bluuebunny/crossref_metadata_2025 huggingface dataset:
The Differences of Ventilation Quality, Natural Lighting and House Wall Conditions to Pulmonary Tuberculosis Incidence in The Working Area of Sidomulyo Health Center, Kediri Regency
Authors: Fitriani Hirda Ulis
Published: February 2020

Introduction: Tuberculosis (TB) was a disease that causes by the manifestation infection of Mycobacterium tuberculosis. As a contagious disease, TB causes high morbidity and mortality. Determinant factors that influence the number of TB incidents in the community were the physical environment. This study aims to analyze the differences in environmental conditions for the TB incident at the working area of the Sidomulyo Health Center, Kediri Regency. Method: This study was an observational research with a case-control study design. A total respondent in this study was 44 respondents, divided into two groups: 22 case group respondents and 22 control group respondents. Respondent chosen by a simple random sampling method. Data collection was done through observation and interview activities. Data analysis using the Mann Whitney test. There were differences in physical environment conditions between the two groups (p <0.05) which consisted of ventilation quality, natural lighting, and wall conditions. Result and Discussion: There was no difference in room occupancy density, room air temperature, room air humidity and room floor conditions in patients with pulmonary TB and non-pulmonary TB. Conclusion: Therefore, there was need socialization to provide information about the importance of healthy homes to the community especially about the presence of ventilation, natural lighting, conditions of residential density and wall conditions.
Understanding the Roles of Effectuation and Bricolage in the Opportunity Creation Framework
Authors: Chinyoka Samuel
Published: February 2020

The process of entrepreneurship is identifying and exploiting opportunities. Entrepreneurial action can also result in forming, rather than merely encountering opportunities. Researchers, like Alvarez and Barney (2007), also distinguish two approaches to entrepreneurial action, discovery and creation. In opportunity creation, opportunities for entrepreneurial profit are formed endogenously through action.Effectuation processes focus on what can be done, given the capacity to influence and means at hand, to move toward a future endpoint. Effectuation was developed in the context of entrepreneurship and it assumes that an opportunity may arise through control-based strategies.Bricolage was initially described by Levi-Strauss (1967) as ‘making do with what’s on hand’. This was extended by Baker and Nelson (2005) and applied to the process of value creation. They observed that some entrepreneurs prefer to engage in a process of “making do by applying combinations of resources at hand to new problems and opportunities”.These are new concepts to most entrepreneurship researchers, yet extremely useful in the understanding of opportunity creation. This conceptual paper will assist in the understanding of these concepts, and clarify the roles of effectuation and bricolage in the opportunity creation framework. A discussion section should attempt to bring the concepts to reality by highlighting realistic examples.
Ratio of Land Consumption Rate to Population Growth Rate - A Case of Gombe Metropolis
Authors: Abdulkadir Ishiyaku , Kumar J. Sathish , Noon Monica
Published: February 2020

Demographic and socio-economic developments couple with other requirements to satisfy human needs result in rapid urban expansion sometimes with increasing rate of surface extent greater than the rate of growth of population, that result in continuous sealing of ground surface thereby affecting ecosystem services. This study applied remote sensing toward achieving the progress of SDGs and stage to determine the ratio of the rate of land consumption to the rate of population growth of Gombe metropolis. QGIS 2.18 was used for the image processing and classification analysis for the key Landsat ETM+ (Enhanced Thematic Mapper), Impervious Surface Indices and population data to inform on the urban trend and LCR/PGR for the periods 2000-2005, 2005-2010, and 2010-2015. The result appears that the LCR/PGR for the periods of study show split trends. During 2000-2005 the result shows that the study area expanded outward with LCR/PGR of 1.2. The result also indicate that during 2005-2010, the study area densified with little expansion with the LCR/PGR of 0.8. The result further reveals that during 2010-2015 the LCR/PGR reached 1.8. Pointing that the study area expanded outward with the rate of ground sealing getting high.
Glucose as a Major Antioxidant: When, What for and Why It Fails?
Authors: Cherkas Andriy , Holota Serhii , Mdzinarashvili Tamaz , Gabbianelli Rosita , Zarkovic Neven
Published: February 2020

A human organism depends on stable glucose blood levels in order to maintain the metabolic needs. Glucose is considered as the most important energy source and glycolysis is postulated as a backbone pathway. However, when glucose supply is limited, ketone bodies and amino acids can be used to produce enough ATP. In contrast, for the functioning of pentose phosphate pathway (PPP) glucose is essential and cannot be substituted by other metabolites. PPP generates and maintains levels of NADPH needed for reduction of oxidized glutathione and protein thiols, synthesis of lipids and DNA as well as for xenobiotic detoxification, regulatory redox signaling and counteracting infections. Flux of glucose into a PPP, particularly under extreme oxidative and toxic challenges is critical for survival, whereas the glycolytic pathway is primarily activated when glucose is abundant, and there is lack of NADP+ that is required for activation of glucose-6 phosphate dehydrogenase. An important role of glycogen stores in resistance to oxidative challenges is discussed. Current evidences explain disruptive metabolic effects and detrimental health consequences of chronic nutritional carbohydrate overload and provides new insights into positive metabolic effects of intermittent fasting, caloric restriction, exercise, and ketogenic diet through modulation of redox homeostasis.
Consultation Urgency And Counseling As Islamic Legal Strategy In Legal Positivisation In Indonesia
Authors: Itmam Muhammad Shohibul
Published: February 2020

