bluuebunny/crossref_metadata_2025 huggingface dataset:
VARYANT, DEĞİŞKEN VE VARYASYON DİLBİLİMİ
Authors: AŞKIN BALCI Hülya
Published: August 2020

Dil incelemelerinde, dilsel varyasyon ve dilsel farklılıklar üzerine yapılan çalışmaların ne zaman başladığı sorusunun cevabına bakıldığında bu gibi yönlere olan ilgi başlangıçlarının yüzyıllar önce dile bağlı olarak değiştiği görülecektir. Ancak yine de bilimsel olarak başlangıcı hakkında bilgi aranırsa o zaman dilbilimine giriş ve toplumdilbilimin başlangıcına bakarak farklı bilgilere ulaşmak mümkündür.
Son zamanlarda dil kullanımındaki değişiklikler sebebiyle dil içindeki dilsel varyasyonun kapsamlı bir şekilde iç ve dış yapıdaki dil çeşitlerini açıklamaya çalışan “varyasyon dilbilimi ” güçlü bir ilgi odağı haline gelmiştir. Bazı dilbilimciler toplumdilbilime atıfta bulunarak başlangıç noktasının bu dilbilim dalının ortaya çıkmasıyla oluştuğu için varyasyon dilbilimi ile toplumdilbilimi eşanlamlı kullanmaktadır. Her ne kadar çoğu zaman toplumdilbilimle ayrı anılsa da aslında bu dilbilim dalı toplumdilbilimin bir alt dalı olarak dilbilimde yerini almaktadır. Bu araştırma yönünün başlangıcının 1960’lardan veya 1970’lerden beri dilbilim çalışmalarında var olduğu ve bu dilbilim alanına ait çalışmaların temel niteliğini oluşturan metinlerin ve açıklamaların ise 1990’lara dayandığı ifade edilmektedir .
Dil içindeki kullanımların dilbilimsel olarak tanımlanması hem konuşucu odaklı hem de dinleyici odaklı incelemelere dayanması sebebiyle dil üretiminin açıklanması hem ampirik hem de teorik açıdan irdelenmelidir. Varyasyon dilbilimi de dil içi farklılıkları ve çeşitlemelerin sınırlandırılmasını belirlemek için dillerin eşzamanlı ve karşılaştırmalı bir çalışmayla yapılmasını savunmaktadır. Bu nedenle dil tipolojisi, alan tipolojisi ve evrensel araştırma gibi diğer yönelimlerin yanı sıra karşılaştırmalı çalışmaların da bir alt disiplini olarak kabul edilmektedir. Bilimsel kanıtlar sayesinde dildeki zenginlik ve farklılıkların ortaya çıkarılması sağlanarak dilbilgisinin tüm düzeylerinde bulunan dilsel kalıpların daha iyi anlaşılması hedeflenmektedir.
Dildeki çeşitlemeler, konuşma üretimi ve konuşma algısı, dil kullanımının sosyal bir alanda gerçekleşmesine göre değişmektedir. Dildeki bu eğilimin aslında Saussure’un dil ve söz arasındaki ayrımı ile başladığı söylenebilir. Saussure, dilin düzeni ve yapısı ile ilgili dilbilimsel çalışmaların yapılması gerektiğine ve bilimsel olarak dilde düzensiz ve değişken yapıların olduğuna inanıyordu. Yarım yüzyıl sonra Chomsky, edim ve yeti kavramlarıyla dilbilime yeni bakış açısı kazandırmayı başarmıştır. Bu bakış açıları çerçevesinde farklı dilbilim yaklaşımları ortaya çıkmıştır. Varyasyon dilbilimi de farklı konuşmacıların birbirinden farklı gerçekleştirdikleri yapıları, konuşmacıların sosyal özelliklerini, sosyal değişkenleri ve sosyal kategoriler gibi konuları irdelemektedir. Biz de bu çalışmamızda varyasyon dilbilimini açıklamaya ve bu dilbilim dalıyla ilgili terimleri irdelemeye çalışacağız.
SAFAHAT’TAN SEÇMELER: ADALET
Authors: GÜLER Zülfi
Published: August 2020

Adalet, her devirde, her dinde ve her felsefede en çok sözü edilen konu olmuştur. İslam dininde ve felsefesinde de böyledir. Adalet ve aynı anlamı ifade eden kelimeler ile onun karşıtı olan cevir ve zulüm kavramlarına Kur’an-ı Kerim’de, hadislerde ve dolayısıyla tefsirlerde ve diğer dini eserlerde çok yer verilmiştir. Adalet çok geniş anlam taşıyan bir kavramdır; tasavvufla, hukukla, felsefeyle, sosyoloji, psikoloji gibi bilim dallarıyla ilgili anlamlar kazanmıştır. Özellikle ahlak ile ilgili bir terimdir; ahlaki bir erdemdir. Hatta denilebilir ki, İslam kültüründe ahlak adalettir, adalet ahlaktır.
YUNUS EMRE’DE KOZMOLOJİNİN ESTETİK SUNUMU
Authors: ÖZDEMİR Mehmet
Published: August 2020

