bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluación de protocolos de tratamientos acortados del programa nacional de tuberculosis
Authors: Rodríguez Tulio S
Published: August 2019

Recibido: 4 feb. 2018 Aceptado: 16 may. 2018

Introducción: La implementación de cualquier protocolo de atención en salud, requiere de la sinergia de esfuerzos de autoridades que velene implementen el sistema, de los recursos materiales destinados para su desarrollo y del ser humano para operacionalizarlo. Objetivos: El objetivo del estudio fue evaluar los tratamientos antituberculosos acortados en pacientes ingresados en el Hospital San Vicente, diagnosticados como casos nuevos y/oretratamientos del 1 de enero al 31 de diciembre del año 2015. Metodología: Del total de 304 pacientes ingresados con diagnóstico de Tuberculosis, setomó una muestra de investigación de 110 pacientes que cumplieran con diagnóstico exclusivo de tuberculosis pulmonar e iniciaran tratamientos contemplados estrictamente en Plan “A” y Plan “B”. Resultados: Se registraron de acuerdo a categorías: Curado en el 65% de los pacientes, quedando muy pordebajo de la norma nacional del 85%. Tratamiento Completo en el 8%, alto, en relación a la norma del 2%. Alta tasa de abandono del 17% en comparación al 6% establecido. Se observó una tasa de abandono recuperado que continuaron tratamiento del 6% y una tasa de fallecidos global de 9.72%. Conclusiones: La eficacia del tratamiento expresada en la tasa de curación, iniciada en el Hospital San Vicente es alta pero no cumple con la meta de la norma nacional del 85% en la fase complementaria en las áreas de salud ambulatorias por una elevada tasa de abandonos y fallecidos.
Amebiasis de cuello uterino. Reporte de caso
Authors: Alarcón William , De la Rosa Emerson , Argueta Víctor , Orozco Roberto
Published: August 2019

La amebiasis de cuello uterino es una enfermedad infrecuente. Pocos casos han sido reportados. Puede confundirse clínicamente con otras entidades, como cáncer de cérvix. Nuestro objetivo es reportar un caso diagnosticado en el Hospital General San Juan de Dios, que permitió el tratamiento oportuno y la resolución del cuadro clínico.
Fotografías de Casos Clínicos Interesantes
Authors: Orozco Roberto
Published: August 2019

Práctica docente hospitalaria, pediatría Hospital General San Juan de Dios, Guatemala, ciudad.
Polifarmacia y adherencia terapéutica en el adulto mayor con Diabetes Mellitus
Authors: Rojas Gómez Rolando , Rojas Gómez Erick
Published: August 2019

Recibido: 23 ago. 2018 Aceptado: 24 sep. 2018

Objetivos: determinar la prevalencia de polifarmacia y adherencia al tratamiento en los pacientes adultos mayores diabéticos atendidos en el servicio de consulta externa de Medicina Interna del Hospital Regional de Occidente de Quetzaltenango.

Materiales y métodos: se realizó un estudio descriptivo transversal en pacientes adultos mayores diabéticos, en quienes se determinó el número de medicamentos consumidos, la adherencia al tratamiento por medio del test de Morisky Green, se midieron la relación entre las variables polifarmacia y adherencia por medio del Odds Ratio.

Resultados: Se analizaron 210 pacientes con una edad promedio de 67.45 años, de estos el 81.9% correspondieron al género femenino y en su mayoría procedentes del Departamento de Quetzaltenango 78.1%. La media de años con diagnósticos de Diabetes Mellitus fue 10.12; el promedio de número de medicamentos consumidos por lo pacientes fue 3.6; El promedio de número de comorbilidades fue 2.86, siendo la comorbilidad más frecuente hipertensión arterial; Basados en el Test de Morisky Green también se observó que un 42.4% de los pacientes tenían adherencia a su tratamiento y que la principal causa de fallo fue que los pacientes olvidaban tomar sus medicamentos.

Conclusión: No existió asociación entre polifarmacia y adherencia al tratamiento.
Calidad microbiológica de la red de distribución de agua potable en Chimaltenango, Guatemala.
Authors: Corado Martínez Claudia , Dardón Rodríguez María , Coyote Cumes Allan , Méndez Barrios Cintia , Cifuentes Alejandra , Ibáñez Ana , Samayoa Girón Mario
Published: August 2019

Recibido: 12 sep. 2018 Aceptado: 30 oct. 2018

Propósito: determinar la calidad microbiológica de la red de distribución de agua potable en los municipios de Patzicía, Patzún, Parramos, Zaragoza, Santa Cruz Balanyá, San Andrés Itzapa y El Tejar, del departamento de Chimaltenango, durante mayo y junio del 2018.

Materiales y métodos: estudio prospectivo, descriptivo de corte transversal realizando análisis microbiológico, mediante el método de filtración de membrana para la detección de coliformes totales y Escherichia coli en 43 muestras de agua, proveniente de la totalidad de hidrantes públicos en el área urbana de dichos municipios. Datos obtenidos de los informes del Laboratorio de Análisis Fisicoquímicos y Microbiológicos de la Facultad de Ciencias Químicas y Farmacia de la Universidad de San Carlos de Guatemala, utilizando como referencia los parámetros establecidos por COGUANOR NTG 29001.

Resultados: el 76.74% de los hidrantes no son sanitariamente seguros para consumo humano de agua, al detectarse en 33 muestras coliformes totales y 23 contaminadas con E. coli. Además, en Patzún y Santa Cruz Balanyá, el 100% de los hidrantes públicos presentaron contaminación fecal, mientras que en Parramos el 83.33% de los hidrantes abastecen agua potable.

