bluuebunny/crossref_metadata_2025 huggingface dataset:
O SISTEMA TRIBUTÁRIO BRASILEIRO, A REGRESSIVIDADE E SUAS REPERCUSSÕES SOCIOECONÔMICAS À LUZ DO PRIMADO CONSTITUCIONAL DA IGUALDADE TRIBUTÁRIA
Authors: Alves Coelho Leandro , Sacramento Peixe Elisângela Paula do
Published: May 2020

O presente artigo tem como objetivo ampliar os estudos atinentes a regressividade tributária, mediante predominância da tributação indireta e linear sobre o consumo em detrimento da tributação direta e proporcional sobre o patrimônio e a renda, agravada pelo esvaziamento da progressividade da tributação direta. O objetivo desta pesquisa é tratar sobre como a regressividade tributária nos ditames brasileiro afeta de forma drástica a população de menor renda a contrário sensu do que apregoa a Constituição Federal, onde o ideal tributário se perfaz na promessa um sistema progressivo de tributos, sobretudo os que incidem sobre a renda e patrimônio e não de forma abrasadora como o sistema regressivo que tributa eminentemente o consumo e o serviço. Para tanto, utilizaremos o método exploratório, revisando bibliografias com a finalidade de levantar questionamentos quanto à aplicabilidade das normas tributarias tendo como corolário o Princípio da Igualdade Tributaria em consonância com a capacidade contributiva. Esperamos com esta pesquisa, trazer novos olhares para uma reforma tributária que abrace mudanças no cenário nacional e que atenda aos objetivos fundamentais da República Federativa do Brasil, qual seja a de construção de uma sociedade justa, homenageando os princípios plasmados na Constituição de 1988, suscitando possibilidades de um ordenamento jurídico reparador no tocante as regras relativas a concessão excessiva de direitos no âmbito tributário a percentual pequeno da população em detrimento de um quantum extremamente significativo.
ENSAIO SOBRE A POLÊMICA VANTAGEM DO INVESTIDOR-ANJO ADVINDA DA LC 155/2016
Authors: J. C. Nunes Paulo
Published: May 2020

O artigo aborda as vantagens e desvantagens que referida lei complementar trouxe ao ordenamento jurídico, ao regulamentar atuação do anjo-investidor, mormente, no campo da proteção patrimonial e tributário. Partindo de um comparativo com determinada figura típica societária e determinada figura típica contratual, chega-se a conclusão no sentido de que o avanço ocorreu apenas no campo societário. O investidor-anjo sofre com uma tributação equiparada a renda fixa, contudo, assume o risco de perda do respectivo capital.
PANCONSTITUCIONALISMO, DEMOCRACIA E JURISTOCRACIA
Authors: Peake Braga Ricardo
Published: May 2020

O abuso no uso dos princípios para a interprestação constitucional levou a uma constitucionalização de todos os aspectos da vida e, por consequência, num aumento de poder das cortes constitucionais e perda de poder dos Poderes Legislativos e Executivos, com grave ameaça à democracia e à liberdade.
BIOÉTICA LATINO-AMERICANA: REFLEXÕES NO CONTEXTO DO NEOCONSTITUCIONALISMO
Authors: Hora Batista Fontes Couvre Tâmis , Coutinho de Faria Alves Míriam , Helena Santos Caldas Kelly
Published: May 2020

A bioética enquanto conjunto de reflexões biofilosóficas inscrita nas ciências da vida, pode ter caráter amplo, a cuidar da sobrevivência na Terra (macrobioética), ou mais restrito, a cuidar das práticas médicas em particular (microbioética). Esse artigo aborda origem e desenvolvimento, ressaltando que os países da América Latina para assegurar seu objetivo intrínseco relativo à preservação da vida digna e da biossegurança de gerações presentes e futuras devem revisitar paradigmas fundantes. Nesse sentido, são abordadas as características do neoconstitucionalismo, alicerce paradigmático que retoma a interlocução entre Direito e Ética, sem se furtar às críticas ao movimento. Por fim, aborda-se o surgimento da bioética latino-americana, como possível norte axiológico para uma bioética que considere em si as peculiaridades de um povo ou de povos semelhantes.
LICENCIAMENTO COMPULSÓRIO NA PROPRIEDADE INDUSTRIAL: UMA VISITA À LEGISLAÇÃO LUSITANA
Authors: Russi Alexandre
Published: May 2020

O licenciamento compulsório dos bens regulados pela propriedade industrial, tais como as invenções e modelos de utilidades, dentre outros, encontra regulamentação no novo Código de Propriedade Industrial de Portugal com as delimitações das hipóteses pelas quais o direito ao exclusivo se excepcione em favor da exploração econômica do bem. Ao interesse do titular do direito da propriedade industrial se sobrepõe o social e econômico, razão pela qual, a legislação destaca quando e como incidirá o licenciamento obrigatório para a exploração do bem. No presente artigo se analisará as regras contidas no Código de Propriedade Industrial de Portugal para que o detentor do direito ao exclusivo seja compelido a permitir a exploração comercial do seu bem patenteado.
A NEUTRALIZAÇÃO DO MEDO NA GESTÃO DE CONFLITOS E O PAPEL DO ADVOGADO NESSA GESTÃO
Authors: Jr Biela , Rodrigues Tinoco Surian Cristina
Published: May 2020

