bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical inactivity as a risk factor for all-cause mortality in Brazil (1990–2017)
Authors: Silva Diego Augusto Santos , Tremblay Mark Stephen , Marinho Fatima , Ribeiro Antonio Luiz Pinho , Cousin Ewerton , Nascimento Bruno Ramos , Valença Neto Paulo da Fonseca , Naghavi Mohsen , Malta Deborah Carvalho
Published: September 2020

Background

The aim of this study was to estimate the mortality from all causes as a result of physical inactivity in Brazil and in Brazilian states over 28 years (1990–2017).

Methods

Data from the Global Burden of Disease (GBD) study for Brazil and states were used. The metrics used were the summary exposure value (SEV), the number of deaths, age-standardized mortality rates, and the fraction of population risk attributable to physical inactivity.

Results

The Brazilian population presented risk of exposure to physical inactivity of (age-standardized SEV) of 59% (95% U.I. 22–97) in 1990 and 59% in 2017 (95% U.I. 25–99). Physical inactivity contributed a significant number of deaths (1990, 22,537, 95% U.I. 12,157–34,745; 2017, 32,410, 95% U.I. 17,976–49,657) in the analyzed period. These values represented mortality rates standardized by age (per 100,000 inhabitants) of 31 (95% U.I. 17–48) in 1990 and 15 (95% U.I. 8–23) in 2017. From 1990 to 2017, a decrease in standardized death rate from all causes attributable to physical inactivity was observed in Brazil (− 52%, 95% U.I. − 54 to − 49). The Brazilian states with better socioeconomic conditions presented greater reductions in age-standardized mortality (male: rho = 0.80; female: rho 0.84) over the period of 28 years.

Conclusions

These findings support the promotion of physical activity in the Brazilian population for the prevention of early mortality.
Hypofractionated radiation therapy comparing a standard radiotherapy schedule (over 3 weeks) with a novel 1-week schedule in adjuvant breast cancer: an open-label randomized controlled study (HYPORT-Adjuvant)—study protocol for a multicentre, randomized phase III trial
Authors: Chatterjee Sanjoy , Chakraborty Santam ,   HYPORT Adjuvant Author Group, Chakraborty Santam , Backianathan Selvamani , Lal Punita , Gupta Subhash , Ahmed Rosina , Misra Shagun , Solomon Patricia , Balakrishan Rajesh , Guha Debashree , Das K. J. Maria , Mahata Anurupa , Mandal Samar , Kumari Abha , Godson Henry Finlay , Ganguly Sandip , Dey Debdeep , Chatterjee Sanjoy
Published: September 2020

Background

Hypofractionated radiotherapy is the current standard for adjuvant radiotherapy across many centres. Further hypofractionation may be possible but remains to be investigated in non-Caucasian populations with more advanced disease, with a higher proportion of patients requiring mastectomy as well as tumour bed boost. We are reporting the design of randomized controlled trial testing the hypothesis that a 1-week (5 fractions) regimen of radiotherapy will be non-inferior to a standard 3-week (15 fractions) schedule.

Methods

We describe a multicentre, randomized controlled trial recruiting patients at large academic centres across India. Patients without distant metastases who merit adjuvant radiotherapy will be eligible for inclusion in the study. Patients in the control arm will receive adjuvant radiotherapy to the breast or chest wall (with/without regional nodes) to a dose of 40 Gy/15 fractions/3 weeks, while those in the experimental arm will receive a dose of 26 Gy/5 fractions/1 week (to the same volume). The use of a simultaneous integrated boost (dose of 8 Gy and 6 Gy, respectively) is allowed in patients who have undergone breast conservation. A sample size of 2100 patients provides an 80% power to detect a non-inferiority of 3% in the 5-year locoregional recurrence rate with a one-sided type I error of 2.5%, assuming that the locoregional recurrence rate in the control arm is 5% at 5 years (corresponding to a hazard ratio of 1.63). Patients will be recruited over a period of 5 years and followed up for a further 5 years thereafter.

Discussion

If a five-fraction regimen of breast cancer is proven to be non-inferior, this will result in a significant improvement in the access to radiotherapy, as well as reduced costs of treatment. The trial gives an opportunity to standardize and quality-assure radiotherapy practices across the nation at the same time. Along with the results of the FAST-Forward trial, the safety of this intervention in advanced node-positive disease requiring regional nodal radiation will be established.

Trial registration

The trial has been registered at the Clinical Trial Registry of India (CTRI) vide registration number: CTRI/2018/12/016816 (December 31, 2018) as well as the ClinicalTrial.gov website at NCT03788213 (December 28, 2018).
Emergency department-based 3D echocardiogram use: a case series
Authors: Matthews Sajith , Levy Phillip D.
Published: September 2020

Background

Three-dimensional echocardiography (3DE) with real-time volumetric imaging can be a vital modality in clinical practice. Despite its potential, it remains underutilized in the acute care setting.

Case presentation

We present two cases describing the use of 3DE in the emergency department (ED) for acute heart failure (AHF) and discuss the potential benefits of routine use in acute care settings.

Conclusions

Three-dimensional echocardiography offers unique information as it relates to cardiac structure and function, and can be valuable for diagnosis and clinical decision-making in the ED.
Juvenile Huntington’s disease: two case reports and a review of the literature
Authors: Lesinskienė Sigita , Rojaka Darja , Praninskienė Rūta , Morkūnienė Aušra , Matulevičienė Aušra , Utkus Algirdas
Published: September 2020

Background

Huntington’s disease is a rare, autosomal dominant neurodegenerative disease characterized by motor, cognitive, and psychiatric symptoms. Usually, the disease symptoms first appear around the age of 40, but in 5–10% of cases, they manifest before the age of 21. This is then referred to as juvenile Huntington’s disease. According to the small number of cases reported in the literature, the course of juvenile Huntington’s disease significantly differs from adult onset and shows significant interpatient variability, making every case unique.

