bluuebunny/crossref_metadata_2025 huggingface dataset:
Helicobacter pylori infection in rehabilitation staff younger than 35 years: Infection surveillance for three years
Authors: Ikezawa Kazuto , Kanamori Takeshige , Iwai Kentaro , Otsuka Kouichirou , Kobayashi Mariko , Ochi Daisuke , Sugiyama Hiroaki , Suzuki Hideo , Soeda Atsuko
Published: June 2019

Background:

Screening for Helicobacter pylori infection is important because of the high risk of gastric cancer development. The H. pylori carrier rate among elderly Japanese patients is still high; therefore, rehabilitation (RH) workers who are in frequent contact with such individuals could be assumed to be at a higher risk of H. pylori infection.

Aim/Objective:

We surveyed RH workers to investigate the initial occurrence of H. pylori infections in adults.

Methods:

Urine samples of RH workers aged < 35 years were screened for H. pylori antibodies to confirm infection. H. pylori infection rates were stratified according to the type of RH work and duration of employment. Infection surveillance was performed at six-month intervals for H. pylori-negative individuals.

Findings/Results:

The H. pylori infection rate among 173 workers was 16.8%. Infection rates were 26.3%, 16.3% and 15.3% among speech, occupational and physiotherapists, respectively. The employment duration was divided into < 24, 24–47, 48–60 and ⩾ 61 months; the respective infection rates were 5.0%, 12.0%, 17.6% and 28.6%. However, no new H. pylori infection was detected in a total of seven surveillance studies of H. pylori-negative workers over a three-year period.

Discussion:

The results of the initial examination showed that the infection rate increased with the duration of employment. However, subsequent surveillance detected no new H. pylori infections.
Contribution of pharmacy education to pharmaceutical research and development: critical insights from educators
Authors: Nouri AI , Hassali MA , Hashmi FK
Published: June 2019

Aims:

This article examines the outputs of pharmaceutical education with the development of the pharmacy profession and how that affects pharmaceutical innovation. It also discusses different models of collaboration between the academic and pharmaceutical industry in order to achieve a healthy collaboration between the stakeholders.

Methods:

The perspective, experiences and insights of educators from various backgrounds, origin and educational levels were sought regarding the role of pharmacy education in providing pharmaceutical research and development workforce.

Results:

Many countries around the world are currently undertaking major reforms in pharmacy education due to the changing landscape of health and healthcare delivery. These reforms must be accompanied by robust systems to assure that the quality of educational structures, processes and outcomes will produce competent pharmacy graduates in the future. It is also considered imperative that pharmacy academic institutions should establish collaboration with the drug development units, the pharmaceutical industry and government agencies for sustainability and positive research outcomes.

Conclusion:

Shortcomings in pharmacy curricula need to be addressed and the authors have proposed the ‘TARGET’ approach for the development of integrated pharmacy curriculum to substantially contribute to pharmaceutical research and development.
Cell-Free Scaffolds in Cartilage Knee Surgery: A Systematic Review and Meta-Analysis of Clinical Evidence
Authors: Andriolo Luca , Reale Davide , Di Martino Alessandro , Boffa Angelo , Zaffagnini Stefano , Filardo Giuseppe
Published: June 2019

Objective

To evaluate current evidence and results of cell-free scaffold techniques for knee chondral lesions.

Design

A systematic review was conducted on 3 medical electronic databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and the methodological quality was assessed with a modified Coleman Methodology Score. A meta-analysis was performed on the articles reporting results for visual analogue scale (VAS), Lysholm, and International Knee Documentation Committee (IKDC) scores. In order to investigate the clinical results improvement over time of cell-free cartilage scaffold implantation, all scores were reported and analyzed as improvement from basal scores at 1, 2, and ≥3 years’ follow-up.

Results

A total of 23 studies involving 521 patients were included in the qualitative data synthesis. The Coleman score showed an overall poor study quality with the majority of studies reporting results at short-/mid-term follow-up. Sixteen studies were included in the meta-analysis, showing a significant improvement from basal score at 1, 2, and ≥3 years’ follow-up. The improvement reached at 1 year remained stable up to the last follow-up for all scores.

Conclusions

The current literature suggests that cell-free scaffolds may provide good clinical short-/mid-term results; however, the low evidence of the published studies and their short mean follow-up demand further evidence before more definitive conclusions can be drawn on their real potential over time and on their advantages and disadvantages compared to the cell-based strategies for the treatment of cartilage lesions.
Differential clusters of modifiable risk factors for impaired fasting glucose versus impaired glucose tolerance in adults 50 years of age and older
Authors: Ghachem Ahmed , Brochu Martin , Dionne Isabelle J.
Published: June 2019

Background:

The aim of this study was to identify modifiable risk factors associated with isolated impaired fasting glucose (IFG), isolate impaired glucose tolerance (IGT), or combined IFG-IGT in men and women aged 50 years and older.

Methods:

Cross-sectional analyses were performed in 703 men and women aged between 50 and 80 years old from NHANES (2007–2008). Outcome variables: IFG and IGT (ADA 2003), estimated body composition, cardiometabolic profile, and socio-demographic, dietary, and lifestyle factors.

