bluuebunny/crossref_metadata_2025 huggingface dataset:
HUMAN LAB RATS IN JAMES DASHNER’S THE MAZE RUNNER SERIES (2009 – 2011): HISTORICAL REFERENCES, PRESENT ALLUSIONS, AND DYSTOPIAN FUTURE
Authors: Z. Alkhafaji Mayada , Yaroub Ansam
Published: November 2019

Purpose: This study aims to shed the light on allusions to real lab rats in Dashner’s trilogy: The Maze Runner (2009), The Scorch Trails (2010), and The Death Cure (2011).  It also aims to trace the historical documents and chronicles essential to reveal the justifications behind the vague political and scientific crimes.  Methodology: The researchers have used the literary analytical approach to study and analyze selected prominent aspects from each novel; such as the concept of lab rats and genocide crimes in The Maze Runner; references to weather experiments, the climate change conspiracy, gas chambers, and the Holocaust in The Scorch Trails; and finally, the man-made diseases and biological weapons in The Death Cure. Results: The outcomes confirm the necessity of knowing history whether bright or dark as a keyword to understand the present and predict the future. Also, Dashner has based The Maze Runners series on historical references as well as present-day vital scientific issues to predict a catastrophic future if a decision is not made. Young adult is chosen to lead the revolution against human abusing crimes and make a change. Applications: To develop a high understanding of young adult fiction, the researchers recommend those who are interested in literature with the necessity to apply this study to other post-apocalyptic, survival, adventure, science and dystopian series fictions, movies adaptations of related books, and related video games series that addressing young adults’ mind in order to diagnose any dilemma . Novelty/Originality: Hence, this study makes a difference in the sense of exposing the genocide crimes committed by the name of science embedded in Dashner's The Maze Runners series by tracing the historical, social, political, and scientific justifications regarding the concept of human lab rats as one of the worst human abusing experiences still used by tyrant regimes till now in ethnic and sectarian purification.
THERMOGRAPHIC EVALUATION FOR THE DIVERSE STAGE OF ANXIETY ON FACE TEMPERATURE AT FRONTAL AND TEMPORAL USING THERMAL IMAGING
Authors: Nata Septiadi Wayan , Dian Sulistiowati Ni Made , Wakhid Abdul
Published: November 2019

that it is able to provide accurate results about the temperature picture. The purpose of this study was to examine if there were differences in anxiety conditions at facial temperatures measured using thermal imaging.

Methodology: Eighty-one participants were taking the pre-clinical exams was chosen as the inclusion criteria and were divided into four categories of anxiety range (not anxious, mild anxiety, moderate anxiety, and severe anxiety) based on their score measured that using the General Anxiety Disorder (GAD-7) as the instrument. The participants were measured their face temperature using thermal imaging on the upper forehead (frontal) and left-right forehead (temporal). Data was analyzed to show the characteristic of anxiety level on the frontal and temporal temperature. There were difference anxiety conditions (no anxious, mildly anxious, moderate anxious and severe anxious) to thermal imaging face temperatures in the frontal and temporal.

Main findings: The results showed that more increased the temporal and frontal of face temperature, more severe the anxiety. There is a significant negative relationship between face temperature and anxiety level (p <0.05).

Implications: These findings showed that anxiety can be fast screening with a thermal imaging image. Further research is needed to determine the specificity and sensitivity of thermal imaging as an anxiety detection tool with a short time and without invasive action as one of the technological advances.

Novelty: There are no studies that discussed the correlation between anxiety with face temperature using thermal imaging.
Diseño experimental: interacciones formativas entre estudiantes y docentes de la Facultad de Diseño
Authors: Ceja Bravo Leobardo Armando
Published: November 2019

Este trabajo muestra algunos resultados obtenidos del proceso de investigación realizado en la materia de Diseño experimental, la cual fue impartida dentro del periodo de febrero a junio del 2018. En ella convergen las licenciaturas en Diseño industrial, de modas y calzado, gráfico, ambiental y espacios, mismas que integran la Facultad de Diseño de la Universidad De La Salle Bajío.
El objetivo fue recuperar los procesos, formas y vivencias de los participantes, dentro de una investigación educativa, mostrando y redimensionando el quehacer pedagógico en el proceso de aprendizaje-enseñanza del diseño desde el punto de vista de los actores. Bajo los postulados metodológicos de la investigación-acción, se precisó desarrollar una investigación de observación no participante, de carácter longitudinal y transversal.
La materia de Diseño experimental corresponde al plan de estudios que entró en vigor en el año 2017, y en cuya constitución fue concebida en un primer momento epistémico como de carácter interdisciplinar, por tal razón era altamente pertinente realizar una investigación in situ. En esta investigación participaron 192 estudiantes provenientes del segundo semestre de las licenciaturas en Diseño gráfico, Diseño ambiental y espacios, Diseño industrial y Diseño de modas y calzado; así mismo contó con la participación de seis profesores, quienes impartieron la materia referida, de forma simultánea, teniendo que socializar con grupos mixtos de estudiantes en cuatro equipos de ocho integrantes cada uno.
Violencia intrafamiliar y pensamiento creativo: factores que inciden en la resolución de conflictos en la infancia
Authors: Grajales Guzmán Catherine , Ceballos Ortiz Daniela , Asprilla Atencia Estefanía , Jaramillo Valencia Bairon
Published: November 2019