Case presentation

Our study aims to highlight the complexity and diversity of rare juvenile Huntington’s disease. We report cases of two Caucasian patients with chronic tics referred to the Huntington’s Disease Competence Center of Vilnius University Hospital Santaros Klinikos with suspicion of juvenile Huntington’s disease due to the appearance of chronic motor tics, and behavior problems. The diagnosis of juvenile Huntington’s disease was confirmed on both clinical and genetic grounds. In both cases described, the patients developed symptoms in all three main groups: motor, cognitive, and psychiatric. However, the first patient was experiencing more severe psychiatric symptoms; in the second case, motor symptoms (rigidity, tremor) were more prominent. In both cases, apathy was one of the first symptoms and affected patients’ motivation to participate in treatment actively. These two case descriptions serve as an important message for clinicians seeing patients with chronic tics and gradually worsening mood and behavior, indicating the need to investigate them for rare genetic disorders.

Conclusions

Description of these two clinical cases of juvenile Huntington’s disease provides insight into how differently it manifests and progresses in young patients and the difficulties the patients and their families face. There were different but painful ways for families to accept the diagnosis. Because the disease inevitably affects the patient’s closest ones, it is crucial to also provide adequate psychological and social support to all the family members. Establishment of multidisciplinary specialist centers for Huntington’s disease, as demonstrated by our experience, not only allows timely diagnosis and treatment plans but also ensures thorough disease management and care for patients and systematic support for their families.
Comparison of the accuracy of intraoral scans between complete-arch scan and quadrant scan
Authors: Moon Youn-Gyeong , Lee Kyung-Min
Published: September 2020

Objective

To compare the accuracy of complete-arch scans and quadrant scans obtained using a direct chairside intraoral scanner.

Material and methods

Intraoral scans were obtained from 20 adults without missing teeth except for the third molar. Maxillary and mandibular complete-arch scans were carried out, and 4 quadrant scans for each arch were performed to obtain right posterior, right anterior, left anterior, and left posterior quadrant scans. Complete-arch scans and quadrant scans were compared with corresponding model scans using best-fit surface-based registration. Shell/shell deviations were computed for complete-arch scans and quadrant scans and compared between the complete-arch scans and each quadrant scans. In addition, shell/shell deviations were calculated also for each individual tooth in complete-arch scans to evaluate factors which influence the accuracy of intraoral scans.

Results

Complete-arch scans showed relatively greater errors (0.09 ~ 0.10 mm) when compared to quadrant scans (0.05 ~ 0.06 mm). The errors were greater in the maxillary scans than in the mandibular scans. The evaluation of errors for each tooth showed that the errors were greater in posterior teeth than in anterior teeth. Comparing the right and left errors, the right side posterior teeth showed a more substantial variance than the left side in the mandibular scans.

Conclusion

The scanning accuracy has a difference between complete-arch scanning and quadrant scanning, particularly in the posterior teeth. Careful consideration is needed to avoid scanning inaccuracy for maxillary or mandibular complete-arch, particularly in the posterior area because a complete-arch scan might have potential error than a quadrant scan.
Generic versus brand-name over-the-counter analgesics: knowledge and attitudes among Swedish pharmacy customers
Authors: Håkonsen Helle , Wängberg Maria , Alani Dina , Hedenrud Tove
Published: September 2020

Background

Due to a liberalisation reform in 2009, the availability of over-the-counter (OTC) analgesics has increased significantly in the Swedish market over the past decade. With the increasing number of generic products available on the market and the possibility of buying OTC drugs from non-pharmacy outlets, a key to safe drug use is that consumers possess the necessary knowledge to differentiate between the different brands and choose the appropriate drug for their ailments. The aim of this study was to investigate Swedish consumers’ knowledge of and attitudes towards generic OTC analgesics.

Methods

A sample of 209 Swedish adults (66% women; mean age 43.1 years) who bought OTC analgesics at a community pharmacy in one of the country’s three largest cities responded to a structured questionnaire. The questions related to knowledge of active substances, the use and choice of OTC analgesics (generic or original brand), attitudes towards generic OTC analgesics, information received about OTC analgesics and experience with generic substitution of prescription drugs.

Results

Almost one in five reported weekly use of OTC analgesics, and 32% assigned minimum three out of four active substances to the correct brand(s) of OTC analgesics. Among the 50 participants (24%) who assigned all four active substances correctly, it was predominantly women and participants with higher education. Four out of five participants were positive towards the cheaper brands, and 69% reportedly chose cheaper generic brands over more expensive brands. Knowledge about the active substances of different brands was associated with positive attitudes towards generic products.

Conclusion

Swedish pharmacy customers have to a varying extent the knowledge to differentiate between different brands of commonly used OTC analgesics in terms of active substances. There is a predominantly positive attitude towards generic OTC analgesics, although some consider generic drugs to be inferior and stay loyal to the original brands.
Suicide risk after psychiatric discharge: study protocol of a naturalistic, long-term, prospective observational study
Authors: Krause Tim J. , Lederer Annette , Sauer Magdalena , Schneider Jasmin , Sauer Cathrin , Jabs Burkhard , Etzersdorfer Elmar , Genz Axel , Bauer Michael , Richter Susann , Rujescu Dan , Lewitzka Ute
Published: September 2020

Background

Suicide risk of psychiatric patients has proven to be strongly increased in the months after discharge from a psychiatric hospital. Despite this high risk, there is a lack of systematic research on the causes of this elevated suicide risk as well as a lack of treatment and intervention for patients at high risk after discharge. The main objective of this pilot study is, firstly, to examine the factors contributing to the elevated suicide risk and, secondly, to investigate whether an additional setting of care starting at discharge may reduce suicidality.

