bluuebunny/crossref_metadata_2025 huggingface dataset:
Posterior-only Approach with Unilateral Fenestration for the Treatment of Thoracic and Lumbar Tuberculosis
Authors: Jiang Liyuan , Guo Zhu , Wu Tianding , Duan Chunyue , Cao Yong , Hu Jianzhong
Published: August 2019

[EXSCINDED]
Abstract
Abstract

Background
Unilateral fenestration (UF) is a minimally invasive technique used for the treatment of spinal stenosis. But whether it applies to spinal tuberculosis (TB) is still unknown. We present a retrospective study to evaluate the clinical efficacy and feasibility of a posterior-only approach with unilateral fenestration (PAUF) for treatment of the thoracic and lumbar TB (T<0.001). At the last follow-up, the mean postoperative kyphotic angle was 9.9°±11.4°. According to the ASIA classification, 92.1% (35 out of 38) patients with preoperative neurological impairment had good neurological improvement after the operation. The VAS pain score significantly decreased from preoperative 6.9±1.1 to 1.3±0.7 one year post operation (p<0.001). All the patients achieved solid bony fusion within 13 months after surgery. There were three relapse TB cases, but they were cured after the second operation and adjustment of anti-TB regimens.Conclusions

For thoracic and thoracolumbar spinal TB patients with one or two consecutive functional spinal unit involvement, posterior-only approach with unilateral fenestration is an effective and feasible surgical treatment which can minimize the surgical damage to the posterior column, control infection, corrects the kyphosis, and maintains correction and neurological improvement over time.
Analysis of reporting completeness in exercise cancer trials: a systematic review
Authors: Meneses-Echavez Jose F , Rodriguez-Prieto Indira , Elkins Mark , Martinez-Torres Javier , Bidonde Julia
Published: August 2019

Background

Exercise is an effective therapeutic intervention for cancer survivors. Concerns about the completeness of reporting of exercise interventions have been raised in the literature, but without any formal analysis. This study aimed to evaluate the completeness of reporting of exercise interventions for cancer survivors in a representative sample of randomized clinical trials (RCTs).

Methods

We developed a pre-defined protocol. We searched MEDLINE, EMBASE, and CENTRAL for exercise trials in oncology between 2010 and 2017. Pairs of independent researchers screened the records, extracted study characteristics, and TIDieR criteria.

The 12-item TIDieR checklist was used to generate a score of reporting completeness, based on how much of the recommended content was reported in the included trials. Because Item 5 on the checklist has two components and Item 8 has four components, the derived score was calculated as how many of the 16 components were reported, converted to a percentage.

Results

We included 131 RCTs reporting 138 interventions in the analysis. Breast cancer was the most common type of cancer (69, 50%), and aerobic exercise was the most studied exercise modality (43, 30%) followed by combined aerobic and resistance training (40, 28%). Completeness of reporting ranged from 42% to 96% among the TIDieR items; none of the items was fully reported. ‘Intervention length’ was the most reported item across interventions (133, 96%), followed by ‘rationale’ (131, 95%), whereas ‘provider’ (58, 42%) and ‘how well (planned)’ (63, 46%) were the two least reported items. Half of the TIDieR items were completely reported in 50% to 70% of the interventions, and only four items were reported in more than 80% of the interventions (Items 2 and 8a to c). The seven items deemed to be core for replication (Items 3 to 9) exhibited a mean reporting of 71%, ranging from 42% to 96%.

Conclusion

Exercise training interventions for cancer survivors are incompletely reported across RCTs published between 2010 and 2017. The reporting of information about the provider, materials, and modifications require urgent improvements. Stronger reporting will enhance usability of trial reports by both healthcare providers and survivors, and will help to reduce research waste.
Sinus node dysfunction associates with atrial high-rate episodes after DDD pacemaker implantation
Authors: Xue Qi , Zou Hai , Wang Lihong , Shao Hong , Ma Yuan
Published: August 2019

Background： Patients implanted with pacemakers frequently develop atrial fibrillation. Pacemaker-detected atrial high-rate episodes or AHREs, where one AHRE is defined as ≥ 160beats/min lasting ≥ 5 minutes, may identify patients at increased risk for stroke and death. In this study, we sought to observe whether patients with sinus node dysfunction or atria-ventricular block are more likely to develop AHREs.
Methods: A total of 103 patients (age 69.4±13.5 years，58% female) with DDD/DDDR pacemakers were enrolled for the study. These pacemakers were equipped with features that enabled the detection and storage of information such as the dates, durations and sequential episodes of AHRE. Patients were followed up for 2 years and the time of the first occurrence of AHRE was determined at follow-up visit. Other data such as age, gender, structural heart disease, concomitant non-cardiac diseases, the cumulative percentage of atrial pacing (Cum% AP) and ventricular pacing (Cum% VP) were also collected.
Results: Atrial fibrillation developed frequently after the dual-chamber pacemaker implantation. AHRE occurred more often in patients with sinus node disease (SND) than those with atrioventricular block (AVB) （OR, 2.553; 95%CI, 1.122-5.814；P=0.045）.
Conclusions: AHRE developed frequently after dual-chamber pacemaker implantation. Patients with SND are more likely to develop AF compared to the patients with AVB.
Clinical Impact of Delayed Initiation of Adjuvant Chemotherapy among Patients with Stage II/III Gastric Cancer: Can We Do Better?
Authors: Chen Qiyue , Liu Zhiyu , Zhong Qing , Xie Jianwei , Wang Jiabin , Lin Jianxian , Lu Jun , Cao Longlong , Lin Mi , Tu Ruhong , Huang Zening , Lin Juli , Zheng Hualong , Li Ping , Zheng Chaohui , Huang Chang-ming
Published: August 2019

