bluuebunny/crossref_metadata_2025 huggingface dataset:
Is outpatient care benefit distribution of government healthcare subsidies equitable in rural ethnic minority areas of China? Results from cross-sectional studies in 2010 and 2013
Authors: Chen Mingsheng , Qian Dongfu , Feng Zhanchun , Si Lei
Published: February 2018

Objectives

Government healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China’s rural ethnic minority areas.

Setting

Inner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province.

Design

Two rounds of cross-sectional study.

Participants

One thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed.

Methods

Benefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified samples were conducted.

Findings

The overall CI for outpatient care was –0.0146 (P>0.05) in 2010 and –0.0992 (P<0.01) in 2013. In 2010, the CI was –0.0537 (P<0.01), –0.0085 (P>0.05) and −0.0034 (P>0.05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was –0.1353 (P<0.05), –0.0695 (P>0.05) and –0.1633 (P<0.01) at the levels of VCs, THCs and CHs, respectively.

Conclusion

Implementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients’ care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution.
The attitudes towards defensive medicine among physicians of obstetrics and gynaecology in China: a questionnaire survey in a national congress
Authors: Zhu Lan , Li Lei , Lang Jinghe
Published: February 2018

Objective

The study aimed to determine prevalence, patterns and risk factors of defensive medicine by obstetricians and gynaecologists across China.

Design

This is a questionnaire survey by written and on-line interview for participants.

Participants

Among 1804 registered physicians participating at the 2017 Congress of Chinese Obstetricians and Gynecologists Association in Chengdu City, Sichuan Province, China, from 17 to 20 August 2017, 1486 participants (82.4%) responded the survey.

Main outcome measures

Participants’ strongly disagreed/disagreed and strongly agreed/agreed options were compared to determine specific factors contributing to their preferences towards defensive medicine.

Results

In the whole cohort of 1486 participants, 903/1486 (60.8%), 283/1486 (19.0%) and 170/283 (60.1%) participants had experienced at least one medical dispute, lawsuit or loss of a lawsuit, respectively; and 1284 (86.4%) participants had witnessed their colleagues exposed to medical disputes, lawsuits or loss of a lawsuit. Generally, 62.9% of the participants strongly agreed or agreed with defensive medicine. Gender, administration duty, employment hospital, education status, subspecialty, exposure to any medical disputes, lawsuits or loss of a lawsuit, and colleagues’ experiences were independent risk factors relevant to participants’ preferences about defensive medicine in a multivariate model. Participants were more prone to accept or endorse defensive medicine if they were female physicians; without administrative duties; working in non-tertiary hospitals; with an undergraduate degree; with any exposure to medical disputes, lawsuits or loss of a lawsuit; or having witnessed colleagues’ similar experiences.

Conclusions

About two-thirds of Chinese physicians practising obstetrics and gynaecology in our survey agreed with the practice of defensive medicine, but they had diverse preferences and understanding of specific practices, harms of defensive medicine and physician’s roles.
Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control
Authors: Hollesen Rikke von Benzon , Johansen Rie Laurine Rosenthal , Rørbye Christina , Munk Louise , Barker Pierre , Kjaerbye-Thygesen Anette
Published: February 2018

Background

A safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%.

Methods

The change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a ‘delivery bundle’, an ‘oxytocin bundle’ and a ‘vacuum extraction bundle’; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming’s system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles and the number of deliveries between newborns with asphyxia (Apgar <7 after 5 min or pH <7) were analysed using statistical process control.

Results

Compliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH <7 and Apgar <7 after 5 min were reduced by 48% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions.

Conclusion

This QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high-performing systems.
Do EPs change their clinical behaviour in the hallway or when a companion is present? A cross-sectional survey
Authors: Stoklosa Hanni , Scannell Meredith , Ma Zheng , Rosner Bernard , Hughes Ashley , Bohan J Stephen
Published: February 2018

Objectives

Our aim was to determine whether emergency physicians (EPs) felt their standard patient evaluation practice was modified by two non-private clinical encounters: hallway encounters and encounters during which a companion was present.

Methods

We administered an iteratively developed cross-sectional survey at an annual national professional meeting. We used logistic regression to compare relationships among non-private clinical encounters and predictors of interest.

Results

409 EPs completed the survey. EPs deviated from standard history-taking when practising in a hallway location (78%) and when patients had a companion (84%). EPs altered their standard physical exam when practising in a hallway location (90%) and when patients had a companion (77%). EPs with at least a decade of experience were less likely to alter history-taking in the hallway (OR 0.55, 95% CI 0.31 to 0.99). Clinicians who frequently evaluated patients in the hallway reported delays or diagnostic error-related to altered history-taking (OR 2.34, 95% CI 1.33 to 4.11). The genitourinary system was the most common organ system linked to a delay or diagnostic error. Modifications in history-taking were linked to delays or failure to diagnose suicidal ideation or self-harm (25%), intimate partner violence (40%), child abuse (12%), human trafficking (8%), substance abuse (47%) and elder abuse (17%).