Methods

In this multi-centre pilot study, treatment as usual is complemented by an additional 18-month post-discharge setting of care for psychiatric patients at high risk for suicide. Two groups of patients differing in the amount of post-discharge personal contacts will be compared. One group of patients will be offered continuous personal contacts after discharge (months 1–6: monthly contacts; months 6–18: every 2 months) while another group of patients will receive contacts only at months 6, 12, and 18 after discharge. Data on suicidality, as well as associated with other symptoms, treatment, and significant events, will be collected. In the case of health-related severe events, the setting of care allows the patient to have the opportunity to connect with the doctor or therapist treating the patient.

Discussion

The results of this study will contribute to identifying critical factors raising suicide risk after discharge and will demonstrate the potential influence on suicide prevention of a setting of care with regular personal contact after discharge.

Trial registration

ZMVI1-2517FSB135 – funded by the German Federal Ministry of Health.
Early surgical intervention for structural infantile spasms in two patients under 6 months old: a case report
Authors: Yang Haiyan , Yang Zhiquan , Peng Jing , Huang Yehong , Yang Zhuanyi , Yin Fei , Wu Liwen
Published: September 2020

Background

Infantile spasms (IS) are the most common childhood epileptic encephalopathy. Focal cortical dysplasia (FCD) and gray matter heterotopias (GH) are common structural causes of IS. The recommended first-line treatment for IS patients with structural causes is surgical intervention, according to the International League Against Epilepsy (ILAE) commission guidelines. However, there is currently no consensus on appropriate timings of surgery.

Case presentations

Two structural IS cases are presented here: one was caused by FCD, and the other by GH. Both patients exhibited recurrent seizures at the age of 2 months, had poor responses to various antiepileptic drugs (AEDs) and displayed severe mental and motor developmental retardation. Seizure types included focal seizures and spasms. Brain magnetic resonance imaging showed abnormal gray signal or suspicious FCD lesions that coincided with the origin of the focal seizures. The patients underwent lesion resection before the age of 6 months. Follow-up observation showed that seizures of both patients were completely controlled several days after the surgery. All AEDs were gradually reduced in dosage within 1 year, and the mental and motor development almost returned to normal.

Conclusion

Early resection of lesions in structural IS patients has benefits of effectively controlling convulsions and improving developmental retardation. Infants at several months of age can well tolerate craniotomy, and their cognitive development is more likely to return to normal after early surgery.
Effects of soluble starch synthase genes on eating and cooking quality in semi waxy japonica rice with Wxmp
Authors: Yao Shu , Zhang Yadong , Liu Yanqing , Zhao Chunfang , Zhou Lihui , Chen Tao , Zhao Qing Yong , Pillay Balakrishna , Wang Cailin
Published: September 2020

The purpose of this study is to reveal the genetic mechanism of the variation of amylose content among different semi waxy or glutinous japonica rice in the background of Wxmp gene. Sixty-four semi waxy lines derived from the hybrid progenies of Wujing 13 and Milky Princess (Kantou 194) with polymorphism in soluble starch synthase gene SSIIa (SSII-3) and SSIIIa (SSIII-2) but no polymorphism in other starch synthase related genes were used as test materials. The genotypes of SSIIa and SSIIIa allele were identified by molecular markers, and the allelic effects of SSIIa and SSIIIa gene on amylose content (AC), gel consistency (GC), gelatinization temperature (GT) and rapid visco analyzer (RVA) profile characteristics were analyzed. The significant effects of SSIIa and SSIIIa alleles and the interactive effects between two genes on AC, GT, GC and RVA profile characteristics were found. The SSIIa and SSIIIa alleles from Wujing13 shown positive effects on AC with an average increase of 1.87 and 1.23% in 2 years respectively. There was no significant effect on GT for SSIIa or SSIIIa allele but remarkable influence on GT when the co-existence of the two genes. The genotype SSIIampSSIIIamp shown 1.34 °C higher GT than genotype SSIIawjSSIIIawj (mp and wj indicated that the gene was derived from Milky Princess and Wujing 13 respectively, the same as in the below). Different genes and alleles resulted in significant different GC. The genetic effect of SSIIawj and SSIIIamp on GC was 8.74 and 9.62 mm respectively. The GC of SSIIawjSSIIIamp was 10.64 and 16.95 mm higher than that of SSIIampSSIIIawj and SSIIawjSSIIIawj, respectively. The allele SSIIawj could increase the peak viscosity (PKV), hot paste viscosity (HPV), cool paste viscosity (CPV) and breakdown viscosity (BDV), while decrease the consistency viscosity (CSV) and setback viscosity (SBV). However for the allele SSIIIawj the opposite was true. The genotype SSIIawjSSIIIamp had the largest PKV, HPV and CPV, the genotype SSIIawjSSIIIawj had the largest BDV and CSV, but the genotype SSIIawjSSIIIamp had the least SBV. According to the comprehensive effect of each trait, the genotype SSIIawjSSIIIamp was the best. The allelic variation and interaction effect of SSIIa and SSIIIa genes have important reference value for improving cooking and eating quality of semi waxy japonica rice.
Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process
Authors: Pace Lydia E. , Schleimer Lauren E. , Shyirambere Cyprien , Ilbawi André , Dusengimana Jean Marie Vianney , Bigirimana Jean Bosco , Uwizeye Francois Regis , Chamberlin Mary , Lee Yeonsoo Sara , Shulman Lawrence N. , Troyan Susan , Anderson Benjamin O. , Duggan Catherine , O’Neil Daniel S. , Dvaladze Allison , Brock Jane , Nguyen Cam , Ruhangaza Deogratias , Habimana Olivier , Nsabimana Nicaise , Butonzi John , Nkusi Eugene , Mpunga Tharcisse , Keating Nancy L.
Published: September 2020

