bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of Madrasah Based Management in Improving the Quality of Aliyah Madrasah Education
Authors: Anwar Lalu Mathlaul , Jufri A. Wahab , Muhaimi Lalu
Published: October 2019

This study aims to identify and describe the steps to implement madrasah-based management, describe the forms of community participation in contributing to improving madrasa quality, identify and describe madrasa efforts in order to ensure effective communication between schools and communities and describe the results of improving madrasah education quality. . The approach used in this research is a qualitative approach through descriptive analysis. The research subjects were the head of the Madrasah, the teacher, the school committee, students and the community. Data collection techniques using interview, observation and documentation. Data validity checking techniques with triangulation include credibility, transferability, dependability and confirmability. Data analysis techniques are using data reduction methods, data presentation and drawing conclusions. The results of data analysis show that the application of madrasah-based management is inseparable from the factors that can support and hinder the process of implementation. Community participation in the development of madrasah-based management can grow and develop in conditions of openness because of the mutual trust between madrasas and the community. One of the efforts of the madrasa committee in exploring community participation in madrasa development needs to get support from all components of education, both teachers, madrasa principals, students, parents / guardians of students, community, and Madrasah Aliyah Al-Aziziyah. Therefore we need close cooperation and coordination among the education components so that efforts to improve the quality of education carried out can be effective and efficient.Keywords: Application of MBM, Community Participation, Quality of Education
Notary’s Responsibility towards the Difference Found in the Content of Original Deed and Its Copy Given to Parties
Authors: Annisaa Kuntum Chaira , Fendri Azmi , Rembrandt Rembrandt
Published: October 2019

Notary is a general official who has authority to make authentic deed and other authorities as stipulated in Law Number 2 of 2014 regarding Amendment of Law Number 30 of 2004 regarding Notary Position. As a general official who has authority to make deed, a notary must be able to provide legal certainty to the community and must be responsible for the deed that he makes. However, a notary is also a human who can make mistakes like the difference found in the original deed content and the copy that has been given to other parties. The researcher is interested in writing a thesis regarding Notary’s Responsbility towards the Differenc found in the Original Deed Content and the Copy that has been given to Parties. The research method used in the problem approach is by judicial-normative approach method which means a research that emphasizes on the use of legal norms in written form and supported by interview results with the resource people and informants. Based on the discussion result of this writing, it can be concluded that: Practically, a notary is also possible to make fraut in making deed, so that what is written in the deed is not in line with what is actually expected to be shown in the deed. Therefore, a notary on his action can be asked for his responsibility based on administrative, civil, and criminal aspects based on the prevailing laws
Çocuk Hastalara Verilen Evde Bakım Hizmetlerinin Değerlendirilmesi
Authors: ÇADIRCI Dursun , KEPENEK Enver , ÖRENLER Mehmet , YAVUZ DAĞLIOĞLU Elif Burcu , GÜZELÇİÇEK Ahmet
Published: October 2019

Amaç: Evde sağlık hizmeti
çeşitli hastalıklara bağlı olarak evde sağlık hizmeti sunumuna ihtiyacı olan
bireylere evinde ve aile ortamında sosyal ve psikolojik danışmanlık
hizmetlerini de kapsayacak şekilde verilen hizmetleri ifade eder. Ülkemizde son
yıllarda evde bakım hizmetleri önem kazanmış ve çalışmamızda evde bakım
ünitesinde takip edilen pediatrik hastaların ve verilen hizmetlerin
değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Şanlıurfa Çocuk Hastalıkları Hastanesi Evde
Bakım Birimi’nde takip edilen hastaların sosyo-demografik özellikleri,
hastalıkları ve aldıkları hizmetler retrospektif olarak değerlendirilmiştir.
Veriler Evde Bakım Birimi’nde hizmet alan hastaların kayıtlı bilgileri
üzerinden toplanmıştır.Bulgular: Evde Bakım Birimi’nde
toplam 167 hasta kayıtlıydı. Verilerine ulaşılabilen 152 hasta çalışmaya
dahil edildi. Hastaların
%57’si erkek, %42’sı kızdı. Hastaların yaş ortalaması 11±4,2 yıl olarak tespit
edildi.Hastaların yarısından
fazlası Serebral Palsi tanısı ile takip ediliyordu. Hastaların %94,7’si oral
olarak besleniyordu. Doktor ziyaretinde var olan en sık şikayet %28,3 ile
öksürüktü. Çalışmamızda hastaların bakımında birincil olarak ilgilenenlerin
%92,8’i anneler olarak tespit edildi. Hiçbir hastanın ücretli çalışan bakıcısı
yoktu.

Sonuç: Evde sağlık bakımı ülkemizde hızla gelişen sağlık hizmetlerinden
biridir ve bu konuda daha kapsamlı araştırmaların gerekli olduğuna inanıyoruz.
Gebe Kadınların Doğum Şekli Tercihi ve Bunları Etkileyen Faktörler
Authors: SÖNMEZ Cemil İşık , SİVASLIOĞLU Ahmet Akın
Published: October 2019

