bluuebunny/crossref_metadata_2025 huggingface dataset:
MAIS DO BOM NÃO FAZ BEM: PROBLEMAS DO REFORÇO LIVRE
Authors: Guilhardi Hélio José
Published: September 2019

Skinner (1986,1987) escreveu sobre os dois efeitos do reforçamento: fortalecimento e prazer. Na sociedade ocidental as práticas culturais têm substituído a função de fortalecimento pela de prazer, quando os reforços são dados sem relação de contingência com os comportamentos. Relações entre comportamento e consequência, que acontecem apenas por contiguidade, dão origem a amplas e variadas classes de respostas chamadas “supersticiosas”, que são mantidas pela satisfação que produzem, em detrimento da função de fortalecimento. Perde-se, assim, a relação entre o organismo e o ambiente própria do paradigma operante, no qual comportamento produz consequências que selecionam os comportamentos que as produzem. Quando os reforços são dados de modo arbitrário e livre o Ser Humano reduz seu repertório de comportamentos operantes produtivos e aumenta a dependência de reforços mediados por outras pessoas; torna-se assim dependente do outro e busca prioritariamente consequências prazerosas. Tais consequências são prejudiciais para o desenvolvimento do indivíduo que tende a se tornar apático, deprimido, dependente de pessoas, reivindicador, insatisfeito com a vida e, como consequência, o grupo social também perde, pois a estabilidade e progresso dele dependem da participação ativa, cooperativa e construtiva de seus membros. Muitos dos problemas comportamentais e afetivos da sociedade atual decorrem do excesso de reforço livre, que resulta em satisfação efêmera e déficit comportamental generalizado, que têm prevalecido nas práticas parentais e educacionais do mundo pós-moderno.Palavras-chave: reforço livre, comportamento supersticioso, prazer e fortalecimento em relações operantes, práticas culturais deletérias.
Business Ethics and Sovereignty in Settler Colonial States
Authors: Poesche Jurgen
Published: September 2019

The objective of this conceptual article is to make the case that Indigenous Cemānáhuacan nations’ sovereignty is valid throughout all of Cemānáhuac (the Americas), thus rendering settler colonial laws illegitimate and illegal. This in turn means that firms need to abide by Indigenous Cemānáhuacan nations’ laws. Theories relating to business, business ethics, compliance, and sustainability reflecting the assumptions of settler colonial sovereignty need to be reworked to take into account the ethical and legal reality of Indigenous Cemānáhuacan nations’ sovereignty. Without coercion-free recognition from Indigenous Cemānáhuacan nations, firms cannot accept any claim of government authority, ownership, or sovereignty made by settler colonial states. This article closes a gap in the literature between Indigenous sovereignty and business ethics in a settler colonial context.
OPTIMIZATION OF CARBOPOL 940 AND OLEIC ACID IN DICLOFENAC SODIUM BASE GEL USING FACTORIAL DESIGN 22 METHOD
Authors: Rahmawati Eka Diana , Bhagawan Weka Sidha , Rizkiah Fidia
Published: September 2019

The aim of the present study was to determine the effect of carbopol 940, oleic acid and interaction of both in the value of viscosity and release rate and to find optimum formula of diclofenac sodium base gel which can produced viscoisity between 20 dPa.s - 200 dPa.s and rate release 50μg/cm2.menit1/2 - 150μg/cm2.menit1/2 using factorial design 22. The level of carbopol 940 were 1,3% and 0,8% while the level of oleic acid were 5% and 20%. Analysis of the research used Design Expert 10 software.The results showed that carbopol 940 and oleic acid had significant effect in determining the viscosity response and the release rate. The addition of carbopol 940 and oleic acid l increased the viscosity response and the addition of carbopol 940 and oleic acid  decreased the release flux response. There were 100 optimum compositions of combination of carbopol 940 between 0.8% to 1,194% and oleic acid between 5% and 19.95% which can be used to obtain sodium diclofenac base gel preparation with viscosity responses between 76,042 dPa.s -199,570 dPa.s and flux release responses from 101,000 μg/cm2.minute1/2 until 124,250 μg/cm2.minute1/2.
EVOLUTION AND EFFECTIVENESS OF COLORMETRIC APPROACH FOR INVESTIGATION OF CEFTRIAXONE MEDICINE AS IN PURE FORM AND IN FORMULATION VIALS
Authors: Al-Rufaie Mohauman Mohammad Majeed
Published: September 2019

A third-generation cephalosporin antibiotic was aceftriaxone medicine. Similar another (3rd generation cephalosporins), it has wide broad spectrum effectiveness versus gram positive as well as gram negative bacteria. Diverse approachs for analyses of the studied medicine are obtainable but are costly additionally time consumption. Therefor we have sophisticated developed novel, easy, simple as well as accurate colormetric approach for investigation of ceftriaxone medicine as pure form as well as in formulation vials by depending on  a specific color-generated reaction. This reaction involves the Schiff 's base formation reaction between ceftriaxone drug  with alcoholic 4- di ethyl amino benzaldehyde  (DEAB) reagent to produce a new ligand that reacts with cobalt (II) ion with heating to (50°C) in acidic media to form green colored complex exhibiting λmax at 496 nm. The medicine conformed with the Beer’s law with the linearity was observed between (2 –52) μg/ml additionally that  correlation coefficient was 0.9992 .The analyses outcomes were supported with LOD, LOQ, accuracy, recovery studies, ruggedness as well as precision. The approach was establish to be robust as well as economical.
PHYTOCHEMICAL SCREENING, TOTAL FLAVONOID, ANTIOXIDANT ACTIVITY, AND TOXICITY OF ETHANOL EXTRACT Cleome gynandra L. HERB
Authors: Widodo Agustinus , Pratiwi Ritha
Published: September 2019

