bluuebunny/crossref_metadata_2025 huggingface dataset:
Decide Now or Wait for the Next Forecast? A Decision Framework Based on an Extension of the Cost-Loss Model
Authors: Jewson Stephen , Scher Sebastian , Messori Gabriele
Published: February 2020

Users of meteorological forecasts are often faced with the question of whether to make a decision now based on the current forecast or wait for the next and hopefully more accurate forecast before making the decision. One would imagine that the answer to this question should depend on the extent to which there is a benefit in making the decision now rather than later, combined with an understanding of how the skill of the forecast improves, and information about the possible size and nature of forecast changes. We extend the well-known cost-loss model for forecast-based decision making to capture an idealized version of this situation. We find that within this extended cost-loss model, the question of whether to decide now or wait depends on two specific aspects of the forecast, both of which involve probabilities of probabilities. We derive an algorithm for calculating these two probabilities for the case of normally distributed weather or climate forecasts and apply it to a series of synthetic weather forecasts of temperature. We find that the algorithm leads to better decisions relative to three simpler alternative decision-making schemes.
Sequence Properties of the MAAP Protein and of the VP1 Capsid Protein of Adeno-Associated Viruses
Authors: Karlin David G.
Published: February 2020

Adeno-associated viruses (AAVs, genus dependoparvovirus) are promising gene therapy vectors. In strains AAV1-12, the capsid gene VP1 encodes a recently discovered protein, MAAP, in an overlapping frame. MAAP binds the cell membrane by an unknown mechanism. We discovered that MAAP is also encoded in bovine AAV and in porcine AAVs (which have shown promise for gene transfer into muscle tissues), in which it is probably translated from a non-canonical start codon. MAAP is predicted to be mostly disordered except for a predicted C-terminal, membrane-binding amphipathic α-helix. MAAP has a highly unusual composition. In particular, it lacks internal methionines, and is devoid of tyrosines in most strains. Unexpectedly, we discovered that the N-terminus of VP1 also lacks several amino acids. In all AAVs that encode MAAP, the first 200 aas of VP1 are devoid of internal methionines, probably owing to a selection against ATG codons that could prevent translation of MAAP and of capsid isoforms (VP2, VP3). The N-terminus of VP1 also lacks cysteines, likely to avoid the formation of disulfide bridges when it becomes exposed outside of the capsid during post-endocytic trafficking. Finally, the region common to VP1 and VP2 lacks tyrosine in the vast majority of AAVs that encode MAAP. Avoiding these "forbidden" aas in MAAP and VP1 when creating recombinant AAV capsids might increase the efficiency of capsid design. Conversely, the presence of "forbidden" aas in some rare strains probably indicates that they have unusual properties that could help us understand the viral cycle.
Development and Implementation of the Application APPMAR 1.0. A Toolbox for Management of Meteorological and Marine Data on Limited Information Regions
Authors: Rivillas-Ospina German , Bolivar Marianella , Maza Chamorro Mauro , Ruiz Gabriel , Casas Diego , Guerrero Roberto
Published: February 2020

This work presents an application called APPMAR 1.0 based on Python ® environment, built to perform the downloading, treatment and analysis of meteorological and marine information. This application is composed of two main modules: the first module allows the downloading of information from the database (NOAA - WW3); the second module uses the principles of statistical mathematics for the treatment of waves and wind. The importance of this simple application is based on the free and agile access to meteorological and marine information for a coastal project. The determination of representative conditions of sea states ultimately will govern the process of design of coastal and oceanic infrastructure. The analysis of historical time series of local waves and winds allows the evaluation of average regimes or operational design, the ultimate limit states or extreme design, and the storms or design by persistence. In spite that the former analysis is a common task for coastal engineers, the codes generated are seldom shared for public use. In summary, for operational purposes is useful to have a freeware that can assist in the data processing for decision making and forcing of the mathematical models that are part of the common practice of coastal, oceanic and offshore engineering. This application has been tested in the Caribbean area of Colombia where meteorological and marine information are scarce.
Opening the Black Box: Interpretable Machine Learning for Geneticists
Authors: Azodi Christina B. , Tang Jiliang , Shiu Shin-Han
Published: February 2020

Machine learning (ML) has emerged as a critical tool for making sense of the growing amount of genetic and genomic data available because of its ability to find complex patterns in high dimensional and heterogeneous data. While the complexity of ML models is what makes them powerful, it also makes them difficult to interpret. Fortunately, recent efforts to develop approaches that make the inner workings of ML models understandable to humans have improved our ability to make novel biological insights using ML. Here we discuss the importance of interpretable ML, different strategies for interpreting ML models, and examples of how these strategies have been applied. Finally, we identify challenges and promising future directions for interpretable ML in genetics and genomics.
A Far More Ambitious Species Goal is Needed for the Post-2020 Global Biodiversity Framework
Authors: Williams Brooke A. , Watson James E.M. , Ward Michelle S. , Butt Nathalie , Simmonds Jeremy S.
Published: February 2020

