bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for cognitive impairment in Arabic-speaking Hajj pilgrims
Authors: Alzahrani Ahmad S. , Alhumaidi Faisal , Altowairqi Abdulaziz , Al-Malki Waad , AlFadhli Israa
Published: September 2019

Background

Although cognitive impairment is common in the elderly population, studies investigating its rate in Hajj pilgrims are lacking.

Objectives

To estimate the rate of cognitive impairment among a sample of Arabic-speaking elderly Hajj pilgrims and examine its association with their activities of daily living (ADL).

Methods

A cross-sectional study was conducted during the Hajj season 1438 Hijri Calendar (August 2017). Hajj pilgrims were recruited using a probability sampling method and were interviewed for demographics, the MINI-Cog and the ADL instrument.

Results

Among the 340 recruited pilgrims, 99 (29.2%) had positive results in the MINI-Cog indicating probable cognitive impairment. In multivariate logistic regression, the educational level (odds ratio (OD) 0.456; 95% CI 0.346 to 0.598) and the need for help during Hajj (OD 0.581; 95% CI 0.342 to 0.984) were found significantly associated with positive MINI-Cog. Although no significant differences in the ADL were found between pilgrims with and without positive MINI-Cog, the scores of the ADL and the MINI-Cog were found to be positively correlated but weak (rs = 0.134, P = 0.013) indicating a possible association between better cognitive functions and better ADL performance.

Conclusion

Probable cognitive impairment among Arabic elderly Hajj pilgrims was found to be very common. Further diagnostic studies and studies on the impact of cognitive impairment on the performance of Hajj pilgrims are warranted.
Membrane condenser as emerging technology for water recovery and gas pre-treatment: current status and perspectives
Authors: Brunetti Adele , Macedonio Francesca , Barbieri Giuseppe , Drioli Enrico
Published: September 2019

The recent roadmap of SPIRE initiative includes the development of “new separation, extraction and pre-treatment technologies” as one of the “key actions” for boosting sustainability, enhancing the availability and quality of existing resources. Membrane condenser is an innovative technology that was recently investigated for the recovery of water vapor for waste gaseous streams, such as flue gas, biogas, cooling tower plumes, etc. Recently, it has been also proposed as pre-treatment unit for the reduction and control of contaminants in waste gaseous streams (SOx and NOx, VOCs, H2S, NH3, siloxanes, halides, particulates, organic pollutants).

This perspective article reports recent progresses in the applications of the membrane condenser in the treatment of various gaseous streams for water recovery and contaminant control. After an overview of the operating principle, the membranes used, and the main results achieved, the work also proposes the role of this technology as pre-treatment stage to other separation technologies. The potentialities of the technology are also discussed aspiring to pave the way towards the development of an innovative technology where membrane condenser can cover a key role in redesigning the whole upgrading process.
Fertility response of lactating dairy cows subjected to three different breeding programs under subtropical conditions
Authors: Khalil Abdeltawab Abdelrazek Yassin
Published: September 2019

Background

It is comprehensively recognized that reduced reproductive efficiency represents a great economic loss to dairy producers. Ovarian cysts and anestrus syndromes are considered the greatest significant causes of low reproductive efficiency in dairy herds worldwide as they detrimentally affect the longevity and profitability of dairy herd. Pregnancy rate is the best available single deciding parameter used for assessment of the reproductive efficiency at the herd level which measures the probability that open cows become pregnant per unit of time. So, the current study was planned to evaluate the suitability of using Ovsynch plus CIDR and G6G resynchronization protocols as an efficient treatment regimen for cystic ovarian diseased cows and anestrus cows, respectively, through comparing pregnancy rates of cystic ovarian diseased cows that subjected to Ovsynch supplemented with controlled internal drug release device with the pregnancy rate of healthy cows that subjected to a Presynch-Ovsynch synchronization protocol, as well as through comparing pregnancy rates of anestrus cows that subjected to G6G treatment protocol with the pregnancy rate of healthy cows. Moreover, possible factors such as breed, parity, and season which may affect the treatment success were also evaluated.

Results

The results of the current study revealed an overall mean pregnancy rate of 36.64%. Moreover, Simmental cows recorded a greater (p < 0.01) pregnancy rate (45.16%) than that recorded for Holstein cows (34.98%). A highly significant seasonal effect was observed, as a higher (p < 0.01) pregnancy rate was recorded for cows inseminated during cold months (39.54%) compared with that recorded for cows inseminated during hot months (29.18%).

Conclusions

No significant differences were detected in the pregnancy rates among the three breeding programs; thence, the application of the G6G synchronization protocol for anestrus cows and Ovsynch-CIDR synchronization protocol for cows with ovarian cysts could be used as effective treatment regimens as they resulted in nearly the same pregnancy rates that recorded for healthy cows. In addition, the treatment response was highly influenced by cow’s breed, parity, and season of breeding.
Serious life events and post-traumatic stress disorder in the Norwegian population
Authors: Heir Trond , Bonsaksen Tore , Grimholt Tine , Ekeberg Øivind , Skogstad Laila , Lerdal Anners , Schou-Bredal Inger
Published: September 2019

Background

It has been suggested that countries with more resources and better healthcare have populations with a higher risk of post-traumatic stress disorder (PTSD). Norway is a high-income country with good public healthcare.