Yunus Emre, yazdığı Divan ve Risâletü’n-Nushiyye adlı eserleri ve bu eserlerinde dile getirdiği fikirler vasıtasıyla yedi yüz yıldır kültür ve edebiyatımızda varlığını sürdüren dâhi bir sanatkârdır. Fikirlerini muhataba aktarmak için şiir formunu kullanan şair, şiirlerindeki varlık âlemine ait maddî unsurları ve şiirin suretini teşkil eden kelimeleri mana âlemine geçiş için bir araç olarak kullanır. Yani onun şiirleri mananın surete bürünmüş şeklidir ki bu durum, genel anlamda estetiği, özel anlamda da İslam estetiğini yansıtır. Bu yüzden onun sanatkârlığı incelenirken İslam estetiğinin temelini oluşturan suret-mana ilişkisi mutlaka göz önünde bulundurulmalıdır. Suret ve mana da estetik obje olan şiirde, real ve irreal varlık alanlarına karşılık gelir.
Estetik objenin (sanat eserinin) real varlık alanını oluştururken sanatçının faydalandığı önemli kaynaklardan biri tabiat, yani fizikî çevredir. Fiziksel çevre, sanatçının çevresinde bulunan bütün tabiat varlıklarını kapsar. Bu kadar geniş bir malzemenin, Yunus Emre’nin eserlerinde tespit edilmesi ve incelenmesi bu çalışmanın sınırlarını aşacaktır. Dolayısıyla bu çalışmada fiziksel çevrede bulunan ve birçok bakımdan insanları etkileyen kozmik unsurların, sanat eserinin ve eserdeki mananın oluşumuna katkısı incelenecektir. Fiziksel çevrede bulunan kozmik unsurlar da Yunus Emre’nin şiirlerinde hem real varlık alanını oluşturan bilgi objeleri hem de irreal varlık alanıyla ilgili düşüncelerin yüklendiği anlam alanları olarak kullanılmıştır. Şimdiye kadar Yunus’un şiirleri hakkında yapılan çalışmalarda İslam estetiğinin izlerini görmek mümkünse de genel anlamda estetik biliminin imkân ve yöntemlerini kullanan çalışmaların yeterli düzeyde olmadığı anlaşılmaktadır. Dolayısıyla bu çalışmanın ilk amacı, Yunus Emre’nin şiirlerinde kullanılan kozmik unsurları tespit etmek ve estetik biliminin yöntemlerinden hareketle estetik objedeki suret-mana ilişkisinin nasıl kurulduğunu araştırmaktır. İkinci ve temel amaç da şairin fikir dünyasının anlaşılmasına katkı sağlamaktır.
KÜLTÜRLERARASI VE DİSİPLİNLERARASI BOYUTUYLA KARŞILAŞTIRMALI EDEBİYAT BİLİMİ
Authors: CİHANGİR Mehmet
Published: August 2020

İnsan sosyal bir varlıktır ve içinde büyüdüğü toplumun önemli bir unsurudur. Bir kişinin tek başına hayatını sürdürebilmesi olanak dışıdır. Yaşamını devam ettirebilmesi için pek çok insanla ilişki kurmaya, alış verişe ihtiyacı olacaktır. Böylelikle kişi kendi ihtiyaçlarını karşıladığı gibi bulunduğu topluma da katkı sunmuş olur. Benzer bir durumun toplumlar ve milletler arası ilişkiler için de geçerli olduğu söylenebilir. Hiçbir toplum ve milletin kendi başına gelişim göstereceği, bir diğer toplum ya da milletin sosyal, kültürel, ekonomik vb. kazanımlarına başvurmadan ilerleme kaydedebileceği düşünülemez. Dolayısıyla her birey ve toplumun farklı kültürden birey ve toplumlarla ilişki kurmaya ihtiyaç duyacağı gelişim ve ilerleme açısından olmazsa olmaz bir zorunluluk olarak ifade edilebilir.
Karşılaştırmalı edebiyat, yukarıda bahsi geçen ilişkileri tespit etmeye, milletler arası münasebetleri ortaya koymaya çalışan bir disiplin olarak açıklamak mümkündür. Bu disiplinin temelinde Alman düşünür Goethe’nin Weltliteratur olarak adlandırılan yaklaşımı vardır. Weltliteratur, farklı ulusların ürettiği edebiyat eserlerinin aidiyet durumu gözetilmeksizin tüm insanlara ve insanlığa hitap etmesinin ve böylelikle tüm insanlığı kapsayan genel bir dünya edebiyatına ulaşılmasının hedeflendiği bir bakış açısı olarak açıklanabilir. Bir diğer ifadeyle böyle bir yaklaşım, tüm dünya ülkelerinden ortaya çıkan edebiyat ürünlerinin Weltliteratur kavramının çatısı altında toplanması ve farklılıklardan bireşimlere ulaşılması şeklinde özetlenebilir. Bu çalışmada karşılaştırmalı edebiyatın kültürler ve disiplinlerarası ilişkisi irdelenecektir.
Pathogenesis of Aging and Age-related Comorbidities in People with HIV: Highlights from the HIV ACTION Workshop
Authors: Gabuzda Dana , Jamieson Beth D. , Collman Ronald G. , Lederman Michael M. , Burdo Tricia H. , Deeks Steven G. , Dittmer Dirk P. , Fox Howard S. , Funderburg Nicholas T. , Pahwa Savita G. , Pandrea Ivona , Wilson Cara C. , Hunt Peter W.
Published: August 2020

