bluuebunny/crossref_metadata_2025 huggingface dataset:
EVALUATION OF BUREAUCRACY REFORM PROGRAM AT STATE PERSONNEL AGENCY
Authors: Naibaho Ramli Effendi Idris
Published: October 2019

The objective of this research is to evaluate the bureaucracy reform program at State Personnel Agency. The evaluation focused on five stages, namely design, installation, process, product and benefit. Qualitative approach used in this research with using Discrepansy Evaluation Model design. Data collecting with in-depth interview, orbservation and documantation study. Interview Data analyzed quantitatively through data reduction, data display, and conclussion drawing. The evaluation results toward the bureaucratic reform program at State Personnel Agency shows: (1) the program has been well defined which is indicated by an explanation of the urgency aspect, has clear goals and objectives, and equipped with key success indicator, (2) the program has been well designed including the formulation of implementation guidelines, resource preparation, work programs, and evaluation and monitoring, (3) implementation of eight areas of changes which cover organizational structuring, structuring of governance managemnt system, structuring of human resources management system, harmonization of legislation, strengthening of supervision, strengthening of performance accountability, public services, mindset and work culture is good. However, hasâ€™t shown the ideal conditions if associated with position of State Personnel Agency as a pioneer and role model for the ministries or other institutions in the implementation of bureaucratic reform program, (4) the bureaucratic reform program has given positive results in the improvement of the quality of clean bureaucracy and free of corruption, collusion and nepotism, the quality of public services, and the capacity and performance accountability, and (5) the bureaucratic reform programs can provide positive benefits in improving bureaucratic governance, enhance the positive image and improve the apparatus job performance. Therefore, State Personnel Agency needed to improve the implementation of bureaucracy reform program continuously in order to achieved the optimal results

Keywords: Program Evaluation, And Bureaucracy Reform, Discrepancies Evaluation Model
DEVELOPMENT STRATEGY OF HUMAN CAPITAL OF PT KIMIA FARMA (PERSERO) TBK
Authors: Arifin Antoni Ludfi
Published: October 2019

This research is a qualitative research with case study at PT Kimia Farma (Persero) Tbk. The purpose of this research is to understand the overall development strategy of human capital of the Company. Data were collected from primary data through interview, observation, and recording; while secodary data were obtained from PT Kimia Farma (Persero) Tbk or from the externals that are used by the researcher to strengthen the premise, theory building, or data from previous researchers.  The data collected from primary and secondary sources are then processed. The validity of data is checked though data accuracy checking process (triangulation). This research found that the Company has conducted human reseource development strategy through 1) Integrated HR Development with the Companyâ€™s visions and missions; 2) open recruitment and selection process will decide and find the candidates who meet the qualifications; 3) preparing assessement center to select the right candidate for the right position; 4) employees training can improve the employeesâ€™ competence; and 5) the right development of human capital to prepare for the competitiveness in the future..

Keywords: Human Capital, Development, Strategy, HR Planning
THE EFFECT OF PERSONALITY, WORK STRESS AND DECISION MAKING TO ORGANIZATIONAL COMMITMENT AT LIMITED COMPANY OF BHUMYAMCA SEKAWAN IN SOUTH JAKARTA
Authors: SARIWULAN TUTY
Published: October 2019

This title of this research is the influence of employees personality, work stress dan decision making to organizational commitment at Limited Company of  Bhumyamca Sekawan in South Jakarta.This study used quantitative approach with survey methods and path analysis technique. The amount of population is 213 employees and using random sampling technique, so the total of sample is 70 employees calculated by slovin formulation Data that used in this research is quantitative data with path analysis methods to find out the path coefficient score. Based on the calculation and hypothesis test, can be concluded as these results: (1) personality has direct positive influence to decision making; (2) work stress has direct positive influence to decision making; (3) personality has direct positive influence to organizational commitment; (4) work stress has direct positive influence to organizational commitment; (5) decision making has direct positive influence to organizational commitment.

Keywords:  personality, work stress, decision making and organizational commitment
Enterprenuerial Motivation Amongst University Students in Pakistan: Proposing and Testing a Mediation Model
Authors: Ahmad Muhammad Ali , Shah Syed Alamdar Ali , Mallah Waqar Ahmed , Saud Muhammad
Published: October 2019

Objective of this research is to explore factors that contribute towards entrepreneurial motivation amongst university students in Pakistan. Data of 500 respondents from HEC recognized universities in Pakistan has been collected and analyzed for the purpose of our research. Data has been gathered from students of different degree programs commerce, business administration, banking and finance, and marketing department of public and private universities of Pakistan. A mediation model has been proposed and tested in order to achieve our objectives. Data has been analyzed using different econometric and statistical techniques. The results suggest that there exists some â€œpsychologicalâ€ and â€œeconomicâ€ factors that influence the entrepreneurial motivation of university students in Pakistan. Over and above, there also that exits a group of psychological factors that partially mediate in our model.
The Effect of Coach Leadership, Team Cooperation, and Achievement Motivation on The Performance of The Depok City Athlete
Authors: Fahmi Muhammad , Wibowo  , Purwana Dedi
Published: October 2019