Cleome gynandra L. is one of the plants that the people of Palu, Central Sulawesi use as food ingredients. This plant is empirically used in traditional medicine. This study aims to determine phytochemical constituents, total flavonoid, antioxidant activity, and toxicity of 96% ethanol extract of C. gynandra herb. C. gynandra herb extract was obtained by maceration. Phytochemical screening of the ethanol extract was carried out qualitatively according to the standard methods. Determination of total flavonoid using AlCl3 then determined by Spectrophotometric UV-Vis. Antioxidant activity using the DPPH method and determined IC50 value. Toxicity test was assessed using shrimp lethality as an indicator of toxicity. Phytochemical screening showed 96% ethanol extract containing alkaloid compounds, flavonoids, saponins, steroids, and tannins. Total flavonoid of the 96% ethanol extract was 4,778 ± 0,522 mg QE/g extract. Antioxidant activity (IC50) of the ethanol 96% extract was 189,455 µg/ml. Lethal concentration 50% of the 96% ethanol extract was 472,648 mg/L (toxic). The results of this study indicate that 96% ethanol extract of C. gynandra herb has antioxidant activity and has the potential to be further tested as an anticancer activity.
Psychometric Evaluation of the Caregiver Needs Screen in Neuro-Oncology Family Caregivers
Authors: Boele Florien W. , Terhorst Lauren , Prince Jennifer , Donovan Heidi S. , Weimer Jason , Lieberman Frank S. , Drappatz Jan , Sherwood Paula R.
Published: September 2019

Background and Purpose

The informal care demands of primary malignant brain tumor (PMBT) patients include unique issues associated with neurological and cognitive symptoms. Existing caregiver needs questionnaires do not include these disease-specific symptoms, which are particularly distressing. Therefore, we have developed the neuro-oncology Caregiver Needs Screen (CNS) and evaluated its psychometric properties.

Methods

The 32-item instrument was developed based on PMBT caregiver interviews (N= 109) and expert review. The CNS was tested along measures of depression, anxiety, burden, and mastery in 122 PMBT caregivers. Principal components analysis was used to examine item properties and internal structure. Internal consistency reliability and construct validity were assessed.

Results

Six subscales were identified with internal consistency ranging between alpha = .653 and .857. Convergent validity was verified by moderate/high correlations between measures of caregiver well-being and CNS scale scores.

Conclusions

Findings provide preliminary evidence of reliability and validity for the CNS. This instrument can be useful when assessing caregivers' needs for supportive care.
A Case of Breastfeeding With Active Breast Cancer
Authors: Gergerich Erika , Garling-Spychala Bethany
Published: September 2019

Introduction

Pregnancy-associated breast cancer is relatively uncommon, with few guidelines for management. Women with an active breast cancer diagnosis who wish to offer their children breast milk (either first or second hand) face a number of obstacles and gaps in information.

Method

This article presents a case study and summary of current research on the topic of breastfeeding and breast cancer.

Results and Discussion

Different types of cancer and cancer treatment influence whether a woman will be able to breastfeed. Some mothers can resume breastfeeding after treatment. If treatment is lengthy, breastfeeding may need to cease permanently. Mothers may need to take medications to help them wean. Finally some mothers may use donor milk to feed their babies once they are no longer able to breastfeed.

Conclusions

Further research is needed to determine and formalize guidelines related to the safety of breastfeeding with an active cancer diagnosis. And there is a need for increased access to breast milk for mothers who are unable to breastfeed. There are geographic barriers, as well as obstacles related to availability and cost.
Los vínculos entre la sal y el dios Hércules en Roma, Ostia y Alba Fucens = The Links between Salt and the God Hercules in Rome, Ostia and Alba Fucens
Authors: Serrano Ordozgoiti David
Published: September 2019

