bluuebunny/crossref_metadata_2025 huggingface dataset:
The modern state of analgesia after total hip replacement
Authors: Timerbaev V. H , Dolgasheva N. S , Genov Pavel G.
Published: September 2020

Total hip replacement is an important orthopedic surgery allowing to increase high-activity profile and longevity of the elderly patients suffered from arthritis and proximal hip fracture. For the good outcome of the surgery we have to use enhanced recovery strategy which in turn needs performing adequate postoperative analgesia. Using painkillers only (per os, i.v., i.m., s.c.) after THR is not enough to reach this aim (well pain relief at rest and during movement) due to low analgesic potency of the non-opioid drugs and adverse reactions related to opioids, so, the regional analgesia methods are widely spread. Considered before as a gold standard epidural analgesia method is not quite suitable for the aged patients as so as the sympathetic and motor blocks hinder an enhanced recovery after THR. In recent decades the interest in peripheral regional analgesia methods has been gradually increasing. Fascia iliaca and psoas compartment blocks, local wound infiltration analgesia are getting the modern regional THR postoperative analgesia armamentarium. Each of them has some benefits and pitfalls and only face-to-face comparisons within the scope of clinical trials will give us the basic for the constituting the local and national post-THR analgesia guidelines.
The problem of acute postoperative pain in neurosurgical patients
Authors: Lubnin Andrei U. , Imaev A. A , Solenkova A. V
Published: September 2020

This is review article concerned to problem of acute postoperative pain in neurosurgical patients. Many ears ago it was widely accepted that wast majority of neurosurgical patients don't have any pain sensation after craniotomy. Following investigations show that it mistake. In this article we discuss new data on statistics of acute postoperative pain after intracranial and spinal neurosurgical interventions, patophysiology of acute p/o pain and various methods preventing and treatment of this pain sensation. Regional scalp block, NSAID, i/v morphine on PCA approach, transdermal therapeutic forms of fentanyl and regional analgesia in spinal neurosurgery - are most perspective directions in solving of this problem.
CAUDAL EPIDURAL ANESTHESIA IN PEDIATRIC PATIENTS
Authors: Matinyan Nune V. , Zabolotski D. V , Martynov L. A , Letyagin I. A
Published: September 2020

Caudal epidural block is the most widely used regional anesthetic technique in children. Its popularity in pediatric anesthesia is mainly due to its broad spectrum of indications, high success rates, and a relative low incidence of complications. The caudal epidural block is generally used for not only lower abdominal or lower extremity surgery but also for upper abdominal surgery via administration of adjuncts such as morphine, which has hydrosoluble potential. The indications, contraindications and technique of caudal epidural block are presented.
The Federation of anesthesiologists - reanimatologists of Russia: on the way toward the effective program
Authors: Lebedinskii Konstantin M. , Zabolotskikh I. B , Ovechkin A. M , Shchegolev A. V , Protsenko D. N , Gritsan A. I , Kirov M. Yu , Bayalieva A. Zh , Molchanov I. V , Shifman E. M , Mazurok V. A , Grigoriev E. V , Gorbachev V. I , Sukhotin S. K , Nikolenko A. V , Afonchikov V. S , Koryachkin V. A , Lekmanov A. U , Mironov P. I , Slepushkin V. D , Nedashkovskiy E. V , Kurapeev I. S , Lazarev V. V , Karelov A. E , Yaroshetskiy A. I , Lyuboshevskiy P. A , Vlasenko A. V , Shevchenko V. P , Zilber A. P , Orlov Yu. P , Kitiashvili I. Z , Oskanova M. Yu , Tolkach A. B , Nikolaenko E. M , Sitkin S. I , Doroginin S. V , Kulikov A. V , Spasova A. P , Kuz'kov V. V , Sumin S. A , Lubnin A. Yu , Popov A. S , Tsypin L. E , Smirnov G. A , Malyshev Yu. P , Kokhno V. N , Martynov D. V , Abazova I. S , Abdulaev R. B , Leiderman I. N , Kudryashov K. A , Mekulov A. H , Fisher V. V , Pyataev N. A , Merenkov V. G , Shumatov V. B , Dunts P. V , Lavretiev A. A , Pylaev A. V , Belkin A. A , Zalesny A. S , Nazarov D. E , Yuzhanin A. A , Stadler V. V , Shen' N. P , Gorobets E. S , Potapov A. L , Ershov V. I , Akulov M. S , Mitkinov O. E , Makarevich A. N , Sorokin E. P , Dashevskiy S. P , Butrov A. V , Markov O. V , Petrova M. V , Slivin O. A , Stepanenko S. M , Rechkalov V. A , Tsarenko S. V , Aslanukova A. N , Sviridov S. V , Nikanorova E. V , Zhenilo V. M , Volchkov V. A , Gelfand B. R
Published: September 2020

The article is devoted to summing up the work of the Federation of anesthesiologists and reanimatologists of Russia and proposing the prospects of its development.
OTsENOChNYE MATERIALY DLYa PODGOTOVKI K AKKREDITATsII VRAChEY - MEDIKO-SOTsIAL'NYKh EKSPERTOV
Authors: Puzin S. N , Bogova O. T , Potapov V. N , Shurgaya M. A , Chandirli S. A , Korshikova Yu. I , Memetov S. S , Lapina E. Yu , Yakushev A. A
Published: September 2020

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Uso de TiO2 Dopado com Íons Terras-raras para Revelar Impressão Digital Latente
Authors: Bernardes Yasmim R. C. P. , Barrado Cristiano M. , Figueiredo Alberthmeiry T. de
Published: September 2020

