra esteio nas obras de Bergamn e Sams (2016), Valente (2017), Monte Mór (2010), Horn e Staker (2015), entre outros.
Avaliação da eficácia de um programa de compreensão da leitura oral dialógica por criança com autismo
Authors: Walter Elizabeth Cynthia , Nunes Débora Regina de Paula
Published: May 2020

Os prejuízos nos níveis de compreensão leitora de educandos diagnosticados com Transtorno do Espectro Autista (TEA) aparecem documentados em pesquisas científicas. Nesse cenário, o desenvolvimento de programas de intervenção que possam remediar, precocemente, esses déficits são essenciais.  O presente estudo tem como objetivo avaliar a eficácia de uma adaptação do programa de intervenção leitora, denominado Reading to Engage Children with Autism in Language and Learning (RECALL). Esse programa incorpora práticas interventivas, baseadas em evidências empíricas, a um modelo de Leitura Dialógica. No caso, uma mãe foi capacitada a empregar estratégias do programa, durante rotinas de leitura com o seu filho, de 6 anos, diagnosticado com TEA. Por meio de um delineamento de pesquisa quase-experimental intrassujeitos, os efeitos das práticas do RECALL, implementadas pela mãe, foram avaliados quanto ao nível de responsividade de seu filho. Os resultados evidenciaram a incorporação parcial das estratégias no repertório de comportamento da mãe e aumento na frequência de ocorrência de turnos comunicativos da criança. Ganhos qualitativos foram identificados no comportamento da díade, incluindo-se melhorias nos níveis de compreensão leitora do menino. Contribuições e limitações do estudo são colocadas em discussão.
As marcas da migração internacional no Vale do Rio Doce pelos utensílios domésticos
Authors: Alves Ricardo , Siqueira Sueli
Published: May 2020

O artigo busca identificar e evidenciar marcas (i)materiais que a emigração em seis cidades do Vale do Rio Doce  inscreve nesses territórios pelos sujeitos e grupos que migram para os Estados Unidos. Para tanto, aciona as teorias da migração internacional e as conjuga com os estudos territoriais. Também se vale da fotografia com instrumental de pesquisa e linguagem expositiva dos resultados ancorada na Semiótica como metodologia de análise das imagens. Neste artigo a série fotográfica dos utensílios domésticos é analisada, revelando a existência de marcantes aspectos que (re)configuram um território historicamente marcado pela vivencia da migração.
Drop foot Post Mitral Valve Replacement and Total correction of Tetralogy of Fallot: A Two Case Report
Authors: Poerwandari Dewi , Lapasi Daisy F , M Bayu Aji
Published: May 2020

Background: Peripheral nerve lesion after heart surgery was reported on brachial plexus, phrenic nerve, laryngeal recurrent nerve facial nerve, lumbosacral root and spinal cord. Incidence of peroneal communis nerve lesion after heart surgery was not much reported (0,19%). Diagnostic procedure of peripheral nerve lesion are including clinical sign and symptom,  electrophysiology studies and MRI. Rehabilitation management of peripheral nerve lesion are not only management of pain and nerve stimulation, but also walking aid beside cardiac rehabilitation due to cardiac problem.Methods: Reporting two case of peripheral nerve lesion after heart surgery. First case is a female, 37 years old suffered from drop foot two days after mitral valve replacement with mechanic valve. She got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation program. Second case is a female, 9 years old, after total correction of Tetralogy of Fallot, got drop foot at day two. She also got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation.Results: First case result was the drop foot getting better after she entered phase two of cardiac rehabilitation. In the second case, the drop foot was relieved at phase two cardiac rehabilitation and back to normal condition after one year after surgery.Conclusion: In these two case of drop foot after heart surgery, the drop foot was relieved after pain and rehabilitation management beside cardiac rehabilitation.
The Outcome of Biofeedback Muscle Re-Education after Brachial Plexus Reconstruction: a Case Series
Authors: Arfianti Lydia , Haryadi Ratna Darjanti
Published: May 2020

The purpose of this report was to evaluate the outcome of biofeedback muscle re-education after brachial plexus reconstruction. A case series was conducted based on registry data of Rehabilitation Outpatient Clinic. A total of 20 subjects underwent surgical reconstruction to restore elbow flexion in the period of 2012-2014 were included in the study. All 20 subjects received biofeedback muscle re-education until end June 2015 (data extraction). Oucome measures were time to recovery (months) after surgical reconstruction and patients’ compliance. Recovery is considered when muscle contraction of biceps (nerve transfer) and gracilis (free functional muscle transfer/ FFMT) are ≥ 100μV, recorded using EMG-surface electrode. Of 4 subjects underwent nerve transfer, all showed recovery with median time of 9 months. Of 16 subjects underwent FFMT, 5 showed recovery with median time of 9 months. The majority of subjects in both groups could comply with once in 2 weeks rehabilitation program.
Direito Minerário e sustentabilidade: por um modelo normativo de outorga que prestigie a proteção ambiental
Authors: Durço Karol Araújo , De Faria Edimur Ferreira
Published: May 2020

