bluuebunny/crossref_metadata_2025 huggingface dataset:
Complex Fuzzy Sets with Application in BCK/BCI-Algebras
Authors: Jun Young Bae , Xin Xiao Long
Published: January 2020

As a generation of fuzzy set, the notion of complex fuzzy set which is an innovative concept is introduced by Ramot, Milo, Friedman and Kandel. The purpose of this article is to apply complex fuzzy set to BCK/BCI-algebras. The notions of a complex subalgebra and a complex left (right) reduced ideal in a BCK/BCI- algebra are introduced, and related properties are investigated. Characterizations of a complex subalgebra are provided, and the homomorphic image (preimage) of a complex subalgebra and a complex left (right) reduced ideal.
Üniversite Öğrencilerinin Tükenmişlik ve Yaşam Doyumunun İncelenmesi: Kırşehir Ahi Evran Üniversitesi
Authors: ÇAĞATAY İN Ezgi , ŞANLI KULA Kamile
Published: January 2020

Bu araştırmada, Kırşehir Ahi Evran Üniversitesinin farklı fakülte/ yüksekokullarında okuyan öğrencilerin tükenmişlik ve yaşam doyumu durumlarının bazı değişkenler açısından incelenmesi amaçlanmıştır. Araştırma 2016-2017 Eğitim-Öğretim Yılı Güz döneminde Kırşehir Ahi Evran Üniversitesi, Fen Edebiyat Fakültesi, Eğitim Fakültesi, İktisadi ve İdari Bilimler Fakültesi, Ziraat Fakültesi, Fizik Tedavi ve Rehabilitasyon Yüksekokulu, Sağlık Yüksekokulu, Beden Eğitimi ve Spor Yüksekokulunun birinci ve dördüncü sınıfında okumakta olan öğrenciler ile gerçekleştirilmiştir. Çalışmada araştırmacılar tarafından geliştirilen Kişisel Bilgi Formu, Tükenmişlik durumu için ilk olarak Schaufeli, Martinez, Marques-Pinto, Salnova ve Bakker (2002) tarafından geliştirilen; Çapri, Gündüz ve Gökçakan (2011) tarafından Türkçeye uyarlanan Maslach Tükenmişlik Ölçeği- Öğrenci Formu (MTÖ-ÖF); Yaşam Doyumu durumu için Diener, Emmons, Larsen ve Griffin (1983) tarafından geliştirilmiş, Türkçe geçerlilik ve güvenirlik çalışması Köker (1991) tarafından yapılmış Yaşam Doyumu Ölçeği (YDÖ) kullanılmıştır. Üniversite öğrencilerinin, cinsiyet, doğum tarihi, sınıf, okuduğu fakülte/yüksekokul, mezun olunan lise türü, aylık gelir, sigara kullanma durumu, matematikte hissedilen seviye, etkinliklere katılma durumu ve haftalık ders saati yükü değişkenleri ile tükenmişlik durumları; cinsiyet, sınıf, kardeş sayısı, aylık gelir, sigara kullanma durumu, matematikte hissedilen seviye, doğup büyüdüğü yer ve etkinliklere katılma durumu değişkenleri ile yaşam doyumu durumu arasında istatistiksel olarak anlamlı farklılıklar bulunmuştur.
AKUMULIACINĖS KARŠTO VANDENS TALPOS VEIKIMO REŽIMŲ VERTINIMAS
Authors: Kropas Tomas , Streckienė Giedrė
Published: January 2020

Vis dažniau naudojant atsinaujinančius energijos šaltinius iškyla šilumos akumuliavimo technologijų svarba. Tačiau, paprastai tokių šaltinių generuojama energija laiko atžvilgiu nesutampa su sistemos ar vartotojo poreikiu – energija gaminama, kai nėra jos naudojimo ir atvirkščiai. Tai skatina tobulinti ir tirti įvairias energijos akumuliavimo technologijas, kurios padeda išspręsti šią problemą ir gali išlyginti energijos gamybos svyravimus paros, ar kito laikotarpio, bėgyje. Kartu iškyla šiose akumuliavimo technologijose vykstančių procesų efektyvumo vertinimo aktualumas bei poreikis. Šiame darbe nagrinėjami vandeninės akumuliacinės talpos veikimo režimai, atliekamas jų vertinimas. Išskirti trys pagrindiniai procesai: įkrovimas, laikymas ir iškrovimas. Atlikti atskiri realūs eksperimentai kiekvienam iš režimų, nustatyti jų efektyvumo koeficientai. Siekiant išnagrinėti šiluminės stratifikacijos pobūdį bei temperatūros pasiskirstymą talpoje išsamiau, iš eksperimentinių duomenų apskaičiuojami stratifikaciją apibūdinantys kriterijai Atlikta skaitinė ir grafinė gautų rezultatų interpretacija. Gauti rezultatai palyginti su termovizinėmis nuotraukomis.
Scaffolding dalam Menyelesaikan Permasalahan KPK dan FPB
Authors: Hadi Sofwan
Published: January 2020

Pembelajaran dalam kelas berisi siswa yang heterogen pada kemampuan memahami materi, yang memerlukan perlakuan berbeda antara siswa dalam kelas. Siswa yang tidak mampu mengkosntruksi pemahaman materi KPK dan FPB dalam pembelajaran perlu mendapat Scaffolding yang cukup oleh Guru. Penelitian ini menggunakan metode Kualitatif Deskriptif untuk menganalisaScaffolding yang diberikan. Pendekatan Scaffolding menggunakan pendekatan Anghiheleri. Penelitian ini menghasilkanScaffolding bisa dilakukan dengan dua jenis. Pertama dengan penguatan materi, dan kedua dengan penguatan dalam kegiatan pembelajaran.
Komunikasi Edukatif dalam Perspektif Alquran (Analisis Kisah Musa)
Authors: Musayadah Khori Robihatul , Mu'afiah Evi
Published: January 2020