Results:

First, 235 had normal glucose tolerance (men = 38.3%, women = 61.7%), 243 had IFG (men = 61.7%, women = 38.3%), 67 had IGT (men = 40.3%, women = 59.7%) and 158 had both conditions (men = 57.0%, women = 43.0%). The only common determinant of both IFG and IGT was triglyceride levels. High total fat mass index (FMI) and high total fat-free mass index (FFMI) were independently associated with IFG; while high C-reactive protein (CRP) levels were independently associated with IGT. Finally, combined IFG-IGT was associated with inadequate fiber intake, high FMI, FFMI, and CRP levels.

Conclusions:

Middle-age and older individuals presented different modifiable risk factors depending on whether they had IFG or IGT. IFG was associated with deteriorated body composition and lipids, whereas IGT was associated with deteriorated lipids and inflammatory factors. IFG-IGT, on the other hand, was associated with a larger number of risk factors, including worsen body composition, cardiometabolic and dietary factors. To prevent the transition to type 2 diabetes, specific clinical interventions targeting these risk factors should be considered.
A pilot cohort study of deprescribing for nursing home patients acutely admitted to hospital
Authors: Russell Patrick , Laubscher Sara , Roberts Gregory W. , Mangoni Arduino A. , McDonald Cameron , Hendrix Ivanka , Hewage Udul , Hofmann Dirk , Michell Sophie , Taeuber Lauren , Woodman Richard J. , Shakib Sepehr , Crawford Gregory B. , Maddison John , Thompson Campbell
Published: June 2019

Background:

Patients from residential aged care facilities are commonly exposed to inappropriate polypharmacy. Unplanned inpatient admissions can provide an opportunity for review of complex medical regimens and deprescribing of inappropriate or nonbeneficial medications. The aim of this study was to assess the efficacy, safety and sustainability of in-hospital deprescribing.

Methods:

We followed a prospective, multi-centre, cohort study design, with enrolment of 106 medical inpatients age 75 years and older (mean age was 88.8 years) who were exposed to polypharmacy prior to admission and with a planned discharge to a nursing home for permanent placement. Descriptive statistics were calculated for relevant variables. The Short Form-8 (SF-8) health survey was used to assess changes in health-related quality of life (HRQOL) at 90-day follow up, in comparison with SF-8 results at day 30.

Results:

Deprescribing occurred in most, but not all patients. There were no differences between the groups in principal diagnosis, Charlson index, number of medications on admission or number of Beers list medications on admission. At 90 days, mortality and readmissions were similar, though the deprescribed group had significantly higher odds of better emotional wellbeing than the nondeprescribed group [odds ratio (OR) = 5.08, 95% confidence interval (CI): 1.93, 13.39; p = 0.001]. In the deprescribing group, 31% of the patients still alive at 90 days had medications restarted in primary care. One-year mortality rates were similar.

Conclusions:

Deprescribing medications during an unplanned hospital admission was not associated with mortality, readmissions, or overall HRQOL.
Developmental changes in fat talk to avoid peer rejection in Japanese girls and young women
Authors: Takamura Ai , Yamazaki Yoko , Omori Mika
Published: June 2019

“Fat talk” refers to conversations focused on body disparagement. We examined developmental changes in fat talk to avoid social rejection and the mediating role of fat talk between “thin-ideal” internalization and body dissatisfaction. A total of 214 high school girls and 227 college-aged women completed questionnaires assessing fat talk engagement, body dissatisfaction, thin-ideal internalization, and sensitivity to rejection. Path analyses showed that fat talk mediated between thin-ideal internalization and body dissatisfaction and that rejection sensitivity predicted fat talk among high school girls, but not among college women. The purpose of fat talk differed by developmental stage, suggesting that interventions for improving body image should be developmentally tailored.
Social Class and Educational Attainment: Do Blacks Benefit Less from Increases in Parents’ Social Class Status?
Authors: Bumpus John P. , Umeh Zimife , Harris Angel L.
Published: June 2019

Classic and contemporary studies show that greater social class status is associated with higher levels of education for youth. However, racialized processes might constrain the benefits blacks receive from increases in parents’ social class. In this study the authors use the Education Longitudinal Study of 2002 to estimate whether race moderates the relationship among three common measures of youths’ social class during high school (parents’ occupations, family income, and parents’ level of education) and their college enrollment two years after high school and educational attainment eight years after high school. The results suggest that black youth receive lower benefits from social class than whites for both outcomes, and parents’ gender plays a role in the racial differences in the link between social class and both outcomes. The authors also find a three-way interaction with family structure for mothers (among race, social class, and family structure); among youth not in two-parent households, blacks benefit less than whites from mothers’ occupational prestige on enrollment. This study extends the literature on social class and racial inequality in education by explicitly testing whether black youth receive lower benefits from social class in their attainment. Doing so separately for mothers’ and fathers’ social class characteristics uncovers a nuanced pattern useful for understanding race as a moderator to social class.
Social capital drives SME growth: A study of family firms in Poland
Authors: Marjański Andrzej , Sułkowski Łukasz , Marjańska-Potakowska Justyna , Staniszewska Katarzyna
Published: June 2019