Conclusions

Our study suggests that alterations in EP usual practice occurs when the doctor–patient dyad is disrupted by evaluation in a hallway or presence of a companion. Furthermore, these disruptions are associated with delays in care and failure to diagnosis medical, social and psychiatric conditions.
Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis
Authors: Foo Chee Yoong , Bonsu Kwadwo Osei , Nallamothu Brahmajee K , Reid Christopher M , Dhippayom Teerapon , Reidpath Daniel D , Chaiyakunapruk Nathorn
Published: February 2018

Objective

This study aims to determine the relationship between door-to-balloon delay in primary percutaneous coronary intervention and ST-elevation myocardial infarction (MI) outcomes and examine for potential effect modifiers.

Methods

We conducted a systematic review and meta-analysis of prospective observational studies that have investigated the relationship of door-to-balloon delay and clinical outcomes. The main outcomes include mortality and heart failure.

Results

32 studies involving 299 320 patients contained adequate data for quantitative reporting. Patients with ST-elevation MI who experienced longer (>90 min) door-to-balloon delay had a higher risk of short-term mortality (pooled OR 1.52, 95% CI 1.40 to 1.65) and medium-term to long-term mortality (pooled OR 1.53, 95% CI 1.13 to 2.06). A non-linear time–risk relation was observed (P=0.004 for non-linearity). The association between longer door-to-balloon delay and short-term mortality differed between those presented early and late after symptom onset (Cochran’s Q 3.88, P value 0.049) with a stronger relationship among those with shorter prehospital delays.

Conclusion

Longer door-to-balloon delay in primary percutaneous coronary intervention for ST-elevation MI is related to higher risk of adverse outcomes. Prehospital delays modified this effect. The non-linearity of the time–risk relation might explain the lack of population effect despite an improved door-to-balloon time in the USA.

Clinical trial registration

PROSPERO (CRD42015026069).
Antiretroviral therapy suppresses rectal HIV-RNA shedding despite inflammation in MSM with rectalC. trachomatisandN. gonorrhoeaeinfections—a cross-sectional, single-center study
Authors: Storim Julian , Verheyen Jens , Wolff Eva , Wohlschlaeger Jeremias , Heintschel von Heinegg Evelyn , Schadendorf Dirk , Esser Stefan
Published: February 2018

Objectives

Rectal infections withChlamydia trachomatisand/orNeisseria gonorrhoeae(CT/NG) are common in men who have sex with men (MSM) and are linked to HIV transmission. However, rectal CT/NG infections are often asymptomatic and it is not known how they contribute to HIV transmission. We assessed clinical and cytological signs of inflammation as well as rectal HIV-RNA in HIV-infected MSM with and without CT/NG infection.

Methods

112 HIV-positive MSM with or without rectal symptoms and with or without antiretroviral therapy who underwent high-resolution anoscopy (HRA) at the proctological outpatient centre of the University Hospital Essen, Germany, between November 2013 and February 2014 were included in this cross-sectional study. During the examination, rectal swabs for the assessment of CT/NG, HIV-RNA and inflammatory cells (granulocytes, lymphocytes, histiocytes) were collected. 110 patients were assessed according to the study protocol, and no imputation of missing data was performed.

Results

Rectal infections with CT or NG were detected in 17 participants, and 4 participants were coinfected. Only symptomatic CT/NG infections (8/17) showed signs of inflammation in HRA. Symptomatic CT/NG infections were also associated with the detection of lymphocytes and histiocytes in rectal cytology (both P<0.001). In contrast, asymptomatic CT/NG infections neither resulted in clinical nor cytological signs of inflammation. Rectal HIV-RNA was undetectable in all participants with rectal CT/NG infections who received combined antiretroviral therapy (ART) when plasma HIV-RNA was below the limit of detection (n=13). Besides rectal CT/NG infections, syphilis (n=4) and HPV-associated lesions (n=37) were frequently detected, and proctological symptoms were associated with simultaneous infection with ≥2 STDs.

Conclusions

Only symptomatic but not asymptomatic rectal infections with CT and/or NG were associated with clinical and cytological signs of inflammation. Rectal HIV shedding was not promoted by CT/NG infections in patients receiving ART with suppressed plasma HIV-RNA.

Trial registration number

UTN: U1111-1150-4804. German Clinical Trials Register (DRKS): DRKS00005468.
Does the location of concentrate provision affect voluntary visits, and milk and milk component yield for cows in an automated milking system?
Authors: Hare K. , DeVries T.J. , Schwartkopf-Genswein K.S. , Penner G.B.
Published: February 2018

Eight Holstein cows were used in a cross-over design to test whether concentrate allocation in an automated milking system (AMS) affects dry matter intake (DMI) and milk production. Cows were fed a high-energy partial mixed ration (HE-PMR) with 0.5 kg of AMS concentrate or a low-energy PMR (LE-PMR) with 5.0 kg of AMS concentrate. The AMS concentrate intake was greater and PMR intake was reduced for LE-PMR than HE-PMR. Milk, fat, and protein yields were not affected by treatment. In a guided-traffic flow barn, providing a PMR with greater energy density increases DMI, but has no effect on milk and milk component yield.
Chronic intermittent hypobaric hypoxia provides vascular protection in the aorta of the 2-kidney, 1-clip rat model of hypertension
Authors: Fu Congrui , Li Na , Yuan Yujia , Wang Ri , Chen Jinting , Yang Jing , Guo Zan , Wang Sheng , Zhang Yi , Liu Yixian , Dong Jinghui
Published: February 2018