Komunikasi merupakan salah satu hal yang sangat diperlukan dalam kehidupan. Komunikasi memiliki banyak fungsi, salah satunya adalah fungsi edukasi atau pendidikan. Nabi Musa merupakan salah satu Rasul Allah yang dapat dijadikan tauladan oleh seorang pendidik dalam melaksanakan pembelajaran. Adapun metode yang digunakan adalah content analysis dan penelitian ini merupakan jenis penelitian library research dengan pendekatan Historis. Adapun hasil dari penelitian ini adalah (1) komunikasi yang terjadi dalam kisah Musa merupakan komunikasi edukatif yang dapat dilihat dari peran Nabi Musa sebagai seorang edukator dan tujuan komunikasi tersebut yaitu mengubah pengetahuan Bani Israil tentang ketauhidan; (2) tahapan-tahapan yang terdapat dalam strategi komu-nikasi edukatif dalam kisah Musa adalah menemukan masalah Bani Israil, menentukan tujuan, merencanakan komunikasi, menyampaikan risalah, Umpan balik, dan evaluasi beru-pa cobaan; (3) tahapan strategi komunikasi edukatif dalam kisah Musa merupakan gabung-an dari tahapan strategi komunikasi Cultid dan Center, Philip Lesly, John Middleton, lima langkah, dan advokasi.
Penggunaan Model Pembelajaran SAVI Untuk Meningkatkan Prestasi Belajar IPS Pada Siswa Kelas V SD Al Husna Kota Madiun
Authors: Yanto Eka Nofri Ari
Published: January 2020

Berdasarkan hasil observasi yang dilakukan peneliti di SD Al Husna (IFDS), diketahui bahwa proses pembelajaran di kelas V masih bersifat konvensional sehingga kurang mengembangkan pola pikir dan kreatifitas siswa. Terdapat beberapa guru khususnya pada mata pelajaran IPS kelas V hanya berceramah dan siswa hanya mendengarkan, mencatat dan menghafalkan materi. Penelitian ini bertujuan untuk meningkatkan prestasi belajar siswa khususnya pada mata pelajaran IPS kelas VA dengan menggunakan model pembelajaran SAVI. Penelitian ini menggunakan metode Penelitian Tindakan Kelas (PTK), prosedur penelitian yang digunakan berupa siklus yang terdiri dari empat tahap yaitu tahap perencanaan, pelaksanaan, observasi dan  refleksi.Teknik pengumpulan data yang digunakan adalah tes kognitif dan alat pengumpulan data yang digunakan adalah instrumen soal dan lembar observasi.

Hasil analisis data yang diperoleh menunjukkan bahwa terjadi peningkatan pada hasil belajar yang berdampak pada prestasi belajar siswa.Hal ini dapat dilihat dari hasil presentase rata-rata pada siklus I yaitu 75% yang artinya ada 15 dari 20 siswa yang tuntas. Terjadi peningkatan pada siklus yang ke II yaitu 80% yang artinya ada 16 dari 20 siswa yang tuntas dalam pembelajaran. Pada siklus terakhir juga mengalami peningkatan yang signifikan dari siklus sebelumnya yaitu 90% yang artinya ada 18 dari 20 siswa yang tuntas pada siklus terkhir ini. Berdasarkan hasil penelitian, dapat disimpulkan bahwa implementasi model pembelajaran SAVI dapat meningkatkan prestasi belajar siswa pada mata pelajaran IPS kelas V SD Al Husna (IFDS).
Pembentukan Karakter Islami dalam Pengelolaan Kelas Aktif
Authors: Ikmah Amit Dana
Published: January 2020

Pendidikan karakter merupakan  pendidikan yang melibatkan aspek pengetahuan, perasaan, dan tindakan. Upaya yang harus dilibatkan dalam pendidikan karakter adalah pihak keluarga,  sekolah, lingkungan sekolah, dan juga masyarakat luas. Pembentukan karakter Islami sangat membantu dalam menghadapi kemajuan ilmu pengetahuan dan teknologi yang begitu pesat saat ini. Kegiatan belajar dapat berhasil dengan baik jika proses belajar terjadi secara aktif. Dan proses pembelajaran dapat dikatakan aktif jika semua otak dalam kondisi bekerja. Pengelolaan kelas dapat dilakukan secara aktif dengan adanya peraturan, konsekuensi, dan penghargaan.
Penerapan Model Pembelajaran Project Based Learning pada Mata Kuliah Kewirausahan dalam Meningkatkan Hasil Belajar Mahasiswa
Authors: Damayanti Susi , Surindra Bayu
Published: January 2020

