bluuebunny/crossref_metadata_2025 huggingface dataset:
Achievements and Challenges in Implementing Urban Family Physician Program in Iran: Viewpoint of Managers and Executives
Authors: Kabir Mohammad Javad , Ashrafian Amiri Hasan , Hassanzadeh-Rostami Zahra , Momtahen Reza , Zafarmand Rasoul , Nasrollahpour Shirvani Seiyed Davoud
Published: September 2019

Background: Urban family physician program is one of the relatively large reforms in Iran's health care system implemented in Fars and Mazandaran provinces since 2012. Nearly five years after implementation of the program, this study aimed to identify the achievements and challenges of this program from the viewpoints of managers and administrators.
Methods: This cross-sectional study was conducted in winter of 2016. The research population included administrators and experts monitoring the urban family physician program and representatives of the family physicians and health care providers selected using the census method. The data collection tool was a two-part researcher-made questionnaire containing 15 questions with confirmed validity. To collect data, 29 panels of experts were held and the collected information was analyzed by SPSS 23 using independent t-tests and ANOVA.
Results: Among the total of 647 participants in 2 provinces, 1540 achievement cases, 2387 challenge cases, and 1641 strategies were found. The average numbers of achievements, challenges, and strategies stated by each person were 2.38 ± 2.0, 3.70 ± 2.7, and 2.54 ± 2.0, respectively. The most frequent achievements, challenges, and strategies were increased disease detection and care (430), untimely payment to physicians (198), and providing sustainable resources for timely payments (119).  The means of achievements, challenges, and strategies had significant relationship with some of the individual and social variables (p < 0.05).
Conclusion: This study showed that increasing the rate of detection was the most important achievement and lack of timely payment was the biggest challenge of the program, which should be considered by policy makers.
Analysis of Emergency Department Queue System Performance: Simulation Approach Based on Experiment Design
Authors: Bahari Arman , Asadi Farzaneh
Published: September 2019

Background: Simulation is an appropriate technique for analyzing and evaluating the dynamic behavior of complex systems. The present study aimed to develop an integrated model using a simulation approach based on designing experiments to analyze performance of the admission queue system of patients, who referred to the emergency department of the Modarres hospital.
Methods: In this descriptive-analytical research, effective variables on resource efficiency empowerment were identified and analyzed using inferential statistics and one-way ANOVA. Later, effects of the effective factors were estimated. Furthermore, performance of the emergency department system was simulated using the Visual Paradigm software. Results obtained from implementation of the simulation model were used as input for designing an experiment. A fully factorial 2-level experiment design was also used with central points. The independent variables studied in the simulation model included practical nurse, emergency secretary, nurse, cardiologist, and hospital bed. The dependent variable was the patients' waiting queue in the studied emergency department.
Results: According to , the acceptable effects were determined based on the results of variance analysis for the model. The value of  indicated that 82.35% of the model explains all variability of the response-level data around the mean. Therefore, it can be concluded that the design space was in accordance with the estimated model based on the results of variance analysis.
Conclusion: In the present study, performance analysis of the emergency department queue system was conducted using simulation and experiment design. The nonlinear regression model was able to predict the queue length. Moreover, this model can be used to predict dependent variables considering acceptable factors. According to the results, minimum length of the queue is obtained when the number of emergency secretaries is at a high level and the number of practical nurses and nurses is at a low level.
IMPACT STRATEGIC SOURCING, SUPPLIER INNOVATIVENESS, AND INFORMATION SHARING ON SUPPLY CHAIN AGILITY
Authors: Jermsittiparsert Kittisak , Rungsrisawat Somdech
Published: September 2019

Purpose: The prime objective of the current study is to explore the nexus between supplier innovativeness, information sharing, strategic sourcing and supply chain agility. The study has tried to investigate the direct impact of supplier innovativeness, information sharing, and strategic sourcing on supply chain agility.

Methodology: In addition to that the current study is also interested in examining the mediating role of information sharing and strategic sourcing in the relationship between supplier innovativeness and supply chain agility. The previous research studies have analysed the influence of supplier innovativeness on the performance of the firm.

Results: It has been revealed through some research studies that there is a positive association among the performance of manufacturers and supplier innovativeness as well as relationship performance. Thus the current study is among the pioneering studies on this issue. Employing the survey-based methodology, the SEM-PLS technique is used to test the hypothesized relationships. So, the current study has used SEM-PLS as a statistical tool to answer the research questions raised in this study and research objectives envisaged in the current study. The findings of the study have provided support to the theoretical foundation and proposed hypothesis of the current study. Current study will be helpful for policymakers and practitioners in understanding the issues related to supply chain risk, supply chain integration and supply chain performance. In the author's knowledge this is among very few pioneering studies on this issue.
Implicaciones de la «gig-economy» en las relaciones laborales: el caso de la plataforma Uber
Authors: Saenz de Buruaga Azcargorta Maria
Published: September 2019