Urgent action is required to ‘bend the curve’ on biodiversity loss. However, the ‘species goal’ (Goal B) unveiled in the recently released Zero Draft of the Post-2020 Global Biodiversity Framework (GBF) is inadequate for mobilizing conservation actions to achieve the outcomes required to halt and reverse species declines. Here we examine the limitations of the goal as presented in the Zero Draft and propose a more ambitious goal for species. The conservation community must ensure that the species goal of the GBF captures what is actually needed from a species perspective for the Post-2020 Framework to achieve its 2030 mission “to put biodiversity on a path to recovery for the benefit of planet and people”, lest the mission be doomed from the start.
Astrocyte-Derived Small Extracellular Vesicles Regulate Dendritic Complexity through miR-26a-5p Activity
Authors: Luarte Alejandro , Henzi Roberto , Fernández Anllely , Gaete Diego , Cisternas Pablo , Pizarro Matías , Batiz Luis Federico , Villalobos Isabel , Masalleras Matías , Vergara Rodrigo , Varas-Godoy Manuel , Herrera-Molina Rodrigo , Lafourcade Carlos , Wyneken Ursula
Published: February 2020

In the last decades, it has been established that astrocytes play key roles in the regulation of neuronal morphology. However, the contribution of astrocyte-derived small extracellular vesicles (sEVs) to morphological differentiation of neurons has only recently been addressed. Here, we showed that cultured astrocytes expressing a GFP tagged version of the stress-regulated astrocytic enzyme Aldolase C (Aldo C-GFP) release small extracellular vesicles (sEVs) which are transferred into cultured hippocampal neurons. Surprisingly, Aldo C-GFP-containing sEVs (Aldo C-GFP sEVs) displayed an exacerbated capacity to reduce the dendritic complexity in developing hippocampal neurons compared to sEVs derived from control (i.e. GFP-expressing) astrocytes. Using bioinformatics and biochemical tools, we found that the total content of overexpressed Aldo C-GFP correlates with an increased content of endogenous miRNA-26a-5p in both total astrocyte homogenates and sEVs. Notably, neurons magnetofected with a nucleotide sequence that mimics endogenous miRNA-26a-5p (mimic 26a-5p) not only decreased the levels of neuronal proteins associated to morphogenesis regulation and also reproduced morphological changes induced by Aldo-C-GFP sEVs. Furthermore, neurons magnetofected with a sequence targeting miRNA-26a-5p (antago 26a-5p) were largely resistant to Aldo C-GFP sEVs. Our results support a novel and complex level of astrocyte-to-neuron communication mediated by astrocyte-derived sEVs and the activity of their miRNA content.
Influence of Irradiation on the Biology of the Brown Marmorated Stink Bug (Halyomorpha halys Stål)
Authors: Nguyen Hai Nam , Stringer Lloyd Damien , Hong Ki-Jeong
Published: February 2020

The irradiation biology of the brown marmorated stink bug (BMSB, Halyomorpha halys Stål) treated at the nymphal stage was investigated to determine its application for sterile insect technique (SIT). Fifth instar males of BMSB were exposed to gamma-radiation 60Co at different doses of 12, 16, 20, 24 and 64 Gy. Irradiated males were mated with non-irradiated virgin females to assess the longevity of both sexes, female fecundity and fertility of their offspring until the egg stage of the F2 generation. The mortality of each of the developmental stages of the F1 and eggs of the F2 generation was observed to determine whether negative effects from exposure to radiation was inherited. The data indicated that irradiation significantly reduced the lifespan of male insects at doses above 20Gy. Irradiated males did not affect the longevity and fecundity of their female partners, nor either sex of their resulting progeny, but it did reduce the hatch rate of the eggs at all doses tested. The sterility rates of F1 eggs were 55.6%, 73.3%, 74.1% and 74.1% at doses of 12Gy, 16Gy, 20Gy and 24Gy respectively. Eggs were completely sterile (100%) at a dose of 64Gy with no egg hatch recorded. A low hatch rate of F2 eggs illustrated that negative effects from radiation was inherited by the subsequent generation. The results support the potential for the use of SIT for BMSB management by irradiating the fifth instar male nymphs at 16-64Gy.
Identifikasi Lahan Pertanian Pangan Berkelanjutan di Kabupaten Gowa, Sulawesi Selatan: Zonasi Lingkup Kawasan Mamminasata Menggunakan Pendekatan MCDM
Authors: Chairuddin Zulkarnain
Published: February 2020