Poland’s successful political, economic, and social transformation since the 1990s has seen the dynamic development of family enterprises. Most of them are in the small- and medium-sized enterprises sector and have become an important part of the Polish economy. What drives these family firms is not necessarily physical or even financial capital, but continuous human or social capital. We analyze how family businesses are based on the interdependence of family ownership and business with the social capital of the family. This article reflects on how the government, in encouraging small- and medium-sized enterprise development in an economy with traditionally low social capital, can benefit from the example of high social capital found in family firms. The article contains the interpretation of the results of research conducted in 2009–2010 and 2014–2016.
Gait speed, grip strength, and clinical outcomes in older patients with hematologic malignancies
Authors: Liu Michael A. , DuMontier Clark , Murillo Anays , Hshieh Tammy T. , Bean Jonathan F. , Soiffer Robert J. , Stone Richard M. , Abel Gregory A. , Driver Jane A.
Published: June 2019

This study aimed to evaluate whether gait speed and grip strength predicted clinical outcomes among older adults with blood cancers. We prospectively recruited 448 patients aged 75 years and older presenting for initial consultation at the myelodysplastic syndrome/leukemia, myeloma, or lymphoma clinic of a large tertiary hospital, who agreed to assessment of gait and grip. A subset of 314 patients followed for ≥6 months at local institutions was evaluated for unplanned hospital or emergency department (ED) use. We used Cox proportional hazard models calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for survival, and logistic regression to calculate odds ratios (ORs) for hospital or ED use. Mean age was 79.7 (± 4.0 standard deviation) years. After adjustment for age, sex, Charlson comorbidity index, cognition, treatment intensity, and cancer aggressiveness/type, every 0.1-m/s decrease in gait speed was associated with higher mortality (HR, 1.20; 95% CI, 1.12-1.29), odds of unplanned hospitalizations (OR, 1.33; 95% CI, 1.16-1.51), and ED visits (OR, 1.34; 95% CI, 1.17-1.53). Associations held among patients with good Eastern Cooperative Oncology Group performance status (0 or 1). Every 5-kg decrease in grip strength was associated with worse survival (adjusted HR, 1.24; 95% CI, 1.07-1.43) but not hospital or ED use. A model with gait speed and all covariates had comparable predictive power to comprehensive validated frailty indexes (phenotype and cumulative deficit) and all covariates. In summary, gait speed is an easily obtained “vital sign” that accurately identifies frailty and predicts outcomes independent of performance status among older patients with blood cancers.
Three-parameter prestack seismic inversion based on L1-2 minimization
Authors: Wang Lingqian , Zhou Hui , Wang Yufeng , Yu Bo , Zhang Yuanpeng , Liu Wenling , Chen Yangkang
Published: June 2019

Prestack inversion has become a common approach in reservoir prediction. At present, the critical issue in the application of seismic inversion is the estimation of elastic parameters in the thin layers and weak reflectors. To improve the resolution and the accuracy of the inversion results, we introduced the difference of [Formula: see text] and [Formula: see text] norms as a nearly unbiased approximation of the sparsity of a vector, denoted as the [Formula: see text] norm, to the prestack inversion. The nonconvex penalty function of the [Formula: see text] norm can be decomposed into two convex subproblems via the difference of convex algorithm, and each subproblem can be solved efficiently by the alternating direction method of multipliers. Compared with the [Formula: see text] norm regularization, the [Formula: see text] minimization can reconstruct reflectivities more accurately. In addition, the [Formula: see text]-[Formula: see text] predictive filtering was introduced to guarantee the lateral continuity of the location and the amplitude of the reflectivity series. The generalized linear inversion and [Formula: see text]-[Formula: see text] predictive filtering are combined for stable elastic impedance inversion results, and three parameters of P-wave velocity, S-wave velocity, and density can be inverted with the Bayesian linearized amplitude variation with offset inversion. The inversion results of synthetic and real seismic data demonstrate that the proposed method can effectively improve the resolution and accuracy of the inversion results.
Attenuation of random noise using denoising convolutional neural networks
Authors: Si Xu , Yuan Yijun , Si Tinghua , Gao Shiwen
Published: June 2019

Random noise often contaminates seismic data and reduces its signal-to-noise ratio. Therefore, the removal of random noise has been an essential step in seismic data processing. The [Formula: see text]-[Formula: see text] predictive filtering method is one of the most widely used methods in suppressing random noise. However, when the subsurface structure becomes complex, this method suffers from higher prediction errors owing to the large number of different dip components that need to be predicted. Here, we used a denoising convolutional neural network (DnCNN) algorithm to attenuate random noise in seismic data. This method does not assume the linearity and stationarity of the signal in the conventional [Formula: see text]-[Formula: see text] domain prediction technique, and it involves creating a set of training data that are obtained by data processing, feeding the neural network with the training data obtained, and deep network learning and training. During deep network learning and training, the activation function and batch normalization are used to solve the gradient vanishing and gradient explosion problems, and the residual learning technique is used to improve the calculation precision, respectively. After finishing deep network learning and training, the network will have the ability to separate the residual image from the seismic data with noise. Then, clean images can be obtained by subtracting the residual image from the raw data with noise. Tests on the synthetic and real data demonstrate that the DnCNN algorithm is very effective for random noise attenuation in seismic data.
Semisupervised sequence modeling for elastic impedance inversion
Authors: Alfarraj Motaz , AlRegib Ghassan
Published: June 2019