TiO2 dopado com íons terras-raras pode ser utilizado para auxiliar a investigaçãocriminal fornecendo evidências para decifrar a autoria de crimes. Esses pós possuema capacidade de revelar impressões digitais latentes que compõem uma cena de crime.Nesse trabalho foram sintetizados o TiO2:Eu3+:bpy e o TiO2:Tb3+:bpy para seremutilizados como pós reveladores de impressão digital latente. Para isso, esses pós foramobtidos pelo método sol-gel, caracterizados estruturalmente e tiveram sua propriedadefotoluminescente confirmada. Como os pós apresentam emissão fotoluminescente visívela olho nu, eles apresentam vantagens quando comparado aos pós reveladores utilizadoscomumente.
Formação por Competências: A Experiência do Curso de Engenharia Química do SENAI CETIQT
Authors: Simões André L. C. , Abreu Cláudia de , Barbosa Josie C. , Pereira Letícia Q. , Picardo Marta C. , Flores Tanise M.
Published: September 2020

Atualmente, o mercado busca engenheiros com perfil mais humanístico e empreendedor,além da formação técnica de qualidade. Para atender essa demanda, as novas DiretrizesCurriculares Nacionais focam na aprendizagem por competências. Essas novas diretrizes,junto com a Metodologia SENAI de Educação Profissional, impulsionaram a adequaçãoda Grade Curricular do Curso de Engenharia Química do SENAI CETIQT. Hoje, aoinvés de disciplinas, tem-se unidades curriculares, que comtemplam competências,técnicas e socio emocionais. A utilização de metodologias ativas, que trazem casosreais, aproximando a indústria dos discentes, apresentou-se muito vantajosa, cativando odiscente e capacitando o profissional para o mercado de trabalho atual.
KELUAR DARI LINGKARAN CSR: CORPORATE SOCIAL ENTREPRENEURSHIP DALAM MENJAWAB TANTANGAN SOSIAL LICENSE TO OPERATE [GETTING OUT FROM THE CIRCLE OF CSR: CORPORATE SOCIAL ENTREPRENEURSHIP IN ANSWERING THE CHALLENGE OF SOCIAL LICENSE TO OPERATE]
Authors: Swara Vandy Yoga , Simatupang Erwinton
Published: September 2020

Many believe that corporate social responsibility (CSR) is able to present social license to operate (SLO) of company’s community and stakeholders. In fact, CSR is not in line with SLO. The root of the problem lies on a CSR approach that differenciates economic and social value. Therefore, pressure, expectation, and need of company’s community and stakeholder will not be able to be met by a corporation despite it has proposed the best CSR programs. Through a series of literature reviews on SLOs and case studies at one company, this article offers an alternative approach to present SLO on business by emphasizing corporate social entrepreneurship (CSE) spirit.
On priorities of scientific and technological development
Authors: Shepelev Gennady V.
Published: September 2020

Approaches to the formation of priorities of R&D development are analyzed: among them determination of goals, formation of R&D problems to be solved, analysis of available resources. The criteria the procedures of priorities of scientific and technological development to be met are formulated. The historical retrospective of the scientific and technological development of mankind is considered from the point of view of overcoming the deficits of key resources that arose at various stages of development (food, energy, information, etc.). It is noted that scientific and technical breakthroughs occurred when resources significant for the development of mankind were in deficit. A model of R&D priorities formation is proposed, based on the analysis of the prospects for the occurrence of resource deficits used by a mankind in its activities. Examples of using the proposed approach for analyzing information resources are given.
“Comedy of mistakes” and “drama of humans”: on the domestic contribution to the creation of The Standard Model of elemantary particle in physics
Authors: Vizgin Vladimir P.
Published: September 2020

The article explores domestic contribution to the creation of The Standard Model (SM). SM is a quantum field gauge theory of electromagnetic, weak and strong interactions, which is the basis of the modern theory of elementary particles. The process of its development covers a twenty-year period – from 1954 (the concept of non-Abelian Yang-Mills gauge fields) to the early 1970s, when the construction of renormalizable quantum chromodynamics and electroweak theory was completed. The reasons for the difficult perception of the Yang-Mills gauge field concept in the USSR are analyzed, associated primarily with the problem of “zero-charge” in quantum electrodynamics, and then in field theories of strong and weak interactions. This result, obtained by the leaders of the outstanding Russian scientific schools of theoretical physics, L. D. Landau, I. Ya. Pomeranchuk and their students, led to the rejection of the majority of Soviet physicists from field theory and to their transition to the position of a non-field phenomenological program (based on the S-matrix theory) in the construction of the theory of elementary particles.
Areas of concern when setting research priority
Authors: Mazov Nikolay A. , Gureyev Vadim N.
Published: September 2020

Detection of research priority is of key importance for the development of researchorganizations, universities, country, and society. The paper briefly reviews a range of issuesaccompanying the processes of research priority setting. These issues are primarily discussedin biomedical papers due to their utmost importance in the system of healthcare.The paper describes the main participants who set research priority including research organizationsand universities, grant funds, business companies and their investors, and governmentagencies. It is shown how relationships between participants can lead to a potential conflict of interest when prioritizing research. Resolution of conflicts at initial stages of researchpriority setting is especially important to maintain principles of fair competition, humanrights observance, development of collaboration, and enhancement of transparency inresearch. Problems of biased priority setting are detected toward international, basic, or hottopics, which requires the development of special criteria for each type of research. Issuesof dual-purpose research are studied from the perspective of publication ethics as they canresult in both advantages and damage for society. Modern approaches to research prioritysetting are reviewed. Methods of the detection of research trends and fronts are also brieflydescribed due to their impact on further priority setting. The mutual influence of researchfronts and research priority was shown. Tools for the detection of research trends and frontscomprise bibliometric analysis while research priority setting is significantly based on expertreview. Multiphase processes using various approaches seem to be the most promising inresearch priority setting.
Tuberous Breast
Authors: Simões da Silva Joana , Alves Teixeira Paula , Rosmaninho Maria Teresa
Published: September 2020