A própria história relata inúmeros conflitos do homem contra seu semelhante, e isso demonstra o quanto o conflito faz parte do ser humano. Entretanto, há um ponto gerador desse conflito: o medo. É preciso pensar em métodos de solução de conflitos onde se leve em conta o histórico emocional das partes envolvidas com base no medo e, a partir daí, gerir o conflito.
ABATE HALAL E KOSHER E BEM-ESTAR ANIMAL
Authors: Pancheri Ivanira , Carvalho Campos Roberto Augusto de
Published: May 2020

Objetiva-se discutir o bem-estar animal diante do abate religioso. Hodiernamente, o Direito Animal faz-se crescente e pois, ordena um repensar científico, ético e legal no tratamento dos animais não humanos. E, ainda que exista uma norma cultural de animais usados para alimentação, termos como dignidade, senciência e bem-estar animal afloram principalmente no momento do abate. Neste universo, o recorte do abate religioso para produção de carne Halal e Kosher surge com especial interesse. Assim, a partir de profícua literatura, alcança-se tema controverso que envolve não apenas questões científicas e éticas, mas principalmente dogmas religiosos. Optou-se todavia, por priorizar o Direito Animal. Não se adentrou em altercações sobre abolicionismo e veganismo. Diante do estado atual das coisas que legaliza a produção de proteína animal, infere-se a incompatibilidade ética, científica e legal da garantia do bem-estar animal em face do apregoado abate humanitário. E, mais especificamente a jugulação cruenta executa a nos abates Halal e Kosher, em que pese práticas milenares, recrudesce intercorrências que desequilibram o bem-estar animal.
CONCEPÇÕES E ATITUDES DE MÉDICOS EM RELAÇÃO A CONTEÚDOS JURÍDICOS EM SUA PRÁTICA PROFISSIONAL NO PREENCHIMENTO DO UNIVERSO DOS DOCUMENTOS MÉDICOS
Authors: Lage Mariz Kátia , Asensi Felipe
Published: May 2020

Analisar concepções e atitudes médicas em relação a conteúdos jurídicos na prática profissional no preenchimento do universo dos documentos médicos; identificando a necessidade de proporcionar noções de conhecimentos jurídicos à formação médica num currículo interdisciplinar entre as ciências da medicina e do direito. Para análise foram realizadas pesquisas qualitativas de caráter exploratório e de caráter descritivo, nas seguintes ferramentas de coleta de dados: entrevistas e questionários. Respectivamente, as primeiras realizadas com dois profissionais diretores médicos, um diretor jurídico e uma advogada e as segundas junto aos profissionais médicos inscritos em cursos de pós-graduação com especialização em residência médica e pós-graduação latu sensu com especialização médica em instituições privadas na cidade do Rio de Janeiro. A combinação das ferramentas, analisadas e ilustradas em tabelas e gráficos no programa Microsoft Excel, levou a conclusão de que os médicos detêm limitado saber jurídico em suas práticas profissionais, validando os produtos de indicação de disciplina de conteúdo médico-jurídico na matriz da grade curricular de cursos de pós-graduação latu – sensu para médicos e de um manual de procedimentos de preenchimento dos documentos médicos na forma escrita e no uso da tecnologia de QR code escaneado pela maioria dos telefones celulares equipados com câmera que converte o código em texto.
Medicines for the Treatment Of COVID-19: Awaiting the Evidence
Authors: Marto Natalia , Monteiro Emília C.
Published: May 2020

The novel severe acute respiratory syndrome coronavirus 2 is the cause of Coronavirus Disease 2019, a new illness with no effective treatment or vaccine that has reached pandemic proportions. In this document, we analyze how health authorities and agencies around the world position themselves regarding the off-label use of repurposed drugs or new investigational drugs to treat Coronavirus Disease 2019. We review the most promising candidate medicines, including available evidence, clinical recommendations and current options for access. Our concluding remarks stress the importance of administering off-label and investigational drugs in the setting of clinical trials, or at least in standardized scenarios, to generate as much scientific knowledge as achievable while engaging in the best efforts to treat patients and save lives.
Wine aging authentication through Near Infrared Spectroscopy: a feasibility study on chips and barrel aged wines
Authors: Nardi Tiziana , Petrozziello Maurizio , Girotto Raffaele , Fugaro Michele , Mazzei Raffaele Antonio , Scuppa Stefano
Published: May 2020