PURPOSE

The burden of cancer is growing in low- and middle-income countries (LMICs), including sub-Saharan Africa. Ensuring the delivery of high-quality cancer care in such regions is a pressing concern. There is a need for strategies to identify meaningful and relevant quality measures that are applicable to and usable for quality measurement and improvement in resource-constrained settings.

METHODS

To identify quality measures for breast cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, we used a modified Delphi process engaging two panels of experts, one with expertise in breast cancer evidence and measures used in high-income countries and one with expertise in cancer care delivery in Rwanda.

RESULTS

Our systematic review of the literature yielded no publications describing breast cancer quality measures developed in a low-income country, but it did provide 40 quality measures, which we adapted for relevance to our setting. After two surveys, one conference call, and one in-person meeting, 17 measures were identified as relevant to pathology, staging and treatment planning, surgery, chemotherapy, endocrine therapy, palliative care, and retention in care. Successes of the process included participation by a diverse set of global experts and engagement of the BCCOE community in quality measurement and improvement. Anticipated challenges include the need to continually refine these measures as resources, protocols, and measurement capacity rapidly evolve in Rwanda.

CONCLUSION

A modified Delphi process engaging both global and local expertise was a promising strategy to identify quality measures for breast cancer in Rwanda. The process and resulting measures may also be relevant for other LMIC cancer facilities. Next steps include validation of these measures in a retrospective cohort of patients with breast cancer.
Association Among Preoperative Cognitive Performance, Regional Cerebral Oxygen Saturation, and Postoperative Delirium in Older Portuguese Patients
Authors: Susano Maria J. , Thedim Mariana , Seixas Francisco S. , Vide Sérgio , Grasfield Rachel , Abelha Fernando J. , Crosby Gregory , Culley Deborah J. , Amorim Pedro
Published: September 2020

BACKGROUND:

Postoperative delirium is common among older patients and preoperative identification of high-risk patients is widely recommended. The aim of this study was to assess whether preoperative cognitive performance using brief screening tools or regional cerebral oxygen saturation (Scto
2) was associated with the development of postoperative delirium in older Portuguese patients undergoing elective surgery.

METHODS:

Prospective observational cohort study where preoperative cognitive screening tools (Mini-Cog, Mini-Mental State Examination, verbal fluency) and Scto
2 (INVOS 5100C; Medtronic, Ireland) were assessed in 238 patients ≥65 years old undergoing elective surgery between July 2017 and May 2019 at a tertiary academic center in Portugal. The primary outcome was postoperative delirium detected by the 3D-Confusion Assessment Method. Data were analyzed by univariate analysis and multivariable logistic regression.

RESULTS:

Delirium was identified in 53 patients (22%); 162 patients (68%) had completed only 4 years of education. On multivariable analysis, probable cognitive impairment tested by the Mini-Cog (odds ratio [OR] = 1.57; 95% confidence interval [CI], 0.70–3.53; corrected P value >.999), by the Mini-Mental State Examination (OR = 2.75; 95% CI, 1.23–6.13; corrected P value = .052), and by the animal verbal fluency test (OR = 1.24; 95% CI, 0.49–3.16; corrected P value >.999) were not significantly associated with the development of postoperative delirium. In contrast, lower preoperative Scto
2 (OR = 1.08; 95% CI, 1.02–1.14; corrected P value = .024 for each point decrease in Scto
2) was associated with postoperative delirium.

CONCLUSIONS:

We did not find enough evidence to suggest that poor preoperative cognitive performance was significantly associated with the development of postoperative delirium in an older Portuguese surgical population with an overall low level of formal education, but rather that preoperative Scto
2 may be helpful in identifying patients at risk for delirium.
A Comparison of the Required Bronchial Cuff Volume Obtained by 2 Cuff Inflation Methods, Capnogram Waveform-Guided Versus Pressure-Guided: A Prospective Randomized Controlled Study
Authors: Yamada Yuko , Tanabe Kumiko , Nagase Kiyoshi , Ishihara Takuma , Iida Hiroki
Published: September 2020

BACKGROUND:

Double-lumen endobronchial tubes (DLTs) are used for one-lung ventilation (OLV) during thoracic surgery. Overinflation into the bronchial cuff causes damage to the tracheobronchial mucosa, whereas underinflation leads to an incomplete collapse of the nonventilated lung or incomplete ventilation of the ventilated lung. However, how to determine the appropriate bronchial cuff volume and pressure during OLV is unclear. The objective of this study is to compare the required bronchial cuff volume for lung separation obtained by 2 different cuff inflation methods under closed- and open-chest conditions.