Islamic law in the context of fiqh positivization needs certain strategies. consultation and counseling can be a strategy in islamic law positivisation. various strategies and explanations provide a special pattern in islamic legal thinking in indonesia. this writing discusses consultation and counseling as an islamic legal strategy leading to legal positivity in indonesia. with an elaborative approach between normative law and empirical law  this writing concludes that islamic law is one part of the raw materials of national law that can be managed pluralistically with other laws that grow in indonesia. the plurality of indonesian law which is an empirical constitution can bring with islamic law through professional consultation and consequences. The practical strategy is uniting perceptions which are the substance of islamic teachings related to the meaning of sharia and fiqh in the values of universality of humanity such as the substance of justice, honesty, equality of balance and liking. with the strategy such islamic law can be a solution for national law at the secondary of islamic laws can move to color the development of national law into positive law.
Kai-Wait Culture as an Effort to Facilitate Interfaith Counseling in Post-Conflict Islamic-Christian Relations on Buru Island Maluku
Authors: Tasidjawa Yuliana Febriani , Engel Jacob Daan
Published: February 2020

This article discusses the role of Kai-Wait as a philosophy of life in the post-conflict reconciliation process towards Islam-Christian relations from the perspective of interfaith and cultural assistance and counseling on Buru Island, Maluku. The method used is a qualitative research method. Data collection techniques used were observing research sites, namely some areas on Buru Island which became a place of debate, interviews with traditional leaders, religious leaders, and the community, as well as conducting literature studies through literature relevant to the research in this paper. Analysis of the data used is the Miles and Huberman Interactive Model. In this study, the authors found that Kai -unggu as the local wisdom of the Buru community was a means of reconciling conflict. In addition to conflict reconciliation, values in the Kai-Wait culture are also an aid in interfaith and cultural assistance and counseling on the island of Buru. The pattern of counseling is done with the help of Centered Client Therapy with common cases such as family problems, social crisis, and trauma. The values that the writer found in interfaith counseling and counseling and the value of brotherhood / family and the value of appreciation.
Open and Closed Reduction for Developmental Dysplasia of the Hip in New York State
Authors: Swarup Ishaan , Ge Yile , Scher David , Sink Ernest , Widmann Roger , Dodwell Emily
Published: February 2020

Background:

There are limited data on the incidence and outcomes of open and closed hip reduction in patients with developmental dysplasia of the hip (DDH). The aims of this study were to determine the incidence of open and closed reduction of the hip using population-level data and to assess the rates of subsequent surgery.

Methods:

Children aged 3 years and younger with DDH who underwent open or closed reduction of the hip between 1997 and 2013 were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patient age, sex, race, and insurance status as well as concurrent procedures were extracted. Admissions through 2014 were searched for subsequent surgeries, providing a minimum 1-year post-reduction surveillance for all patients. Age-specific incidence rates were calculated using New York State annual population data. The rates of concurrent and subsequent surgeries were calculated. A sensitivity analysis was performed to provide a range for the rates of subsequent surgery. Univariate analyses consisted of chi-square or Fisher exact tests for categorical variables.

Results:

In total, 897 patients (637 who underwent closed reduction and 260 who underwent open reduction) were identified. The age-specific incidence per 100,000 population was 12.5 for closed reduction and 2.6 for open reduction for <1-year-olds, 2.2 for both closed and open reductions for 1-year-olds, 0.4 for closed reduction and 1.0 for open reduction for 2-year-olds, and <0.3 for closed reduction and 0.5 for open reduction for 3-year-olds. Overall, closed reductions were performed more frequently over the study period (p < 0.01). The estimated rate of subsequent ipsilateral surgery was 12.4% (range, 9.4% to 33.1%) after index closed reduction and was 14.2% (range, 8.5% to 40.1%) after index open reduction.

Conclusions:

We found that the incidence of closed or open hip reduction for DDH was small and that there was an increase in the number of closed reductions performed over time. The rates of subsequent surgery remained relatively high for patients after index closed or open hip reduction.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Investigation of Smart Waterflooding in Sandstone Reservoirs: Experimental and Simulation Study Part 2
Authors: Al-Saedi Hasan N. , Flori Ralph E. , Alsaba Mortadha
Published: February 2020

In a previous work (Al-Saedi et al. 2018c), we studied the effect of mineral composition of cores (using synthetic columns with varying mineralogy) on low-salinity (LS) waterflooding, and we presented a reactive-transport model (RTM) for the water/rock interactions. The results showed that kaolinite has the strongest effect and then quartz because of the high kaolinite surface area, and the most effective complexes were >SiOH (hydroxylated Si), >AlO– (aluminum oxide complex on quartz surface), and >SiO– (silicon mono oxide complex on quartz surface).

In this paper, we use the same Bartlesville Sandstone cores (constant mineralogy) for all cases to investigate the effect of water chemistry on water/rock interactions during seawater and smart waterflooding of reservoir sandstone cores containing heavy oil. Oil recovery, surface-reactivity tests, and multicomponent reactive-transport simulation using CrunchFlow (Steefel 2009) were conducted to better understand smart waterflooding.