BACKGROUNDS

To investigate the prognostic effects and risk factors of the omission and delay of postoperative chemotherapy of stage II/III gastric cancer (GC).

METHODS

The clinicopathological data of 1520 patients undergoing radical gastrectomy for stage II/III GC were collected and retrospectively analyzed. We defined the chemotherapy delayed until more than 60 days after radical gastrectomy and the complete omission of chemotherapy as unacceptable chemotherapy initiation (UAC group), while the chemotherapy conducted within 60 days of radical gastrectomy was defined as acceptable chemotherapy initiation (AC group). The survival between the two groups was compared, and the trends and risk factors of UAC were analyzed.

RESULTS

There were 539 (35.5%) patients with UAC. The OS and DFS of the UAC group patients were significantly inferior to those in the AC group (p<0.001). Cox multivariate analysis demonstrated that UAC is an independent predictor of OS (p<0.05). The OS and DFS of the patients in UAC group were close to those of the patients without chemotherapy (p>0.05). Logistic analysis showed female, old age, a self-paid status, a very low social status, high ASA scores, intra-abdominal surgery history, and serious postoperative complications were independent risk factors of UAC (p<0.05). The radar chart shows the risk factors of UAC changed with time.

CONCLUSIONS

UAC after radical gastrectomy is an independent risk factor for the prognosis of stage II/III GC patients. However, no significant decline of UAC has been achieved recently and should call for the attention of both government and clinicians.
Primary care practitioner diagnostic action when the patient may have cancer: a vignette survey in 20 European countries
Authors: Harris Michael , Brekke Mette , Dinant Geert-Jan , Esteva Magdalena , Hoffman Robert , Marzo-Castillejo Mercé , Murchie Peter , Neves Ana Luísa , Smyrnakis Emmanouil , Vedsted Peter , Aubin-Auger isabelle , Azuri Joseph , Buczkowski Krzysztof , Buono Nicola , Foreva Gergana , Babić Svjetlana Gašparović , Jakob Eva , Koskela Tuomas , Petek Davorina , Ster Maria Petek , Puia Aida , Sawicka-Powierza Jolanta , Streit Sven , Thulesius Hans , Weltermann Birgitta , Taylor Gordon
Published: August 2019

Background
Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence Primary Care Practitioners’ (PCPs’) referral decisions in patients that could have cancer, and how this links with cancer survival.
This study aimed to explore PCPs’ diagnostic actions in patients with symptoms that could be due to cancer, how they vary across European countries with marked differences in socio-economic development, healthcare investment and organisation, and how they relate to cancer survival rates.

Methods
A primary care study, with centres in twenty European countries with widely varying cancer survival rates. The on-line survey of PCPs used vignettes describing four patients with symptoms that could indicate cancer (lung, ovary, breast and colorectal). PCPs were asked how they would manage these patients. Correlations between the likelihood of taking immediate diagnostic action and physician characteristics were calculated. The likelihood of taking immediate diagnostic action in the different participating countries was also analysed, as well as the correlation with national 1-year relative cancer survival rates.

Results
A total of 2,086 PCPs answered the survey question, with a median of 72 PCPs per country. PCPs’ likelihood of organising a diagnostic test and/or referring to a specialist at the first consultation varied from 50 to 82% between countries PCPs who were more experienced, were working in more remote areas, or worked alone or in smaller practices, were more likely to take immediate diagnostic action than their peers. There was a significant negative correlation between national healthcare expenditure levels and likelihood of immediate diagnostic action (r=–0.55, P=0.012). However, there was no significant correlation between the likelihood of taking immediate diagnostic action and cancer survival (r=–0.27, P=0.278).