En un entorno laboral cada vez más digitalizado, proliferan en España nuevas formas de trabajo al margen del actual cuadro normativo. Así, plataformas de la «gig-economy» como Uber, Deliveroo o Glovo cuentan cada día con más «microtrabajadores» dispuestos a prestar servicios y realizar pequeños encargos. Este artículo trata de analizar, partiendo del caso de la plataforma de transporte urbano Uber, la relación que une a las plataformas digitales y a aquellos que ofrecen sus servicios en éstas. En este sentido, se analiza a partir de un análisis pormenorizado de los rasgos definitorios de estas nuevas formas contractuales, la existencia de laboralidad a la luz de los últimos pronunciamientos administrativos, jurisprudenciales y doctrinales habidos hasta la fecha. Por último, se presentan soluciones regulatorias ad hoc para tratar de dar respuesta a los distintos intereses que se hallan en conflicto: por un lado, la necesaria protección de los prestadores de servicios y, por otro, su creciente popularidad y atractivo entre proveedores y usuarios.Recibido: 15 febrero 2019Aceptado: 21 junio 2019Publicación en línea: 31 julio 2019
José Tudela, Josep María Castell a, Enriqueta Expósito y Mario Kölli ng (eds.). Libro blanco sobre calidad democrática en España. Marcial Pons. Madrid, 2018. 331 pp.
Authors: Fondevila Marón Manuel
Published: September 2019

Nadie puede ignorar que la influencia que actualmente ejercen los/las Profesores/as de Derecho en el ámbito político-legislativo es muy inferior a la que tenía años atrás. Este no es lugar apropiado para disertar sobre las causas de esta pérdida de espacios de diálogo y encuentro entre ambos mundos, pero sí para indicar que la obra que se presenta resulta idónea para tratar de revertir esta situación. Publicación en línea: 31 julio 2019
Kelsen y constitucionalismo contemporáneo: la continua presencia de los temas kelnesianos
Authors: Carrozza Paolo
Published: September 2019

Este capítulo pretende demostrar la importancia perdurable del pensamiento de Kelsen en el constitucionalismo contemporáneo y sostiene que los constitucionalistas son considerablemente más kelsenianos de lo que generalmente se supone. El capítulo comienza con una breve reconstrucción de tres períodos diferentes en el pensamiento legal de Kelsen: su contribución a la Escuela de Derecho de Viena bajo la influencia del positivismo alemán; El compromiso de Kelsen, desde 1918 hasta 1933, hacia la república austriaca recién nacida; su emigración forzada a los EE. UU. en 1940 y su encuentro con la escuela estadounidense de derecho y ciencias políticas. La contribución de Kelsen al constitucionalismo contemporáneo comienza con la gran influencia de su pensamiento en la Constitución austriaca de 1920, que Kelsen defendió en artículos periodísticos y en estudios académicos. El capítulo sostiene que la ciencia jurídica kelseniana tiene una importancia continua en dos campos principales del constitucionalismo contemporáneo, ambos originados por la consideración de la constitución como una ley superior: el primero, el modelo austriaco para la revisión judicial de la legislación, que dio forma al modelo europeo de la adjudicación constitucional, hoy en día difundida en todo el mundo; y la segunda, la teoría «gradualista » de las fuentes del derecho (la Stufenbau). Se argumenta que el pensamiento legal de Kelsen tiene una importancia perdurable en la crisis actual del constitucionalismo, no solo para la comprensión legal del gobierno multinivel (monismo contra dualismo) sino también para la globalización del constitucionalismo y la idea de apertura. Terminó el constitucionalismo.Recibido: 11 mayo 2019Aceptado: 21 junio 2019Publicación en línea: 31 julio 2019
Tool Orientation Angle Optimization for a Multi-Axis Robotic Milling System
Authors: Silva Leandro Batista da , Yoshioka Hayato , Shinno Hidenori , Zhu Jiang ,   Body Production Engineering Division, Honda Engineering Co., Ltd. 6-1 Hagadai, Haga-machi, Haga-gun, Tochigi 321-3395, Japan,   Laboratory for Future Interdisciplinary Research of Science and Technology (FIRST), Institute of Innovative Research (IIR),
Tokyo Institute of Technology, Yokohama, Japan,   School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
Published: September 2019

The present study introduces a novel tool orientation angle optimization method for improving the machining accuracy of robotic milling systems. The proposed approach considers the intrinsic properties of serial mechanisms and their relationship with robotic stiffness to select optimal robot postures in the generation of tool orientation angle for finish cut. The evaluation of the robotic stiffness is carried out with two performance indices presented in this study: the volumetric stiffness performance index, which measures the overall robot stiffness, and the unidirectional stiffness performance index, which measures the robotic stiffness along a specific direction. As machining errors are reduced by optimally selecting the tool orientation angle without modifications to the tool path itself, the proposed method is significantly less convoluted than conventional optimization methods. The efficacy of the proposed method is validated experimentally using a purpose-designed multi-axis milling robot. Experimental results show that the robotic milling system is capable of machining three-dimensional shapes with a fine surface, and reducing the twist caused by the displacement of the cutting tool towards the direction of lowest robotic stiffness.
Effect of CAD/CAM Post Process on S-Shaped Machining Test for Five-Axis Machining Center
Authors: Ihara Yukitoshi , Takubo Koichiro , Nakai Tatsuo , Sato Ryuta ,   Osaka Institute of Technology 5-16-1 Omiya, Asahi-ku, Osaka 535-8585, Japan,   Yamazaki Mazak Corp., Niwa, Japan,   Kobe University, Kobe, Japan
Published: September 2019