Bartlesville Sandstone cores were saturated with heavy oil and connate formation water. Secondary waterflooding of these cores with formation water (FW) at 25°C resulted in an ultimate oil recovery of approximately 50% original oil in place (OOIP) for all reservoir cores in this study. FW salinity was 104,550 ppm. FW was diluted twice to obtain Smart Water 1 (SMW1). SMW2 was similar to SMW1 but depleted in divalent cations (Ca2+ and Mg2+). SMW3 was also similar to SMW1 but depleted in Mg2+ and SO42−, whereas SMW4 was the same as SMW1 but Ca2+ was diluted 100 times. Seawater (SW) salinity was 48,300 ppm, which is close to the SMW salinity (52,275 ppm). No oil recovery was observed during SMW1 flooding, whereas softening SMW1 (SMW2) resulted in a significant additional oil recovery of OOIP. Depleting Mg2+ and SO42− resulted in additional oil recovery but less than in SMW2. Diluting Ca2+ 100 times was the second-best scenario, after depleted Ca2+ in SMW2. The results of this study showed that the more diluted Ca2+ is in the injected brine, the more additional oil recovery that can be obtained, although the other divalent/monovalent cations/anions were increased or decreased or even depleted.

Additional reservoir cores were allocated for surface-reactivity tests. The absence of an oil phase allows us to isolate the important water/rock reactions. The Ca2+, Mg2+, and SO42− effluents for all cores were matched using CrunchFlow, and then further investigations of the water/rock interactions were conducted. The RTM showed that decreasing the Mg2+ concentration will decrease the number of the most effective kaolinite edges Si-O− and Al-O−, but was not as pronounced as that in the presence of Ca2+, which explains why lowering the Mg2+ concentration gives lower additional oil recovery and why lowering the Ca2+ concentration gives higher additional oil recovery.
Asphaltene Deposition and Removal in Flowlines and Mitigation by Effective Functional Molecules
Authors: Kar Taniya , Naderi Khosrow , Firoozabadi Abbas
Published: February 2020

Efficient removal of deposited asphaltenes on the surface of metallic flowlines by functional molecules is investigated by nonionic and ionic surfactants at low concentrations. Deposition removal by aromatic solvent toluene is measured as a reference. Water is often coproduced with crude oil and may affect deposition of asphaltenes and removal. In this study, we investigate the effect of water in both asphaltene deposition and removal by functional molecules. Two different crudes from different fields that give rise to serious asphaltene deposition are extensively investigated. For these two crudes, we find one ionic and one nonionic surfactant to be effective in deposition removal at 1 wt% concentration in the crude. This concentration is much lower than that of the commonly studied acidic dodecylbenzene sulfonic acid (DBSA) surfactant. Toluene concentration in the crude varies from 40 to 60 wt% for asphaltene deposition removal. Water delays deposition significantly. However, water does not have an appreciable effect on performance of functional molecules on removal of deposited asphaltenes.
Seascape genomics reveals population isolation in the reef-building honeycomb worm, Sabellaria alveolata (L.)
Authors: Muir Anna P , Dubois Stanislas F. , Ross Rebecca E. , Firth Louise B. , Knights Antony M. , Lima Fernando P. , Seabra Rui , Corre Erwan , Corguillé Gildas Le , Nunes Flavia L. D.
Published: February 2020

Background: Under the threat of climate change populations can disperse, acclimatise or evolve in order to avoid fitness loss. In light of this, it is important to understand neutral gene flow patterns as a measure of dispersal potential, but also adaptive genetic variation as a measure of evolutionary potential. In order to assess genetic variation and how this relates to environment in the honeycomb worm (Sabellaria alveolata (L.)), a reef-building polychaete that supports high biodiversity, we carried out RAD sequencing using individuals from along its complete latitudinal range. Patterns of neutral population genetic structure were compared to larval dispersal as predicted by ocean circulation modelling, and outlier analyses and genotype-environment association tests were used to attempt to identify loci under selection in relation to local temperature data. Results: We genotyped 482 filtered SNPs, from 68 individuals across nine sites, 27 of which were identified as outliers using BAYESCAN and ARLEQUIN. All outlier loci were potentially under balancing selection, despite previous evidence of local adaptation in the system. Limited gene flow was observed among reef-sites (FST= 0.28 ± 0.10), in line with the low dispersal potential identified by the larval dispersal models. The North Atlantic reef emerged as a distinct population and this was linked to high local larval retention and the effect of the North Atlantic Current on dispersal. Conclusions: As an isolated population, with limited potential for natural genetic or demographic augmentation from other reefs, the North Atlantic site warrants conservation attention in order to preserve not only this species, but above all the crucial functional ecological roles that are associated with their bioconstructions. Our study highlights the utility of using seascape genomics to identify populations of conservation concern.
Prevalence and Associated Factors for Frailty among Elder Patients in China: A multicenter cross-sectional study
Authors: Jiao Jing , Wang Yu , Zhu Chen , Li Fangfang , Zhu Minglei , Wen Xianxiu , Jin Jingfen , Wang Hui , Lv Dongmei , Zhao Shengxiu , Wu Xinjuan , Xu Tao
Published: February 2020