People with HIV (PWH) experience accentuated biological aging, as defined by markers of inflammation, immune dysfunction, and the epigenetic clock. They also have an elevated risk of multiple age-associated comorbidities. To discuss current knowledge, research gaps, and priorities in aging and age-related comorbidities in treated HIV infection, the NIH program staff organized a workshop held in Bethesda, Maryland in September 2019. This review article describes highlights of discussions led by the Pathogenesis/Basic Science Research working group that focused on three high priority topics: immunopathogenesis; the microbiome/virome; and aging and senescence. We summarize knowledge in these fields and describe key questions for research on the pathogenesis of aging and age-related comorbidities in PWH. Understanding the drivers and mechanisms underlying accentuated biological aging is a high priority that will help identify potential therapeutic targets to improve healthspan in older PWH.
COMMUNITY PERCEPTION OF WOMEN WORKING IN PALM OIL PLANTATIONS IN THE VILLAGE SALIKI, KECAMATAN MUARA BADAK, KUTAI KARTANEGARA DISTRICT
Authors: Norhadi Norhadi
Published: August 2020

Abstract: The role of women is no longer associated with their nature as housewives, but has developed to work in the public sector, this research method is qualitative descriptive research. The focus of the research is the people in Saliki Village. The data used are primary data sources and secondary data. Data collection using field research consists of observation, interviews, and documentation. Qualitative analysis techniques of Miles Huberman and Saldana.The perception of the people in Saliki Village provides positive things and supports women working as laborers on oil palm plantations, with the aim of helping the family economy, time to gather and interact with limited communities and social activities are not always time, but still maintained relationships and good friendship with community in Saliki Village. The role of women in the public sector is well run and in the domestic sector remains responsible as a housewife.

Abstrak: Peran perempuan tidak lagi dikaitkan dengan kodratnya sebagai ibu rumah tangga, tapi telah berkembang untuk bekerja di sektor publik, metode penelitian ini adalah penelitian deskriptif kualitatif. Fokus penelitian yaitu masyarakat di Desa Saliki. Data yang digunakan adalah sumber data primer dan data sekunder. Pengumpulan data mengunakan penelitian lapangan terdiri dari observasi, wawancara, dan dokumentasi. Teknik analisis kualitatif Miles Huberman dan Saldana. Persepsi masyarakat di Desa Saliki memberikan hal positif dan mendukung perempuan bekerja menjadi buruh di perkebunan kelapa sawit, dengan tujuan untuk membantu ekonomi keluarga, waktu berkumpul dan berinteraksi dengan masyarakat terbatas dan kegiatan sosial tidak selalu ada waktu, tetapi tetap terjaga hubungan dan silaturahmi yang baik dengan masyarakat di Desa Saliki. Peran perempuan di sektor publik dijalankan dengan baik dan di sektor domestik tetap bertanggung jawab sebagai ibu rumah tangga.
A case for the growth of ancient ooids within the sediment pile
Authors: Anderson Noah T. , Cowan Clinton A. , Bergmann Kristin D.
Published: August 2020

In modern ooid-forming environments in the Caribbean, aerobic respiration of organic matter below the sediment–water interface drives an increase in pCO2 and a corresponding decrease in carbonate saturation state (Ω) that creates shallow sediment porewater that is neutral or slightly caustic to carbonate. The locus of ooid growth, therefore, is presumed to be in the water column during suspension, where supersaturation with respect to calcium carbonate is the norm. In the past, however, during conditions of low aqueous O2, high Ω, or low organic-matter input, the shallow sub-sediment marine burial environment was conducive to carbonate precipitation.

Here we present petrographic and electron probe microanalyzer (EPMA) data from exquisitely preserved oolites through time that suggests that some ancient ooids may have grown within the sediment pile. We propose that each increment of ooid cortical growth originated as incipient isopachous marine cement formed during shallow burial within migrating ooid dunes. After a period of burial (∼ weeks to months), ooids were remobilized and rounded during bedload transport.