Amaç: Doğum olayı kadını gerek gebelik gerekse doğum ve doğum sonu dönemde pek çokriskle karşı karşıya bırakabilecek bir süreçtir. Bu süreçte karar verilmesi gereken önemlikonulardan bir tanesi kadının doğum şeklidir. Kadınlar doğum şekline karar verirken birçokfaktörden etkilenebilirler, fakat önemli olan doğru kaynaklar tarafından, yeterli düzeydebilgilendirilerek, uygun doğum şekline yönlendirilmeleri ve doğum eyleminin sağlıklı biranne ve bebekle sonuçlanmasıdır. Bu araştırmadan çıkacak sonuçlarla sezaryen oranlarınınyükselişinin engellenmesi için gebe kadınların sezaryen ve normal vajinal doğuma karşıbakışlarını irdelemek ve yeni sağlık stratejilerinin geliştirilmesine katkıda bulunmayıamaçladık.Gereç ve Yöntem: Kadın sağlığı ve doğum polikliniğine başvuran gebe kadınlara 23 sorudanoluşan anket uygulanmıştır. Ankete 6 ile 40 gebelik haftası arasında olan gebeler alındı.Gebelik haftası olarak poliklinikte yapılan obstetrik ultrasonografi değeri esas alındı. Anketepolikliniğe sancı (travayda olan) nedeniyle başvuran gebeler alınmadı. Anket katılımcılarının(gebeler) demografik özelliklerine göre verilen cevaplar değerlendirildi ve gebelerin doğumşekli hakkındaki tutumlarının altında yatan sebepler ortaya konmaya çalışılmıştır.Bulgular: 30 yaş ve üzeri bireylerin %71,6’sı sezaryenle doğumu tercih etmişlerdir.Bireylerin gebelik haftası ile doğum şekli tercihleri arasında istatistiksel olarak anlamlı ilişkiyoktur. Sağlık personeli olan bireylerin, postpartum komplikasyonu alt faktörü puanları vedoğum şekli bilgisi toplam puanları diğer meslek gruplarından elde edilen puanlardan dahayüksek çıkmıştır. Vajinal doğumu tercih nedenini bildirenlerin %75,1’i anne-bebek sağlığıiçin tercih ettiklerini belirtirken, sezaryen doğumu tercih edenlerin %37,8’i ilk doğumusezaryen olduğu için tercih ettiklerini belirtmişlerdir.Sonuç: Doğum şeklinin, anne ve bebeğin en yüksek yararına belirlemesinde, gereksizsezaryen girişimlerin azaltılmasında sağlık personeli ve aile hekimlerine önemli görevdüşmektedir.
The RIPPLES of Meaningful Involvement: A Framework for Meaningfully Involving Indigenous Peoples in Health Policy Decision-Making
Authors: Fridkin Alycia J. , Browne Annette J. , Dion Stout Madeleine Kétéskwēw
Published: October 2019

Indigenous Peoples experience the greatest health inequities in Canada and other colonized countries, yet are routinely excluded from health-related policy decisions. Those advocating for Indigenous health equity are often left wrestling with the question: What constitutes, and what can foster, meaningful involvement of Indigenous Peoples in the contemporary health policy climate? Twenty (n = 20) in-depth, open-ended interviews with Indigenous and non-Indigenous leaders in health and health policy were conducted with a view to understanding what constitutes meaningful involvement of Indigenous Peoples in health policy decision-making. The analysis suggests meaningful involvement requires attuning to underlying power dynamics inherent in policy making and taking action to decolonize and transform the policy system itself. Based on these findings, the authors offer a framework for meaningful involvement.
Przyszłość cywilnoprawnych stosunków zatrudnienia
Authors: Duraj Tomasz
Published: October 2019

W artykule podjęto próbę ukazania przyszłości cywilnoprawnych stosunków zatrudnienia. Autor przedstawia skalę i przyczyny zjawiska upowszechniania się w gospodarce rynkowej cywilnoprawnych form zatrudnienia oraz pracy na własny rachunek, które coraz częściej wypierają klasyczny stosunek pracy. Jego zdaniem, tendencja ta ma charakter trwały i nieodwracalny. W przyszłości należy utrzymać model zatrudnienia oparty na różnorodności dopuszczalnych podstaw zatrudnienia, zakładający swobodę wyboru reżimu pomiędzy stosunkiem pracy, umowami prawa cywilnego a samozatrudnieniem. Istnieje konieczność pozostawienia dotychczasowej konstrukcji stosunku pracy opartej na kryterium pracy podporządkowanej, wykonywanej pod kierownictwem pracodawcy. To właśnie ten model zatrudnienia musi gwarantować najszerszy (najpełniejszy) zakres ochrony, która winna rekompensować pracownikowi permanentny stan zależności (podporządkowania) względem pracodawcy. Wokół tak określonego modelu stosunku pracy możliwe jest natomiast budowanie innych cywilnoprawnych form zatrudnienia, do których w ograniczonym zakresie powinny mieć zastosowanie ochronne przepisy prawa pracy. Ponadto istnieje potrzeba doprecyzowania w przepisach Kodeksu pracy kryteriów odróżniających stosunek pracy podporządkowanej od cywilnoprawnych stosunków zatrudnienia, zwłaszcza zaś kryterium kierownictwa pracodawcy.
Czas jako element stosunku pracy (uwagi na gruncie treści art. 22 §1 k.p.)
Authors: Driczinski Sławomir
Published: October 2019