METHODS:

A total of 64 patients scheduled to undergo elective thoracic surgery requiring OLV were recruited. Left DLTs were used for both right- and left-sided surgery. The patients were randomly assigned to 1 of 2 inflation-type groups to estimate the bronchial cuff volume. In the capnogram waveform–guided bronchial cuff inflation group (capno group, n = 27), the bronchial cuff was inflated until a capnometer sampling gas containing CO2 from the nonventilated lung displayed a flat line. The corresponding bronchial cuff volume and pressure were then recorded. In the pressure–guided bronchial cuff inflation group (pressure group, n = 29), the bronchial cuff was inflated by a cuff inflator to a pressure of 20 cm H2O. Lung separation was confirmed when a flat line of a capnometer was observed after gas sampling from the nonventilated lung.

RESULTS:

Under closed-chest conditions, the bronchial cuff sealing volume for the capno group was significantly lower than that for the pressure group (mean [standard deviation {SD}], 1.00 [0.65] mL vs 1.44 [0.59] mL, mean difference, −0.44; 97.5% confidence interval [CI], −0.78 to −0.11; P = .010). Under open-chest conditions, the bronchial cuff sealing volume for the capno group was also significantly lower than that for the pressure group (mean [SD], 0.65 [0.66] mL vs 1.22 [0.45] mL, mean difference, −0.58; 97.5% CI, −0.88 to −0.27; P < .001).

CONCLUSIONS:

The lowest cuff volume providing an air-tight bronchial seal was obtained by the capnogram waveform–guided bronchial cuff inflation method. Since the cuff volume required to achieve an air-tight seal decreases after opening the chest, readjustment of the bronchial cuff volume to prevent bronchial cuff damage to the tracheobronchial mucosa after opening the chest may be advisable.
A Continuous Noninvasive Method to Assess Mixed Venous Oxygen Saturation: A Proof-of-Concept Study in Pigs
Authors: Karlsson Jacob , Lönnqvist Per-Arne , Wallin Mats , Hallbäck Magnus
Published: September 2020

BACKGROUND:

Mixed venous oxygen saturation (Svo
2) is important when evaluating the balance between oxygen delivery and whole-body oxygen consumption. Monitoring Svo
2 has so far required blood samples from a pulmonary artery catheter. By combining volumetric capnography, for measurement of effective pulmonary blood flow, with the Fick principle for oxygen consumption, we have developed a continuous noninvasive method, capnodynamic Svo
2, for assessment of Svo
2. The objective of this study was to validate this new technique against the gold standard cardiac output (CO)-oximetry Svo
2 measurement of blood samples obtained from a pulmonary artery catheter and to assess the potential influence of intrapulmonary shunting.

METHODS:

Eight anesthetized mechanically ventilated domestic-breed piglets of both sexes (median weight 23.9 kg) were exposed to a series of interventions intended to reduce as well as increase Svo
2. Simultaneous recordings of capnodynamic and CO-oximetry Svo
2 as well as shunt fraction, using the Berggren formula, were performed throughout the protocol. Agreement of absolute values for capnodynamic and CO-oximetry Svo
2 and the ability for capnodynamic Svo
2 to detect change were assessed using Bland-Altman plot and concordance analysis.

RESULTS:

Overall bias for capnodynamic versus CO-oximetry Svo
2 was −1 percentage point (limits of agreement −13 to +11 percentage points), a mean percentage error of 22%, and a concordance rate of 100%. Shunt fraction varied between 13% at baseline and 22% at the end of the study and was associated with only minor alterations in agreement between the tested methods.

CONCLUSIONS:

In the current experimental setting, capnodynamic assessment of Svo
2 generates absolute values very close to the reference method CO-oximetry and is associated with 100% trending ability.
Predicting Perioperative Respiratory Adverse Events in Children With Sleep-Disordered Breathing
Authors: Pehora Carolyne , Faraoni David , Obara Soichiro , Amin Reshma , Igbeyi Brenda , Al-Izzi Adel , Sayal Aman , Sayal Aarti , Mc Donnell Conor
Published: September 2020

BACKGROUND:

No evidence currently exists to quantify the risk and incidence of perioperative respiratory adverse events (PRAEs) in children with sleep-disordered breathing (SDB) undergoing all procedures requiring general anesthesia. Our objective was to determine the incidence of PRAEs and the risk factors in children with polysomnography-confirmed SDB undergoing procedures requiring general anesthesia.

METHODS:

Retrospective review of all patients with polysomnography-confirmed SDB undergoing general anesthesia from January 2009 to December 2013. Demographic and perioperative outcome variables were compared between children who experienced PRAEs and those who did not. Generalized estimating equations were used to build a predictive model of PRAEs.

RESULTS:

In a cohort of 393 patients, 51 PRAEs occurred during 43 (5.6%) of 771 anesthesia encounters. Using generalized estimating equations, treatment with continuous positive airway pressure or bilevel positive airway pressure (odds ratio, 1.63; 95% confidence interval [CI], 1.05–2.54; P = .031), outpatient (odds ratio, 1.37; 95% CI, 1.03–1.91; P = .047), presence of severe obstructive sleep apnea (odds ratio, 1.63; 95% CI, 1.09–2.42; P = .016), use of preoperative oxygen (odds ratio 1.82; 95% CI, 1.11–2.97; P = .017), history of prematurity (odds ratio, 2.31; 95% CI, 1.33–4.01; P = .003), and intraoperative airway management with endotracheal intubation (odds ratio, 3.03; 95% CI, 1.79–5.14; P < .001) were associated with PRAEs.

