bluuebunny/crossref_metadata_2025 huggingface dataset:
Spatial Distribution of Radiated Seismic Energy of Three Aftershocks Sequences at Guerrero, Mexico, Subduction Zone
Authors: Plata‐Martínez Raymundo , Pérez‐Campos Xyoli , Singh Shri Krishna
Published: November 2019

General characteristics of seismic energy release of thrust earthquakes in Mexico have been reviewed in the past; however, a detailed analysis can contribute to a better understanding of the mechanisms that control its distribution along the Guerrero, Mexico, subduction zone. To address it, we obtain the source spectra of the 2012 Mw 7.5 Ometepec‐Pinotepa Nacional, the 2014 Mw 7.2 Papanoa, and the 2018 Mw 7.2 Pinotepa Nacional earthquakes, as well as of their M≥4.0 aftershocks to estimate their seismic moment M0 and radiated seismic energy ES. The first and the last sequences occurred at the southern border of the Guerrero seismic gap, a region where no significant earthquake (M>7.0) has occurred at least in the last century; whereas the second sequence was located at the northern edge of the same seismic gap. The mean value of the log of radiated seismic energy scaled with the seismic moment, log(e˜)=log(ES/M0), for this set of earthquakes is −5.05±0.25. We classify the analyzed events into four regions, two in the southern edge of the gap and two in the northern one. At both ends, there is one region that shows regular values of log(e˜) (−4.64±0.25 and −4.62±0.25), whereas the other one shows low values of log(e˜) (−5.40±0.25 and −5.55±0.25) that could be related to a possible slow‐rupture behavior. These last regions are identified near the trench at southern Guerrero coast and immediately outside the northern end of the seismic gap. The distribution of log(e˜) is spatially heterogeneous along the trench, suggesting variations on the shear strength and coupling at the interface.
Well-being and College Success of Undergraduate Students
Authors: Kovich Melissa K. , Simpson Vicki L.
Published: November 2019

Background:  In order to build a culture of well-being among students in post-secondary academic communities, an assessment of current well-being and related factors is necessary. Common barriers to optimal well-being may include stress, anxiety, and depression in college students. Low levels of well-being have been associated with higher levels of impaired academic performance. Aim: Explore the relationship between academic success and time spent performing well-being activities. Methods:  Seligman’s Well-Being Theory was used to guide this study. The relationship between well-being and academic success of undergraduate students at a large Midwestern university (N = 5008) was evaluated using data from a 278 item 2018 Student Experience at a Research University (SERU) survey. Measures of academic success included late assignments, going to class unprepared, and skipping class. Measures of well-being included time spent in: physical exercise, spiritual practice, community service, and club participation; time with family and friends were also included. Results: Pearson Chi-Square analysis revealed a total of five significant relationships between well-being activities and late assignments, being unprepared for class, and skipping class at α=.05. Conclusions:  Further research is needed to understand the relationship between well-being and academic success to guide development of strategies to support well-being in university students.
Right breast cancer with contralateral left axillary sentinel lymph node detected through lymphoscintigraphy
Authors: Salem Yousif , Alkhaja Sara , Alshaibani Noof , El Gaid Salwa Abd
Published: November 2019

Altered contralateral axillary drainage is extremely rare after curative breast cancer treatment. We present a case of a 64 year-old women, with a past history of right breast invasive ductal carcinoma managed surgically by lumpectomy and right axillary lymph node dissection 20 years ago. She presented with recurrent right breast cancer and was scheduled to undergo right mastectomy along with sentinel lymph node biopsy. Technetium-99m nano colloid sentinel lymphoscintigraphy performed on the day of surgery showed sentinel lymph node on the contralateral left axilla. This case report aims to discuss the presentation of such uncommon contralateral sentinel axillary lymph nodes in patients with breast cancer and highlight the importance of considering the lymphatic obliteration after ipsilateral axillary lymph node clearance.
LINGUIST-TRANSLATOR’S PROFESSIONAL COMPETENCE: ITS ESSENCE AND CONTENT
Authors: Gorbunov Yu. I. , Gorbunova O. Yu.
Published: November 2019