Many studies have demonstrated that chronic intermittent hypobaric hypoxia (CIHH) can reduce blood pressure in spontaneously hypertensive rats and renovascular hypertensive (RVH) rats in which endothelial dysfunction is determined as a critical factor. However, whether CIHH can regulate vasodilation of the aorta in RVH rats remains unknown. The purpose of this study was to investigate the effect of CIHH on impaired relaxation of the aorta in the 2-kidney, 1-clip (2K1C) RVH rat model. The results showed CIHH improved the impaired endothelium-dependent relaxation in the 2K1C rat aorta. The endothelial dysfunction was prevented by the p38 antagonist SB203580, but not by the ERK1/2 antagonist PD98059 or JNK antagonist SP600125. Furthermore, the expression of p-eNOS, HIF-1α, and HIF-2α increased while that of p-p38 and BMP-4 decreased in CIHH-treated aortas from 2K1C rats. Finally, the p-eNOS expression was upregulated and the p-p38 expression was downregulated by pre-incubation of SB203580 or the BMP-4 antagonist Noggin with the aorta. CIHH ameliorated the impairment of endothelium-dependent relaxation through upregulating the expression of p-eNOS, which may be mediated by the inhibition of BMP-4/p-p38 MAPK, and upregulating the expression of HIFs in the 2K1C rat aorta.
Oral hormonal therapy with ethinylestradiol–levonorgestrel improves insulin resistance, obesity, and glycogen synthase kinase-3 independent of circulating mineralocorticoid in estrogen-deficient rats
Authors: Adeyanju Oluwaseun A. , Soetan Olaniyi A. , Soladoye Ayodele O. , Olatunji Lawrence A.
Published: February 2018

Estrogen deficiency has been associated with increased incidence of cardiovascular diseases , and recent clinical trials of standard formulations of hormonal therapies have not demonstrated consistent beneficial effects. Estrogen–progestin therapy has been used as exogenous estrogen to normalize depressed estrogen level during menopause. Ovariectomized rodents mimic an estrogen-deficient state in that they develop cardiometabolic dysfunction, including insulin resistance (IR). We therefore hypothesized that hormonal therapy with combined oral contraceptive steroids, ethinylestradiol–levonorgestrel (EEL), improves IR, obesity, and glycogen synthase kinase-3 (GSK-3) through reduction of circulating mineralocorticoid in ovariectomized rats. Twelve-week-old female Wistar rats were divided into 4 groups: sham-operated (SHM) and ovariectomized (OVX) rats were treated with or without EEL (1.0 μg ethinylestradiol and 5.0 μg levonorgestrel) daily for 8 weeks. Results showed that OVX or SHM + EEL treated rats had increased HOMA-IR (homeostatic model assessment of IR), 1 h postload glucose, HOMA-β, triglycerides (TG), total cholesterol (TC), TC/HDL cholesterol, TG/HDL cholesterol, plasma insulin, GSK-3, corticosterone, and aldosterone. On the other hand, OVX + EEL treatment ameliorated all these effects except that of aldosterone. Taken together, the results demonstrate that oral hormonal replacement with EEL improves IR and pancreatic β-cell function and suppresses GSK-3 and glucocorticoid independent of circulating aldosterone, suggesting a positive cardiometabolic effect of oral EEL therapy in estrogen-deficient rats.
The capricious electrostatic force: Revealing the signaling pathway in integrin α2-I domain
Authors: Jia Zhe , Li Lin , Peng Yunhui , Ding Feng , Alexov Emil
Published: February 2018

Integrins are cellular adhesion proteins located on cell surface. They are known to have open and closed conformations that correspond to high and low binding affinity to ligands, respectively. Integrin [Formula: see text]2 binds to the ligands via the ligand binding domain, [Formula: see text]2-I domain, which also has open and closed conformations. Experimentally, the closed to open conformation change is shown to be triggered by pulling the C-terminal away from the ligand binding site, but how the signal propagates from the distant C-terminal to the binding site is unknown. To explain the mechanisms of the conformation change, we built models of the [Formula: see text]2-I domain open and closed conformations in ligand free and ligand bound states, respectively. We found that the signaling pathway consists of F313-I280-V252 residues that connect the C-terminal and the ligand binding site. The pathway is highly conserved as revealed by a protein sequence analysis among 55 species. Furthermore, MM/PBSA energy calculations on the stabilities and ligand binding affinities of the closed and open conformations are consistent with experimental measurements. The open conformation is more favorable for ligand binding, and the closed conformation is more stable in unbound state. Energy analysis also revealed the “hot spots” for ligand binding, and most residues that contribute strongly to ligand binding free energy are highly conserved in evolution. In addition, the electrostatic analysis showed that the closed conformation has stronger long-range electrostatic attraction to the ligand compared with the open conformation. The difference is caused by the rearrangement of several charged residues during the binding. These observations make us suggest that the integrin [Formula: see text]2-I domain binding process involves the two-step “dock-lock” mechanism. The closed conformation first attracts the ligand from a long distance and afterwards, the open conformation locks the ligand at the binding site with high binding affinity.
Stem Cells for Cartilage Repair: Preclinical Studies and Insights in Translational Animal Models and Outcome Measures
Authors: Lo Monaco Melissa , Merckx Greet , Ratajczak Jessica , Gervois Pascal , Hilkens Petra , Clegg Peter , Bronckaers Annelies , Vandeweerd Jean-Michel , Lambrichts Ivo
Published: February 2018