ABSTRACT: The objective of this research was to examine and analyze the effect of coach leadership, teamwork, and achievement motivation on the performance of Depok cityâ€™ athletes, It was a quantitative research with associative approach, conducted at Depok National Sports Committee (KONI). The data were collected through questionnaire involving 203 samples of respondent of athletes and coach among Depok National Sports Committee. Data collection techniques carried out in this study were using questionnaire instruments. The questionnaire used consisted of questionnaires, variables of coach leadership, teamwork, achievement motivation and athlete's performance. The type of questionnaire is a closed questionnaire where the questionnaire distributed to respondents has provided the answer in the form of five answer choices, so the respondent just has to choose one of the five answers provided. The measurement scale of the coach leadership questionnaire, teamwork, achievement motivation and athlete's performance used a Likert scale. The primary data collected then through the estimated error normality test, linearity test and significance test. Then analyzed and tested the hypothesis using path analysis. Data analysis techniques in this study include: (1) descriptive data analysis, (2) requirements test, (3) inferential data analysis.

 

The data analysis and interpretation indicates that: (1) Coachâ€™ leadership has no direct effect on athletesâ€™ performance. (2) Coachâ€™ leadership has no direct effect on achievement motivation. (3) Coachâ€™ leadership has direct effect on teamwork. (4) Teamwork has direct effect on achievement motivation. (5) Teamwork has direct effect on athletesâ€™ performance. (6) Achievement motivation has direct effect on athletesâ€™ performance. (7) Coachâ€™ leadership has no indirect effect on athletesâ€™ performance through achievement motivation. (8) Coachâ€™ leadership has an indirect effect on athletesâ€™ performance through teamwork. (9) Coachâ€™ leadership has an indirect effect on athletesâ€™ performance through teamwork and achievement motivation

 

Keywords: coach leadership, teamwork, achievement motivation, athletesâ€™ performance
The Anterior Subcutaneous Pelvic Ring Fixator
Authors: Jordan Martin C. , Brems Anna-Christina , Heintel Timo , Jansen Hendrik , Hoelscher-Doht Stefanie , Meffert Rainer H.
Published: October 2019

Background:

Subcutaneous fixation of the anterior pelvic ring is an emerging surgical technique for trauma patients. The aim of this study was to biomechanically evaluate 2 internal fixation devices for stabilizing a disrupted pelvic ring and compare them with traditional external fixation.

Methods:

Thirty-six synthetic pelvises with a simulated unstable ring fracture (anteroposterior compression type III) were divided into 3 groups. Group A underwent fixation with a supra-acetabular external fixator; group B, with an internal fixator using the USS II polyaxial system; and group C, with an internal fixator using the Click′X polyaxial system. Biomechanical testing included measurement of peak-to-peak displacement at 300, 400, and 500 N; total displacement; plastic deformation; stiffness; and fracture-line displacement.

Results:

Statistical analysis of all measured parameters revealed no significant differences among the groups. However, vertical displacement of the preshaped connecting rod within the screw heads occurred as a result of inadequate stability of the internal fixation at the rod-screw interface.

Conclusions:

Although internal fixator devices are placed close to the bone and should therefore maintain greater stiffness, our data did not support the hypothesis of superior stability. Special attention is required when using a curved connecting rod as the rod is easily displaced, placing relevant anatomical structures at risk. These devices require further refinement to avoid potential patient injury.
Validated Risk-Stratification System for Prediction of Early Adverse Events Following Open Reduction and Internal Fixation of Closed Ankle Fractures
Authors: Bohl Daniel D. , Idarraga Alexander J. , Holmes George B. , Hamid Kamran S. , Lin Johnny , Lee Simon
Published: October 2019

Background:

As orthopaedic surgery moves toward bundled payments, there is growing interest in identifying patients at high risk of early postoperative adverse events. The purpose of this study was to develop and validate a risk-stratification system for the occurrence of early adverse events among patients treated with open reduction and internal fixation (ORIF) for a closed fracture of the ankle.

Methods:

Patients undergoing ORIF for a closed ankle fracture during the period of 2006 to 2017, as documented by the American College of Surgeons National Surgical Quality Improvement Program, were identified. For the 60% of patients randomly selected as the development cohort, multivariate Cox proportional hazards modeling was used to identify factors that were independently associated with the occurrence of adverse events (including events such as reoperation, surgical site infection, and pulmonary embolism). On the basis of these results, a nomogram analysis was used to generate a point-based risk-stratification system. To evaluate the validity of the point-based system, the system was applied to the remaining 40% of patients constituting the validation cohort and tested for its ability to predict adverse events.

Results:

Of the 7,582 patients in the development cohort, 455 developed an adverse event (estimated adverse event risk of 6%). On the basis of Cox proportional-hazards regression, patients were assigned points for each of the following significant risk factors: +1 point for age of 40 to 59 years, +3 points for age of 60 to 79 years, +5 points for age of ≥80 years, +1 point for female sex, +2 points for chronic obstructive pulmonary disease (COPD), +2 points for insulin-dependent diabetes, +3 points for anemia, and +4 points for end-stage renal disease. The validation cohort included 5,263 patients. Among this second cohort, the risk-stratification system predicted the risk of early adverse events (p < 0.001; Harrell C = 0.697).