This “bedform model” for ooid growth explains: 1) why ancient ooids are not limited by the precipitation–abrasion balance that appears to prohibit modern tangential Caribbean ooids from achieving grain sizes larger than coarse sand, 2) the radial crystal fabric that defines the internal structure of many ancient ooids, and 3) the first-order correlation of the abundance of large and giant ooids in the rock record to periods with predicted high porewater Ω. This model implies that photosynthetic microbes were unimportant for growth of large and giant ooid but it remains agnostic to the effect of other microbes. The physical and chemical milieu of modern marine ooid-forming environments is perhaps not the best analogue for ancient ooid-forming environments; this should be considered when using ancient ooids to reconstruct secular trends in ocean chemistry.
A Semianalytical Approach for Analysis of Wells Exhibiting Multiphase Transient Linear Flow: Application to Field Data
Authors: Hamdi Hamidreza , Behmanesh Hamid , Clarkson Christopher R.
Published: August 2020

Rate-transient analysis (RTA) is a useful reservoir/hydraulic fracture characterization method that can be applied to multifractured horizontal wells (MFHWs) producing from low-permeability (tight) and shale reservoirs. In this paper, we applied a recently developed three-phase RTA technique to the analysis of production data from an MFHW completed in a low-permeability volatile oil reservoir in the Western Canadian Sedimentary Basin.

This RTA technique is used to analyze the transient linear flow regime for wells operated under constant flowing bottomhole pressure (BHP) conditions. With this method, the slope of the square-root-of-time plot applied to any of the producing phases can be used to directly calculate the linear flow parameter xfk without defining pseudovariables. The method requires a set of input pressure/volume/temperature (PVT) data and an estimate of two-phase relative permeability curves. For the field case studied herein, the PVT model is constructed by tuning an equation of state (EOS) from a set of PVT experiments, while the relative permeability curves are estimated from numerical model history-matchingresults.

The subject well, an MFHW completed in 15 stages, produces oil, water, and gas at a nearly constant (measured downhole) flowing BHP. This well is completed in a low-permeability,near-critical volatile oil system. For this field case, application of the recently proposed RTA method leads to an estimate of xfk that is in close agreement (within 7%) with the results of a numerical model history match performed in parallel. The RTA method also provides pressure–saturation (P–S) relationships for all three phases that are within 2% of those derived from the numerical model. The derived P–S relationships are central to the use of other RTA methods that require calculation of multiphase pseudovariables.

The three-phase RTA technique developed herein is a simple-yet-rigorous and accurate alternative to numerical model history matching for estimating xfk when fluid properties and relative permeability data are available.
Frequent fragility of randomized controlled trials for HCC treatment
Authors: Hao Zhang , Jingtao Li , Zeng Wenting
Published: August 2020

Background: The fragility index (FI) of trial results can provide a measure of confidence in the positive effects reported in randomized controlled trials (RCTs). The aim of this study was to calculate the FI of RCTs supporting HCC treatments.Methods: A methodological systematic review of RCTs in HCC treatments was conducted. Two-arm studies with randomized and positive results for a time-to-event outcome were eligible for the FI calculation.Results: A total of 6 trails were included in this analysis. The median FI was 0.5 (IQR 0-10). FI was ≤ 7 in 4 (66.7%) of 6 trials; in those trials the fragility quotient was ≤ 1%.Conclusion: Many phase 3 RCTs supporting HCC treatments have a low FI, which challenges the confidence in concluding the superiority of these drugs over control treatments.
Key stakeholder experiences of an integrated healthcare pilot in Australia: A thematic analysis
Authors: TRANKLE STEVEN , USHERWOOD TIM , ABBOTT PENELOPE , ROBERTS MARY , CRAMPTON MICHAEL , GIRGIS CHRISTIAN M , RISKALLAH JOHN , CHANG YASHU , SAINI JASPREET , REATH JENNIFER
Published: August 2020

BackgroundIn Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally.MethodsWe administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n=42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts.ResultsKey themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting.Conclusions Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.
Social, economic, and legislative factors and global road traffic fatalities
Authors: Haghighi Mohammad Reza Rahmanian , Sayari Mohammad , Ghahramani Sulmaz , Lankarani Kamran Bagheri
Published: August 2020

Abstract
Background: Road traffic fatalities (RTF) is the 8th cause of mortality around the world. At the end of the Decade of Action, it would be of utmost importance to revisit our knowledge on the determinants of RTF. The aim of this study is to assess factors related to RTF at global level.
Methods: We used road safety development index which accounts for the interactions between system, human and products to assess the RTF in 115 and 113 countries in 2013 and 2016, respectively. To analyze data, three statistical procedures (linear regression, classification and regression trees, and multivariate adaptive regression splines) were employed.
Results: Classification and regression trees has the best performance amongst all others followed by multivariate adaptive regression splines for 2013 and 2016 data set with an R2 around 0.83. Results show that any increase in human development index was associated with RTF reduction. Comparing RTF data of 2013 and 2016, 8 countries experienced a change of more than 30%, which demonstrated a significant relationship with GINI index (named after Corrado Gini). Considering the three components of human development index, it is revealed that education explained most of RTF variation in classification and regression trees model followed by income and life expectancy.
Conclusion: Policymakers should consider road collisions as a socio-economic issue. In this regard, they can make provisions to reduce RTF in the long run by focusing on enhancing the three components of human development index, mainly education. However, there is a need to investigate the causation pathway among these three components with RTF with different time-trend procedures.
Effect of a free healthy school meal on fruit, vegetables and unhealthy snacks intake in Norwegian 10- to 12-year-old children
Authors: Vik Frøydis Nordgård , Heslien Kaia Elisabeth Paulsen , Lippevelde Wendy Van , Øverby Nina Cecilie
Published: August 2020