The protection of agricultural land is very important to be studied scientifically considering the rapid growth of the population so that the possibility of land use conflict is very high. The main purpose of this research is to identify and inventory agricultural land of food especially existing rice-paddy fields to find zonasi agricultural land for sustainable foodcrops (ALSF) and agricultural reserved land for sustainable foodcrops (ARLSF)) with the level of threat from the transfer function in Gowa Regency area of hinterland Mamminasata, South Sulawesi. This study used a multiple criteria decision making approach with purpose mapping function of ALSF and ARLSF. The generic attributes, from: the biophysical aspects of the land (altitude, sizes of soil cracking, length of rice-field in slope landscape unit, proportion of paddy field area, top soil thickness), and socio-economic aspects (population density, population growth rate, demand for paddy field, productivity of paddy fields, equilibrium of paddy field), and policy aspects (local regulations status, detailed spatial plan status, type of irrigation networks). While the scenario of zonation of ALSF and ARLSF is used the criteria of distance from the provincial capital (Makassar) and the district capital (Sombaopu), the status of the rice-paddy field equilibrium and the trend pattern of percentage of space requirement. The results of the research shows that the existing position of paddy field is identified as ALSF and ARLSF zonation currently 24,210 Ha. The level of vulnerability of land conversion, which is in a "safe" position of 15,407 Ha (63.64%), and "threatened" of 8,803 Ha (36.36%). The prediction of productivity potential is related to the area of land that can be managed optimally in the vulnerable time up to the year 2020 covering 19,499 Ha (80.54%), and subsequently, by 2040 the area will shrink to only 10,173 Ha (42.02%).
IDENTIFIKASI STATUS HARA TANAH PADA LAHAN KERING SEBAGAI DASAR PEMUPUKAN KEDELAI DI KECAMATAN ANDOOLO KABUPATEN KONAWE SELATAN
Authors: Musyadik Musyadik
Published: February 2020

Soybean is a potential type of legume plant to be developed in Andoolo District, South Konawe Regency. However, the soybeans production is still relatively low. The main problem in the low production of soybeans is the unavailability of information on soil fertility status, especially the status of organic C-nutrients, P and K. Therefore information on soil nutrient status is very necessary. The study was conducted in the village of Ataku, Andoolo District, South Konawe Regency in May to July 2018 using the Dry Soil Test Equipment (PUTK) method. There were 27 soil samples taken randomly to obtain soil nutrient status including organic matter, P, K and soil pH and recommendations for soybean fertilizer dosages in the Andoolo District. The results of this study showed that C-Organic status, P, K and pH in Andoolo District varied. Based on the results of the analysis, the recommended fertilizer dosage in Andoolo District is giving 2 tons/ha of organic matter plus 200 kg/ha of Urea fertilizer, 200 kg/ha of SP36, and 100 kg/ha of KCl for low K status, 75 kg/ha of KCl for moderate K status and 50 kg/ha of KCl for soil with high K status. For soil with a very acidic and acidic pH status, it is recommended to give 500 kg/ha of lime doses to increase the soil pH to neutral conditions.
A Four-Year Hospital-Based Retrospective Study of the Predictors of Tuberculosis in People Living with HIV and Receiving Care at Bamenda Regional Hospital, Cameroon
Authors: Anye Cho Sabastine , Nkfusai Claude Ngwayu , Yankam Brenda Mbouamba , Wirsiy Frankline Sevidzem , Tsoka-Gwegweni Joyce Mahlako , Cumber Samuel Nambile
Published: February 2020

Background: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infections place immense burdens on healthcare systems with particularly diagnostic and therapeutic challenges. TB is high among opportunistic diseases and the most leading cause of death among patients with HIV/AIDS. HIV infection is the most-known risk factor for Mycobacterium tuberculosis infection and progression to active disease, which increases the risk of latent TB reactivation by 20-fold. We present a four-year descriptive analysis of TB in people living with HIV in the Bamenda Regional Hospital (BRH) from 2012-2016.

Methods: This was a hospital-based descriptive chart review. We conducted manual reviews of medical records of HIV/TB co-infected patients from June 2017-July 2017 at BRH
Un poeta narrador
Authors: Favela Bustillo Tania
Published: February 2020

En el presente ensayo me interesa mostrar cómo es que José Watanabe2 se asume como un artesano, un poeta- narrador que va tejiendo los hilos narrativos con el espíritu poético. Para analizar la función del narrador tomé, entre otros textos, el ensayo «El narrador», de Walter Benjamin; en este, Benjamin señala que la narración es una forma artesanal de comunicación. A partir de la reflexión benjaminiana analicé el papel de la fábula y de las parábolas como pivotes de las narraciones de Watanabe, y al mismo tiempo como semillas para el poema. Las semillas que arrojan al margen de la historia que cuentan permitenel nacimiento de la poesía en los poemas; la narración, la historia, es, por decirlo así, la tierra que permite el vuelo de la poesía.
Dimas Arrieta Corazón de viento. Bitácora del explorador
Authors: Trujillo Valverde Said Ilich
Published: February 2020