En este artículo se evidencia la incidencia de la violencia intrafamiliar en el pensamiento creativo; y, por ende, en la resolución de conflictos en la infancia entre los 7 y 9 años. Además, se encuentran definidos los términos de creatividad, pensamiento, pensamiento creativo y sus manifestaciones; a su vez, también se hallan los términos de agresividad, violencia, violencia intrafamiliar y sus tipos. Consecuentemente, este estudio se ubica en el paradigma cualitativo, más específicamente dentro del enfoque hermenéutico, haciendo uso de las narrativas como estrategia metodológica; la entrevista a profundidad y las técnicas interactivas como instrumentos de recolección de información.
Termal ve Kimyasal Önişlemlerin Atıksu Çamuru ve Şeker Pancarı Küspesi Karışımından Biyogaz Eldesindeki Etkilerinin Belirlenmesi
Authors: Peker Burak , Dadaşer Çelik Filiz
Published: November 2019

Bu
çalışmada, evsel atık suların arıtılması sonrası oluşan arıtma çamuru ve şeker
fabrikalarından atık olarak çıkan şeker pancarı küspesi kullanılarak biyogaz üretim
düzeyleri incelenmiştir. Bu maddelerden biyogaz üretim veriminin arttırılması
için termal ve kimyasal önişlemlerin etkileri değerlendirilmiştir.  Çalışmada 30 gün süreyle mezofilik şartlarda
anaerobik işlem uygulanmış, biyogaz üretim düzeyleri ve biyogaz içindeki metan
oranları ölçülmüştür. Önişlem uygulanmamış şeker pancarı küspesinden metan
üretim düzeyleri 84 L/kg UKM (uçucu katı madde) olarak gerçekleşirken, önişlem
uygulanmamış arıtma çamuru 67 L/kg UKM düzeyinde metan üretmiştir. Şeker
pancarı küspesi ve arıtma çamuru birlikte hammadde olarak kullanıldığında ise
metan üretim düzeyi 103 L/kg UKM olarak gerçekleşmiştir. Şeker pancarı küspesi ve
arıtma çamuru karışımlarına termal ve kimyasal (O3 ve NaOH) ön
işlemler uygulanmıştır. Termal ön işlemli karışımın metan üretim düzeyi 116
L/kg UKM, NaOH ile önişlem uygulanmış karışımın metan üretim düzeyi 99 L/kg UKM
ve ozon ile önişlem uygulanmış karışımın metan üretim düzeyi ise 133 L/kg UKM
olarak gerçekleşmiştir. Sonuç olarak, kimyasal ve termal önişlemlerin
atıklardan biyogaz eldesini arttırdığı tespit edilmiştir. Hammaddelere
uygulanan önişlemler organik maddenin daha kolay bozunabilir hale gelmesini
sağlamış, böylece daha yüksek biyogaz üretimi gerçekleşmiştir.
Dos espaços modernistas aos lugares da comunidade
Authors: Derntl Maria Fernanda
Published: November 2019

Os edifícios monumentais e amplos espaços abertos do Plano Piloto definiram imagens emblemáticas de Brasília. Este artigo busca, porém, destacar outras representações da capital, a partir da análise de memórias recentes de migrantes que se estabeleceram em cidades-satélites construídas na periferia de Brasília desde fins dos anos 50. Os relatos de experiências e práticas de construção naqueles núcleos dão novos significados a espaços concebidos segundo princípios modernistas e expressam sentimentos de pertencimento a comunidades vinculadas ao lugar. Mais do que analisar a efetiva construção de cidades-satélites, pretende-se investigar o modo como esse processo foi assimilado e narrado na dimensão subjetiva de quem o vivenciou.
Gloria, Afrenta Y Pesar Del Protector Del Perú
Authors: Pinto-Bazurco Mendoza Ricardo
Published: November 2019

El inexorable paso del tiempo avanza y con él se recrudecen los pesares y dolores propios de una vida que se apaga. Una intensa vida que estuvo inmersa en gloria pero que en su ocaso solo encontró, en los recuerdos de su propio autor, el único reconocimiento permanente que, lamentablemente, solo le otorgó la posteridad. Saludos y honores que, paulatinamente, se apagaron; situación que se manifestó a través de tres momentos claves expresados en elogios, pasquines y epístolas que nos permiten tener una clara idea de la relación que mantuvo el general José de San Martín y Matorras con una elite limeña que se encontró en vilo, económica y socialmente, como resultado de un plan político y una estrategia que no buscaron otra cosa que la libertad del Perú, y con ello sellar la independencia de Sudamérica. Esta relación se resume perfectamente en la gloria, afrenta y dolor del Protector del Perú.
La Voluntaria Incoherencia
Authors: Vivar Mendoza Aldo
Published: November 2019

.
La Tercera Singularidad
Authors: Casas Castañeda Jorge , Casas Quaderer Sebastian
Published: November 2019

La Inteligencia Artificial (IA) es un tema de gran actualidad, este artículo revisa el escenario actual en el cual se basa el próximo devenir de la IA y también vincularla en una perspectiva holística con la primera y segunda singularidad, las que culminan con la apertura del escenario para la tercera singularidad, perspectiva que servirá como un replanteamiento de la importancia universal de este próximo evento
Compare and Contrast Different Meanings of the Term World Music/World Music
Authors: Li Xueqian
Published: November 2019