O Direito Minerário existe para definir as regras a serem obedecidas pela atividade de mineração. Essa atividade é imprescindível ao desenvolvimento da espécie humana, observada a necessidade de sustentabilidade. Nesse contexto, o presente artigo objetiva investigar o papel do sistema de outorga de direitos minerários para promover o desenvolvimento sustentável. Tem-se por problema a seguinte indagação: o sistema de outorga está conectado à proteção ambiental? Para responder essa indagação adotaram-se os métodos analítico, investigativo e comparativo. A metodologia da pesquisa consistiu em revisão bibliográfica e legislativa. Ao final, constatou-se que o atual sistema previsto, em especial, no Código de Mineração, necessita de aperfeiçoamento. Por outro lado, o Projeto de Novo Código de Mineração estabelece mecanismos que garantem formas concorrenciais de outorga, os quais se entendem serem meios mais adequados à proteção ambiental, confirmando-se a hipótese de que o sistema de outorga pode ser fator de desenvolvimento sustentável.
Proteção de dados e tributação na Alemanha: repercussões do Regulamento Geral sobre Proteção de Dados
Authors: Seer Prof. Dr. Roman , Brandau Signoretti Diogo
Published: May 2020

Em 25.05.2018 entrou em vigor em todos os estados-membros da UE o  RGPD. O processo de tributação alemão não passou incólume. O legislador nacional introduziu, por meio da „Gesetz [Lei] zur Änderung des Bundesversorgungsgesetzes und anderer Vorschriften“, de 17.7.2017, um grande número de normas de acompanhamento na Abgabenordnung (AO). As relações entre o RGPD, a AO e, parcialmente, também a Lei Federal de Proteção de Dados (BDSG) não são claras. Logo, o âmbito de aplicação do RGPD no tocante à seara tributária [alemã] não foi ainda claramente determinado. O presente artigo esclarece a relação entre os novos dispositivos, bem como se se dedica a questões polêmicas e demonstra as vastas possibilidades de tutela jurídica da proteção de dados, junto às quais a nova autoridade de controle federal para proteção de dados e liberdade de informação, como órgão federal, passou recentemente a ter um papel importante
Online Sequential Extreme Learning Machine: A New Training Scheme for Restricted Boltzmann Machines
Authors: Tarek BERGHOUT
Published: May 2020

Abstract: The main contribution of this paper is to introduce a new iterative training algorithm for restricted Boltzmann machines. The proposed learning path is inspired from online sequential extreme learning machine one of extreme learning machine variants which deals with time accumulated sequences of data with fixed or varied sizes. Recursive least squares rules are integrated for weights adaptation to avoid learning rate tuning and local minimum issues. The proposed approach is compared to one of the well known training algorithms for Boltzmann machines named “contrastive divergence”, in term of time, accuracy and algorithmic complexity under the same conditions. Results strongly encourage the new given rules during data reconstruction.
Sleep Optimizes Time in the Effective Environment
Authors: Ataie Niloufar
Published: May 2020

Why animals sleep is an outstanding open question. Information about the toxic byproducts of aerobic cellular respiration along with the analysis of patterns in animal size, sleep needs, dietary-type, metabolism, number of heart beats, transportation-network design, and transportation energetics/dynamics suggest that the function of sleep is to maximize the time an animal has to perform its life functions given the finite and constant number of lifetime heart beats it has. Sleep slows down metabolism, and the heart rate, thereby decreasing the load of toxic reactive oxygen species in the cell and extending the cell’s lifetime/proper-functioning. I argue that this is used to maximize the time an animal spends in its ‘effective environment’, which is defined as the period in the light cycle (day or night) where the essential life-functions of that animal (like finding resources, finding sex, hunting) are better achieved. Larger, slow-metabolizing animals need less sleep because their large-bodily-networks and slow metabolisms keep their heart rates relatively low, resulting in a lower rate of oxidative damage, and more relative time in the ‘effective environment’ to get their essential life-functions accomplished.
On Generalized Tetranacci Numbers: Closed Form Formulas of the Sum $\sum_{k=0}^{n}W_{k}^{2}$ of the Squares of Terms
Authors: Soykan Yüksel
Published: May 2020

In this paper, closed forms of the sum formulas $\sum_{k=0}^{n}W_{k}^{2}$ \ for the squares of generalized Tetranacci numbers are presented. We also present the sum formulas $\sum_{k=0}^{n}W_{k+1}W_{k},$ $\sum_{k=0}^{n}W_{k+2}W_{k},$ and $\sum_{k=0}^{n}W_{k+3}W_{k}.$ As special cases, we give summation formulas of the of Tetranacci, Tetranacci-Lucas and some other fourth order linear recurrance sequences.
Myths about Menstrual Personal Hygiene among FemaleAdolescents
Authors: Palupi Tyas Diah , Pristya Terry Y.R. , Novirsa Randy
Published: May 2020