Conclusions:

The occurrence of early adverse events following ORIF for closed ankle fractures was associated with greater age, female sex, COPD, insulin-dependent diabetes, anemia, and end-stage renal disease. We present and validate a simple point-based risk-stratification system to predict the risk of early adverse events.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Model United Nations: Improving the Students' Speaking Skill
Authors: Nasution Sukma Septian , Sukmawati Nur Najibah
Published: October 2019

Model United Nations promotes students’ learning opportunities in three successive ways: optimizing individual development through un-moderated caucus, growing competitiveness through working paper forum and sharpening problem solving skill through draft -resolution forum. This is a classroom action research that investigates the improvement of students’ speaking skill taught by using Model United Nations at Pamulang University. Two cycles were conducted where the first cycle consisted of four meetings and the second cycle consisted of three meetings. The population of this study was the fourth semester students in the academic year of 2017/2018. Both quantitative and qualitative data were employed to analyze the data. Quantitative data were in the form of oral test scores taken from students’ public speaking skill. On the other hand, qualitative data were in the form of observation sheet, questionnaire sheet, and documentation. The treatments signified improvements of students’ public speaking skill in each cycle which is represented by the mean score. The mean score of pre-test was 58.775. It improved to 69.525 in the first cycle, and became 78.675 in the last cycle. The observation sheet, questionnaire sheets and documents proved that students performed active participation and engagement during the instructional process that fostered better skill in public speaking.
Integrating Web 2.0 Tools in Writing Class to Promote Assessment for Learning
Authors: Rahmawanti Movi Riana , Umam Amalul
Published: October 2019

Technology has been implemented for instruction with various resources to explore course content and assess students’ learning. In this study, Web 2.0 tools was implemented in writing classroom for Higher education students. A Web 2.0 tools that was used was because it is known as an online means and has been used to perpetuate interactions and communication within a collaborative learning. Assessment is central to teaching and learning, from which a decision whether or not the goals of education are being met. At the same time, the demand of today’s era makes it quite challenging for educators to find the best way to assess their students. Action research method was employed in the study in which observation and individual semi-structured interviews we re used to collect the data. The result of the study is the knowledge of implementation of Web 2.0 tools in EFL (English as foreign language) classroom, from which a guidance of using Web 2.0 tools to promote assessment for learning will be arrived at. This study concludes that Web 2.0 tools can be applied to promote Assessment for learning, and it has several benefits to the student s to improve their learning quality.
Combining Regularized Convolutional Neural Networks with Production Data Integration for Geologic Scenario Selection
Authors: Jiang Anyue , Jafarpour Behnam
Published: October 2019

Reservoir model calibration against dynamic response data is often constrained by a prior conceptual model of geologic scenario that specifies the expected types of spatial variability and features in the solution. However, geologists have significant uncertainty in developing a conceptual model, e.g., due to limited data, process-based modeling assumptions, and subjectivity. Therefore, it is prudent to consider the uncertainty in the geologic scenario when solving the model calibration problem as it will provide an opportunity to utilize the response data in supporting or rejecting the proposed scenarios. We present a new approach for geologic scenario identification based on dynamic response data by combining gradient-based inversion for feature extraction and a convolutional neural network for feature recognition. To compactly represent each scenario while ensuring data sensitivity, the approach relies on extremely low-rank parameterization of individual geologic scenarios based on the Principal Components Analysis (PCA). The PCA basis elements of each scenario are then combined to capture the salient features in any of the scenarios, or their possible combinations. An iterative least-squares formulation is then formulated to detect scenarios that are supported by the observed data. The inversion results in an approximate (smooth) spatial solution that contains the dominant spatial patterns. A pre-trained convolutional neural network (CNN) is then used to identify the relevant geologic scenarios based on the reconstructed spatial solution. Two main advantages of the workflow include: (i) the ability to combine different scenarios if supported by data, instead of evaluating individual scenarios, and (ii) efficient gradient-based implementation that does not require extensive forward simulation runs. In addition, the training of CNN is implemented using only geologic realizations without requiring additional reservoir simulation. The performance of the workflow is evaluated using tomographic inversion and model calibration in fluvial reservoirs.
Functional Results and Photic Phenomena with new Extended-Depth-of-Focus Intraocular Lens
Authors: Giers Bert C. , Khoramnia Ramin , Varadi Dorottya , Wallek Hannah , Son Hyeck Soo , Attia Mary S. , Auffarth Gerd U.
Published: October 2019

Background: Evaluation of clinical and functional results of a new extended depth of focus intraocular lens (EDOF-IOL).