With the booming popularity of the music industry today, there has been an equally increasing demand for new or refreshing music types. Over the years, this has a resulted in alternative/non-mainstream music genres gradually being accepted as popular music. To cater for the different tastes of music for consumers, in a world where advancement in technology has accelerated globalization to unprecedented levels, music Creators are producing music that have blurred the boundaries between music genres. On the other hand World Music is one that is seen by many as one which is routed in tradition. In that aspect, world music and popular music can be seen as two contrasting categories.
Effects of Water Supply Using Ultrasonic Atomization on the Working Life of MCF Slurry in MCF Polishing
Authors: Nomura Mitsuyoshi , Makita Naoya , Fujii Tatsuya , Wu Yongbo ,   Department of Mechanical Engineering, Akita Prefectural University 84-4 Aza Ebinokuchi, Tsuchiya, Yurihonjo City, Akita 015-0055, Japan,   Department of Mechanical and Energy Engineering, Southern University of Science and Technology, Shenzhen, China
Published: November 2019

The magnetic compound fluid (MCF) polishing process is a precision finishing method that has been applied to a large variety of materials, from soft optical polymers to hard ceramics. The purpose of this study is to extend the working life of MCF slurry. In this paper, we focus on the drying phenomenon of MCF slurry during polishing, and we develop a new water supply system that uses an ultrasonic atomization mechanism. This system can moisturize the MCF polishing area locally. Polishing experiments involving supplying water to MCF slurry are carried out, and extending the working life of MCF slurry is discussed.
New Magnetic Abrasive Finishing for Alumina Ceramic Plane Using Alternating Magnetic Fields
Authors: Dong Chaowen ,   Graduate School of Engineering, Utsunomiya University 7-1-2 Yoto, Utsunomiya, Tochigi 321-8585, Japan, Zou Yanhua
Published: November 2019

In this paper, we propose a new plane magnetic abrasive finishing method, applicable to planes, that uses the alternating magnetic fields to solve problems such as the easy deformation and poor recovery of a magnetic brush in conventional magnetic abrasive finishing method. Compared with the magnetic brush used in conventional magnetic abrasive finishing, that in the new method can stably shape a workpiece under an alternating magnetic field. To determine the optimal finishing parameters, we focused on studying the effects of spindle rotational speed, size of diamond particle, and frequency of alternating magnetic field on the finishing surface. Then, according to the obtained optimal finishing parameters, multi-stage finishing experiments were performed with the new method. The results show that surface roughness can be improved from 230 nm Ra to 19 nm Ra in 60 min with the proposed method.
Micro Fabrication of Au Thin-Film by Transfer-Printing Using Atomic Diffusion Bonding
Authors: Kaneko Arata ,   Faculty of Systems Design, Tokyo Metropolitan University 6-6 Asahigaoka, Hino, Tokyo 191-0065, Japan, Katayama Taira , Morishita Shun
Published: November 2019

Transfer printing of a thin film is a great candidate technique for micro/nanofabrication for microelectromechanical system (MEMS) elements. The authors propose a technique to apply atomic diffusion bonding to transfer printing of a gold (Au) thin film. When a substrate is previously coated with Au thin film as an adhesive, another Au thin film can be transfer-printed from a h-PDMS stamp to the substrate. It enables 50 μm-wide line patterns of the Au thin film located on the Au-coated Si substrate, whereas the Au thin film cannot be transfer-printed on a bare (uncoated) Si surface. The interface between two Au thin films disappears after transfer printing; hence, the Au atoms can interdiffuse from one to another to make a strong bonding. This process can be performed with a soft contact without any pressure in atmospheric and vacuum conditions. In the case of Au, the atoms can interdiffuse around a contacted area at room temperature. Moreover, one can make 50 μm-wide line patterns by 1 min of transfer printing and that of 24 h. The proposed process makes the line patterns of the Au thin film transfer-printed to be a bridged microbeam over the grooves when a prestructured (grooved) substrate is prepared.
Automated Process Planning System for End Milling Operation Constrained by Geometric Dimensioning and Tolerancing (GD&T)
Authors: Nishida Isamu ,   Kobe University 1-1 Rokko-dai, Nada-ku, Kobe, Hyogo 657-8501, Japan, Adachi Shogo , Shirase Keiichi
Published: November 2019

To realize autonomous machining, it is necessary to focus on machining tools and also on the automation of process planning in the preparation stage. This study proposes a process planning system that automatically defines the machining region and determines the machining sequence. Although previous studies have explored computer-aided process planning, only a few have considered geometric tolerances. Geometric tolerances are indicated on product drawings to eliminate their ambiguity and manage machining quality. Geometric dimensioning and tolerancing (GD&T) is a geometric tolerance standard applied to a three-dimensional computer-aided design (3D CAD) model and are expected to be used for the digitization of manufacturing. Therefore, this study developed an automated process planning system by using GD&T as a sequencing constraint. In the proposed system, the machining sequence is automatically determined by the geometrical constraints, which indicate whether the tool can approach, and GD&T, which indicates the geometric tolerance and datum in a 3D CAD model. A case study validated the proposed method of automated process planning constrained by GD&T. The result shows that the proposed system can automatically determine the machining sequence according to the geometric tolerance in a 3D CAD model.
Irrigation and Debridement, Modular Exchange, and Implant Retention for Acute Periprosthetic Infection After Total Knee Arthroplasty
Authors: Choo Kevin J. , Austin Matthew , Parvizi Javad
Published: November 2019

The role of irrigation and debridement, modular exchange, and implant retention for the treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) remains controversial. The proposed benefits of debridement, antibiotics, and implant retention, often referred to as DAIR, include reduced economic cost and morbidity of 2-stage reimplantation
1
. The primary disadvantage of this approach is a higher rate of failure and infection recurrence
2,3
. Furthermore, several authors have demonstrated inferior outcomes of 2-stage exchange revision arthroplasty after a failed attempt at limited debridement with implant retention
4–6
.