Due to the restricted intrinsic capacity of resident chondrocytes to regenerate the lost cartilage postinjury, stem cell-based therapies have been proposed as a novel therapeutic approach for cartilage repair. Moreover, stem cell-based therapies using mesenchymal stem cells (MSCs) or induced pluripotent stem cells (iPSCs) have been used successfully in preclinical and clinical settings. Despite these promising reports, the exact mechanisms underlying stem cell-mediated cartilage repair remain uncertain. Stem cells can contribute to cartilage repair via chondrogenic differentiation, via immunomodulation, or by the production of paracrine factors and extracellular vesicles. But before novel cell-based therapies for cartilage repair can be introduced into the clinic, rigorous testing in preclinical animal models is required. Preclinical models used in regenerative cartilage studies include murine, lapine, caprine, ovine, porcine, canine, and equine models, each associated with its specific advantages and limitations. This review presents a summary of recentin vitrodata and fromin vivopreclinical studies justifying the use of MSCs and iPSCs in cartilage tissue engineering. Moreover, the advantages and disadvantages of utilizing small and large animals will be discussed, while also describing suitable outcome measures for evaluating cartilage repair.
ПІДЛІТКОВИЙ АЛКОГОЛІЗМ: СОЦІАЛЬНІ ФАКТОРИ РИЗИКУ
Authors: Lysyuk I. V. , Khristenko M.
Published: February 2018

У статті проаналізовано історичні аспекти проблеми алкоголізму, фактори ризику розвитку алкогольної залежності. Наведено статистичні дані дослідження з даної проблеми.
Atrial Fibrillation and Cause‐Specific Risks of Pulmonary Embolism and Ischemic Stroke
Authors: Hald Erin M. , Rinde Ludvig B. , Løchen Maja‐Lisa , Mathiesen Ellisiv B. , Wilsgaard Tom , Njølstad Inger , Brækkan Sigrid K. , Hansen John‐Bjarne
Published: February 2018

Background

Atrial fibrillation (
AF
) is a well‐established risk factor for ischemic stroke (
IS
). Emerging evidence also indicates an association between
AF
and pulmonary embolism (
PE
). Because
IS
may potentially mediate the observed risk of
PE
in
AF
, we aimed to assess the impact of
AF
on the cause‐specific risks of
PE
and
IS
in a large cohort recruited from the general population.

Methods and Results

We observed 29 842 participants from 3 surveys of the Tromsø study (inclusion in 1994–1995, 2001–2002, and 2007–2008) to the end of 2012. Incident events of
AF
,
IS,
and
PE
during follow‐up were recorded, and information on potential confounders was obtained at baseline. Cox regression models, with
AF
as a time‐dependent variable, were used to calculate cause‐specific hazard ratios (
HR
s) with 95% confidence intervals (
CI
s) for
PE
and
IS
. There were 2067 participants diagnosed as having
AF
, 296 with
PE
and 1164 with
IS,
during a median of 17.6 years of follow‐up. The risks of
PE
(
HR,
10.88; 95%
CI
, 6.23–18.89) and
IS
(
HR,
6.16; 95%
CI
, 4.47–8.48) were substantially increased during the first 6 months after
AF
diagnosis, with crude incidence rates of 18.5 per 1000 person‐years for
PE
and 52.8 per 1000 person‐years for
IS
. The risk estimates remained elevated for both
PE
(
HR
, 1.72; 95%
CI,
1.10–2.71) and
IS
(
HR,
2.45; 95%
CI,
2.05–2.92) throughout the study period.

Conclusions

AF
was associated with increased cause‐specific risks of both
PE
and
IS
. Our findings infer that the risk of
PE
in
AF
is not explained by intermediate
IS
.
Integrating mammographic breast density in glandular dose calculation
Authors: Suleiman Moayyad E , Brennan Patrick C , Ekpo Ernest , Kench Peter , McEntee Mark F
Published: February 2018

Objective:

This work proposes the use of mammographic breast density (MBD) to estimate actual glandular dose (AGD), and assesses how AGD compares to mean glandular dose (MGD) estimated using Dance et al method.

Methods:

A retrospective sample of anonymised mammograms (52,405) was retrieved from a central database. Technical parameters and patient characteristics were exported from the Digital Imaging and Communication in Medicine (DICOM) header using third party software. LIBRA (Laboratory for Individualized Breast Radiodensity Assessment) software package (University of Pennsylvania, Philadelphia, USA) was used to estimate MBDs for each mammogram included in the data set. MGD was estimated using Dance et al method, while AGD was calculated by replacing Dance et al standard glandularities with LIBRA estimated MBDs. A linear regression analysis was used to assess the association between MGD and AGD, and a Bland-Altman analysis was performed to assess their mean difference.