Tujuan dari penelitian ini yaitu ingin mengetahui perbedaan hasil belajar mahasiswa baik sebelum maupun sesudah penerapan model pembelajaran project based learning pada mata kuliah kewirausahaan. Jenis penelitian yang digunakan yaitu penelitian tindakan kelas yang memiliki tujuan  untuk mengetahui peningkatan hasil belajar mahasiswa melalui penerapan model pembelajaran project based learning pada mata kuliah kewirausahaan. Yang menjadi subjek penelitian ini yaitu Program Studi Pendidikan Guru Sekolah Dasar Universitas Nusantara PGRI Kediri tingkat IV kelas E yang berjumlah 33 mahasiswa, sedangkan objek dalam penelitian ini yaitu hasil belajar mahasiswa PGSD mata kuliah kewirausahaan. Teknik analisis data yang dipakai yaitu analisi deskriptif untuk mengetahui perbedaan sebelum dan sesudah penerapan model pembelajaran project based learning pada mata kuliah kewirausahaan. Dari hasil pengolahan data dengan menggunakan software SPSS terdapat peningkatan hasil belajar mahasiswa, serta dari hasil uji signifikansi didapatkan data nilai Sig.(2-tailed) adalah 0,000 < 0,05, sehingga dapat disimpulkan bahwa penerapan model pembelajaran project based learning pada mata kuliah kewirausahaan ada perbedaan yang signifikan. Selanjutnya dari hasil ketuntasan belajar mahasiswa juga mengalami peningkatan dari siklus 1 dengan nilai rata-rata sebesar 68%, meningkat pada siklus 2 dengan nilai rata-rata sebesar 85,7%.
Diagnosa Kesulitan Mahasiswa PGMI IAIN Ponorogo Dalam Membelajarkan Bilangan Pecahan
Authors: Fatmahanik Ulum
Published: January 2020

Pecahan merupakan salah satu materi yang diajarkan dalam matematika yang mencakup konsep dasar dan materi prsayarat dalam mempelajari bilangan yang lain serta  mengembangkan kemampuan penalaran aljabar mahasiswa. Tetapi kebanyakan mahasiswa calon guru SD/MI mengalami kesulitan dalam membelajarkan bilangan pecahan. Hal ini perlu dianalisis karena apabila calon seorang guru dalam mengajarkan banyak terjadi kesalahan maka dapat dipastikan bahwa siswa yang diajar juga akan mengalami hal yang sama. Sehingga sebagai mahasiswa calon guru SD/MI harus mempunyai bekal penguasaan materi yang memadai. Penelitian ini merupakan penelitian kualitatif yang menghasilkan data mengenai permasalahan mahasiwa PGMI IAIN dalam membelajarkan bilangan pecahan. Hasil penelitian menunjukkan bahwa permasalahan yang dialamai mahasiswa calon guru SD/MI dalam membelajarkan bilangan pecahan diantaranya yaitu: 1) kesulitan dalam membelajarkan makna pecahan, 2) kesulitan dalam membelajarkan pecahan senilai, 3) Kesulitan dalam membelajarkan penjumlahan bilangan bilangan pecahan jika mempunyai penyebut yang tidak sama, 4) Kesulitan dalam membelajarkan pengurangan bilangan pecahan dengan penyebut tidak sama, 5) Kesulitan dalam membelajarkan perkalian pecahan, 6) Mahasiswa mengalami kesulitan dalam membelajarkan makna dan hasil pembagian pecahan.
Manajemen Perubahan Lembaga Pendidikan Islam (Studi Kasus di Pesantren Fathul ‘Ulum Kwagean Kediri)
Authors: Ali Mustopa
Published: January 2020

Artikel penelitian ini ingin membahas tentang Perubahan pada sebuah organisasi pendidikan pesantren, dimana perubahan organisasi merupakan sudah sangat wajar terjadi, perubahan juga terjadi di lembaga pendidikan Islam seperti Pesantren. Kyai menerapkan manajemen perubahan ini untuk mempertahankan salaf dengan perangkat modern serta mengikuti perkembangan di era globalisasi dengan manajemen perubahan pada beberapa sisi serta mempertahankan kearifan yang telah ada sebagai ciri pesantren tersebut. Penelitian ini bertujuan untuk: 1) Mendapatkan gambaran secara utuh tentang fase perubahan di pesantren Fat?ul ‘Ul?m Kewagean Kediri dan 2) Menjelaskan perubahan pesantren Fat?ul ‘Ul?m Kewagean Kediri pada ranah struktur, tata fisik, teknologidan manusia.

Penelitian ini dilakukan dengan pendekatan kualitatif, dengan rancangan studi kasus serta penjelasannya menggunakan logika deductive analitis.Lokasi penelitian ini adalah di Pesantren Fat?ul ‘Ul?m Kwagean Kediri. Pengumpulan data dilakukan dengan observasi dilapangan, wawancara dan dokumentasi. Data yang terkumpul direduksi serta disajikan selanjutnya dianalisis kemudian mengambil sebuah kesimpulan.

Hasil penelitian menjunjukkan bahwa 1) terdapat tiga fase perubahan yaitu pertama, fase pencairan (unfreezing), yakni langkah awal organisasi mendiskusikan serta menganalisis kesiapan organisasi menghadapi perubahan, kedua, fase mulai berubah (changing), merupakan langkah inti perubahan dilaksanakan. Ketiga, fase pembekuan kembali (refreezing), merupakantindakan organisasi dalam membiasakan diri dengan keadaan setelah berubah. 2) peruabahan pada ranah struktur, Pesantren Fat?ul ‘Ul?m secara struktur organisasi berubah dari kepemimpinan terpusat menjadi sistem yayasan serta secara teknis membentuk organisasi kelembagaan pada tiap-tiap bidang yang melibatkan santri sebagai pengurus. Perubahan tata fisik, Pesantren mulai berdiri sampai akhir 2017 telah mengalami perpindahan tempat, mulai dari ndalem wetan (rumah mertua Kyai Hanan), ndalem kulon dan berakhir di Kwagean utara, selain itu pembangunan gedung secara terus menerus setiap tahun. Perubahan teknologi, pesantren telah memanfaatkan fasilitas teknologi komputerisasi dan jaringan internet.untukperubahan manusia, santri dan para pengajarnya sudah banyak yang kuliah, secara kuantitas jumlah santri meningkat serta jumlah pengajarpun demikian.
Analisis Implementasi Program Adiwiyata dalam Membangun Karakter Peduli Lingkungan
Authors: Diyan Nurvika Kusuma Wardani
Published: January 2020

Artikel penelitian ini bertujuan siswa harus memiliki karakter peduli lingkungan agar terbiasa hidup bersih dan sehat, serta dapat menciptakan lingkungan yang kondusif untuk kegiatan sehari-hari, dengan lingkungan yang kondusif akan tercipta proses pembelajaran yang bermutu. Karakter peduli terhadap lingkungan dapat dibentuk melalui barbagai cara. Salah satunya adalah melalui implementasi program adiwiyata. MIN 1 Ponorogo telah mendapatkan penghargaan tingkat provinsi sebagai sekolah Adiwiyata. Pelaksanaan program Adiwiyata di MIN 1 Ponorogo sudah sesuai dengan 4 komponen program Adiwiyata yang tercantum dalam buku pedoman Adiwiyata.