Because of study heterogeneity, the outcomes of acute PJI treatment with irrigation and debridement and implant retention have been variable in the literature, with reported success rates ranging from 16% to 100%; overall, the success rate is around 50%
3,7,8
. Recently, studies evaluating outcomes of DAIR have indicated that host factors, organism type, the timing of intervention, and the duration of symptoms can influence the likelihood of success with this approach
7,9–12
.

DAIR may be considered for all patients with early postoperative PJI or an acute hematogenous infection in the context of well-fixed implants and a healthy soft-tissue envelope. Chronic PJI should be considered an absolute contraindication to DAIR
13
. The patient’s health status, comorbidities, and immune status also should be considered. Caution should be exercised when considering DAIR for a patient in whom preoperative cultures demonstrate a drug-resistant or highly virulent organism, because of a higher risk of failure
1,9,14,15
. With careful patient selection and meticulous surgical technique, it is possible to achieve success with this treatment strategy.

The surgical procedure begins with a medial parapatellar approach and arthrotomy. A complete synovectomy is then performed, and remaining synovial tissue is aggressively debrided. Multiple culture samples should be obtained, and aseptic technique should be utilized to decrease contamination. The implant is interrogated to ensure stable fixation. Following adequate debridement, high-volume irrigation is performed; in cases involving irrigation and debridement with implant retention, we recommend incorporation of an antiseptic solution such as povidone-iodine. We recommend switching to a clean setup to facilitate sterile, uncontaminated closure of the wound, which is performed in a standard fashion. Meticulous attention should be paid to layered closure, and, if there is concern about delayed skin-healing, incisional negative-pressure wound therapy may be utilized.
New Tools for the Evaluation of Asbestos-Related Risk during Excavation in an NOA-Rich Geological Setting
Authors: Turci Francesco , Avataneo Chiara , Botta Serena , Marcelli Igor , Barale Luca , Tomatis Maura , Cossio Roberto , Tallone Sergio , Piana Fabrizio , Compagnoni Roberto
Published: November 2019

The presence of naturally occurring asbestos (NOA) in many areas worldwide requires an enhanced geological risk evaluation to ensure workplace safety from asbestos during large construction projects. Due to the complexity of the geological risk definition, health and safety regulations for working with asbestos-bearing materials are often not enforceable in NOA settings. Therefore, to correctly estimate the risk of NOA in these scenarios, new procedures are urgently needed to provide (1) a detailed geological model representative of the possible presence of the asbestos, (2) representative sampling, and (3) a reliable quantitative determination of asbestos content in rocks. This work aims to discuss the improvements on the two latter points specifically developed during the design of the “Gronda di Genova” project, a 50-km-long tunnel bypass partially designed in the NOA-bearing meta-ophiolites of the Ligurian Alps and ophiolites of the northern Apennines in Italy. Implementation of Gy's theory on sampling was used to maintain statistical validity during sample processing from the primary sample to the analytical sample and is here described. The scanning electron microscopy/energy dispersive spectroscopy procedure for the quantification of NOA was improved with an error analysis delivering the minimum number of fibers to be measured to achieve the best analytical results.
Reduced-Order Modeling of Coupled Flow and Quasistatic Geomechanics
Authors: Jin Zhaoyang Larry , Garipov Timur , Volkov Oleg , Durlofsky Louis J.
Published: November 2019

A reduced-order-modeling (ROM) framework is developed and applied to simulate coupled flow/quasistatic-geomechanics problems. The reduced-order model is constructed using POD-TPWL, in which proper orthogonal decomposition (POD), which enables representation of the solution unknowns in a low-dimensional subspace, is combined with trajectory-piecewise linearization (TPWL), where solutions with new sets of well controls are represented by means of linearization around previously simulated (training) solutions. The overdetermined system of equations is projected into the low-dimensional subspace using a least-squares Petrov-Galerkin (LSPG) procedure, which has been shown to maintain numerical stability in POD-TPWL models. The states and derivative matrices required by POD-TPWL, generated by an extended version of the Stanford University Automatic Differentiation General Purpose Research Simulator (AD-GPRS), are provided in an offline (preprocessing or training) step. Offline computational requirements correspond to the equivalent of five to eight full-order simulations, depending on the number of training runs used. Run-time (online) speedups of O(100) or more are typically achieved for new POD-TPWL test-case simulations. The POD-TPWL model is tested extensively for a 2D coupled problem involving oil/water flow and geomechanics. It is shown that POD-TPWL provides predictions of reasonable accuracy, relative to full-order simulations, for well-rate quantities, global pressure and saturation fields, global maximum- and minimum-principal-stress fields, and the Mohr-Coulomb rock-failure criterion, for the cases considered. A systematic study of POD-TPWL error is conducted using various training procedures for different levels of perturbation between test and training cases. The use of randomness in the well-bottomhole-pressure (BHP) profiles used in training is shown to be beneficial in terms of POD-TPWL solution accuracy. The procedure is also successfully applied to a prototype 3D example case.
Are the Philippines ready for HIV self-testing?
Authors: Gohil Jesal , Baja Emmanuel , SY Tyrone Reden , Guevara Ernest , Hemingway Charlotte , Medina Paul Mark , Coppens Leila , Dalmacion Godofreda V. , Taegtmeyer Miriam
Published: November 2019