Poor personal hygiene during menstruation among adolescents can lead to urinary tract infection, reproductive tract infection, and skin irritation. This studyaimed to determine the relationship between belief in myths and personal hygiene during menstruation. Cross-sectional quantitative study was conductedusing a sample of 119 10th grade female students from Tangerang 13 State Senior High School selected through purposive sampling. Logistic regressionanalysis was used in this study to determine the relationship between myths and personal hygiene after age of menarche, attitude, socioeconomic status,information, and maternal education were controlled. In the bivariate selection, modeling was completed by entering confounding and interaction variablesthen reducing the confounding variables by examining changes in the odds ratio. Results showed that the students who believed the myths were 3.7 timesmore likely to not practice personal hygiene during menstruation compared with those who did not believe the myths after attitude and status socioeconomicstatus were controlled. No interaction was observed between the myths and socioeconomic status.
Effects of Climbing Choice, Demographic, and Climate on Walking Behavior
Authors: Ekawati Febriani Fajar , Eves Frank Francis
Published: May 2020

Walking is a public health recommendation to increase physical activity. Although walking for transport is associated with health benefits, it is frequently avoided when a mechanized alternative is available and when the weather or individuals’ available resources are unfavorable. The present quasi-experimental study used chosen walking speed to estimate the use of resources by pedestrians and investigated 730 pedestrians’ behavior when approaching a choice point between a short stair and a ramp at an exit from a university campus toward the local train station on six separate days. Results revealed that individuals who climbed the stairs walked faster than those who chose the ramp. In addition, females and those who were overweight walked slower than their comparator groups. Temperature was associated with walking behavior; as temperature increased, the walking speed of pedestrians decreased. Moreover, the purpose of walking is an important determinant of walking speed. Minimization of time to arrive at the train station as quickly as possible is a plausible alternative explanation for the effects of resource allocation on walking speed.
Identifying the Weak Foundation of Public Health Resilience forNational Disaster Policy in Indonesia’s Mid-term DevelopmentAgenda 2015–2019: A Policy Content Analysis
Authors: Warsito Gita Miranda , Budiharsana Meiwita , Burns Sharyn
Published: May 2020

Indonesia is one of the most susceptible nations toward natural disasters in the world. Since 1992, approximately 37 tsunami incidents have occurred inIndonesia, with at least 1,244 cases of natural disasters during 2018. Despite the overwhelming impact of disasters on Indonesia, Public Health Resilience,as an approach to disaster countermeasures, has been poorly elaborated in Indonesia’s development agenda (National Mid-term Development Plan (NMDP),or Rencana Pembangunan Jangka Menengah Nasional (RPJMN), 2015 - 2019). By utilizing the method of policy content analysis, this study aimed to analyzethe policy background of Public Health Resilience against disasters in the NMDP 2015 - 2019 and National Disaster Management Authority (NDMA)’s, orBadan Nasional Penanggulangan Bencana (BNPB),Strategic Plan 2015 - 2019. The results showed that the NMDP 2015 - 2019 and NDMA‘s Strategic Plan2015 - 2019 lack the scientific background for Public Health Resilience building in Indonesia. Enhancing the scientific background in these plans will enhancefocus on evidence-based Public Health Resilience establishment.
Combined Combustion of Various Industrial Waste Flows in Boiler Furnaces. Part 1
Authors: Yarmolchick Yu. Р. , Schröger R. , Haberfelner H. , Pichler M. , Kostić D. , Moroz G. V.
Published: May 2020

Direct flaring of industrial waste flows specifically in the combustion chambers of heat generating plants makes it possible to significantly reduce the loss of thermal energy, as well as the capital costs of equipping thermal units without using of preliminary furnaces. However, given the increasingly strict environmental standards for the burning of various fuels, it seems important to determine the optimal combustion conditions depending on the composition of the waste products. The article shows that only a complex solution can be a successful solution to the problem of organizing high-quality combustion of industrial waste flows. On the one hand, it is necessary to obtain extremely environmentally friendly combustion products, and, on the other hand, the waste disposal process should be energy efficient. The article discusses the stages of the implementation of the projects of energy-efficient utilization of industrial waste in compliance with the established environmental standards for emissions of pollutants. The analysis of initial combustible chemical substances that are part of solid, liquid and gaseous wastes of industrial technologies is given. The main classes of fuels that determine combustion reactions are identified. Global chemical reactions and oxidation mechanisms are considered. The combustible properties, chemical composition, and degree of impact of the products of combustion of industrial waste on the environment are determined, depending on the content of various starting substances. The most difficult aspect of the flaming disposal of industrial waste flows is the presence of harmful substances of various hazard classes. The conditions for achieving complete fuel combustion, stoichiometry, and equilibrium conditions for different air/fuel ratios (depending on fuel composition) with incomplete combustion are determined. The analysis of products of incomplete combustion is given as well as of and hazard classes of the corresponding pollutants. The maximum value of the coefficient φ was determined beyond which solid carbon should be formed in a homogeneous mixture.
Exposure to environmental tobacco smoke and prevalence of asthma among adolescents in a Middle Eastern country
Authors: Booalayan Hussain , Abdulrasool Mosa , Al-Shanfari Saad , Boujarwa Abdulwahab , Al-Mukaimi Abdullah , Alkandery Omar , Akhtar Saeed
Published: May 2020