Penelitian ini menggunakan pendekatan kualitatifdengan Jenis penelitianstudi kasus. Adapun teknik pengambilan data menggunakan observasi, wawancara, dan dokumentasi. Sedangkan teknik analisa data yang digunakan model Miles and Huberman yang meliputi: reduksi data, penyajian data dan penarikan kesimpulan.

Hasil penelitian ini, dapat disimpulkan bahwa: (1) Pelaksanaan program Adiwiyata melalui 4 komponen program adiwiyata di MIN 1 Ponorogo sudah berjalan dengan baik, dengan melibatkan seluruh stakeholder. (2) Proses pembinaan karakter peduli lingkungan pada pada peserta didik di MIN 1 Ponorogo yaitu melalui: a) pembiasaan. b) keteladanan. c) pembinaan disiplin peserta didik. d) terintegrasi dalam mata pelajaran. e) kegiatan rutin. f) pengkondisian. g) pengembangan budaya sekolah. (3) Faktor pendukung dalam pelaksanaan program adiwiyata dalam membina karakter peduli lingkungan di MIN 1 Ponorogo diantaranya adalah komitmen dari stakeholder madrasah,Sedangkan faktor penghambatnya antara lain adalah belum adanya campur tangan dari kemenag dalam hal pendanaan; lingkungan keluarga.
Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden
Authors: Davis Jason , Saunders Rhodri
Published: January 2020

Background
Bariatric surgery, such as Roux-en-Y gastric bypass [RYGB] has been shown to be an effective intervention for weight management in select patients. After surgery, different patients respond differently even to the same surgery and have differing weight-change trajectories . The present analysis explores how improving a patient’s post-surgical weight change could impact co‑morbidity prevalence, treatment and associated costs in the Canadian setting.
Methods
Published data were used to derive statistical models to predict weight loss and co‑morbidity evolution after RYGB. Burden in the form of patient-years of co-morbidity treatment and associated costs was estimated for a 100-patient cohort on one of 6 weight trajectories, and for real-world simulations of mixed patient cohorts where patients experience multiple weight loss outcomes over a 10-year time horizon after RYGB surgery. Costs (2018 Canadian dollars) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language.
Results
Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Improvement of 100 patients from the worst to the best weight loss trajectory was associated with a 50% reduction in 10-year co-morbidity treatment costs, decreasing to a 27% reduction for an intermediate improvement. Results applied to mixed trajectory cohorts revealed that broad improvements by one trajectory group for all patients were associated with 602, 1,710 and 966 patient-years of treatment of type 2 diabetes, hypertension and dyslipidaemia respectively in Ontario, the province of highest RYGB volume, corresponding to a cost difference of $3.9 million.
Conclusions
Post-surgical weight trajectory, even for patients receiving the same surgery, can have a considerable impact on subsequent co-morbidity burden. Given the potential for alleviated burden associated with improving patient trajectory after RYGB, health care systems may wish to consider investments based on local needs and available resources to ensure that more patients achieve a good long-term weight trajectory.
Eosinopenia as a diagnostic marker of bloodstream infection in a general internal medicine setting: A cohort study
Authors: Hirosawa Takanobu , Harada Yukinori , Morinaga Kohei , Takase Hiroshi , Nin Michihiro , Shimizu Taro
Published: January 2020

Background Little is known about the potential use of the eosinophil count as a predictive marker of bloodstream infection. In this study, we aimed to assess the reliability of eosinopenia as a predictive marker of bloodstream infection. Methods This study was a retrospective cohort study. The outpatient department and general internal medicine department of a tertiary university hospital in Japan. A total of 189 adult patients with at least 2 sets of blood cultures obtained during January 1–December 31, 2018, after excluding those with the use of antibiotic therapy within 2 weeks prior to blood culture, steroid therapy, a history of haematological cancer, or eosinophilia. The diagnostic accuracies of each univariate variable and the multivariable logistic regression models were assessed by calculating the areas under the receiver operating characteristic curves (AUROCs). The primary outcome was a positive blood culture indicating bloodstream infection. Results Severe eosinopenia (<10 cells/mm3) alone yielded little overall predictive ability (AUROC: 0.606, 95% confidence interval (CI): 0.502–0.710, P=0.035), and only moderate sensitivity (50%, 95%CI: 29–70%) and specificity (71%, 95%CI: 63–78%). The model comprising baseline variables (age, sex) and the C-reactive protein level yielded an AUROC of 0.7384, and the further addition of eosinopenia yielded a slight improvement, with an AUROC of 0.7547 (P=0.4297) and a statistically significant net reclassification improvement (NRI) (P=0.03). However, the integrated discrimination index (IDI) (P=0.282) remained non-significant. Conclusions Severe eosinopenia can be considered an inexpensive marker of bloodstream infection in a general internal medicine setting.
Transcriptomic study of pedicels from GA3-treated table grape genotypes with different susceptibility to berry drop reveals responses elicited in cell wall yield, primary growth and phenylpropanoids synthesis.
Authors: Meneses Marco , García-Rojas Miguel , Muñoz-Espinoza Claudia , Carrasco-Valenzuela Tomás , Defilippi Bruno , González-Agüero Mauricio , Meneses Claudio , Infante Rodrigo , Hinrichsen Patricio
Published: January 2020