Background: The Philippines is facing a rapidly rising HIV epidemic among young men who have sex with men (MSM). Testing rates among young populations is poor. HIV self-testing (HIVST) is a promising strategy to address this testing gap. Exploring the perceived acceptability, feasibility and programmatic challenges of HIVST among key informants and target users is an important first step.Method: A qualitative study involving semi-structured interviews and focus group discussions (FGD). We interviewed 15 key informants involved with HIV testing programs or policies and 42 target users in six FGD in Metro Manila. We held separate discussions with high socio-economic MSM (n= 12), urban poor MSM (n=15) and transgender women (TGW) (n= 15). Results were analysed using a thematic framework approach.Results: MSM and TGW welcomed the convenience and privacy HIVST could provide. They preferred an inexpensive accurate blood-based kit attained from reputable sites. Key informants at national and local level equally welcomed HIVST but identified a number of policy and regulatory issues. Both groups articulated the challenge of enrolling those who test reactive using HIVST to further testing and treatment in an environment characterised by acute stigma around HIV.Conclusions: HIVST was found to be highly acceptable to target users and was welcomed as an additional testing approach at national level. Strategic alliances are now needed between stakeholders to proactively deliver a patient-centred HIVST program that could provide an effective, safe means of increasing testing coverage in this escalating context.
Patterns of physical activity and health-related quality of life amongst patients with multimorbidity in a multi-ethnic Asian population
Authors: Subramaniam Mythily , Zhang Yunjue , Lau Jue Hua , Vaingankar Janhavi Ajit , Abdin Edimansyah , Chong Siow Ann , Lee Eng Sing
Published: November 2019

Background: The co-occurrence of two or more chronic medical conditions in an individual is defined as multimorbidity. Lifestyle factors, including poor dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption are key modifiable risk factors that play a role in the development of chronic medical conditions and potentially multimorbidity. The current study aimed to examine the levels of physical activity among those with multimorbidity and its association with socio-demographic factors, clinical parameters, and health-related quality of life (HRQoL) among community-dwelling adults attending a primary care clinic in Singapore. Methods: This cross-sectional study was conducted among patients with multimorbidity between August 2014 and June 2016. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) Short Form. Health related quality of life (HRQoL) was measured using the EuroQol-5 Dimension (EQ-5D-3L). Data on clinical parameters like hemoglobin A1c (HbA1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure were collected from patient records. Multivariable logistic regression analysis and linear regression were performed to determine the association between IPAQ and clinical health outcomes, as well as HRQoL measures, respectively. Results: In all, 932 respondents with multimorbidity were recruited for the study. Of them, 500 (53.8%) had low physical activity, 325 (35.0%) had moderate physical activity, while 104 (11.2%) had high physical activity. Respondents who were insufficiently active had significantly higher odds of being overweight/ obese (OR: 1.5, 95% confidence interval [CI]: 1.1- 1.9, p = 0.01) as compared to those were sufficient physical active. The multiple linear regression model revealed that insufficient activity level was negatively associated with EQ-5D index scores (β = -0.05, p < 0.001) and the visual acuity scale measuring HRQoL as compared to sufficient activity levels in respondents with multimorbidity. Conclusions: The low levels of physical activity among patients with multimorbidity, and its association with overweight status and poorer HRQoL emphasizes the importance of increasing physical activity in this population. Family physicians treating patients with chronic diseases need to continue encouraging and helping individuals to initiate and maintain appropriate physical activity levels.
Facilitators and Barriers of Managing Patients with Multiple Chronic Conditions in the Community: A Qualitative Study
Authors: Foo Kah Mun , Sundram Meena , Legido-Quigley Helena
Published: November 2019

Background About one-third of all adults worldwide were diagnosed with multiple chronic conditions (MCCs). Literature had found several challenges of providers and patients coping with managing MCCs in the community, and yet limited research studies that consider their viewpoints in combination. A qualitative study involving healthcare providers and users was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore. Methods This involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provides subsidised primary care services. Topic guides were developed with reference from literature review, Chronic Care Model (CCM) and Framework for patient-centred access to healthcare. Results Despite perceived affordable charges and availability of support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nation-wide medical savings scheme to cover outpatient treatment and medications. Half of the healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those that did not turn up might not receive timely care. Furthermore, patients reported long consultation waiting time. Physicians were able to propose and drive quality improvement projects to improve care quality. However, there were challenges of delivering safe and quality care with limited consultation duration due to the need to manage waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients. Although providers could equip patients with self-management and lifestyle related guidelines, patients’ actions are influenced by multiple factors including work nature, beliefs and environment. Conclusions There were barriers on care access, delivery and self-management as reported. It is crucial to adopt whole-of-society approach involving individuals, community, institutions and policymakers to improve and support MCCs management. This study has also highlighted the importance to consider different viewpoints of healthcare providers and users in policy formulation and community care planning.
Lassa Fever in post-Ebola Sierra Leone. Sociodemographics and case fatality rates of in-hospital patients admitted at the Kenema Government Hospital Lassa Fever Ward between 2016-2018
Authors: Kangbai Jia Bainga , Kamara Fatima Kinto , Lahai Rosaline Chukwu , Gebeh Fatmata
Published: November 2019