Aims

To examine lifetime trauma exposure and the point prevalence of PTSD in the general Norwegian population.

Method

A survey was administered to a national probability sample of 5500 adults (aged ≥18 years). Of 4961 eligible individuals, 1792 responded (36%). Responders and non-responders did not differ significantly in age, gender or urban versus rural residence. Trauma exposure was measured using the Life Events Checklist for the DSM-5. PTSD was measured with the PTSD Checklist for the DSM-5. We used the DSM-5 diagnostic guidelines to categorise participants as fulfilling the PTSD symptom criteria or not.

Results

At least one serious lifetime event was reported by 85% of men and 86% of women. The most common event categories were transportation accident and life-threatening illness or injury. The point prevalence of PTSD was 3.8% for men and 8.5% for women. The most common events causing PTSD were sexual and physical assaults, life-threatening illness or injury, and sudden violent deaths. Risk of PTSD increased proportionally with the number of event categories experienced.

Conclusions

High estimates of serious life events and correspondingly high rates of PTSD in the Norwegian population support the paradox that countries with more resources and better healthcare have higher risk of PTSD. Possible explanations are high expectations for a risk-free life and high attention to potential harmful mental health effects of serious life events.

Declaration of interest

None.
MARS: Mutation-Adjusted Risk Score for Advanced Systemic Mastocytosis
Authors: Jawhar Mohamad , Schwaab Juliana , Álvarez-Twose Iván , Shoumariyeh Khalid , Naumann Nicole , Lübke Johannes , Perkins Cecelia , Muñoz-González Javier I. , Meggendorfer Manja , Kennedy Vanessa , Metzgeroth Georgia , Fabarius Alice , Pfeifer Dietmar , Sotlar Karl , Horny Hans-Peter , von Bubnoff Nikolas , Haferlach Torsten , Cross Nicholas C.P. , Hofmann Wolf-Karsten , Sperr Wolfgang R. , García-Montero Andrés C. , Valent Peter , Gotlib Jason , Orfao Alberto , Reiter Andreas
Published: September 2019

PURPOSE

To develop a risk score for patients with advanced systemic mastocytosis (AdvSM) that integrates clinical and mutation characteristics.

PATIENTS AND METHODS

The study included 383 patients with AdvSM from the German Registry on Disorders of Eosinophils and Mast Cells (training set; n = 231) and several centers for mastocytosis in the United States and Europe, all within the European Competence Network on Mastocytosis (validation set; n = 152). A Cox multivariable model was used to select variables that were predictive of overall survival (OS).

RESULTS

In multivariable analysis, the following risk factors were identified as being associated with OS: age greater than 60 years, anemia (hemoglobin < 10 g/dL), thrombocytopenia (platelets < 100 × 109/L), presence of one high molecular risk gene mutation (ie, in SRSF2, ASXL1, and/or RUNX1), and presence of two or more high molecular risk gene mutations. By assigning hazard ratio–weighted points to these variables, the following three risk categories were defined: low risk (median OS, not reached), intermediate risk (median OS, 3.9 years; 95% CI, 2.1 to 5.7 years), and high risk (median OS, 1.9 years; 95% CI, 1.3 to 2.6 years; P < .001). The mutation-adjusted risk score (MARS) was independent of the WHO classification and was confirmed in the independent validation set. During a median follow-up time of 2.2 years (range, 0 to 23 years), 63 (16%) of 383 patients experienced a leukemic transformation to secondary mast cell leukemia (32%) or secondary acute myeloid leukemia (68%). The MARS was also predictive for leukemia-free survival ( P < .001).

CONCLUSION

The MARS is a validated, five-parameter, WHO-independent prognostic score that defines three risk groups among patients with AdvSM and may improve up-front treatment stratification for these rare hematologic neoplasms.
Practice-Level Adoption of Conservative Management for Prostate Cancer
Authors: Modi Parth K. , Kaufman Samuel R. , Herrel Lindsey A. , Dupree James M. , Luckenbaugh Amy N. , Skolarus Ted A. , Hollenbeck Brent K. , Shahinian Vahakn B.
Published: September 2019

PURPOSE:

We describe the longitudinal adoption of conservative management (ie, the absence of treatment) for prostate cancer among urology group practices in the United States and identify group practice features that influence this adoption.

METHODS:

Using a 20% sample of Medicare claims, we identified men with incident prostate cancer from 2010 through 2014 and assigned each to his predominant urologist. We linked each urologist to a practice and characterized the practice’s organization (eg, solo, single specialty, multispecialty) and ownership of intensity-modulated radiation therapy. For each group, we determined the rate of conservative management within 1 year of diagnosis. We then fit mixed-effects logistic regression models to assess relationships between practice organization and the adoption of conservative management over time, adjusted for patient characteristics.