Background: There is increasing evidence linking exposure to environmental tobacco smoke (ETS) at homes to the development of asthma among adolescents. Few studies have addressed this issue in the Middle Eastern countries including Kuwait. Therefore, this study cross-sectional assessed the prevalence of ETS exposure at home, prevalence of asthma and other respiratory morbid conditions and examined the ETS exposure and personal smoking status as risk factors for self-reported asthma among high-school students in Kuwait. Methods: During October 2015, a cross-sectional study design was implemented using a self-administered modified version of the ISAAC (International study of asthma and allergies in childhood) questionnaire among students enrolled in nine high-schools of Hawally Governorate of Kuwait. Prevalence of ETS exposure and self-reported asthma were computed. Multivariable log-binomial regression models were used to evaluate association between exposures of interest and self-reported asthma status. Results: Of 800 invited students, 746 (92.2%) participated, of whom 74.8% were Kuwaiti and 50.1% were female with a mean (SD) age of 16.8 (0.68) years. ETS exposure prevalence at home was 54% and personal current smoking was 12.4%. Self-reported asthma prevalence was 20.5%. Furthermore, the prevalence of physician-diagnosed asthma, wheezing during the last 12 months and wheezing ‘ever’ was 16.4%, 20.1% and 26.2%, respectively. Final multivariable log-binomial regression model showed that compared to the adolescents without asthma, adolescents with self-reported asthma tended to be current smokers (adjusted prevalence ratio (adjusted PR) = 1.82; 95% CI: 1.30 – 2.56; p = 0.001) or significantly more likely to have had ETS exposure at home (adjusted PR = 1.64; 95% CI: 1.21 – 2.23; p = 0.002). Conclusions: We recorded high prevalence of ETS exposure at home, high prevalence of self-reported asthma and identified ETS exposure at home and being a current smoker as strong risk factors for self-reported asthma among adolescents. Voluntary household smoking bans may substantially minimize the ETS exposure among adolescents. Additionally, such restriction may inculcate an antismoking attitude and prevent smoking initiation among adolescents. Such efforts are likely to pay dividends in terms of reduction in ETS exposure and associated asthma risk and other smoking-related morbidities in this and other similar settings.
Analysis of exosomal circRNAs upon irradiation in pancreatic cancer cell repopulation
Authors: Chen Yi-yun , Jiang Ming-jie , Chen Zhi-long , Tian Ling
Published: May 2020

Background : Pancreatic cancer is one of most malignant tumors. However, radiotherapy can lead to tumor recurrence, which is caused by the residual surviving cells repopulation stimulated by some molecular released from dying cells. Exosomes may mediate cell-cell communication and transfer kinds of signals from the dying cells to the surviving cells for stimulating tumor repopulation. Circular RNAs (circRNAs) may be one vital kind of exosomal cargos involving in modulating cancer cell repopulation. Methods: Next generation sequencing (NGS) and bioinformatics were performed to analyze and annotate the expression and function of exosome-derived circRNAs in pancreatic cells during radiation. 4 circRNAs were chosen for qRT-PCR analysis to validate the sequencing results. Results: In this study, 3,580 circRNAs were annotated in literatures and circBase among 12,572 identified circRNAs. There were 196 filtered differentially expressed circRNAs (the up-regulation and down-regulation respectively is 182 and 14, fold change >2, p-value <0.05). Regulation of metabolic process and lysine degradation were the main biological processes and pathway enrichment according to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Conclusions: The hsa_circ_0002130-hsa_miR_4482-3p-NBN interaction network suggested potential miRNA sponge and target mRNA. Our results provided potential functions of circRNAs to explore molecular mechanisms and therapeutic targets in pancreatic cancer cell repopulation upon irradiation.
Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study
Authors: Ghimire Umesh , Aryal Binod Kumar , Gupta Ankush Kumar , Sapkota Suman Sapkota
Published: May 2020