Background Lassa fever (LF) is a zoonotic acute viral illness mainly found in West Africa. The disease is endemic in some parts of West Africa including Sierra Leone, Liberia, Guinea and Nigeria; while other neighboring countries at high risk of its outbreak since the animal vectors are distributed throughout the region.Methods This is a retrospective mixed cohort study that analysed the treatment history containing the sociodemographic and clinical characteristics of 52 laboratory-confirmed LF cases that were admitted to the Kenema Government Hospital Lassa Fever Ward (KGHLFW) during 2016 to 2018; i.e. during the post Ebola outbreak in Sierra Leone. The LF patients whose treatment history we analysed came from either within or outside Kenema district were the KGHLFW is located.Results Majority (59.6%, n = 31/52) of the LF cases recorded during the period under review were adults; females (65.4%, n = 34/52). 2016 recorded more (40.4%, n = 21/52) LF cases; 2017 (28.8%, n = 15/52) and 2018(30.8%, n = 16/52).Conclusions We highlighted the significance of LF preventive and control measures that can target its seasonal epidemics. These measures could include strategies that can reduce human contact with the rodent vector as well as raise sensitization and awareness about LF among local residents especially those residing along the LF belt in eastern Sierra Leone.
What are the Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes
Authors: Kruse Clemens Scott , Ehrbar Nolan
Published: November 2019

Background Computerized decision support systems (CDSS) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSS, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. The purpose of this review was to analyze the relationship between CDSS, practitioner performance, and patient medical outcomes. PubMed, CINAHL, and Cochrane databases were queried.Methods 27 articles were chosen based on year published (last ten years), high quality source, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet to collect information on the relationship between CDSS and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, and outcomes (PICO) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse Protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting.Results Fourteen articles (52%) discussed positive practitioner performance, three articles (11%) found no difference in practitioner performance, ten articles (37%) did not discuss practitioner performance. Zero articles reported negative practitioner performance. Fifteen articles (56%) discussed positive patient medical outcomes, two articles (7%) found no statistically significant difference in medical outcomes between intervention and control groups, and ten articles (37%) did not discuss medical outcomes. Zero articles found negative patient medical outcomes.Conclusions Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found significant positive reporting of a positive effect on patient medical outcomes. Our findings support adoption of decision support systems.
Integrated gene-based and pathway analyses using UK Biobank data identify novel genes for chronic respiratory diseases
Authors: Wang Lijuan , Zhu Meng , Qin Na , Wang Yuzhuo , Fan Jingyi , Sun Qi , Ji Mengmeng , Fan Xikang , Xie Junxing , Ma Hongxia , Dai Juncheng
Published: November 2019

Background
Chronic respiratory diseases have become a nonnegligible cause of death globally. Although smoking and environmental exposures are primary risk factors for chronic respiratory diseases, genetic factors also play an important role in determining individual’s susceptibility to diseases. Here we performed integrated gene-based and pathway analyses to systematically illuminate the heritable characteristics of chronic respiratory diseases.
Methods
UK (United Kingdom) Biobank is a very large, population-based prospective study with over 500,000 participants, established to allow detailed investigations of the genetic and nongenetic determinants of the diseases. Utilizing the GWAS-summarized data downloaded from UK Biobank, we conducted gene-based analysis to obtain associations of susceptibility genes with asthma, chronic obstructive pulmonary disease (COPD) and pneumonia using FUSION and MAGMA softwares. Across the identified susceptibility regions, functional annotation integrating multiple functional data sources was performed to explore potential regulatory mechanisms with INQUISIT algorithm. To further detect the biological process involved in the development of chronic respiratory diseases, we undertook pathway enrichment analysis with the R package (clusterProfiler).
Results
A total of 195 susceptibility genes were identified significantly associated with chronic respiratory diseases ( P bonferroni <0.05), and 28/195 located out of known susceptibility regions (e.g. WDPCP in 2p15). Within the identified susceptibility regions, functional annotation revealed an aggregation of credible variants in promoter-like and enhancer-like histone modification regions and such regulatory mechanisms were specific to lung tissues. Furthermore, 110 genes with INQUISIT score ≥1 may influence diseases susceptibility through exerting effects on coding sequences, proximal promoter and distal enhancer regulations. Pathway enrichment results showed that these genes were enriched in immune-related processes and nicotinic acetylcholine receptors pathways.
Conclusions
This study conducted an integrated gene-based and pathway strategy to explore the underlying biological mechanisms and our findings may serve as promising targets for future clinical treatments of chronic respiratory diseases.
A multi-institutional and cross-sectional study on empathy in Chinese medical students: Differences by student cadre or not, future career preference, and father's education status
Authors: Yi Kangqi , Kang Mingyi , Li Dongju , Wang Zhipeng , Bai Jinsong , Xu Huiming , Ma Shulan
Published: November 2019