Methods: Fourteen cataract patients (twenty-eight bilateral implantations) were assessed for uncorrected (UDVA) and corrected (CDVA) distance visual acuities; uncorrected (UNVA), distance-corrected (DCNVA) and best corrected (CNVA) near visual acuities; and uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuities - as well as binocular defocus curves. Photopic and mesopic contrast sensitivity was recorded. Reading acuity was evaluated using an electronic reading desk at fixed distances and at the patient’s preferred near and intermediate distances. Visual symptoms were assessed with a halo and glare simulator plus a patient questionnaire which also recorded quality of life.

Results: Median postoperative monocular UDVA was 0.13logMAR (range -0.08 to 0.42logMAR), median CDVA was -0.01logMAR (range -0.20 to 0.22logMAR), median UIVA at 80 cm was -0.05logMAR (range -0.18 to 0.58logMAR) and median UNVA at 40 cm was 0.14logMAR (range -0.10 to 0.64logMAR). Binocular uncorrected reading acuity was 0.10logMAR at 40 cm and 0.11logMAR at 80 cm. Patients preferred a median intermediate reading distance of 62.8 cm over the predetermined 80 cm, which allowed them to read smaller letter size but did not improve reading acuity. Patients reported a high rate of spectacle independence and satisfaction in everyday life and little to no dysphotopsia.

Conclusion: The Mini WELL Ready IOL provided good postoperative functional results at far and intermediate distances and improved the visual and reading acuity at reading distance. The lens caused little to no dysphotopsia.
Adaptation and Validation of a Spanish version of the Treatment Burden Questionnaire in Patients with Multiple Sclerosis
Authors: Ysrraelit Maria Celica , Fiol Marcela Paula , Peña Fernando Vazquez , Vanotti Sandra , Terrasa Sergio Adrián , Tran Viet Thi , Montori Victor M , Correale Jorge
Published: October 2019

Background: The Treatment Burden Questionnaire (TBQ) is a self-reported measure of the effect of treatment workload on patient wellbeing. We sought to validate the TBQ in Spanish and use it to estimate the burden of treatment in Argentinian patients with multiple sclerosis (MS). Methods: The TBQ was forward-backward translated into Spanish. Two focus groups and 25 semi-structured interviews focused on wording and possible item exclusion. Validation was performed in 2 steps. First, 162 patients across a range of MS severity completed the questionnaire. Confirmatory factor analysis assessed the dimensional structure of the TBQ. Construct validity was assessed by studying correlations with fatigue and quality of life (QoL). Then, in a second cohort of 171 patients, we evaluated the association between TBQ scores and patients’ sex, age, education level, employment status, type of MS, disease duration, comorbidities, EDSS, pharmacological treatment and medication adherence. Results: The questionnaire presented a 3-factor structure in which burden was related to pharmacological treatment; comprehensive health assistance; and psycho-social-economic context. Composite reliability was > 0.8 for all factors. TBQ showed positive correlation with fatigue (rs= 0.467, p=0.006), negative correlation with QoL (rs -0.446, p=0.009). For the second cohort, total TBQ score was 43 (SD 29). Lowest scores were observed on self-monitoring (0.53, SD 1.3) and highest for administrative load (4.2, SD 3.4). Inverse association was found between the TBQ score and medication adherence (r 0.243 p=0.001). TBQ scores also correlated with daily patient pill/injection requirements (r 0.175 p=0.020). Individuals receiving injectable treatment scored higher than patients on oral drugs (total TBQ 51 (SD 32) vs 39 (SD 27) p=0.002). Conclusions: The TBQ in Spanish is a reliable instrument and showed adequate correlation with QoL and adherence scales in MS patients. TBQ may benefit health resources allocation and provide tailor therapeutic interventions to construct a minimally disruptive care.
Childbirth Experience Questionnaire (CEQ): Research Proposal for Translation and Validation into Sinhala Language among a Lankan cohort of women.
Authors: Patabendige Malitha
Published: October 2019

Introduction: The Childbirth Experience Questionnaire (CEQ) is a Sweden origin, self-administered questionnaire to assess birth satisfaction of women in different aspects of their first labour and birth. It measures four main domains of the woman’s childbirth experience. Those are own capacity, professional support, perceived safety and participation, comprising of 22 items.
Objectives: To conduct a linguistic translation, to conduct a validation study and to assess the psychometric properties of the Sinhala version of the CEQ.
Efficacy of integrating vestibular rehabilitation and cognitive behaviour therapy in persons with long-term dizziness in primary care– a study protocol for a randomised controlled trial
Authors: Kristiansen Lene , Magnussen Liv Heide , Wilhelmsen Kjersti Thulin , Mæland Silje , Nordahl Stein-Helge Glad , Clendaniel Richard , Hovland Anders , Juul-Kristensen Birgit
Published: October 2019