RESULTS:

We identified 22,178 men with newly diagnosed prostate cancer managed by 350 practices. Practices that increased use the most over time also used conservative management the most in 2010, whereas those that increased use the least used conservative management the least in 2010. Thus, the difference in average use of conservative management between highest- and lowest-use practices widened between 2010 and 2014. Urology groups increased their use of conservative management more rapidly than multispecialty groups. There was no difference in the rate of increase between intensity-modulated radiation therapy owning and nonowning groups.

CONCLUSION:

There is increasing variation among group practices in the use of conservative management for prostate cancer. This underscores the need for a better understanding of practice-level factors that influence prostate cancer management.
Real-World Clinical and Economic Outcomes and the Role of Bevacizumab in Patients With Non–Small-Cell Lung Cancer With Liver Metastases
Authors: Wong William B. , Wu Ning , Yang Erru , Davies Jessica , Chae Young Kwang
Published: September 2019

PURPOSE:

Liver metastases are associated with poor outcomes in patients with advanced non–small-cell lung cancer (aNSCLC). Nevertheless, the vasculature in the liver microenvironment may be conducive to the use of antiangiogenesis inhibitors to potentially improve outcomes. Limited real-world clinical and economic data are currently available for this patient subpopulation.

METHODS:

Two retrospective cohort analyses were conducted using data from an electronic health record (n = 14,209) and a claims database (n = 9,017). Patients with aNSCLC with and without liver metastases were identified in each database. Patients with baseline liver metastases in the electronic health record database were further categorized into two subgroups—those who had or had not received bevacizumab-containing regimens. Multivariable Cox proportional hazards regression models were used to adjust for baseline characteristics to evaluate the effect of treatment of bevacizumab.

RESULTS:

Liver metastases were associated with significantly poorer survival (median overall survival, 6.3 months v 10.1 months) and higher costs and health care resource utilization—total per-patient-per-month costs of $27,589 versus $19,607. Cost differences were primarily driven by inpatient costs, including a two-fold increase in hospitalizations and a 1.7-fold higher mean length of stay. Treatment with bevacizumab was associated with improved survival. Whereas overall survival improved in patients with and without baseline liver metastases who received bevacizumab, the relative survival benefit was greater in patients with liver metastases (hazard ratio, 0.63 [95% CI, 0.50 to 0.81] v hazard ratio, 0.80 [95% CI, 0.74 to 0.86]).

CONCLUSION:

Patients with aNSCLC with liver metastases have poorer survival and a higher cost and health care resource utilization burden. Bevacizumab was associated with a survival benefit in patients with aNSCLC with liver metastases.
Patient Navigation in Cancer: The Business Case to Support Clinical Needs
Authors: Kline Ronald M. , Rocque Gabrielle B. , Rohan Elizabeth A. , Blackley Kris A. , Cantril Cynthia A. , Pratt-Chapman Mandi L. , Burris Howard A. , Shulman Lawrence N.
Published: September 2019

PURPOSE:

Patient navigation (PN) is an increasingly recognized element of high-quality, patient-centered cancer care, yet PN in many cancer programs is absent or limited, often because of concerns of extra cost without tangible financial benefits.

METHODS:

Five real-world examples of PN programs are used to demonstrate that in the pure fee-for-service and the alternative payment model worlds of reimbursement, strong cases can be made to support the benefits of PN.

RESULTS:

In three large programs, PN resulted in increased patient retention and increased physician loyalty within the cancer programs, leading to increased revenue. In addition, in two programs, PN was associated with a reduction in unnecessary resource utilization, such as emergency department visits and hospitalizations. PN also reduces burdens on oncology providers, potentially reducing burnout, errors, and costly staff turnover.

CONCLUSION:

PN has resulted in improved patient outcomes and patient satisfaction and has important financial benefits for cancer programs in the fee-for-service and the alternative payment model worlds, lending support for more robust staffing of PN programs.
Optimization of Cancer Treatment in the Frequency Domain
Authors: Schulthess Pascal , Rottschäfer Vivi , Yates James W. T. , van der Graaf Piet H.
Published: September 2019

Thorough exploration of alternative dosing frequencies is often not performed in conventional pharmacometrics approaches. Quantitative systems pharmacology (QSP) can provide novel insights into optimal dosing regimen and drug behaviors which could add a new dimension to the design of novel treatments. However, methods for such an approach are currently lacking. Recently, we illustrated the utility of frequency-domain response analysis (FdRA), an analytical method used in control engineering, using several generic pharmacokinetic-pharmacodynamic case studies. While FdRA is not applicable to models harboring ever increasing variables such as those describing tumor growth, studying such models in the frequency domain provides valuable insight into optimal dosing frequencies. Through the analysis of three distinct tumor growth models (cell cycle-specific, metronomic, and acquired resistance), we demonstrate the application of a simulation-based analysis in the frequency domain to optimize cancer treatments. We study the response of tumor growth to dosing frequencies while simultaneously examining treatment safety, and found for all three models that above a certain dosing frequency, tumor size is insensitive to an increase in dosing frequency, e.g., for the cell cycle-specific model, one dose per 3 days, and an hourly dose yield the same reduction of tumor size to 3% of the initial size after 1 year of treatment. Additionally, we explore the effect of drug elimination rate changes on the tumor growth response. In summary, we show that the frequency-domain view of three models of tumor growth dynamics can help in optimizing drug dosing regimen to improve treatment success.
Characteristics and function of a novel cystatin gene in the pine wood nematode Bursaphelenchus xylophilus
Authors: Xue Qi , Wu Xiao-Qin
Published: September 2019