Conclusiones: el agua distribuida en el departamento de Chimaltenango no se considera potable, al no cumplir con los límites permisibles establecidos por COGUANOR NTG 29001, detectando 76.74% de muestras analizadas coliformes totales y en 53.49% E. coli. Los municipios en los que se identificó más contaminación del agua son Patzún y Santa Cruz Balanyá, por el contrario Parramos distribuye mayor proporción de agua potable.
Prevalencia de depresión y estrés postraumático en los bomberos voluntarios
Authors: Velásquez Miriam Velásquez , Castillo Caren , Mancilla Iracema , López Irene , Arenales Roberto
Published: August 2019

Recibido: 31 dic. 2018 Aceptado: 23 may. 2019

Propósito: Determinar la prevalencia de depresión y estrés postraumático en los bomberos voluntarios en el departamento de Guatemala.

Material y Métodos: Se desarrolló un análisis cuantitativo, con diseño descriptivo, transversal, en trabajadores que han laborado más de un año en el cuerpo de bomberos voluntarios de las estaciones No. 4, 10, 25,50 y 100 del departamento de Guatemala, se obtuvieron los datos por medio de la evaluación de estrés postraumático y la escala auto aplicada de evaluación de depresión de Beck.

Resultados: En las estaciones de bomberos voluntarios, se evidenció que el 20% presenta síntomas de depresión y 10% presenta síntomas sugestivos de estrés postraumático. El grupo etario más afectado es el de 40 a 50 años siendo en su mayoría de sexo masculino. Según la clasificación de depresión, el 13% presenta depresión leve, el resto se encuentra normal al momento del estudio.

Conclusiones: Se observó que 2 de cada 10 bomberos voluntarios presenta síntomas de depresión y 1 de cada 10 bomberos voluntarios presenta síntomas de estrés postraumático.
Nefrectomía por hidronefrosis grado iv Reporte de caso
Authors: González Reynoso Gustavo , Molina Estrada Allan
Published: August 2019

La hidronefrosis se define como una dilatación del sistema colector renal debida a dificultad para la eliminación de la orina, causada por la existencia de un obstáculo en algún punto del sistema urinario, que puede ser de tipo mecánico o funcional. Se acompaña de atrofia progresiva del parénquima renal. Las causas más comunes difieren con la edad.

Caso Clínico: Se presenta caso de una paciente femenina de 47 años, que es admitida en la sin antecedentes importantes con motivo de consulta de dolor lumbar izquierdo tipo cólico de tres semanas de evolución.

Discusión: Este es un síndrome complejo que resulta de interacciones entre la hemodinámica glomerular y alteraciones en la función tubular asociado.

Conclusión: El retraso en el diagnostico por la sintomatología inespecífica y en el inicio del tratamiento conllevan a un peor pronóstico.
Infección severa de vías urinarias asociada a uso de inhibidores de SGLT2 Reporte de Caso
Authors: Nitsch Montiel Mario , Nitsch Prado Alejandro
Published: August 2019

Se reporta el caso de un paciente de 56 años con diagnóstico de diabetes, quien luego de un año de uso de canagliflozina desarrolla una infección severa de vías urinarias que requirió terapia en cuidados intensivos. Se revisa la literatura al respecto y se enfatiza la importancia de la instrucción a pacientes sobre posibles efectos secundarios de medicamentos.
A 50-YEAR REVIEW ON THE PREVALENCE OF CLINICAL DISEASES AND DISORDERS OF CATTLE IN BANGLADESH
Authors: Samad M. A.
Published: August 2019

Background: The 25.7 million cattle populations in Bangladesh which is endangered by different diseases and disorders that are associated with significant socio-economic losses to the smallholder farmers and even in modern dairy farms. More than 100 articles on the retrospective evaluation of clinical case records have been published during the last 50 years from 1968 to 2018 in Bangladesh and their compilation and evaluation would help to understand the predominant diseases associated with morbidity and mortality.

Objectives: To analyze and evaluate the 50-year data on the prevalence of clinical diseases and disorders of cattle to identify the predominant and priority ailments for their prevention and control.

Materials and Methods: Data obtained from all the available 118 articles published on clinical cases of cattle during the last 50 years in Bangladesh were analyzed to detect their status on bovine health.

Results: Out of 137 different types of clinical cases recorded during the last 50 years, of which, calves affected with 27 (19.71%), adult cattle with 76 (55.47%) and both calves and adult cattle with 34 (24.82%) types of diseases and disorders. The highly statistical significant (p < 0001) percentage of clinical cases of cattle required medicinal treatment (81.19%) in comparison to surgical (10.03%) and gynaeco-obstetrical (GO; 08.78%) intervention. Results revealed that the parasitic diseases (fascioliasis 66.16%, humpsore 22.35%, gastro-intestinal (GI) nematodiasis 17.44%, ascariasis 12.17%, tick infestation 15.71%) and GI disorders (anorexia 14.90%, indigestion 6.15%) were highly prevalent as clinical cases in comparison to infectious diseases (anthrax 0.21%, BQ 0.92% and HS 0.45%) except FMD (10.13%) and mastitis (6.46%). Anestrus (3.04%), retained placenta (2.73%), repeat breeding (2.73%) and pyometra (2.12%) were recorded as major gynaeco-obstetrical problems, whereas umbilical myiasis (10.11%), lameness (4.25%) and abscess (1.15%) that mainly required surgical interventions.

Conclusions: The analysis of 50-year published reports on clinical cases of cattle gives an overall comprehensive idea about the disease problems that would help to formulate the devices for their prevention and control.