ISO 10791-7, the test standard for machining centers, was revised in 2014 to add the test method for five-axis machining centers. However, an S-shaped test was additionally proposed as an accuracy test of aircraft parts from China immediately before the establishment of the test standard. In an ISO meeting, various problems such as creating three-dimensional models and evaluation items have been indicated for the proposed test method. By revising these problems, the standard was finally completed and will be introduced as an informative annex soon. However, it is still an inappropriate test method from the viewpoint of performance inspection for machine tools. In this research, the S-shaped test method draft proposed in September 2016 is tested using two types of five-axis machining centers and commercial CAM software. Consequently, a hidden problem is revealed, that is, an abrupt movement that affected the final result is added to the machine because the rotation direction of the rotary axes is not ideal. This is attributed to the performance of the CAM software’s post processor that converts from CL data to NC program. This study provides some insights into avoiding the problem and obtaining better test results.
Machine Tool Assignment Realized by Automated NC Program Generation and Machining Time Prediction
Authors: Nishida Isamu ,   Kobe University 1-1 Rokko-dai, Nada-ku, Kobe, Hyogo 657-8501, Japan, Shirase Keiichi
Published: September 2019

The present study proposed a method to automatically generate a numerical control (NC) program by referring to machining case data for each machine tool with only 3D-CAD models of a product and workpiece as the input data, and to select machine tools for machining the target removal region among several machine tools with different characteristics. The special features of the proposed method are described as follows. The removal volume can be automatically obtained from the total removal volume (TRV), which is extracted from the workpiece and product using a Boolean operation by dividing it on the XY plane. The removal region changed according to the determined machining sequence. The conditions for machining the removal region is automatically determined according to the machining case data, which is stored by linking the geometric properties of the removal region with the machining conditions determined by experienced operators. Furthermore, an NC program is automatically generated based on the machining conditions. The machine tools for machining the target region are selected according to the predicted machining time of each machine tool connected by a network.

A case study was conducted to validate the effectiveness of the proposed system. The results confirm that machining can be conducted using only 3D-CAD models as input data. It was suggested that the makespan would be shortened by changing the machining sequence from the optimized machining sequence when machining a plurality of products.
Analisis Ketersediaan Air Meteorologis Untuk Memenuhi Kebutuhan Air Domestik Penduduk di Kabupaten Malang
Authors: Millah Maula Zakiyyatul
Published: September 2019

Kabupaten Malang merupakan salah satu kabupaten yang terletak di Provinsi Jawa Timur. Perkembangan suatu wilayah  akan menyebabkan kebutuhan air terus meningkat seiring dengan bertambahnya jumlah penduduk. Persebaran curah hujan yang tidak merata akibat dari keragaman kondisi fisiografis Kabupaten Malang juga menyebabkan ketersediaan air disetiap wilayah berbeda. Metode yang digunakan dalam penelitian adalah metode deskriptif dengan menggunakan pendekatan kuantitatif. Sampel wilayah yang digunakan dalam penelitian ini adalah tujuh kecamatan yang ada di Kabupaten Malang, yaitu Kecamatan Kalipare, Kecamatan Donomulyo, Kecamatan Pagak, Kecamatan Sumbermanjing Wetan, Kecamatan Jabung, Kecamatan Singosari, dan Kecamatan Lawang.Tujuan penelitian ini adalah menganalisis ketersediaan air meteorologis dan mengalisis kebutuhan air domestik penduduk, serta menganlisis kekeritisan air domestik di Kabupaten Malang. Tahapan penelitian yang dilakukan yakni: 1) Mengumpulkan data yang digunakan dalam penelitian; 2) Melakukan analisis ketersediaan air meteorologis; 3) Melakukan analisis kebutuhan air domestic; 4) Melakukan analisis tingkat kekritisan air; 5) Melakukan survey lapangan; 6) Melakukan pemetaan. Hasil penelitian menunjukkan bahwa ketersediaan air meteorologis tertinggi yaitu di Kecamatan Sumbermanjing Wetan dan ketersediaan air meteorologis terendah yaitu di Kecamatan Lawang, Sedangkan untuk kebutuhan air domestik tertinggi yaitu di Kecamatan Lawang dan kebutuhan air domestik terendah yaitu di Kecamatan Pagak. Wilayah dengan tingkat kekritisan air pada kategori sangat kritis yaitu di Kecamatan Lawang dan Kecamatan Singosari dengan, sedangkan wilayah tingkat kekritisan air pada ketegori tidak kritis yaitu di Kecamatan Donomulyo.
MSOR Connections 17-3 Table of Contents
Authors: Mann Tony
Published: September 2019

Table of contents for isse 17-3
Embeddedness of Mathematics e-Assessment and Attitudes Affecting Adoption
Authors: Casey Deirdre , Crowley Julie
Published: September 2019