Bursaphelenchus xylophilus is the pathogen, which causes pine wilt disease (PWD). The disease has caused significant economic losses and damage to forests. However, the pathogenic mechanism of B. xylophilus remains unclear. Cystatins are involved in various biological processes where they regulate normal proteolysis and also play a role in pathogenicity, but their functions in B. xylophilus are unknown. Therefore, we cloned the full-length cDNA of a cystatin gene of B. xylophilus (Bx-cpi-1) by rapid-amplification of cDNA ends and analyzed its characteristics with bioinformatic methods. In situ mRNA hybridization analyses showed that transcripts of Bx-cpi-1 were abundantly expressed in the reproductive organs of B. xylophilus. The expression of Bx-cpi-1 was investigated using qPCR. Bx-cpi-1 was expressed during each of the different developmental stages of B. xylophilus. The highest gene expression was at the egg stage. After infection of Pinus massoniana, the expression of Bx-cpi-1 increased. The functions of Bx-cpi-1 were verified by RNA interference. The feeding rate, reproduction and pathogenicity of B. xylophilus all decreased as a result of silencing of the Bx-cpi-1 gene. These results revealed that Bx-cpi-1 may be a variant of a type II cystatin gene which is involved in the development and pathogenic process of B. xylophilus.
Standardizing the determination and interpretation of Pcrit in fishes
Authors: Reemeyer Jessica E. , Rees Bernard B.
Published: September 2019

The critical oxygen tension (Pcrit) for fishes is the oxygen level below which oxygen consumption (MO2) becomes dependent upon ambient oxygen partial pressure (PO2). We compare multiple curve-fitting approaches to estimate Pcrit of the Gulf killifish, Fundulus grandis Baird & Girard, 1853, during closed and intermittent-flow respirometry. Fitting two line segments of MO2 versus PO2 produced high and variable estimates of Pcrit, as did nonlinear regression using a hyperbolic (Michaelis-Menton) function. Using nonlinear regression fit to an exponential (modified Weibull) function, or linear regression of MO2 versus PO2 at low PO2, and determining Pcrit as the PO2 when MO2 equals standard metabolic rate (SMR) yielded values that were consistent across fish and among experimental trials. The magnitude of the difference in Pcrit determined by alternative calculation methods exceeded the differences determined in closed and intermittent-flow respirometry, highlighting the need to standardize analytical as well as experimental approaches in determining Pcrit.
Clinical application of contrast-enhanced ultrasound after percutaneous renal tumor ablation
Authors: Guo Fang , Hu Bing , Chen Lei , Li Jia
Published: September 2019

Objective:

To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in detecting incomplete ablation and local recurrence of renal tumors after percutaneous radiofrequency ablation (RFA).

Methods:

31 patients were included for RFA treatment and underwent CEUS examination after RFA, ablation zone and contrast distribution in the ablation area were observed, CEUS images were compared with enhanced CT/MRI images to determine the residual tumors and local recurrence of renal tumors.

Results:

The average maximum diameters of the tumor and the ablation zone after the first RFA were 32.3 ± 14.7 mm and 35.9 ± 12.2 mm, respectively. A higher rate of complete tumor ablation was achieved if the ablation zone was larger than the primary tumor (p = 0.026). Within 1 month after RFA, contrast-enhanced CT/MRI examinations demonstrated incomplete ablation in 9 of 31 patients (29.0%), while CEUS revealed incomplete ablation in 8 of 31 patients (25.8%). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in evaluating complete ablation of renal tumors were 88.9%, 100%, 100%, 95.7%, respectively. During the follow-up period, local recurrence was reported in 2 (7.4%) of the 27 patients with complete tumor ablation. Tumor recurrence signs in the two patients were identified by both CEUS and contrast-enhanced CT/MRI. Therefore, both the sensitivity and specificity of CEUS for the evaluation of tumor recurrence were 100%.

Conclusion:

After percutaneous RFA of renal tumors, the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors is basically the same as that of contrast-enhanced CT/MRI.

Advances in knowledge:

In this study, we evaluated the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors after RFA is basically the same as that of contrast-enhanced CT/MRI. Combining multiple follow-up methods may improve the detection rate of residual or recurrent tumors.
Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study
Authors: Kuper Hannah , Lyra Tereza Maciel , Moreira Maria Elisabeth Lopes , de Albuquerque Maria do Socorro Veloso , de Araújo Thália Velho Barreto , Fernandes Silke , Jofre-Bonet Mireia , Larson Heidi , Lopes de Melo Ana Paula , Mendes Corina Helena Figueira , Moreira Martha Cristina Nunes , do Nascimento Marcos Antonio Ferreira , Penn-Kekana Loveday , Pimentel Camila , Pinto Marcia , Simas Clarissa , Valongueiro Sandra
Published: September 2019

Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes—congenital Zika syndrome (CZS)—and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback.