Keywords: Prevalence, Clinical diseases and disorders, 50-year review, Calf diseases, Adult cattle diseases, Medicinal cases, Gynaeco-obstetrical cases, Surgical cases
PREVALENCE OF SUB-CLINCIAL KETOSIS AND ITS ASSOCIATED COW LEVEL RISK FACTORS IN LACTATING DAIRY CROSS-BRED COWS IN BANGLADESH
Authors: Hossain S. M. S.
Published: August 2019

Background: Ketosis is one of the most economically important metabolic diseases commonly found in high milk producing dairy cows worldwide. Objectives: The main objectives of this study were: (a) to evaluate the relationship between the urinary ketone bodies Rothera’s test and the serum glucose level to determine the prevalence of sub-clinical ketosis (SCK) and (b) to explore the cow-level risk factors associated with SCK in cross-bred dairy cows. Materials and Methods: Two types of cross-bred, Holstein Friesian  Local (HF  L) and Shahiwal  Local (SH  L) of a total of 68 lactating cows of three dairy herds were randomly selected to study the SCK from January to May 2012. Serum glucose level (SGL) was estimated by using Reflotron Glucose test strip (Roche) and urinary ketone bodies (UKB) by Rothera’s nitroprusside test. Results: An overall 25% prevalence of SCK was detected by Rothera’s test of which comparatively higher percentage of SCK was recorded in HF  L (25.9%) than SH  L (21.43%) cross-bred lactating cows. The overall SGL of Rothera’s test positive cases varied from 30 to 39 mg / dl with an average of 34.24  2.44 which was significantly (p < 0.001) lower than the Rothera’s test negative cows (40 to 49 and 46.27  3.77 mg / dl). The SCK detected on Rothera’s test was compared with SGL which was 100% sensitivity at  39 mg / dl which could be considered as a ‘cutoff point’ of SGL for SCK. Results of the Rothera’s test were highly correlated with the concentrations of SGL. The significantly (p < 0.01) highest prevalence of SCK was recorded in the fourth parity (66.7%) and fourth week of lactation (46.7%) in comparison to their respective parameters. Conclusions: The present findings reveal that the prevalence of SCK in lactating dairy cows in Bangladesh is very high and remain undetected and unattended. To prevent the SCK, feeding a good feed stuff and implementing good management at the transition period with regular testing for detecting SCK to reduce the consequences and economic losses caused by SCK in dairy industry in Bangladesh. Keywords: Serum glucose level, Rothera’s test, Subclinical ketosis, Cross-bred dairy cows, Cow-level risk factors
OBSERVATIONS OF SIX REPRODUCTIVE CYCLES AND FOOD HABITS OF BROWN FISH OWL NESTING AT THE HUMAN HABITAT IN BANGLADESH
Authors: Samad M. A.
Published: August 2019

Background: Research reports on wild nocturnal bird especially Brown fish owl are very limited not only in Bangladesh but also elsewhere.

Objectives: This paper describes the diet profile and physiology of reproduction of a pair of wild Brown fish owl.

Materials and Methods: A breeding pair of Brown fish owl has been used the abandoned flower planting site on the window sunshade for their reproduction during six breeding cycles from 2013 to 2019. The behavior, food sources, food habits and their physiology of reproduction were observed closely and keenly for six reproductive cycles.

Results: The male owl is usually brought prey by hunting at night and supplied to the female owl and their owlet at the nest but the only unconsumed prey lying on the nest were identified visually during the daytime. The most commonly recorded prey consumed by the habitat lost Brown fish owl include fish, frogs, rats, snake, birds and lizards. Investigation of all the six breeding cycles of this species of owl showed that all the six reproductive cycles were completed during the high cold winter months from end of November to early March. The egg clutch size varied from 1-2 with an average of 1.33 and the female owl alone incubated eggs and the incubation period varied from 37 to 38 days with an average of 37.5 days. The brooding and care of owlets were mainly performed by the female owl but the male owl supplied the food usually at night time. All the six reproductive cycles of the owls were successfully completed with fledged the juvenile owls between 53-63 days with an average of 59.25 days parental care with a total of breeding cycle from 91 to 101 with an average of 96.75 days.

Conclusions: The objectives of the wild and zoo birds are for the conservation, research, education, recreation, ecology and economic benefits. This article would help to encourage development of bird parks, to create awareness of bird life and generate interest in ornithology and to help promote conservation of endangered species of birds by captive breeding.

Keywords: Brown fish owl, Food and food habits, Physiology of reproduction, Egg clutch, Incubation period, Seasonal breeding cycle
A comparison of morphology and web geometry between hypogean and epigean species of Metellina orb spiders (family Tetragnathidae)
Authors: Hesselberg Thomas , Simonsen Daniel
Published: August 2019

Studies on the behaviour of subterranean animals are rare, mainly due to the problems with collecting data in these inaccessible habitats. Web-building cave spiders, however, leave a semi-permanent record of their foraging behaviour, which can relatively easily be recorded. In this study, we compare size, leg lengths and web characteristics between hypogean populations of Metellina merianae with its close wood-inhabiting relative M. mengei. We confirm previous observations that M. merianae does not show any obvious morphological and behavioural adaptions to a subterranean life-style, although individuals of the cave species were significantly larger and had webs with relatively fewer radii and capture spiral turns than M. mengei. We were, however, not able to determine if these findings indicate a transition towards behavioural adaptation to caves or if they are a result of behavioural flexibility in response to the different humidity and temperature between caves and woodland. Finally, we did not find any effect of cave characteristics on either the number of radii or the area of the M. merianae web.
Reproductive Pattern in Women with Idiopathic Inflammatory Myopathy: A Population-based Study
Authors: Che Weng Ian , Hellgren Karin , Lundberg Ingrid E. , Holmqvist Marie
Published: August 2019

Objective.