N/a.
A Load Balancing Per Connection Classifier Dengan Pengukuran Quality of Service Pada Jaringan LAN Lingkup Universitas
Authors: Nur Utomo Aulia Desy Aulia
Published: September 2020

Abstract

In the use of internet networks that are general in nature need to implement an appropriate network configuration to maximize the use of internet connections provided by service providers. This is important for the optimal use of internet services and in accordance with utilities that are basically general and shared can be achieved. Per Connection Classifier is a load balancing method for distributing traffic loads to more than one network connection point in a balanced way, so that traffic can run optimally.

This research focuses on network configuration methods to maximize internet usage for all users. Quality of Service is used to see the performance of network traffic which is indicated by the value of the parameter delay, throughput, and packet loss.

Based on the results of testing and research that have been carried out before and after using load balancing per connection clasifier, the delay value is decreased from 180.26 ms to 148.36 ms and throughput increased from 1.76% to 2.03%, then packet loss decreased from 25.37% to 18.59% according to the TIPHON standard.

Keywords: Quality of Service, Per Connection Classification, load balancing, delay, throughput, packet loss
Desain Digital Right Management (DRM) Untuk Perangkat Lunak Berbasis Desktop Menggunakan Teknik Mutual Authentication
Authors: Setyoko Yoso Adi
Published: September 2020

Software yang tergolong sebagai aplikasi desktop cukup rentan dari bentuk pembajakan. Pembajakan terhadap software sangat mudah yaitu dengan cara menduplikat software tersebut. Untuk menanggulangi permasalahan duplikasi data tersbut maka dibutuhkan mekanisme perlindungan data yang disebut sebagai Digital Right Management (DRM). Beberapa pihak pembuat software telah menerapkan teknik-teknik DRM contohnya dengan menggunakan Public Key Infrasturktur (PKI), kemudian dengan teknik penggunaan kode lisensi, serta Attribute Based Access Control (ABAC).Sedangkan penelitian kami saat ini melakukan pendekatan lain dalam pembuatan DRM yaitu menggunakan teknik rekayasa protokol jaringan yang  disebut dengan proses Mutual Authenticataion atau autentikasi dua arah. Pada tahun 2004 Philips menerbitkan sebuah dokumen dan protokol yang digunakan untuk komunikasi smart card dan reader-nya. Protokol yang dibuat oleh Philips di dalamnya terdapat proses Mutual Authentication Pada penelitian ini penulis mengadopsi protokol tersebut untuk diterapkan sebagai DRM. Hasil penelitian kami dapat membuktikan secara matematis bahwa protokol hasil adopsi dan modifikasi tersebut mampu mengamankan komunikasi yang dilakukan antara client (software) dan server. Celah yang dapat ditanggulangi melalui protokol ini adalah celah kebocoran kunci, celah kebocoran autentikasi, dan celah kebocoran pertukaran data. Kelanjutan penelitian ini adalah pengujian availability dan performansi protokol.
INTERAKSI SOSIAL ANTARA DIFABEL DENGAN PEDAGANG PASAR TANGGUL DI KOTA SURAKARTA
Authors: Saputra Johan Effendy Dwi
Published: September 2020

The rapid development and growth in the trade sector makes the traditional market a place where sellers and buyers exchange for goods and services. With the traditional market everyone has the right to access it as well as the diffable that have special needs. This research aims to determine the social interaction between the disabled and the market trader of Surakarta City and to know the service provided by the trader to the diffable. This study used the symbolic interacionism theory of George Herbert Mead. This research with a qualitative descriptive approach gathered from findings in the field through observation, in-depth interviews and documentation. The results of this research show that the form of social interaction that occurs between the diffable with the market trader of the city embankment of Surakarta is associative and dissociative. Pasar Tanggul also provides some services to the diffable by providing a friendly smile, good service by traders and market managers, whether it is to serve the diffable honestly and help the diffable in shopping. So that the diffable feel comfortable with the service provided. In addition, it is also supported and availability of accessible facilities that facilitate the accessibility of Tanggul market.

Keywords: Social interactions, Diffable, Merchants, Traditional Markets.

 

Abstrak

Perkembangan dan pertumbuhan yang sangat pesat dalam sektor perdagangan menjadikan pasar tradisional sebagai tempat penjual dan pembeli mengadakan pertukaran barang dan jasa. Dengan adanya pasar tradisional semua orang berhak untuk mengaksesnya begitu juga dengan difabel yang memiliki kebutuhan khusus. Penelitian ini bertujuan untuk mengetahui bentuk interaksi sosial antara difabel dengan pedagang Pasar Tanggul Kota Surakarta dan Untuk mengetahui pelayanan yang diberikan pedagang terhadap difabel. Penelitian ini menggunakan teori Interaksionisme Simbolik dari George Herbert Mead. Penelitian ini dengan pendekatan deskriptif kualitatif yang dikumpulkan dari hasil temuan di lapangan melalui observasi, wawancara mendalam dan dokumentasi. Hasil penelitian ini menunjukkan bahwa bentuk interaksi sosial yang terjadi antara difabel dengan pedagang Pasar Tanggul Kota Surakarta yaitu asosiatif dan disosiatif. Pasar Tanggul juga memberikan beberapa pelayanan terhadap difabel dengan memberikan senyuman yang ramah, pelayanan yang baik oleh pedagang maupun pengelola pasar, baik itu dalam melayani difabel dengan jujur dan membantu difabel dalam berbelanja. Sehingga difabel merasa nyaman dengan pelayanan yang diberikan. Selain itu juga didukung dan tersedianya fasilitas yang ramah difabel yang mempermudah difabel dalam mengakses Pasar Tanggul.