El libro está dividido en siete capítulos, en los que se intercalan la narraciónimpersonal de las aventuras don Manuel Eugenio y la bitácora delexplorador, relato en primera persona en la que la voz narrativa se permitereflexionar sobre sus acciones y su relación con el mundo que lo rodea. Loscapítulos impares son los de la narración y en ella el énfasis está puestoen el desarrollo de las acciones. El primer capítulo inicia mucho despuésdel inicio de la primera bitácora y nos ubica de lleno en lo importante: lafundación de Palambla y la misión de don Manuel ahí. Con el correr de las páginas la novela se perfila como una continuadorade la tradición de novelas fundacionales: un patriarca excepcionalque deja una prole numerosa y que acompañado por una mujer de fuertecarácter deja una huella indeleble en la memoria de todos los que los conocen.Pero hay algo que distingue a Corazón de viento y es el gran énfasispuesto en las culturas originarias y cómo Manuel Eugenio es introducidoen estas. Desde los telares que sirven para dar la bienvenida a cada nuevocapítulo hasta el séquito misterioso del Taytay, pasando por el caciqueCosme Chinguel, el mundo no occidental está ahí, siempre presente.
Seis tesis sobre los orígenes teológicos del poder
Authors: Lagunas David
Published: February 2020

En este ensayo se plantea una reflexión acerca de los orígenes teológicos del poder. La relación entre la religión y el poder más obvia reside en los rituales políticos y en los religiosos. Sin embargo, la alianza entre ambas dimensiones de la cultura va más allá de esta semejanza formal y se extiende hacia varias dimensiones de la religión que reflejan una vinculación con el poder, lo cual me permite pensar heurísticamente sobre el fenómeno religioso.
El ámbar gris como recurso marino en la península de Yucatán, siglo XVI al XIX. Una historia corta
Authors: Victoria Ojeda Jorge
Published: February 2020

El artículo presenta datos históricos del siglo XVII al XIX, escritos y cartográficos, que indican la presencia de ámbar gris en la costa oriental de la península de Yucatán (México), marcado incluso con el hecho de que una parte de la geografía continental e insular recibió como topónimo el nombre del producto marino. Esa codiciada materia era, seguramente, traficada de manera regional por los españoles, los piratas y por los ingleses asentados en Wallix (Belice), pero su mención también orilló a la Corona hispana a averiguar la posibilidad de conocer su potencial como género explotable en el marco del reformismo económico del siglo XVIII. La ausencia de datos a propósito de ello hace suponer lo fallido del intento. Actualmente, el ámbar gris no se encuentra de manera fácil en las playas debido a la baja poblacional de esos mamíferos pero también a la captura clandestina que propicia la cotizada secreción.
Breve análisis morfosintáctico de las expresiones de los periodistas policiales de Lima
Authors: Velezmoro Contreras Úrsula Yvonne
Published: February 2020

En el presente estudio, se ha registrado el léxico empleado por los periodistas policiales de Lima (LPPL) en laprensa escrita, radial y televisiva. Esta investigación pretende ser útil a las personas ajenas a esta lengua profesional, a fin de que puedan conocer lo que ellos expresan en sus enunciados lingüísticos. Aunque este análisis no contiene todo el LPPL, sí presenta una selección completa de su código. Este trabajo presenta palabras y acepciones que han sido recogidas con significados circunscritos a sus expresiones entre julio y octubre de 2009, entradas que han sido actualizadas desde abril hasta junio de 2016. Se trata de una muestra de casos en los que se observan los procesos morfológicos de derivación, composición, metátesisy supresión, así como la construcción de locuciones adverbiales y verbales, a través de los cuales se forman las palabras de esta lengua profesional.
Costumbrismo y tradicionismo: la representación literaria en México y el Perú en el siglo XIX
Authors: Lima Baca Francisco
Published: February 2020

El propósito de este trabajo es realizar una comparación entre dos modelos estéticos y narrativos en Méxicoy el Perú en el siglo XIX: el costumbrismo y el tradicionismo. Al realizar dicho análisis comparativo podemos entender la forma en que se representó la realidad a través de la ficción en las jóvenes naciones latinoamericanas, en las cuales la literatura sirvió como fundamento para crear un proyecto de identidad nacional en el que la historia, íntimamente vinculada con el tradicionismo peruano, y la representación de las costumbres nacionales, vinculadas con el denominado costumbrismo mexicano, son la pauta para definir una literatura de carácter nacional en cada uno de los países señalados.
Poesía indígena actual: textos que se cantan susurrados en sus lenguas y textos bilingües que se leen
Authors: Rodríguez Monarca Claudia
Published: February 2020

Referirse a la poesía indígena actual supone tomar en cuenta la variable de la heterogeneidad no solo de los  textos, sino también de los modelos de textos que subyacen en las distintas propuestas poéticas. A pesar de esa variedad, proponemos que la poesía indígena actual se canaliza a través de dos tipos de modelos textuales disponibles y vigentes, repertorios que están operando en las distintas culturas, uno de carácter defensivo (esto es, de resistencia y repliegue intracultural) y otro transdiscursivo (de diálogo y despliegue intercultural e interdisciplinar). Los poetas suelen asumir ambas actitudes y transitar de un modelo a otro, desplazamiento propio de los procesos de reterritorialización (simbólica, cultural y geográfica) que les ha tocado experimentar. El corpus considera producciones poéticas andinas actuales (quechua, kichwa, aimara), amazónicas (tikuna, okaína, uitoto, camentsá, ashánica, shuar, bora), guaraní y mapuche.
Calibrating the Todd and Longstaff Mixing Parameter Value for Miscible Finite-Sized Slug WAG Injection for Application on a Field Scale
Authors: Al-Haboobi Zainab I. M. , Christie Michael A. , Graham Alexander J.
Published: February 2020