To examine the reproductive pattern of women with idiopathic inflammatory myopathy (IIM) compared to the general population.

Methods.

Population-based, nationwide registers were used to identify offspring of women with IIM and comparators.

Results.

Women with IIM in general had similar reproductive patterns as the comparators, whereas in those diagnosed between 26 and 45 years of age, there was an overall trend for fewer children as well as a higher proportion of nulliparity and a lower fertility rate in women with dermatomyositis than their comparators.

Conclusion.

Reproductive attention should be paid to patients with IIM diagnosed during the childbearing period.
Widefield Swept-Source Optical Coherence Tomography Angiography of Proliferative Diabetic Retinopathy
Authors: Motulsky Elie H. , Liu Guanghui , Shi Yingying , Zheng Fang , Flynn Harry W. , Gregori Giovanni , Rosenfeld Philip J.
Published: August 2019

BACKGROUND AND OBJECTIVE:

To demonstrate the utility of widefield swept-source optical coherence tomography angiography (SS-OCTA) for the diagnosis and management of proliferative diabetic retinopathy (PDR).

PATIENTS AND METHODS:

Consecutive patients with vision-threatening diabetic retinopathy were imaged with widefield SS-OCTA using the 12 mm × 12 mm scan pattern.

RESULTS:

Twenty-four eyes of 12 patients underwent SS-OCTA imaging. In all 24 eyes, the en face total retinal flow images detected areas of decreased retinal perfusion, and the en face vitreoretinal interface (VRI) slabs detected foci of retinal neovascularization (NV). NV was treated and followed using the VRI images.

CONCLUSIONS:

Widefield SS-OCTA is a useful, noninvasive technology for the detection and monitoring of NV in PDR. Features of interest, such as areas of decreased retinal perfusion, increased retinal thickness, and NV, can be identified from different en face slabs extracted from a single 12 mm × 12 mm scan.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:474–484.]
Indications and Outcomes for the Removal of Intraocular Lens Implants in a Retinal Surgery Practice
Authors: Patel Nimesh A. , Gangasani Nikitha , Yannuzzi Nicolas A. , Melo Gustavo , Flynn Harry W. , Smiddy William E.
Published: August 2019

BACKGROUND AND OBJECTIVE:

To describe the reasons for and clinical outcomes of intraocular lens (IOL) removal, with or without exchange, in the setting of retina surgery.

PATIENTS AND METHODS:

This is a retrospective, noncomparative, consecutive, interventional case series of patients undergoing IOL removal at an academic referral center performed by a single surgeon between 2002 and 2013. Data collected included baseline patient characteristics, visual acuity (VA), type of IOL, reason for IOL removal, and postoperative complications.

RESULTS:

The study cohort included 63 eyes with IOL removal. Of these, 51 (81%) were left aphakic. For cases of IOL opacification or dislocated IOL (56), the decision to remove was made for 35 (63%) during concurrent retinal surgery due to obstruction in visualization. Overall, the most common reason for removal of the IOL was IOL opacities in 42 eyes (67%), followed by nonspecific nature of opacities (n = 19; 45%), oil artifact (n = 17; 40%), opaque nonvascular membranes (n = 4; 10%), and fibrovascular proliferation (n = 2; 5%). Other causes for removal were IOL dislocation (n = 14; 22%), endophthalmitis (n = 7; 11%), and broken IOL haptic (n = 1; 2%). The composition of the 42 IOLs with opacification included 19 (45%) silicone, 14 (33%) unspecified, five (12%) polymethyl methacrylate, and four acrylic (10%). From the 17 IOLs removed due to oil opacification, 15 (83%) were silicone, and two (17%) were unspecified. Postoperative complications included recurrent retinal detachment (n = 13; 21%), hypotony (n = 8; 13%), phthisis bulbi (n = 8; 13%), corneal edema (n = 7; 11%), cystoid macular edema (n = 5; 8%), elevated intraocular pressure (n = 3; 5%), vitreous hemorrhage (n = 3; 5%), hyphema (1; 2%), anterior synechiae (1; 2%), and subretinal hemorrhage (1; 2%) The mean (SD) immediate, 3 months, and final best-corrected VA in logMAR were 2.18 (0.47), 1.85 (0.82), and 1.97 (0.85).

CONCLUSION:

The vitreoretinal surgeon must be prepared for IOL removal, especially if IOL opacification and dislocation compromise the view or capability to achieve primary retinal reattachment objectives.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:504–508.]
Resolution of Unilateral Dome-Shaped Macula With Serous Detachment After Treatment of Topical Carbonic Anhydrase Inhibitors
Authors: Chen Nan-Ni , Chen Ching-Lung , Lai Chien-Hsiung
Published: August 2019

Dome-shaped macula (DSM) is a morphological feature outlined through the use of optical coherence tomography and characterized by an inward or anterior deviation of the macula with respect to chorioretinal concavity. Currently, there is no validated therapy for serous retinal detachment secondary to DSM. The authors report a case of childhood unilateral DSM in a hyperopic eye with normal axial length that was complicated with subretinal fluid (SRF). Topical carbonic anhydrase inhibitors may be an acceptable and safer option for patients presented with nonresolving SRF associated with DSM. Further randomized controlled trials are necessary to confirm the efficacy of this therapeutic approach.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:e218–e221.]
AN OPTIMAL APPROACH FOR EEG/ERP NOISE CANCELLATION USING ADAPTIVE FILTER WITH OPPOSITIONAL WHALE OPTIMIZATION ALGORITHM
Authors: Nagal Rachana , Kumar Pradeep , Bansal Poonam
Published: August 2019