Background: Dizziness is a common complaint, and the symptom often persists, together with additional complaints. A treatment combining of Vestibular Rehabilitation (VR) and Cognitive Behaviour Therapy (CBT) is suggested. However, further research is necessary to evaluate the efficacy of such intervention. The objective of this paper is to present the design of a randomised controlled trial aiming at evaluating the efficacy of an integrated treatment of VR and CBT on dizziness, physical function, psychological complaints and quality of life in persons with persistent dizziness. Methods/Design: The randomised controlled trial is an assessor-blinded block randomised parallel-group design, with a 6- and 12- month follow-up. The study includes 125 participants from Bergen (Norway) and surrounding areas. Included participants present with persistent dizziness lasting at least 3 months, triggered or exacerbated by movement. All participants receive a one-session treatment (Brief Intervention) with VR before being randomised into a control-group or an intervention-group. The intervention-group will further be offered an eight-session treatment integrating VR and CBT. The primary outcomes in the study are the dizziness handicap inventory and preferred gait velocity. Discussion: Previous studies combining these treatments have been of varying methodological quality, with small samples, and long-term effects have not been maintained. In addition, only the CBT has been administered in supervised sessions, with VR offered as home-exercises. The current study focuses on the integrated treatment, sufficiently powered sample size, and a standardised treatment program evaluated by validated outcomes using a standardised assessment protocol. Trial registration: The study was registered at www.clinicaltrials.gov (NCT02655575) on January 14th 2016. Keywords: Protocol, RCT, persistent dizziness, vestibular rehabilitation, cognitive behaviour therapy, dizziness handicap inventory, gait velocity, rehabilitation
Four collateral circulation pathways were observed after common carotid artery occlusion
Authors: Wang Jianan , Zheng Chengrong , Hou Bei , Huang Aihua , Zhang Xiongwei , Du Bin
Published: October 2019

Background: Common carotid artery (CCA) occlusion (CCAO) is a rare condition. Owing to collateral circulation, ipsilateral internal carotid artery (ICA) and external carotid artery (ECA) are often patent. Methods: This study included 16 patients with unilateral CCAO and patent ipsilateral ICA and ECA. The pathways which supplied ICA were investigated by digital subtraction angiography (DSA), transcranial Doppler (TCD), magnetic resonance angiography (MRA) and computed tomography angiography (CTA). Results: In all 16 patients, TCD found antegrade blood flow in ipsilateral ICA in all 16 patients, which was supplied by retrograde blood flow in ipsilateral ECA through carotid bifurcation. We call this phenomenon “ICA steal”. DSA and CTA discovered four pathways of ICA steal, including 1) ipsilateral vertebral artery – occipital artery – ECA – ICA, 2) ipsilateral thyrocervical trunk or costocervical trunk – ascending cervical artery or deep cervical artery – occipital artery – ECA – ICA, 3) contralateral ECA – contralateral superior thyroid artery – ipsilateral superior thyroid artery – ipsilateral ECA – ICA, and 4) ipsilateral thyrocervical trunk – inferior thyroid artery – superior thyroid artery – ECA – ICA. Conclusions: ICA is possible to be patent and supplied by several collateral circulation pathways after CCAO.
The impact of C-reactive protein levels on headache frequency. The HUNT Study 2006-2008
Authors: Hagen Knut , Stovner Lars Jacob , Nilsen Kristian Bernhard , Kristoffersen Espen Saxhaug , Winsvold Bendik Slagsvold
Published: October 2019

Background Increased high sensitivity C- reactive protein (hs-CRP) levels have been found in many earlier studies on migraine, and recently also in persons with migraine and insomnia. The aim of this study was to see whether these findings could be reproduced in a large-scale population-based study.
Methods A total of 50,807 (54%) out of 94,194 invited aged ≥ 20 years or older participated in the third wave of the Nord-Trøndelag Health Study study performed in 2006-2008. Among these, 38,807 (41%) had valid measures of hs-CRP and answered questions on headache and insomnia. Elevated hs-CRP was defined as >3.0 mg/L. The cross-sectional association with headache was estimated by multivariate analyses using multiple logistic regression. The precision of the odds ratio (OR) was assessed with 95% confidence interval (CI).
Results In the fully adjusted model, elevated hs-CRP was associated with migraine (OR 1.14, 95% CI 1.04-1.25) and migraine with aura (OR 1.15, 95% CI 1.03-1.29). The association was strongest among individuals with headache ≥ 15 days/month for any headache (OR 1.26, 95% CI 1.08-1.48), migraine (OR 1.62, 95% CI 1.21-2.17), and migraine with aura (OR 1.84, 95% CI 1.27-2.67). No clear relationship was found between elevated hs-CRP and headache less than 7 days/month or with insomnia.
Conclusions Cross-sectional data from this large-scale population-based study showed that elevated hs-CRP was associated with headache ≥ 7 days/month, especially evident for migraine with aura.
Understanding Family Caregivers’ Needs to Support Relatives with Advanced Disease at Home: An Ethnographic Study in Rural Portugal
Authors: Teixeira Maria Joao Cardoso , Abreu Wilson , Costa Nilza , Maddocks Matthew
Published: October 2019