Recent applications of machine learning algorithms in the seismic domain have shown great potential in different areas such as seismic inversion and interpretation. However, such algorithms rarely enforce geophysical constraints — the lack of which might lead to undesirable results. To overcome this issue, we have developed a semisupervised sequence modeling framework based on recurrent neural networks for elastic impedance inversion from multiangle seismic data. Specifically, seismic traces and elastic impedance (EI) traces are modeled as a time series. Then, a neural-network-based inversion model comprising convolutional and recurrent neural layers is used to invert seismic data for EI. The proposed workflow uses well-log data to guide the inversion. In addition, it uses seismic forward modeling to regularize the training and to serve as a geophysical constraint for the inversion. The proposed workflow achieves an average correlation of 98% between the estimated and target EI using 10 well logs for training on a synthetic data set.
Incisional Injury Modulates Morphine Reward and Morphine-Primed Reinstatement: A Role of Kappa Opioid Receptor Activation
Authors: Nwaneshiudu Chinwe A. , Shi Xiao-You , Clark J. David
Published: June 2019

BACKGROUND:

Persistent use of prescription opioids beyond the period of surgical recovery is a large part of a public health problem linked to the current opioid crisis in the United States. However, few studies have been conducted to examine whether morphine reward is influenced by acute pain and injury.

METHODS:

In a mouse model of incisional injury and minor trauma, animals underwent conditioning, extinction, and drug-primed reinstatement with morphine to examine the rewarding properties of morphine in the presence of acute incisional injury and drug-induced relapse, respectively. In addition, we sought to determine whether these behaviors were influenced by kappa opioid receptor signaling and measured expression of prodynorphin messenger RNA in the nucleus accumbens and medial prefrontal cortex after conditioning and before reinstatement with morphine and incisional injury.

RESULTS:

In the presence of incisional injury, we observed enhancement of morphine reward with morphine-conditioned place preference but attenuated morphine-primed reinstatement to reward. This adaptation was not present in animals conditioned 12 days after incisional injury when nociceptive sensitization had resolved; however, they showed enhancement of morphine-primed reinstatement. Prodynorphin expression was greatly enhanced in the nucleus accumbens and medial prefrontal cortex of mice with incisional injury and morphine conditioning and remained elevated up to drug-primed reinstatement. These changes were not observed in mice conditioned 12 days after incisional injury. Further, kappa opioid receptor blockade with norbinaltorphimine before reinstatement reversed the attenuation induced by injury.

CONCLUSIONS:

These findings suggest enhancement of morphine reward as a result of incisional injury but paradoxically a protective adaptation with incisional injury from drug-induced relapse resulting from kappa opioid receptor activation in the reward circuitry. Remote injury conferred no such protection and appeared to enhance reinstatement.
The American Board of Anesthesiology’s Staged Examination System and Performance on the Written Certification Examination After Residency
Authors: Zhou Yan , Sun Huaping , Macario Alex , Martin Donald E. , Rathmell James P. , Warner David O.
Published: June 2019

This study compared anesthesiology residency graduates’ written certification examination performance before and after the American Board of Anesthesiology (ABA) introduced the staged examination system. After equating test scores using common test items, the first 2 cohorts (2013, 2014) in the staged system scored 7.1 points and 8.3 points higher than the 2011 baseline cohort in the former examination system. The 2013 and 2014 cohorts’ pass rates (94.2% and 95.9%) were also higher than the 2011 and 2012 cohorts (91.9% and 92.6%) if a common standard had been applied. The staged examination system may be associated with improved knowledge of anesthesiology graduates.
Heterogeneity Among Hospitals in the Percentages of All Lumbosacral Epidural Steroid Injections Where the Patient Had Received 4 or More in the Previous Year
Authors: Pearson Amy C. S. , Dexter Franklin , Epstein Richard H.
Published: June 2019

BACKGROUND:

Current guidelines for the administration of therapeutic epidural injections suggest that these be limited to a maximum of 4 per year. We sought to gain an understanding of the proportion of lumbosacral epidural injections administered to patients who had received ≥4 such injections during the preceding 364 days, and whether these proportions varied among hospitals.

METHODS:

This observational cohort study included data from all facilities owned by the 121 nonfederal hospitals in the State of Iowa, July 2012 through September 2017. One end point was the percentage of all lumbar or sacral transforaminal or interlaminar epidural injections where the patient had received ≥4 such injections during the preceding 364 days. Comparisons also were made among hospitals’ percentages of injections that were the fifth or greater (ie, patient had already received ≥4 during preceding 364 days) using Bonferroni-adjusted conservative 95% confidence intervals.