Aim: This research primarily focuses on exploring the suitability of near infrared (NIR) spectroscopy with multivariate data analysis as a tool to classify commercial wines depending on the aging process. It is aimed at discriminating between wines aged in barrels and those obtained using alternative products (chips).Methods and Results: Around 75 commercial barrel-aged red wines issued from the appellation “Valpolicella” (Italy) were analyzed. Moreover, 15 wines were aged at the experimental winery of the Research Centre of Viticulture and Enology in Asti using different types of commercial oak chips. Wines were analyzed in transmittance using NIR regions of the electromagnetic spectrum. Principal component analysis (PCA) and partial least squares (PLS) analyses were used to classify wines: a preliminary step was carried out using PCA that showed interesting groups in the whole data set. Next, in order to test if combined explanatory variables made it possible to discriminate treatments and how they are useful to predict which group a new observation will belong to, an orthogonal partial least squares discriminant analysis (OPLS-DA) was carried out. Several wine groups were considered, defined by factors including the aging process, the type of oak used for aging (wood barriques, barrels or chips) and the wine typologies (differing for some enological parameters).Conclusions: Overall, OPLS-DA models correctly classified >90 % of the wines. These results demonstrate the potential of combining spectroscopy with chemometric data analysis as a rapid method to classify wines according to their aging process. Nevertheless, the development of a mathematical model for predictive purposes is a complex task: indeed, large databases for different wines should be constructed, and other spectral IR zones might be evaluated for improving the method performance in determining wine aging process.Significance and impact of the study: This study contributes to the development of an easy-to-use and easily applicable NIR method for correlating the infrared “fingerprint” spectrum with the aging process in wines, aimed at implementing a technique able to discriminate wines aged with different wood types, that can be progressively used in the laboratory for routine fraud inspection.
Improved Model-Free Adaptive Control of Pneumatic Gravity Compensation System
Authors: Liu Yu , Peng Feng , Hua Zhen , Liu Changlong , Zhao Guoxin ,   Information Engineering College, Beijing Institute of Petrochemical Technology No.19 Qingyuan North Road, Daxing District, Beijing 102617, China,   Information Science Department, Beijing University of Technology No.100 Pingleyuan, Chaoyang District, Beijing 100022, China
Published: May 2020

A pneumatic gravity compensation system is typically nonlinear in behavior. It is difficult to establish an accurate mathematical model for it, and it is particularly difficult to realize high-precision pressure control. A pneumatic gravity compensation system driven by a frictionless cylinder is built. Considering that the traditional model-free adaptive control is slow for pseudo-gradient identification, an improved model-free adaptive control is proposed to predict the changes in the pseudo gradient and accelerate the process of pseudo gradient identification. The static and dynamic gravity compensation of the pneumatic gravity compensation system is realized. Finally, the experimental results show that the steady-error of step response of the improved model-free adaptive controller is less than 200 Pa, and the rise time is approximately 13 seconds. The sinusoidal tracking error (0.04 Hz) is approximately 1.94 KPa.
Do You Forgive Past Mistakes of Animated Agents? A Study of Instances of Assistance by Animated Agents
Authors: Yuasa Masahide ,   Shonan Institute of Technology 1-1-25 Tsujido-Nishikaigan, Fujisawa, Kanagawa 251-8511, Japan
Published: May 2020

Many studies on human–computer interaction have demonstrated that the visual appearance of an agent or a robot significantly influences people’s perceptions and behaviors. Several studies on the appearance of agents/robots have concluded that consistency between expectations from an agent’s or a robot’s appearance and performances was an important factor to the continuous use of these agents/robots. This is because users would stop interacting with the agents/robots when predictions are not met by actual experiences. However, previous studies mainly focused on the consistency between an initial expectation and a performance of a single instance of a task. The influence of the orders of successes or failures for more than one instance of a task has not been examined in detail. Therefore, in this study, we investigate the order effects of how the timing of sufficient or insufficient results of animated agents affects user evaluation. This will lead to the contribution to fill the lack of studies regarding more than one task in the field of human–computer interaction and to realize the continuous use of agents/robots as long as possible and to avoid stopping to use the agents/robots owing to their successful design. We create a simulated retrieval website and conduct an experiment using retrieval assistant agents that show both sufficient and insufficient results for more than one instance of retrieval tasks. The experimental results demonstrated a recency effect wherein the users significantly revised their evaluations of the animated agents based on new information more than that based on initial evaluations. The investigation of the case of repeated instances of a task and the influence of successes or failures is important for designing intelligent agents that may show incomplete results in intelligent tasks. Furthermore, the result of this study will contribute to build strategies to design behaviors of agents/robots that have a high or low evaluation based on their appearance in advance to prevent users from stopping use of the agents/robots.
Total Count of Lactic Acid Bacteria in Goats and Cows Milk Yoghurt using Starter S. thermophilus RRAM-01, L. bulgaricus RRAM-01 and L. acidophilus IIA-2B4
Authors: Mega Olfa , Jahidin Jaya Putra , Sulaiman Noraimah Binti , Yusuf Muhammad , Arifin Muhamad , Arief Irma Isnafia
Published: May 2020