Background Gibberellins (GA3) are the most sprayed growth regulator for table grape production worldwide, increasing berry size of seedless varieties through pericarp cell expansion. However, these treatments also exacerbate berry drop, which has a detrimental effect on the postharvest quality of commercialized clusters. Several studies have suggested that pedicel stiffening caused by GA3 would have a role in this disorder. Nevertheless, transcriptional and phenotypic information regarding pedicel responses to GA3 is minimal. Results Characterization of responses to GA3 treatments using the lines L23 and Thompson Seedless showed that the former was up to six times more susceptible to berry drop than the latter. GA3 also increased the diameter and dry matter percentage of the pedicel on both genotypes. Induction of lignin biosynthesis-related genes by GA3 has been reported, so the quantity of this polymer was measured. The acetyl bromide method detected a decreased concentration of lignin seven days after GA3 treatment, due to a higher cell wall yield of the isolated fractions of GA3-treated pedicel samples which caused a dilution effect. Thus, an initial enrichment of primary cell wall components in response to GA3 was suggested, particularly in the L23 background. A transcriptomic profiling was performed to identify which genes were associated with these phenotypic changes. This analysis identified 1,281 and 1,787 genes differentially upregulated by GA3 in L23 and cv. Thompson Seedless, respectively. Concomitantly, 1,202 and 1,317 downregulated genes were detected in L23 and cv. Thompson Seedless (FDR≤0.05). Gene ontology analysis of upregulated genes showed enrichment in pathways including phenylpropanoids, cell wall metabolism, xylem development, photosynthesis and the cell cycle at seven days post GA3 application. Twelve genes were characterized by qPCR and striking differences were observed between genotypes, mainly in genes related to cell wall synthesis. Conclusions High levels of berry drop are related to an early strong response of primary cell wall synthesis in the pedicel promoted by GA3 treatment. Genetic backgrounds can produce similar phenotypic responses to GA3, although there is considerable variation in the regulation of genes in terms of which are expressed, and the extent of transcript levels achieved within the same time frame.
Brain Natriuretic Peptide to Predict Successful Liberation from Mechanical Ventilation in Critically Ill Patients: a Systematic Review and Meta-Analysis
Authors: Deschamps Jean , Andersen Sarah K. , Webber Jordan , Featherstone Robin , Sebastianski Meghan , Vandermeer Ben , Senaratne Janek , Bagshaw Sean M.
Published: January 2020

Background: Predicting successful liberation from mechanical ventilation (MV) in critically ill patients is challenging. Brain natriuretic peptide (BNP) has been proposed to help guide decision-making for readiness to liberate from MV following a spontaneous breathing trial (SBT). Methods : We performed a systematic review and meta-analysis of randomized and prospective observational studies that measured BNP levels at the time of SBT in patients receiving MV. The primary endpoint was successful liberation from MV (absence of re-intubation or non-invasive ventilation at 48h). Statistical analyses included bi-variate and Moses-Littenberg models, and DerSimonian-Laird pooling of areas under ROC curve (AUROC). Results: A total of 731 articles were screened. Eighteen adult and 2 pediatric studies were fulfilled pre-specified eligibility. The measure of the relative variation of BNP during SBT (DBNP%) after exclusion of SBT failure by clinical criteria in adults yielded a sensitivity and specificity of 0.889 [0.831-0.929] and 0.828 [0.730-0.896] for successful liberation from MV respectively, with a pooled AUROC of 0.92 [0.88-0.97]. The pooled AUROC for any method of analysis for absolute variation of BNP (DBNP), pre-SBT BNP and post-SBT BNP were 0.89 [0.83-0.95], 0.77 [0.63-0.91], and 0.85 [0.80-0.90], respectively.Conclusion: The relative change in BNP during a SBT has potential value as an incremental tool after successful SBT to predict successful liberation from MV in adults. There is insufficient data to support the use of BNP in children or as an alternate test to clinical indices of SBT or the use of DBNP, BNP-pre and BNP-post as an alternate or incremental test.Trial registration number: PROSPERO CRD42018087474 (2018-02-06)
A Longitudinal Implementation Evaluation of a Physical Activity Program for Cancer Survivors: LIVESTRONG® at the Y.
Authors: Faro Jamie M , Arem Hannah , Heston Ann-Hilary , Hohman Katherine , Hodge Heather , Wang Bo , Lemon Stephenie C , Houston Thomas K , Sadasivam Rajani S
Published: January 2020