The Numbas e-assessment system was first introduced to Cork Institute of Technology (CIT) in 2014. It has been implemented in several modules and is used regularly by a number of Lecturers. The aim of this case study was to investigate how embedded Numbas is in the Mathematics department in CIT and to examine the perceptions of the lecturing staff which have led to their individual adoptions of the Numbas e-assessment tool. The results of a survey of lecturers within the department show that the use of Numbas is common and varied and that Lecturers’ attitudes towards Numbas are positive. Several themes arose around ways to increase or improve the use of Numbas including the need for ongoing training and ideas for the broadening of use. Lessons learned could be applied to advancing the integration of Numbas in Cork Institute of Technology but may also be of use to others hoping to increase adoption of e-assessment in Mathematics within their institutions.
MSOR Connections 18(1) Editorial
Authors: Rowlett Peter
Published: September 2019

Editorial.
A Time-dependent Genome-Wide SNP-SNP Interaction Analysis of Chicken Body Weight
Authors: Li Fang-Ge , Li Hui
Published: September 2019

Background
The important property of the quantitative traits of model organisms is time-dependent. However, the methodology for investigating the genetic interaction network over time is still lacking. Our study aims to provide insights into the mechanistic basis of epistatic interactions affecting the phenotypes of model organisms.
Results
We performed an exhaustive genome-wide search for significant SNP-SNP interactions associated with male birds’ body weight (n=475) at multiple time points (day of hatch body weight (BW0) and one, three, five and seven weeks (BW1, BW3, BW5, BW7). Statistical analysis detected 67, 4, and 2 significant SNP pairs associated with BW0, BW1, and BW3, respectively, with a significance threshold at 8.67×10 −12 (Bonferroni-adjusted: 1%). Meanwhile, no significant SNP pairs associated with BW5 and BW7 were found. The SNP-SNP interaction networks of BW0, BW1, and BW3 were built and annotated.
Conclusions
With strong annotated information and a strict significant threshold, SNP-SNP interactions underpinned the gene-gene interactions that might occur between chromosomes or within the same chromosome. Comparing and combing the networks, the results indicated that the genetic network for chicken body weight was dynamic and time-dependent.
Germline knockdown of spargel (PGC-1) produces embryonic lethality in Drosophila
Authors: George Jack , Jacobs Howard Trevor
Published: September 2019

Background: The transcriptional co-activators of the PGC-1 family have been proposed as master regulators of mitochondrial biogenesis. Drosophila has a single member of the family, Spargel (srl). Functional studies of srl allow PGC-1 role(s) in development and physiology to be elucidated without the confounding effects of tissue-specificity and redundancy. Spargel was previously shown to govern the expression of genes for mitochondrial functions in the adult fat body.

Results: Here we analysed the role of srl in early development. srl RNA was abundant in ovaries and early embryos but, upon cellularization, fell to low levels where it remained for the rest of development. Knockdown of srl in the female germline resulted in embryonic semilethality, with only ~10% of embryos able to complete development. Embryos from germline srl-knockdown mothers were predominantly small, with the majority suffering a catastrophic derangement of development marked by failure to form a uniform blatstoderm, irregular cell size and chaotic cell movements instead of orderly gastrulation. However, genes whose expression in early embryos depends on localized determinants were expressed normally. The abundance of representative mitochondrial proteins was not decreased in knockdown ovaries or embryos, and their mRNAs were generally increased rather than decreased.

Conclusions: We infer that srl has a more general role in early development, distinct from specifically promoting mitochondrial biogenesis.
Achieving improved health and human rights for street-based sex workers - an ethnographic exploration of factors that drive policing of cisgender female sex workers in a U.S. setting
Authors: Footer Katherine HA , Silberzahn Bradley E. , Lim Sahnah , Huettner Steven , Kumar Victor A. , Loeffler Derek , Peitzmeier Sarah M. , Sherman Susan G.
Published: September 2019

Background: Building on a broader sociological discourse around policing approaches towards vulnerable populations, increasing public health evidence points to policing practices as a key health determinant, particularly among street-based sex workers. Despite the importance of policing as a structural health determinant, few studies have sought to understand the factors that underlie and shape policing practices towards sex workers. This study therefore aimed to explore the drivers for policing attitudes and practices towards street-based cisgender female sex workers.

Methods: Drawing on ethnographic methods, 280 hours of observations with police patrol and 10 stakeholder interviews with senior police leadership in Baltimore City, USA were carried out to better understand the drivers for policing strategies towards cisgender female sex workers. Analysis was data- and theory-driven, drawing on the concepts of police culture and complementary criminological and sociological literature exploring the more explicitly spatial exercise of police discretion and structural forces operating on police decision making.

Results: Ecological factors at the structural (e.g., criminalization), organizational (e.g., violent crime control), community and individual level (e.g., stigmatizing attitudes) emerged as key to shaping individual police practices and attitudes towards cisgender female sex workers in this setting. Findings indicate senior police support for increased alignment with public health goals. However, the study highlights that interventions need to move beyond individual officer training and address the broader structural and organizational setting in which police practices towards sex work operate.