The current article deals with the essence and content of the professional linguist-translators competence. The authors strongly consider that professional competence implies complex multi-dimensional category representing a range of separate key competences among which primarily is figured out a communicative competence including all its basic components. Communicative competence is viewed as an ability to use the language correctly in all the range of socially-determined situations. Communicative competence consists of several principal competences such as linguistic competence, discourse competence and sociocultural competence forming its core. Along with communicative competence within a structure of linguist-translators professional competence one can figure out a set of special competences depicting the specificity of a translators job. The key ones are presented by text-forming competence, technical competence and information-technological competence implying the practical usage of modern information technologies connected with a foreign texts automatic processing, automatic annotation, abstracting and a foreign texts translation.The article displays the model of future linguist-translators professional competence formation, which includes above all previously mentioned competences, the teaching materials along with practical course of technical translations curriculum, bilingual learning automotive thesaurus and special manual training French-Russian technical translation skills. The main goal of our pedagogical model, above introducing it into educational process, is to ensure the efficiency of future linguist-translators professional competence.
Применение Smart-технологий: оценка влияния на развитие человеческого капитала
Authors: Городнова Наталья Васильевна , Скипин Дмитрий Леонидович , Роженцов Иван Сергеевич
Published: November 2019

Проблема адаптации трудовых ресурсов к условиям быстро меняющего внешнего мира становится еще более актуальной в оцифрованной среде. В настоящее время магистральное направление нашего государства – развитие цифровой экономики. Российская экономика существенно отстает от развитых экономик мира, в которых формирование и обработка гигантских массивов информации с помощью it- и Smart-технологий становится повседневной реальностью. Реализация концепции построения Smart-пространства за рубежом нацелена на повышение комфортности среды обитания общества, качества их жизни, сформирование «умного» человеческого капитала, рост эффективности использования трудовых и иных ресурсов, что, в конечном счете, благоприятно влияет н все сферы социально-экономической жизни общества.
Цель данного научного исследования – на основании прогнозирования основных трендов и тенденций, связанных с развитием цифровой экономики, оценить влияние внедрения «умных» технологий на процесс развития человеческого капитала, а также осмыслить роль человека в оцифрованном мире.
В ходе исследования проанализированы факторы развития человеческого капитала на рынке труда, исследованы перспективы глобальной трансформации отраслей экономики, рассмотрены модели систем управления стратегий Smart City, выявлены возможности применения цифровых технологий в Свердловской области, в частности, разработано модельное представление концепции Smart-region, а также разработана динамическая модель, позволяющая учесть влияние применение Smart-продуктов на развитие человеческого капитала государственных технологических корпораций.
Сделан вывод о том, что применение Smart-систем открывает новые возможности для прорывного развития территорий, которые должны применяться в целях развития всех секторов инфраструктуры. Однако следует отметить и возможные негативные последствия на состояние рынка труда и человеческого капитала. Применение цифровых технологий призвано повысить качество жизни граждан России путем создания высокоэффективных рабочих мест и повышения социальной мобильности, поддержки социально значимой трудовой занятости, обеспечения доступности объектов социальной, инженерной и транспортной инфраструктур.
Результаты могут быть полезными для властных структур и научного сообщества, для которых применение информационных и Smart-технологий представляет профессиональный интерес.
Моделирование процесса цифровой трансформации фирмы
Authors: Гарифуллин Булат Маратович , Зябриков Владимир Васильевич
Published: November 2019