Background The aims of this study were to examine the factor structure of the Chinese version of the Jefferson Scale of Empathy for medical students (JSE-S) and investigate differences in empathy scores among Chinese medical students according to gender, student cadre or not, future career preference, and parents’ education.Methods Medical students from three universities completed an online questionnaire containing the JSE-S. Exploratory factor analysis was conducted to determine the factor structure, and group comparisons of empathy scores were examined via t-tests and analysis of variance.Results Four factors emerged from the factor analysis: “perspective taking,” “compassionate care,” “standing in the patient’s shoes,” and an uninterpretable factor. The results indicated that students who were female, held positions as student cadres, preferred to become a doctor, and whose fathers had a high school education or below tended to have more empathy.Conclusions Overall, the findings provide information on the dimensions of empathy applicable to Chinese medical students and confirm the factors found in the original measure. The dimensions have implications for developing empathy among Chinese medical students. Educators can use the information to design interventions to foster empathy among students in the context of Chinese medical education reform.
Identification of incipient tuberculosis in household contacts. The relevance of tuberculosis exposure scores and contact investigations.
Authors: Bekken Gry Klouman , Ritz Christian , Selvam Sumithra , Nelson Jesuraj , Hesseling Anneke C , Doherty Timothy Mark , Grewal Harleen MS , Vaz Mario , Jenum Synne
Published: November 2019

Background The goal of tuberculosis elimination put forward in the End TB Strategy prioritizes diagnosis and treatment of incipient TB, recently defined by key stakeholders as an “asymptomatic, early pre-clinical disease during which pathology evolves” . Regarded as indicative of a high risk of TB progression, considerable efforts have been made to identify incipient TB through exploration of biomarkers. The present study aimed to evaluate simple scoring systems for TB exposure as screening tools for incipient TB in a contact investigation (CI) setting of low HIV-prevalence.
Methods Nested within a large prospective study in household contacts (HHCs) of smear positive pulmonary TB cases in South-India conducted 2010-2012, we assessed 1) the association between the Tuberculosis Contact Score (TCS) and the Infectivity Score with established tools for Mycobacterium tuberculosis (Mtb) infection corrected for established TB risk factors and 2) the capability of the TB exposure scores to identify incipient TB defined by Mtb- culture positivity in sputum or gastric aspirate (subjects <5 years) specimen.
Results Of 525 HHCs, 29 were Mtb -culture positive and 96.6% of these asymptomatic. The TCS and the Infectivity Score associated with positive Tuberculin Skin Test and QuantiFeron TB-Gold In-tube assay (QFT) results in multivariate analyses (TCS: OR TST 1.16, 95%CI: 1.01, 1.33; OR QFT 1.33 95%CI: 1.16, 1.51. Infectivity Score: OR TST 1.39, 95%CI: 1.10, 1.76; OR QFT 1.41 95%CI: 1.16, 1.71). The Infectivity Score showed a moderate capability to identify incipient TB (AUC of 0.61, 95%CI: 0.52, 0.70).
Conclusion Although our results did not identify an easily applicable screening tool for incipient TB, the present study indicates that focusing on TB-related symptoms in CI settings may be of limited value for early identification of HHCs with high risk for TB progression, one of the goals of the End TB Strategy.
iTRAQ-Based Proteomic Analysis Reveals the Mechanisms of Botrytis cinerea controlled with Wuyiencin
Authors: Shi Liming , Ge Beibei , Wang Jinzi , Liu Binghua , Ma Jinjin , Wei Qiuhe , Zhang Kecheng
Published: November 2019

Background
Grey mould is an important plant disease worldwide, caused by Botrytis cinerea ，resulting in serious economic loss. Wuyiencin, a low toxicity, high efficiency, and broad-spectrum agricultural antibiotic, has been demonstrated effectiveness against B. cinerea.
Methods
In this study, we characterized the differential protein expression in wuyiencin-treated B. cinerea using high-resolution mass spectrometry and bioinformatic tools.
Results
Wuyiencin treatment inhibited growth and sporulation of B. cinerea, specifically altering hypha morphology and intracellular structures. These changes were accompanied by differential expression (fold change >2.0) of 316 proteins identified by iTRAQ-labelling LC-MS/MS analysis (P < 0.05). Up-regulation of 14 proteins, including carbohydrate metabolism proteins and cell wall stabilization proteins, was validated by parallel reaction monitoring (PRM). Down-regulation of 13 proteins was validated by PRM, including regulators of energy metabolism, nucleotide/protein synthesis, and the biosynthesis of mediators of plant stress and decay.
Conclusion
Our results confirm the inhibitory biological effects of wuyiencin on B . cinereal and elaborate on the differentially expressed proteins and associated pathways implicated in the capacity of wuyiencin to debilitate the growth and pathogenicity of grey mould. This study provides validated candidates for further targeted exploration with the goal of optimizing wuyiencin as a safe, low-toxicity agent for biological control.
Differential effect of chemical compounds on Helicobacter pylori growth and subsequent apoptosis
Authors: Kashyap Dharmendra , Baral Buddhadev , Verma Tarun Prakash , Sonkar Charu , Chatterji Debi , Jain Ajay Kumar , Jha Hem Chandra
Published: November 2019