Resumen: A menudo, el interés científico por la sal ha encontrado provechosos socios en los investigadores de la economía ro­mana, más que en su relación simbólica con los pobladores. Por ello, el estudio se propone analizar la relación existen­te entre la sal y la religión romana, to­mando para ello el ejemplo del culto de Hércules en Roma, Ostia y el centro de Italia. Con ese fin se analizará en un pri­mer momento la figura del dios itálico en su contexto originario, subrayando sus diferencias conceptuales con el dios grecorromano más tardío y su relación con la sal y su culto urbano. En un se­gundo momento, se revisará el papel que desempeña el dios con la ciudad de Ostia y su casuística, para, en último lugar, es­tudiar la devoción de la divinidad en el centro de Italia, tremendamente radica­da desde tiempos muy remotos en san­tuarios como el de Alba Fucens.Abstract: The scientific interest in salt has often found useful partners in researchers of the Roman economy, rather than in its symbolic relationship with the settlers. For this reason, the study aims to an­alyse the relationship between salt and Roman religion, taking the example of the cult of Hercules in Rome, Ostia and central Italy. To this end, the figure of the Italic god in its original context will be analysed first, highlighting its con­ceptual differences with the later Gre­co-Roman god and its relationship with salt and its urban cult. In a second mo­ment, the role that the god plays with the city of Ostia and its casuistry will be reviewed, in order to, finally, study the devotion of the divinity in the centre of Italy, tremendously rooted since very remote times in sanctuaries such as that of Alba Fucens.Palabras clave: Sal, religión romana, Hércules, Roma, Ostia, Alba Fucens, Via Salaria.Key words: Salt, Roman Religion, Hercules, Rome, Ostia, Alba Fucens, Via Salaria.
Edifici per gli dei. Evergeti pubblici e privati nei santuari del Peloponneso del II secolo d.C. = Buildings for the Gods. Public and Private Benefactors in the 2nd. Century AD. Peloponnese Sanctuaries
Authors: Lo Monaco Analissa
Published: September 2019

Riassunto: Quali edifici sono dedicati agli dei nel II secolo d.C.? Chi li pagava? Esiste una pre­dilezione per un particolare genere di edi­fici (funzionali, di recezione, sacri in senso stretto) a seconda che si tratti di interventi finanziati dall’imperatore o da una commit­tenza pubblica (i demi e i consigli locali), o che siano invece interventi privati? Questo articolo offre una rassegna delle principali tipologie di interventi edilizi e architettonici individuabili nel II secolo d.C. nei santuari del Peloponneso, esaminandoli in diacronia a seconda della loro funzione specifica (ter­me, teatri, edifici di assemblea) e mettendo in luce in che modo essi cambiarono la per­cezione e la vita quotidiana all’interno delle aree sacre.Abstract: Which buildings are dedicated to the gods in the 2nd century AD? Who paid for them? Is there a preference for a particu­lar kind of buildings (functional, recep­tion, sacred) depending on whether they are interventions financed by the emper­or or a public commission (the demi and local councils), or whether it is instead a private intervention? This article offers an overview of the main types of build­ing and architectural interventions that can be identified in the 2nd century AD. in the sanctuaries of the Peloponnesus, ex­amining them in diachrony according to their specific function (thermal buildings, theaters, assembly buildings) and high­lighting how they changed perception and daily life within the sacred areas.Parole chiave: Peloponneso, santuari, evergeti, impera­tori, dediche.Key words: Peloponnesus, sanctuaires, benefactors, imperators, dedications.
A Taxonomy of Blockchain Threats and Vulnerabilities
Authors: Alkhalifah Ayman , Ng Alex , Kayes A. S. M. , Chowdhury Jabed , Alazab Mamoun , Watters Paul
Published: September 2019

Blockchain technology has become one of the most popular technologies for maintaining digital transactions. From the foundation of Bitcoin to the now predominant smart contract, blockchain technology promises to induce a shift in thought about digital transactions in many fields, such as energy, healthcare, Internet of Things, cybersecurity, financial services and the supply chain. Despite blockchain technology offers many cryptography advantages such as immutability, digital signature and hashing; it has suffered from several critical cybersecurity threats and vulnerabilities. In this paper, we build upon the previous studies on vulnerabilities and investigates over 60 real cybersecurity incidents that have been happening on the blockchain networks between 2009 and 2019. We categorise those incidents against the key cybersecurity vulnerabilities in blockchain technologies; and have developed a taxonomy that captures five types of cybersecurity threats and vulnerabilities based on five main players in blockchain. The outcome of this research prompted concerns and research direction in developing countermeasures to alleviate these risks.
Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed-methods Study on Outcomes and Implementation Challenges
Authors: Dey Abhijit , Thekkur Pruthu , Ghosh Ayan , Dasgupta Tanusree , Bandopadhyay Soumyajyoti , Lahiri Arista , SV Chidananda , Dinda Milan , Sharma Vivek , Dimari Namita , Chatterjee Dibyendu , Roy Isita , Chanda Anuradha , Shanmugam Parthiban , Saha Brojokishore , Ghosh Sanghamitra , Nagaraja Sharath
Published: September 2019

Background: Active case finding for TB was implemented in selected sixty high TB burden wards of Kolkata, India. Community volunteers called TOUCH agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the ‘care cascade’ of PTBPs identified during July to December, 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. Methods: An explanatory mixed methods study with quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Results: Of the 3, 86,242 individuals enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%) and the number needed to screen for one TB was 2,183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage loss for attending health facilities and substance abuse among PTBPs. Conclusion: The yield of ACF was suboptimal with low PTBP identification rate and high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.
Radiosensitization of HSF-1 Knockdown Lung Cancer Cells by Low Concentrations of Hsp90 Inhibitor NVP-AUY922
Authors: Kuehnel Annett , Schilling Daniela , Combs Stephanie , Haller Bernhard , Multhoff Gabriele
Published: September 2019