Background: Norwegian children have a lower intake of fruit, vegetables, and a higher intake of unhealthy snacks compared to dietary guidelines. Such dietary inadequacies may be detrimental for their current and future health. Schools are favorable settings to establish healthy eating practices. Still, no school meal arrangement is provided in Norway, and most children typically bring packed lunches from home. The aim of this study was to investigate whether serving a free healthy school meal for one year resulted in a higher intake of fruit and vegetables and a lower intake of unhealthy snacks in total among 10-12-year-olds in Norway.Methods: The School Meal Project in Southern Norway was a non-randomized trial in two elementary schools in rural areas in the school year 2014/2015. The study sample consisted of 10- to 12-year-old children; an intervention group (N=55) and a control group (N=109) resulting in a total of 164 school children at baseline. A food frequency questionnaire was completed by the children at baseline, at five months follow-up and after one year to assess fruit, vegetable and snacks intake. Multiple linear regression analyses were performed to assess intervention effects on overall intake of fruit and vegetables and unhealthy snacks.Results: Serving of a free healthy school meal for one year was associated with a higher weekly intake of vegetables on sandwiches in the intervention group compared to the control group, adjusted for baseline intake (B: 1.11 (95% CI: .38, 1.85)) at the end of the intervention. No other significant intervention effects were found for the remaining fruit and vegetables measures. Serving of a free healthy school meal was not associated with a lower weekly intake of unhealthy snacks (i.e. potato chips, candy, sugar sweetened beverages) in the intervention group compared to the control group. Conclusions: A free healthy school meal was associated with a higher weekly intake of vegetables on sandwiches but did not significantly change any other investigated dietary behaviors. However, given the inadequate intake of vegetables among children and that even moderate improvements have public health relevance, a free healthy school meal for all school children could be beneficial. Trial registration: ISRCTN61703361 Date of registration: December 3rd, 2018 Retrospectively registered
What Are the Potential Advantages and Disadvantages of Merging Health Insurance Funds? A Qualitative Policy Analysis from Iran
Authors: Bazyar Mohammad , Yazdi-Feyzabadi Vahid , Rahimi Nouroddin , Rashidian Arash
Published: August 2020

Background:In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran. Methods:In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results. Results:The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization’s unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system. Conclusion:Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents’ objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.
Elevated Blood Urea Nitrogen are associated with Recurrence of post-operative Chronic Subdural Hematoma
Authors: Wang Ning , Hu Jiangnan , Oppong-Gyebi Anthony , Zhu Xuanhao , Li Yihao , Yang Jianjing , Ruan Linhui , Zhuge Qichuan , Ye Sheng
Published: August 2020

Background: Chronic subdural hematoma (CSDH) is fundamentally treatable with about 2-31% recurrence rate. Recently, there has been renewed interest in the association between Blood Urea Nitrogen (BUN) and intracranial lesion. Therefore, this paper attempts to show the relationship between BUN and CSDH recurrence.Methods: A total of 653 CSDH cases with Burr-hole Irrigation (BHI) were enrolled from December 2014 to April 2019. The analyzed parameters included age, gender, comorbidities, laboratory investigations, medication use and hematoma location. The cases were divided into recurrence and non-recurrence groups while postoperative BUN concentration was further separated into quartiles (Q1 ≤ 4.0 mmol/L, 4.0 < Q2 ≤ 4.9 mmol/L, 4.9 < Q2 ≤ 6.4 mmol/L, Q4 > 6.4 mmol/L). Restricted cubic spline regressions and logistic regression models were performed to estimate the effect of BUN on CSDH recurrence.Results: CSDH recurrence was observed in 96 (14.7%) cases. Significant distinctions were found between recurrence and non-recurrence groups in postoperative BUN quartiles of cases (P=0.003). After adjusting for the potential confounders, the odds ratio of recurrence was 3.069 (95%CI =1.488–6.330, p = 0.002) for the highest quartile of BUN compared with the lowest quartile. In multiple-adjusted spline regression, high BUN level visually showed significantly high OR value of recurrence risk.Conclusions: Elevated BUN at post-operation is significantly associated with the recurrence of CSDH, and it is indicated that high levels of serum BUN after evacuation may be served as a risk factor for CSDH recurrence.
Comparison of Conventional Fenestration Discectomy with Transforaminal Endoscopic Lumbar Discectomy for Treating Lumbar Disc Herniation：Minimum 2-year Long-term Follow-up in 1,100 patients
Authors: Li Quanyi , zhou yongchun
Published: August 2020