Background: Up to date, most of previous studies of frailty among hospitalized elder Chinese patients were conducted based on a small sample, which could not represent the elder patient population. The aim of this study is to identify the prevalence and the risk factors for frailty among elder patients in China. Study Design and Setting: This is a cross-sectional study, 9996 elder patients from 6 tertiary level hospitals in China were surveyed. The prevalence of frailty among patients from selected wards was surveyed by trained investigators. Mixed-effect Poisson regression model were used to analyze the associated factors of frailty among elder patients. Results: The mean age of all subjects was72.47±5.77years. The prevalence rate of frailty in this study was 18.02%. After controlling the confounding effect of hospital wards clustering effect, Mixed-effect Poisson regression model showed that the associated factors of frailty included: age(OR:1.016, 95% CI:1.012 -1.020), patients with BMI < 18.5(OR: 1.248, 95% CI:1.171-1.330), female(OR:1.058, 95% CI:1.004 -1.115), ethnic minorities(OR: 1.152, 95% CI: 1.073-1.236), admission to hospital by the emergency department(OR: 1.104, 95% CI:1.030 -1.184),the former drinker(OR: 1.094, 95% CI:1.022 -1.171),fall history in past 12 month(OR:1.257, 95%CI:1.194-1.323),vision dysfunction(OR:1.144 , 95% CI:1.080 -1.211),cognition impairment(OR:1.182 , 95% CI:1.130 -1.237),sleeping dysfunction(OR:1.215, 95% CI:1.215 -1.318),urinary dysfunction(OR: 1.175, 95% CI:1.104 -1.251),defecation dysfunction(OR:1.286 , 95% CI:1.217 -1.358). Conclusion: We identified a relatively high prevalence of frailty among elder patients, and there are several associate factors among the population derived from an investigation of a large-scale, multicenter, nationwide representative Chinese elderly inpatient population. Trial registration: Chinese clinical Trial registry, ChiCTR1800017682, Registered 09 August 2018 Keywords: Frailty; Elder patients; Prevalence; Associate factors
Genome-wide analysis of Myo-inositol oxygenase gene family in tomato reveals their involvement in ascorbic acid accumulation
Authors: Munir Shoaib , Mumtaz Muhammad Ali , Ahiakpa John Kojo , Liu Genzhong , Zheng Wei , Zhou Guolin , Zheng Wei , Ye Zhibiao , Zhang Yuyang
Published: February 2020

Background: Ascorbic acid (Vitamin C, AsA) is an antioxidant metabolite involved in plant development and environmental stimuli. AsA biosynthesis has been well studied in plants, and MIOX is a critical enzyme in plants AsA biosynthesis pathway. However, Myo-inositol oxygenase (MIOX) gene family members and their involvement in AsA biosynthesis and response to abiotic stress remain unclear. Results : In this study, five tomato genes encoding MIOX proteins and possessing MIOX motifs were identified. Structural analysis and distribution mapping showed that 5 MIOX genes contain different intron/exon patterns and unevenly distributed among four chromosomes. Besides, expression analyses indicated the remarkable expression of SlMIOX genes in different plant tissues. Furthermore, transgenic lines were obtained by over-expression of the MIOX4 gene in tomato. The overexpression lines showed a significant increase in total ascorbate in leaves and red fruits compared to control. Expression analysis revealed that increased accumulation of AsA in MIOX4 overexpression lines is possible as a consequence of the multiple genes involved in AsA biosynthesis. Myo inositol (MI) feeding in leaf and fruit implied that the Myo-inositol pathway improved the AsA biosynthesis in leaves and fruits. MIOX4 overexpression lines exhibited a better light response, abiotic stress tolerance, and AsA biosynthesis capacity. Conclusions: These results showed that MIOX4 transgenic lines contribute to AsA biosynthesis, evident as better light response and improved oxidative stress tolerance. This study provides the first comprehensive analysis of the MIOX gene family and their involvement in ascorbate biosynthesis in tomato.
An exclusion mechanism is epistatic to an internal detoxification mechanism in aluminum resistance in Arabidopsis
Authors: Wang Yuqi , Yu Wancong , Cao Yu , Cai Yanfei , Lyi Sangbom M. , Wu Weiwei , Kang Yan , Liang Cuiyue , LIU JIPING
Published: February 2020

Background In Arabidopsis , the aluminum (Al) exclusion mechanism is mainly facilitated by ALMT1-mediated malate exudation and MATE-mediated citrate releases from the root. Recently, we have demonstrated that coordinated functioning between the ALMT1-mediated Al exclusion mechanism, via exudation of malate from the root tip, and a NIP1;2-facilitated internal detoxification mechanism, via removal of Al from the root cell wall and subsequent root-to-shoot Al translocation, plays critical roles in achieving overall Al resistance. However, the genetic relationship between ALMT1 and NIP1;2 in these processes remained unclear. Results Through genetic and physiological analyses, we demonstrate that unlike ALMT1 and MATE , which function independently and additively, ALMT1 and NIP1;2 show an epistatic relationship in Al resistance. These results indicate that ALMT1 and NIP1;2 function in the same biochemical pathway, whereas ALMT1 and MATE in different ones. Conclusion The establishment of the epistatic relationship and the coordinated functioning between the ALMT1 and NIP1;2-mediated exclusion and internal detoxification mechanisms are pivotal for achieving overall Al resistance in the non-accumulating Arabidopsis plant. We discuss and emphasize the indispensable roles of the root cell wall for the implementation of the Al exclusion mechanism and for the establishment of an epistatic relationship between the ALMT1-mediated exclusion mechanism and the NIP1;2-facilitated internal detoxification mechanism.
Measuring the effectiveness of digital nursing technologies: Development of a comprehensive digital nursing technology outcome framework based on a scoping review
Authors: Krick Tobias , Huter Kai , Seibert Kathrin , Domhoff Dominik , Wolf-Ostermann Karin
Published: February 2020