Background: Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6-59 months in the two districts of Nepal. Methods: We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centres (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value <0.05 was considered as significant. Results: Out of 398 children, 5.8 percent were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23 - 12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88-10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06 - 71.09) children (0 - 12 vs. 24 - 59 months). . Conclusions: The findings of this study indicated that household size, household food access, and the child’s age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.
Catastrophic Healthcare Expenditure and Coping Strategies among Patients Attending Cancer Treatment Services in Addis Ababa, Ethiopia
Authors: Kasahun Gebremicheal Gebreslassie , Gebretekle Gebremedhin Beedemariam , Gecho Yohannes Hailemichael , Woldemariam Aynalem Abraha , Fenta Teferi Gedif
Published: May 2020

Background: With the rapid increase in magnitude and mortality of cancer, which is costly disease to manage, several patients particularly in developing countries are facing a huge financial burden. The aim of the study was to examine the incidence of catastrophic health expenditure (CHE), identify associated factors and coping strategies among patients attending cancer treatment services in Addis Ababa, Ethiopia.Methods: A hospital based cross-sectional survey of patients with cancer was conducted in public and private hospitals between January and March 2018. Data was collected using a structured questionnaire. All direct medical and nonmedical expenditures were measured and reported as expenditure (US$) per patient (1US$ equivalent to 23.41 Ethiopian Birr). The CHE was estimated using a threshold of 10% of annual household income.Results: A total of 352 (response rate of 87.1%) participants were interviewed. Majority (73.3%) of the respondents were females; most (94%) from public hospitals and their mean (±SD) age was 48±13.2 years. Breast (36.9%) and Cervical (16.5%) cancers accounted the largest proportion. Vast majority (74.4%) of patients experienced CHE with mean overall expenditure of $2366 per patient (median: $1708). Medical expenditure sharedthe highest overall expenditure (83.6%) with mean medical and nonmedical costs of $1978 (median: $1394) and $388 (median: $222), respectively. Patients who took greater than six cycles of chemotherapy (AOR: 3.64; 95% CI: 1.11-11.92), and age (AOR: 1.03; 95% CI: 1.01-1.06) were significantly associated with CHE. Household saving (85.5%) followed by financial support (43.0%) were the main coping strategies.Conclusion: A substantial number of patients with cancer are exposed to CHE with considerable medical expenditure. Hence, while efficient mobilization of the over introduced health insurance scheme other better prepayment or insurance mechanisms should also be considered to ensure financial risk protection and realize universal health coverage for patients with cancer.
Exploring the reasons why women prefer to give birth at home in rural northern Ghana: A qualitative study
Authors: Adatara Peter , Strumpher Johanita , Ricks Esmeralda
Published: May 2020

Background: Skilled birth care during childbirth is reported in literature as one critical strategy for reducing maternal morbidity and mortality. Despite the importance of birth care provided by skilled birth attendants, women in rural areas of northern Ghana still give birth utilising the birth services provided by Traditional Birth Attendants.The aim of this study therefore is to explore and describe the factors and experiences of a small group of rural women choosing homebirth in rural northern Ghana. Methods: A qualitative approach was adopted to explore the reasons for women preference to deliver at home in rural areas of northern Ghana. Individual interviews were used to obtain a thick description of factors and experiences of women associated with home births in rural areas in Ghana. The research population consisted of 10 women who utilised birth care services provided by Traditional Birth Attendants in a rural of northern Ghana. Data collected from the interviews were transcribed verbatim and analysed to identify themes. Results: A study with a small group of women showed that these women gave birth at home in rural northern Ghana due to: Perceived poor quality of care and conduct of skilled birth attendants; women received better care from Traditional Birth Attendants; due to financial constraints and women lacked access to healthcare facilities in the rural areas. Conclusion : The study highlighted some barriers experienced by participants to the utilisation of birth care services provided by skilled birth attendants in rural northern Ghana. Management of healthcare facilities should facilitate the implementation of a supportive supervision in the maternity units to improve the quality of care and attitude delivered by skilled birth attendants in maternity care in rural communities.
Anxiety related disorders in adolescents in the United Arab Emirates: a population based cross-sectional study
Authors: Al-Yateem Nabeel , Issa Wegdan Bani , Rossiter Rachel C , Al-Shujairi Arwa , Radwan Hadia , Awad Manal , Fakhry Randa , Mahmoud Ibrahim
Published: May 2020