Purpose: To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) with transforaminal endoscopic lumbar discectomy (TELD) for treating lumbar disc herniation (LDH). Methods: The clinical data of 1,100 patients who had been diagnosed with LDH between January 2012 and December 2017 were retrospectively analysed. IFD was performed on 605 patients in Group A, whereas TELD was performed on 505 patients in Group B. The Oswestry Disability Index, Visual Analogue Scale for pain and modified MacNab criteria were used to evaluate the outcomes. The surgery duration, intraoperative blood loss, postoperative off-bed activity and postoperative length of hospital stay were recorded. Results: The follow-up period ranged from 24 to 60 months, with an average of 43 months. The excellent and good outcome rates were 93.5% in Group A and 92.6% in Group B. There was no significant difference in efficacy between the groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest duration and postoperative length of hospital stay than Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions: Although conventional IFD and TELD had similar levels of efficacy in treating LDH, TELD had several advantages. There was less intraoperative bleeding, shorter length of hospital stay and shorter bed rest duration. It can be considered a safe and effective surgical option for treating LDH.
What Matters to Patients? A Mixed Method Study of the Importance and Consideration of Patient Demands
Authors: Waelli Mathias , Minvielle Etienne , Acero Maria Ximena , Aribi Khouloud Ben , Lalloue Benoit
Published: August 2020

BackgroundA patient-centred approach is increasingly the mandate for healthcare delivery, especially with the growing emergence of chronic conditions. A relevant but often overlooked obstacle to delivering person-centred care is the identification and consideration of all demands based on individual experience, not only disease-based requirements. Mindful of this approach, there is a need to explore how patient demands are expressed and considered in healthcare delivery systems.This study aims to: (i) understand how different types of demands expressed by patients are taken into account in the current delivery systems operated by Health Care Organisations (HCOs); (ii) explore the often overlooked content of specific non-clinical demands (i.e. demands related to interactions between disease treatments and everyday life).MethodWe adopted a mixed method in two cancer centres, representing exemplary cases of organisational transformation: (i) circulation of a questionnaire to assess the importance that patients attach to every clinical (C) and non-clinical (NC) demand identified in an exploratory inquiry, and the extent to which each demand has been taken into account based on individual experiences; (ii) a qualitative analysis based on semi-structured interviews exploring the content of specific NC demands.ResultsFurther to the way in which the questionnaires were answered (573 answers/680 questionnaires printed) and the semi-structured interviews (36) with cancer patients, results show that NC demands are deemed by patients to be almost as important as C demands (C = 6.53/7 VS. NC = 6.13), but are perceived to be considered to less of an extent in terms of pathway management (NC = 4.02 VS C = 5.65), with a significant variation depending on the type of non-clinical demands expressed. Five types of NC demands can be identified: demands relating to daily life, alternative medicine, structure of the treatment pathway, administrative and logistic assistance and demands relating to new technologies.ConclusionsThis study shows that HCOs should be able to consider non-clinical demands in addition to those referring to clinical needs. These demands require revision of the healthcare professionals’ mandate and transition from a supply-orientated system towards a demand-driven approach throughout the care pathway. Other sectors have developed hospitality management, mass customisation and personalisation to scale up approaches that could serve as inspiring examples.
Mathematical models for devising the optimal SARS-CoV-2 strategy for eradication in China, South Korea, and Italy
Authors: Jiang Shuo , Li Qiuyue , Li Chaoqun , Liu Shanshan , He Xiaomeng , Wang Tao , Li Hua , Corpe Christopher , Zhang Xiaoyan , Xu Jianqing , Wang Jin
Published: August 2020

Background: Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spreads rapidly and has attracted worldwide attention.Methods: To improve the forecast accuracy and investigate the spread of SARS-CoV-2, we constructed four mathematical models to numerically estimate the spread of SARS-CoV-2 and the efficacy of eradication strategies.Results: Using the Susceptible-Exposed-Infected-Removed (SEIR) model, and including measures such as city closures and extended leave policies implemented by the Chinese government that effectively reduced the β value, we estimated that the β value and basic transmission number, R0, of SARS-CoV-2 was 0.476/6.66 in Wuhan, 0.359/5.03 in Korea, and 0.400/5.60 in Italy. Considering medicine and vaccines, an advanced model demonstrated that the emergence of vaccines would greatly slow the spread of the virus. Our model predicted that 100,000 people would become infected assuming that the isolation rate α in Wuhan was 0.30. If quarantine measures were taken from March 10, 2020, and the quarantine rate of α was also 0.3, then the final number of infected people was predicted to be 11,426 in South Korea and 147,142 in Italy.Conclusions: Our mathematical models indicate that SARS-CoV-2 eradication depends on systematic planning, effective hospital isolation, and SARS-CoV-2 vaccination, and some measures including city closures and leave policies should be implemented to ensure SARS-CoV-2 eradication.
The Effect of Social Norm-based Intervention with Observable Behaviour on Physical Activity among Adolescents: A Randomized Controlled Trial
Authors: Lee Jia Jia , Nadkarni Nivedita Vikas , Teo Irene , Ozdemir Semra
Published: August 2020