Results:

The final data set included 31,097 mammograms from 7728 females. MGD, AGD, and MBD medians were 1.53 , 1.62 mGy and 8% respectively. When stratified per breast thickness ranges, median MBDs were lower than Dance’s standard glandularities. There was a strong positive correlation (R  2 = 0.987, p < 0.0001) between MGD and AGD although the Bland-Altman analysis revealed a small statistically significant bias of 0.087 mGy between MGD and AGD (p < 0.001).

Conclusion:

AGD estimated from MBD is highly correlated to MGD from Dance method, albeit the Dance method underestimates dose at smaller CBTs.

Advances in knowledge:

Our work should provide a stepping-stone towards an individualised dose estimation using automated clinical measures of MBD.
Shared Decision‐Making During Inpatient Rounds: Opportunities for Improvement in Patient Engagement and Communication
Authors: Blankenburg Rebecca , Hilton Joan F. , Yuan Patrick , Rennke Stephanie , Monash Brad , Harman Stephanie M. , Sakai Debbie S. , Hosamani Poonam , Khan Adeena , Chua Ian , Huynh Eric , Shieh Lisa , Xie Lijia , Satterfield Jason M.
Published: February 2018

BACKGROUND

Shared decision‐making (SDM) improves patient engagement and may improve outpatient health outcomes. Little is known about inpatient SDM.

OBJECTIVE

To assess overall quality, provider behaviors, and contextual predictors of SDM during inpatient rounds on medicine and pediatrics hospitalist services.

DESIGN

A 12‐week, cross‐sectional, single‐blinded observational study of team SDM behaviors during rounds, followed by semistructured patient interviews.

SETTING

Two large quaternary care academic medical centers.

PARTICIPANTS

Thirty‐five inpatient teams (18 medicine, 17 pediatrics) and 254 unique patient encounters (117 medicine, 137 pediatrics).

INTERVENTION

Observational study.

MEASUREMENTS

We used a 9‐item Rochester Participatory Decision‐Making Scale (RPAD) measured team‐level SDM behaviors. Same‐day interviews using a modified RPAD assessed patient perceptions of SDM.

RESULTS

Characteristics associated with increased SDM in the multivariate analysis included the following: service, patient gender, timing of rounds during patient's hospital stay, and amount of time rounding per patient (P < .05). The most frequently observed behaviors across all services included explaining the clinical issue and matching medical language to the patient's level of understanding. The least frequently observed behaviors included checking understanding of the patient's point of view, examining barriers to follow‐through, and asking if the patient has any questions. Patients and guardians had substantially higher ratings for SDM quality compared to peer observers (7.2 vs 4.4 out of 9).

CONCLUSIONS

Important opportunities exist to improve inpatient SDM. Team size, number of learners, patient census, and type of decision being made did not affect SDM, suggesting that even large, busy services can perform SDM if properly trained.
EU policy and Roma integration (2010–14)
Authors: Andor László
Published: February 2018

This paper provides an overview of EU policies, initiatives and activities from the 2010–14 period in the area of Roma inclusion. The intention is to take stock of the evolution of EU engagement in Roma integration policies and related debates within one policy cycle, highlight the main policy objectives and tools, and draw some lessons as well. The content is largely based on the personal experience of the author and some related press coverage.
Conhecimento das Gestantes acerca do Parto na Admissão Intrapartal
Authors: Cabral Symara Abrantes Albuquerque de Oliveira , Carmo Larissa Araújo do , Barbosa Sylvio Elvis Da Silva , Fontes Núbia Anuncia Silva de , Gabriel Igor De Sousa , Barroso Marianna Leite
Published: February 2018

O nascimento de uma criança é, sem dúvida, o evento mais importante na vida dos seres humanos, seja para quem estará gestando e parindo, seja para criança e mesmo para aqueles que os cercam. Neste sentido, a assistência é importante, especialmente quando ao desfecho do evento, ao parto. Deste modo o presente trabalho buscou, através de um estudo de campo avaliar a importância do conhecimento de gestantes acerca do parto no favorecimento para o desfecho gestacional típico. Deste modo, observou-se que no serviço há uma predominância de partos cesáreos, que as informações prestadas no pré-natal são insuficientes, e ainda que mesmo motivadas para o parto vaginal, os desfechos são, em sua maioria cesáreas sem indicações legítimas para tal. Diante dos resultados conclui-se que há a necessidade de revisitar práticas e muda-las de modo a buscar o devido respeito a mulher e o provimento das melhores estratégias de cuidado as pessoas envolvidas no evento do parto.
O Papel do Esporte Universitário: As impressões dos gestores de uma Faculdade Privada
Authors: Costa Antonio Marcos Andrade da , Escudero Jaime Caiceo
Published: February 2018