CONCLUSIONS:

We propose the risk factors identified within this cohort of SDB patients could be incorporated into a preoperative risk assessment tool that might better to identify the risk of PRAE during general anesthesia. Further investigation and validation of this model could contribute to improved preoperative risk stratification, decision-making (postoperative admission and level of monitoring), and health care resource allocation.
Total Laparoscopic Resection of Hilar Cholangiocarcinoma Type 3b: Applying a Parachute Technique for Hepaticojejunostomy
Authors: Sucher Robert , Scheuermann Uwe , Seehofer Daniel
Published: September 2020

Background

Laparoscopic liver resection for perihilar cholangiocarcinoma (pCCA) is still in its infancy. The biliary-enteric reconstruction represents one of the most delicate parts of this minimally invasive procedure.

Methods

In this study, a 78-year old woman with perihilar cholangiocarcinoma (pCCA) type 3b underwent a hepaticojejunostomy performed by a parachute technique.

Results

The operation, performed totally by minimally invasive resections, was completed in 386 min, with a blood loss of less than 400 ml and no transfusion requirements. Two intraluminal stents were placed during the hepaticojenunostomy for splinting of the biliary-enteric anastomosis. The patient required prolonged antibiotic treatment for postoperative cholangitis and finally was discharged on postoperative day 15. The histopathologic grading displayed a G 2–3 adenocarcinoma, pT3 pN0, M0, L1, V1, pN1, UICC IIIc R0, and the patient was referred to adjuvant chemotherapy.

Conclusion

Resections of pCCAs, performed totally by minimally invasive techniques, may be feasible and safe for a selected group of patients. With this approach, a running-suture hepaticojejunostomy using the parachute technique represents a worthwhile strategy for biliary-enteric reconstruction.
Beyond Competitive Devaluations: The Monetary Dimensions of Comparative Advantage
Authors: Bergin Paul R. , Corsetti Giancarlo
Published: September 2020

Motivated by the long-standing debate on competitive devaluation, we propose a new perspective on how monetary and exchange rate policies can contribute to a country’s international competitiveness. We refocus the analysis on the implications of monetary stabilization for a country’s comparative advantage. We develop a two-country New Keynesian model with two tradable sectors in each country: one perfectly competitive, the other producing differentiated goods under monopolistic competition subject to sunk entry costs and nominal rigidities and hence more sensitive to macroeconomic uncertainty. Monetary policy can disproportionately foster competitiveness of differentiated goods firms, ultimately affecting the composition of domestic output and exports. (JEL E12, E23, E52, F11, F31)
Quantitative Easing, Collateral Constraints, and Financial Spillovers
Authors: Geanakoplos John , Wang Haobin
Published: September 2020

The steady application of quantitative easing (QE ) has been followed by big and nonmonotonic effects on international asset prices and capital flows. We rationalize these observations in a model in which a central bank buys domestic assets that serve as the best collateral for investors worldwide. The crucial insight is that domestic private agents adjust their portfolios of domestic and foreign assets in different ways to offset QE, conditional on whether they are (i) fully leveraged, (ii ) partially leveraged, or (iii) unleveraged. These portfolio shifts can diminish or even reverse the impact of ever-larger QE interventions on asset prices. (JEL E31, E32, E43, E44, E52, E58, F34)
Minimally invasive (flapless) crown lengthening by erbium:YAG laser in aesthetic zone
Authors: Capodiferro Saverio , Tempesta Angela , Limongelli Luisa , Barile Giuseppe , Di Venere Daniela , Corsalini Massimo
Published: September 2020

Crown lengthening is a surgical procedure aimed at exposure of a larger tooth surface by gingivectomy alone or with cortical bone remodelling for aesthetic purposes in the anterior zone of the maxilla or for reconstruction of teeth affected by subgingival caries. We report two cases of crown lengthening in the anterior maxilla for aesthetic purposes by gingival and bone re-contouring performed by erbium-doped yttrium aluminium garnet (erbium:YAG) laser. As highlighted in this report, the erbium:YAG laser-assisted crown lengthening is less invasive and also leads to faster clinical outcomes in contrast to the conventional surgical technique by scalpel incision, flap elevation and osteoplastic.
Determinants of skilled care during delivery among mothers in Bomachoge Chache, Kisii county, Kenya
Authors: Malachi Zillah , Onkware Richard Seme
Published: September 2020

Background/Aims

Utilisation of skilled care delivery remains low in developing countries, including Kenya. Literature shows that predictors of skilled birth attendance differ from region to region. This study aimed to identify predictors of skilled birth attendance for delivery among women in Bomachoge Chache, Kenya.

Methods

This was a case control study conducted in 2015, in Bomachoge Chache Sub County, Kisii County, Kenya. The study targeted postnatal mothers who brought their children for immunisation. A total of 322 postnatal mothers (n=161 delivered at home; n=161 delivered in a health facility) answered questions about sociodemographic characteristics on a pretested researcher-administered questionnaire. Association of characteristics with skilled birth attendance was analysed using the chi square test. Multivariate logistic regression was used to determine the strength of the associations and to control for confounders, with significance assumed at P<0.05.

Results

The likelihood of mothers delivering at home was higher in mothers who had two or more children (adjusted odds ratio=28.4, P=0.0005) and in mothers whose spouses were casual labourers (adjusted odds ratio=16.9, P=0.0048). However, the likelihood of delivering at home was lower in mothers who had at least secondary level education (adjusted odds ratio=0.33, P=0.03) and in mothers who were farmers (adjusted odds ratio=0.32, P=0.03).