Background: The rising prevalence of childhood obesity in developing and developed countries poses a major public health challenge to policy makers and an effective strategy to promote physical activity among adolescents is warranted. This study aimed to evaluate the effectiveness of providing descriptive norms messages with personal identification in promoting physical activity among adolescents by measuring step counts via a randomized controlled trial (NCT03081013). Methods: A total of 311 participants aged 13-16 were randomized into two study arms (Onymous and Anonymous Arms). Each arm consisted of 13 groups of 12 participants. During the trial, participants received weekly short message service (SMS) about their past week’s physical activity performance Participants in the Anonymous Arm received information about step counts of group members ranked from highest to lowest. Participants in the Onymous Arm received the same information with the group members’ full names. Participants’ quality of life, depression, and physical activity social support, self-efficacy and enjoyment before and after the intervention were also evaluated. This study adheres to the CONSORT guidelines.Results: The number of steps was not higher when descriptive norm message was onymous compared to when it was anonymous. Scores in quality of life, depression, social support, self-efficacy, and enjoyment of physical activity were not significantly different between both arms (p>0.05).Conclusions: Our findings indicated that the effect of providing descriptive norms messages containing personal identification on physical activity promotion was not evident in the main analysis. Future studies may consider using a more relevant reference group to use social norms as a tool to increase physical activity among adolescents.Trial registration: ClinicalTrials.gov - NCT03081013. Registered 15 Mar 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03081013
Connecting METTL3 and intratumoural CD33+ MDSCs in predicting clinical outcome in cervical cancer
Authors: Ni Huan-he , Zhang Lin , Huang He , Dai Shu-qin , Li Jiang
Published: August 2020

Background: Methyltransferase-like 3 (METTL3) is a member of the m6A methyltransferase family and acts as an oncogene in cancers. Recent studies suggest that host innate immunity is regulated by the enzymes controlling m6A epitranscriptomic changes. Here, we aim to explore the associations between the levels of METTL3 and CD33+ myeloid-derived suppressor cells (MDSCs) in tumour tissues and the survival of patients with cervical cancer (CC).Methods: Paraffin tumour specimens from 197 CC patients were collected. The expression levels of METTL3 and CD33 were measured by immunohistochemical (IHC) staining. The clinical associations of the IHC variants were analysed by Pearson's or Spearman's chi-square tests. Overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method and log-rank test. Hazard ratios (HRs) and independent significance were obtained via Cox proportional hazards models for multivariate analyses. METTL3 in CD33+ cells or CC-derived cells was knocked down by METTL3-specific siRNA, and MDSC induction in vitro was performed in a co-culture system in the presence of METTL3-siRNA and METTL3-knockdown-CC-derived cells compared with that of the corresponding controls.Results: We found that tumour tissues displayed increased levels of METTL3 and CD33+ MDSCs compared with tumour-adjacent tissues from the same CC patients. Importantly, METTL3 expression was positively related to the density of CD33+ cells in tumour tissues (P = 0.011). We further found that the direct CD33+CD11b+HLA-DR- MDSC induction and tumour-derived MDSC induction in vitro were decreased in the absence of METTL3. The level of METTL3 in tumour microenvironments was significantly related to advanced tumour stage. The levels of METTL3 and CD33+ MDSCs in tumour tissues were notably associated with reduced DFS or OS. Cox model analysis revealed that the level of METTL3 in tumour cells was an independent factor for patient survival, specifically for DFS (HR = 3.157, P = 0.022) and OS (HR = 3.271, P = 0.012), while the CD33+ MDSC number was an independent predictor for DFS (HR: 3.958, P = 0.031). Interestingly, in patients with advanced-disease stages (II-IV), METTL3 in tumour cells was an independent factor for DFS (HR = 6.725, P= 0.010) and OS (HR = 5.140, P= 0.021), while CD33+ MDSC density was an independent factor for OS (HR = 8.802, P = 0.037).Conclusion: Our findings suggest that CD33+ MDSC expansion is linked to high levels of METTL3 and that METTL3 and CD33+ MDSCs are independent prognostic factors in CC.
How nursing students’ placement preferences and perceptions of community care develop in a more ‘community-oriented’ curriculum: A longitudinal cohort study
Authors: Iersel Margriet van , Latour Corine H.M. , Rijn Marjon van , de Vos Rien , Kirschner Paul A. , Reimer Wilma Scholte op
Published: August 2020