The inhibition of heat shock protein 90 (Hsp90) a molecular chaperone for multiple oncogenic client proteins is considered as a promising approach to overcome radioresistance. Since most Hsp90 inhibitors activate HSF-1 that induces the transcription of cytoprotective and tumor-promoting stress proteins such as Hsp70 and Hsp27, a combined approach consisting of HSF-1 knockdown (k.d.) and Hsp90 inhibition was investigated. A specific HSF-1 k.d. was achieved in H1339 lung cancer cells using RNAi-Ready pSIRENRetroQ vectors with puromycin resistance. The Hsp90 inhibitor NVP-AUY922 was evaluated at low concentrations - ranging from 1-10nM - in control and HSF-1 k.d. cells. Protein expression (i.e., Hsp27/Hsp70, HSF-1, pHSF-1) and transcriptional activity was assessed by Western blot analysis and luciferase assays and radiosensitivity was measured by proliferation, apoptosis (Annexin V, active caspase 3), clonogenic cell survival, alkaline comet, γH2AX, 53BP1 and Rad51 foci assays. The k.d. of HSF-1 resulted in a significant reduction of basal and NVP-AUY922-induced Hsp70/Hsp27 expression levels. A combined approach consisting of HSF-1 k.d. and low concentrations of the Hsp90 inhibitor NVP-AUY922 potentiates radiosensitization which involves an impaired homologous recombination mediated by Rad51. Our findings are key for clinical applications of Hsp90 inhibitors with respect to adverse hepatotoxic effects.
Analisis Kemampuan Multiple Representasi Siswa Kelas XI MAN 1 Pekanbaru Pada Materi Titrasi Asam Basa
Authors: Mainur Hikmayanti  , Lisa Utami
Published: September 2019

Penelitian ini dilatarbelakangi oleh pemahaman kimia yang membutuhkan kemampuan berfikir menggunakan tiga level representasi yang berbeda tetapi saling berhubungan yaitu makroskopik, submikroskopik, dan simbolik. Penelitian ini bertujuan untuk mengetahui bagaimana kemampuan multiple representasi siswa kelas XI MAN 1 Pekanbaru pada materi titrasi asam basa. Metode penelitian  ini merupakan metode penelitian deskriptif kuantitatif. Sampel dalam penelitian diambil dari kelas XI MIA 2 yang berjumlah 30 orang berdasarkan teknik purposive sampling. Instrumen penelitian yang digunakan adalah tes multiple representasi berbentuk soal pilihan ganda dan essay serta wawancara. Berdasarkan hasil analisis data ditemukan bahwa nilai rata-rata kemampuan multiple representasi siswa pada level makroskopik sebesar 95.33%, level simbolik sebesar 64.58%, dan level submikroskopik sebesar 41.11%. Hasil penelitian menunjukkan bahwa rata-rata ketercapaian kemampuan multiple representasi siswa pada aspek pengetahuan kognitif sebesar 67.00%, kategori ketercapaian cenderung baik yang mengindikasikan bahwa penguasaan aspek pengetahuan kemampuan multiple representasi siswa pada materi titrasi asam basa tergolong baik.

 

Kata Kunci

Multiple Representasi dan Titrasi Asam Basa
THE BUTTERFLY EFFECT
Authors: Henderson Alex
Published: September 2019

Interactive narratives—such as story-driven, choice-based video games—provide a space for playing with tropes and genre. Players are invited to collaborate in the creation of these stories, and can thus exercise their agency to interact with and subvert, harmful tropes and genre conventions. Here I specifically explore the use—and potential subversion—of problematic conventions regarding character death, such as the conflation of queerness and tragedy commonly known as ‘Bury Your Gays’ as explored in Life is Strange (DontNod 2015), and Carol J. Clover’s concept of ‘The Final Girl’ in the horror genre as explored in Until Dawn (Supermassive 2015).
Decision Making in the Presence of Geological Uncertainty With the Mean-Variance Criterion and Stochastic Dominance Rules
Authors: Gallardo Enrique , Deutsch Clayton V.
Published: September 2019

At the heart of petroleum reservoir management (PRM) resides the challenge of selecting the best project from a group of feasible candidates in the presence of geological uncertainty. The challenge is particularly relevant in low-oil-price investment environments where many upstream projects are economically marginal and must be optimized. Companies are now more cautious. Investors are aware that they should consider not only the rewards of the projects but also their risks. For these reasons, the selection of projects to be implemented in the field should consider the geological risk and the capacity of the companies to tolerate it. In this paper, we introduce a decision-making model for active geological-risk management. The model is consistent with the utility theory framework and combines the mean-variance criterion (MVC) and stochastic dominance rules (SDRs) to guide the selection process. Two examples in the context of steam-assisted gravity drainage (SAGD) are presented.
Protocol for controlled modeling of human epiblast and amnion development using stem cells
Authors: Zheng Yi , Fu Jianping
Published: September 2019

Due to the inaccessibility of post-implantation human embryos and the restriction on in-vitro fertilization (IVF) embryos cultured beyond 14 days, the knowledge of early post-implantation human embryogenesis remains extremely limited. Recently, we have developed a microfluidic in-vitro platform, based on human pluripotent stem cells (hPSCs), which is capable of recapitulating several key developmental landmarks of early human post-implantation embryonic development, including lumenogenesis of the epiblast (EPI), amniogenesis, and specification of primordial germ cells (PGCs) and of primitive streak (PS) cells. Given its controllability and reproducibility, the microfluidic platform provides a powerful experimental platform to advance knowledge of human embryology and reproduction. This protocol describes the preparation of the microfluidic device and its implementation for modeling human post-implantation epiblast and amnion development using hPSCs.
Effects of Astragalus injection and Salvia Miltiorrhiza injection on serum inflammatory markers in patients with stable coronary heart disease: a randomized controlled trial study
Authors: Zhihao Luo , Liu Yuntao , Zhao Zhen , Yan Xia , Wang Dawei , Liu Qing
Published: September 2019