O presente trabalho trata sobre uma proposta de captação de recursos financeiros para um departamento de esporte de uma Faculdade privada. Objetivo: Descrever as impressões dos gestores de uma IES a respeito do Esporte desenvolvido dentro de sua Instituição. Métodos: Trata-se de uma pesquisa qualitativa, onde foram organizadas entrevistas semiestruturadas no intuito conhecermos o fenômeno estudado. Resultados e Discussões: Foi possível, constatarmos que ambos consideram o departamento de esportes, uma importante ferramenta de inclusão, além de concordarem que, um dos problemas mais importantes seja a falta de um parceiro para dividir os custos operacionais do departamento. Conclusão: Na visão dos gestores, existe a necessidade da criação de parcerias com outras instituições, minimizando assim, custos operacionais.
Biochemical markers and levels of physical activity related to the hepatic condition of patients infected by the hepatitis C virus
Authors: de Sousa Fernandes Matheus Santos , e Silva Lucas de Lucena Simões , Santos Gabriela Carvalho Jurema , de Siqueira Érika Rabelo Forte
Published: February 2018

Study aim: The study is quantitative, with a cross-sectional comparison design, and aimed to verify the association between physical activity (PA) levels and biochemical markers linked to liver function of patients infected with hepatitis C virus (HCV). Material and methods: The following biochemical variables were analyzed: alanine aminotransferases (ALT), gamma-glutamyl transpeptidase (γGt), and alkaline phosphatase (FA), these being good markers for hepatic damage, besides glycemia, HDL, LDL, and triglycerides. The International Physical Activity Questionnaire (IPAQ), short version, was used to evaluate the lev­els of physical activity, being classified as active and physically inactive. Results: The sample consisted of 84 individuals aged 56.2 ± 11.6 years; there was a predominance of males, patients with dif­ferent socioeducational patterns and those followed up for more than 6 months in the hepatology service with positive serology for HCV and HCV (RNA+), attending the Institute of Liver and Transplants of Pernambuco (IFP). The results obtained in this study indicate smaller values of the median with maximum and minimum scores of the analyzed parameters in patients consid­ered to be physically active (ALT: p = 0.43, FA: p = 0.86 and γGt: p = 0.15, glycemia: p = 0.22, LDL: p = 0.58, HDL: P = 0.004, triglycerides: p = 0.47), in comparison with the physically inactive patients. It is concluded that patients who have a higher level of physical activity present lower values of biochemical markers, positively affecting their hepatic condition. Conclusions: There was only a significant difference in the HDL variable, but the patients with a lower level of physical activ­ity showed greater values in general, less in the triglyceride variability. In order to test these and other important variables and improve the quality of life and health by a more direct method.
Mathematical Model of Multi-Phase Power Converter for Parallel Computation
Authors: Belov Vladimir , Leisner Peter , Mannikoff Anders , Belov Ilja
Published: February 2018

Abstract — A mathematical model of a multi-phase power conversion system composed of modified bridge-elements (B-system) capable for parallel computation has been developed. Experimental validation on the example of a power system including a synchronous generator and an AC-DC rectifier has been performed. A mathematical algorithm for B-system assembly and steps to obtain mathematical model of the B-system have been developed. Integration of mathematical models of conversion system into the complete model of a multi-phase power system has been explained and evaluation of computational efficiency of parallel computation techniques for the developed model of an AC-DC-AC converter has been performed. The presented modelling method can be employed in the design phase of smart grids, for power quality and conducted emission analysis.
Chiral symmetry restoration and the critical end point in QCD
Authors: Morones-Ibarra Jose Rubén , Enriquez-Perez-Gavilan Armando , Rodriguez Abraham Israel Hernández , Flores-Baez Francisco Vicente , Mata-Carrizalez Nallaly Berenice , Ordoñez Enrique Valbuena
Published: February 2018

In a system of quark matter we study the chiral phase transition, the behavior of the chiral and quark number susceptibility and the CEP at finite temperature and chemical potential. This is done within the framework of two-flavor Nambu and Jona-Lasinio model. We have calculated the chiral quark condensate and the quark number density and, with this, we have found the phase transition type. With these quantities we have determined the phase diagram for QCD and the CEP.
3-dimensional computer model of electrospinning multicapillary unit used for electrostatic field
analysis
Authors: Firych-Nowacka Anna , Smółka Krzysztof , Wiak Sławomir , Gliścińska Eulalia , Krucińska Izabella , Chrzanowski Michał
Published: February 2018

Electrospinning is an experimental method of the polymer super thin fibres formation using the electrostatic field. The distribution of electrostatic field affects the effectiveness of the electrospinning. In order to analyse the electrostatic field for given technological parameters the 3-D computer model of an electrospinning device must be applied.
Optimization of wearable microwave antenna with simplified electromagnetic model of the human body
Authors: Januszkiewicz Łukasz , Barba Paolo Di , Hausman Sławomir
Published: February 2018

In this paper the problem of optimization design of a microwave wearable antenna is investigated. Reference is made to a specific antenna design that is a wideband Vee antenna the geometry of which is characterized by 6 parameters. These parameters were automatically adjusted with an evolution strategy based algorithm EStra to obtain the impedance matching of the antenna located in the proximity of the human body. The antenna was designed to operate in the ISM (industrial, scientific, medical) band which covers the frequency range of 2.4 GHz up to 2.5 GHz. The optimization procedure used the finite-difference time-domain method based full-wave simulator with a simplified human body model. In the optimization procedure small movements of antenna towards or away of the human body that are likely to happen during real use were considered. The stability of the antenna parameters irrespective of the movements of the user’s body is an important factor in wearable antenna design. The optimization procedure allowed obtaining good impedance matching for a given range of antenna distances with respect to the human body.
Zeichenwahl zur Präzisierung von Konsonant oder Vokal: zi und ṣe (zí) im Kodex Hammurapi
Authors: Meyer-Laurin Vera
Published: February 2018