Background: Extramuralisation in healthcare has influenced medical and nursing curricula internationally with the incorporation of themes related to primary/ community care. Despite this, students do not easily change their career preferences. The hospital is still favourite, leading to labour market shortages in extramural care. This study investigates how baccalaureate nursing students’ perceptions of community care and placement preferences develop over time in a more'community-care-oriented' curriculum, to gain insights on which curriculum elements potentially influence career choices.Methods: A nursing student cohort of a University of Applied Sciences in the Netherlands (n = 273) underwent a new four-year curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). Data were collected each year of study. Descriptive statistics were used to investigate students’ placement preferences and perceptions, and linear mixed model techniques (LMMs) for measuring how students’ perceptions develop over time. Patterns of placement preferences at individual level were visualised. Results: Students’ perceptions of community care, as measured with SCOPE, show a slight decrease between year 1 and 4, while items mutually differ substantially. In contrast, the preference of community care for a placement increases from 2.6% in year 1 tot 8.2% in year 4. The hospital is favourite in year 1 (79.8%), and remains most popular. At individual level, students often change placement preferences, although a preference for the hospital is more consistent. The LMMs indicates that, at the four time-points, the estimated marginal means of students’ perceptions fluctuate between 6 and 7 (range 1-10). A placement in community care did not positively influence students’ perceptions, and an intensive one week theoretical programme was only temporarily influential. Conclusions: Although interest for placement in community care increased substantially, it was not clear which curriculum elements stimulated this, nor did the curriculum positively influence students’ perceptions. As most students do not look forward to the high responsibility of the field, other curricula with educational tracks for more mature students/ nurses with a vocational training may be an alternative contribution to solving the labour market problems in community care.
Genome-Wide Identification and Analysis of Class III Peroxidases in Betula pendula
Authors: Cai Kewei , Chen Song , Liu Yi , Zhao Xiyang , Chen Su
Published: August 2020

Background: Class III peroxidases (POD) proteins are widely present in the plant kingdom that are involved in a broad range of physiological processes including stress responses and lignin polymerization throughout the plant life cycle. However, little is known about the POD genes in Betula pendula , although it has been characterized in Arabidopsis , rice and maize. The POD genes remain to be determined in Betula pendula . Results : A total of 90 nonredundant POD genes were identified in Betula pendula . (designated BpPODs ). These POD genes were divided into twelve groups based on their phylogenetic relationships. The BpPODs are unevenly distributed on the 14 chromosomes. In addition, some BpPOD genes were located sequentially in tandem on chromosomes, inferred that tandem duplication contributes to the expansion of the POD genes family in Betula pendula . Analysis of the distribution of conserved domains of BpPOD proteins showed that all these proteins contain highly conserved motifs. We also investigated their expression patterns in different tissues, the results show that some BpPOD genes might play significant roles in root, xylem, leaf and flower. Furthermore, under low temperature conditions, some BpPOD genes showed different expression patterns at different times. Conclusions: Comprehensive study of the POD genes suggests that their functional diversity during Betula pendula growth and development. Our findings provide a basis for further functional analysis on POD genes family in Betula pendula .
Remarkable metabolic reorganization and altered metabolic requirements in frog metamorphic climax
Authors: Zhu Wei , Chang Liming , Zhao Tian , Wang Bin , Jiang Jianping
Published: August 2020

Background Metamorphic climax is the crucial stage of amphibian metamorphosis responsible for the morphological and functional changes necessary for transition to a terrestrial habitat. This developmental period is sensitive to environmental changes and pollution. Understanding its metabolic basis and requirements is significant for ecological and toxicological research. Rana omeimontis tadpoles are a useful model for investigating this stage as their liver is involved in both metabolic regulation and fat storage. Results We used a combined approach of transcriptomics and metabolomics to study the metabolic reorganization during natural and T3-driven metamorphic climax in the liver and tail of Rana omeimontis tadpoles. The metabolic flux from the apoptotic tail replaced hepatic fat storage as metabolic fuel, resulting in increased hepatic amino acid and fat levels. In the liver, amino acid catabolism (transamination and urea cycle) was upregulated along with energy metabolism (TCA cycle and oxidative phosphorylation), while the carbohydrate and lipid catabolism (glycolysis, pentose phosphate pathway (PPP), and β-oxidation) decreased. The hepatic glycogen phosphorylation and gluconeogenesis were upregulated, and the carbohydrate flux was used for synthesis of glycan units (e.g., UDP-glucuronate). In the tail, glycolysis, β-oxidation, and transamination were all downregulated, accompanied by synchronous downregulation of energy production and consumption. Glycogenolysis was maintained in the tail, and the carbohydrate flux likely flowed into both PPP and the synthesis of glycan units (e.g., UDP-glucuronate and UDP-glucosamine). Fatty acid elongation and desaturation, as well as the synthesis of bioactive lipid (e.g., prostaglandins) were encouraged in the tail during metamorphic climax. Protein synthesis was downregulated in both the liver and tail. The significance of these metabolic adjustments and their potential regulation mechanism are discussed. Conclusion The energic strategy and anabolic requirements during metamorphic climax were revealed at the molecular level. Amino acid made an increased contribution to energy metabolism during metamorphic climax. Carbohydrate anabolism was essential for the body construction of the froglets. The tail was critical in anabolism including synthesizing bioactive metabolites. These findings increase our understanding of amphibian metamorphosis and provide background information for ecological, evolutionary, conservation, and developmental studies of amphibians.