Conclusions
Europe shows large between-country variations in PCPs’ diagnostic action rates for patients who could have cancer. These are linked with differences in healthcare organisation and levels of healthcare investment.
The relationship between sclerostin and carotid artery atherosclerosis in patients with stages 3-5 chronic kidney disease
Authors: Zhao Ban , Chen Aiqun , Wang Haitao , Cui Ju , Sun Ying , Xu Lengnan , Mao Yonghui
Published: August 2019

Background: Sclerotin is an antagonist of the Wnt-β-catenin pathway, may play an important role in the pathophysiology of artery atherosclerosis. Previously, we reported that sclerostin was closely related to carotid atherosclerosis and the long-term outcomes of hemodialysis patients. Here, we aimed to investigate the associations of sclerostin with renal function and carotid artery atherosclerosis in non-dialysis patients with chronic kidney disease in stages 3–5 (CKD 3–5ND).
Methods: A total of 140 patients with CKD 3–5ND were enrolled in this cross-sectional study. The Chronic Kidney Disease Epidemiology Collaboration Equation (CKD-EPI) was used to estimate glomerular filtration rate (eGFR). Carotid artery atherosclerotic plaques were identified by B-mode Doppler ultrasound. Blood samples were collected to assess serum sclerostin. Unconditional logistic regression analysis was used to assess risk factors for carotid atherosclerotic plaques.
Results: The median eGFR and serum sclerostin were 24.9 mL/min/1.73m 2 (interquartile range: 10.0 to 40.3 mL/min/1.73m 2 ) and 46.76 pmol/L (interquartile range: 30.18 to 67.56 pmol/L) , respectively. Carotid atherosclerotic plaques were detected in 104 subjects (74.3%). There was a negative association between sclerostin and eGFR (r = -0.214, p = 0.011). Unconditional logistic regression revealed that sclerostin was an independent factor that was significantly related to the presence of carotid plaques, with odds ratio (OR) of 1.026 (1.003, 1.051).
Conclusions: Patients with CKD 3–5ND showed a gradual increase in serum sclerostin with declining renal function, and sclerostin is an independent correlate for carotid atherosclerosis.
Prevalence and determinants of chronic kidney disease in urban adults’ populations of northern Cameroon: a cross-sectional study
Authors: Kaze Francois Folefack , Maimouna Mahamat , Beybey Augustin Fanday , Pefura-Yone Eric Walter , Balkissou Adamou Dodo , Halle Marie Patrice , Kowo Mathurin Pierre , Ashuntantang Gloria , Kengne Andre-Pascal
Published: August 2019

Background: Chronic kidney disease (CKD) is a major health problem with growing prevalence in sub-Saharan Africa. We present the prevalence and determinants of CKD in Garoua and Figuil cities of the North region of Cameroon.
Methods: A cross-sectional survey was conducted from January to June 2018 in the two cities, using a multi-level cluster sampling. All adults with low estimated glomerular filtration rate (eGFR) (< 60 ml/min/1.73 m2) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albuminuria (≥ 30 mg/g) were reviewed three months later. Logistic regression models (accounting for the sampling strategy) were used to investigate the predictors of the outcomes.
Results: A total of 433 participants were included, with a mean age (95%CI) of 45.0 (43.4-46.6) years, 212 (48.7%) men, 294 (67.9%) from Garoua and 218 (45.6%) with no formal education. Risk factors for chronic nephropathy were highly prevalent including longstanding use of street medications (52.8%), herbal medicines (50.2%) and non-steroidal anti-inflammatory drugs (50%), alcohol consumption (34.4%), hypertension (33.9%), overweight/obesity (33.6%), hyperuricemia (16.8%), smoking (11.3%) and hyperglycemia (6.5%). The prevalence of CKD was 11.7% overall, 10.7% in Garoua and 13% in Figuil participants. Equivalents figures for CKD G3-5 and albuminuria were 2.8%, 2.0% and 4.5%; and 9.1%, 9.3% and 8.5% respectively. History of diabetes, increase systolic blood pressure, hyperglycemia and hyperuricemia were predictors of CKD.
Conclusion: The prevalence of CKD is as high in these northern cities as previously reported in southern cities of Cameroon, driven mostly by known modifiable risk factors of chronic nephropathy.
Familial Atypical Hemolytic Uremic Syndrome with Positive pS1191L (c.3572C> T) Mutation in CFH A Single-Center Experience
Authors: DURSUN Fadime ERSOY , YESIL Gözde , DURSUN Hasan , SASAK Gülşah
Published: August 2019