Kata kunci: Interaksi Sosial, Difabel, Pedagang, Pasar Tradisional.

 
Anemia at Presentation Predicts Acute Mortality and Need for Readmission Following Geriatric Hip Fracture
Authors: Ryan Gareth , Nowak Lauren , Melo Luana , Ward Sarah , Atrey Amit , Schemitsch Emil H. , Nauth Aaron , Khoshbin Amir
Published: September 2020

Background:

There is a paucity of research regarding the relationship between anemia and postoperative morbidity and mortality among geriatric patients presenting with hip fracture. The objective of this study was to determine the effect of anemia at presentation on 30-day morbidity and mortality among geriatric patients with hip fracture.

Methods:

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all hip fracture patients ≥60 years old from 2011 to 2016. Included were all emergency unilateral, nonpathological hip fractures (femoral neck, intertrochanteric, or subtrochanteric) treated with arthroplasty, intramedullary nailing, or open reduction and internal fixation. Anemia was classified as a hematocrit (HCT) level of <0.41 and <0.36 for male and female patients, respectively. Age, body mass index (BMI), race, comorbidities, smoking status, American Society of Anesthesiologists (ASA) class, baseline functional status, time to surgery, operative time, anesthesia type, need for transfusion, fixation method, length of stay (LOS), and discharge destination were collected. Our primary outcome of interest was 30-day postoperative mortality, with all-cause readmission and any postoperative ischemic events (cerebrovascular accident [CVA] and myocardial infarction [MI]) analyzed as secondary outcomes. A multivariable regression analysis was performed and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated while controlling for confounding variables.

Results:

Of 34,805 patients identified, 22,469 (65%) were anemic at presentation (63% female; mean age, 80 ± 8 years), while 12,336 (35%) were non-anemic (85% female; mean age, 79 ± 8 years). Anemia at presentation was independently associated with higher odds of mortality (OR,1.3 [95% CI, 1.1 to 1.5]) and readmission (OR, 1.2 [95% CI, 1.1 to 1.3]), while no relationship was observed for MI (OR, 1.1 [95% CI, 0.9 to 1.4]) or CVA (OR, 0.8 [95% CI, 0.6 to 1.1]).

Conclusions:

Our findings suggest that anemia at presentation is associated with greater 30-day postoperative morbidity and mortality in geriatric hip fracture patients. Additional research should focus on elucidating this modifiable risk factor and advancing the preoperative optimization of hip fracture patients.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Compared with two-stage revision, retained spacers have a similar infection-relief rate and a higher complication rate
Authors: Cai Yuanqing , Fang Xinyu , Lin Yi , Huang Zida , Zhang Chaofan , Li Wenbo , Zhang Wenming , Guan Zhenpeng
Published: September 2020

Background: Periprosthetic joint infection (PJI) is a devastating complication for joint arthroplasty, there are many challenges in therapy. The treatment of PJI including surgery and systemic administration of antibiotics. As for surgery, two-stage revision is regarded as the “gold standard” for PJI treatment presently, in which antibiotic-impregnated spacers play an important role. However, some patients are unable to undergo reimplantation of the prosthesis after spacer implantation, this spacer, namely, “destination joint spacer”. The clinical outcomes of these patients remain unknown. The purpose of this research was to study the infection-relief rate and clinical outcome of these patients.Methods: From January 2006 to December 2017, data from PJI patients who underwent implantation with antibiotic-impregnated cement spacers in our center due to chronic PJI were collected retrospectively. Age, sex, body mass index (BMI) and laboratory test results were recorded, and the infection-relief rate and clinical outcomes were observed.Results: A total of 62 patients who were diagnosed with PJI were enrolled, with an age of 65.13 ±9.94 (39-88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group. Our study showed that the infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the incidence of complications was higher than that of two-stage revision, especially for the type I spacer used in this study.Conclusions: The infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the complication rate was higher than that of two-stage revision (especially for the type I spacer).
Risk Factors for the Transmission of Mycobacterium Bovis to Slaughterhouses Workers in Brazzaville, Republic of the Congo
Authors: Miassangoumouka Jean P. , Linguissi Laure S. Ghoma , Itoua Lauréat Pavel , Fotso Brigitte Tumamo , Andoseh Geneviève , Numfor Leonard , Amona Inestin , Kikayi Hortense Goma , Ntoumi Francine
Published: September 2020