Background: Coronary heart disease (CHD) is a clinical syndrome caused by coronary atherosclerosis (AS) or functional changes of coronary arteries. Our previous experimental study found that the main component of Astragalus, Astragaloside IV, and the main component of Salvia Miltiorrhiza, Tanshinone IIA, can effectively improve myocardial ischemic injury. Methods: This study was a prospective, randomized, blinded, parallel design trial. A total of 160 eligible patients were randomized to a treatment group (in three groups) or the placebo control group in a 1:1:1:1 ratio using a central randomization system. Patients will receive appropriate treatment for 7 days within 24 hours after enrollment and follow-up for 28 days. Main evaluation indicators: cell count, serum high-sensitivity C-reactive protein (hs-CRP) level, monocyte chemoattractant protein 1 (MCP-1), Interleukin-6(IL-6), IL-1β, IL-8, IL-18, IL-10, Tumor necrosis factor(TNF-α), Oxidized low density lipoprotein(OX-LDL), exosome levels, and angina grade and Traditional Chinese Medicine (TCM) symptom changes scale. Secondary evaluation indicators: B-type natriuretic peptide (BNP) level, troponin (cTn), muscle enzyme isoenzyme (CK-MB), heart-type fatty acid binding protein (H-FABP), liver function, renal function, blood coagulation and the like. Adverse events will be monitored throughout the trial. Discussion: This is a randomized controlled trial of Chinese herbal extracts for the treatment of coronary heart disease. The results of this trial will provide valuable clinical evidence for the recommendations for disease management and identify its underlying mechanisms.
Efficacy of acupuncture in improving the quality of life of patient’s with moderate or severe acne vulgaris: protocol for a randomized controlled trial
Authors: Jiao Ruimin , Huang Man , Zhang Weina , Liu Zhishun
Published: September 2019

Background Acne vulgaris (AV) is a common chronic dermatologic disease that tends to impair the quality of life of patients. None of the previous clinical trials of acupuncture therapy for AV used the quality of life as a primary outcome or employed a sham acupuncture control arm. Methods/design Participants with AV will be randomly assigned to acupuncture or sham acupuncture groups (1:1 allocation). All participants will receive 4-week treatment comprising of a total of 12 sessions (3 sessions per week). The primary outcome will be change from baseline in the Skindex-16 scale total score at treatment completion. The secondary outcomes will be Skindex-16 subscale scores, the Dermatology Life Quality Index scale total score, the total lesion count and inflammatory lesion count, itch and pain assessment using the visual analogue scale score, patient expectations of acupuncture, patient satisfaction with treatment, and the blinding of the effect of sham acupuncture. Follow-up evaluation will be performed at weeks 16 and 28. All outcome analyses will be performed in the intention-to-treat population. Discussion This is the first randomized controlled trial which will compare the effect of acupuncture versus sham acupuncture in improving the quality of life of patients with moderate or severe acne vulgaris (AV). The limitation of the design of this trial is that the sample size of a single center trial, which may lead to potential overestimation of the effect of acupuncture. Meanwhile, due to the characteristics of acupuncture, the acupuncturists will not be blinded and the use of non-acupoints and minimal acupuncture without any manipulation, which may introduce an element of bias and cause some biological effect.
Knowledge and perception of surgical informed consent and associated factors among adult surgical patients in Gondar University Comprehensive and Specialized Hospital, Ethiopia
Authors: Yesuf Nurhusien Nuru , Belay Anteneh Yehuala , Jemberie Senetsehuf Melkamu , Netsere Henok Biresaw
Published: September 2019

Introduction: there are many studies regarding informed consent in clinical trials, however, only few studies have assessed adult patient’s knowledge and perception of surgical informed consent in clinical practice. Therefore, the purpose of this study was to assess knowledge and perception of surgical informed consent and associated factors among adult surgical patients in Gondar University Comprehensive and Specialized Hospital, Northwest Ethiopia, 2018 Methods: responses from 312 postoperative adult surgical patients was taken using pretested structured interviewer administered questionnaires for one month. Result: there were a total of 302 respondents, (40% males and 60% females). More than half, 178 (59%) were in age groups of 31-43 years. Of the study participants, 193(63.91%) of them had poor knowledge and 155(51.3%) had poor perception about surgical informed consent in the study area. On the other hand, living in urban, being higher educational status and having past history of surgery were positively associated with good knowledge of patients towards surgical informed consent while being urban, higher education, being ophthalmologic patient & receiving consent from physician were positively associated with perception of patients regarding surgical informed consent. Conclusion: majority of the study participants had limited knowledge and poor perception about surgical informed consent. Adequate preoperative health education for patients should improve patients’ knowledge and perception. Keywords: Gondar University Comprehensive Specialized Hospital, Knowledge, patient perception, surgical informed consent
Physical activity in paid work time: a qualitative study of employers’ and employees’ perspectives
Authors: Ryde Gemma , Atkinson Patricia , Stead Martine , Gorely Trish , Evans Josie
Published: September 2019