Background: Atypical hemolytic uremic syndrome is a condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury, which can exhibit a poor prognosis. Gene mutations play a key role in this disease, which may be sporadic or familial. Methods: We studied, 13 people from the same family were investigated retrospectively for gene mutations of familial atypical hemolytic uremic syndrome after a patient presented to our emergency clinic with atypical hemolytic uremic syndrome and reported a family history of chronic renal failure. Results: The pS1191L mutation in the complement factor H gene was heterozygous in 6 people from the family of the patient with atypical hemolytic uremic syndrome. One of these people was our patient with acute renal failure and the other two are followed up by the Nephrology Clinic due to chronic renal failure. The other 3 persons showed no evidence of renal failure. The index case had a history of 6 sibling deaths; two of them died of chronic renal failure. Plasmapheresis and fresh frozen plasma treatment was given to our patient. When patient showed no response to this treatment, eculizumab therapy was started. Conclusions: The study demonstrated that a thorough family history should be taken in patients with atypical hemolytic uremic syndrome. These patients may have familial type of the disease and they should be screened genetically. Eculizumab should be the first choice in the treatment with plasmapheresis. It should be kept in mind that the use of eculizumab as prophylaxis in post-transplant therapy is extremely important for prevention of rejection.
Hospital Accreditation: A solution for developing countries challenges or a challenge for the hospitals?
Authors: Bordbar Najme , Manesh Fatemeh Golestan , Kavosi Zahra , Pourmohammadi Kimia , Ravangard Ramin , Kashefian-Naeeini Sara , Bastani Peivand
Published: August 2019

Background

Inasmuch as accreditation is of great significance for hospitals, this study aimed to explain the accreditation challenges of Iranian hospitals through a content analysis approach.

Methods

A qualitative study was run through the content analysis method in 2018. 19 semi-structured interviews were conducted with experts and data were saturated in this level. To increase the accuracy and precision of the study, Guba and Lincoln’s four criteria including credibility, dependability, conformability and transferability were used. MAX QDA10 was used for data analysis via 5-step framework analysis approach.

Results

The findings of the interview analysis led to the identification of 5 main themes and 29 subthemes. The main themes included macro problems and policy making, evaluators' problems, structural and process problems, executive problems, and problems with the accreditation measures.

Conclusion

The results shed light on the fact that Iranian hospitals need to experience major changes in applying accreditation as a quality assurance mechanism. In other words, it seems necessary for policy makers affiliated with Ministry of Health and Medical education to revise accreditation measures according to hospital needs and try to clarify the structure and executive process of the accreditation. Moreover, improving and standardizing the evaluators` skills is recommended.
Financial catastrophism inherent with out-of-pocket payments in long term care for households: a latent impoverishment
Authors: Pozo-Rubio Raul del , Pardo Isabel , Escribano-Sotos Francisco
Published: August 2019

Background

Out-of-pocket (OOP) payments are configured as an important source of financing long-term care (LTC). However, very few studies have analyzed the risk of impoverishment and catastrophic effects of OOP in LTC.

Objective

To estimate the contribution of users to the financing of LTC and to analyze the economic consequences for households in terms of impoverishment and catastrophism.

Data and Methods

The data base which was used is 2008 Spanish Disability and Dependency Survey, projected to 2012. We analyze the OOP payments effect associated to the impoverishment of households comparing volume and financial situation before and after OOP payment. At the same time, the extent to which OOP payment had led to catastrophism was analyzed using different thresholds.

Results

The results show that contribution of dependent people to the financing of the services they receive exceeds by 50% the costs of these services. This expenditure entails an increase in the number of households that live below the poverty. In terms of catastrophism, more than 80% of households dedicate more than 10% of their income to dependency OOP payments. In annual terms, the catastrophe gap generated by devoting more than 10% of the household income to dependent care OOP payment reached €3,955, 1 million (0,38% of GDP).

Conclusion

This article informs about consequences of OOP in LCT and supplements previous research that focus on health. Our results should serve to develop strategic for protection against the financial risk resulting from facing the costs of a situation of dependence.
Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees
Authors: McHugh John , Keohane Laura , Grebla Regina , Lee Yoojin , Trivedi Amal
Published: August 2019

Background: While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay.

Methods: We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007-2010 period.

Results: The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI -1.8 to -0.9), 6.9 inpatient days/100 enrollees (95% CI -10.1 to -3.8) and 0.7 percentage points in the probability of hospital admission (95% CI -1.0 to -0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI -8.4 to 1.4), 31.1 days/100 (95% CI -75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI -3.8 to -0.6) in intervention plans relative to control plans.

Conclusions: Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.
Institutional strategies as a mechanism to rationalize the negative effects of judicialization of access to medicine in brazil
Authors: Chagas Virginia Oliveira , Provin Mércia Pandolfo , Mota Pedro Augusto Prado , Guimarães Rafael Alves , Amaral Rita Goreti
Published: August 2019

Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, is related to flaws in policies and to insufficient funds available for the State to meet every demand, and it has created challenges. These challenges required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs’ disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Non-Standardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.
Effectiveness of the psychoeducation module for screened positive cases of depression among elderly females in rural South India, a Quasi experimental study
Authors: Puttur Anushree , Rao Chythra R
Published: August 2019

Background:

With the increasing population of geriatric women in India, it has become more necessary to identify morbidities in this population as well as potential interventions to treat them. In this study, we estimate the prevalence of depression in geriatric women living in a district in rural South India, and evaluate the effectiveness of a psycho education on improving knowledge and awareness on depression.