Purpose: Increased physical activity (PA) levels in cancer survivors are associated with decreased risk of recurrence and mortality as well as additional positive health outcomes. PA interventions have shown to be efficacious, though many lack translation to and sustainability in community settings. We used dimensions of the RE-AIM framework to evaluate LIVE STRONG® at the YMCA, a nation-wide community-based PA program for cancer survivors delivered at Ys. Methods: LIVE STRONG at the Y national data compiled by YMCA of the USA and Y Association Program Managers between the years of 2010-2018 was examined. We assessed reach (number of participants), adoption (Associations offering the program), implementation (conducting 3 fidelity checks), setting-level maintenance (Associations recently offering program) and participant-level maintenance (membership conversion rate). We also examined relationships between organizational characteristics (years of program existence and Association area household income), and program implementation factors with member conversion. Results: As of 2018, LIVE STRONG at the Y has reached 62,044 survivors and 245 of the 840 (29.2%) of Y Associations have adopted the program. Among the adopters, 91% were aware of fidelity checks; implementation of Observational (62.3%), Goal-setting (49.9%), and Functional (64.6%) checklists varied. Most (95.1%) adopters reported offering ≥1 LIVE STRONG session per year (setting-level maintenance) and a facility-level mean membership conversion percentage of 46.9±31.2% (participant-level maintenance). Fewer years implementing the program and higher Association area household income were significantly associated with a greater membership conversion rate vs their comparison (all t-test p’s <0.05). In a multiple regression model controlling for organizational characteristics, conducting the fidelity checks (Observational, β=8.41; Goal-setting, β=9.70; and Functional, β=9.61; all p’s <0.01) was positively associated with higher membership conversion rates. Conclusions: LIVE STRONG at the Y, in its early years, has shown promise for high reach, while adoption at more Associations could be facilitated. Implementing fidelity checks along with organizational characteristics were associated with higher participant-level maintenance. Identification of Association-level strategies to increase reach, adoption, implementation and maintenance may increase the impact of this community-based PA program.
Hearing and vision care provided to older people residing in care homes: a cross-sectional survey of care home staff
Authors: Andrusjak Wendy , Barbosa Ana , Mountain Gail
Published: January 2020

Background: Hearing and vision loss in older people has proven to affect physical and mental health and increase the speed of cognitive decline. Studies have proven certain practices and aspects of staff knowledge increase the effective care of residents’ ears and eyes, yet it is not known which of these are being implemented in care homes. This study aims to identify the gaps in staff knowledge and underused practices evident in long term care homes when identifying and managing hearing and vision difficulties in older residents. Methods: This study used a cross-sectional survey design. Survey questions were informed by the existing literature and were focused on practices, staff knowledge, and other aspects that have shown to affect residents’ hearing and vision care. The survey was sent to care homes across England between November 2018 and February 2019 both via Email and in paper format for care home staff to complete. Descriptive statistics and Chi-Square analysis was used to assess the factors particularly influencing the current care being provided to care home residents. Results: A total of 400 care home staff responded from 74 care homes. The results revealed that screening tools are rarely used by staff to identify hearing and vision impairments, care homes have limited access to other assistive devices, and audiology services do not regularly assess care home residents. A majority of staff were also not entirely confident in their knowledge of ear and eye care. Responses were also affected by the respondents’ job role, length of time working in care homes and also the care home type and care home capacity revealing a lack of standardised practice and shared communication. Conclusion: This study identifies which practices known to facilitate ear and eye care are currently under used in care homes across England and what particularly staff are not knowledgeable on when it comes to ear and eye care. This can now inform future research of the areas requiring improvement to as effectively address to acknowledged slow identification and poor management of hearing and vision loss in older people residing in care homes.
Hybrid Simulation of pediatric gynecologic examination: a mix-methods study of learners’ attitudes and factors affecting learning.
Authors: Torres Anna , Horodeńska Magdalena , Witkowski Grzegorz , Torres Kamil
Published: January 2020

Background: Children and adolescents with reproductive health issues may require immediate or emergency care, however in many countries availability of the pediatric and adolescent gynecology (PAG) service is low. That being said, teaching PAG examination to OBGYN, pediatrics and emergency medicine residents seems reasonable and cannot be underestimated. In order to provide residents with opportunity to learn PAG examination a high-fidelity hybrid simulation (HFHS) workshop was implemented in our institution.Methods: The study aimed to investigate learners’ attitudes towards the hybrid model as compared with pelvic trainer in the HFS environment and the factors connected to learners’ attitudes towards the hybrid model that could influence learning in HFS. The concept of attitude was used as the theoretical framework and the mixed method approach to study design was utilized with simultaneous collection of quantitative (original questionnaires) and qualitative data (semi-structured interviews). Results: Residents valued the hybrid model higher over task trainer-SP-voice model in regards to all three attitude components: cognitive (95%), affective (87.5%) and behavioral (83.7%). Analysis of qualitative data revealed six themes important to learners and informing learning of PAG examination in HFS and allowed to develop a conceptual model.Conclusions: Participants of our study appreciated the learning experience with hybrid model more based on attitude questionnaire. Moreover, findings revealed that multiple, various factors connected to attitude may influence learning of PAG examination in HFS with hybrid model, and we propose a conceptual model illustrating relationships between those factors.
WITHDRAWN: Exploring the Effectiveness of Convolutional Neural Network with Ensemble Technique
Authors: Ghosh Monalisha , Sanyal Goutam
Published: January 2020

­­­­­­­­­­­­­­­­­­­­­­­­­­­ Sentiment Analysis has recently been considered as the most active research field in the natural language processing (NLP) domain. Deep Learning is a subset of the large family of Machine Learning and becoming a growing trend due to its automatic learning capability with impressive consequences across different NLP tasks. Hence, a fusion-based Machine Learning framework has been attempted by merging the Traditional Machine Learning method with Deep Learning techniques to tackle the challenge of sentiment prediction for a massive amount of unstructured review dataset. The proposed architecture aims to utilize the Convolutional Neural Network (CNN) with a backpropagation algorithm to extract embedded feature vectors from the top hidden layer. Thereafter, these vectors augmented to an optimized feature set generated from binary particle swarm optimization (BPSO) method. Finally, a traditional SVM classifier is trained with these extended features set to determine the optimal hyper-plane for separating two classes of review datasets. The evaluation of this research work has been carried out on two benchmark movie review datasets IMDB, SST2. Experimental results with comparative studies based on performance accuracy and F-score value are reported to highlight the benefits of the developed frameworks.
Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl's node: a prospective study of 65 patients
Authors: Zhang Yaoshen , Yin Peng , Yang Jincai , Hai Yong
Published: January 2020