Background: Anxiety disorders are common among children and adolescents. However, there is a paucity of up-to-date data on the prevalence and correlates of anxiety-related disorders among children and adolescents in the United Arab Emirates (UAE).Methods: We conducted a cross sectional study to determine the prevalence of specific anxiety-related disorders (e.g., generalized anxiety disorder, panic disorder, separation anxiety, social anxiety) in the UAE, and identify correlations between these disorders and adolescents’ demographic variables. Participants were 968 adolescents aged 13–18 years attending secondary schools across the UAE. Convenience sampling was used to recruit participants. We collected demographic information and data about participants’ anxiety levels. Anxiety was assessed using the Arabic and English versions of the Screen for Child Anxiety Related Disorders scale. Univariate analyses (independent sample t-tests and analysis of variance) were performed to evaluate factors affecting participants’ anxiety scores. Chi-square tests were used to compare factors associated with anxiety disorders.Results: Participants’ mean age was 16±1.8 years, and 65.8% were female. The overall prevalence of anxiety disorders was 28%, with this being significantly higher in girls (33.6%) than boys (17.2%) (p<0.0001). Participants aged <16 years had higher generalized anxiety, separation anxiety, and social anxiety scores compared with those aged ≥16 years (p≤0.05). Those from households with a maid had significantly higher generalized anxiety, panic disorder, separation anxiety, and significant school avoidance scores than those without a maid (p≤0.05). In addition, participants from middle and low economic backgrounds had higher separation anxiety scores compared with children from high economic backgrounds (p≤0.05). The multivariate analysis showed the main associated factors with anxiety were gender (being female, p<0.001) and caregiver (other than mother and father together, p<0.001). Conclusions: We found a high incidence of anxiety-related disorders among school-aged adolescents in the UAE, with girls being more affected than boys. This suggests that age-appropriate initiatives are urgently needed to reduce the high rate of anxiety-related disorders. It may also be necessary to further investigate the two main associated factors with anxiety identified in this study (being female and non-parental caregivers).
Psychosocial barriers and enablers of exclusive breastfeeding: lived experiences of mothers in low-income townships, North West Province, South Africa
Authors: Witten Chantell Beverley , Claasen Nicole , Kruger Herculina S , Coutsoudis Anna , Grobler Herman
Published: May 2020

Background: Despite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32%. The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeeding mothers at postnatal time points 3-14 days, 4-8 weeks, 10-14 weeks and 20-24 weeks. Methods: This community-based mixed-methods study collected data within a prospective cohort study on socio-demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6-8 weeks with infant feeding data collected at 4-8, 10-14 and 20-24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6-24 weeks were conducted. Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data.Results: The majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%). EBF decreased from 34% at 4-8 weeks to 9.7% at 20-24 weeks. Mixed feeding with infant formula increased from 17.0% to 30.6% and food feeding from 3.1% to 54.2%. While there were no statistically significant associations between EBF and any of the quantitative socio-demographic variables, in the qualitative data, codes associated with barriers were more than enablers. The themes were Mothers’ attributes (wellbeing, experiences and relationships) with the code mother’s stress the strongest barrier, Mother’s knowledge, attitudes and practices of breastfeeding with the code conventional medicines the strongest barrier, Family environment with the code home setting the strongest barrier, Social environment with public spaces and places a barrier and in Baby cues the code baby stomach ailments the barrier. Within these same themes mother’s positive emotions, benefits of breastfeeding, support in the home, access to information and services from health professionals and baby’s health were strong enabling factors. Conclusions: Low EBF, high mixed feeding and a high EPDS score were explained by the barriers identified in the qualitative data. The data suggests that mothers from low-income households would be better supported through interventions that address food insecurity; family relationships and those that build confidence in mothers and resilience in confronting difficult and hostile breastfeeding environments.
Health-related quality of life (FACT-GP) in Sweden
Authors: Bagge Ann-Sophie Lindqvist , Carlander Anders , Fahlke Claudia , Bagge Roger Olofsson
Published: May 2020

Background: Many studies have used disease-specific instruments, such as the Functional Assessment of Cancer Therapy (FACT), when studying health-related quality of life (HRQOL) in patients. Few studies however, have described normative HRQOL values in the general population using FACT - General Population (FACT-GP) . The general aim of the present study is thus to describe the normative HRQOL values in the general Swedish population by using the FACT-GP instrument and to investigate to what degree sociodemographic factors and status of self-rated health (SRH) correlate with HRQOL. Methods: The participants consisted of a pre-stratified (gender, age and education) sample of Swedish citizens that previously had enrolled to be a part of a web panel hosted by a research institute (SOM Institute) at the University of Gothenburg in Sweden. The HRQOL was assessed by using the FACT-GP and SRH. Results: A higher FACT-GP score was mainly associated with males, higher age, higher income and better SRH. The results showed that the Swedish sample scored lower on FACT-GP than previous studies. Conclusions: Since HRQOL is frequently used as an important endpoint in healthcare research, there is an increasing need for normative data. The results from this study serve as a general population standard against which other studied HRQOL-data could be evaluated.
Racial/Ethnic differences in the prevalence and incidence of Metabolic Syndrome in high-income countries: a protocol for a systematic review
Authors: Adjei Nicholas Kofi , Samkange-Zeeb Florence , Kebede Mihiretu , Saleem Maham , Heise Thomas L , Zeeb Hajo
Published: May 2020