Background: Family caregivers play an important role supporting their relatives with advanced progressive disease to live at home. There is limited research to understand family caregiver needs over time, particularly outside of high-income settings. The aim of this study was to explore family caregivers’ experiences of caring for a relative living with advanced progressive disease at home, and their perceptions of met and unmet care needs over time.
Methods: An ethnographic study comprising observations and interviews. A purposive sample of 10 family caregivers and 10 relatives was recruited within a rural area in the north of Portugal. Data were collected between 2014-16 using serial participant observations (n=33) and in-depth interviews (n=11). Thematic content analysis was used to analyse the data.
Results: Five overarching themes were yielded: (1) provision of care towards independence and prevention of complications; (2) perceived and (3) unknown caregiver needs; (4) caregivers’ physical and emotional impairments; and (5) balancing limited time. An imbalance towards any one of these aspects may lead to reduced capability and performance of the family caregiver, with increased risk of complications for their relative. However, with balance, family caregivers embraced their role over time.
Conclusions: These findings enhance understanding around the needs of family caregivers, which are optimally met when professionals and family caregivers work together with a collaborative approach over time. Patients and their families should be seen as equal partners. Family-focused care would enhance nursing practice in this context and this research can inform nursing training and educational programs.
Relation between carotid vulnerable plaques and peripheral leukocyte: A case-control study of comparison utilizing multi-parametric CEUS
Authors: Luo Xianghong , Li Wanbin , Bai Yun , Du Lianfang , Wu Rong , Li Zhaojun
Published: October 2019

Background: This study evaluates carotid vulnerable plaques using contrast-enhanced ultrasound (CEUS) and explores the relationship between vulnerable plaques and leukocytes.Methods: Sixty-two symptomatic and 54 asymptomatic patients underwent CEUS. The images were analyzed using time-intensity and fitting curves, and peak (PTIC), mean (MTIC), peak (PFC), sharpness (SFC), and area under the curve (AUCFC) were obtained. The relations between CEUS parameters and leukocytes were analyzed.Results: In the symptomatic group, total leukocytes and neutrophils were higher, while lymphocyte was decreased; PTIC, MTIC, PFC, SFC,, and AUCFC were significantly higher; MTIC and AUCFC were negatively correlated with lymphocytes, and MTIC was positively correlated with neutrophils. Classification and regression tree analysis showed that MTIC at a cutoff of 20.8 and AUCFC at a cutoff of 8.8 resulted in a predictive of acute cerebral infarction, accuracy of 84.3%, sensitivity of 87.1%, and specificity of 81.5%.Conclusions: The variation in the perivascular leucocyte is significantly related to intraplaque inflammatory activities, CEUS is a feasible monitor of intraplaque neovascularization, so CEUS combined with perivascular leucocyte could be helpful as a warning for vulnerable plaques.
Reducing preterm mortality in eastern Uganda: The impact of introducing low-cost bubble CPAP on neonates <1500g
Authors: Okello Francis , Egiru Emmanuel , Ikiror Juliet , Acom Linda , Loe Kate SM , Olupot-Olupot Peter , Burgoine Kathy
Published: October 2019

Background:
Complications of prematurity are the leading cause of deaths in children under the age of five.The predominant reason for these preterm deaths is respiratory distress syndrome (RDS). In low-income countries (LICs) there are limited treatment options for RDS. Due to their simplicity and affordability, low-cost bubble continuous positive airway pressure (bCPAP) devices have been introduced in neonatal units in LICs to treat RDS. This study is the first observational study from a LIC to compare outcomes of very-low-birth-weight (VLBW) neonates in pre- and post-CPAP periods.

Methods:
This was a retrospective study of VLBW neonates (weight <1500 grams) in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. It aimed to measure the outcome of VLBW neonates in two distinct study periods: A 14-month period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period following the introduction of bCPAP (post-bCPAP). After the introduction of bCPAP, it was applied to preterm neonates with RDS when clinically indicated and if a device was available. Clinical features and outcomes of all neonates <1500g were compared before and after the introduction of bCPAP.

Results:
The admission records of 377 VLBW neonates <1500g were obtained. 158 were admitted in the pre-bCPAP period and 219 in the post-bCPAP period. The mortality rate in the pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P =0.012) in the post-bCPAP period. Overall, there was a 44% reduction in mortality (OR 0.56, 95%CI 0.36-0.86, P = 0.01).There were no differences in birthweight, sex, presence of signs of respiratory distress or apnoea between the two groups.

Conclusion:
Specialized and resource-appropriate neonatal care, that appropriately addresses the challenges of healthcare provision in LICs, has the potential to reduce neonatal deaths.The use of a low-cost bCPAP to treat RDS in VLBW neonates resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Since RDS is one of the leading causes of neonatal mortality, it is possible that this relatively simple and affordable intervention could have a huge impact on global neonatal mortality.
Challenges With Study Fidelity When Conducting Household Surveys: Reports From The Field
Authors: Folayan Morenike , Alade Michael A , Ozeigbe Elizabeth O
Published: October 2019

Objectives: The aim of the study was to identify reasons for protocol deviations during conduct of large epidemiological surveys despite training of field workers, validating clinicians, and providing field supervisory support. Enquiries focused on breaches of recruitment procedures, privacy, confidentiality, and informed consent. The case study was a household survey conducted in Ile-Ife, Nigeria.