Background: The Schmorl's nodes (SNs) is defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the schmorl's node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. Methods: Clinical data and medical records of 65 patients with the fresh endplate fracture aroud SNs who underwent single level (PVP) from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary surgery. Surgery related data including duration of the operation, injected cement volumes and surgical complications were recorded. Results: Sixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered. Conclusions: Based on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs.
Staged surgical strategy of symptomatic lumbar adjacent-segment degeneration: full-endoscopic decompression versus extended posterior interbody fusion
Authors: Li Tong , Zhu Bin , Liu Xiaoguang
Published: January 2020

Background Symptomatic adjacent-segment degeneration (ASD) is a common complication after lumbar fusion surgery. We want to evaluate the clinical and imaging outcome of full-endoscopic lumbar decompression (FELD) in comparison with extended posterior lumbar interbody fusion (PLIF) for ASD after lumbar fusion surgeries and develop a staged revision strategy. Methods This retrospective study enrolled 65 patients with ASD who treated with FELD (n=31) or extended PLIF (n=34) between January 2014 and January 2018. Clinical outcome evaluations were performed preoperatively, at 3, 12, 24 months postoperatively, including Oswestry Disability Index (ODI) score and Japanese Orthopaedic Association (JOA) scores for function assessment, visual analog scale (VAS) scores for low-back pain and leg pain. Imaging outcome evaluations were performed preoperatively, immediately after surgery and at the last follow up, including disc height (DH) and lumbar lordosis (LL). Results The ratio of patients with adjacent segmental instability in the PLIF group was significantly higher than that in the FELD group (p<0.05). There was no significant difference in other baseline data for FELD and PLIF groups (p>0.05). Mean operative time, blood loss and length of hospital stay were significantly decreased for the FELD group (p<0.001). For patients with stable adjacent segments, there was no significant difference in preoperative and postoperative low-back pain, leg pain and function between 2 groups (p>0.05). The patients in PLIF group had restored DH after surgery, which was significantly higher than FELD group (p<0.05). For patients with unstable adjacent segments, the low-back and leg pain of PLIF group were significantly relieved than that in FELD group within 24 and 3 months after surgery (p<0.05). The function of PLIF group was significantly improved within 12 months after surgery (p<0.05). The DH was only significantly restored within 3 months after surgery (p<0.05). Recurrence was found in 2 (6.5%, p>0.05) patients in FELD group, while no patient in PLIF group had recurrence. Conclusions FELD could achieve satisfactory safety and efficacy for the treatment of stable ASD, which was not worse than PLIF. With less trauma and faster recovery, FELD may be an alternative surgical treatment for stable ASD.
The effectiveness of vitamin D supplementation in functional outcome and quality of life(QoL) of lumbar spinal stenosis(LSS) requiring surgery
Authors: Ko Sangbong , Chae Seungbum , Choi Wonkee , Kwon Jaibum , Choi Je-Yong
Published: January 2020

Study design: Retrospective cohort comparative study Objective: To identify the prevalence of vitamin D deficiency in patients with LSS requiring surgery, and to compare the differences between the cases whether vitamin D is supplemented and vitamin D is not supplemented in terms of a QoL during postoperative two year. Summary of Background Data: Vitamin D supplementation is considered to be associated with good functional outcome. Thus, a few studies have proposed vitamin D supplementation is benefit to the functional outcome in LSS requiring surgery. Methods: All patients with LSS who underwent surgery from March 1, 2015 to August 31, 2016 were enrolled. Among them, 61 patients with vitamin D deficiency were divided into two groups (supplemented group (A) and non-supplemented group (B)). Functional outcomes using Oswestry Disability Index (ODI) and Rolland Morris Disability Index (RMDQ) and QoL using SF-36 were evaluated at 12month, and 24month follow up periods. Differences in functional score and SF-36 between the vitamin D supplemented and non-supplemented group were compared. Results : Among the total 102 patients, 78 patients (76.5%) had vitamin D deficiency. Of the 78 patients, 61 patients were included, 27 patients were group A and 27 patients were group B. There was no difference in age and 25-OHD level between the two groups (all 0>0.05). Group A were better functional outcomes at two years after surgery (p<0.05). On the QoL, group A were higher score than group B from twelve month later after surgery (p<0.05). Conclusions: Vitamin D deficiency was highly prevalent in LSS patients (76.5%). Assessment of serum 25-hydroxyvitamin D (25(OH)D) are recommended in LSS needing surgical intervention and active treatment vitamin D supplementation and maintenance of normal range should be considered for better postoperative functional outcome and QoL.
General Practitioners’ Perceptions of their Practice of Evidence-based Chronic Disease Prevention Interventions: A Quantitative Study in Shanghai, China
Authors: Fan Feng , Chen Chen , Shen Delei , Yu Zhaohu , Liu Xin , Zhou Huining , Wang Zhaoxin , Shi Jianwei
Published: January 2020