Background: Digital nursing technologies (DNT) comprise an expanding, highly diverse field of research, explored using a wide variety of methods and tools. Study results are therefore difficult to compare, which raises the question how effectiveness of DNT can be adequately measured. Methods currently used might not be sufficient for certain specific nursing contexts. A comprehensive outcome framework that shows the multitude of possible outcome areas could be useful to generate more comparable results. The aim of the present study is to develop an outcome framework for DNT and to indicate which outcome areas have been most frequently evaluated in previous studies and how this has been done. Methods: A mixed method design was used to develop the DNT outcome framework. The numerical analysis is based on a scoping review focussing on the effectiveness of DNT for persons in need of care, formal or informal caregivers or care institutions. Nine databases were included in the screening: Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. Additional literature searches and expert interviews were included. Results: The developed framework comprises four outcome target groups and 47 outcome areas. There are considerable differences in the researched outcome areas for the individual outcome target groups. Persons in need of care were by far the most frequently surveyed, particularly with respect to their psychological health. There are much fewer studies on formal and informal caregivers, and it is particularly noticeable that the quality of life of both groups has rarely been investigated. Care process quality was most frequently researched for organisations. Conclusion: We were able to provide a comprehensive DNT outcome framework, thereby identifying the outcome tools used and the less researched outcome areas. We recommend a detailed investigation of all areas and tools in future research projects with a view to initiating a discussion on the differing importance of existing outcome areas and on a standardisation of outcome tools. We also recommend the development of outcome areas for the macro level of effectiveness assessment. Keywords: Technology, Care, Nursing, Framework, Effectiveness, Effect, Digital, Outcome, Evidence
Intravenous oxycodone compared to morphine for post-operative opioid-related adverse events in opioid naïve patients: a prospective randomized controlled trial
Authors: cuvillon philippe , Alonso Sandrine , Lhermite Joel , Reubrecht Vanessa , Zoric Lana , Vialees Nathalie , faillie jean-luc. , Kouyoumdjian Pascal , Boisson Christope , raux mathieu , langeron olivier
Published: February 2020

Bacground: Intravenous oxycodone compared to morphine for postoperative pain relief is controversial. The purpose of this study was to assess opioid-related adverse events of oxycodone versus morphine in opioid-naive patients after orthopaedic surgery. Methods: Patients scheduled for total hip arthroplasty under general anesthesia combined with a multimodal analgesia (acetamnophen, nonsteroidal anti-inflammatory) were randomized in a triple-blinded trial to postopertaive pain treatment with either intravenous oxycodone or morphine (potency ratio 1:1). After surgery, patients received similar drug regimen for titration in the postoperative care unit (bolus 2-3 mg, 5 min period, when pain score was >3/10) followed by an intravenous patient controlled analgesia (bolus 1 mg, lockout time 7 min) postoperatively. The primary outcome was number of patients with ≥1 opioid-related adverse events within the first 24 hours (at least one of the following complications: nausea, vomiting, respiratory depression, pruritus, urinary retention requiring evacuation, allergy, hallucination). Secondary outcomes included pain scores, opioid consumption. Patients were followed up to 4 months. Results: The intention-to-treat analysis included 241 patients with similar characteristics. There were 55 patients with at least one opioid-related adverse events in oxycodone group versus 46 in morphine group (48% vs 40%, p=0.19; relative risk= 1.22 [0.91; 1.63]). Oxycodone versus morphine requirements were respectively: 6 [0-11] versus 8 [0-12] mg (p=0.06) for titration, 15 [8-26] versus 8 [5-16] mg (p=0.001) for PCA dose, and 22 [12-37] mg versus 19 [11-28] mg for the titration and PCA accumulated consumption (p=0.048). During the first 24 hours, there were no other differences in secondary outcomes between both drugs for (respectively oxycodone versus morphine in %): nausea (15 versus 13), vomiting (5 versus 5 ), urinary retention (20 versus 12 ) and pain scores. Conclusion: This study demonstrated that oxycodone required lower doses for titration in postoperative care unit, but did not significantly reduce opioid-related adverse events within the first 24 hours compared to morphine.
An empirical analysis of Unit costs of public hospitals in Jordan
Authors: Hammad Eman A , Alabbadi Ibrahim , Taissir Fardos , Hajjwi Malek , Obeidat Nathir M. , Alefan Qais
Published: February 2020