W opracowaniu autor podjął tematykę użytego w artykule 22 § 1 Kodeksu pracy pojęcia czasu. Analizuje rolę i zasadność zamieszczenia w art. 22 § 1 Kodeksu pracy sformułowania dotyczącego czasu wykonywania pracy. Dotyczy to między innymi relacji z takimi pojęciami jak podporządkowanie czy czas pracy. Postawione zostały tezy dotyczące możliwego szerszego rozumienia pojęcia czasu realizacji umowy. Stworzyłoby to opcję rozszerzenia tego pojęcia również na stosunki prawne nieobjęte do tej pory ochroną w kontekście długości ich realizacji.
CYTOLOGICAL DIAGNOSTICS OF INTRAOPERATIVE PERITONEAL WASHES IN GASTRIC CANCER
Authors: Putova M. V. , Noskova K. K. , Pomortsev B. A. , Semenov N. E. , Izrailov R. E.
Published: October 2019

Diagnosis of peritoneal microcanceromatosis is the most important task allowing to determine treatment strategy for patients with stomach cancer. Laparoscopy combined with peritoneal flushing and subsequent cytological examination should be performed to detect the peritoneal microcanceromatosis at the preoperative stage. The objective of this work was to improve cytological diagnostics of peritoneal washings using immunocytochemical techniques and the cell block method. The work was carried out on the basis of 276 surgical peritoneal washings in patients with stomach cancer who were on treatment in the department of high-tech surgery of the Moscow Clinical Scientific Centre of the State Budgetary Healthcare Institution named after Loginov A.S. from June 2016 to June 2018. As a result, the optimal panel of monoclonal antibodies (Ber-EP4, CEA, CK20) was chosen, which increased the sensitivity from 52% to 96% and the specificity of cytological diagnosis from 80% to 98%, and the overall accuracy of the method from 67% to 98%.
APPLICATION OF THE METHOD OF LIQUID CHROMATO-MASS SPECTROMETRY FOR DETERMINATION OF BISOPROLOL AND ATORVASTATIN
Authors: Dukhovskaya N. E. , Vavilova T. P. , Gorbacheva S. Yu. , Gremyakova P. V. , Ostrovskaya I. G.
Published: October 2019

A technique has been developed for the quantitative determination of bisoprolol and atorvastatin in mixed saliva on a LCMS-8040 triple quadrupole liquid chromatographic mass spectrometer with ionization, separation and detection of samples, which allows determining the concentration in mixed saliva of bisoprolol with an accuracy of 93.7 to 98, 5% and atorvastatin from 95.6 to 98.3%.
IN VITRO MODELS OF MYCOBACTERIUM TUBERCULOSIS DORMANCY, AND IN VIVO MODELS OF LATENT TUBERCULOSIS INFECTION
Authors: Fursov M. V. , Dyatlov I. A. , Potapov V. D.
Published: October 2019

Modeling of tuberculosis infection is carried out in order to clarify various aspects of the tuberculosis pathogenesis, as well as the testing of new anti-tuberculosis drugs. The characteristic of in vitro models (n = 16) for Mycobacterium tuberculosis dormant state and in vivo models (n = 14) for the latent tuberculosis infection involving several animal species published to date are presented in this review. A brief description of the models and the results obtained by the authors are presented. The analysis of the published data reflects the list of methodological procedures that allow researchers to study the mechanism of the transition of M. tuberculosis cells to a dormant state and reverse to metabolically active state, as well as the process of conversion of active tuberculosis infection to a latent tuberculosis and reactivation.
Epigenetic Mechanisms: An Introduction for the NICU Nurse
Authors: Braid Susan , Zelac Daniel E.
Published: October 2019

Our understanding of epigenetics and the mechanisms of gene expression has grown rapidly, requiring the NICU nurse to understand the implications on a neonate's health. Epigenetics is heritable changes of the gene expression without changing the DNA sequence. Though most of the etiologies of birth disorders remain unknown, they could result from interactions of genetics, lifestyle, and environment that make changes in the epigenome landscape. Epigenetics may help explain disorders neonates express including cardiovascular defects, cleft lip and palate, and neural tube defects. As our understanding of epigenetics improves, NICU nurses will need to understand possible epigenetic implications on the neonate's health so as to provide better care and guidance to families.
Ethics and the Genome in the NICU: Stewardship from the Bedside Nurse
Authors: Poston Rebecca , Bernstein Jenny , Braid Susan
Published: October 2019

Medical technology has rapidly decreased the time and cost required to sequence, visualize, and analyze an individual's genome since the Human Genome Project (HGP) ended in April of 2003. The resulting real-time implementation and expanded use of genetic testing in clinical practice, especially in the NICU, has often left ethicists playing catch-up and providing reactive guidance rather than proactive guidance, and nurses struggling to understand their role in resolving associated legal, ethical, and social concerns. This article provides proactive guidance concerning some of the common ethical issues that are manifest in the application of genomics in the NICU as well as practical resources for navigating these conversations with parents and families. Clinical scenarios illustrate key points of consideration for NICU nurses engaged with challenging issues related to genomics in the NICU.
Interleaving Benefits the Learning of Complex Perceptual Categories: Evidence Against the Discriminative-Contrast Hypothesis
Authors: Yan Veronica X. , Sana Faria
Published: October 2019

Interleaving examples of to-be-learned categories, rather than blocking examples by category, frequently enhances category induction. The presently dominant theory is that interleaving promotes discriminative-contrast, and suggests that category similarity structure modulates this interleaving benefit: that blocking should benefit learning when within-category similarity is low and that interleaving should benefit learning when between-category similarity is low. We test whether predictions of this hypothesis hold when generalized to real, complex categories artists' painting styles. Specifically, we test two predictions: (a) that within- and between-category structure should modulate the interleaving benefit (Exp 1a and 1b) and (b) that deliberately juxtaposing similar examples by different artists to highlight their key differences should improve learning (Exp 2a and 2b). We did not, however, find evidence that the discriminative-contrast hypothesis explains the interleaving benefit for complex, perceptual categories.
The Relationships Between Personality Traits, Subjective Well-Being, and Academic Achievements Among Physical Education Teacher Education Students
Authors: Zach Sima , Inglis Varda
Published: October 2019