A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.
Prevalência de aconselhamento para atividade física na Atenção Básica à Saúde: uma revisão sistemática
Authors: Moraes Sheylane de Queiroz , Souza Juliana Hegeto de , Araújo Pablo Antônio Bertasso de , Rech Cassiano Ricardo
Published: September 2019

O aconselhamento tem se mostrado promissor para mudança de comportamento. Este estudo teve como objetivo realizar uma revisão sistemática sobre a prevalência de aconselhamento para a prática de atividade física oferecido pelos pro ssionais de saúde e recebido pelos usuários no contexto da Atenção Básica à Saúde. Foram revisadas as bases de periódicos PsycINFO, EBSCOhost, PubMed, ScienceDirect, Web of Science, LILACS e SciELO. O risco de viés foi avaliado em todos os artigos. Foram incluídos na revisão 44 artigos, destes, 21 investigaram aconselhamento fornecido por profissionais de saúde e 23 analisaram aconselhamento recebido por usuários. A prevalência de aconselhamento variou de 11,8% a 95,0% entre os profissionais (60,2 ± 22,7%) e 4,5% a 61,6% entre usuários (36,6 ± 14,2%). Médicos são os profissionais mais investigados. Usuários com fatores de risco para as doenças crônicas são os que mais relatam receber aconselhamento. O aconselhamento ainda é incipiente na Atenção Básica à Saúde, especialmente pela baixa percepção de aconselhamento recebido pelos usuários. Existe a necessidade de padronizar métodos para avaliar o aconselhamento para prática de atividade física, especialmente no tempo, no tipo e na forma de aconselhar.
Opinion Leaders and Product Variety
Authors: Kuksov Dmitri , Liao Chenxi
Published: September 2019

Optimal adjustment of the product variety due to consumer quality inference from opinion leader recommendations.
An Exact Algorithm for the Pickup and Delivery Problem with Time Windows and Last-in-First-out Loading
Authors: Alyasiry Ali Mehsin , Forbes Michael , Bulmer Michael
Published: September 2019

Applications of the pickup and delivery problem with time windows and last-in-first-out (LIFO) loading (PDPTWL) constraints can be found in the transportation of animals, heavyweight goods, and hazardous materials, where unloading vehicles requires more time and special handling. Examples include carrying livestock, cars, and chemical containers. Research on exact methods to solve the pickup and delivery problem with time windows (PDPTW) and its variants has mainly focused on branch-and-price-and-cut algorithms. In this paper, we propose a novel exact approach based on fragments—a series of pickup and delivery requests starting and ending with an empty vehicle. We use fragments to formulate a relaxed network flow model with side constraints. Lazy constraints are used to cut off any illegal solution that may occur while solving the integer program. Extensive computational experiments show that the proposed approach is superior to the current state-of-the-art method.
The Penetration of Mobile Technology and Its Implementation on Learning in Indonesian High School
Authors: Sulisworo Dwi , Muqoyyanah Muqoyyanah
Published: September 2019

The use of a smartphone as a mobile learning tool in schools is controversial. On the one hand, the teacher prohibits it because it would interfere with the learning process in the classroom; and on the other hand, the teacher saw a lot of potentials can be used from mobile technology. The goal of this study is to describe how the development of secondary schools in Indonesia can facilitate students through the use of mobile learning with the hope that it can be taken at the school level policies to strengthen the existing learning system so that students can achieve optimal learning competencies. This research used descriptive qualitative evaluations to make observations on the application of mobile learning in several secondary schools in several regions in Indonesia during 2015. The results of this study indicate that some of the schools that have implemented mobile learning have a tendency that mobile learning was not planned and structured as a school program; so that the advantages of mobile technology has not been effectively used. Two important things to solve this condition are the availability of government policy and improving teachers literacy in managing mobile learning application.
The Development of Worksheet Based on Guided Discovery Learning Method Helped by PhET Simulations Interactive Media in Newton's Laws of Motion to Improve Learning Outcomes and Interest of Vocational Education 10th Grade Students
Authors: Nurahman Arip , Widodo Widodo , Ishafit Ishafit , Saulon Butch O.
Published: September 2019

This research was aimed to produce students worksheet (LKPD) based on PhET Interactive Simulations Software in cognitive through the application of physics-based guided discovery learning model that is devoted to the concept of Newton's Law of Motion. Guided Discovery-based approach is expected and is believed to develop students' skills in various aspects of one study that showed achievement levels mastery of physics students after participating in the learning process under the expected educational purposes. Researchers conducted a study on the process of learning physics for the discovery-oriented at vocational senior high school students in Newton's law of motion with R&D. Subjects were students of class X TKRO in the first semester of the academic year 2018-2019 in vocational high school in Ciamis, West Java Province as many as 35 students. Data collected through tests, observations and interviews.
Flipped Classroom As a Millenial Teaching Model
Authors: Astuti Irnin Agustina Dwi , Bhakti Yoga Budi , Sumarni Ria Asep , Sulisworo Dwi , Toifur Moh.
Published: September 2019