Background: Public providers in low-middle income countries face enormous pressures to meet complex needs of its population. This study aimed to benchmark unit costs of hospital services in public providers in Jordan to provide useful insight and readings of healthcare delivery and sustainability. Methods: Unit costs of hospital services per admission, inpatient days, outpatient visits, emergency visits and surgical operations were estimated using standard average costing method. Unit costs per inpatient days was estimated relevant to nine specialities, staff and selected medical services too. Unit costs were estimated in Jordanian Dinars (exchange rate= US$1.41). Results: Average unit cost per admission was 782.3 JDs (U$1101.8), per inpatient day was 236.6 JDs (U$ 333.2), per bed day was 172.9 JDs (U$244.9), per outpatient visit was 58.4 JDs (U$ 82.3), per operation was 449.6 JDs (U$ 633.2) and per emergency room visit was 31.8 JDs (U$44.8). ICU/CCU and OB/GYN presented the highest unit costs per inpatient days across providers; U$532.9 and U$510.7 respectively. Unit costs varied depending on service utilization, type of service and organizational outset. Conclusions: Countries in areas of political conflicts face enormous fiscal constraints, health policy makers, managers and stakeholders ought to understand these challenges and foster use of value based budgeting and performance analysis.
Combined Use of Intravenous and Topical Tranexamic Acid Efficiently Reduce Blood Loss in Patients Undergoing 2-level lumbar fusion
Authors: Li Jianjiang , Wang Long , Bai Tao , Liu Yanlu , Huang Yifei
Published: February 2020

Purpose: The current study was conducted to assess the efficacy and safety of the intravenous (IV) administration combined with topical administration of tranexamic acid （TXA）in patients (aged over 60) scheduled for 2-level lumbar fusion surgery. Methods: 280 patients scheduled for 2-level lumbar fusion surgery were randomized into four groups, including an IV group, a local group, a combined group, and a control group. Patients in the combined group, in the IV group, in the topical group, and in the control group were administrated with 15 mg/kg of IV-TXA + 2 g TXA in local,15 mg/kg IV-TXA, 2 g TXA in local ,and 100 ml IV, respectively. The results of total blood loss (TBL) , maximum hemoglobin drop, the transfusion rate, and the number of allogeneic blood units were compared. Deep venous thrombosis (DVT) and pulmonary embolism (PE) events were monitored and recorded. Results: The TBL was 635.49 ± 143.60, 892.62 ± 166.85, 901.11 ± 186.25, and 1,225.11 ± 186.25 mL for the combined group, the IV group, the topical group, and the control group, respectively.(p = 0.015, p = 0.001 respectively).The average maximum hemoglobin drop in the four above groups was 2.18 ± 0.24, 2.80 ± 0.37, 2.40 ± 0.64 ，and 3.40 ± 1.32 g/dL, respectively. No PE event was reported during the follow-up. Although asymptomatic DVT events was reported by 1, 2, and 2 patients in the combined group, topical group, and control group, respectively, there is no intergroup difference. Conclusions: The combined use of TXA effectively reduced total blood loss and blood transfusion rate in patients aged over 60 scheduled for 2-level lumbar fusion, without increasing the incidence of DVT and PE formation. Keywords: Tranexamic acid, Total hip arthroplasty, Blood loss, Combined treatment
Quality of Life as a predictor of mortality in the general population: a systematic review and meta-analysis
Authors: Phyo Aung Zaw Zaw , Freak-Poli Rosanne , Craig Heather , Gasevic Danijela , Stocks Nigel , Gonzalez-Chica David A. , Ryan Joanne
Published: February 2020

Background: Quality of life (QoL) is multi-dimensional concept of an individual’ general well-being status in relation to their value, environment, cultural and social context in which they live. This study aimed to quantitatively synthesise available evidence on the association between QoL and mortality in the general population.Methods: An electronic search was conducted using three bibliographic databases, MEDLINE, EMBASE and PsycINFO. Inclusion criteria were studies that assessed QoL using standardized tools and examined mortality risk in a non-patient population. Qualitative data synthesis and meta-analyses using a random-effects model were performed.Results: Of 4,184 articles identified, 47 were eligible for inclusion, involving approximately 1,200,000 participants. Studies were highly heterogeneous in terms of QoL measures, population characteristics and data analysis. In total, 43 studies (91.5%) reported that better QoL was associated with lower mortality risk. The results of four meta-analyses indicated that higher health-related QoL (HRQoL) is associated with lower mortality risk, which was consistent for overall HRQoL (HR 0.633, 95% CI: 0.514 to 0.780), physical function (HR 0.987, 95% CI: 0.982 to 0.992), physical component score (OR 0.950, 95% CI: 0.935 to 0.965), and mental component score (OR 0.980, 95% CI: 0.969 to 0.992).Conclusion: These findings provide evidence that better QoL/HRQoL was associated with lower mortality risk. The utility of these measures in predicting mortality risk indicates that they should be considered further as potential screening tools in general clinical practice, beyond the traditional objective measures such as body mass index and the results of laboratory tests.
Experiences And Needs Concerning Health Related Information For Newly Arrived Refugees In Sweden
Authors: Mårtensson Lena , Lytsy Per , Westerling Ragnar , Wångdahl Josefin
Published: February 2020