RESULTS:

There were 48,270 unique patients who underwent at least 1 lumbosacral epidural steroid injection. The patients received care at 112 hospitals’ facilities. Most patients received no additional steroid injections within 364 subsequent calendar days after the first steroid injection (54.1%). There were ≥5 steroid injections for 1.27% of patients (ie, the injection was the fifth or greater). Among the 39 hospitals in Iowa that performed overall at least 1 steroid injection every 4 days, there were 6 hospitals at which the percentages of injections that were the fifth or greater significantly exceeded the overall prevalence of 1.91% (range: 3.0%–6.4%). There were 14 of the 39 hospitals with prevalences significantly less.

CONCLUSIONS:

Although most patients received only 1 lumbosacral steroid injection within 1 year, 1.27% of patients received 5 or more, and 1.91% of injections were the fifth or greater. Several hospitals had significantly greater than the overall average percent of steroid injections which were fifth or more. This heterogeneity warrants study of whether annual steroid injections per patient should be a clinical quality measure for the care received by patients with lower back pain or whether payment should be greater when injections are in accordance with guidelines.
Price Theory
Authors: Weyl E. Glen
Published: June 2019

I argue that there exists a coherent and relevant tradition in economic thought that I label “price theory.” I define it as neoclassical microeconomic analysis that reduces rich and often incompletely specified models into “prices” (approximately) sufficient to characterize solutions to simple allocative problems. I illustrate this definition by highlighting distinctively price theoretic approaches to prominent research practices (diagrams and problems sets) and substantive research topics (e.g. selection markets and media slant). I trace the origins of price theory from the early nineteenth century through its segregation into the Chicago School in the last quarter of the twentieth. I argue that price theory plays a valuable complementary role to two traditions, “reductionism” and “empiricism,” with which I contrast it and show how this contribution of price theory has fueled a resurgence in this style of research in fields ranging from market design to international trade. Approximations critical to price theory are less formally developed than tools used in other methodological traditions, suggesting a research agenda to clarify the accuracy and range of validity of these methods.(JEL B13, B21, B41, D00, D47, F10)
Dynamic Mechanism Design: An Introduction
Authors: Bergemann Dirk , Välimäki Juuso
Published: June 2019

We provide an introduction to the recent developments of dynamic mechanism design, with a primary focus on the quasilinear case. First, we describe socially optimal (or efficient) dynamic mechanisms. These mechanisms extend the well-known Vickrey– Clark–Groves and D’Aspremont–Gérard–Varet mechanisms to a dynamic environment. Second, we discuss revenue optimal mechanisms. We cover models of sequential screening and revenue-maximizing auctions with dynamically changing bidder types. We also discuss models of information management where the mechanism designer can control (at least partially) the stochastic process governing the agents’ types. Third, we consider models with changing populations of agents over time. After discussing related models with risk-averse agents and limited liability, we conclude with a number of open questions and challenges that remain for the theory of dynamic mechanism design. ( JEL D44, D81, D82)
What We Have Learned about Terrorism since 9/11
Authors: Gaibulloev Khusrav , Sandler Todd
Published: June 2019

This overview examines critically the post-9/11 empirical literature on terrorism. Major contributions by both economists and political scientists are included. We focus on five main themes: the changing nature of terrorism, the organization of terrorist groups, the effectiveness of counterterrorism policies, modern drivers or causes of terrorism, and the economic consequences of terrorism. In so doing, we investigate a host of questions that include: How do terrorist groups attract and retain members? What determines the survival of terrorist groups? Is poverty a root cause of terrorism? What counterterrorism measures work best? In the latter regard, we find that many counterterrorism policies have unintended negative consequences owing to attack transference and terrorist backlash. This suggests the need for novel policies such as service provision to counter some terrorist groups’ efforts to provide such services. Despite terrorists’ concerted efforts to damage targeted countries’ economies, the empirical literature shows that terrorism has had little or no effect on economic growth or GDP except in small terrorism-plagued countries. At the sectoral level, terrorism can adversely affect tourism and foreign direct investment, but these effects are rather transient and create transference of activities to other sectors, thus cushioning the consequences. (JEL F21, F52, H56, K42, Z31)
Carrying out streamlined routine data analyses with reports for observational studies: introduction to a series of generic SAS® macros
Authors: Liu Yuan , Nickleach Dana C. , Zhang Chao , Switchenko Jeffrey M. , Kowalski Jeanne
Published: June 2019

For a typical medical research project based on observational data, sequential routine analyses are often essential to comprehend the data on hand and to draw valid conclusions.  However, generating reports in SAS® for routine analyses can be a time-consuming and tedious process, especially when dealing with large databases with a massive number of variables in an iterative and collaborative research environment. In this work, we present a general workflow of research based on an observational database and a series of SAS® macros that fits this framework, which covers a streamlined data analyses and produces journal-quality summary tables. The system is generic enough to fit a variety of research projects and enables researchers to build a highly organized and concise coding for quick updates as research evolves. The result reports promote communication in collaborations and will escort the research with ease and efficiency.
Toward understanding scarless skin wound healing and pathological scarring
Authors: Karppinen Sanna-Maria , Heljasvaara Ritva , Gullberg Donald , Tasanen Kaisa , Pihlajaniemi Taina
Published: June 2019