The Todd and Langstaff (1972) mixing parameter (ω) is the most commonly used parameter in black oil reservoir simulators for modeling the effects of viscous fingering on a field scale, as their model is a useful alternative to compositional simulations. Todd and Longstaff (1972) recommended a choice for the value of ω to be ⅔ for secondary miscible gas injection to match the recovery of oil from Blackwell et al. (1959) experiments and ωto be13 for secondary miscible gas injection on a field scale to account for field-scale heterogeneities. Blunt and Christie (1993) extended the model and showed that ω needs to be calibrated for simultaneous water alternating gas (SWAG) injection. They showed that the mixing parameter should be increased to 1 when modeling secondary miscible SWAG injection, and to 0.92 when modeling tertiary miscible SWAG injection. This work is a modification of Blunt and Christie's (1993) work to calibrate the value of ω for miscible finite-sized slug water alternating gas (FSS WAG) injection.

In this paper we focus on the impact of WAG ratio, slug size, and type of recovery on the calibration of Todd and Longstaff's (1972) mixing parameter to highlight the importance of taking this parameter into account when simulating miscible FSS WAG injection using a black oil simulator. The value of ω was computed by matching the solvent concentration and the water saturation profiles from the 1D model against the 2D simulation. The results show that as the slug size increases, the value of ω decreases at different WAG ratios for both secondary and tertiary recovery. The application of the calibrated value of ω on a field scale showed that the value of ω had an impact on the oil recovery and on the total gas and water production, highlighting the importance of an appropriate mixing parameter selection.
Using a Facebook Group to Facilitate Faculty-Student Interactions during Preclinical Medical Education: a Retrospective Survey Analysis
Authors: Henry David S. , Wessinger William D , Meena Nikhil K. , Payakachat Nalin , Gardner Jerad M. , Rhee Sung W
Published: February 2020

Background: Strong learner-teacher relationships are associated with more successful learning outcomes. With shortened modular curricula and increased availability of online resources, fostering faculty interaction with preclinical medical students has become more challenging. We sought to enhance learner-teacher relationships by engaging in discussion with preclinical medical students in their own online space. Methods: We utilized a closed Facebook discussion group, where faculty and students voluntarily joined in informal discussions and shared announcements related to their courses. The closed discussion group allowed only participating students and faculty to see others’ posts within the group. This provided a platform to freely interact within the confines of the group while maintaining privacy for the personal Facebook accounts of both faculty and students. We utilized the discussion group through 3 separate organ system-based modules for 14 weeks. Afterward, students were asked to complete an anonymous, voluntary online survey about their experience. Results: 94.1% (160/170) of enrolled second-year medical students joined the voluntary FB discussion group. There were 214 posts, 628 comments, and 4166 reactions in this discussion group during the three modules. Of the students in the group, 74.4% (119/160) responded to the online survey. Overall, students strongly agreed that the Facebook discussion group fostered better rapport with faculty, helped content learning, and improved emotional well-being. Also, they felt more comfortable seeking academic help after using the discussion group. They reported a slight preference for Facebook over email as a medium for asking questions, but no preference for either as a medium for distributing announcements. Students overwhelmingly recommended that the discussion group should be continued in future years. Conclusion: The Facebook discussion group was a free, efficient, and effective method of cultivating the learner-teacher relationship with the preclinical medical students, resulting in reported enhancement of learning and morale.
A community-based randomized trial for the prevention and control of brucellosis among rural populations in Iran: application of the PRECEDE planning model
Authors: Jahangiry Leila , Khazaee-Pool Maryam , Babazadeh Towhid , Sarbakhsh Parvin , Ponnet Koen
Published: February 2020

Background: Brucellosis is one of the most frequently occurring zoonotic diseases of veterinary and a public health problem in developing countries. It affects human and animal health and has measurable effects on the productive and reproductive performance of livestock. Therefore, the main purpose of this study was to develop a community-based intervention program for brucellosis prevention and control. A two-arm parallel cluster randomized controlled trial investigated the effectiveness of the program over six months in a rural population in Ahar, East Azerbaijan, Iran. A total of 16 village health houses were randomly allocated to the intervention and the control groups (eight per arm), and 400 participants were recruited via household health records in the health houses. The PRECEDE model, which is an acronym for Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation, was used to design, implement, and evaluate the brucellosis prevention and control program. Knowledge, attitudes, self-efficacy, social support, environmental enabling, and behavioral factors were measured at the baseline and the six-month follow-up. A generalized mixed effects model was used to analyze data. Results: The mean ages (SD) of the intervention and control group respondents were 35.9 (11.87) and 37.28 (11.04) years, respectively. After the six-month intervention, significant between-group differences were found on all PRECEDE variables, adjusted for education, history of brucellosis, and family history of brucellosis. Conclusion: There is a need to consolidate collaborative health and veterinary sector efforts, as well as increase regular vaccination practices and financial resources to support farmers willing to slaughter animals and/or offer slaughter facilities. The present study was able to demonstrate which educational and ecological factors influence behaviors and environments related to brucellosis and, as such, provide evidence of the effectiveness of interventions based on the PROCEDE model.
Determinants of Hospital Efficiency: insights from the literature
Authors: Asbu Eyob Zere , Masri Maysoun Dimachkie , Naboulsi Marwan Al
Published: February 2020