The aim of this study was to portray a model that describes the relationships between personality traits, life satisfaction, positive and negative affects, stress, and academic achievements among physical education teacher education students. Participants were 173 first-year students. Four questionnaires were used to collect data: The Big Five Personality Inventory; the five-item Satisfaction with Life Scale; the Positive and Negative Affect Schedule; and the Perceived Stress Scale. In addition, the students' average grades were calculated. A Structural Equation Modeling for analyzing the structural model was performed. According to the model, 47% of the variance in subjective well-being is explained by personality traits, and 23% of the variance in academic achievement is explained by subjective well-being and the direct and indirect effects from the personality traits. Our study provides an understanding of the predictive power of personality traits and subjective well-being on academic achievements of physical education student teachers.
TURKEY-VATICAN RELATIONS FROM THE OTTOMANS TO THE REPUBLIC
Authors: TÜRKAN Ahmet
Published: October 2019

The relations between Turkey and Vatican had started to be spoken more frequentlyafter Pope Francis’s visit to Turkey in 2014. Turkey-Vatican relations which were established formally in 1960 embody an important historical past. Formal relations, which were tried to be established substantially during the reign of Sultan Abdulhamit II,-especially to reduce the impact of France over the Catholics and for many other reasons-, were not established due to many different reasons, each different than the other.In this study, we will try to examine the reasons why the Turkish-Vatican relations that started at high friendship level in the second half of the 19th century, hadn’t been realized at formal level until the second half of the 20th century. Furthermore, we will examine the effective factors over these relations both for the Ottoman and the Republic periods. We will also discuss to what degree the Catholics and the Orthodox in Turkey were influential over these relations. In this sense, main part of our work will be within the frame of first-hand sources and documents obtained from the Turkish Republic State Archives.
PERENCANAAN KOMUNIKASI PEMASARAN TERPADU ASIAN GAMES 2018 SEBAGAI NATION BRANDING
Authors: Wardani Ayu Septiana , Dyanasari Reni
Published: October 2019

In addition to acting as a government system, the Indonesian state also acts as a brand that makes it necessary to make efforts to nation branding. Sport mega event is one way to build nation branding. Indonesia was trusted to host the Asian Games 2018. By being in charge of holding a sport mega event (SMEs), Indonesia will gain some benefits from global publicity that can be used to build nation branding. Indonesia's success in holding the Asian Games 2018 has made a positive impact on Indonesia's nation branding. In the implementation of SMES, integrated marketing communications is one of the important factors that determine its success. Indonesia's success in using the Asian Games 2018 moment to build nation branding attracted the attention of researcher to conduct research on the Asian Games 2018 integrated marketing communications planning as a means of building nation branding using qualitative methods. The results of this study indicate that Indonesia implemented six steps in zero based integrated marketing communications planning. When conducting a promotion based on this plan, INASGOC also applies two steps in building Indonesia’s nation branding and communicating the values that Indonesia have through three components in the Nation Brand Hexagon.Keywords: Asian Games, INASGOC, Promotion, Nation Branding, Indonesia
Osteochondral Autograft Transplant (Mosaicplasty) for Knee Articular Cartilage Defects
Authors: Inderhaug Eivind , Solheim Eirik
Published: October 2019

Osteochondral autograft transplant (mosaicplasty) is a cartilage repair procedure for patients with knee articular cartilage lesions of a substantial size (>3 cm2). Patient selection is key to a successful result; patients with established osteoarthritis or systematic disorders such as rheumatoid arthritis should not undergo surgery. An exercise program involving neuromuscular training for a minimum of 3 months should be attempted before proceeding to osteochondral autograft transplant. The procedure can, in many cases, be performed arthroscopically. Patients should, however, provide consent for a mini-arthrotomy as this might be needed to achieve optimal access for graft harvesting and insertion. The procedure, in general, consists of 4 major steps. (1) At the initial arthroscopic examination, the size and localization of the defect are assessed after a proper debridement has been performed. The number and size of autografts needed can thereafter be assessed. (2) Graft harvesting is then performed from the periphery of the non-weight-bearing trochlea. (3) To prepare for graft insertion at the recipient site, a drill guide is inserted perpendicular to the joint surface in the defect to allow graft sockets to be reamed. (4) Grafts should be spaced approximately 3 mm apart to avoid confluence of tunnels and weakening of condyles. The orientation and depth of insertion of the grafts are key to mimic the native curvature of the affected joint surface.