Zoonotic tuberculosis is a major form of TB affecting humans and many animal species. Infected cattle pose a threat to public health. The aim of the study was to characterize the risks of exposure to bovine tuberculosis by slaughterhouse workers in Brazzaville. A survey was carried out among 57 workers from three slaughterhouses in Brazzaville (Mpila, Kanga Mbanzi and La Fougère) using questionnaires and field observations. The results of the profile revealed that the majority of staff are made up mainly of people over 40 years old (40.6 ± 8.4) i.e. 50.9% and 96.5% male. Married workers represent a third of respondents (29.8%) and live in families made up of 4.9 ± 2.4 people. Workers with secondary education are the majority (66.7%). The average number of years of work in slaughterhouses in Brazzaville is 18.9 ± 9.5 years. The survey also showed that many workers, 52.6%, have never received training to work in slaughterhouses. A tier of workers (31.7%) have no knowledge of animal tuberculosis, in particular its modes of transmission or its clinical signs. The premises are; normal, regularly cleaned, but are not disinfected. Despite the common occurrence of injuries, 73.7% of those surveyed said that they were not subjected to medical checks. To this, we must add, the lack of work clothes adapted by some (29.8%). All of these shortcomings constitute significant risks of contamination from zoonoses, and tuberculosis in particular. Thus, the study recommends strengthening the capacities of professionals in slaughterhouses, their medical follow-up and improve infrastructure. Finally, the fight against zoonotic tuberculosis requires a multisectoral framework involving doctors and veterinarians in the context of the "One Health" approach.
Analysis of continuity of care and related factors in diabetic patients in Korea
Authors: Shin Ji Yeh , Kim Ha Jin , Cho BeLong , Yang Yun Jun , Yun Jae Moon
Published: September 2020

Background: Diabetes is one of the fastest growing diseases with approximately 463 million patients worldwide. It is established that to manage diabetes, continuity of care in primary care setting is crucial. We aim to statistically define and analyze factors of continuity that are associated with patient, clinic, and geographical relationship.Methods: We used 2014~2015 claim data from National Health Insurance Service (NHIS), with 39,096 eligible outpatient attendances across 29,912 office-based clinics. We applied multivariable logistic regression to analyze factors that may affect three kinds of continuity of care index for each patient: most frequent provider continuity index (MFPC), modified-modified continuity index (MMCI), and continuity of care index (COC). Results: Mean value of continuity of care indices were MFPC 0.90, MMCI 0.96, COC 0.85. Among patient factors, old age above 80 (MFPC 0.81 [0.74-0.89], MMCI 0.84 [0.76-0.92], COC 0.81 [0.74-0.89]) and disability were strongly associated with lower continuity of care. Another significant factor was residential area: further the patients lived from their primary care clinic, lower the continuity of diabetes care (MFPC 0.74 [0.70–0.78], MMCI 0.70 [0.66–0.73], COC 0.74 [0.70–0.78]). Patients who lived in metropolitan areas had higher continuity of care compared to those of other areas (metropolitan area, MFPC 1.19 [1.17-1.27], MMCI 1.17 [1.10-1.25], COC 1.19 [1.12-1.27]). There was no statistical significance among clinic factors, such as the number of physicians or nurses hired per clinic, between the lower and the higher continuity of care groups.Conclusion: Geographical proximity of patient’s residential area and clinic location showed the strongest correlation as factor of continuity. Political support is necessary to geographically align the imbalance of supply and demand of medical needs.
A Situational Analysis of Competences of Research Ethics Committee Members in Review of Research Protocols with Complex and New Study Designs in Uganda
Authors: Ainembabazi Provia , Castelnuovo Barbara , Okoboi Stephen , Arinaitwe Walter Joseph , Parkes-Ratanshi Rosalind , Byakika-Kibwika Pauline
Published: September 2020

BACKGROUND Over the past two decades, Uganda has experienced a significant increase in clinical research driven by both industry and the need to combat the emergence and re-emergence of infectious disease epidemics. This has broadened the spectrum of research proposals that need evaluation by Research Ethics Committees (RECs) with associated requirement for new expertise. We assessed the competencies of REC members in review of research protocols with complex and new research study designs to guide development of a training curriculum to improve the quality of review.METHODS This was a cross-sectional study design, with quantitative and qualitative data collection methods. We used a structured pre-coded questionnaire to collect data on competencies of REC members in review of research protocols with complex and new research study designs. Research Ethics Committee members were also asked to outline a list of additional topics for which they needed training. Data from coded questions was entered into Epidata Version 3.1 and then exported to STATA Version14.1 for analysis. Descriptive analysis was performed for quantitative data and findings were presented using percentages and frequencies. RESULTS We enrolled 55/97 REC members from 6 RECs, majority of whom were males (56.4%, n= 31/55). The level of competence for review of selected study design was lowest for Controlled Human Infection Model (6, 10.9%) and reverse pharmacology design (6, 10.9%,), and highest for cluster randomized study design (29, 52.7%) and implementation science research (29, 52.7%).CONCLUSION There is lack of competence in review of research protocols with complex and new study design and our analysis suggests that additional training in this area is an urgent priority.
Evaluation of Refeeding Outcomes Over 5-Years in A Specialist Adolescent Eating Disorder Center in The UK: A Retrospective Chart Review Study.
Authors: Brennan Cliona Rae , Chapman Simon , Illingworth Sarah
Published: September 2020