Background

Achieving Universal Health Coverage and other health and health-related targets of the sustainable development goals entails curbing waste in health spending due to inefficiency. Inefficiency is a pervasive problem in health systems. The World Health Organization estimates that on average, 20-40% of the global total health expenditure is wasted. The proportion of total health expenditure attributed to hospitals is high, which implies that improving the efficiency of hospitals will lead to more efficient health systems. This study aims to synthetize the major determinants of hospital inefficiency and to develop a framework to identify causes of inefficiency and develop multi-factor interventions to address inefficiencies.

Methods

The study is based on survey of the literature on hospital efficiency and its determinants. The studies include those that employ ratio methods of efficiency analysis, data envelopment analysis and stochastic frontier models and econometric models such as the tobit regression to assess determinants of technical efficiency. Data was extracted in a table format categorized as those that are within the hospital, outside the hospital but within the health system and those that are outside the hospital and health system in the broader macroeconomic system and analyzed.

Results

Hospital efficiency is influenced by factors that may be internal to the hospital or external and thus could be wholly or partially out of the control of the hospital. Hospital-level characteristics that influence efficiency include ownership, size, specialization/scope economies, teaching status, membership of multihospital system and other factors such as case-mix and ratio of outpatients to inpatients. However, the effects of these variables are not definitive and consistent; all depends on the context. Factors out of the direct control of the hospital include geographic location, competition and reimbursement systems. The findings further elucidate that no single factor is effective in addressing hospital inefficiencies in isolation from others.

Conclusion

There is no one single magic formula or intervention that can be adopted by different hospitals and can be effective in improving hospital efficiencies. Multiple factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its environment should be developed.
No man is an Island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches.
Authors: Nascimento Miguel , Lourenço Beatriz , Coelho Ines , Aguiar Joana , Lázaro Mariana , Silva Mariana , Pereira Camila , Neves-Caldas Inês , Gomes Filipe , Garcia Sara , Nascimento Sandra , Pereira Guilherme , Nogueira Violeta , Costa Pedro , Nobre Alice
Published: February 2020

Purpose: to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF). Methods: spatial autocorrelation statistics regarding all patients observed at CHPL in 2017, at the census subsection level, considering a queen criterion of contiguity, regarding not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000m. Results: All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800. Conclusions: as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.
Psychometric Properties of Instrumented Postural Sway Measures Recorded in Community Settings in Independent Living Older Adults
Authors: Alqahtani Bader , Sparto Patrick J. , Whitney Susan L. , Greenspan Susan L. , Perera Subashan , Brach Jennifer S.
Published: February 2020

Background: In the last few decades, research related to balance in older adults has been conducted in lab-based settings. The lack of portability and high cost that is associated with the current gold standard methods to quantify body balance limits their application to community settings such as independent living facilities. The purpose of the study was to examine the relative and absolute reliability and the convergent validity of static standing balance performance using an accelerometer device. Methods: A total of 131 participants (85% female, mean age 80 ± 8 years) were included for the validity aim, and a subsample of 38 participants were enrolled in the reliability testing (89% female, mean age 76 ± 7 years). The root-mean-square (RMS) and normalized path length (NPL) for sway in antero-posterior (AP) and medio-lateral (ML) directions were calculated for different standing balance conditions. Test-retest reliability was assessed over two testing visits occurring one week apart using the intraclass correlation coefficient (ICC) for relative reliability, and the minimal detectable change (MDC) was calculated for the absolute reliability. Spearman’s rank correlation coefficient was used to test convergent validity at baseline between balance measurements and related mobility measures. Results: Reliability of balance performance using accelerometers was good to excellent with ICC values ranging from 0.41 to 0.83 for RMS sway and from 0.49 to 0.82 for NPL sway. However, the ICC during semi-tandem stance in A-P direction was 0.35, indicating poor reliability. The MDC of the sway measurements ranged from 2.4 to 9.4 for the RMS and 5.2 to 13.8 for the NPL. Balance measurements were correlated with mobility measurements. Conclusions: Using a portable accelerometer to quantify static standing postural control provides reliable measurements in community settings.
Prognostic factors and survival according to tumour subtype in women presenting with breast cancer bone metastases at initial diagnosis: a SEER based study
Authors: Li Xiao , Zhang Xiaoli , Liu Jie
Published: February 2020