After an initial phase of non-weight-bearing focusing on range of motion, a gradual increase in neuromuscular exercises is recommended. Patients are typically advised to delay their return to sports until 6 months at the earliest. Results after mosaicplasty have shown that the procedure improves subjective outcomes, compared with baseline function, for up to 10 years after surgery. The additional effect over traditional microfracture treatment is, however, reduced over time. A study evaluating early factors affecting outcomes after cartilage repair procedures (including mosaicplasty) found that a series of factors, such as the time from the onset of symptoms to surgery, number and size of lesions, location and quality of surrounding cartilage, as well as concomitant meniscal injuries, were important
3
.
Cyclic compression emerged dual effects on the osteogenic and osteoclastic status of LPS-induced inflammatory human periodontal ligament cells according to loading force
Authors: Jia Ru , Yi Yingjie , Liu Jie , Pei Dandan , Hu Bo , Hao Huanmeng , Wu Linyue , Wang Zhenzhen , Luo Xiao , Lu Yi
Published: October 2019

Background: Appropriate mechanical stimulation is essential for bone homeostasis in healthy periodontal tissues. While the osteogenesis and osteoclast differentiation of inflammatory periodontal ligament cells under different dynamic loading has not been yet clear. The aim of this study is to clarify the inflammatory, osteogenic and pro-osteoclastic effects of different cyclic stress loading on the inflammatory human periodontal ligament cells (hPDLCs) .
Methods: hPDLCs were isolated from healthy premolars and cultured in alpha minimum Eagle’s medium (α-MEM). Lipopolysaccharides (LPS) were used to induce the inflammation state of hPDLCs in vitro . Determination of LPS concentration for the model of inflammatory periodontium was based on MTT and genes expression analysis. Then the cyclic stress of 0, 0-50, 0-90 and 0-150 kPa was applied to the inflammatory hPDLCs for 5 days respectively. mRNA and protein levels of osteogenic, osteoclastic and inflammation-related markers were examined after the treatment.
Results: MTT and RT-PCR results showed that 10 μg/ml LPS up-regulated TNF-α, IL-1β, IL-6, IL-8 and MCP-1 mRNA levels ( P <0.05) and did not affect the cell viability ( P >0.05). The excessive loading of stress (150 kPa) with or without LPS strongly increased the expression of inflammatory-related markers TNF-α , IL-1β , IL-6 , IL-8 , MCP-1 ( P <0.05) and osteoclastic markers RANKL , M-CSF , PTHLH and CTSK compared with other groups ( P <0.05), but had no significant effect on osteogenic genes. While 0-90 kPa cyclic pressure could up-regulate the expression of osteogenic genes ALP, COL-1 , RUNX2, OCN, OPN and OSX in the healthy hPDLSCs.
Conclusions: Collectively, it could be concluded that 0-150 kPa was an excessive stress loading which accelerated both inflammatory and osteoclastic effects, while 0-90 kPa may be a positive factor for the osteogenic differentiation of hPDLCs in vitro.
Electronic Health Record Nested Pragmatic Randomized Controlled Trial of a Reminder System for Serum Lithium Level Monitoring in Patients with Mood Disorder: KONOTORI study protocol
Authors: Seki Tomotsugu , Aki Morio , Kawashima Hirotsugu , Miki Tomotaka , Tanaka Shiro , Kawakami Koji , Furukawa Toshi A.
Published: October 2019

Background: The weaknesses of classical explanatory randomized controlled trials (RCTs) include limited generalizability, high cost, and time burden. Pragmatic RCTs nested within electronic health records (EHRs) can be useful to overcome such limitations. Serum lithium level monitoring has often been underutilized in real-world practice in Japan. This trial aims to evaluate the effectiveness of the EHR-nested reminder system for serum lithium level monitoring in the maintenance of therapeutic lithium concentration and in the improvement of the quality of care for patients on lithium maintenance therapy. Methods: The Kyoto tOyooka Nested cOntrolled Trial Of Reminders (KONOTORI trial) is an EHR-nested, parallel-group, stratified permuted block randomized controlled trial. Screening, random allocation, reminder output, and outcome collection will be conducted automatically by the EHR-nested trial program. Patients with a mood disorder taking lithium carbonate for maintenance therapy will be randomly allocated to the two-step reminder system for serum lithium level monitoring or to usual care. The primary outcome is achievement of therapeutic serum lithium concentration between 0.4 and 1.0 mEq/L after 18 months. Discussion: The KONOTORI trial uses EHRs to enable the efficient conduct of a pragmatic trial of the reminder system for lithium monitoring. This may contribute to improved quality of care for patients on lithium maintenance therapy.
Chinese herbal medicine Tangshen Formula Treatment For Type 2 Diabetic Kidney Disease in Early Stage : study protocol for a randomized controlled trial
Authors: Jin De , Huang Wen-Jing , Meng Xiang , Yang Fan , Bao Qi , Zhang Mei-zhen , Yang Ya-nan , Lian Feng-Mei , Ni Qing , Tong Xiao-Lin
Published: October 2019

Abstract
Background:
Diabetic kidney disease (DKD) is the main cause of end stage kidney disease (ESKD) and It has become a heavy economic and social burden due to its high prevalence and morbidity. The most effective strategy is that patients with DKD should be diagnosed and treated early. Preliminary studies showed the Chinese herbal Tangshen Formula (TSF) may delay the progression of DKD, reducing micro-and macro-albuminuria and improving renal function. We designed a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of TSF in patients with DKD.

Methods/design:
This trial is a thirteen-center, randomized, double-blind, placebo-controlled study. 623 participants will be randomized in a 1:1 ratio to an experiment group (TSF plus Losartan) and a control group (placebo plus Losartan). The trial cycle will last 24 weeks. The primary outcome will be the change in Urine microalbumin creatinine ratio （ ACR ） from baseline to week 24. The secondary outcome will be the change in the rate of progression into the clinical proteinuria period after intervention, the rate of urine microalbumin negative conversion, the rate of normal urinary microalbumin, doubling rate of baseline creatinine value and glomerular filtration rate (GFR) between the two groups. Safety in medication will also be evaluated.