Background Despite increasing calls internationally for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming and policymaking, there is relatively sparse research assessing the current capacity of physicians and the factors influencing that capacity in China.Method A total of 892 physicians were collected from community healthcare centers (CHCs) in Shanghai, China. The experience-based chronic disease prevention (EBCDP) evaluation tool assessed physicians’ awareness, adoption, implementation and maintenance of EBCDP based on the RE-AIM framework. Linear regression analysis was used to assess associations between each EBCDP process and personal characteristics or organizational factors. Result Physicians from CHCs perceived their awareness (mean=4.90, SD=1.02) and maintenance (mean=4.71, SD=1.07) of EBCDP to be relatively low. Physicians with lower titles and monthly incomes >9,000 RMB per month tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P<0.05). Those who participated in one program were less likely to adopt (b=-0.284, P=0.007), implement (b=-0.292, P=0.004), and maintain (b=-0.225, P=0.025) EBCDP than those who participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P<0.0001). Those who were from the suburbs had lower scores regarding awareness (b=-0.150, P=0.047), implementation (b=-0.171, P=0.029), and maintenance (b=-0.237, P=0.002) compared with those from urban areas. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP processes compared with those in CHCs not affiliated with a university. Conclusions This study provides evidence quantitatively illustrating the practice of EBCDP among physicians in CHCs with various personal and organizational characteristics. More solutions should be provided to increase their awareness of EBCDP to stimulate the use of EBCDP for chronic disease prevention and other public health priorities.
Disease burden of chronic hepatitis B and complications in China from 2006 to 2050: an individual-based modeling study
Authors: Zheng Yang , Wu Jie , Ding Cheng , Xu Kaijin , Yang Shigui , Li Lanjuan
Published: January 2020

Background: Chronic hepatitis B has become a major public health problem in China. An accurate depiction of the disease burden has not yet been thoroughly conducted. We aimed to project the disease burden of chronic hepatitis B virus infection and related complications by modeling various scenarios. Method : An individual-based Markov model was used to predict disease burden from 2006 through 2050. We simulated 5 scenarios with different annual incidences, diagnosis and nucleotide analogs (NAs) treatment rates as well as treatment eligibility, which included a natural history without diagnosis or NAs therapy, a base-case, a World Health Organization proposed target case and two ideal cases. Result: Natural history scenario is projected to have the fewest HBsAg loss (27.59 million) and highest HBV-related deaths (27.19 million). With improved diagnosis and treatment rates of NAs therapy, ideal cases have fewer HBV-related deaths (14.46-14.77 million) than WHO (15.13 million) and base-case (16.89 million), but proportion of HBsAg loss is similar among them. With reduced new infections, prevalence of chronic HBV in 2050 is expected minimally to be 27.03-27.49 million under WHO and ideal cases.
Conclusion: If the future disease burden of chronic HBV is to be lowered dramatically, reducing new infection is more effective than increasing diagnosis, treatment rate and treatment eligibility. Additionally, without high potency new drugs, it will be hard to avert increasing trend of cumulative cirrhosis, DC, HCC, LT and HBV-related death.
A Mutant Vesicular Stomatitis Virus with Reduced Cytotoxicity and Enhanced Anterograde Trans-synaptic Efficiency
Authors: Lin Kunzhang , Zhong Xin , Ying Min , Li Lei , Tao Sijue , Zhu Xutao , He Xiaobin , Xu Fuqiang
Published: January 2020

Understanding the connecting structure of brain network is the basis to reveal the principle of the brain function and elucidate the mechanism of brain diseases. Trans-synaptic tracing with neurotropic viruses has become one of the most effective technologies to dissect the neural circuits. Although the retrograde trans-synaptic tracing for analyzing the input neural networks with recombinant rabies and pseudorabies virus has been broadly applied in neuroscience, viral tools for analyzing the output neural networks are still lacking. The recombinant vesicular stomatitis virus (VSV) has been used for the mapping of synaptic outputs. However, several drawbacks, including high neurotoxicity and rapid lethality in experimental animals, hinder its application in long-term studies of the structure and function of neural networks. To overcome these limitations, we generated a recombinant VSV with replication-related N gene mutation, VSV-NR7A, and examined its cytotoxicity and efficiency of trans-synaptic spreading. We found that VSV-NR7A exhibits attenuated cytotoxicity, delayed but enhanced anterograde trans-synaptic tracing efficiency, compared with the wild-type VSV. Our work could provide an improved tool for structural and functional studies of neurocircuit.
Exploring learners’ perspectives of a Project ECHO palliative care education curriculum in resource-limited settings in light of key learning theories
Authors: Doherty Megan , Modanloo Shokoufeh , Evans Emily , Newhook Dennis , Archibald Doug
Published: January 2020

Background: Project ECHO (Extension of Community Healthcare Outcomes) is a well-established telehealth educational platform developed to improve access to specialist care training in underserved areas. The objective of this study is to explore the learning experiences of participants in a Project ECHO targeting care providers in India and explore considerations for how ECHO programs could be modified to cater to the unique learning needs of individuals in low- and middle-income countries. Methods : We implemented a one-year Project ECHO on pediatric palliative care (ECHO PPC) targeting healthcare providers in India. The program consisted of 24 bi-weekly sessions (March 2018-February 2019) hosted by the Hyderabad Centre for Palliative Care in Hyderabad, India. Learners who attended at least 20% (5 sessions) were eligible to participate. Data related to demographic characteristics of ECHO PPC participants were collected. Four focus groups were conducted (February-April 2019) either online via videoconference or in person. Focus groups recordings were transcribed, coded and independently verified. The codes were then arranged into overarching themes.Results : Thirty-six learners were eligible and invited to participate in the study. Seventeen individuals completed the study. Following coding and analysis, two major themes and seven sub-themes were identified. The themes included: (1) Benefits of participation in ECHO PPC (creation of a community of practice; opportunity to exchange cultures, ideas and experiences; supportive role of the facilitator and peers; increased relevant knowledge and skills; and access to additional learning resources) and (2) Barriers to participation (difficulties with time and practice schedule management and language and sociocultural factors). Conclusion: The key principals of learning theories were incorporated into forming the Project ECHO conceptual model in this study. PPC Project ECHO facilitated community building, stimulated professional interest and additional learning outside of the program. However, addressing the barriers and challenges might likely enhance the success of the program in future.