Background: Metabolic Syndrome is a constellation of various cardiovascular and type 2 diabetes risk factors, such as abdominal obesity, atherogenic dyslipidemia, high blood pressure and high blood glucose, but its prevalence varies widely by geographical region, sex and race/ethnicity. The objective of this study will be to examine the prevalence and incidence of metabolic syndrome among adults of different racial/ethnic origins in high-income countries. Methods: We designed and registered a study protocol for a systematic review of descriptive epidemiological data. Observational studies (e.g. cross-sectional and cohort studies) reporting morbidity data of metabolic syndrome and conducted in a wide range of adult people (e.g. different racial/ethnic origins, including migrants) will be included. The primary outcome will be the prevalence and incidence of metabolic syndrome. Secondary outcomes will be the prevalence and incidence of individual components of metabolic syndrome (e.g. abdominal obesity, dyslipidemia, high blood pressure and high blood glucose). Literature searches will be conducted in several electronic databases (from inception onwards), including MEDLINE, Web of Science Core Collection (Science Citation Index and Social Science Citation Index), CINAHL, and Cochrane Library. Two investigators will independently screen all reference titles, abstracts, and full-text articles. The methodological quality (or potential bias) of selected studies will be appraised using an appropriate tool. Our results will be described narratively. Random-effects meta-analysis will be conducted, if feasible and appropriate. Additional analyses will be conducted to explore the potential sources of heterogeneity.Conclusion: This systematic review will identify, evaluate and integrate prevalence and incidence data of metabolic syndrome, with focus on racial/ethnic differences in high-income countries. We anticipate our findings may guide policy formulation and identify knowledge gaps in the literature that future research should address.Systematic review registration: PROSPERO, CRD42020157189
Comparison of the effect of rapeseed oil or amaranth seed oil supplementation on weight loss, body composition, and changes in the metabolic profile of obese patients following 3-week body mass reduction program: a randomized clinical trial
Authors: Moszak Małgorzata , Zawada Agnieszka , Juchacz Aldona , Grzymisławski Marian , Bogdański Paweł
Published: May 2020

Background: Amaranth seed oil (ASO) and rapeseed oil (RSO) are representative functional food with glucose and cholesterol-lowering, antioxidant, and hepatoprotective properties. We aimed to compare the effect of RSO and ASO on weight loss and metabolic parameters during the 3-week body mass reduction program.Methods: Eighty-one obese subjects (BMI > 30 kg/m2) aged 25-70 years enrolled in a 3-week body mass reduction program based on calorie-restricted diet and physical activity. The participants were randomly administered 20 mL/d of ASO (AO group) or 20 mL/d of RSO (RO group) or were assigned to the control (C) group (without oil supplementation). Anthropometric and metabolic parameters were measured at baseline and at an endpoint. Results: At the end of the study, significant (P < 0.05) decrease in weight, BMI, WC (waist circumference), HC (hip circumference), FM (fat mass), LBM (lean body mass), VFM (visceral fat mass), and TBW% (total body water) were observed in all groups. There were no significant improvements in clinical parameters in the C group, while reduction in fasting insulin (Δ -5.9, P = 0.001 and Δ -5.7, P = 0.005) and HOMA-IR (Δ -1.1, P = 0.02 and Δ -0.5, P = 0.03) were observed in the RO and AO groups. Compared to the RO group, significant improvement in fasting glucose Δ -8.5, (P = 0.03), total cholesterol (Δ -14.6, P = 0.03), non-HDL cholesterol (Δ 15.9, P = 0.01), TG/HDL ratio (Δ -0.6, P = 0.03), LDL cholesterol (Δ -12.3, P = 0.04), and triglycerides (Δ -6.5, P = 0.000) in the AO group were observed. Conclusions: The 3-week body mass reduction intervention resulted in a significant reduction in weight, BMI, WC, HC, FM, and VFM in all the studied groups. Except for HOMA-IR, in clinical parameters were no statistical differences between all groups. However, the trend to improvement in insulin level and HDL% was noticed only in AO and RO. Therapies targeting edible oils with high nutritional value as RSO and ASO may in the future be a promising tool in support metabolic measurement improvement during the body mass reduction programs.Take home message: Supplementation with RSO or ASO may bring additional benefits to obese patients undertaking a weight reduction program.Trial registration: DRKS00017708
Adjunct use of mouth rinses with a sonic toothbrush accelerates the detachment of a Streptococcus mutans biofilm: an in vitro study
Authors: Ohsumi Tatsuya , Takenaka Shoji , Sakaue Yuuki , Suzuki Yuki , Nagata Ryoko , Hasegawa Taisuke , Ohshima Hayato , Terao Yutaka , Noiri Yuichiro
Published: May 2020