In this paper, the Oppositional Whale Optimization Algorithm (OWOA) is applied to Adaptive Noise Canceller (ANC) for the filtering of Electroencephalography/Event-Related Potentials (EEG/ERP) signals. Performance of ANC will be improved by calculating the optimal weight value and proposed OWOA technique is used to update weight value. Adaptive filter’s noise reduction capability has been tested through consideration of White Gaussian Noise (WGN) over contaminated EEG signals at various SNR levels ([Formula: see text]10[Formula: see text]dB, [Formula: see text]15[Formula: see text]dB and [Formula: see text]20[Formula: see text]dB). The performance of the proposed OWOA algorithm is assessed in terms of Signal to Noise Ratio (SNR) in dB, mean value, and the correlation between resultant and input ERP. In this work, ANCs are also implemented by utilizing conventional gradient-based techniques like Recursive Least Square (RLS), Least Mean Square (LMS) and other optimization algorithms such as Genetic Algorithm (GA), Particle Swarm Optimization (PSO) and WOA techniques. In average cases of noisy environment, comparative analysis shows that the proposed OWOA technique provides higher SNR value and significantly lower mean, and correlation as compared to gradient-based and swarm-based techniques. The comparative results show that extracting the desired EEG component is more effective in the proposed OWOA method. So, it has seen that OWOA-based noise reduction technique removing the artifacts and improving the quality of EEG signals significantly for biomedical analysis.
DEVELOPING AN EARLY PREDICTIVE SYSTEM FOR IDENTIFYING GENETIC BIOMARKERS ASSOCIATED TO ALZHEIMER’S DISEASE USING MACHINE LEARNING TECHNIQUES
Authors: Abd El Hamid Marwa Mostafa , Mabrouk Mai S. , Omar Yasser M. K.
Published: August 2019

Alzheimer’s disease (AD) is an irreversible, progressive disorder that assaults the nerve cells of the brain. It is the most widely recognized kind of dementia among older adults. Apolipoprotein E (APOE), is one of the most common genetic risk factors for AD whose significant association with AD is observed in various genome-wide association studies (GWAS). Single nucleotide polymorphisms (SNPs) are the most common type of genetic variation among individuals. SNPs related to many common diseases like AD. SNPs are recognized as significant biomarkers for this disease, they help in understanding and detecting the disease in its early stages. Detecting SNPs biomarkers associated to the disease with high classification accuracy leads to early prediction and diagnosis. Machine learning techniques are utilized to discover new biomarkers of the disease. Sequential minimal optimization (SMO) algorithm with different kernels, Naive Bayes (NB), tree augmented Naive Bayes (TAN) and K2 learning algorithm have been applied on all genetic data of Alzheimer’s disease neuroimaging initiative phase 1 (ADNI-1)/Whole genome sequencing (WGS) datasets. The highest classification accuracy was achieved using 500 SNPs based on the [Formula: see text]-value threshold ([Formula: see text]-value [Formula: see text]). In whole genome approach ADNI-1, results revealed that NB and K2 learning algorithms scored an overall accuracy of 98% and 98.40%, respectively. In whole genome approach WGS, NB and K2 learning algorithms scored an overall accuracy of 99.63% and 99.75%, respectively.
Morphology and Morphometry of prehistoric skeletal remains found in Potana, Sigiriya, Sri Lanka
Authors: Chandimal K. M. , Adikari G. , Yasawardene S. G.
Published: August 2019

This study explores morphology, morphometry of prehistoric skeletal remains found at Potana, Sigiriya, Sri Lanka that has been radio carbon dated as 4,000 years before present (YBP). The gender, age, stature, cause of death, health status, food habits and the way of life of Potana population have been explored by following the methods described in slandered text. One skeleton unearthed from context no 10 of the excavation presently displayed at National Museum, Colombo is of female sex and age at death is around 25-35 years. The calculated stature of the individual is 170 cm. Other skeleton found at the same context presently displayed at Sigiriya Museum is of male sex and determined age at death is around 25-30 years. The calculated stature of the male is 173.61cm. The skeleton excavated in context no 03 presently stored at Osteology Laboratory, Postgraduate Institute of Archaeology, University of Kelaniya is determined as female and age at death is around 35-40 years. In general, the prehistoric population that lived in Potana is further identified as a hunter gatherer population that shared many biometrics and socioeconomic characteristics among contemporary prehistoric populations that lived in Sri Lanka such as Bellan bandi Palassa, Batadomba lena, Beli lena, Fa Hien lena etc.
Mass balance results from the Cordillera Glacier-Climate Observing Network, British Columbia, Northwest
Territories, and Alberta, for 2015 and 2016 balance years
Authors: Ednie M , Demuth M N
Published: August 2019

Geological Survey of Canada Open File 8503 presents mass balance data from glaciers in the Cordillera Glacier-Climate Observing network for the 2015 and 2016 balance years. Glacier-wide net annual balances at all observing sites were negative for both years.
Results from the surveys indicate warmer summer conditions with less winter accumulation occurred throughout western and northern Cordillera in 2015 compared to 2016. Where historical mass balance data exists, annual glacier-wide mass balances during both balance years were more negative than
long-term averages. Historically significant melt rates were observed at Peyto Glacier where annual balance was 2nd most negative on record.
Translation, Adaptation, and Assessment of the Communication Assessment Tool in Tigray, Northern Ethiopia
Authors: Goba Gelila Kidane , George Jessica , Alemayehu Mussie , Amdeslasie Fasika , Divelbess Ken , Makoul Gregory , Curry Raymond H. , Stephenson Mary D.
Published: August 2019

Background

Ethiopia has experienced tremendous growth in medical education beginning in the early 2000s. Research shows a need for emphasis on empathy and compassionate care in this setting. In the United States, the Communication Assessment Tool (CAT) is a widely used, validated survey measuring provider-patient interactions.