Yoghurt is a well-known fermented dairy product which produced using a combination of lactic acid bacteria (LAB) of Streptococcus thermophilus, Lactobacillus bulgaricus and L. acidophillus as fermentation starters. Cow milk is usually used as a raw ingredient. The LAB-based local yoghurt starter (S. thermophilus RRAM-01 (ST), L. bulgaricus RRAM-01 (LB) and L. acidophilus IIA-2B4 (LA)) were previously isolated from milk and meat, nevertheless had not been extensively attempted to be used in yoghurt production. This study aimed to evaluate the characteristics of cow and goat milk based yoghurt produced by using a single local strater of S. thermophilus RRAM-01 (ST) or L. bulgaricus RRAM-01 (LB) or L. acidophilus IIA-2B4 (LA). The yoghurts were produced through addition of the starter (3% v/v each) with 1010 CFU mL-1 of initial population, and then fermented at room temperature for 24 hr.  The result revealed that initial population of LAB in goat’s milk yoghurt fermented by ST or LB were significantly higher than that of by LA. Yet, after 24-hour of storage at room temperature, the total population of LA increased and reached final population which was higher than LB or ST. Meanwhile, cow’s milk yoghurt fermented by LB had the highest population of at the initial day (D0), while after fermentation the highest population were observed on LB or LA cow’s milk yoghurt. Overall goat’s milk yoghurt had significantly lower pH values than the cow’s milk yoghurt. These were accompanied by higher the total titrated acid (TTA) of goat’s milk yoghurt than that of cow’s milk yoghurt. Based on pH and TAT values, it was found that  ST bacteria produced significantly higher total acidity goat’s milk yoghurt, followed by LB and LA. However, the type of culture had no effect on total acidity of cow's milk yoghurt.
Diagnosis of Periprosthetic Infection
Authors: Wasterlain Amy S. , Goswami Karan , Ghasemi S. Ali , Parvizi Javad
Published: May 2020

➤ There is no absolute test for the preoperative diagnosis of periprosthetic joint infection (PJI); thus, clinical practice relies on a combination of supportive tests and criteria.

➤ Novel serum and synovial tests have improved our ability to diagnose PJI. The 2018 evidence-based algorithm for PJI diagnosis provides weighted scores for serum markers, as well as synovial markers, to facilitate diagnosis when major criteria such as positive cultures or a sinus tract are not present.

➤ Culture-independent technologies such as next-generation sequencing can facilitate pathogen identification, particularly in the setting of culture-negative PJI.

➤ Despite recent developments, PJI diagnosis remains challenging and warrants further innovation.
The Repair of an Acute Pathological Subtrochanteric Femur Fracture Using an Adult 3.5-mm Proximal Humerus Locking Plate in an Adolescent Patient
Authors: Newbury Alex J. , Aurigemma Philip , Kraus Mark , Most Mathew
Published: May 2020

Case:

We report a novel case of the successful repair of a pathological fracture of a 14-year-old boy's proximal femur using open reduction and internal fixation with an adult 3.5-mm proximal humerus locking plate.

Conclusion:

Successful repair of a pediatric pathologic femur fracture due to an aneurysmal bone cyst may be achieved using an adult proximal humerus locking plate in select patients.
A Case of Atraumatic Acute Compartment Syndrome: Beware of the Existence of This Orthopaedic Emergency
Authors: Aburas Amar , Salehi Parnia , Lee Gregory , Whitfield Bryan
Published: May 2020

Case:

We present a 44-year-old man diagnosed with atraumatic, idiopathic acute compartment syndrome (ACS) of the left lower extremity treated with an emergent single incision fasciotomy with the release of the anterior and lateral compartments. The patient's condition was diagnosed without delay and successfully treated, resulting in a full recovery.

Conclusion:

Immediate diagnosis and emergent surgical treatment of atraumatic ACS is critical in preventing surgical complications and preserving function of the limb. Recognition of this condition existing in the absence of the typical history of an inciting event or underlying predisposition is important to avoid missing the need for emergent surgical intervention.
Proximal Hamstring Tendon Avulsion Resulting in Acute Posterior Thigh Compartment Syndrome
Authors: Purnell Jennifer , Monument Michael J. , Johnston Kelly , Desy Nicholas M.
Published: May 2020

Case:

A healthy 36-year-old man developed compartment syndrome of the posterior thigh with an associated sciatic nerve palsy secondary to an acute proximal hamstring tendon avulsion injury.

Conclusion:

Compartment syndrome of the thigh is rare and is usually associated with high-energy trauma. Atraumatic causes have been described, typically involving the anterior compartment. Posterior thigh compartment syndrome is especially uncommon. This case highlights the potential occurrence of posterior thigh compartment syndrome after proximal hamstring tendon rupture. Given the morbidity associated with compartment syndrome, it is important to recognize the risk factors and injury patterns that can cause thigh compartment syndrome.
PERKEMBANGAN PENGENDALIAN PENYAKIT VASCULAR STREAK DIEBACK PADA TANAMAN KAKAO / Current Research Progress and Strategy to Control Vascular Streak Dieback (VSD) Disease of Cacao
Authors: Harni Rita , Wahyuno Dono , Trisawa Iwa Mara
Published: May 2020