Conclusions: A more in-depth understanding of the circumstances that drive law enforcement approaches to street-based sex work is critical to the collaborative design of interventions with police in different settings. In considering public health-police partnerships to address the needs of sex worker populations in the U.S. and elsewhere, this study supports existing calls for decriminalization of sex work, supported by institutional and policy reforms, neighborhood-level dialogues that shift the cultural landscape around sex work within both the police and larger community, and innovative individual-level police trainings.
Short or Long Antibiotic Regimes in Orthopaedics (SOLARIO): a Randomised Controlled Open-Label Non-Inferiority Trial of Duration of Systemic Antibiotics in Adults with Orthopaedic Infection Treated Operatively with Local Antibiotic Therapy
Authors: Dudareva Maria , Kümin Michelle , Vach Werner , Kaier Klaus , Ferguson Jamie , McNally Martin , Scarborough Matthew
Published: September 2019

Background Orthopaedic infections such as osteomyelitis, diabetic foot infection and prosthetic joint infection, are most commonly treated by a combination of surgical debridement and a prolonged course of systemic antibiotics, usually for at least 4 -6 weeks. Use of local antibiotics, implanted directly into the site of infection at the time of surgery, may improve antibiotic delivery and allow us to shorten the duration of systemic antibiotic therapy, thereby limiting the frequency of side effects, cost and selection pressure for antimicrobial resistance. Methods SOLARIO is a multi-centre open label randomised controlled non-inferiority trial comparing short and long systemic antibiotic therapy alongside local antibiotic therapy. Adult patients with orthopaedic infection, who have given informed consent, will be eligible to participate in the study provided that no micro-organisms identified from deep tissue samples are resistant to locally-implanted antibiotics. Participants will be randomised in a 1:1 ratio to receive either a short course (≤ 7 days) or currently recommended long course (≥ 4 weeks) of systemic antibiotics. The primary outcome will be treatment failure by 12 months following surgery, as ascertained by an independent Endpoint Committee blinded to treatment allocation. An absolute non-inferiority margin of 10% will be used for both per-protocol and intention-to-treat populations. Secondary outcomes will include probable and definite treatment failure, serious adverse events, treatment side-effects, quality of life scores and cost analysis. Discussion This study aims to assess a treatment strategy that may enable the reduction of systemic antibiotic use for patients with orthopaedic infection. If effective, this will be to the advantage of patients and contribute to antimicrobial stewardship.
Determinants of health-related quality of life among adolescents with cerebral palsy in Bangladesh
Authors: Power Rosalie , Galea Claire , Muhit Mohammad , Heanoy Eamin , Karim Tasneem , Badawi Nadia , Khandaker Gulam
Published: September 2019

Background: The health-related quality of life (HRQoL) of adolescents with cerebral palsy (CP) in low and middle-income countries is often poor, as is the case in Bangladesh. This study examined what modifiable factors are predictors of HRQoL among adolescents with CP in rural Bangladesh, a typical low- and middle-income country (LMIC).
Methods: Adolescents with CP (10 to 18y) were identified using the Bangladesh Cerebral Palsy Register. HRQoL was assessed with the Cerebral Palsy Quality of Life-Teens questionnaire (CPQoL-Teens). Bivariate analysis and hierarchical multiple linear regression models related adolescent clinical characteristics and mental health, caregiver mental health and proxies of socioeconomic status to HRQoL outcomes.
Results: 154 adolescents with CP (mean age 15y 1mo SD 1y 8mo, female n =31.2%) participated in this study. Numerous characteristics correlated to HRQoL; strongest correlation was between ‘feelings about functioning’ and motor impairment ( r =0.545). Nine factors were predictive of CPQoL-Teens dimensions; adolescent sex, school attendance, severity of motor impairment, hearing and speech impairment, mother’s education, primary caregiver depression and stress, and having a sanitary latrine at home resulting in score changes of between 0.79 (95% CI 0.24 to 1.35) to 35.1 (95% CI 6.03 to 64.22).
Conclusions: Many of the factors predicting the HRQoL of adolescents with CP are amenable to intervention, and have the potential to improve adolescent wellbeing. Several determinants are priorities of the sustainable development goals (SDGs); these findings should inform resource prioritization to improve the wellbeing of adolescents with CP in Bangladesh and other LMICs.
How does a targeted active labour market program impact on the well-being of the unemployed? A Concept Mapping study on Barcelona “Employment in the Neighbourhoods”
Authors: Puig-Barrachina Vanessa , Malmusi Davide , Artazcoz Lucía , Bartoll Xavier , Clotet Eva , Cortés-Franch Imma , Ventura Lorena , Daban Ferran , Díez Èlia , Borrell Carme
Published: September 2019