Discussion: We hypothesize that type 2 diabetic patients in early stage of DKD will benefit from TSF. If successful, this study will provide evidence-based recommendations for clinicians.

Trial registration: ClinicalTrials.gov (NCT03009864)

Keywords: Diabetes Kidney Disease, Traditional Chinese medicine, Treatment, Randomized controlled trial
Effect of a community-based intervention for cardiovascular risk factor control on stroke mortality in rural Gadchiroli, India: study protocol for a cluster randomised controlled trial
Authors: Kalkonde Yogeshwar , Deshmukh Mahesh , Nila Sindhu , Jadhao Sunil , Bang Abhay
Published: October 2019

Background
Stroke has emerged as a leading cause of death in rural India. However, well tested healthcare interventions to reduce stroke mortality in rural under-resourced settings are lacking. The aim of this study is to evaluate the effect of a community-based preventive intervention on stroke mortality in rural Gadchiroli, India.
Methods
The study is a two-arm, parallel group, cluster randomised controlled trial where 32 villages each will be randomised to the intervention and the enhanced usual care (EUC) arm. In the intervention arm, individuals ≥ 50 years of age will be screened for hypertension, diabetes and stroke by trained Community Health Workers (CHWs). Screen positive individuals will be referred to a mobile outreach clinic which will visit intervention villages. A physician in the clinic will confirm the diagnosis, provide guideline-based treatment and follow up patients at periodic intervals. The CHWs will make home visits once a month to ensure medication compliance and counsel patients to reduce salt consumption and quit tobacco and alcohol. In the EUC arm, households will be provided information on the ill effects of tobacco and steps to quit it. Individuals from both the arms will have access to government’s national programme for prevention and control of non-communicable diseases where treatment for hypertension, diabetes and preventive treatment after stroke is available, nearest at the primary health centres (PHCs). The intervention will be implemented for 3.5 years. The primary outcome will be reduction in stroke mortality in the last 2.5 years of the intervention.
Discussion
This trial will provide important information regarding the feasibility and effect of a community-based preventive intervention package on stroke mortality in a rural under-resourced setting and can inform India’s non-communicable diseases prevention and control programme. If successful, such an intervention can be scaled up in rural regions of India and other countries.
Tumor secreted ANGPTL2 facilitates recruitment of neutrophils to the lung to promote lung pre-metastatic niche formation and targeting ANGPTL2 receptor signaling prevents metastatic disease.
Authors: Charan Manish , Dravid Piyush , Cam Maren , Setty Bhuvana , Roberts Ryan D , Houghton Peter J , Cam Hakan
Published: October 2019

The authors have withdrawn the journal submission associated with this preprint and requested that the preprint also be withdrawn.
Selenium, Copper, Zinc and Hypertension: An Analysis of the National Health and Nutrition Examination Survey (2011-2016)
Authors: Bastola Mrigendra Mani , Locatis Craig , Maisiak Richard , Fontelo Paul
Published: October 2019

Background: Hypertension is a major cardiovascular illness worldwide with many underlying causes. The role of trace elements selenium, copper, and zinc in hypertension is uncertain. The objective of this study was to evaluate the role of these trace elements in hypertension. Method: Data from 6683 National Health and Nutrition Examination Survey (NHANES) participants from 2011 to 2016 were analyzed using Statistical Analytical System (SAS, version 9.4) software for the role of trace elements in hypertension in age range 8 to 80 years, irrespective of the antihypertensive medication taken. Recent American Heart Association guidelines and pediatric practice guidelines for hypertension were used.Results: Findings showed a significant positive association between serum selenium levels and hypertension but not serum zinc and copper. At optimal levels for transport and distribution, serum selenium levels of 120 µg/L or higher (reference level 70 -150 µg/L) were significantly associated with hypertension (OR = 1.46, 95% CI= 1.29 – 1.66) after adjusting for confounding factors. At serum selenium level greater than 150 µg/L, the association with hypertension strengthened (OR= 1.69, 95% CI = 1.32-2.17). Conclusion: A positive association was found between serum selenium and hypertension, irrespective of age or anti-hypertensive medications intake. These findings also suggest that the reference levels of serum levels in healthy individuals may need to be re-determined, if supported by additional studies. If validated, patients with hypertension may also need to be cautioned about selenium intake.
The effect of antibiotics on post-adenotonsillectomy morbidity in tanzanian children: study protocol for a randomized double-blind placebo-controlled trial.
Authors: Katundu Denis Robert , Shija Peter Stephen , Nyombi Baltazari , Semvua Hadija , Oussoren Fieke K , Heerbeek Niels van
Published: October 2019