Vascular streak dieback (VSD) merupakan penyakit penting pada tanaman kakao. Penyakit ini telah berkembang luas di sentra produksi kakao di Indonesia dan menyebabkan kerugian 30-45% dari produksi. Luas serangan VSD di Indonesia pada tahun 2007 adalah 70.000 ha dengan kehilangan hasil sebesar  Rp 405 643 680 000/tahun, dan kerugian terus meningkat dari tahun ke tahun. Tujuan dari revieu ini adalah menginformasikan tentang penyakit VSD dan perkembangan teknologi pengendaliannya. Penyakit VSD adalah penyakit pembuluh kayu yang  menyerang tanaman kakao. Gejala serangan ditunjukkan oleh daun yang  mengalami klorosis, gugur dan meranting, hingga akhirnya tanaman tidak berproduksi. Penyakit VSD disebabkan oleh cendawan Ceratobasidium theobromae, yang bersifat obligat parasit, tersebar melalui spora udara (basidiospora), melalui bahan tanam atau bibit kakao yang telah terinfeksi. Keberhasilan spora untuk berkecambah dan melakukan penetrasi jaringan daun sangat tergantung pada kondisi lingkungan. Karakteristik C theobromae yang sulit diperbanyak pada medium buatan menjadikan penelitian VSD sangat tergantung dengan kondisi inokulum di lapang. Komponen pengendalian yang telah dikembangkan berupa varietas atau klon kakao tahan VSD, aplikasi fungisida, agens hayati dan kultur teknis.    Pengembangan kakao tahan VSD perlu disertai dengan pengembangan komponen teknologi pengendalian lainnya. Penanaman klon tahan VSD disertai dengan penerapan kultur teknis budidaya kakao yang tepat  disertai aplikasi komponen pengendalian yang sesuai dianggap sebagai strategi untuk menekan penyebaran VSD yang efisien, efektif dan ramah lingkungan. .

 

 

ABSTRACT

Vascular Streak Dieback (VSD) is a main disease in cacao. It has been widely spread in cacao producing centers in Indonesia which has caused 30-40% production loss. Infested plant showed symptoms such as clorosis on its leaves which then fall off and die back. eventually stop producing.  VSD is caused by a obligate parasite fungus Ceratobasidium theobromae ,  , spread through basidiospora, plant materials, or infected seedlings. Since this fungus is difficult to be cultured in artificial media causes the research on VSD highly depends on the availability of inoculum at the field   The ability of spora to germinate and penetrate leaves tissue is determined by environment conditions.  Components of control which have been developed are varieties or cacao clones, fungicide application, biocontrol agents, and technical culture.  Developing VSD resistant cacao also necessitates the development of control technology components. Planting VSD resistant clones combines with sugested cultural practices are considered efficient and effective for controlling VSD as well as an environmental friendly control strategy.

 
Mala nutrición a nivel municipal en población preescolar mexicana y cobertura del Programa Nacional México Sin Hambre
Authors: Quezada-Sánchez Amado D , García-Guerra Armando , Galindo-Gómez Carlos , García-Morales Concepción , Molina-Vélez Diana , Palacio-Mejía Lina Sofia
Published: May 2020

Objetivo. Estimar las prevalencias municipales de mala nutrición en población preescolar en México, y describir su variabilidad y su relación con la cobertura del Programa Nacional México Sin Hambre. Material y métodos. A partir de datos de la Encuesta Nacional de Salud y Nutrición de 2012, la desigualdad del ingreso y marginación municipal se aplicó un modelo normal generalizado para obtener las distribuciones municipales de los indicadores de nutrición y estimar las prevalencias de mala nutrición. Resultados. Las prevalencias de talla baja variaron de 7.8% (IC95%: 5.9-8.9) a 64.2% (49.2-72.5), las de bajo peso de 0.6% (0.005-1.7) a 22.2% (13.5-34.9) y de sobrepeso u obesidad de 2.6% (0.2- 3.9) a 14.4% (11.9-27.7). De los 554 municipios con prevalencias de talla baja mayor que 25%, 275 fueron cubiertos por el programa México Sin Hambre. Conclusiones. La estimación de prevalencias municipales de mala nutrición evidenció grandes diferencias al interior del país, mismas que podrían asistir la política pública.
Violencia obstétrica desde la perspectiva de las parteras tradicionales
Authors: Aranda-Téllez Carlos Alberto , Yam-Chalé Hugo Alberto
Published: May 2020

No disponible
Código Nutricia: nutrición y conflicto de interés en la academia
Authors: Barquera Simón , Balderas Nydia , Rodríguez Estefanía , Kaufer-Horwitz Martha , Perichart Otilia , Rivera-Dommarco Juan A
Published: May 2020

Para combatir la mala nutrición en todas sus formas es necesario integrar acciones desde la sociedad en su conjunto. El interés superior de los actores involucrados en generar estas acciones debe ser la salud. No obstante, existen actores con conflictos de interés que interfieren en el diseño, planeación, implementación y monitoreo de las políticas derivadas de dichas acciones. A fin de mitigar el efecto adverso que generan estos conflictos desde la etapa de generación de evidencia hasta el diseño e implementación de las políticas, se propone este código. Se invita a la comunidad de nutrición y salud a adoptarlo, promoverlo y sumarse al mismo, para favorecer el avance de las acciones y políticas necesarias sin interferencia de la industria y resolver el problema de la mala nutrición.
Leadership Training Programs in Graduate Medical Education: A Systematic Review
Authors: Kumar Bharat , Swee Melissa , Suneja Manish
Published: May 2020