Background In 12 neighbourhoods of Barcelona (Spain), an innovative tailored-made Active Labour Market Program called “Employment in the neighbourhoods” was implemented to get people from deprived, high-unemployment neighbourhoods back to work. This study aimed to identify the effects of the program on participants’ quality of life, as well as the mechanisms underlying these effects. Methods We used Concept Mapping, a mixed methods approach that combines qualitative and quantitative analysis to develop a conceptual map of perceptions of participants and technical staff about changes in the participants’ quality of life. Data collection occurred within the generation and structuring steps where participants brainstorm answers to the focus question, and then rate and sort the responses. To compute maps, we used Concept Systems Incorporated software which conducted two main forms of analysis, a multidimensional scaling analysis followed by hierarchical cluster analysis. Results Study participants report several positive effects on mental health and emotional wellbeing, including self-esteem and empowerment. The mechanisms identified were strengthened social networks, skills acquisition and emotional and technical coaching. We also identified some negative impacts, mainly related to the labour market situation. We observed marked gender differences in the discourses of program participants. Conclusions The results obtained have allowed us to identify different mechanisms and impacts by which the “Employment in the Neighbourhoods” Active Labour Market Programme can influence the quality of life of participants from the most deprived areas of Barcelona. Improvement on mental health has been also shown in a pre-post evaluation using quantitative methodology
Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth Intervention in Brazil: A cross-sectional study
Authors: Fernandes Luísa M M , Lansky Sônia , Oliveira Bernardo J , Friche Amélia A L , Bozlak Christine T. , Shaw Benjamin A.
Published: September 2019

Background

Senses of Birth (SoB) is a health education intervention in Brazil that addresses reproductive rights, the benefits and risks of normal birth and cesarean, and use of evidence-based practices (EBP) during labor and childbirth, aiming to reduce unnecessary cesareans in the country. This study evaluates the impact of the SoB intervention on pregnant women’s perceived knowledge about normal birth, cesarean, and use of EBP in childbirth.

Method

1,287 pregnant women answered a structured questionnaire, immediately after their visit to the exhibition, between March 2015 and March 2016, in four cities. To identify the impact of the intervention on women’s perceived knowledge and possible association with socioeconomic and demographic characteristics, statistical analyses were performed including paired T-tests, ANOVA, and logistic and linear regressions.

Results

The mean score (MS) of perceived knowledge after the intervention was higher than the mean score before experiencing the SoB for all three knowledge domains: Normal Birth (MS Before= 3.71 x MS After= 4.49), Cesarean (MS Before= 3.54 x MS After= 4.26) and EBPs (MS Before= 3.14 x MS After= 4.14). The results suggest that SoB intervention was more effective for low income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49- 4.09 for normal birth), women with private prenatal care (OR 2.42, 95% CI: 1.59- 3.66 for normal birth), women experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for normal birth; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and women in their first or second trimester at the time of the intervention (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for normal birth; OR 1.85, 95% CI: 1.40-2.41 for cesarean).

Conclusion

The study showed opportunities to increase knowledge among Brazilian pregnant women for the three knowledge domains, and a need to focus the discussion on how to achieve a positive experience of birth using EBP. The intervention gains relevance considering the lack of evidence of the efficacy of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries targeting women.
Abortion Service Provision in South Asia: A Comparative Study of Four Countries
Authors: Singh Susheela , Sundaram Aparna , Hossain Altaf , Puri Mahesh , Sathar Zeba , Shekhar Chander , Crowell Marjorie , Moore Ann
Published: September 2019

Background

Safe abortion services are essential if women are to fulfill their right to have the number of children they want, when they want them. This paper examines the provision of abortion and menstrual regulation (MR) services in four South Asian countries that have many commonalities in sexual and reproductive outcomes and in barriers to accessing needed services, despite variation in their abortion laws —Nepal, India (six states), Bangladesh, and Pakistan.

Methods

Using representative health facility surveys, we assess availability of legal abortion/MR services —relevant in three of the countries—and post-abortion care, relevant for all four countries. We examine the role of the public sector in providing these services and the proportion of facilities located in rural areas, as indicators of service accessibility for poor and rural women. We assess quality of abortion care through selected indicators: provision of WHO-recommended methods, vacuum aspiration (VA) and medication abortion (MA); use of outdated, invasive methods such as dilatation and curettage (D&C); and the proportion of facilities turning away women seeking services.

Results

Results show that in India and Nepal the majority of public sector facilities do not provide induced abortion services, and in India and Pakistan, the majority of facilities providing any abortion services are private sector. Further, although all four countries are mostly rural, the majority of facilities providing abortion services are located in urban areas. While facilities that provide abortion services already commonly provide MA in Nepal and India and increasingly offer MRM (MR with medication) in Bangladesh, D&C is over-used in all four countries for PAC and in India for induced abortions as well.

Conclusion

There is an urgent need to expand and improve provision of abortion and post-abortion care to reduce abortion-related morbidity and mortality and to fulfill the rights of all women to quality sexual and reproductive health care.
Comparison of efficacy of dental plaque reduction between use of an electric toothbrush with and without plaque visualisation: A one-week randomized controlled trial
Authors: Akifusa Sumio , Isobe Ayaka , Kibata Kanako , Oyama Akinori , Oyama Hiroko , Ariyoshi Wataru , Nishihara Tatsuji
Published: September 2019

Background

To evaluate the efficacy of a newly developed electric toothbrush in reducing dental plaque via a quantitative light-induced fluorescence-digital (QLF-D)-applied visualisation system in the brush head.

Methods

Participants included 20 adults aged 19 to 28 years. Participants were randomly assigned either (i) an electric toothbrush with a monitor to visualise red-fluorescent dental plaque via a camera built into the brush head (monitor usage group, n = 10) or (ii) an electric toothbrush without a monitor (monitor-non-use group, n = 10). The amount of dental plaque was assessed by personal hygiene performance (PHP) at baseline and 1 week later.