The efficient healing of skin wounds is crucial for securing the vital barrier function of the skin, but pathological wound healing and scar formation are major medical problems causing both physiological and psychological challenges for patients. A number of tightly coordinated regenerative responses, including haemostasis, the migration of various cell types into the wound, inflammation, angiogenesis, and the formation of the extracellular matrix, are involved in the healing process. In this article, we summarise the central mechanisms and processes in excessive scarring and acute wound healing, which can lead to the formation of keloids or hypertrophic scars, the two types of fibrotic scars caused by burns or other traumas resulting in significant functional or aesthetic disadvantages. In addition, we discuss recent developments related to the functions of activated fibroblasts, the extracellular matrix and mechanical forces in the wound environment as well as the mechanisms of scarless wound healing. Understanding the different mechanisms of wound healing is pivotal for developing new therapies to prevent the fibrotic scarring of large skin wounds.
Better and fulfilling healthcare at lower costs: The need to manage health systems as complex adaptive systems
Authors: Sturmberg Joachim P. , Bircher Johannes
Published: June 2019

Rising healthcare costs are major concerns in most high-income countries. Yet, political measures to reduce costs have so far remained futile and have damaged the best interests of patients and citizen. We therefore explored the possibilities to analyze healthcare systems as a socially constructed complex adaptive system (CAS) and found that by their very nature such CAS tend not to respond as expected to top-down interventions. As CAS have emergent behaviors, the focus on their drivers – purpose, economy and behavioral norms – requires particular attention. First, the importance of understanding the purpose of health care as improvement of health and its experience has been emphasized by two recent complementary re-definitions of health and disease. The economic models underpinning today’s healthcare – profit maximization – have shifted the focus away from its main purpose. Second, although economic considerations are important, they must serve and not dominate the provision of healthcare delivery. Third, expected health professionals’ behavioral norms – to first consider the health and wellbeing of patients – have been codified in the universally accepted Declaration of Geneva 2017. Considering these three aspects it becomes clear that complex adaptive healthcare systems need mindful top-down/bottom-up leadership that supports the nature of innovation for health care driven by local needs. The systemic focus on improving people’s health will then result in significant cost reductions.
Exploring the Role of Oral Reading Fluency (ORF) in Reading Instruction: A Classroom-based Study with Engineering Students
Authors: Prakash Remya Rebecca , Kurian Abjy
Published: June 2019

Teaching reading is a complicated task as reading entails the simultaneous interaction of various component processes. Learning to read fluently is a crucial part of reading acquisition. Despite research conducted in L1 contexts regarding reading fluency, this area has been relatively unexplored in L2 contexts. In reading fluency research, Oral Reading Fluency (ORF) is an important construct which has been closely associated with the reading comprehension of young learners in L1 contexts. This paper aims to investigate the nature of the relationship between ORF and reading comprehension in ESL learners. If ORF proves to be significantly related to reading comprehension, it would be a valuable addition to reading instruction for ESL learners.
Measuring Back Injury Risk in Mexican Workers of an Automotive Company
Authors: Cuautle-Gutiérrez, Ph. D Luis , Escobedo-Portillo, Ph. D María Teresa , Uribe-Pacheco, MS Luis Alberto , García-Tepox, MS José Domingo
Published: June 2019

Introduction: The Mexican manufacturing sector in the automotive industry employs an average of 8 million 850 thousand workers per year spread across the 32 states, of which Puebla contributes with 465 106, developing, in a high percentage, the verification of new parts as part of the manufacture process. This activity is supported by the use of devices known as fixtures, whose equipment and tool forces operators to lift loads between 10 and 50 kilograms by performing manual operations to hold parts, presenting pain at the lumbar level, therefore, it is essential to measure the risks of back injuries in the study population. The objective was to identify and measure the risks of back injuries in the study population. Materials and methods: The inspection process is analyzed by identifying the potential risk factors. Ergonomic methodologies and instruments are used, such as Quick Exposure Check (QEC), the National Institute for Occupational Safety and Health (Niosh) equation, the reba (Rapid Entire Body Assessment) method, Ovako’s Work Posture Analysis System (OWAS), among others. Results: The qec method shows that trunk/back and wrist/hand are the most sensitive parts to risk exposure, indicating that 18 % of the postures are rated 4 in the level of risk, with the back rotated and bent in over 32 % of time. The weight of the operation exceeds 20 kilograms in 71.4 %. Conclusion: Four ergonomic techniques are used to assess the risk of injury, the inspection process of manufactured parts is analyzed.
Síndrome metabólico en conductores de transporte intermunicipal de Tunja, Boyacá
Authors: Ramírez López, Msc Laura Ximena , Calero Saa Pedro Antonio , Arias Holguín, Mg German Javier , Quincos Echeverry, Bact Diana Carolina , Tipazoca Nontién, Bact Luz Angélica , Monroy Díaz, Mg Ángela Liliana
Published: June 2019