Background : With the increasing recognition that leadership skills can be acquired, there is a heightened focus on incorporating leadership training as a part of graduate medical education. However, there is considerable lack of agreement regarding how to facilitate acquisition of these skills to resident, chief resident, and fellow physicians. Methods : Articles were identified through a search of Ovid MEDLINE, EMBASE, CINAHL, ERIC, PsycNet, Cochrane Systemic Reviews, and Cochrane Central Register of Controlled Trials from 1948 to 2019. Additional sources were identified through contacting authors and scanning references. We included articles that described and evaluated leadership training programs in the United States and Canada. Methodological quality was assessed via the MERSQI (Medical Education Research Study Quality Instrument). Results : 15 studies, which collectively included 639 residents, chief residents, and fellows, met the eligibility criteria. The format, content, and duration of these programs varied considerably. The majority focused on conflict management, interpersonal skills, and stress management. Twelve were prospective case series and three were retrospective. Seven used pre- and post-test surveys, while seven used course evaluations. Only three had follow-up evaluations after six months to one year. MERSQI scores ranged from 6 to 9. Conclusions : Despite interest in incorporating structured leadership training into graduate medical education curricula, there is a lack of methodologically rigorous studies evaluating its effectiveness. High-quality well-designed studies, focusing particularly on the validity of content, internal structure, and relationship to other variables, are required in order to determine if these programs have a lasting effect on the acquisition of leadership skills.
Development of thermo-photo sensitive genic male sterile lines in wheat using doubled haploid breeding
Authors: Li Hongsheng , Li Shaoxiang , Abdelkhalik Sedhom , Shahzad Armaghan , Gu Jian , Yang Zhonghui , Ding Mingliang , Liu Kun , Zhao Hong , Yang Mujun
Published: May 2020

Background: Two-line hybrid wheat system using thermo-photo sensitive genic male sterility (TPSGMS) is currently the most promising approach for wheat heterosis utilization in China. However, during past twenty years only few TPSGMS lines were developed in hybrid wheat breeding, which has been the main limiting factor to create heterotic hybrids. Application of doubled haploid (DH) breeding provides a useful strategy to efficiently develop practically usable TPSGMS lines.Results: F1s and selected F2 and F3 sterile plants of eight crosses made from two commercial TPSGMS lines were used to produce DH lines. We developed a total of 24 elite DH sterile lines with stable sterility, good outcrossing and yield potential, resistance to yellow rust and powdery mildew, as well as desirable plant height (50-60 cm). These DH lines were developed within 4 years through at least one year of evaluation. The stability of male sterility was confirmed for most (20/24) of these elite DH sterile lines by multiple tests in two or three years. These lines are expected to be used in hybrid wheat breeding. The percentage of elite lines developed from the tested DH lines produced from filial generations was in the order of F2 > F3 > F1.Conclusions: We demonstrate that coupling DH techniques with conventional breeding is an efficient strategy for accelerating the development of more practical wheat TPSGMS lines. Generation of DHs from F2 generation appeared to be the better choice considering the balance of shortening breeding time and overall breeding efficiency.
Implementation and adoption of a health insurance support tool in the electronic health record: A mixed methods analysis within a randomized trial
Authors: Hatch Brigit , Tillotson Carrie , Huguet Nathalie , Marino Miguel , Baron Andrea , Nelson Joan , Sumic Aleksandra , Cohen Deborah , DeVoe Jennifer
Published: May 2020

Background: In addition to delivering vital health care to millions of patients in the United States, community health centers (CHCs) provide needed health insurance outreach and enrollment support to their communities. We developed a health insurance enrollment tracking tool integrated within the electronic health record (EHR) and conducted a hybrid implementation-effectiveness trial in a CHC-based research network to assess tool adoption using two implementation strategies. Methods: CHCs were recruited from the OCHIN practice-based research network. Seven health center systems (23 CHC clinic sites) were recruited and randomized to receive basic educational materials alone (Arm 1), or these materials plus facilitation (Arm 2) during the 18-month study period, September 2016-April 2018. Facilitation consisted of monthly contacts with clinic staff and utilized audit and feedback and guided improvement cycles. We measured total and monthly tool utilization from the EHR. We conducted structured interviews of CHC staff to assess factors associated with tool utilization. Qualitative data were analyzed using an immersion-crystallization approach with barriers and facilitators identified using the Consolidated Framework for Implementation Research. Results: The majority of CHCs in both study arms adopted the enrollment tool. The rate of tool utilization was, on average, higher in Arm 2 compared to Arm 1 (20.0% versus 4.7%, p <0.01). However, by the end of the study period, the rate of tool utilization was similar in both arms; and observed between-arm differences in tool utilization were largely driven by a single, large health center in Arm 2. Perceived relative advantage of the tool was the key factor identified by clinic staff as driving tool utilization. Implementation climate and leadership engagement were also associated with tool utilization. Conclusions: Using basic education materials and low-intensity facilitation, CHCs quickly adopted an EHR-based tool to support critical outreach and enrollment activities aimed at improving access to health insurance in their communities. Though facilitation carried some benefit, a CHC’s perceived relative advantage of the tool was the primary driver of decisions to implement the tool. Trial Registration: ClinicalTrials.gov: NCT02355262, Posted February 4, 2015
Quality Use Of Medicines In Patients With Chronic Kidney Disease
Authors: Castelino Ronald L , Saunder Timothy , Kitsos Alex , Peterson Greg , Jose Matthew , Wimmer Barbara , Khanam Masuma , Bezabhe Woldesellassie , Stankovich Jim , Radford Jan
Published: May 2020