The fact that the signs zi and zí were both used in the Codex Hammurapi to write the sequences /ṣi/ and /ze/ will be explained by the superposition of two orthographic systems. One system is based on the acquisition of phonetic values from Sumerian in which the vowels /i/ and /e/ were distinguished. In the other system, which must have developed in a Semitic context – presumably due to frequent writings of the sequence /ṣe/ in forms of the common verb waṣûm –, the primary phonetic value of the sign zí is /ṣe/. It will be demonstrated that the combination of the two orthographic systems was advantageously used in the Codex Hammurapi. The sign zí was employed for a more precise identification of the /ṣ/ onset and the sign zi for a more accurate marking of the /i/ vowel of the sequence /ṣi/.
Najafabad, Sargon II’s Stele, and Mount Urattus: The Geological and Archaeological Evidence
Authors: Alibaigi Sajjad , Rezaei Iraj , Beheshti Seyed Iraj
Published: February 2018

In 1965, a very important discovery took place in Najafabad village in Asadabad district, located in western Iran: the find of a monumental stele of Sargon II dating to his campaign into the central Zagros in 716 B.C. This article examines the questions of where the stele was exactly found and where it had been originally erected. It shows that the stele was made of local limestone and that the mound at Najafabad contained an Iron Age settlement. Mount Alvand is identified with the Orontes/Oroandes of Greek and Roman sources and also with Urattus, the last place Sargon visited during the campaign.
Intense Isolated Short Attosecond Pulse Generation from a Coherent Superposition State in a Spatially Inhomogeneous Field
Authors: Zhang Gangtai , Bai Tingting
Published: February 2018

We theoretically present an efficient method of generating an intense isolated short attosecond (as) pulse in a spatially inhomogeneous field. It is shown that this spatiotemporally combined field can significantly extend the harmonic cut-off and enhance the harmonic efficiency when the initial state is a coherent superposition of the ground and excited states. Then, a highly efficient continuum spectrum with an extremely wide bandwidth is directly generated. Due to the introduction of the spatial inhomogeneity, the short path is selected and the long one is removed; as a result, an intense isolated 17.3-as pulse is obtained straightforwardly. In addition, we also investigate the influences of the parameters including the population of the excited state, spatial inhomogeneity, carrier–envelope phase, pulse duration, and intensity on the harmonic spectrum.
PTSD-Related Behavioral Traits in a Rat Model of Blast-Induced mTBI Are Reversed by the mGluR2/3 Receptor Antagonist BCI-838
Authors: Perez-Garcia Georgina , De Gasperi Rita , Gama Sosa Miguel A. , Perez Gissel M. , Otero-Pagan Alena , Tschiffely Anna , McCarron Richard M. , Ahlers Stephen T. , Elder Gregory A. , Gandy Sam
Published: February 2018

Battlefield blast exposure related to improvised explosive devices (IEDs) has become the most common cause of traumatic brain injury (TBI) in the recent conflicts in Iraq and Afghanistan. Mental health problems are common after TBI. A striking feature in the most recent veterans has been the frequency with which mild TBI (mTBI) and posttraumatic stress disorder (PTSD) have appeared together, in contrast to the classical situations in which the presence of mTBI has excluded the diagnosis of PTSD. However, treatment of PTSD-related symptoms that follow blast injury has become a significant problem. BCI-838 (MGS0210) is a Group II metabotropic glutamate receptor (mGluR2/3) antagonist prodrug, and its active metabolite BCI-632 (MGS0039) has proneurogenic, procognitive, and antidepressant activities in animal models. In humans, BCI-838 is currently in clinical trials for refractory depression and suicidality. The aim of the current study was to determine whether BCI-838 could modify the anxiety response and reverse PTSD-related behaviors in rats exposed to a series of low-level blast exposures designed to mimic a human mTBI or subclinical blast exposure. BCI-838 treatment reversed PTSD-related behavioral traits improving anxiety and fear-related behaviors as well as long-term recognition memory. Treatment with BCI-838 also increased neurogenesis in the dentate gyrus (DG) of blast-exposed rats. The safety profile of BCI-838 together with the therapeutic activities reported here, make BCI-838 a promising drug for the treatment of former battlefield Warfighters suffering from PTSD-related symptoms following blast-induced mTBI.
Reward-Predictive Neural Activities in Striatal Striosome Compartments
Authors: Yoshizawa Tomohiko , Ito Makoto , Doya Kenji
Published: February 2018