Results: The study reveals that despite training of field workers, providing supervisory support, and conducting validation exercises, protocol deviation still occurred. Measures to improve internal research validity during the conduct of surveys can minimise but not eliminate protocol deviations. Individual and environmental factors increase the risk for protocol deviation. Individual factors include personal bias against adherence to elements of the protocols, and pressure to meet personal recruitment targets to maximise remuneration. These pressures increase the risk of breaching study participants’ recruitment process. Environmental pressures resulted from low research literacy that made it possible for field workers not to consent participants and for participants not to prioritise privacy. The use of electronic data collection enhanced data security. A key recommendation from the study was that improved field supervision will reduce the risk for protocol violation.
A nationwide survey of the opinions of paediatricians regarding the management of neonates born to women with group B Streptococcus in Japanese maternity homes
Authors: yamaguchi kotomi , Ohashi Kazutomo
Published: October 2019

Objective: The Japanese Midwifery Association (JMA) guidelines allow midwives to manage group B Streptococcus (GBS)-positive women during pregnancy and labour at maternity homes. However, no guidelines exist to manage neonates born to GBS-positive women in Japan. We aimed to investigate the opinions of paediatricians regarding optimal management strategies for neonates born to GBS-positive women in maternity homes. A questionnaire was sent to paediatricians at 396 Japanese perinatal medical centres. We examined opinions regarding examinations and routine clinical tests for neonates born to GBS-positive women in maternity homes.
Results: Of 235 paediatricians, only 11.2% considered that paediatric examinations were unnecessary for neonates born to GBS-positive women in maternity homes. Moreover, 20.5%, 13.2%, and 11.1% of paediatricians considered culture test of the nasal cavity, serum C-reactive protein level analysis, and blood cell count analysis, respectively, necessary for neonates born to GBS-positive pregnant women with intrapartum antibiotic prophylaxis (IAP), whereas 36.3%, 56.2%, and 40.6% of paediatricians considered these tests necessary in cases without IAP. The JMA guidelines had low penetration rates among paediatricians in Japan. To manage neonates born to GBS-positive women in maternity homes, midwives should engage with commissioned paediatricians in more detail and develop appropriate strategies to increase awareness and cooperation.
Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke
Authors: he lanying , Xu Ronghua , Wang Jian , Zhang LIli , Zhang Lijuan , Zhao Wang , Dong Weiwei
Published: October 2019

Background: Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS).
Methods: This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and n o prestroke statins use groups , who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score≥3), and composite outcome (death/major disability) at 3 months after AIS.
Results: 136 patients were in no prestroke statins use group, and 106 in prestroke statins use group . Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P<0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval(CI), 0.99-1.12; P=0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16–0.91; P=0.031)], major disability (adjusted OR, 0.38; 95%CI, 0.15–0.99; P=0.047), and composite outcome (adjusted OR, 0.31; 95% CI,0.17–0.74; P=0.009).
Conclusions: Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.
Magnitude of metabolic syndrome and its associated factors among patients with type 2 diabetes mellitus in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2019: a cross sectional study
Authors: Gebremeskel Gebreamlak Gebremedhn , Berhe Kalayou Kidanu , Belay Desta Siyoum , Kidanu Berihu Hailu , Negash Assefa Iyasu , Gebreslasse Kfle Tekulu , Tadesse Degena Bahrey , Birhanu Mulugeta Molla
Published: October 2019

Abstract
Objective : The objective of this study was to assess magnitude of metabolic syndrome and its associated factors among type 2 diabetes mellitus patients in Ayder comprehensive specialized hospital. A hospital based cross sectional study design was used. Binary logistic regression model was used.
Result : A total of 419 respondents (208 males and 211 females) were enrolled; the mean age was 56.39 (SD 10.18), 51.1% of the respondents had metabolic syndrome according to international diabetes federation. Sex and age were statistically associated with metabolic syndrome with [AOR (95% CI) = 1.93(1.057, 3.533) and 1.04 (1.012, 1.072)] respectively. Regular physical exercise, overweight and obesity were statistically associated with metabolic syndrome with [AOR (95% CI) =1.84 (1.002, 3.362), 2.68 (1.518, 4.747) and 3.55 (1.254, 10.074)] respectively. To conclude, Magnitude of metabolic syndrome was high. The associated factors for metabolic syndrome are physical inactivity, inadequate intake of fruits, family history, overweight, and obesity.
Key words : Ethiopia, Associated Factors, Magnitude, Metabolic syndrome
Determinants and Seasonality of Major Structural Birth Defects Among Newborns Delivered at Primary and Referral Hospital of East and West Gojjam Zones, North West Ethiopia 2017- 2018: Case- Control Study
Authors: Tsehay Binalfew , Shitie Desalegn , Lake Akilog , Abebaw Erimiyas , Taye Amisalu , Essa Enatinesh
Published: October 2019