Introducción: el síndrome metabólico (SM) se considera una epidemia mundial; el aumento global de su prevalencia se ha extendido en los países tanto industrializados como en vías de desarrollo, como resultado de una mayor proporción de obesidad y sedentarismo en la población. El objetivo de esta investigación fue determinar la prevalencia de SM en conductores de transporte intermunicipal de Tunja en 2017. Materiales y métodos: se realizó un estudio analítico de corte transversal a una muestra de 115 conductores de transporte intermunicipal en la ciudad de Tunja, se evaluaron índices antropométricos, glicemia, triglicéridos, HDL y se aplicó el cuestionario internacional de actividad física IPAQ. La presencia de SM se identificó de acuerdo con los criterios de NCEP/ATP III, se calculó la razón de prevalencias y se determinó significancia mediante la prueba exacta de Fisher y de U de Mann-Whitney. Resultados: se encontró una prevalencia de SM del 10.4 % (12/115; ic 95 % 4.6-15.7) y se hallaron diferencias significativas entre los pacientes con y sin SM en relación con la hipertensión (p = 0.03), niveles de glucosa (p = 0.0004), triglicéridos (p = <0.001), HDL (p = 0.00004), perímetro abdominal (p = 0.008) e índice de masa corporal (p = 0.001). Conclusión: en esta población de conductores, la hipertrigliceridemia fue el criterio más frecuente entre los que tenían síndrome metabólico, y se observó una tendencia hacia el sobrepeso y la obesidad, que determina la importancia de la generación de programas de información, educación y comunicación dirigidos a estas poblaciones que promuevan la alimentación saludable y la actividad física.
Tumor fibroso solitario gigante de pleura en paciente joven
Authors: Beltrán-García, MD, MSc Tatiana Carolina , Vargas-Parada, Est Isabella , Amaya-Dueñas, Est Camilo Andrés , López-Ordóñez, MD, MSc Mario Andrés
Published: June 2019

Introducción: el tumor fibroso solitario de pleura (tfsp) es una patología poco frecuente, corresponde a menos del 5 % de los tumores primarios de pleura, siendo aún más raros los tumores mayores de 15 cm y aquellos en pacientes menores de 35 años, ya que el pico de incidencia es entre los 60 a 70 años con un solo caso reportado en Colombia. Presentación de caso: paciente femenina de 33 años, sin exposición a asbesto o cigarrillo. Consultó por cuadro de disnea de moderados esfuerzos y dolor dorsal derecho. La tomografía axial computarizada (TAC) contrastada de tórax evidenció una gran masa sólida de contornos lobulados que comprometía el 70 % del hemitórax derecho de origen extrapulmonar y que comprimía la aurícula derecha, la inmunohistoquímica de la biopsia percutánea clasificó la lesión como tumor fibroso solitario. Fue llevada a toracotomía posterolateral derecha extendida, donde se encontró un tumor dependiente de la pleura parietal derecha resecado en su totalidad. Histopatología e inmunohistoquímica del producto de resección quirúrgica, compatibles con tumor fibroso solitario de pleura, tamaño 30 x 23 x 16 cm sin características de malignidad. La evolución posoperatoria fue satisfactoria, se logró un egreso hospitalario temprano. Discusión: en una paciente joven, el TFSP gigante es inusual, posterior a su diagnóstico, y a pesar de tener algunas características que sugerían malignidad, tamaño y origen en la pleura parietal, la resección quirúrgica fue el tratamiento indicado para este tumor, con posterior confirmación histopatológica compatible con tumor benigno.
Neoliberalismo, violencia política y salud mental en Perú (1990-2006)
Authors: Palma, PhD Patricia
Published: June 2019

Introducción: el presente artículo examina los factores que han ocasionado el precario estado de la salud mental en el Perú, donde casi el 90 % de pacientes con síntomas asociados con problemas mentales no reciben tratamiento. Desarrollo: se analiza el programa neoliberal de salud implementado durante el gobierno de Alberto Fujimori (1990-2000). Posteriormente, se estudia cómo esta política pública afectó al programa de salud mental y al estado de la salud de la población. Finalmente, se examinan diversos diagnósticos sobre la salud mental posterior al retorno a la democracia en el año 2000, desde una per- spectiva de los derechos humanos. Esta investigación finaliza el año 2006, momento en que el gobierno presentó un nuevo Plan Nacional de Salud Mental. Conclusiones: la falta de acceso a un tratamiento adecuado a nivel nacional ha sido consecuencia directa del reducido gasto del Estado en materia de sa- lud, en especial hacia las enfermedades no transmisibles y de salud mental. Las políticas neoliberales de salud implementadas durante el gobierno de Alberto Fujimori redujeron el rol del Estado como garante del acceso universal a los servicios de salud, y situaron a la salud mental en un lugar marginal dentro de la salud pública. El retorno a la democracia en el año 2000, el informe final de la Comisión de la Verdad y Reconciliación (2003) y el llamado de organismos internacionales, Iglesias Católicas y Evangélicas, junto con ong, presionaron al gobierno para situar a la salud mental como parte importante de la agenda de pública de salud.
Optimal wound closure of diabetic foot ulcers with early initiation of TLC-NOSF treatment: post-hoc analysis of Explorer
Authors: Lázaro-Martínez José Luis , Edmonds Michael , Rayman Gerry , Apelqvist Jan , Van Acker Kristien , Hartemann Agnès , Martini Jacques , Lobmann Ralf , Bohbot Serge , Kerihuel Jean-Charles , Piaggesi Alberto
Published: June 2019