The striatum has been shown to play a critical role in reward prediction. It is composed of two neurochemically and anatomically distinct compartments known as the striosomes and the matrix. The striosomes comprise only about 15% of the striatum by volume and are distributed mosaically therein. Accordingly, it has been difficult to identify striosomal neurons in electrophysiological recordings and it has been unclear whether striosomal neurons, which project to midbrain dopaminergic neurons, engage in reward prediction. In this study, we utilized a mouse line (Sepw1-NP67) selectively expressing Cre in striosomal neurons, combined with endoscopicin vivocalcium imaging to selectively record activities of striosomal neurons during an odor-conditioning task. As mice learned the task, striosomal neurons in the dorsomedial striatum (DMS) showed predictive activities to odor cues that were associated with water rewards or aversive air puffs. These activities were proportional to the expected reward or air-puff intensity. Intriguingly, repeated recordings of the same striosomal neurons over a period of weeks revealed that predictive activities were learning-stage specific. That is, these activities disappeared after continuous training. Furthermore, presentations of rewards or air puffs activated some striosomal neurons. These findings suggest that the striosomes participate in reward prediction with learning stage-specific neural ensembles, and that they also send reward and aversive signals to dopaminergic neurons.
Construction and validation of forms: systematization of the care of people under hemodialysis
Authors: Arreguy-Sena Cristina , Marques Tais de Oliveira , Souza Luciene Carnevale de , Alvarenga-Martins Nathália , Krempser Paula , Braga Luciene Muniz , Parreira Pedro Miguel dos Santos Dinis
Published: February 2018

ABSTRACT Objective: create and validate forms to subsidize the systematization of nursing care with people on hemodialysis. Method: institutional case study to support the systematization of assistance from the construction of forms for data collection, diagnoses, interventions and nursing results, using cross-mapping, Risner's reasoning, Neuman's theory, taxonomies of diagnoses, interventions and nursing results with application in clinical practice and validation by focal group with specialist nurses. Results: 18 people on hemodialysis and 7 nurses participated. Consensus content of form matter with specialist nurses in the area (Crombach 0.86). The papers captured 43 diagnoses, 26 interventions and 78 nursing results depicting human responses in their singularities. Final considerations: the validated forms fill a gap by enabling the capture of human responses from people on hemodialysis and by subsidizing the planning of nursing care on a scientific basis.
The free spirit: spiritualism meanings by a Nursing team on psychiatry
Authors: Lavorato-Neto Gabriel , Rodrigues Larissa , Turato Egberto Ribeiro , Campos Claudinei José Gomes
Published: February 2018

ABSTRACT Objective: To analyze the meanings attributed by nursing professionals in psychiatry to spirituality and its relationship with care. Method: Clinical-qualitative, with appreciation of symbolic meanings. We interviewed 18 individuals for a semi-structured script of open questions and the data were analyzed in the light of psychoanalytic hermeneutics. The discussion was undertaken with the overlap of understanding of the sacred symbol, psychological and the meaning of life. Results: Different spiritualities are interposed by personal restlessness and the experience of transience. Spirituality aids in social functions, personal balance and commitment to endure the anguish of transience. Among professionals, it has been shown as an ethical-combative attitude to evil forms, but there is a restriction in dealing with patients' spirituality. Final considerations: The meanings pointed to the limits of human reason, resembling caregivers and patients in subjective conditions by which they avoid spirituality in psychiatry. It is suggested that spiritual attention be given to professionals.
Workload of nurses: observational study of indirect care activities/interventions
Authors: Campos Mariana Santos de , Oliveira Bruna Andrade de , Perroca Marcia Galan
Published: February 2018

ABSTRACT Objective: Observe the workflow of nurses in hospitalization units identifying indirect care activities/interventions; measure the frequency and average time spent in performing them; and to verify the associations between average time of the activities interventions grouped into categories and per hospitalization unit. Method: Observational exploratory study using the timed technique. It was conducted in medical, surgical and specialized clinic units of a teaching hospital in the northwest of São Paulo Brazil, with 16 attending nurses as participants. Results: 90 hours of observation were performed, of which 58% (52 hours and 10 minutes) were related to indirect care activities of the patients. The most frequent activities/interventions were: "Communication" - 1,852 (44.1%), mean 34.6 (SD = 54); "Walking" - 1,023 (24.3%), mean 22 (SD = 49.2); and "Documentation" - 663 (15.8%), mean 82.7 (SD = 144.4). Conclusion: These findings favor a redesign of the work process and foster the need to update and refine the current workload measurement instruments.
The daily lives of people with Parkinson's disease
Authors: Valcarenghi Rafaela Vivian , Alvarez Angela Maria , Santos Silvana Sidney Costa , Siewert Josiane Steil , Nunes Simony Fabíola Lopes , Tomasi Andrelise Viana Rosa
Published: February 2018

ABSTRACT Objective: To understand the daily lives of people with Parkinson's disease. Method: Qualitative research, using as methodological and theoretical referential the Grounded Theory and Symbolic Interactionism, respectively. The in-depth interview was conducted with 30 people with Parkinson's disease. Results: From data analysis, three themes were selected: Living with the disease - living with the treatment and changes in lifestyle; Modifying of one's job performance - revealing incapacity for work and the need to anticipate retirement and; Living with the stigma - the feeling of prejudice against the disease and the perceived limitations of the health services. Final considerations: Living with a chronic and non-transferable disease encompasses social, physical and cultural effects, along with the personal experiences of each unique individual. This study assists the improvement of care to people with the disease, because the care practice emerges from the interactions between the subjects.