Background Increasing levels of employee stress and poor mental health are a significant concern for workplaces. Physical activity (PA) has been shown as an effective strategy for preventing and treating numerous mental health issues as well as improving mental wellbeing. However, there are many barriers to taking part in PA (such as lack of time) with participation rates typically low. Providing PA in paid work time might be a way to overcome these issues, yet employers’ and employees’ opinions of this concept are unknown. The aim of this study was to explore employee and employer perspectives of PA in paid work time.Methods Focus groups and interviews were conducted with employees and managers at workplaces in central Scotland that had large numbers of desk based employees. All discussions were digitally recorded and transcribed verbatim. Data were analysed thematically.Results Three out of five organisations approached took part in this qualitative study. Interviews were held with two strategic managers, and focus groups with16 middle managers and 45 employees. Barriers identified included organisational barriers (cost of lost time), the nature of the job (workload, logistical considerations) and existing workplace norms (colleague’s expectations and a no break, be at your culture). Benefits were anticipated for both employees and the organisation and included improved mental health, productivity and external more favourable employee perceptions of the employer.Conclusion This study suggests that there are significant barriers to PA in paid work time. Whilst numerous anticipated benefits were conveyed by both employees and managers, PA in paid work time is unlikely to become common place until changes in attitudes and the culture towards movement at work occur.
MiR-34c Downregulation Leads to SOX4 Overexpression and Cisplatin Resistance in Nasopharyngeal Carcinoma
Authors: Bissey Pierre-Antoine , Teng Mona , Law Jacqueline H , Shi Wei , Bruce Jeff P , Petit Valentin , Sai Tsao W , Yip Kenneth W , Liu Fei-Fei
Published: September 2019

Background: A major cause of disease-related death in nasopharyngeal carcinoma (NPC) is the development of distant metastasis (DM) despite combination chemo-radiotherapy. We have previously identified and validated a four micro-RNA (miRNA) signature which was prognostic for DM. In this study, characterization of a key component of this signature, miR-34c, revealed its role in chemotherapy resistance.
Methods: 246 NPC patient biopsies samples were subject to comprehensive miRNA profiling and immunohistochemistry (IHC). Two human normal nasopharyngeal cell lines (immortalized; NP69 and NP460), as well as the NPC cell line C666-1, were used to generate pre-miR-34c (gain of function) and anti-miR-34c (loss of function) cells. Signaling pathways were assessed using quantitative real-time PCR (qRT-PCR) and Western blot. Cell viability was measured using the ATP lite assay.
Results: MiR-34c was downregulated in NPC patient samples, and confirmed in vitro to directly target SOX4, a master regulator of epithelial-to-mesenchymal transition (EMT). MiR-34c downregulation triggered EMT-representative changes in NP69 and NP460; Snail, ZEB1, CDH2, and SOX2 were upregulated, while Claudin-1 and CDH1 were downregulated. Phenotypically, inhibition of miR-34c led to cisplatin resistance, whereas miR-34c over-expression sensitized NPC cells to cisplatin. TGFβ1 decreased miR-34c and increased SOX4 expression in vitro. The TGFβ receptor 1 inhibitor SB431542 reduced SOX4 expression and increased cisplatin sensitivity. Finally, immunohistochemistry revealed that in chemotherapy-treated NPC patients, lower SOX4 expression was associated with improved overall survival.
Conclusion: Taken together, miR-34c downregulation correlates with higher incidence of DM; miR-34c also increases SOX4 expression which leads to cisplatin resistance. In association, TGFβ1 represses miR-34c expression, and inhibition of the TGFβ1 pathway is one strategy to restore cisplatin sensitivity in NPC.
Differentiation of suprasellar meningiomas from non-functioning pituitary macroadenomas by 18F-FDG and 13N-Ammonia PET/CT
Authors: Ding Lei , Zhang Fangling , Li Zhoulei , Shi Xinchong , Li Ruocheng , Zhang Xiangsong
Published: September 2019

Objective: Differentiation of suprasellar meningiomas (SSMs) from non-functioning pituitary macroadenomas (NFPMAs) is beneficial for clinical management. We investigated the utility of 13 N-ammonia combined with 18 F-FDG positron emission tomography (PET)/computed tomography (CT) in distinguishing SSMs from NFPMAs in this study. Patients and Methods: Fourteen patients with histopathologic diagnosis of NFPMAs and eleven patients with SSMs were included in this study. Every patient underwent both 18 F-FDG and 13 N-ammonia PET/CT scans. The tumor to gray matter (T/G) ratios were calculated for the evaluation of tumor uptake. Results: The uptake of 18 F-FDG was higher in NFPMAs than SSMs whereas the concentration of 13 N- ammonia was lower in NFPMAs than SSMs. There were significant differences of 18 F-FDG and 13 N-ammonia uptake between the two groups (0.92[0.46] vs 0.59[0.29], P <0.05, 18 F-FDG; 1.58±0.56 vs 2.80±1.45, P <0.05, 13 N-ammonia). Tumor classification demonstrated a high overall accuracy of 96.0% for differential diagnosis. When the two traces were combined, only 1 SSM were misclassified into the NFPMA group. Conclusion: SSMs and NFPMAs have different metabolic characteristics on 18 F-FDG and 13 N-ammonia images. The combination of these two tracers can effectively distinguish SSMs from NFPMAs.
Epidemiology and outcomes of injuries among trauma patients in Ethiopia: A 5 -years retrospective Analysis
Authors: Abate semagn , Abafita Bedru Jemal , Kassim Hailemariam Mulugeta , Basu Bivash
Published: September 2019