Objective:

In March 2018, the Explorer study, an international, double-blind, randomised controlled trial (RCT), established that adding a TLC-NOSF (UrgoStart Contact, Laboratoires Urgo, France) dressing to good local standard of care (SoC) significantly and substantially increases wound closure and reduces the healing time of neuroischaemic diabetic foot ulcers (DFU). Besides the TLC-NOSF treatment, the wound duration was the only other covariate that had an influence on the wound closure rate in the regression model used in the original study. The purpose of this work was to further document the impact of wound duration on the healing outcomes of the DFUs included in the Explorer study and to discuss complementary pragmatic observations on the TLC-NOSF effect.

Method:

In this post-hoc analysis of the Explorer data, the wound closure rates by week 20 are reported for the global cohort (n=240, Intention-to-treat population) and for the treated (n=126) and control groups (n=114) according to DFU duration and location.

Results:

For the combined group, wound closure rates decreased with the increase of wound duration at baseline (from 57% in wounds ≤2 months to 19% in wounds >11 months). Whatever the wound duration subgroups analysed, higher closure rates were reported in the TLC-NOSF group than in the control group. However, the maximal difference between the two treatments was reported in wounds with a duration of ≤2 months (71% versus 41%, 30 percentage points difference, Relative Risk 1.7, 95% Confidence Interval 1.1 to 2.8). Regarding wound location subgroup analyses, the outcomes were always in favour of the TLC-NOSF treatment, with closure rates ranging between 43% and 61% within the TLC-NOSF group, and between 25% and 40% within the control group.

Conclusion:

This clinical evidence supports that treating DFUs with TLC-NOSF dressing and good SoC results in higher wound closure rates than with a neutral dressing and the same good standard of care, whatever the duration and the location of the treated wounds. However, the earlier the TLC-NOSF dressing is initiated in DFU treatment, the greater the benefits.
Local treatment of pressure ulcers in long-term care: a correlational cross-sectional study
Authors: Stolt Minna , Hjerppe Anna , Hietanen Helvi , Puukka Pauli , Haavisto Elina
Published: June 2019

Objective:

To analyse the treatment of pressure ulcers (PU) in long-term care.

Method:

In this correlational cross-sectional study, data was collected between November 2015 and January 2016 from older people with PUs in private and public long-term care facilities in Finland. Data collection was conducted by trained nurses using the Pressure Ulcer Patient Instrument (PUP-Ins). Outcomes measured were: prevalence and localisation of PU, local PU treatment, frequency (how often/week/day) and duration (minutes/week or day) of PU treatment.

Results:

In total, 112 patients with 158 PUs were identified (a prevalence rate of 5%). PUs were located most often on the heel (38%), hip (13%), buttocks (10%) and lateral malleolus (9.5%). The most frequently used PU treatment was skin protecting agents and local wound care products. The most typical treatment in category I, II and III PUs were foam dressings. In category III PUs, ribbon gauze dressings were also used. The most typical products for category IV PUs were complex dressings. Category I PUs received more treatment per day or week than other categories of PUs.

Conclusion:

PU treatment is inconsistent and often conducted with varying methods and products. Holistic patient care must be the focus. Nurses in long-term care settings might benefit from in-depth in-service education focusing on the treatment of PUs. More research is needed about nurses' competence in PU treatment.
The Fairy Tales in Building Children Values
Authors: Fernandes Elaine Ferreira Banja , Jiménez Luis Ortiz
Published: June 2019

Abstract: The present study aims to discuss the Construction of the Values of the Child from the fairy tales as didactic methodology in the classroom. Literature bridges knowledge and the human psyche. Fairy tales, in a psychoanalytic view, seek interpretation as a very important resource for the mental life of children. The results led to believe that one can consider the elements of myth, fantasy, and the unusual as developers of the human personality, for it is through the symbology that the person represents and expresses his thoughts and actions. It was concluded that, more and more, educators should use children's stories and fairy tales in their classes, enriching the possibilities of child associations with their daily reality. Keywords: Fairy tales; Construction of Human Values; Child education.
The fairy tales in building children values
Authors: Fernandes Elaine Ferreira Banja , Jiménez Luis Ortiz
Published: June 2019

The present study aims to discuss the Construction of the Values of the Child from the fairy tales as didactic methodology in the classroom. Literature bridges knowledge and the human psyche. Fairy tales, in a psychoanalytic view, seek interpretation as a very important resource for the mental life of children. The results led to believe that one can consider the elements of myth, fantasy, and the unusual as developers of the human personality, for it is through the symbology that the person represents and expresses his thoughts and actions. It was concluded that, more and more, educators should use children's stories and fairy tales in their classes, enriching the possibilities of child associations with their daily reality. Keywords: Fairy tales; Construction of Human Values; Child education.