Background: Adenotonsillectomy is the most frequently performed operation in children worldwide. For decades prophylactic antibiotics have been prescribed to limit postoperative complications. In a Cochrane review the effect of this antibiotic use has been refuted. However, all reviewed studied were done in developed countries. In Tanzania, like many other developing countries with limited resources and a high burden of infectious diseases, postoperative antibiotic prescription is still very common to decrease the supposed higher postoperative morbidity. However, as a consequence of this widespread use of postoperative antibiotics cross-resistance and risk of allergic side effects rise. Well designed randomised controlled trials are needed to limit unnecessary antibiotic prescription and secondary antibiotic resistance.
Aim: The aim of this study is to analyse the prophylactic role of postoperative antibiotic on the morbidity following adenotonsillectomy in children in Tanzania.
Design: A double blinded randomised placebo controlled trial set in northern Tanzania. Participating centres are the department of otolaryngology at Kilimanjaro Christian Medical Centre (KCMC) in Moshi and the department of paediatric surgery at the Arusha Lutheran Medical Centre (ALMC) in Arusha.
Methods: Around 270 children aged 2 to 14 years, all scheduled for elective (adeno)tonsillectomy, will be included and assigned to receive either a standard regimen of 5 days antibiotic prophylaxis or placebo after surgery. The primary outcomes are postoperative haemorrhage, fever and pain. Secondary outcomes are the time until normal diet is resumed, the time until normal activities are resumed, occurrence of adverse events and microbial recolonization of the tonsillar beds.
Discussion: This study will enhance increase of proper antimicrobial prescription in Tanzanian institutions as well as other resource-limited countries where prescription of antibiotics is still very common. In addition, it might augment current knowledge about surface and core tonsillar micro-organisms and sensitivity patterns.
The Effect of TRX vs. Aquatic Exercises on Self-Reported Knee Instability and Affected Factors in Women with Knee Osteoarthritis: A Randomized Controlled Trial
Authors: Asar Shirin , Gandomi Farzaneh , Mozafari Mahsa , Sohaili Freshteh
Published: October 2019

Background

Knee Instability (KI) is described as a sense of the knee buckling, shifting, or giving way during the weight bearing activities. High prevalence (65%) has been reported for KI amongst the patients with knee osteoarthritis (KOA). So, we studied the effect of two interventions on self-reported KI and affected factors.Methods

In this single blind, randomized, and controlled trial, 36 patients with radiographic grading (Kellgren–Lawrence 1–4) of knee osteoarthritis were selected for participating. patients were allocated in three groups aquatic exercises (n=12), Total Resistance eXercises (TRX) exercises (n=12) and control (n=12) by random. 8-week TRX and aquatic exercises were carried out by experimental groups. Pain severity was assessed by visual analog scale (VAS), Balance was also evaluated by Berg Balance Scale (BBS), quadriceps strength by dynamometer, and knee range of motion (ROM) by inclinometer, Western Ontario and McMaster Universities Osteoarthritis (WOMAC), self-reported KI were also measured before and after interventions.Results

The results of One-way ANOVA showed that there was no significant difference between aquatic exercises and TRX (P>0.05) for KI, BBS, WOMAC, and pain. But there was significant difference between the aquatic exercises and the control for KI (P=0.0001), BBS (P=0.0001), WOMAC Stiffness (P=0.0001), and pain (P=0.006). Also, there was significant difference between the TRX and the control for KI (P=0.0001), BBS (P=0.0001), and pain (P=0.003) except WOMAC Stiffness (P=0.07).Conclusions

TRX and aquatic interventions had a similar effect on the patients’ KI, pain, function, and also balance variables, but TRX exercises had more effect on the knee stiffness improvement.
Smart Pumps Improve Medication Safety but Increase Alert Burden in Neonatal Care
Authors: Melton Kristin , Timmons Kristen , Walsh Kathleen E , Meinzen-Derr Jareen K , Kirkendall Eric
Published: October 2019

Background: Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source of alert burden and alert fatigue in an intensive care environment. Methods: Using smart pump records, over 370,000 infusion starts for continuously infused medications used in neonates and infants hospitalized in a level IV NICU from 2014-2016 were evaluated. Attempts to exceed preset soft and hard maximum limits, percent variance from those limits, and pump alert frequency, patterns and salience were evaluated. Results: Smart pumps prevented 160 attempts to exceed the hard maximum limit for doses that were as high as 7-29 times the maximum dose and resulted in the reprogramming or cancellation of 2093 infusions after soft maximum alerts. While the overall alert burden from smart pumps for continuous infusions was not high, alerts clustered around specific patients and medications, and a small portion (17%) of infusions generated the majority of alerts. Soft maximum alerts were often overridden (79%), consistent with low alert salience. Conclusions: Smart pumps have the ability to improve neonatal medication safety when compliance with dose error reducing software is high. Numerous attempts to administer high doses were intercepted by dosing alerts. Clustered alerts may generate a high alert burden and limit safety benefit by desensitizing providers to alerts. Future efforts should address ways to improve alert salience.
Characteristics And Outcome Of Influenza-Associated Encephalopathy/Encephalitis Among Children In A Tertiary Pediatric Hospital In Italy, 2017-2019
Authors: Mastrolia Maria Vincenza , Rubino Chiara , Resti Massimo , Trapani Sandra , Galli Luisa
Published: October 2019