Objective

The goal of this study was to translate, culturally adapt, and pilot the CAT to allow it to be used with trainees and patients in Ethiopia.

Methods

Bilingual experts translated the CAT into Tigrigna, the primary language of the Tigray region in northern Ethiopia, followed by focus group discussions, back translation, and review by the original author of the CAT. The translated tool was administered to the patients of resident physicians in 6 specialties at Ayder Referral Hospital between December 2016 and February 2017.

Results

Our translation of the CAT into Tigrigna had semantic, idiomatic, and experiential equivalence. Of 1024 patients recruited, 1002 (98%) completed interviews using the CAT. Mean score was 3.09; 3% of all scores were excellent and 54% were good. Cronbach's alpha score for the full survey was 0.942, demonstrating high reliability.

Conclusions

The translated CAT in Tigrigna can be used to assess communication skills in Ethiopian residents. Both mean score and percentage of excellent scores were considerably lower than scores in other countries, suggesting that there may be opportunities for improvement in residents' communication skills.
Shared Decision-Making Training in Internal Medicine: A Multisite Intervention Study
Authors: Ritter Simon , Stirnemann Jerome , Breckwoldt Jan , Stocker Hans , Fischler Manuel , Mauler Sarah , Fuhrer-Soulier Valérie , Meier Christoph A. , Nendaz Mathieu
Published: August 2019

Background

Research shows that when patients and health care providers share responsibility for clinical decisions, both patient satisfaction and quality of care increase, and resource use decreases. Yet few studies have assessed how to train residents to use shared decision-making (SDM) in their practice.

Objective

We developed and evaluated a SDM training program in internal medicine.

Methods

Senior internal medicine residents from 3 hospitals in Switzerland were assessed shortly before and 2 months after completing a program that included a 2-hour workshop and pocket card use in clinical practice. Encounters with standardized patients (SPs) were recorded and SDM performance was assessed using a SDM completeness rating scale (scores ranging from 0 to 100), a self-reported questionnaire, and SPs rating the residents.

Results

Of 39 eligible residents, 27 (69%) participated. The mean (SD) score improved from 65 (SD 13) to 71 (SD 12; effect size [ES] 0.53; P = .011). After training, participants were more comfortable with their SDM-related knowledge (ES 1.42, P < .001) and skills (ES 0.91, P < .001), and with practicing SDM (ES 0.96, P < .001). Physicians applied SDM concepts more often in practice (ES 0.71, P = .001), and SPs felt more comfortable with how participants discussed their care (ES 0.44, P = .031).

Conclusions

The SDM training program improved the competencies of internal medicine residents and promoted the use of SDM in clinical practice. The approach may be of interest for teaching SDM to residents in other disciplines and to medical students.
Residency and Fellowship Program Administrator Burnout: Measuring Its Magnitude
Authors: Ewen Alana M. , Higgins Mikhail C.S.S. , Palma Sandra , Whitley Kathryn , Schneider Jeffrey I.
Published: August 2019

Background

Little is known about the level of burnout among program administrators (PAs) working in graduate medical education.

Objective

We created a national database with baseline burnout data for PAs from residency and fellowship programs, including intention to leave their current positions.

Methods

A cross-sectional study was conducted in July 2017 to assess levels of burnout in a national cohort of PAs, who were largely members of online specialty forums. The Copenhagen Burnout Inventory (CBI) was used to measure burnout. Univariate analysis produced descriptive statistics for CBI. We performed a 2-sample t test to measure differences in average burnout scores for those who had thoughts of resigning from their positions and those who had not.

Results

Of the approximately 10 205 national PAs, we sampled 1126 (11%). Of the 1126 individuals who received the study information, 931 (83%) completed the baseline survey. Total mean scores for all subscales were elevated (personal: 53.7, SD 21.4; work-related: 52.0, SD 22; and client-related: 30.6, SD 20.8; each scale ranged from 0, low, to 100, high). Burnout scores differed between those contemplating leaving their jobs and those who were not, across all subscales of CBI, including personal (64.2 versus 42.4, –24.18 to –19.44 confidence interval [CI]), work-related (63.5 versus 39.7, –26.12 to –21.35 CI), and client-related (36.6 versus 24.2, –14.95 to –9.84 CI; P < .0001 for all).

Conclusions

In this national survey of PAs, burnout scores measured by the CBI were higher among those who had considered leaving their positions.
An Electronic-Based Curriculum to Train Acute Care Providers in Rural Haiti and India
Authors: Khan Ayesha , Sebok-Syer Stefanie S. , Linstadt Hanna , Storm Megan , Modan Nadeem , Bosco Mukteshwari K. , Prashanth Gayathri , Mahadevan S.V.
Published: August 2019

Background

Access to a trained, competent health care workforce remains a challenge globally, particularly in rural settings. To bridge this gap, the World Health Organization calls for innovations in electronic learning and task shifting. Yet, these approaches are underutilized due to cost, challenges associated with implementing technology, and a lack of suitably educated trainees.

Objective

We explored the feasibility of the Acute Care Providers Project (ACPP) to remotely train community members to be health care providers in 2 sites: Haiti and India.