Background and aims: Refeeding syndrome (RS) is a serious clinical syndrome, its early identification is key to safe management. The aim of this study was to evaluate existing practices in a highly specialist centre for eating disorders and compare refeeding management, nutritional, and clinical outcomes in cases admitted to secondary care with those managed in primary care.Methods: Retrospective analysis of electronic case records of adolescent patients at moderate – high risk of developing refeeding syndrome and treated for anorexia nervosa by a specialist eating disorder centre in London over a 5-year period. Statistical analysis compared refeeding methods used in this population to establish if there were differences in refeeding methods used within the sample and if so, how they impacted on outcomes. Results: Adolescents admitted to inpatient care had significantly lower energy intakes (374kcal/d ± 205 compared with 621kcal/d ± 348, p = 0.001 ) and higher rates of weight loss at assessment (0.86kg/week ± 0.7 compared with 0.38kg/week ± 0.7, p = 0.003), without significant differences in other markers of medical instability. Incidence of RS symptoms did not differ significantly between groups and, similarly, no statistically significant difference was found between groups in treatment outcomes, measured by discharge weight (kg) and percentage median BMI (41.5kg ± 8.3 compared with 43.7kg ± 7.7, p = 0.322 and 81.6% ± 8.5 compared with 82.3% ± 9.7, p = 0.622). Conclusions: Findings from this study support the hypothesis that refeeding adolescents with AN, at high risk of developing RS, with higher energy feeds than that advised by national guidance, in the absence of prophylactic phosphate supplementation or incremental energy increases, does not increase the risk of developing refeeding complications. These findings support recent evidence that advocates a less conservative refeeding approach and a review of current national guidance.
Highlighting Recovery Services Promoting Personal Recovery of Adults Living With Severe Mental Illness – A Comprehensive Integrative Review 
Authors: Badu Eric , O’Brien Anthony Paul , Mitchell Rebecca
Published: September 2020

Background: There is increasing call regarding recovery services, however, little review studies have been undertaken regarding such services. This integrative review aimed to identify and synthesize evidence on the usefulness of recovery services used to promote personal recovery among adults living with severe mental illness. Methods: A search of the published literature was conducted using: Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, Web of Science, and Scopus. Mixed methods synthesis was used to analyse the data. The search was limited to papers published in English from January 2008 to January 2020. The review integrated both qualitative and quantitative data into a single synthesis. Results: Out of 40 included papers, 62.5 %( 25/40) used Quantitative data, 32.5% used Qualitative and 5 %( 2/40) used mixed methods. The review identified three recovery services such as integrated recovery model, vocational rehabilitation (Individual Placement Services), as well as recovery narrative photovoice and art-making services. The recovery services are useful in areas such as medication and treatment adherence, improvement in functioning, symptoms, physical health & social behaviour, self-efficacy, economic empowerment, social inclusion, household integration and access to support services. Conclusions: The evidence on recovery services focused largely on integrated rehabilitation and individual placement services, with a few studies implementing recovery narrative photovoice and art-making services. Mental health professionals are encouraged to implement the identified recovery services to improve the personal recovery goals of consumers.
Interactive Multiobjective Optimization for Finding The Most Preferred Exercise Therapy in Knee Osteoarthritis
Authors: shavazipour Babooshka , Afsar Bekir , Multanen Juhani , Kujala Urho M , Miettinen Kaisa
Published: September 2020

Background: The primary purpose of this study is to develop a decision support approach to support physicians or other healthcare professionals in comparing diﬀerent exercise therapies and identifying the most preferred one by balancing among cost, ability of improving physical function and reducing pain in patients with knee osteoarthritis.Methods: Thirty-one exercise therapies were selected from twenty-one randomized controlled trials from a previous meta-analysis. A multiobjective optimization model was designed to characterize the goodness of an exercise therapy based on ﬁve conﬂicting criteria: minimizing cost, maximizing pain reduction and disability improvement, minimizing the number of supervised exercise sessions and the length of the treatment period. Costs were estimated based on personal expenses regarding the information given in the collected randomized controlled trials. A novel interactive multiobjective optimization method was introduced to solve the model, where the physician’s preferences were taken into account in ﬁnding the most preferred exercise therapy. Results: An experienced physiotherapist was involved as a decision maker in the interactive solution process testing the proposed decision support approach. He iteratively provided preference information until he was satisﬁed with the set of therapies shown. After a more in-depth detailed analysis of selected therapies, the decision maker was able to ﬁnd the most preferred exercise therapy based on the patient's needs and health status. Conclusions: The proposed interactive multiobjective optimization method is promising in supporting the decision maker in balancing among conﬂicting criteria to ﬁnd the most preferred exercise therapy for patients with knee osteoarthritis. Moreover, the proposed method is generic enough to be applied in any field of medical and healthcare settings, where several alternative treatment options exist.
Direct and indirect neurological, cognitive and behavioral effects of COVID-19 on the normal elderly, Mild-Cognitive-Impairment and Alzheimer’s Disease populations
Authors: Iodice Francesco , Cassano Valeria , Rossini Paolo Maria
Published: September 2020

This article reviews the main articles that have been published so far about the direct and indirect effects of the COVID-19 pandemic on a particularly fragile population represented by the healthy elderly people as well as those with Mild Cognitive Impairment and Alzheimer's disease. Such populations have been among the most affected in the early stages of the pandemic due to the direct effects of the virus and numerous indirect effects now emerge and will have to be carefully assessed over time. The pandemic associated to COVID-19 has shifted most of the health resources to the emergency area and has consequently left the three main medical areas that dealing with the elderly population (oncology, time-dependent diseases and degenerative disease) temporarily “uncovered”. In the phase following the emergency, it will be crucial to guarantee to each area the economic and organizational resources to quickly return to the level of support of the pre-pandemic state. The emergency phase represented an important moment of discussion on the possibilities of telemedicine which will inevitably become increasingly important but all the limits of its use in the elderly population have to be considered. In the post-lockdown recovery phase, alongside the classic medical evaluation, the psychological evaluation must become even more important for doctors caring about people with cognitive decline.
Hippocampal Volume Influences the Correlations Between White Matter Disruption and Tau Protein in aMCI and mild AD
Authors: Magalhães Thamires Naela Cardoso , Casseb Raphael Fernandes , Gerbelli Christian Luiz Baptista , Nogueira Mateus Henrique , Pimentel-Silva Luciana Ramalho , Teixeira Camila Vieira Ligo , Carlleti Ana Flávia Mac Knight , Rezende Thiago Junqueira Ribeiro de , Joaquim Helena Passarelli Giroud , Talib Leda Leme , Forlenza Orestes , Cendes Fernando , Balthazar Marcio Luiz Figueredo
Published: September 2020