Results

In the monitor-usage group, PHP score was significantly lower at the 1-week follow-up than at baseline (6 vs 16; range, 0–12 vs 13–21; P = 0.029). This change was not observed in the monitor-non-use group. After 1 week, the change in PHP scores in the monitor usage group was significantly greater than that in the monitor non-use group (−10 vs 0; range, -21 to 9 vs -8 to 16; P = 0.021).

Conclusions

Our results clearly demonstrate that brushing teeth while looking at a monitor that depicts red-autofluorescent dental plaque via application of QLF-D improved the efficacy of dental-plaque removal relative to brushing teeth without a monitor.
Adapting a nurse-led primary care initiative to cardiovascular disease control in Ghana: A qualitative study
Authors: Haykin Leah A. , Francke Jordan A. , Abapali Aurelia , Yakubu Elliasu , Dambayi Edith , Jackson Elizabeth , Aborigo Raymond , Awuni Denis , Nonterah Engelbert A. , Oduro Abraham R. , Bawah Ayaga A , Phillips James F. , Heller David J
Published: September 2019

Background : Cardiovascular Disease (CVD) is a growing cause of morbidity and mortality in Ghana, where rural primary health care is mainly provided by the Community-based Health Planning and Services (CHPS) initiative. CHPS locates nurses in community-level clinics for providing basic curative, preventive health services, and home and outreach services. CHPS currently lacks capacity to screen for or treat CVD and its risk factors.

Methods : In two rural districts, in depth interviews were conducted with 21 nurses and 10 supervisors to identify factors constraining or facilitating CVD screening and treatment. Audio recordings were transcribed, coded for content, and analyzed for key themes.

Results : Respondents emphasized three themes: community demand for CVD care; community access to CVD care; and provider capacity to render CVD care. Nurses and supervisors noted that community members were often unaware of CVD, despite high reported prevalence of risk factors. Community members were unable to travel for care or afford treatment once diagnosed. Nurses lacked relevant training and medications for treating conditions such as hypertension. Respondents recognized the importance of CVD care, expressed interest in acquiring further training, and emphasized the need to improve ancillary support for primary care operations.

Conclusions : CHPS staff expressed multiple constraints to CVD care, but also cited actions to address them: CVD-focused training, provision of essential equipment and pharmaceuticals, community education campaigns, and referral and outreach transportation equipment. Results attest to the need for trial of these interventions to assess their impact on CVD risk factors such as hypertension, depression, and alcohol abuse.
Xpert MTB/Rif assay in the diagnosis of smear-negative pulmonary tuberculosis: a prospective study from Nepal
Authors: Khadka Priyatam , Thapaliya Januka , Basnet Ramesh Bahadur , Ghimire Gokarna Raj , Amatya Jyoti , Rijal Basista Parsad
Published: September 2019

Background
For improving patient care and abbreviating the disease transmission chain, speedy detection of tuberculosis and its drug-resistance with precision is crucial.
Methods
We analyzed, pulmonary tuberculosis (PTB) suspected, 360 smear-negative sputum from the patients attending Tribhuvan University Teaching Hospital (TUTH). The patients were selected as per the algorithm of National Tuberculosis Programme(NTP) for Xpert MTB/RIF testing. Participants’ demographic and clinical information were collected using a pre-tested questionnaire. The specimens were collected, processed directly for Xpert MTB/RIF test according to the manufacturer’s protocol. The same samples were stained using Ziehl-Neelsen technique then observed microscopically. Both findings were interpreted; rifampicin-resistant, if obtained, on Xpert testing was confirmed with Line Probe Assay.
Result
Of 360 smear-negative sputum samples analyzed, 85(23.61%) found positive while 3 of them were rifampicin resistance. The infection was higher in male, i.e. 60(25.3%) compared to female 25(20.3%). The age group, >45(nearly 33%) with median age 42± 21.5, were prone to the infection. During the study period, 4.6% (515/11048) sputum samples were reported as smear-positive in TUTH; consequently, with Xpert MTB/RIF assay, additional case 16.5% (n=85/515) missed on the smear microscopy, were detected—surging overall confirmed cases. Among the most occurring clinical presentations, cough and chest pain were more evident in PTB with relative-risk at 95% confident-levels i.e. 3.03(1.01-9.11) and 3.47(2.29-5.27) respectively. A higher number of new suspects (n=63) were found positive compared to previously treated suspects. The upper lobe infiltrates (36.4%) and pleural effusion (40.4%) were peculiar radiological impression noted in PTB patient. 94 MDR suspected cases were enrolled; of total suspected cases, 29 samples were found rifampicin sensitive, 1 indeterminant while 2 of them were rifampicin-resistant. However, a single rifampicin-resistant; case was detected in patient which was not MDR suspected.
Conclusion
Additional cases of PTB which are neglected as smear-negative on microscopy and other conventional tests can be detected with gene Xpert test. Hence, recommended to every suspect as a presumptive test could be a wise investment in diagnosis to restrict the global burden to some extent.
Keywords: Xpert MTB/Rif assay, Mycobacterium tuberculosis, Line Probe Assay, MDR-TB
Cell-free spent media obtained from whey or 3'-sialyllactose fermentation by Bifidobacterium mongoliense modulate the virulence expression of intestinal pathogens
Authors: Bondue Pauline , Milani Christian , Arnould Emilie , Ventura Marco , Daube Georges , Lapointe Gisèle , Delcenserie Veronique
Published: September 2019