Background Owing to communication challenges and a lack of knowledge about the health care system, refugees may be at risk of having limited health literacy, meaning that they will have problems in achieving, understanding, appraising and using health information or navigating in the health care system. The aim of this study was to explore experiences and needs concerning health related information for newly arrived refugees in Sweden. Methods A qualitative design with a focus group methodology was used. The qualitative content analysis was based on seven focus group discussions, including 28 Arabic and Somali speaking refugees. Results Four categories emerged. ‘Concrete instructions and explanations’ includes appreciation of knowledge about how to act when facing health problems. ‘Contextual knowledge’ comprises experienced needs of information about the health care system, about specific health risks and about rights in health issues. ‘A variation of sources’ describes suggestions as to where and how information should be given. ‘Enabling communication’ includes the wish for more awareness among professionals from a language and cultural point of view. Conclusion Concrete instructions and explanations are experienced as valuable and applicable. Additional information about health issues and the health care system is needed. Information concerning health should be spread by a variety of sources. Health literate health organizations are needed to meet the health challenges of refugees, including professionals that emphasize health literacy.
Effectiveness over 10 years (2004-2014) of the echinococcosis control progamme in China: Impact on humans and dogs population
Authors: Yu Qing , Han Shuai , Tian Tian , Xiao Ning , Zhou Xiaonong
Published: February 2020

Background A national control program for echinococcosis has been in effect since 2005 in China. This program has applied a comprehensive strategy, and good control results have been achieved. The objective of this study is focusing on the effectiveness of the programme with two indices, including patients treatment and registered dogs deworming, in endemic areas of echincoccosis control over the period of 10 years (2004-2014) in China. MethodsThe study was conducted in the pastoral and farming-pastoral regions of project counties in 10 provinces and autonomous regions, a database was established that included demography at county and township levels, grouping available patients into those subjected to surgery and those receiving drug treatment after population screening. Information was given regarding the diagnosis (CE, AE, co-infection or unclassified) and the number of registered dogs and that of those dewormed. All statistical analyses were performed using SPSS software version 18 (SPSS Institute, Chicago, IL, USA). The results are shown as percentages with the corresponding 95% confidence intervals (95% CIs). The situation with respect to humans and dogs were described using epidemiological descriptive analyses and the direct costs calculated after discount. ResultsOur study showed that over the 10-years period, the coverage rate for the patients treatment had increased 32.4% on surgical treatment as well as 81.3% on medical treatment, meanwhile, it had increased by 58.6% for registered dog deworming since 2007. The accumulated costs of US 27.03 $ million after discount on patients and registered dog treatment, it has account for 1/4 on total accumulated inputs (110.67 $ million) by Chinese government, in addition, it was by 57-fold on the annual inputs whereas 368-fold on accumulated inputs since the national program implementation. Conclusions As found through this study, it is suggested that sustainable follow-up evaluations are crucial for success and continued implementation of the national program, which will be necessary until the disease is under control and has been eliminated in all endemic areas of China. Based on the results obtained through this study, we recommend that more attention should be paid to controlling stray dogs during the ongoing program period. Keywords: Control progamme; Effectiveness, Echinococcosis, humans and dogs
Socioeconomic status, social capital, health risk behaviors, and health-related quality of life among Chinese older adults
Authors: Yang Ying , Wang Shizhen , Chen Lei , Luo Mi , Xue Lina , Cui Dan , Mao Zongfu
Published: February 2020

Background: The present study described the occurrence of health risk behaviors among Chinese older adults, and developed a structural equation model (SEM) to assess the associations between socioeconomic status (SES), social capital, health risk behaviors, and health-related quality of life (HRQoL). Methods: We conducted this cross-sectional study in Hubei, Jiangxi, Guangdong, and Fujian provinces, etc., China between January and March 2018. Demographic characteristics (age, gender, marital status, place of residence), SES (education level, family income), and health risk behaviors (smoking, alcohol consumption, physical inactivity, unhealthy diet, overweight or obesity, and sleep insufficient or excessive) were investigated. Social capital and HRQoL were assessed by the 16-item Personal Social Capital Scale (PSCS-16) and WHOQOL-Old, respectively. Structural equation modeling was applied to assess the associations between variables. Results: A total of 5439 older adults were included in this study. The prevalence of smoking, alcohol consumption, physical inactivity, unhealthy diet, overweight or obesity, and sleep insufficient or excessive were 34.7%, 34.4%, 64.3%, 45.0%, 26.6%, and 40.1%, respectively. 75% of the participants reported ≥2 health risk behaviors. Elderly individuals with more co-occurrence number of health risk behaviors demonstrated significant poor HRQoL ( F = 52.99, p <0.01). Smoking, physical inactivity, and unhealthy diet exhibited significant negative associations with HRQoL. Social capital, SES, as well as overweight or obesity, and sleep insufficient or excessive showed positive associations with HRQoL. Higher level of social capital positively associated with the occurrence of alcohol consumption, sleep insufficient or excessive, and negatively associated with physical inactivity, unhealthy diet, and overweight or obesity. Conclusions: Chinese older adults demonstrated high prevalence of health risk behaviors, as well as the proportion of their co-occurrences. Socioeconomic status, social capital, and health risk behaviors were important predictors of the elderly’s quality of life. Increasing elderly’s social capital, so as to prevent and control the occurrence of health risk behaviors, which might be an effective approach to improve the elderly’s health.
Changes in the geomagnetic field has little effect on the overwintering range of Eastern North American fall migratory monarch butterflies (Danaus plexippus), indicating a lack of an innate magnetic map sense for navigation
Authors: Guerra Patrick Anthony , Matter Stephen
Published: February 2020