Methods:
This cross sectional study was performed among 218 females above the age of 60 years in rural areas who were interviewed using Beck’s Depression Inventory and evaluated for depression. A questionnaire was then administered to assess knowledge and attitudes regarding depression once prior to and once after the psychoeducation module was presented to assess the effectiveness of the module. Multivariate analysis was performed to identify key variables that predisposed participants for depression as well as those variables that affected the effectiveness of the psychoeducation module.

Results: The study showed 31.7% of the participants to have depression using Beck’s Depression Inventory. Low education status [ AOR: 5.95(1.04-34.10), p = 0.04], decreased social interactions [AOR: 10.97 (1.43-84.13), p = .02.], daily concerns regarding health [AO: R5.09 (1.031-25.10), p = 0.05), loans to settle [AOR: 18.55(2.65-129.64), p = 0.003] and poor sleep quality [AOR:94.82 (13.97-643.72, p < .001] were positively correlated with the presence of depression. Of those participants diagnosed with depression, the psychoeducation module was less effective in those who engaged in hobbies/social activities, had good relationships with family and had concerns about their health.

Conclusion:
Of those interviewed, one-third were estimated to have depression. Administration of a psycho-education was seen to reduce stigma and improve health-seeking behavior. As this stigma is particularly pervasive in geriatric women in rural south India, population specific interventions need to be identified in order to improve knowledge and health seeking behavior.
Keywords: Depression, Elderly, Rural India, Women, Geriatric, Psychoeducation, Intervention
Pregnancy options counselling in Ghana: A case study of women with unintended pregnancies in Kumasi metropolis, Ghana
Authors: Agbeno Evans Kofi , Gbagbo Fred Yao , Morhe ESK , Maltima Soale Issah , Sarbeng Kwadwo
Published: August 2019

Background
Unintended pregnancies have significantly contributed to maternal deaths and illnesses globally. Although good clinical practices show that options counselling enable clients to make informed decisions for healthy pregnancy outcomes, studies on this practice remain a grey area in Ghana.

Aim of the study
The study examines proportions of women exposed to pregnancy options counselling before decision-making, effects of counselling on pregnancy outcomes and associations between women characteristics and counselling.

Methods
Analytical cross-sectional study design was done in selected specialised public and NGO health facilities within Kumasi Metropolis of Ghana, using self-administered structured questionnaires for data collection from 1st January to 30th April, 2014. Participants were 442 women with unintended pregnancies seeking abortion services. Data was analysed using Epi-Info (7.1.1.14) and STATA 12 to generate descriptive statistics, Pearson chi-square and multivariable logistic regressions. The Kwame Nkrumah University of Science and Technology approved the study.

Results
Respondents had divergent reproductive and socio-demographic profiles. Majority (about 58%) of them had been pregnant more than twice, but about 53% of this population had no biological children. (Although about 90% of respondents held perceptions that the index and previous pregnancies were mistimed/unintended, the majority (72%) had no induced abortion history. Induced abortion (208, 49%) and parenting (216, 51%) were mentioned as the only available options to unintended pregnancy in hospitals. Exposure to options counselling was observed to be significantly associated with parity (P= <0.001), gestational age (P= <0.001), previous induced abortions (P= <0.001), perception of pregnancy at conception (P= <0.001) and level of education (P= 0.002). The logistic regression analysis also shows that higher education has statistically significant effect on being exposed to options counselling (P= <0.001). Majority of respondents (95%) were not aware that giving a child up for adoption is an option to pregnancy crisis management.

Conclusions
Pregnancy options counselling remains a major challenge in some Ghanaian health facilities as evident by the study results. Multi-sectorial collaboration for education on pregnancy options counselling and further research to assess the type and depth of counselling services provided pregnant women in health facilities is recommended to inform reproductive health policy and program decisions.
Virtual Implant Rehabilitation Of The Severely Atrophic Maxilla: A Radiological Study
Authors: Manacorda Michele , Chaurand Bianca Poletti de , Merlone Alberto , Tetè Giulia , Capparè Paolo , Vinci Raffaele
Published: August 2019