Background: Injury becomes life threatening community health problem associated with significant mortality and morbidity worldwide. Road traffic accident is the most commonly encountered trauma and the leading cause of death and disability from injuries in Ethiopia. The aim of this study is to assess the epidemiology and outcomes of injury in Ethiopian University Hospital. Methods: Institutional based retrospective cross-sectional study was conducted from January 2015 to June 2019. Data was collected using questionnaire adapted from WHO injury surveillance guideline. Bivariate and multivariate logistic regressions were performed to determine factors associated with hospital mortality. Results: A total of 376 trauma cases were included in the study. The majority of 196(52.1%) victims were in the age range of 20-40 years. Road traffic accident was the commonest mechanism of injury 178(47.3%) followed by interpersonal violence 113(30.1%). The majority of patients 135(35.9%) had associated with lower extremity injury and there was 23(6%) mortality in this study. Revised trauma score (RTS) < 10 (AOR=2.5; 95% CI, 1.8-25.6), Glasgow coma scale (GCS) (AOR =0.3; 95% CI, 0.13-0.5), Length of hospitalization (LOS) 1-7 days (AOR=0.1; 95% CI, 0.01-0.8), and Time to arrival >24hr were predictors of mortality in a patient with injury. Conclusion: A lower extremity injury was common and mostly associated with RTA. Length of hospitalization > 7 days, RTS<10, decrease GCS and time to arrival >24hr were factors associated with mortality. Pre-hospital emergency medical service system and trauma registry needs to be established to decrease burden of injury. Keywords: Injury, Epidemiology, Outcome, Ethiopia
Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada
Authors: Burrows Kristen , Abelson Julia , Miller Patricia , Levine Mitch , Vanstone Meredith
Published: September 2019

Background To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 to help increase access to care, decrease wait times, and improve continuity of care. Integration of new health professional roles is often stymied by role resistance and funding barriers. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple case settings and to understand the role of PAs within complex adaptive systems.Methods An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases: inductive thematic analysis within each of the four cases; a cross-case thematic analysis; and a broader exploration of cross-case patterns pertaining to specific complexity theory principles of interest.Results Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability (in relation to sustainability and funding) are interconnected and dynamic in hospital and community settings. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PA’s willingness to work and ability to build relationships within existing health systems allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e. health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory.Conclusions By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in community and hospital settings, PAs are making a significant contribution to Ontario healthcare settings.
The Barriers in the implementation of Antimicrobial Stewardship Programs: A systematic Review
Authors: Ahmed Nehad , Khan Irfanullah , Hassali Mohamed Azmi , Haseeb Abdul , Khan Amer Hayat
Published: September 2019

Background The resistance to Antimicrobial is considered as one of the most important risks that affect public health and healthcare. Antimicrobial stewardship programs comprise a series of interventions that help to stop the inappropriate use of antimicrobials.Methods The published literature on the barriers of implementing stewardship programs is limited. We searched for the relevant articles from 2007 till the end of 2017 using the keyword “Antimicrobial Stewardship Programs" in PubMed database.Results There are many barriers in the implementation of antimicrobial stewardship programs. To improve the rational use of antibiotics it is important to overcome these barriers.Conclusion According to the included studies into current review or manuscript, there are 9 major barriers for ASPs. Lack of training and knowledge, inter-professional and inter-specialty conflict, and lack of resources are the most common barriers.
Factors associated with delayed onset of active labor following administration of vaginal Misoprostol among women at Mbarara Regional referral hospital, Uganda: A prospective cohort study
Authors: Kajabwangu Rogers , Bajunirwe Francis , Lukabwe Henry , Atukunda Esther , Munyanderu Baraka , Sanchez Emilio , Nakalinzi Joanita , Mugyenyi Godfrey Rwambuka
Published: September 2019

Background Vaginal misoprostol has been recommended by the World Health Organization as one of the effective methods for induction of labor. Globally 9.6% of all deliveries follow induction of labor. Although the goal of labor induction is to initiate active labor with subsequent vaginal delivery, some mothers undergoing labor induction delay to get into active labor and some fail completely. The factors associated with delayed onset of active labor following labor induction with vaginal misoprostol have not been sufficiently explored in resource limited settings.Methods We conducted a prospective cohort study over a period of 6 months on the antenatal ward and labor suit of Mbarara Regional Referral Hospital, southwestern Uganda. We enrolled mothers of gestational age at least 28 weeks, with indication for labor induction. They received 50 micrograms of vaginal misoprostol every 6 hours with a maximum of 4 doses and were followed up until onset of active labor. Onset of active labor was considered delayed if it occurred at more than 12 hours after administration of the first dose of vaginal misoprostol. Bivariate and multivariate analysis was done to determine the factors associated with delayed onset of active labor.Results Eighty-eight mothers underwent induction of labor, 22.7% had delayed onset of active labor. After adjusting for potential confounders, low/no parity (Relative Risk or RR 2.67, p-value=0.01), low gestational age (RR 3.1, p-value=0.006) and higher BMI (RR 0.36, p-value=0.005), were associated with delayed onset of active labor following vaginal misoprostol administration.Conclusion Nulliparity, gestational age less than 37weeks are associated with delayed onset of active labor following labor induction with vaginal misoprostol while BMI of 26 and above is protective from delayed onset of labor.
Prevalence and associated factors of Khat chewing among people with HIV/AIDS at rural health centers of Ethiopia: a cross-sectional study
Authors: Belayneh Zelalem , Mekuriaw Birhanie
Published: September 2019