Objective: Although infant mortality because of birth defect has increased in both developed and developing countries, had not got attention like other health issues at national, regional, or local levels. Documenting the risk factors that influence the occurrence of birth defects and its seasonality will help to inform the community and to develop preventive strategies for the country.
Results: Factors associated with higher likelihood of a major structural birth defects included maternal age; neonates born from women living in urban; and in Dega; history of fever during pregnancy; intake of herbal medicine; and drinking alcohol. Counselling for pregnancy preparation and folic acid supplementation was found protective for the likelihood of birth defect.
Key words: Birth defect, maternal illness, maternal medication use, environmental exposure
Patient Satisfaction with Clinical Laboratory Services and Associated Factors among Adult Patients Attending Outpatient Departments at Debre Markos Referral Hospital, Northwest Ethiopia
Authors: Alelign Asmamaw , Belay Yihalem Abebe
Published: October 2019

Abstract
Objectives : There is limited evidence on patient satisfaction with clinical laboratory services in Northwest Ethiopia. This study aimed to assess patient satisfaction with clinical laboratory services and associated factors among adult patients attending outpatient departments at Debre Markos hospital, Northwest Ethiopia. Cross-sectional study was conducted among 391 patients from April 09-16, 2019 using interviewer-administered questionnaire. Systematic random sampling technique was used. Data were entered into Epi-Data software version 4.2, and analyzed using SPSS 23. Binary logistic regression analysis was employed. Variables having p-value < 0.05 were considered as statistically significant.
Results: Overall level of patient satisfaction towards clinical laboratory services was 48.3%. Patients with no occasion of missing laboratory results [AOR: 2.10; 95% CI (1.13, 3.83)], had diplomas and above educational level [AOR: 0.38; 95% CI (0.15, 0.96)], and who reported no place in the laboratory to put personal things [AOR: 0.37; 95% CI (0.21, 0.54)] were significant factors. Hospital administration and laboratory department in Debre Markos hospital should strengthen their effort to improve patient satisfaction focusing on educational status of patients, missing laboratory results, and the availability of places to put personal things in the blood drawing room.
Key words: Debre Markos hospital; Patient satisfaction; Laboratory services
Multi-drug Resistant Extended Spectrum Beta-Lactamase Producing E. coli and Salmonella on Raw Vegetable Salads Served at Hotels and Restaurants in Bharatpur, Nepal
Authors: Sapkota Sanjeep , Adhikari Sanjib , Pandey Asmita , Khadka Sujan , Adhikari Madhuri , Kandel Hemraj , Pathak Sandhya , Pandey Asmita
Published: October 2019

Antimicrobial resistance among bacteria present in ready-to-eat foods like vegetable salads is an emerging concern today. The current study was undertaken to investigate the presence of multi-drug resistant extended-spectrum β-lactamase (ESBL) producing E. coli and Salmonella spp. in raw vegetable salads served at hotels and restaurants in Bharatpur. A total of 216 salad samples were collected from three different grades of hotels/restaurants and examined for the presence of E. coli and Salmonella spp. in Microbiology laboratory of Birendra Multiple Campus by conventional microbiological techniques. Out of 216 samples, 66 samples (35.2%) showed presence of Salmonella spp. whereas E. coli was recovered from 29(13.4%) samples of which 3 samples harbored E. coli O157: H7. Antibiotic susceptibility testing revealed that 9(13.6%) Salmonella and 4(13.8%) E. coli isolates were multi-drug resistant. Total ESBL producers reported were 5(7.57%) Salmonella and 4(13.8%) E. coli . The study also assessed a significant association between occurrence of E. coli and Salmonella with grades of hotels/restaurants, personal hygiene and literacy rate of chefs and with type of cleaning materials used to wash knives and chopping boards (p<0.05). The findings suggest immediate need of attention by concerned authorities to prevent emergence and transmission of food-borne pathogens and antimicrobial resistance.
Febrile neutropenia management in pediatric cancer patients at Ethiopian Tertiary Care Teaching Hospital
Authors: Bedewi Husnia , Berihun Malede , Mulu Atalay , Assefa Tamrat
Published: October 2019

Objective This study aimed at assessing the management practice of febrile neutropenia (FN) in pediatric cancer patients at Tikur Anbessa Specialized Hospital (TASH), Ethiopia by reviewing patients’ charts from 135 participants retrospectively. Data was entered into Epi-info 7 and exported to SPSS 20 for analysis. Results Empiric antibiotics therapy (EAT) was given to all patients in which ceftriaxone with gentamycin constituted of 71.9% followed by ceftriaxone monotherapy. EATs were converted to others in 20 (14.8%) and 2(1.5%) patients for the first and second times respectively, mainly based on poor clinical response without conducting culture and sensitivity tests. These tests were done only for 13 (9.6%) participants and growth was seen in 5 patients; and definitive therapy was given for 2 patients. ANC value was above 500 cell/mm3 in 80.7% of patients and 98.5% of study participants were afebrile after completion FN treatment. Most of them (70.4%) were treated for FN and 7 of patients died due to all case mortality. The hospital should not rely mainly only on ceftriaxone with gentamycin as EAT and also should do culture and sensitivity test to optimize therapy based on susceptibility result before conversion and modification of therapy in management of FN.