This study is a literature review. The flipped classroom is the latest pedagogical model that has the potential to change the current traditional way of teaching. Flipped classroom emphasizes on learning activities that promote critical thinking and motivation among the students with the assistance of technology. The flipped classroom allows educators to move from ‘the sage on the stage’ to ‘the guide on the side. The basic and simplest form of flipped classroom is students are expected to watch digital resources prior to class. The students are then required to come prepared for class and perform hands-on activities that are related to the digital resources. The digital resources can be in any form such as video, audio or the internet. This allows teachers to spend more time with their students to carry out in class activities and allow immediate response to students’ needs. Student feedback on this pedagogy was generally very positive with many respondents considering it effective and helpful for learning. One of the biggest advantages mentioned by students is that they had the option to watch each video lecture as many times as required to be prepared for class.
Investigating The Effects of Activation Temperature on The Crystal Structure of Activated Charcoal From Palm Bunches (Arengga Pinnata Merr.)
Authors: Mongkito Vivi Hastuti Rufa , Anas Muhammad , Bahar Wisda Puspita
Published: September 2019

This research aims to determine the effect of activation temperature the crystal structure of activated charcoal. The material used activated charcoal bunches (Arengga Pinnate Merr). The process of making activated charcoal divided into two, namely the carbonization stage at a temperature of 250- 400 oC and the activation stage at a temperature variation of 600 - 800 ̊C. To find the crystal structure, the sample characterized by X-Ray Diffraction. The results of analysis the dominant elements diamond before activation with a percentage of 90.2% and an orthorhombic crystalline structure, where the lattice parameter a = 4.12700 Å; b = 4.93700 Å; c = 4.81900 Å. Peak Carbon has a hexagonal crystal structure in all temperature variations. Peak Graphite an orthorhombic crystal structure and at a temperature of 700 oC a hexagonal crystal structure formed. Therefore, giving temperature variations the activated charcoal of the bunches affects the structure of the formed Crystal. Wherein increasing the activation temperature, the crystal structure that forms look more amorphous marked by a widening diffraction peak intensity decreased crystals
Assessment and documentation of incontinence-associated dermatitis after implementation of a standardised instrument: a comparative study
Authors: Montague Mary , Karafa Matthew , Albert Nancy M.
Published: September 2019

Objective:

In this study, clinical nurses' documentation of incontinence-associated dermatitis (IAD) were compared with wound expert documentation before and after implementing a valid, reliable severity index (SI) instrument.

Methods:

A prospective, non-equivalent, two group comparative design within three hospital medical units. Pre- and post-implementation skin condition documentation were compared by clinician type, and post-implementation IADSI scores were assessed for agreement using standard and weighted Kappa.

Results:

Of 89 patients (pre-, n=48 and post-, n=38), mean (standard deviation) age was 72.4±13.7 years and 57.3% had IAD. Mean IADSI score was 13.2 (standard deviation: 10.5; range: 0–52), reflecting pink intact skin. Post-implementation, skin documentation between clinicians was more likely to match, from 35.4 to 84.2%, p<0.001. Post-implementation, after controlling for age, gender and race, the odds ration (OR) of matched documentation between clinicians was 5.80 ([95% confidence interval: 1.8, 18.6], p=0.003) compared with pre-implementation. In the post-implementation period, standard Kappas for agreement in clinical nurse-wound expert documentation in the lower back/buttocks/upper thigh areas ranged from 0.82 to 1.0, reflecting very good agreement. Weighted kappas ranged from 0.76 to 1.0, also reflecting good to very good agreement.

Conclusion:

Implementation of an IADSI assessment instrument improved accuracy of IAD documentation.
Prehospital use of the traction splint for suspected mid-shaft femur fractures
Authors: Howland Ian Ronald , Howard Ian Lucas , Pillay Yugan , Ludick Beverley Dawn , Castle Nicholas Raymond
Published: September 2019

Introduction:

A retrospective audit of electronic patient care records (ePCRs) highlighted the infrequent use of the traction splint for the management of femur fractures. The aim of this study was to improve the use of the traction splint for patients presenting with a mid-shaft femur fracture in the absence of contraindications, by means of introducing a purpose-designed trauma CPD training course.

Methods:

An intervention consisting of a simulation-based mandatory trauma CPD training session for all operational prehospital care providers was implemented over a 3-month period, supported by a pre- and post-implementation staff survey regarding staff perceptions of using a traction splint. Following the intervention period, a repeat retrospective audit of the ePCR database was conducted to identify any improvement in the use of the traction splint.

Results:

The use of the traction splint for a femur fracture in the pre-intervention stage was found to be underutilised (Median 16%). Following the intervention period, however, traction splint use increased significantly (Median 50%). An improvement was also noted in staff perception and understanding of the management of femur fractures.

Conclusion:

This study found that focused trauma training is an effective means to improve patient care. Training should be ongoing in order to maintain skills and knowledge needed for management of femur fractures.
Menière’s disease treated by grommet insertion
Authors: Kanegaonkar RG , Najuko-Mafemera A , Hone R , Tikka T
Published: September 2019

Introduction

Menière’s disease (MD) is an uncommon cause of sudden profound vertigo. A variety of medical and surgical treatments have been used to manage this condition. This study reviewed the outcomes of patients treated with grommet insertion and transtympanic steroid injection.