Introduction : Tumour subtype have a significant effect on bone metastasis in breast cancer, but population-based estimates of the prognosis of bone metastases at diagnosis of breast cancer are lacking.The aim of this study was to analyse the influence of tumour subtype and other factors in the prognostic and survival of patients with bone metastases of stage IV breast cancer. Methods : Using the Surveillance, Epidemiology, and End Results Program (SEER) data of 2012 to 2016 conducted a retrospective cohort study to investigate stage IV patients with bone metastases in breast cancer. Stage IV Patients characteristic according subtype were compared using chi-square, overall survival (OS), prognostic factor calculated using the Kaplan-Meier method and the Cox proportional hazards model. Results : A total of 3384 stage IV patients were included in this study. 63.42% were HR+/HER2-, 19.86% were HR+/HER2+, 9.34% were HR-/HER2-, and 7.39% were HR-/HER2+. Median OS for the whole population was 38 months, 33.9% of the patients were alive at five-year. The median OS and five-year survival rate among the different subtype of breast cancer stage IV patients are significant differences ( p <0.05). Multivariate Cox regression analysis showed that age of 55-59 (HR=1.270 ), black race (HR=1.317 ), grade in III/IV ( HR=1.960 ), HR-/HER2- (HR=2.808 ), lung metastases (HR=1.378 ), live metastases ( HR= 2.085 ), brain metastases (HR=1.903 ) are independent risk factors of prognosis; married ( HR=0.819 ), HR+/HER2+ (HR= 0.631 ), HR-/HER2+ (HR= 0.716 ), insurance ( HR=0.587 ) and surgery (HR=0.504 ) are independent protection factors of prognosis. There is interaction between HR+/HER2+ subtype and other metastases (except bone metastases , HR=0.694 , 95%CI: 0.485 -0.992 on prognosis. Conclusions : There were substantial differences in OS according to tumour subtype. In addition to tumour subtype, other independent predictors of OS are age at diagnosis, race, marital status, insurance, grade, surgery and visceral metastases. There is interaction between HR+/HER2+ subtype and other metastases (except bone metastases ）on prognosis. Tumour subtype, as a significant prognostic factor, warrant further investigation.
How can gastro-intestinal tuberculosis diagnosis be improved? A prospective cohort study
Authors: Lowbridge Christopher , Fadhil Soraya A. M. , Krishnan Gayathri D. , Schimann Emma , Karuppan Raman Muthu , Sri Nagaraj , Rajahram Giri Shan , Menon Jayaram , Patel Aatish , William Timothy , Paul Dawn Carmel , Ralph Anna P.
Published: February 2020

Background
Gastrointestinal tuberculosis (TB) is diagnostically challenging; therefore, many cases are treated presumptively. We aimed to describe features and outcomes of gastrointestinal TB, determine whether a clinical algorithm could distinguish TB from non-TB diagnoses, and calculate accuracy of diagnostic tests.
Methods
We conducted a prospective cohort study of hospitalized patients in Kota Kinabalu, Malaysia, with suspected gastrointestinal TB. We recorded clinical and laboratory characteristics and outcomes. Tissue samples were submitted for histology, microscopy, culture and GeneXpert MTB/RIF®. Patients were followed for up to two years.
Results
Among 88 patients with suspected gastrointestinal TB, 69 were included in analyses; 52 (75%) had a final diagnosis of gastrointestinal TB; 17 had a non-TB diagnosis. People with TB were younger (42.7 versus 61.5 years, p=0.01) and more likely to have weight loss (91% versus 64%, p=0.03). An algorithm using age <44, weight loss, cough, fever, no vomiting, albumin >26 g/L, platelets >340 x10 9 /L and immunocompromise had good specificity (96.2%) in predicting TB, but very poor sensitivity (16.0%). GeneXpert® performed very well on gastrointestinal biopsies (sensitivity 95.7% versus 35.0% for culture against a gold standard composite case definition of confirmed TB). Most patients (79%) successfully completed treatment and no treatment failure occurred, however adverse events (21%) and mortality (13%) among TB cases were high. We found no evidence that six months of treatment was inferior to longer courses.
Conclusions
The prospective design provides important insights for clinicians managing gastrointestinal TB. We recommend wider implementation of high-performing diagnostic tests such as GeneXpert® on extra-pulmonary samples.
The association between dietary antioxidants intakes and the risk of cardiovascular disease: Tehran Lipid and Glucose Study
Authors: Mirmiran Parvin , Esfandiar Zohreh , Hosseini-Esfahani Firoozeh , Hosseinpour-Niazi somayeh , Azizi Fereidoun
Published: February 2020