Background: Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriate adjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of this study was to determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures.Methods Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). All adults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis. Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recorded values <60 mL/min/1.73m2, and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmol in males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the Cockcroft-Gault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook. Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n=9,926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.
Evaluation of the Effect of Items’ Format and Type on Psychometric Properties of Sixth Year Pharmacy Students Clinical Clerkship Assessment Items
Authors: AlKhatib Hatim S. , Brazeau Gayle , Akour Amal , Almuhaissen Suha
Published: May 2020

Background Examinations are the traditional assessment tools. In addition to measurement of learning, exams are used to guide the improvement of academic programs. The current study attempted to evaluate the quality of assessment items of sixth year clinical clerkships examinations as a function of assessment items format and type/structure and to assess the effect of the number of response choices on the characteristics of MCQs as assessment items. Methods A total of 173 assessment items used in the examinations of sixth year clinical clerkships of a PharmD program were included. Items were classified as case based or noncase based and as MCQs or open-ended. The psychometric characteristics of the items were studied as a function of the Bloom’s levels addressed, item format, and number of choices in MCQs. Results Items addressing analysis skills were more difficult. No differences were found between case based and noncase based items in terms of their difficulty, with a slightly better discrimination in the latter . Open-ended items were easier, yet more discriminative. MCQs with higher number of options were easier. Open-ended questions were significantly more discriminative in comparison to MCQs as case based items while they were more discriminative as noncase based items. Conclusion Item formats, structure, and number of options in MCQs significantly affected the psychometric properties of the studied items. Noncase based items and open-ended items were easier and more discriminative than case based items and MCQs, respectively. Examination items should be prepared considering the above characteristics to improve their psychometric properties and maximize their usefulness.
Exploring the directionality in the relationship between descriptive and injunctive parental and peer norms and snacking behavior in a three-year-cross-lagged study
Authors: Bevelander Kirsten , Burk William , Smit Crystal , Woudenberg Thabo van , Buijs Laura , Buijzen Moniek
Published: May 2020

Background. People’s eating behavior is assumed to be influenced by what other people do (perceived descriptive norms) and what others approve of (perceived injunctive norms). It has been suggested that adolescents are more susceptible to peer norms than parental norms, because they experience a strong need for group acceptance that leads to conforming to peer group norms. The current study examined changes in snacking behavior and four types of social norms (i.e., parental and peer descriptive and injunctive norms) that promoted fruit and vegetable intake among adolescents. This study was the first to examine whether snacking behavior also influenced norm perceptions by testing the directionality of these associations.Methods. The study consisted of 819 participants (M [SD] age = 11.19 [1.36]; 46.1% boys), collected at three time points (T1 = 2016, T2 = 2017 and T3 = 2018) during the MyMovez project. Self-reported frequency of snack consumption, perceived parental and peer descriptive and injunctive norms were assessed. The primary analysis consisted of a series of cross-lagged autoregressive models specified in a structural equation modeling framework. Results. Model comparisons testing the descriptive and injunctive norms in separate models and in an additional combined model revealed evidence for bi-directional associations between norms and snacking behavior. Descriptive peer and parent norms were not found to have an effect on subsequent snacking behaviors. Perceived injunctive parental norms were positively associated with healthy snack food intake and negatively associated with unhealthy snack intake (forward direction). Injunctive peer norms were negatively associated with healthy snack food intake. In addition, higher unhealthy snack food intake was negatively associated with the perception of descriptive and injunctive parental norms one year later (reversed direction). We did not find peer norms to be more closely associated with changes in snacking behaviors compared to parental norms. Conclusions. Parents expecting their children to snack healthy had a positive influence on healthy snacking behavior whereas only acting as a healthy role model did not. Future research should address the possible interaction between descriptive and injunctive norms. Research should also take into account the bi-directional relations between eating behaviors and normative perceptions.
Laboratory colonization by Dirofilaria immitis alters the microbiome of female Aedes aegypti mosquitoes
Authors: Adegoke Abdulsalam , Neff Erik , Geary Amie , Husser Montana Ciara , Wilson Kevin , Norris Shawn Michael , Dharmarajan Guha , Karim Shahid
Published: May 2020