Conclusions

Sociodemographic characteristics including parity, occupation, spousal occupation and education impact the use of skilled care at birth and should be evaluated to inform policy for maternal and neonatal care. Further studies at a household level are recommended to fully understand disparities in skilled attendance at birth.
EFEITO DA POLÍTICA DE DESONERAÇÃO DO IPI SOBRE O REPASSE DO FUNDO DE PARTICIPAÇÃO E NÍVEL DE ARRECADAÇÃO DOS MUNICÍPIOS DOS ESTADOS DO ACRE, AMAPÁ E RORAIMA.
Authors: Miranda Marconi Silva , Abrantes Luiz Antônio , Rocha Tiago carneiro da
Published: September 2020

Este artigo avaliou o efeito da política de desoneração do Imposto sobre os Produtos Industrializados (IPI), no período de 2006 a 2015, sobre o Fundo de Participação dos Municípios (FPM), nos estados do Acre, Roraima e Amapá. O objetivo foi avaliar o comportamento dos repasses do FPM e das arrecadações próprias dos municípios destes estados. A estratégia empírica consistiu em estimar modelos econométricos de dados em painel para efeitos fixos pelo Método dos Mínimos Quadrados Ordinários (MQO) e traçar curvas de tendências para as arrecadações próprias dos municípios. Os resultados mostram que no período em estudo, as desonerações provocaram aumento nos repasses do FPM. Apresentaram também aumento na arrecadação própria municipal. O estudo evidencia a necessidade, por parte do governo federal, de avaliar melhor as possíveis consequências de políticas públicas que possam a vir a interferir nas receitas municipais.Palavras-chave: Municípios. Arrecadação. Desoneração
TRANSPORTE URBANO DE BAIXO CARBONO NA CIDADE DE SÃO PAULO: ANÁLISE DAS POLÍTICAS PÚBLICAS LOCAIS
Authors: Maglio Leonardo Machado , Gallardo Amarilis Lucia Casteli Figueiredo
Published: September 2020

Na cidade de São Paulo, assim como em outras grandes metrópoles, o setor de transporte é o maior responsável pelas emissões de GEE. Desse modo, essa pesquisa pretende analisar em que medida as políticas públicas que incidem no setor de transportes adotam medidas para redução as emissões de GEE Para tal, foi adotado como roteiro da análise o A-S-I Framework, proposto pela organização GIZ (2014) para o planejamento de políticas públicas para o transporte urbano de baixo carbono. Os resultados dessa pesquisa revelaram que a cidade de São Paulo possui importantes instrumentos políticos de planejamento do uso do solo, do transporte público e dos modos não motorizados para descarbonizarão do setor de transportes, mas precisa avançar em medidas econômicas e regulatórias que já vem sendo adotadas em grandes cidades mundiais com resultados significativos, como a tarifa zero no transporte público e o pedágio urbano.
A SUSTENTABILIDADE E A TRANSPARÊNCIA INFLUENCIAM TOMADA DE DECISÃO DO INVESTIDOR BRASILEIRO?
Authors: Quirós Dannie Delanoy Carr , Peixoto Fernanda Maciel , Fagundes André Francisco Alcântara , Maestri Cláudia Olímpia Neves Mamede
Published: September 2020

A literatura aponta que a divulgação dos dados contábeis é essencial para a tomada de decisões de investimento. No entanto, cada indivíduo processa de forma distinta a informação financeira para tomar decisões (HENDRIKSEN; VAN BREDA, 1999). Argumenta-se que é racional investir em empresas sustentáveis e transparentes dado que elas tendem a apresentar melhor performance (BODHANWALA; BODHANWALA, 2018). Considerando este panorama teórico, este estudo buscou investigar os possíveis efeitos que a sustentabilidade e a transparência podem ter sobre a tomada de decisão dos investidores que investem em ações. Para isto, foi desenvolvido um experimento por meio de uma pesquisa de opinião aplicada a estudantes universitários. O método de análise envolveu análise bivariada e regressão múltipla cross-section. Constatou-se que a sustentabilidade e a transparência não influenciaram a tomada de decisão de investimento. No entanto, percebeu-se uma relação entre o volume de recursos investido e a idade do investidor.
Asymmetrical 1st reflection trend owing to metallization difference at ± Z-faces in indium tin oxide coated Fe-doped lithium niobate
Authors: Wang Chao , Su Hang , Ma Xinyan , Zhao Hua
Published: September 2020

The charges accumulated at the interface of indium tin oxide (ITO) and iron doped lithium niobate (LN) in an extremely thin layer because of semiconductor band alignment were analyzed with ab initio theory. The formation of 2D electron gas makes the interface metallic and the excitation of surface plasmon polaritons (SPPs) possible. In experiments, diametrically opposite trends of the very first reflection (VFR) on the ± Z-faces of ITO coated Fe-LN slabs were observed and associated with the differences in metallization and the photovoltaic charge accumulation there. Microscopically, the electric environments of the two ITO/LN interfaces differ greatly owing to spontaneous polarization and photovoltaic fields, which alter the band structures and band alignment, resulting in phase gratings with a π-shift difference recorded at the two interfaces. This affects the opposite energy coupling between the SPPs and laser beams and results in the dramatically opposite trends of VFR.
Bandwidth optimization of cascaded long-period gratings for broadband mode conversion over 1.0-2.2 µm waveband
Authors: Liu Zuyao , Liu Yunqi , Zhao Xinyi , Mou Chengbo
Published: September 2020