The authors have requested that this preprint be removed from Research Square.
Candidemia in Intensive Care Units Over Nine Years at a Large Italian University Hospital 
Authors: Mazzanti Sara , Brescini Lucia , Morroni Gianluca , Orsetti Elena , Pocognoli Antonella , Donati Abele , Cerutti Elisabetta , Munch Christopher , Montalti Roberto , Barchiesi Francesco
Published: September 2020

Purpose: Candidemia is an alarming problem in critically ill patients including those admitted in intensive care units (ICUs). We aimed to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to Candida spp. in patients admitted to ICUs of an italian tertiary referral university hospital over nine years. Methods: A retrospective observational study of all cases of candidemia in adult patients was carried out from January 1, 2010 to December 31, 2018 at a 980-bedded University Hospital in Ancona, Italy, counting five ICUs. The incidence, demographics, clinical and microbiologic characteristics, therapeutic approaches and outcomes of ICU-patients with candidemia were collected. Early (7 days from the occurrence of the episode of Candida BSI) and late (30 days) mortality rates were calculated. Results: During the study period, 188/505 (36%) episodes of candidemia occurred in ICU patients. Incidence rate was 9.9/1000 ICU admission and it showed to be stable over time. Candida albicans accounted for 52% of the cases, followed by C. parapsilosis (24%), and C. glabrata (14%). With the exception of isolates of C. tropicalis which showed to be fluconazole resistant in 25% of the cases, resistance to antifungals was not of concern in our patients. Early and late mortality rates were 19% and 41%, respectively and did not increased significantly over time. Independent risk factors for higher mortality were septic shock, acute kidney failure, pulmonary embolism and lack of antifungal therapy. The type of antifungal therapy did not influence the outcome. Conclusion: Neither incidence rate nor crude mortality of candidemia in ICU patients increased over time at our institution. However, mortality rate remained high and significantly associated with specific host-related factors.
The Association Between Anion Gap and Diabetic Retinopathy: Based on Hospital Registry Data in Liaoning Diabetic Microvascular Complications Study
Authors: Wang Xinyu , Yao Litong , Li Xiang , Zhong Yifan , Wang Yan , Wu Jingyang , Geng Jin , Zhou Yun , Zhang Jiahua , Chen Jun , Xu Yingying , Liu Lei , Hu Yudong
Published: September 2020

Background: Current evidences supported a highly relevant between acid-load and diabetes. The rise of serum anion gap (AG) has performed the significances in metabolic acidosis. Some factors correlated to diabetes might affect its complications such as diabetic retinopathy (DR).Methods: A total of 3,411 Chinese adults with type 2 diabetes were selected form the hospital registry data on DR Sub-study of Liaoning Diabetic Microvascular Complications Study (LD-MCS), included 1,137 DR as the cases and 2,274 non-DR as the matching controls. Fasting venous blood test was applied to ascertain the ion levels, and serum AG (mmol/L) was computed by: AG = (sodium + potassium) – (chlorine + bicarbonate). According to Early Treatment for Diabetic Retinopathy Study standards, DR was diagnosed by two-field fundus photographs and classified as mild non-proliferative DR (NPDR), moderate NPDR, and vision-threatening DR (VTDR). Logistic regression models and linear regression models were used to analyze the relationships.Results: In setting of the non-acidosis, higher AG was significantly associated with DR (P = 0.001), increased with aggravating retinopathy but decreased in VTDR level (P < 0.001). Multivariable-adjusted models showed that AG quartiles were independently linked with higher odds to occurrence (P for trend < 0.001) and severity (P for trend < 0.05) of DR, but with attention to the fluctuation of 75th AG quartiles. Linear logistic regression by stepwise method suggested the growth of age (P = 0.014), glycated hemoglobin (P = 0.018), and the homeostasis model assessment of insulin resistance index (P < 0.001) played an intimate role in the association between AG and DR.Conclusions: Higher AG was independently related to the occurrence and progression of DR. Our findings suggested that serum AG might alter the risk of DR by affecting glucose metabolism and insulin sensitivity in patients with type 2 diabetes.
Red Cell Distribution Width to Platelet Count Ratio as a Promising Indicator of Mortality for Acute Traumatic Brain Injury: a Study on Large ICU Cohorts
Authors: Ge Xintong , Zhu Luoyun , Li Wenzhu , Sun Jian , Jiang Rongcai , Lei Ping , Zhang Jianning
Published: September 2020