Background : Advanced maxillary atrophy is often observed and implant placement could become difficult. Nevertheless, a volumetric evaluation using a proper diagnostic software could facilitate the implant planning. The purpose of the present study is to reveal the existence of a sufficient bone volume in the maxilla also in patients presenting a severely atrophic maxilla.
Methods: A sample of CBCT images of 59 patients was evaluated. After a 3D anatomical evaluation, tilted implants has been virtually positioned in the retro-canine regions. All the implants were inserted with the same procedure at 30° and 45° degrees of tilting. The length, the palatal angulation and the diameter of the placed implant were identified.
Results: 220 tilted implants were placed. An average implant measurement of 13,508 mm of length and 3,42 mm of diameter were calculated. Also, an average buccal-palatal angulation of 6° was identified. After the statistical analysis implant length was found significantly higher at 45° degrees than at 30° degree (<0.0001).
Conclusions: A considerable amount of patients show a significant degree of bone atrophy. The implant-supported treatment plan can rely on the three dimensional imaging of the residual bone as a guiding tool to establish the most effective implant position for each specific case. In this study it is founded that in the majority of the maxillary atrophy the volumetric evaluation of the bone near the lateral wall of the nasal cavity could suggest the presence of an adequate basal bone volume for tilted implants placement.
Development of a Prognosis Nomogram of Treatment Outcomes for MDR-Tuberculosis in Guinea (Conakry): A retrospective cohort analysis
Authors: Diallo Alhassane , Diallo Boubacar Djelo , Camara Lansana Mady , Diallo Mafouné , Camara Souleymane , Bah Boubacar , Camara Aboubacar , Magassouba Aboubacar Sidiki , Barry Alpha Oumar , Diallo Thierno Hassane , Miguel Lotshutshu , Diallo Mamadou Hassimiou , Sow Oumou Younoussa
Published: August 2019

Abstract

Background: Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes.

Methods:A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative c-index, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used.

Results:Among 232 patients with MDR-TBenrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%.Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m2(p = 0.0253; aOR = 2.94), good adherence to treatment (p = < 0.0001; aOR = 33.92), normal platelets count (p = 0.0053; OR = 1.004), and the absence of clinical symptoms such as chest pain (p = 0.0083; aOR = 3.19) and depression (p = 0.0308; aOR = 8.62). The discrimination (c-index= 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-LX2= 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%.

Conclusion:Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice.

Keywords:Nomogram, Multidrug-resistant, Tuberculosis, Guinea.
Preliminary Assessment of Ferrate Treatment of Metals in Acid Mine Drainage
Authors: Goodwill Joseph E. , LaBar Julie , Slovikosky Debbie , Strosnider William H. J.
Published: August 2019

We report a preliminary assessment of ferrate [Fe(VI)] for the treatment of acid mine drainage (AMD), focused on precipitation of metals (i.e., iron [Fe] and manganese [Mn]) and subsequent removal. Two dosing approaches were studied to simulate the two commercially viable forms of Fe(VI) production: Fe(VI) only, and Fe(VI) with sodium hydroxide (NaOH). Subsequent metal speciation was assessed via filter fractionation. When only Fe(VI) was added, the pH remained <3.6, and the precipitation of Mn and Fe was <30 and <70%, respectively, at the highest, stoichiometrically excessive Fe(VI) dose. When NaOH and Fe(VI) were added simultaneously, precipitation of Mn was much more complete, at doses near the predicted oxidation stoichiometric requirement. The optimal dosage of Fe(VI) for Mn treatment was 25 μM. The formation of Mn(VII) was noted at Fe(VI) dosages above the stoichiometric requirement, which would be problematic in full‐scale AMD treatment systems. Precipitation of Fe was >99% when only NaOH was added, indicating that oxidation by Fe(VI) did not play a significant role when added. The Fe(III) and Al(III) particles were relatively large, suggesting probable success in subsequent removal through sedimentation. Resultant Mn‐oxide particles were relatively small, indicating that additional particle destabilization may be required to meet Mn effluent goals. Ferrate seems viable for the treatment of AMD, especially when sourced through onsite generation due to the coexistence of NaOH in the product stream. More research on the use of Fe(VI) for AMD treatment is required to answer extant questions.

Core Ideas

Ferrate is likely a viable option for acid mine drainage treatment.

Oxidation of manganese with ferrate and NaOH approached stoichiometric prediction.

Resultant particles may challenge downstream clarification.
Phosphorus and the Chesapeake Bay: Lingering Issues and Emerging Concerns for Agriculture
Authors: Kleinman Peter J. A. , Fanelli Rosemary M. , Hirsch Robert M. , Buda Anthony R. , Easton Zachary M. , Wainger Lisa A. , Brosch Chris , Lowenfish Martin , Collick Amy S. , Shirmohammadi Adel , Boomer Kathy , Hubbart Jason A. , Bryant Ray B. , Shenk Gary W.
Published: August 2019

Hennig Brandt's discovery of phosphorus (P) occurred during the early European colonization of the Chesapeake Bay region. Today, P, an essential nutrient on land and water alike, is one of the principal threats to the health of the bay. Despite widespread implementation of best management practices across the Chesapeake Bay watershed following the implementation in 2010 of a total maximum daily load (TMDL) to improve the health of the bay, P load reductions across the bay's 166,000‐km2 watershed have been uneven, and dissolved P loads have increased in a number of the bay's tributaries. As the midpoint of the 15‐yr TMDL process has now passed, some of the more stubborn sources of P must now be tackled. For nonpoint agricultural sources, strategies that not only address particulate P but also mitigate dissolved P losses are essential. Lingering concerns include legacy P stored in soils and reservoir sediments, mitigation of P in artificial drainage and stormwater from hotspots and converted farmland, manure management and animal heavy use areas, and critical source areas of P in agricultural landscapes. While opportunities exist to curtail transport of all forms of P, greater attention is required toward adapting P management to new hydrologic regimes and transport pathways imposed by climate change.