We investigated theoretically and experimentally the cascaded long-period fiber gratings (c-LPFGs) in a few-mode fiber (FMF) for the generation of LP11 core mode in a broad wavelength range. The dependence of the transmission spectra of the c-LPFGs on the spacing between the gratings, and grating periods are studied in detail. The c-LPFGs experimentally generate LP11 core mode in a 10-dB bandwidth of 193.6 nm in 1.55 µm waveband and 447.5 nm in 2 µm waveband, respectively. The first-order orbital angular momentum mode can be converted by the c-LPFGs with the same broadband wavelength range. The 10-dB bandwidth and corresponding wavelength range for mode conversion can be adjusted by changing the grating spacing and grating periods.
Consecuencias de los factores psicosociales en la calidad de vida laboral
Authors: Abouzeid Abouzeid Ghada Khalil , López Montesinos María José , Martínez Alarcon Laura
Published: September 2020

Introducción: Los factores psicosociales influyen en la calidad de vida de los profesionales de enfermería en el ámbito hospitalario asociados a variables sociodemográficas y laborales que repercuten en su calidad de vida.Objetivo: Analizar la calidad de vida laboral percibida por los profesionales de enfermería en un centro hospitalario, asociada a factores psicosociales y sociodemográficos.Metodología: Trabajo de campo descriptivo, observacional, cuantitativo, concurrente, transversal sobre calidad de vida. Muestra: profesionales de enfermería del ámbito hospitalario (N=240). El estudio realizado desde 2016 a 2018.Herramienta medición: cuestionario CVP-35, y datos sociodemográficos y laborales.Resultados: La satisfacción de los profesionales con la calidad de vida percibida (94%) es alta. Los porcentajes bajos se presentan en el apoyo directivo (48%). Existen asociaciones significativas (p<0.05) entre los ámbitos sociodemográficos y su relación con las tres dimensiones analizadas de la calidad de vida laboral.Conclusiones: El apoyo directivo hacia los enfermeros no ha sido un estímulo apropiado para el desarrollo y mejora de sus funciones.
Axiology in Latvia`s Insolvency policy
Authors: Savickis Valdis
Published: September 2020

The closing period for the validity of the policy planning documents in the sphere of insolvency proceedings in the Republic of Latvia is approaching (the Insolvency Policy Development Guidelines 2016-2020, as well as their implementation plan). Given the extensive work done by the state on reforming and reorganizing the insolvency and regulatory framework, the author focuses on the axiological aspect of the insolvency policy. Parallel to the modernization of the insolvency process, because of which the role of the state in the control and supervision of the insolvency sector has significantly increased and considering the correlation between the speed and efficiency of insolvency process, there will be conducted value-oriented study on the insolvency sector. The aim of the paper is to carry out research and analysis of insolvency policy through the prism of axiology. The study uses analytical, descriptive, and deduction/induction methods, evaluating the various policy planning documents that make up insolvency policy, paying attention to the specifics of the insolvency process of legal entities.

Keywords: Insolvency policy, axiology, value, business environment
The Aesthetic and Plastic Values for the Concept of Synthesis through the Ages and the Variables of Material and Designing the Hanging Textile
Authors: El-Deeb Nahla Ahmed Hamdy
Published: September 2020

Synthesis means intermarriage and compatibility between more than one raw material in a single artwork. Interacting with its various properties and sources to reach a balance between expressive and technical aspects within the framework of the technical and technical capabilities of that raw material. By adding raw materials, they are woven with textured structures or by the new method developed through the art of gluing or collage and the art of assembly through deletion and addition within the scope of plastic treatments of the textile surface or by using both the traditional and the new method combined to merge between Woven materials and added media on the surface of the artwork. The research deals with synthesis through the ages (the ancient Egyptian - Coptic - Islamic - popular) and some schools of modern art (Cubism - Dada - Pop Art) and some pioneers in plastic art in Egypt (Munir Kanaan - Ahmed Nawar - Farghali Abdul Hafeez - Zainab Sabra).

Research Problem: - To what extent can the aesthetic and plastic values ​​be benefited from the different treatments of natural and synthetic textile materials for the concept of synthesis?

Research Aims: - Revealing the aesthetic, plastic, and artistic values ​​of the synthesis method throughout the ages to find new approaches to teaching manual fabric. - Create innovative aesthetic values ​​and formulations on the surface of the tissue sphere. The current research provides a program consisting of 3 teaching entrances that depend on a number of key and sub-concepts proposed for the concept of synthesis through art education.

Keywords: The Aesthetic - Plastic Values - The Concept of Synthesis – Variables of Material and designing - Hanging Textile
The Role of Family Policy in Solving Demographic Problems: Study of the Polish Program Family 500+
Authors: Wilk Sławomir
Published: September 2020

This article offers a critical reflection on the Programme “Family 500+” introduced by the Polish government and aimed at improving the financial situation of Polish families in order to increase the fertility rate. Families have been supported with the benefit of 500 PLN given for each child under 18. The article presents the results of the research carried out in 2019 on the representatives of the households (N= 3347). The interviewees most frequently pointed to the increase of the quality of living conditions and the increase in the consumption of goods and services. Approximately 80% of the interviewees have noticed the fact that the benefit boosted potential development of children by enabling them to participate in the extracurricular activities and visit leisure centers. 64,7% of the interviewees believe that the Programme let them have savings and 17,8% of respondents claim that the benefit will not contribute to their savings but will be consumed on a day-to-day basis. Despite the initial assumptions of the Programme , the policy of pronatalism was not achieved as the fertility rate did not reach the assumed level. It must be stated that even though the legislative activities constitute a milestone in the Polish pro-family policy these solutions have many disadvantages. The Programme should not be the main tool of the Polish demographic policy but just supplementary.

 Keywords: Family 500+ Programme; family policy; demographic policy; State Aid for Child Support Act; household finance; family benefits