Methods

Patients diagnosed with MD between 2007 and 2017 were identified, and case notes and audiological data were retrieved for those managed by grommet (ventilation tube) insertion with and without transtympanic steroid injection.

Results

Thirty-three patients were identified as being diagnosed with MD. Grommet insertion resulted in cessation or improvement of attacks in 91% of cases. The mean follow-up duration was 33.8 months (median: 29 months). The mean hearing threshold across the low frequencies improved from 57.2dBHL to 49.4dBHL (p=0.031). Following the intervention, improved tinnitus was reported in 80% of cases. Twelve patients (36%) reported aural fullness prior to grommet insertion; all reported improved symptoms following the procedure.

Conclusions

Early grommet insertion with transtympanic steroid injection, combined with customised vestibular physiotherapy, may provide an alternative first-line strategy for MD, preventing further true MD attacks. In some patients, it may significantly improve hearing thresholds.
Gynaecomastia: a cosmetic concern or a concerning clinical sign?
Authors: Whitehead IJ , Fernandes L , Haris O , Chagla L
Published: September 2019

Gynaecomastia is common and often physiological, leading to frequent dismissal as a cosmetic condition. It can however be a symptom of underlying hormone imbalance, which requires further assessment to exclude underlying sinister pathology. We discuss a rare cause of gynaecomastia that demonstrates the importance of a holistic approach to patient assessment.
Congenital mesoblastic nephroma: a single-centre series
Authors: Pachl M , Arul GS , Jester I , Bowen C , Hobin D , Morland B
Published: September 2019

Background

Congenital mesoblastic nephroma is a rare disease. Treatment is surgical in the first instance. Chemotherapy has traditionally been thought not to have a role. Recent literature suggests a 50% mortality rate for recurrent/metastatic disease.

Materials and methods

This study is a retrospective case review of prospectively collected data. Demographics, histopathology, treatment, outcomes and follow up were reviewed.

Results

Nine patients, 6 male and 3 female, were included. The median age at presentation was one month (range 0–7 months); follow-up was for a median of 21.5 months (range 16–79 months). Two patients had mixed and classical subtypes and the other five had the cellular subtype. Surgery was completed by an open procedure in eight patients and laparoscopically in one. There were three recurrences; two were local and one was pulmonary. Recurrences were treated with a combination of chemotherapy, radiotherapy and surgery. One patient with recurrent disease died from acute-on-chronic respiratory failure secondary to lung irradiation but was disease free. The other eight are disease free, alive and well with no sequelae at latest follow-up.

Conclusions

Surgery remains the mainstay of management with chemo- and radiotherapy reserved for unresectable tumours or adjuvant management of recurrent disease. Specimen-positive margins are not an indication for instituting chemotherapy. The tyrosine kinase pathway seems to be a potential target for future chemotherapeutic agents although it is too early to assess how that will impact on the management of congenital mesoblastic nephroma.
A novel surgical strategy for the resection of duodenal gastrointestinal stromal tumours located close to the duodenal ampulla: a case report
Authors: Kono S , Kumamoto T , Kurahashi Y , Niwa H , Ishida Y , Shinohara H
Published: September 2019

Although the optimal surgical procedure for the resection of duodenal gastrointestinal stromal tumours has not yet been characterised due to the low prevalence of these tumours and the anatomical complexity of the duodenopancreatic region, difficult surgical procedures such as pancreaticoduodenectomy are often proposed for stromal tumours located in the second portion of the duodenum. Our case report highlights a novel surgical strategy that can be implemented as an alternative to pancreaticoduodenectomy for such tumours close to the duodenal ampulla. A 70-year-old man incidentally diagnosed with a stromal tumour close to the duodenal ampulla in the second portion of the duodenum underwent local resection guided by an endoscopic nasobiliary drainage tube with primary closure. This tube was converted to a percutaneous trans-small intestinal biliary drainage tube during the procedure to prevent biliary leakage biliary stasis due to swelling of the duodenal ampulla. He also underwent a simple distal gastrectomy with Roux-en-Y reconstruction. This resulted in successful R0 resection. There were no procedure-related complications or post-surgery weight changes. Our simple novel surgical strategy may therefore be useful for avoiding pancreaticoduodenectomy and maintaining quality of life in patients with stromal tumours close to the duodenal ampulla.
Urological Sequelae to Acute Spinal Cord Injury in Pet Dogs: A Natural Disease Model of Neuropathic Bladder Dysfunction
Authors: Cook Laurie , Byron Julie , Moore Sarah
Published: September 2019

The authors review urologic dysfunction, including urine retention, incontinence, and recurrent and resistant urinary tract infection, in dogs as a sequela to acute spinal cord injury. Urologic sequelae to acute spinal cord injury (SCI) pose significant complications in human and canine patients impacting quality of life and long-term cost of treatment. Dogs with intervertebral disc extrusion may serve as a natural disease model of acute SCI for investigating translational interventions, both prophylactic and therapeutic, for urologic dysfunction in human SCI patients.
Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection
Authors: Flores-Mireles Ana , Hreha Teri N. , Hunstad David A.
Published: September 2019