Aim: This study aimed at investigating the association between daily consumption of dietary vitamins A, E, and C, and zinc and the incidence of cardiovascular disease (CVD).
Methods: Eligible adults (n=5102) were selected from the participants of the Tehran Lipid and Glucose Study with an average follow-up of 5.3 years. Dietary intakes were assessed using a valid and reliable semi-quantitative food frequency questionnaire. Anthropometrics and biochemical variables were evaluated at baseline and follow-up examinations. Multivariate Cox proportional hazard regression models were used to estimate the development of CVD associated with total intakes of vitamins A, E, and C, and zinc.
Results: This study was conducted on 2,253 men and 2,849 women aged 47.0±11.6 and 45.6±10.5 years, respectively. The main sources of dietary vitamins A, E, and C and zinc were fruits, vegetables, and legumes. Risk of CVD decreased from quartile 1 to quartile 4 for vitamin E intake (HR (95% CI): 1.00, 0.91, 0.77, and 0.57; P trend =0.03). The association between risk of CVD and the quartiles of vitamins A and C and zinc intake was not significant.
Conclusion : Our study suggested an inverse association between vitamin E intake and the risk of CVD. The results emphasized a potential protective role of its dietary sources in the prevention of CVD.
How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography.
Authors: Santiago Tania , Santiago Tania Louza , Santiago Mariana Galante , Coutinho Margarida Macedo , Salvador Maria Joao , Silva José António Pereira Da
Published: February 2020

Objective To assess changes in skin stiffness in SSc patients using SWE during a five-year follow-up. Methods Skin stiffness [i.e. shear-wave velocity values (SWV) in m/s] was assessed by SWE ultrasound (using virtual touch image quantification) at the 17 sites of the mRSS, in each participant, at baseline and follow-up. mRSS was performed at both time points. Differences between groups were analysed using the related-samples Wilcoxon Signed Rank test and the Mann–Whitney U test. Results We included 21 patients [85.7% females; mean age 56.3 (10.4) years at baseline, 57.1% with limited SSc] and, 15 healthy controls [73.3% females; mean age 53.6 (14.1) years)]. The median follow-up was 4.9 (0.4) years. Skin stiffness decreased significantly at all Rodnan sites (p≤0.001), (except in the fingers), in SSc patients, over time. The same phenomenon occurred in controls, but to a lesser degree, in terms of percentage change. The percentage reduction in skin stiffness varied in the different Rodnan sites and in different phases of the disease. In addition, SWV values also decreased significantly in 15/16 skin sites with local normal Rodnan at baseline, whereas local Rodnan skin score only changed significantly in the upperarm (p=0.046) and forearm (p=0.026). Conclusion This study provides first-time evidence suggesting that skin SWV values are more sensitive to change over time than mRSS, and reduce significantly over time in SSc and normal controls.
A nationwide survey on the use of Heated Humidified High Flow Oxygen therapy on the paediatric wards in the UK: Current practice and research priorities
Authors: Hosheh Osama , Edwards Christopher T , Ramnarayan Padmanabhan
Published: February 2020

Background:
Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research.
Methods:
We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients’ characteristics and their primary pathologies were also analysed.
Results:
Participation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1-11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6%, 95%CI:22.6%-50.4%, P< .001). Sixty-eight percent of the respondents agreed that HHFNC is either the same or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1%, and 28% respectively).
Conclusion:
This survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.
Ticks and associated pathogens in camels (Camelus dromedarius) from Riyadh province, Saudi Arabia
Authors: Alanazi Abdullah Daria , Nguyen Viet Linh , Alyousif Mohamed Saleh , Manoj Ranju Ravindran Santhakumari , Alouffi Abdulaziz Saleh , Donato Ridolfi , Sazmand Alireza , Mendoza-Roldan Jairo Alfonso , Dantas-Torres Filipe , Otranto Domenico
Published: February 2020

Background: Camel production in Saudi Arabia is severely affected by various diseases and by inadequate veterinary services. Ticks and tick-borne pathogens (TBPs ) affect the health and wellbeing of camels consequently diminishing their productivity and performances. In addition, camels may act as hosts for TBPs (e.g. Anaplasma phagocytophilum ) causing diseases in humans. The current study aimed to determine the prevalence of ixodid ticks and molecularly investigate the associated pathogens in camels from Saudi Arabia. Methods: Blood and tick samples were collected from camels ( n = 170) in Riyad Province of Saudi Arabia. Ticks were morphologically identified, and blood of camels were molecularly screened for apicomplexan (i.e. Babesia spp . , Theileria spp., Hepatozoon spp.) and rickettsial parasites (i.e. Ehrlichia spp. and Anaplasma spp.). Results: Of the 170 camels examined, 116 (68.2%; 95% CI: 60.9–75.1%) were infested by ticks with a mean intensity of 2.53 (95% CI: 2.4–2.6). In total of 296 ticks collected, Hyalomma dromedarii was the most prevalent (76.4%), followed by Hyalomma impeltatum (23.3%) and Hyalomma excavatum (0.3%). Of the tested animals, 13 (7.6%; 95% CI: 4.3–12.8%) scored positive to at least one TBP, with Anaplasma platys (5.3%; 95% CI: 2.7–9.9%) being the most prevalent species, followed by Anaplasma phagocytophilum , Anaplasma sp., Ehrlichia canis and Hepatozoon canis (0.6% each; 95% CI: 0.04–3.4%). None of the camels were found to be co-infected with more than one pathogen. All samples tested negative for Babesia spp. and Theileria spp. Conclusions: The present study reveals the occurrence of different tick species and tick-borne pathogens in camels from Saudi Arabia. Importantly, these camels may carry A. phagocytophilum and A. platys , representing a potential risk to humans.