Human milk oligosaccharides (HMO) could promote the growth of bifidobacteria, improving young children’s health. In addition, fermentation of carbohydrates by bifidobacteria can result in the production of metabolites presenting an antivirulent activity against intestinal pathogens. Bovine milk oligosaccharides (BMO), structurally similar to HMO, are found at high concentration in cow whey. This is particularly observed for 3’-sialyllactose (3’SL). This study focused on enzymes and transport systems involved in HMO/BMO metabolism contained in B. crudilactis and B. mongoliense genomes, two species from bovine milk origin. The ability of B. mongoliense to grow in media supplemented with whey or 3’SL was assessed. Next, the effects of cell-free spent media (CFSM) were tested against the virulence expression of Escherichia coli O157:H7 and Salmonella enterica serovar Typhimurium.
Due to the presence of genes encoding β-galactosidases, β-hexosaminidases, α-sialidases and α-fucosidases, B. mongoliense presents a genome more sophisticated and more adapted to the digestion of BMO/HMO than B. crudilactis (which contains only β-galactosidases). In addition, HMO/BMO digestion involves genes encoding oligosaccharide transport systems found in B. mongoliense but not in B. crudilactis. B. mongoliense seemed able to grow on media supplemented with whey or 3’SL as main source of carbon (8.3±1.0 and 6.7±0.3 log cfu/mL, respectively). CFSM obtained from whey resulted in a significant under-expression of ler, fliC, luxS, stx1 and qseA genes (-2.2, -5.3, -2.4, -2.5 and -4.8, respectively) of E. coli O157:H7. CFSM from 3’SL resulted in a significant up-regulation of luxS (2.0) gene and a down-regulation of fliC (-5.0) gene. CFSM obtained from whey resulted in significant up-regulations of sopD and hil genes (2.9 and 3.5, respectively) of S. Typhimurium, while CFSM obtained from 3’SL fermentation down-regulated hil and sopD genes (-2.7 and -4.2, respectively).
From enzymes and transporters highlighted in the genome of B. mongoliense and its potential ability to metabolise 3’SL and whey, B. mongoliense seems well able to digest HMO/BMO. The exact nature of the metabolites contained in CFSM has to be identified still. These results suggest that BMO associated with B. mongoliense could be an interesting synbiotic formulation to maintain or restore intestinal health of young children.
A multi-fault diagnosis method for piston pump in construction machinery based on information fusion and PSO-SVM
Authors: Tang Hongbin , Wang Zichao , Wu You
Published: September 2019

Piston pumps are key components in construction machinery, the failure of which may cause long delay of the construction work and even lead to serious accident. Because construction machines are exposed to poor working conditions, multiple faults of piston pumps are most likely to occur simultaneously. When multiple faults occur together, it is difficult to detect. A multi-fault diagnosis method for piston pump based on information fusion and PSO-SVM is proposed in this thesis. Information fusion is used as fault feature extraction and PSO-SVM is applied as the fault mode classifier. According to the method, vibration signal and pressure signal of piston pump in normal state, single fault state and multi-fault state are collected at first. Then the empirical mode decomposition (EMD) is used to decompose vibration signals into different frequency band and energy features are extracted. These energy features extracted from vibration signals and time-domain features extracted from pressure signal are information fused at the feature layer and constitute the eigenvectors. Finally, these eigenvectors are put into support vector machine (SVM) and the working conditions of piston pump were classified. Particle swarm optimization (PSO) is applied to optimize two parameters of SVM. The experimental results show that the recognition accuracy of the normal state, three single failure modes and multi-fault modes are 98.3 %, 97.6 % and 94 % respectively. These recognition accuracies are higher than which using vibration signal or pressure signal alone. So, the proposed method can not only identify the single fault, but also effectively identify the multi-fault of piston pump.
Status of Labor Productivity in Kemerovo Region
Authors: Aniskin Vladislav , Belchik Tatyana
Published: September 2019

The article considers the level and dynamics of labor productivity in the Kemerovo region in comparison with the Russian Federation. The research objective was to reveal the current state of the local labor productivity. A number of statistical problems were revealed as a result of an analysis of labor productivity dynamics and highly productive jobs. The author determines the main factors affecting the level of labor productivity and suggests measures to eliminate them. The study was based on statistical data, as well as research results of Russian and foreign analysts. The analysis involved both absolute and relative values, methods of comparison, grouping and analysis. The author believes that the low level of labor productivity in the region can only be increased by the combined efforts of the state and individual enterprises. The set of measures should include reduction of the depreciation of fixed assets, improvement of statistical reporting, raising awareness and control over labor productivity, raising the level of skills and personal interest of employees in high-performance work, and stimulating enterprises.