Urinary tract infections (UTIs) are among the most common microbial infections in humans and represent a substantial burden on the health care system. UTIs can be uncomplicated, as when affecting healthy individuals, or complicated, when affecting individuals with compromised urodynamics and/or host defenses, such as those with a urinary catheter. There are clear differences between uncomplicated UTI and catheter-associated UTI (CAUTI) in clinical manifestations, causative organisms, and pathophysiology. Therefore, uncomplicated UTI and CAUTI cannot be approached similarly, or the risk of complications and treatment failure may increase. It is imperative to understand the key aspects of each condition to develop successful treatment options and improve patient outcomes. Here, we will review the epidemiology, pathogen prevalence, differential mechanisms used by uropathogens, and treatment and prevention of uncomplicated UTI and CAUTI.
Implications of Bacteriuria in Myelomeningocele Patients at Time of Urodynamic Testing
Authors: Preece Janae , Haynes Andria , Gupta Sudipti , Becknell Brian , Ching Christina
Published: September 2019

Objective: To identify those myelomeningocele (MMC) patients at risk for post-urodynamic study (UDS) complications. We hypothesized that patients who manage their bladder with clean intermittent catheterization (CIC) would have a greater risk of post-instrumentation complications due to higher rates of bacteriuria compared to those who freely void (FV). Design/Methods: Urine was collected from patients with MMC without augmentation cystoplasty undergoing routine renal ultrasound or urodynamic study (UDS). Samples were divided into those with bacteriuria (urine culture ≥10,000 colony-forming units) and those without. Post-UDS complications were evaluated and compared between CIC and FV patients. Results: A total of 91 urine samples from 82 total MMC patients were included for evaluation. Significantly more patients on CIC than those who FV had bacteriuria (67% vs 33%, p = .0457). From these urine samples, 54 were obtained at time of UDS of which 45 were from patients on CIC and 9 from FV patients. More patients on CIC had bacteriuria at the time of UDS than those who FV (60% vs 33%, respectively), but this did not reach significance ( p = .1416). No patient with bacteriuria on CIC had a complication after UDS while one FV patient with bacteriuria developed post-UDS pyelonephritis. Conclusion: MMC patients with bacteriuria on CIC did not have post-UDS complications. Patients with bacteriuria who FV may be at particular risk for post-instrumentation UTI, providing guidance as to which MMC patients should undergo urine testing prior to UDS in order to prevent post-instrumentation pyelonephritis.
Pedagogic Paths to Liberation: Personal Struggles, Institution Building and the Rise of the Walter Rodney School of Groundings Praxis in Atlanta
Authors: Benjamin Jesse , Vaught Seneca
Published: September 2019

Dr. Seneca Vaught interviewed Dr. Jesse Benjamin about his personal pedagogical background and process, its intersections with activism and scholarship, and how this led him to working with the Walter Rodney Foundation and various associated projects in the Atlanta area. The discussion moves from research at a radical experimental Quaker international college, to activism and research in upstate New York, at Binghamton University, and finally to work as an engaged community professor in Atlanta. Also covered are the establishment of a Coloniality Research Working Group and a Walter Rodney Study Group in New York, and the influence of Sylvia Wynter. The discussion concludes with an overview of institution building activities in Atlanta, conjecturing the rise of Walter Rodney School of Praxis.
“Ain't No Rest for the Weary:” Continuing the Historical Legacy of Educational Praxis and Advocacy for Black Youth
Authors: Benson Richard D.
Published: September 2019

This essay addresses the role of historical and socio-political nexus of educational praxis and advocacy in educating Black youth. The motivation for this work extends from the critical need of educators of Black youth to contextualize the general experiences of Black education as part of a greater trajectory of liberatory activism. By connecting the historical precedents of Black education, this essay also suggests that while the contemporary educational challenges of Black youth plague an ever changing national landscape, the methods of effectively addressing these deficiencies are historically rooted. Contemporary educational challenges for Black youth, which are the byproducts of neo-liberal agendas, can be addressed through deep historical analysis and by modeling many of the solutions-based methodologies of past generations.
Using a design approach to create collaborative governance
Authors: Bryson John M , Crosby Barbara C , Seo Danbi
Published: September 2019

In complex, shared-power settings, policymakers, administrators and other kinds of decision makers increasingly must engage in collaborative inter-organisational efforts to effectively address challenging public issues. These collaborations must be governed effectively if they are to achieve their public purposes. A design approach to the governance of collaborations can help, especially if it explicitly focuses on the design and use of formal and informal settings for dialogue and deliberation (forums), decision making (arenas) and resolution of residual disputes (courts). The success of a design approach will depend on many things, but especially on leaders and leadership and careful attention to the design and use of forums, arenas and courts and the effective use of power. The argument is illustrated by examining the emergence and governance of a collaboration designed to cope with the fragmented policy field of minority business support.