Core Ideas

At the midpoint of the Chesapeake TMDL, dissolved P is increasing in some tributaries.

Lingering concerns include legacy P, artificial drainage, animal heavy use areas.

Extreme events represent an acute risk to water quality.
Capturing Gas Fluxes on Your Phone: An iOS‐ and Android‐based Data‐Logging Setup for EGM‐4 Environmental Gas Monitoring Systems
Authors: Sterk Henk Pieter , Detrey Iain , Marshall Chris , Cowie Neil R. , Payne Richard , McIlvenny Jason , Andersen Roxane
Published: August 2019

Mobile devices have become increasingly important for field monitoring to improve data capture efficiency, increase storage capacity, and replace heavy equipment. We introduce a quick and straightforward protocol to capture greenhouse gas (GHG) emission rates on mobile devices. We developed our setup on the widely used infrared gas analyzer (IRGA) EGM‐4 by PP Systems. This IRGA has a limited internal storage capacity and requires an external device such as a laptop to conduct even modest field sampling. Furthermore, when raw data storage is required, carbon dioxide concentration resolution is reduced by the internal EGM‐4 software settings, making the equipment less suitable for high‐frequency measurements. Our protocol lets the user bring either an iOS or Android mobile device in to the field to connect to the EGM‐4's data stream. For both platforms, a mobile console application was used to read, log, and share flux data. The raw data can be processed in either Python, R, or Matlab using the provided scripts that give the user flexibility to amend further postprocessing steps to obtain GHG fluxes. We demonstrate the flexible applicability of mobile devices for field recording and show that a cost‐effective solution can enhance the operational life of superseded field equipment while also increasing the quality of the captured data.

Core Ideas

Easy‐to‐use protocol captures carbon flux data on a mobile device.

Increases data storage, resolution, and setup flexibility compared with common practices.

Mobile devices can replace heavy equipment and increase useful time in the field.
Establishment and Stand Development of Alfalfa Interseeded into Native Grass Mixture: Cultivar and Row Spacing Effects
Authors: Dhakal Madhav , West Charles P. , Villalobos Carlos
Published: August 2019

Interseeding alfalfa (Medicago sativaL.) into native grasslands can enrich forage nutritive value, but successful establishment in semiarid regions is limited by chronic water deficit. The objective was to evaluate establishment and stand development of two upright‐type alfalfa cultivars, ‘WL 440HQ’ (WL), ‘NuMex Bill Melton’ (NM), and prostrate‐type ‘Falcata’–‘Rhizoma’ blend (FR), interseeded into mixtures of four native grass species at 36‐ or 71‐cm row spacing near Lubbock, TX. Average emergence was 265, 216, and 175 seedlings m−2for WL, NM, and FR, respectively; however, the WL stand declined faster than the FR and NM stands during seedling and crown development stages (P< 0.01). The upright‐type cultivars maintained a greater crown density and ground cover compared with FR at both row spacings (P< 0.05). Alfalfa seedling or crown density fitted against time (d) with exponential models revealed an initial sharp decline followed by a slow rate of decline after establishment. At the end of 3 yr, row‐spacing results converged to similar levels for plant density (6.5 crowns m−2) and alfalfa cover (23.5%). This indicates significant seed cost savings with the wider row spacing at that level of stand establishment. Interseeding adapted, upright‐type cultivars at wide row spacing can produce a desirable level of alfalfa establishment in a semiarid grassland of the southern Great Plains.
A Road Map for Conservation, Use, and Public Engagement around North America's Crop Wild Relatives and Wild Utilized Plants
Authors: Khoury Colin K. , Greene Stephanie L. , Krishnan Sarada , Miller Allison J. , Moreau Tara
Published: August 2019