Methods

The ACP program is an asynchronous curriculum that provides core health content and a structured approach to clinical care through an electronic curriculum. The curriculum is reinforced with case-based practice and hands-on workshops for procedural skills. ACPP was deployed in rural Haiti and India. Evaluation of the program included multiple-choice pretests and posttests, an objective structured clinical examination (OSCE), and direct observation of skills.

Results

Four Haitian and 55 Indian trainees completed the course. In Haiti, mean scores were 34.8% (SD 12.4) on the pretest and 78.0% (SD 6.5) on the posttest (P = .004). Trainees scored 100% on the OSCE and passed the skills checklist. In India, mean scores were 16.5% (SD 3.9) on the pretest and 81.7% (SD 9.0) on the posttest (P < .001). Trainees scored a median of 91.8% (SD 3.95) on the OSCE and all passed the skills checklist.

Conclusions

The ACPP offers a scalable, replicable asynchronous curriculum to train lay individuals to provide basic health care in rural communities.
Assessing the Clinical Learning Environment in an Institution in the United Arab Emirates: The Resident Perspective
Authors: Kannan Indira , Jaiganesh Thiagarajan , Nair Satish Chandrasekhar , Alhammadi Yaaqoob , Nabi Bibi Fatima Ghulam , Alabdouli Amani Obaid Salem , Sheleh Hussein
Published: August 2019

Background

A new accreditation model in the United States has increased focus on the clinical learning environment (CLE). There is limited research on trainee perceptions of the CLE in international settings.

Objective

We surveyed residents to obtain their perspective on the CLE at 1 sponsoring institution in the United Arab Emirates (UAE).

Methods

We surveyed residents at Tawam Hospital, UAE, a sponsoring institution with 142 trainees, on their perspectives in the 6 focal areas of the US Clinical Learning Environment Review (CLER) to gather baseline information. We administered a 26-item questionnaire to residents through an audience response system in November 2018.

Results

Of 100 residents in postgraduate year 2 and above, 72 (72%) responded. The perspective of the majority of respondents was favorable in the areas of reporting patient safety incidents, engaging in quality improvement activities, using a standardized form for care transition, and using professional guidelines for electronic health record documentation. In contrast, only half of the respondents perceived there is honesty in the reporting of duty hours, and only 36% felt the organization supported fatigue management. Other areas for improvement included residents' understanding of the concept of health disparities and activities to address health disparities.

Conclusions

Our findings suggest that in key focal areas related to patient safety, health care quality, care transitions, and professionalism, UAE residents have similar perceptions of their CLE as US trainees. Opportunities for improvement include duty hour reporting, fatigue mitigation, and addressing health disparities.
Contrasting Residency Training in Japan and the United States From Perspectives of Japanese Physicians Trained in Both Systems
Authors: Heist Brian S. , Torok Haruka Matsubara
Published: August 2019

Background

International medical graduates (IMGs) have significant exposure to clinical training in their home country, which provides opportunity for international comparison of training experiences. One relevant IMG population is Japanese physicians who have completed some training before entering residency programs in the United States and desire to improve medical education in Japan.

Objective

We examined Japanese IMGs' perceptions of the respective attributes of residency in the United States and Japan.

Methods

Individual semistructured interviews were conducted with 33 purposively sampled Japanese IMGs who had completed training. We used exploratory thematic analysis, iterative data collection, and thematic analyses with constant comparison.

Results

Comments were organized into 3 categories: (1) attributes of US residency preferable to Japanese residency; (2) attributes of residency training with no clear preference for the US or Japanese systems; and (3) attributes of Japanese residency preferable to US residency. Within each category, we matched themes to residency program requirements or culture of medical training. Main themes include high regard for Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements, with emphasis on efficient achievement of clinical competency through graded responsibility, contrasted with preference expressed for a Japanese training culture of increased professional commitment facilitated by a lack of work hour limits and development of broad clinician skills, including bedside procedures and radiology interpretation.

Conclusions

Japanese training culture contrasts with a US model that is increasingly focused on work-life balance and associated compartmentalization of patient care. These findings enhance our understanding of the global medical education landscape and challenges to international standardization of training.
Group Assessment of Resident Performance: Valuable for Program Director Judgment?
Authors: Duitsman Marrigje E. , Slootweg Irene A. , van der Marel Imke C. , Kate-Booij Marianne ten , de Graaf Jacqueline , Fluit Cornelia , Jaarsma Debbie
Published: August 2019

Background

Group discussion of resident performance is an emerging assessment approach in postgraduate medical education. However, groups do not necessarily make better decisions than individuals.

Objective

This study examined how group meetings concerning the assessment of residents take place, what information is shared during the meetings, and how this influences program directors' judgment of resident performance.

Methods

In 2017, the researchers observed 10 faculty group meetings where resident performance was discussed and interviewed the program directors within a month after the meetings. We used a thematic framework analysis to identify themes from the transcribed meetings and interviews.

Results

The information shared by group members during the meetings had 2 aims: (1) forming a judgment about the residents, and (2) faculty development. Most group members shared information without written notes, most discussions were not structured by the program director, the major focus of discussions was on residents with performance concerns, and there was a lack of a shared mental model of resident performance. The program directors who benefited most from the meetings were those who thought group members were engaged and summarized the information after every discussion.