Objective: Khat, sometimes called “Qat” or “Chat” is fresh leaves a plant commonly chewed for its psycho-stimulant and euphorigenic effects of the brain. Although the adverse and complicated conspectuses of long term Khat use are evidenced, it is a commonly chewed in Ethiopia. Its burden and associated factors is not well addressed among HIV/AIDS in Ethiopia. This addressed this missed opportunity by assessing the frequency, pattern and associated factors of current Khat use among people with HIV/AIDS in Ethiopia. A systematic random sampling was used to select the study participants. Binary logistic regression was commutated to identify factors associated with Khat use. Results: About 30.1% and 24.7% of people with HIV/AIDS had lifetime and current khat use southern Ethiopia. Male sex {OR=2.46 95% CI(1.28, 4.73)}, rural residency { OR=2.4695%: CI(1.28, 10.14)}alcohol drinking {OR=1.84:95% CI(1.00, 3.37)} and frequency of schedule {OR=5.2595%CI(2.33, 11.85)} had a statistically significant association with current Khat use. This alarms a need for designing appropriate preventive and intervention programs for people living with HIV.
Proposal for name of surgical access-Substernal instead Subxiphoid for pericardial fenestration
Authors: Valchev Daniel Georgiev
Published: September 2019

Objective:
Various surgical accesses for pericardial fenestration are described and used in the literature. Each of
them has its advantages and disadvantages depending on the cause of the need for pericardial
fenestration.
Results:
Operative and perioperative mortality has not been reported. Operative complications such as bleeding, injury to the coronary artery or myocardium have not occurred. Substernal access after resection of the xiphoid process is a safe and effective approach for surgical treatment of pericardial tamponade.
Finite element analysis of occlusal splint therapy in patients with bruxism
Authors: Gholampour Seifollah , Gholampour Hanie , Khanmohammadi Hamed
Published: September 2019

Background: Bruxism is among the habits considered generally as contributory factors for temporomandibular joint (TMJ) disorders and its etiology is still controversial.Methods: Three-dimensional models of maxilla and mandible and teeth of 37 patients and 36 control subjects were created using in-vivo image data. The maximum values of stress and deformation were calculated in 21 patients six months after using a splint and compared with those in the initial conditions. Results: The maximum stresses in the jaw bone and head of mandible were respectively 4.4 and 4.1 times higher in patients than in control subjects. Similar values for deformation were 5.8 and 4.9, respectively. The maximum stress in the jaw bone and head of mandible decreased six months after splint application by up to 71.0% and 72.8%, respectively. Similar values for the maximum deformation were 80.7% and 78.7%, respectively. Following the occlusal splint therapy, the approximation of maximum deformation to the relevant values in control subjects was about 2.6 times the approximation of maximum stress to the relevant values in control subjects. The maximum stress and maximum deformation occurred in all cases in the head of the mandible and the splint had the highest effectiveness in jaw bone adjacent to the molar teeth. Conclusions: Splint acts as a stress relaxer and dissipates the extra stresses generated as well as the TMJ deformation and deviations due to bruxism. The splint also makes the bilateral and simultaneous loading possible and helps with the treatment of this disorder through regulation of bruxism by creating a biomechanical equilibrium between the physiological loading and the generated stress.
Crop Yield and Nitrous Oxide Emissions following Swine Manure Application: A Meta‐Analysis
Authors: Luo Weiquan , O'Brien Peter L. , Hatfield Jerry L.
Published: September 2019

Core Ideas

Swine manure is a potential nutrient source but may harm environmental quality.

Crops fertilized with swine manure matched those using synthetic fertilizer.

Swine manure did not increase nitrous oxide compared with synthetic fertilizer.

Manure application method and conditions dictate yield and environmental impacts.

Swine manure has potential for reuse as fertilizer on cropland and pastureland. Currently, producers may be hesitant to land apply swine manure because information regarding the impacts to crop production and environmental quality has been inconsistent. The objective of this research was to synthesize the literature investigating impacts of swine manure application on crop yield and soil nitrous oxide emissions as compared to synthetic fertilizer. Overall, the meta‐analysis of 39 studies shows that swine manure does not affect either crop yield or nitrous oxide emissions. However, a moderator analysis indicated that crop yield using manure fertilizer may be adversely affected in fine‐textured soils or when applied to the soil surface. While these results suggest that swine manure may be safely applied as fertilizer, producers should still be cautious with how manure is applied to capture its N value without yield losses or detrimental effects to environmental quality.