Background : The aim of this in vitro study was to examine the possible enhancement of the biofilm peeling effect of a sonic toothbrush following the use of an antimicrobial mouth rinse. Methods: The biofilm at a noncontact site in the interdental area was treated by sound wave convection with the test solution or by immersion in the solution. The biofilm peeling effect was evaluated by determining the bacterial counts and performing morphological observations. A Streptococcus mutans biofilm was allowed to develop on composite resin discs by cultivation with stirring at 50 rpm for 72 hours. The specimens were then placed in recesses located between plastic teeth and divided into an immersion group and a combination group. The immersion group was treated with phosphate buffer, Peridex™ mouth rinse or Listerine ® mouth rinse. The combination group was treated with Peridex™ or Listerine ® and a sonic toothbrush. Results: The biofilm thickness was reduced by approximately one-half compared with the control group. The combination treatment produced a 1 log reduction in the number of bacteria compared to the Listerine ® immersion treatment. No significant difference was observed in the biofilm peeling effect of the immersion group compared to the control group. Conclusions: The combined use of a sonic toothbrush and a mouth rinse enhanced the peeling of the biofilm that proliferates in places that are difficult to reach using mechanical stress.
The effect of short-course antibiotics on the resistance profile of colonizing gut bacteria in the ICU: a prospective cohort study
Authors: Munck Christian , Sheth Ravi U , Cuaresma Edward , Weidler Jessica , Stump Stephania L , Zachariah Philip , Chong David H , Uhlemann Anne-Catrin , Abrams Julian A , Wang Harris H , FREEDBERG DANIEL E
Published: May 2020

Background : The need for early antibiotics in the intensive care unit (ICU) is often balanced against the goal of antibiotic stewardship. Long-course antibiotics increase the burden of antimicrobial resistance within colonizing gut bacteria, but the dynamics of this process are not fully understood. We sought to determine how short-course antibiotics affect the antimicrobial resistance phenotype and genotype of colonizing gut bacteria in the ICU by performing a prospective cohort study with assessments of resistance at ICU admission and exactly 72 hours later. Methods : Deep rectal swabs were performed on 48 adults at the time of ICU admission and exactly 72 hours later, including patients who did and did not receive antibiotics. To determine resistance phenotype, rectal swabs were cultured for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). In addition, Gram-negative bacterial isolates were cultured against relevant antibiotics. To determine resistance genotype, quantitative PCR (qPCR) was performed from rectal swabs for 87 established resistance genes. Within-individual changes in antimicrobial resistance were calculated based on culture and qPCR results and correlated with exposure to relevant antibiotics (e.g., did β-lactam antibiotic exposure associate with a detectable change in β-lactam resistance over this 72-hour period?). Results : Of 48 ICU patients, 41 (85%) received antibiotics. Overall, there was no increase in the antimicrobial resistance profile of colonizing gut bacteria during the 72 hour study period. There was also no increase in antimicrobial resistance after stratification by receipt of antibiotics (i.e., no detectable increase in β-lactam, vancomycin, or macrolide resistance regardless of whether patients received those same antibiotics). This was true for both culture and PCR. Antimicrobial resistance pattern at ICU admission strongly predicted resistance pattern after 72 hours. Conclusions . Short-course ICU antibiotics made little detectable difference in the antimicrobial resistance pattern of colonizing gut bacteria over 72 hours in the ICU. This provides improved understanding of the dynamics of antimicrobial resistance in the ICU and some reassurance that short-course antibiotics may not adversely impact the stewardship goal of reducing antimicrobial resistance.
The reporting quality of the interventional animal experiments in Chinese journals based on the evaluated results of the Animals in Research: Reporting In Vivo Experiments (ARRIVE) guidelines
Authors: Zhao Bing , Jiang Yanbiao , Zhang Ting , Shang Zhizhong , Zhang Weiyi , Hu Kaiyan , Chen Fei , Mei Fan , Gao Qianqian , Zhao Li , Ma Bin , Kwong Joey S.W.
Published: May 2020

Objective To retrospectively evaluate the reporting quality of animal experiments published in Chinese journals adhering to the Animals Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. Methods The databases CNKI, WanFang, VIP, and CBM were searched from inception until July 2018. Two appropriately-trained. reviewers screened and extracted articles independently. The ARRIVE guidelines were used to assess the quality of the published reports of animal experiments. The compliance rate of every item was analyzed relative to the different dates of publication. Results A total of 4342 studies were finally included, of which 73.03% had been cited ≤ 5 times. Only 29.04% (1261/4342) were published in journals listed in the Chinese Science Citation Database. The results indicate that the compliance rate of around half of the sub-items (51.3%, 20/39) was less than 50% and 65.0% (13/20) was less than 10%. Conclusions The reporting quality of animal experiments in Chinese journals is generally at a low to moderate level. Due to the publication of the ARRIVE guidelines in 2010, the compliance rate of the majority of items in the ARRIVE guidelines has improved to some extent. However, less attention has been paid to the ethics and welfare of experimental animals, and a number of specific items in the Methods, Results, and Discussion sections continue to not be reported in sufficient detail. Therefore, it is necessary to popularize the ARRIVE guidelines, advocate researchers to adhere to them in the future, and in particular promote the use of the guidelines in specialized journals, in order that the design, implementation, and reporting of animal experiments is promoted, to ultimately improve their quality.