Conclusions

Unstructured discussions and a lack of a shared mental model among group members impede effective information sharing about resident performance with a developmental approach. Structured discussions with an equal amount of discussion time for every resident and creating a shared mental model about the purpose of the discussions and the assessment approach could enhance use of a developmental approach to assessing resident performance.
Roles, Responsibilities, and Needs of Institutional GME Leaders: A Multinational Characterization of Designated Institutional Officials
Authors: Abdel-Razig Sawsan , Ibrahim Halah
Published: August 2019

Background

Since 2012, several academic centers in the Middle East have attained accreditation by the Accreditation Council for Graduate Medical Education International (ACGME-I). An emerging group of GME leaders have assumed the role of designated institutional official (DIO), leading their institutions to accreditation. Despite these DIOs' key positions in driving GME reform, there is a lack of published studies on the roles, responsibilities, and needs of DIOs in international settings.

Objective

We examined the characteristics, roles, responsibilities, and needs of DIOs in the Middle East.

Methods

A questionnaire was electronically distributed from December 2018 to February 2019 to all current and former DIOs in ACGME-I accredited institutions in the Middle East.

Results

Of 16 surveys sent, 11 (69%) were returned. All DIOs were physicians; the majority were women less than 55 years of age, and assumed the role of DIO in the past decade. Most DIOs felt prepared for the position and well supported by their institution and their program directors. All reported having additional roles beyond the DIO position. Most identified the most challenging aspect of their role related to GME budgets, training for their responsibilities, sharing best practices and documents such as DIO job descriptions and other key documents, and DIO training.

Conclusions

ACGME-I accreditation is a critical driver of efforts to define the DIO role. DIOs in the Middle East share common perceptions, experiences, and needs. Further research should identify professional development needs in an increasingly diverse international worldwide DIO community.
Psychoanalytic representation of poverty, corruption and the Nigerian Church in Chukwuma Ibezute’s Stain on a White Robe
Authors: Awuzie Solomon
Published: August 2019

This article contends that despite the fact that Nigeria is still referred to as a country that is blessed with enormous natural resources, writers and scholars have referred to it as a country that harbours some of the poorest people in the world. As a result, the act of swindling popularly known as “419” has taken the centre stage. Some of the fraud stars now feign to be pastors and prophets and own churches where they extort money and other valuables from their victims. This antisocial behaviour is noted in Chukwuma Ibezute’s White Robe. The novel depicts how poverty and corruption have crippled the present day Nigerian churches and got them almost all ruined.Keywords: Poverty, Corruption, Christians, Church(es), Chukwuma Ibezute, Nigeria(ns)
Three evidence explicating the visual dimensions of music
Authors: Ogisi Arugha Aboyowa
Published: August 2019

Music is an aural art because it uses organized sound as the medium for the several roles that it plays in society including but not limited to validation of social institutions, reinforcing culture, as culture, for catharsis, socialisation, education, therapeutic and communication, among others. Through the ages, the perception of music as an exclusive aural art has been perpetuated in literature that it appears invisible. However, it is not only at the sonic level that it functions. Data from this study came from observation of musical performances and audience behaviour in several contexts and study of the definitions of music in extant literature. When observed closely, one finds that it has a visual element as attested to by response to aesthetic appreciation of musical performances, linguistic expressions, and preferential response of market forces for audio-visual recordings than audio recordings. These examples question the long held perception that music is entirely a sonic art whereas it is not so. It is therefore imperative to re-examine and redefine music as an art that is not just aural but with an audio-visual component.Keywords: Aural, Audio-visual Art, Music, Sonic Art, Visual Art
High contributions of fossil sources to more volatile organic aerosol
Authors: Ni Haiyan , Huang Ru-Jin , Cao Junji , Dai Wenting , Zhou Jiamao , Deng Haoyue , Aerts-Bijma Anita , Meijer Harro A. J. , Dusek Ulrike
Published: August 2019

Abstract. Sources of particulate organic carbon (OC) with different
volatility have rarely been investigated, despite the significant importance
for better understanding of the atmospheric processes of organic aerosols.
In this study we develop a radiocarbon-based (14C) approach for source
apportionment of more volatile OC (mvOC) and apply to ambient aerosol
samples collected in winter in six Chinese megacities. mvOC is isolated by
desorbing organic carbon from the filter samples in helium (He) at 200 ∘C in a custom-made aerosol combustion system for 14C
analysis. Evaluation of this new isolation method shows that the isolated
mvOC amount agrees very well with the OC1 fraction (also desorbed at 200 ∘C in He) measured by a thermal–optical analyzer using the
EUSAAR_2 protocol. The mvOC, OC and elemental carbon (EC) of
13 combined PM2.5 samples in six Chinese cities are analyzed
for 14C to investigate their sources and formation mechanisms. The
relative contribution of fossil sources to mvOC is 59±11 %,
consistently larger than the contribution to OC (48±16 %) and
smaller than that to EC (73±9 %), despite large differences in
fossil contributions in different cities. The average difference in the
fossil fractions between mvOC and OC is 13 % (range of 7 %–25 %),
similar to that between mvOC and EC (13 %, with a range 4 %–25 %). Secondary OC
(SOC) concentrations and sources are modeled based on the
14C-apportioned OC and EC and compared with concentrations and sources
of mvOC. SOC concentrations (15.4±9.0 µg m−3) are
consistently higher than those of mvOC (3.3±2.2 µg m−3),
indicating that only a fraction of SOC is accounted for by the more volatile
carbon fraction desorbed at 200 ∘C. The fossil fraction in SOC is
43 % (10 %–70 %), lower than that in mvOC (59 %, with a range of 45 %–78 %). Correlation between mvOC and SOC from nonfossil sources (mvOCnf
vs. SOCnf) and from fossil sources (mvOCfossil vs.
SOCfossil) is examined to further explore sources and formation
processes of mvOC and SOC.