Background: The ability of blood feeding arthropods to successfully acquire and transmit pathogens of medical and veterinary importance has been shown to be interfered or enhanced by the arthropod’s native microbiome. Mosquitoes transmit bacteria, viruses, protozoan and filarial nematodes, majority of which contributes to the 17% of infectious disease cases worldwide. Dirofilaria immitis, a mosquito transmitted filarial nematodes of dogs and cats, is vectored by several mosquito species including Aedes aegypti.Methods: In this study, we investigated the impact of D. immitis colonization on the microbiome of laboratory reared female A. aegypti. Metagenomic analysis of the V3-V4 variable region of the microbial 16SRNA was used for identification of the microbial differences down to species level.Results: We generated a total of 1068 OTUs representing 16 phyla, 181 genera and 271 bacterial species. Overall, in order of abundance, Proteobacteria, Bacteroidetes, Actinobacteria and Firmicutes were the most represented phylum with D. immitis infected mosquitoes having more of Proteobacteria (71%) than uninfected mosquitoes (56.9%). An interesting finding in this study is the detection of Klebsiella oxytoca in relatively similar abundance in infected and uninfected mosquitoes. It has been previously shown to indirectly compete for nutrients with fungi on the domestic housefly eggs and larva. While not statistically significant, D. immitis infection alters bacterial diversity by reducing the bacterial species richness and abundance.Conclusions: In conclusion, this is the first study to the best of our knowledge to understand the impact of a filarial infection on the microbiome of its mosquito vector. While the microbiome composition of A. aegypti mosquito have been previously reported, our study shows that in an effort to establish itself, a filarial nematode modifies and alters the overall microbial diversity within its mosquito host.
Zebrafish retinal mRNA RNA-seq data processing
Authors: Owen Nicholas , Moosajee Mariya
Published: May 2020

This protocol details the step-by-step procedures followed to process zebrafish retinal mRNA sequencing data generated by the SMARTSeq2 library preparation protocols in the manuscript Richardson et al 2019 1.
DICOM segmentation and STL creation for 3D Printing: A Process and Software Package Comparison for Osseous Anatomy
Authors: KAMIO Takashi , SUZUKI Madoka , ASAUMI Rieko , KAWAI Taisuke
Published: May 2020

Background: Extracting and three-dimensional (3D) printing an organ in a region of interest in DICOM images typically calls for segmentation as a first step in support of 3D printing. The DICOM images are not exported to STL data immediately, but segmentation masks are exported to STL models. After primary and secondary processing, including noise removal and hole correction, the STL data can be 3D printed. The quality of the 3D model is directly related to the quality of the STL data. This study focuses and reports on the DICOM to STL segmentation performance for nine software packages.Methods: Multidetector row CT scanning was performed on a dry human mandible with two 10-mm-diameter bearing balls as a phantom. The DICOM image file was then segmented and exported to an STL file using nine different commercial/open-source software packages. Once the STL models were created, the data (file) properties and the size and volume of each file were measured, and differences across the software packages were noted. Additionally, to evaluate differences between the shapes of the STL models by software package, each pair of STL models was superimposed, with the observed differences between their shapes characterized as the shape error.Results: The data (file) size of the STL file and the number of triangles that constitute each STL model were different across all software packages, but no statistically significant differences were found across software packages. The created ball STL model expanded in the X-, Y-, and Z-axis directions, with the length in the Z-axis direction (body axis direction) being slightly longer than that in the other directions. The mean shape error between the software packages of the mandibular STL model was 0.11 mm, but there was no significant difference in the shape error across the software packages for the mandible STL model.Conclusions: Our results revealed that there are some differences between the software packages that perform the segmentation and STL creation of the DICOM image data. In particular, the features of each software package appeared in the fine and thin areas of the osseous structures. When using these software packages, it is necessary to understand the characteristics of each.
Antioxidant dressing therapy versus standard wound care in chronic wounds (REOX study): Study protocol for a randomized controlled trial
Authors: Comino-Sanz Inés María , López-Franco María Dolores , Castro Begoña , Pancorbo-Hidalgo Pedro Luis
Published: May 2020

Background: A wound that does not heal in the orderly stages of the healing process or does not heal within three months is considered a chronic wound. Wound healing is impaired when the wound remains in the inflammatory stage for too long. A range of factors can delay the healing process: imbalance between proteases and protease inhibitors in the wound bed; bacterial colonization and the presence of biofilm; and oxidative stress.Recently, wound management has improved significantly. A new antioxidant dressing has been developed, which combines an absorbent matrix obtained from Locust Bean Gum (LBG) galactomannan and a hydration solution with curcumin and N-acetylcysteine (NAC). This dressing combines the advantages of moist healing in exudate management and free radical neutralization, achieving wound reactivation.The primary aim of this study is to compare the effect of antioxidant dressing on chronic wound healing with the use of standard wound dressing in patients with hard-to-heal wounds.Methods: We will conduct a multicentre, single blinded, randomized, controlled trial with parallel groups. Participants will be selected from three primary public health-care centres, located in Andalucía (southern Spain). Patients will be randomized into an intervention group (antioxidant dressing) or control group (standard wound dressing). Assessment will be carried out in weeks 2, 4, 6 and 8. Follow-up will be of 8 weeks or complete healing, if it happens earlier.Discussion: The findings from this study should provide scientific evidence on the efficacy of the antioxidant dressing as an alternative for the treatment of chronic wounds. This study fills some of the gaps in the existing knowledge about patients with hard-to-heal wounds.Trial registration: ClinicalTrials.gov, NCT03934671. Registered on 2 May 2019.