BackgroundIndividuals of many species that perform annual long-distance migrations are capable of stopping at specific overwintering destinations, despite having not been there before. The iconic monarch butterfly (Danaus plexippus) and its annual long-distance fall migration is a famous example of this phenomenon. During the fall, Eastern North American monarch butterflies use various compass mechanisms to properly orient their flight southwards, in order to leave their summer breeding grounds in Southern Canada and the Northern United States, and reach their overwintering sites in Central Mexico. It remains a mystery, however, how monarchs locate and stop at these specific, consistent overwintering sites, especially since these individuals are on their maiden voyage. MethodsWe test the hypothesis that fall migrant monarchs locate these overwintering sites by using an innate, inherited map sense based on sensing and responding to specific geomagnetic signatures that are correlated with the overwintering sites. Using a natural displacement approach, we examined if the locations of overwintering sites and the abundance of monarchs at them, changes with the natural shift of the Earth’s magnetic field over time (2004-2018).ResultsWe found that despite the natural displacement of the geomagnetic field over the years, the locations of the overwintering sites and monarch abundance were unaffected. For example, fall monarchs continued to overwinter at the most southern sites in Mexico, even when the geomagnetic coordinates associated with these sites would have shifted north due to the natural shift of the Earth’s magnetic field, placing these sites significantly outside the range of the overwintering area.ConclusionsOur results suggest that monarchs do not employ a map sense based on geomagnetic cues for finding their overwintering sites, and might instead use other mechanisms or strategies for locating them (potentially using localized sensory cues) once they are near or have arrived in Central Mexico. We suggest that future work should now focus on understanding what these cue parameters are, in order to inform conservation efforts that are aimed at protecting the threatened monarch butterfly and preserving its annual long-distance migration.
Recurrent Sequence Evolution After Independent Gene Duplication
Authors: Dunk Samuel Hermann Alexander Von Der , Snel Berend
Published: February 2020

Background Convergent and parallel evolution provide unique insights into the mechanisms of natural selection. Some of the most striking convergent and parallel (collectively recurrent ) amino acid substitutions in proteins are adaptive, but there are also many that are selectively neutral. Genome-wide assessment of recurrent substitutions has only been performed for orthologs. These studies have revealed that the pervasiveness of recurrent substitutions is for a large part explained by purifying selection. At any position in a protein, only a subset of amino acids is allowed, increasing the chance of the same substitution happening in different lineages. ResultsWe developed a framework that detects patterns of recurrent differentiation in paralogs across 90 divergent eukaryotic genomes. A skew in recurrent substitutions serves as a proxy for a recurrent trend in function. We find remarkable examples of recurrent sequence evolution after independent duplication, in some cases involving more than ten different lineages where duplicates show a similar differentiation. We reveal the implicated functional patterns for the gene families Hint1/Hint2, Sco1/Sco2 and vma11/vma3. ConclusionsThe presented methodology provides a means to study the biochemical underpinning of functional differentiation between paralogs. For instance, two abundantly repeated substitutions are identified between independently derived Sco1 and Sco2 paralogs. Such identified substitutions allow direct experimental testing of the biological role of these residues for the repeated functional differentiation. The present study uncovers a diverse set of families with recurrent sequence evolution and reveals trends in the functional and evolutionary trajectories of this hitherto understudied phenomenon.
Trigger team activation for acute patients. A cohort study at a level 1 university hospital in Denmark
Authors: Posth Stefan , Froberg Lonnie , Bak Søren , Jensen Lisette Okkels , Brabrand Mikkel , Lassen Annmarie
Published: February 2020

Background While patients with major trauma, suspected ST-elevation myocardial infarction (STEMI) or stroke have implemented pathways for quick access to specialized trigger teams, other patients with time dependent diseases present with less obvious aetiology and have less documented pathways at arrival to the hospital. Aim To describe the number, diagnosis and prognosis of patients arriving to the trigger teams for trauma, suspected STEMI, suspected stroke, and Medical emergency patients (MEP) Method Retrospective cohort study of all patients who between November 2012 and September 2015 had either a trauma, STEMI, stroke or MEP trigger team activation at arrival to Odense University Hospital – a level 1 trauma centre, a direct referral centre for patients with suspected STEMI to the catheterization laboratory or stroke, and with a trigger team at emergency department arrival of MEP patients from the local area. Results There were 8,075 activations of a trigger team at hospital arrival, median 7.6 calls per day (range 1-18); 16.7% trauma, 28.3% STEMI, 19.7% stroke and 35.3% MEP calls. This corresponds to 161/100,000 person years (py) with trauma calls, 64/100,000 py STEMI calls, 72/100,000 py stroke calls and 340/100,000 py MEP calls. Patients from the different calls had a 30-day mortality of 12% (trauma), 8% (STEMI), 5% (stroke), and 25% (MEP). Whereas patients from trauma, STEMI and stroke calls were mainly discharged within a few ICD10 (International classification of diseases, version 10) main coding areas, patients from MEP calls had discharge diagnosis within many different ICD10 main coding areas. Conclusion Trauma, STEMI and stroke trigger teams are used at a daily base, treat a prehospitally well-defined patient population and have a relatively low 7-day mortality. Patients with MEP calls are more frequent, have a diverse aetiology and a higher mortality than patients in the other trigger teams.