Background: Outcome prediction is crucial for the effective treatment of patients with acute traumatic brain injury (TBI). However, there is still a lack of reliable and routinely available blood predictors with sufficient clinical evidence till now. This research is designed to investigate the association between red cell distribution width to platelet count ratio (RPR) and mortality risk of TBI patients, thereby providing a promising indicator for prognosis evaluation of TBI.Methods: Clinical data of 2,220 patients with TBI that extracted from two large ICU cohorts (MIMIC-III database and eICU Collaborative Research Database), were integratively analyzed using our developed method named MeDICS. The association between RPR and hospital mortality was determined using the logistic regression model and Lowess Smoothing technique. Multivariable logistic regression analyses were used to control for confounders. The receiver-operating characteristic (ROC) curve was depicted to show the prognostic performance. The stepwise backward elimination method was performed to develop a nomogram, where tenfold cross-validation was used to protect it against overfitting. Results: Higher RPR can be observed among non-survivors than survivors with TBI (p < 0.001). Besides, high RPR was associated with increased mortality, with the odds ratio (OR) increasing from RPR of 0.074-0.098 (OR: 2.13, 95% CI 1.39 to 3.28, p = 0.001) to > 0.098 (OR: 3.82, 95% CI 2.55 to 5.72, p < 0.001), using RPR of < 0.057 as the reference. RPR had a moderately good prognostic performance with an area under ROC Curve (AUC) of 0.7367, which was greater than that of Glasgow Coma Scale (GCS, AUC = 0.6022). The nomogram consisting of RPR, GCS and other risk factors can further improve the prognostic value of RPR (Harrell’s C-index = 0.8582, p value of Hosmer-Lemeshow test = 0.3159). In addition, in-vivo experiments indicated that the continuous change in RPR after TBI was attributed to the development of inflammatory response.Conclusions: As an easily accessible index, RPR is a promising predictor of mortality for acute TBI. The nomogram generated from RPR can be used in resource-limited settings, thus be proposed as a prognosis evaluation aid for patients with TBI in all levels of medical system.
LncRNA MALAT1 Forms a Negative Feedback Loop With lncRNA CRNDE in Sepsis to Regulate Lung Cell Apoptosis
Authors: Yue Caifang , He Muhan , Teng Yanping , Bian Xiaoli
Published: September 2020

Background: It has been reported that lncRNAs MALAT1 and CRNDE plays opposite roles in sepsis. Therefore, they may have crosstalk. We therefore explored the potential interaction between them in sepsis. Methods: Plasma samples were collected from both sepsis patients (n=60) and healthy controls (n=60). Expression of MALAT1 and CRNDE in plasma samples before than after treatment was determined by RT-qPCR. Results: Overexpression of MALAT1 and CRNDE in Human Bronchial Epithelial Cells (HBEpCs) was achieved to explore the relationship between them. The roles of MALAT1 and CRNDE in regulating the apoptosis of HBEpCs were analyzed by cell apoptosis assay. MALAT1 was upregulated in sepsis, while CRNDE was downregulated in sepsis. In lung cells, overexpression of MALAT1 and CRNDE mediated the downregulation of each other. With proper treatment, MALAT1 was downregulated in sepsis and CRNDE was upregulated in sepsis. In lung cells, LPS mediated the upregulation of MALAT1 and the downregulation of CRNDE. Cell apoptosis analysis showed that MALAT1 overexpression promoted the apoptosis of lung cells induced by LPS, and the overexpression of CRNDE played an opposite role. Moreover, CRNDE overexpression attenuated the effects of MALAT1 overexpression. Conclusion: MALAT1 may form a negative feedback loop with CRNDE in sepsis to regulate lung cell apoptosis.
WITHDRAWN: First molecular evidence of Hepatozoon canis infection in Rhipicephalus sanguineus (sensu lato) ticks in Iran
Authors: Zeinali MohammadReza , Malekifard Farnaz , Rakhshanpour Alaleh , Yakhchali Mohammad
Published: September 2020

Background
Hepatozoon canis is a protozoan that is transmitted by the ixodid ticks. Ingesting the tick or a section of the tick organ which is infected by the mature oocysts containing infectious sporozoite is the main source of infection in dogs. Canine hepatozoonosis infects dogs in Iran, but the vector for Hepatozoon protozoa from Iran has never been demonstrated. The present study aims to detect H. canis in dogs and vector ticks in Iran.
Methods
During the period of 2018–2019, Blood samples and ixodid ticks were collected and examined using microscopical, molecular, and serological methods. A total of 246 blood samples were collected from the cephalic vein of pet, stray, and shelter dogs (103 stray, 99 shelter, and 44 pets) of both genders and varying ages in Northwest of Iran.
Results
Microscopically, infected neutrophils with Hepatozoon spp. were detected in 5 of 246 (2.03%) thin stained blood smears with low parasitemia. Indirect immunofluorescent antibody test (IFAT) was used to test the serum samples and antibodies against H. canis were detected in 31 (12.6%) of the serum samples. Molecularly, 23 out of 246 (9.34%) blood samples were found to be infected with H. canis. A comparison of the results of 3 diagnostic methods demonstrated a good agreement between IFAT and PCR and a poor agreement between microscopical examination with IFAT and PCR. There was no significant difference in different age groups and sex of sampled dogs. However, stray dogs had significant infection rate of than pets and shelter ones. In body inspection, 141 adult ticks (31 partially engorged females, 26 fully engorged female and 84 fed males) were collected from examined dogs and all ticks were belonging to species of Rhipicephalus sanguineus (sensu lato). Positive reaction to H. canis was observed in the genomic DNA of the 7 ticks (4.96%). A BLAST analysis of obtaining sequences isolated from both dogs and ticks indicated a 99–100% similarity with H. canis 18S rRNA gene sequences in GenBank. This is the first study in Iran to detect H. canis in R. sanguineus tick.