Crop wild relatives—the plant species closely related to agricultural crops—are valuable genetic resources used by plant breeders to increase pest and disease resistance, stress tolerance, nutritional profile, and other traits critical to productivity, quality, and sustainability. Wild utilized plants provide food and a variety of other ecosystem and cultural services to people. North America harbors a rich native flora that includes wild relatives of important food, fiber, industrial, feed and forage, medicinal, and ornamental crops, as well as a diversity of regionally significant wild utilized plants. Many of these species are threatened in their natural habitats, and most are underrepresented in plant genebanks and botanical gardens. These conservation gaps limit the portfolio of useful plant diversity available to present and future generations. Likewise, the myriad potential uses of North American crop wild relatives and wild utilized plants are underexplored, and public awareness of their value and threats is limited. Greater coordination of efforts among plant conservation, land management, agricultural science, and botanical education and outreach organizations will be necessary to secure, enhance use, and raise awareness with regard to these species. A road map for collaborative action is presented here, focused on five priorities: (i) to understand and document North America's crop wild relatives and wild utilized plants, (ii) to protect threatened species in their natural habitats, (iii) to collect and conserve ex situ the diversity of prioritized species, (iv) to make this diversity accessible and attractive for plant breeding, research, and education, and (v) to raise public awareness of their value and the threats to their persistence.
Soil‐Gas Diffusivity and Soil‐Moisture effects on N2O Emissions from Intact Pasture Soils
Authors: Chamindu Deepagoda T.K.K. , Jayarathne J.R.R.N. , Clough Timothy J. , Thomas Steve , Elberling Bo
Published: August 2019

Grazed pastures are recognized as a dominant source of nitrous oxide (N2O), a highly potent greenhouse gas. Studies have examined soil physical controls on N2O emissions, including soil moisture status. Limited attempts to link N2O emissions with soil‐diffusivity (Dp/Do), using repacked soil cores, have shown peak N2O emissions to align with a relatively narrow window ofDp/Do, despite a relatively wide range in water‐filled pore space (WFPS), across a range of soil bulk densities. Such detailed studies have not been performed withintactsoil cores. We investigated the effects of soil‐water characteristic (SWC) andDp/Doon N2O emissions from intact soil samples, retrieved at three depths (0–5, 5–10, 10–15 cm) from three perennial pasture sites that received a KNO3solution (1800 mg, N mL−1). We observed distinct fingerprints of SWC andDp/Do, which showed clear effects of soil structure on diffusion‐controlled gas emissions. Depth‐wise variation in soil moisture diminished as the soil was subjected to higher matric potential (> ∼ ‐100 kPa). Variation inDp/Do, was more pronounced in the dry soil (> ∼ ‐1000 kPa), being largely constrained by soil moisture in wet soil (∼ ‐100 kPa) with little depth‐wise variation. Measured N2O fluxes peaked within narrow ranges of WFPS andDp/Do, 0.90–0.95 and 0.005–0.01, respectively. The value ofDp/Docan be determined using parametric models and presents a pasture management (e.g., irrigation, soil physical disturbance such as pasture renovation and animal treading)) tool to minimize N2O emissions: soilDp/Doshould be maintained above a range of 0.005–0.01 to minimize N2O emissions.

Core Ideas

Peak N2O fluxes fromintactsoil cores occurred when diffusivity ranged from 0.005–0.01

This peak N2O flux diffusivity range was 0.005–0.01 regardless of soil or depth (0–15 cm)

The diffusivity range for peak N2O flux equalled that observed inrepackedsoil cores

Diffusivity values are readily determined and add to the suite of soil management tools
Quantitative Guidelines for Establishing and Operating Soil Archives
Authors: Ayres Edward
Published: August 2019

Soil archives are widely recognized as important, but there is limited information available on the basic elements of archive design, such as how much material to archive, which sites and horizons to prioritize, and the most effective way to promote an archive. Here I address these gaps based on 6 yr of operating the National Ecological Observatory Network's (NEON) Megapit Soil Archive, which has provided over 1500 samples to researchers. Active outreach by NEON staff was the most effective way of raising awareness of the archive among the user community. On average, 14.6 ± 4.3 g soil was sent to requesters per sample per year, with soils from A horizons and intensively studied sites consumed fastest. Based on these consumption rates and depending on soil horizon and site type, archiving between 22.3 and 39.9 g soil for each year of a sample's desired lifespan would be sufficient to ensure that it is not exhausted earlier than expected with ≥89% confidence. Similarly, 500 g of archived soil would be sufficient for the vast majority of samples to last at least 12 to 22 yr, depending on horizon and site type. A simple equation is proposed, and parameterized using NEON data, to determine the quantity of soil necessary to archive if the desired sample lifespan is known. Setting a desired lifespan can inform archive management decisions, such as the number of requests to approve and whether to increase or decrease the allocation of resources to raising awareness of the archive.

Core Ideas

Soil archive samples were consumed at 15 ± 4 g yr−1(mean ± SD).

Soils from A horizons and intensively studied sites were consumed fastest.

Depending on site and horizon, 500 g archived soil would last at least 12 to 22 yr.

Informal interactions were the most effective way to raise archive awareness.
Biopolítica afirmativa de los movimiento sociales: el caso del movimiento sin tierra y piqueteros
Authors: Herrera Avila Gina Paola
Published: August 2019

Se aplicaran los conceptos de biopoder y biopolítica en el accionar de los movimientos sociales, con lo que se demuestra que dichos conceptos pueden ser positivizados en tanto hacen parte de las nuevas formas de resistencia a las formas de dominación utilizadas por el capitalismo.