BACKGROUND: Influenza is the most frequent cause of acute upper respiratory tract infections during winter season. Although rare, neurological manifestations are known to occur during influenza infection and approximatively three-quarters of cases are in children. In this study, we aimed to characterize the burden and clinical spectrum of influenza-associated encephalopathy and encephalitis in children admitted at a tertiary pediatric hospital in Italy over two influenza seasons (2017-2019).
METHODS: We retrospectively analyzed clinical, laboratory, instrumental data and outcome of patients discharged with ICD9-CM 487.0 code
RESULTS: Fifteen children (13.1% of those discharged with a diagnosis of influenza infection in the study period), had influenza-associated central nervous system (CNS) manifestations. Eight patients (53.3%) were diagnosed as influenza encephalitis, 7 (46.7%) as influenza encephalopathy. Median age was 27 months. In children under 2 years of age (40% of all cases) altered consciousness was the most frequent neurological manifestation while respiratory symptoms were present at admission in all cases. Younger children also required intensive care support more frequently. Five subjects (33.3%) presented comorbidity. None of the patients had received seasonal influenza vaccination. The median time from onset of respiratory signs to onset of neurological manifestations was 24 hours. Cerebrospinal fluid (CSF) analysis was normal in most patients and polymerase chain reaction for influenza virus RNA on CSF, when performed, was negative in all samples. Neuroradiological investigations, performed in 5 children, reported cortical and subcortical white matter signal alterations. Oseltamivir was administered only in 2 cases. Fourteen patients recovered without sequelae, and only a 2-year-old girl had minimal impairment in fine motor skills at discharge.
CONCLUSIONS: All children presenting acute neurological features during influenza season should be evaluated for influenza-associated CNS complications even if the respiratory involvement is mild. Absence of underlying diseases or other risk factors are not protective factors against CNS influenza-associated complications. The lack of CSF pleocytosis does not exclude CNS involvement. Children under 2 years of age are at higher risk of requiring intensive care support.
Total resuscitative endovascular balloon occlusion of the aorta causes inflammatory activation and organ damage within 30 minutes of occlusion in normovolemic pigs
Authors: Sadeghi Mitra , Dogan Emanuel M. , Karlsson Christina , Jansson Kjell , Seilitz Jenny , Skoog Per , Hörer Tal M. , Nilsson Kristofer F.
Published: October 2019

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) causes physiological, metabolic, end-organ and inflammatory changes that need to be addressed for better management of severely injured patients. The aim of this study was to investigate occlusion time-dependent metabolic, end-organ and inflammatory effects of total REBOA in Zone I in a normovolemic animal model. Methods: Twenty-four pigs (25-35kg) were randomized to total occlusion REBOA in Zone I for either 15, 30, 60 minutes (REBOA15, REBOA30, and REBOA60, respectively) or to a control group, followed by 3-hour reperfusion. Hemodynamic variables, metabolic and inflammatory response, intraperitoneal and intrahepatic microdialysis, and plasma markers of end-organ injuries were measured during intervention and reperfusion. Intestinal histopathology was performed. Results: Mean arterial pressure and cardiac output increased significantly in all REBOA groups during occlusion and blood flow in the superior mesenteric artery and urinary production subsided during intervention. Metabolic acidosis with increased intraperitoneal and intrahepatic concentrations of lactate and glycerol was most pronounced in REBOA30 and REBOA60 during reperfusion and did not normalize at the end of reperfusion in REBOA60. Inflammatory response showed a significant and persistent increase of pro- and anti-inflammatory cytokines during reperfusion in REBOA30 and was most pronounced in REBOA60. Plasma concentrations of liver, kidney, pancreatic and skeletal muscle enzymes were significantly increased at the end of reperfusion in REBOA30 and REBOA60. Significant intestinal mucosal damage was present in REBOA30 and REBOA60. Conclusion: Total REBOA caused severe systemic and intra-abdominal metabolic disturbances, organ damage and inflammatory activation already at 30 minutes of occlusion.
Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.
Authors: Iflaifel Mais HM , Lim Rosemary , Ryan Kath M , Crowley Clare
Published: October 2019

Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC was conceptualised, described and interpreted, to describe the methods used to study, and to identify factors that develop RHC. Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search for studies published in books that explained how RHC as a concept was interpreted, methods used to study, and factors to develop RHC. Studies were evaluated independently by two researchers. Data was synthesised using a deductive thematic approach. Results Twenty-seven studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods such as observations and interviews were used to study RHC. Models for studying RHC currently exist and were in the early stages of implementation. Effective team relationships, trade-offs and healthcare ‘resilience’ training of health care professionals were factors used to develop RHC. Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and factors to develop RHC, further research should focus on operationalising RHC assessment methods and developing, testing and evaluating interventions for developing RHC.
Explaining the Dimensions of Social Support for Breakfast and Healthy Snacks in Students: A Qualitative Study
Authors: Bastami Fatemeh , Ardalan Arash , Zamani-Alavijeh Fereshteh , Mostafavi Firoozeh
Published: October 2019

Background: breakfast elimination as well as consumption of low-value snacks is ever increasing among adolescents. This study sought to explain the dimensions of social support for breakfast and healthy snacks among students. Methods : A qualitative research was conducted in Isfahan, Tehran, and Khorramabad high schools in 2017--18. Data were obtained from five focus group discussions and 35 in-depth interviews as well as semi-structured interviews with students of both sex, parents and school authorities. The data simultaneously analyzed using conventional content analysis in three stages including preparation, organization, and reporting. Prolonged engagement, maximum variation of sampling and member check were the enrichment factors of the research. Results : Three main categories emerged. First, family supports with sub- categories of family in the school programs as well as mother-sponsored support and family life patterns. Second, school supports with sub- categories of instrumental and informational support. And third, support of other community organizations with sub- categories of intra-department coordination and mass media. Conclusion : By providing exciting advocacy opportunities such as holding an exhibition and building families' confidence in the safety of school nutrition, school can attract family partnerships. In addition, promoting healthy eating needs multi-level supports such as mass media, municipalities, police, and the school's renovation office as well as the coordination of these organizations with health sector.