Background Helicobacter pylori (H. pylori) is well-known for its role in chronic gastritis and gastric cancer. Eradication of these carcinogenic bacteria from the gut is one of the major challenges for the clinicians. The complexity of treatment is mainly owing to, antibiotic resistance and relapse due to extra gastric reservoir in the oral cavity. Our study focuses on the isolation of H. pylori from distinct habitats (gastric biopsy and gastric juice) of the gut microenvironment and its subsequent characterization. Further, we have also evaluated the effect of various plaque control agents on isolated strains of H. pylori.Results The strains isolated from two different habitats of the same subject shows a striking difference in their growth pattern. Promisingly, some included chemicals are effective in growth inhibition after recommended 30 sec treatment. The subsequent evaluation shows that chemical B (out of chemical A, B, C, D and E) is the most effective and downregulate the expression of CagA in the infected AGS cells.Conclusion For the fast time, in our study the pylori isolated from different habitat of the same subject shows differential growth pattern. Nowadays, antibiotic resistance and relapse of H. pylori make it difficult to eradicate the bacteria from gastric as well as oral reservoir. Thus, this study may help to reduce the bacteria in their oral reservoir and also control the H. pylori migration from oral to gastric compartment.
Dynamics of asymptomatic infections and symptomatic malaria show different temporal profiles among infants living in a high transmission area of Ghana
Authors: Botwe Akua Kyerewaa , Owusu-Agyei Seth , Asghar Muhammad , Hammar Ulf , Oppong Felix Boakye , Gyaase Stephaney , Dosoo David , Jakpa Gabriel , Twumasi Mieks Frenken , Kaali Ellen Boamah , Osier Faith , Farnert Anna , Asante Kwaku Poku
Published: November 2019

Background Although infants are vulnerable to malaria, the characteristics of their patterns of infections are not well described. This study aimed to examine the longitudinal profiles of asymptomatic infections and symptomatic malaria in the first year of life. Methods A birth cohort in Kintampo, Ghana (N = 1855) was followed actively with monthly blood sampling and passively for any febrile illness between 2008 and 2011. Malaria parasites were detected by light microscopy and infants who were infected or uninfected were identified. Infections were classified as either symptomatic or asymptomatic using fever and temperature readings over twelve months of follow up. The longitudinal infection profiles in all infants were then compared. Results: Asymptomatic infections and symptomatic malaria were observed at all ages but were rare the first months of life and the proportion of symptomatic malaria increased after six months. Among 1264 infants having microscopy data for at least eight monthly visits, four patterns were observed: parasite negative at all visits (36%), always asymptomatic (7%), always symptomatic (35%) and alternating between asymptomatic infections and symptomatic malaria (22%). The cumulative incidence of infection was highest in the alternating group, and many different profiles (87 different combinations) of asymptomatic infections and symptomatic malaria were observed in this group . Parasite densities were significantly low for the always asymptomatic group and highest for always symptomatic group. Conclusion Infants in malaria endemic areas experience highly different infection profiles over the first year of life despite living in the same area. In-depth investigations of why some infants are parasite free and others have repeated symptomatic malaria or maintain asymptomatic infections or alternate between asymptomatic infections and symptomatic malaria can contribute to understanding malaria susceptibility during infancy.
Türkiye’de Rüzgâr Erozyonuna Bağlı Toprak Kayıplarının Konumsal ve Zamansal Değişiminin Tahmin Edilmesi
Authors: İNCE Kenan , AKGÖZ Reşat , ERPUL Günay
Published: November 2019

Küresel ısınma ve iklim değişikliğine bağlı olarak kuraklığın ciddi bir arazi tahribatına neden olduğu bölgelerde, Sürdürülebilir Toprak Yönetimi (STY) ve Sürdürülebilir Arazi Yönetiminin (SAY) etkin bir şekilde uygulanamaması durumunda, rüzgâr erozyonunun etki alanını ve şiddetini giderek artırması beklenmektedir. Bu kapsamda farklı konumsal ve zamansal ölçeklerde model tabanlı rüzgâr erozyonu tehlikesi tahmin haritalarının üretilmesi büyük önem taşımaktadır. Bu çalışma ile rüzgâr erozyonu dinamikleri, kurak ve yarı kurak havzalar temelinde ulusal ölçekte değerlendirilerek karar vericiler için daha somut bir planlama veri tabanı olarak kullanıma hazır hale getirilmiş ve çok daha küçük alan ölçeğinde çalışma yapan araştırmacılar için de önemli bir uygulama altlığı olarak kullanıma sunulmuştur. Ulusal ölçekte rüzgâr erozyonunun tahmin edilebilmesi için kapsamlı, dinamik ve güncellenebilir veri kümeleri toplanmış ve Yenilenmiş Rüzgâr Erozyonu Eşitliği (Revised Wind Erosion Equation [RWEQ]) kullanılarak bir tahmin sistemi inşa edilmiştir. RWEQ modeline ait ana parametreler ve bunlara bağlı alt bileşenler matematiksel olarak analiz edilmiş ve Türkiye ölçeğinde rüzgâr erozyonu sonucu taşınan sediment miktarı ve rüzgâr erozyonunun etkilediği alanlara ait ara sonuçlar başarıyla üretilmiştir. Böylece aylık ve yıllık toprak kayıplarını tahmin etmek için 30mx30m mekânsal çözünürlükle üretilen model sonuçları yardımıyla STY ve SAY uygulamalarının stratejik olarak önceliklendirileceği alanlar belirli istatistiksel değişim aralığı içerisinde belirlenmiştir.