В статье рассматривается периодизация эволюции бизнес-моделей фирмы, которая проходила параллельно во времени с эволюцией представлений о внутренней среде фирмы, показаны перспективы их совместного использования. Показано, что широко распространенная в бизнесе схема – канва бизнес-модели Остервальдера-Пинье адекватно описывает последовательность этапов цифровой трансформации фирмы. Авторы подчеркивают важность описания не только факторов и процессов внутренней среды фирмы, но и необходимость их гармоничного сопряжения с внешней средой фирмы, которая и является источником цифровых новаций, в разрезе PEST-координат.
Алгоритм создания малых инновационных производственных предприятий в условиях ускоренного технологического развития
Authors: Ханина Анна Владимировна , Бабикова Анна Валерьевна , Вартанян Анастасия Александровна , Литвинова Инна Евгеньевна , Германова Вероника Геннадьевна
Published: November 2019

Проблема современного экономического развития напрямую связанна с проведением технологической модернизации инновационного сектора экономики, созданием и развитием инновационных предприятий. Авторами была предложена гипотеза о том, что указанная проблема не может быть решена в полной мере на базе крупных предприятий и промышленных комплексов. В силу специфических особенностей малых инновационных предприятий (МИП), заключающихся в их адаптивных возможностях и гибкости, они вносят значительный вклад в инновационное развитие национальной экономики. Целью данной статьи было предложение алгоритма создания малых инновационных предприятий, позволяющего усовершенствовать процессы их формирования и развития. С целью прогнозирования изменений социально-экономического развития на краткосрочный, среднесрочный и долгосрочный периоды после увеличения количества малых инновационных предприятий также была разработана дорожная карта. При помощи данного инструмента, возможно, предложить более эффективную стратегию технологического развития экономики на основе использования потенциала малых инновационных предприятий. Научная новизна данной работы заключается в доказательстве необходимости проведения технологической модернизации экономики страны посредством не только крупных промышленных гигантов, но и малого бизнеса, а также в разработке алгоритма создания малых инновационных предприятий.
Обзор международных организаций как механизма достижения целей устойчивого развития ООН
Authors: Поляков Федор Андреевич , Бойцов Константин Константинович
Published: November 2019

Исторически сложилось, что за последние полтора века экономика в развитых странах развивалась быстрыми темпами в сравнении с веками предшествующие ранее. Этот прогресс сопровождался неконтролируемым потреблением не возобновляемых природных ресурсов, что стало грозить миру экологическими катастрофами в недалеком будущем. Теперь же научная общественность озабочена вопросами исправления сложившейся ситуации. Для решения данной проблемы ООН разработала программу «Цели развития тысячелетия» (ЦРТ). Одним из инструментов реализации целей поставленных в данной программе является работа различных международных организаций. В их задачи входит разработка, реализация и внедрение в практику различных программ и мероприятий, направленных на достижение целей.
Определение сценарных моделей ресурсного обеспечения предприятий
Authors: Суходоева Людмила Федоровна , Роганова Светлана Юрьевна , Суходоев Дмитрий Викторович
Published: November 2019

В статье рассматриваются вопросы использования ресурсного потенциала региона и развитие ресурсной базы предприятий. Дан порядок организации распределения ресурсов, определена неоднородность развития предприятий, рассмотрен процесс ресурсозамещения. Подробно рассмотрена модель координации распределения ресурсов. Значительное внимание уделено механизму ресурсного обеспечения инновационных технологий. Предложен цифровой механизм управления источниками ресурсов.
El Rol Estratégico De Los Gobiernos Locales y Regionales En La Implementación De La Agenda 2030: Experiencias Desde La Cooperación Sur-Sur y Triangular
Authors: Ojeda Medina Tahina
Published: November 2019

Los gobiernos locales y regionales tienen un rol estratégico en la implementación de la Agenda 2030. Estos actores, a través de la cooperación Sur-Sur descentralizada y la cooperación trian­gular, cobran especial relevancia, tanto en la planificación multinivel como en la ejecución de políticas públicas destinadas a la imple­mentación de los Objetivos de Desarrollo Sostenible en sus territorios. Con la revisión de distintas experiencias en América Latina se ponen de relieve sus aportaciones al desarrollo sostenible y a las alianzas multiactor en el con­texto de la Agenda 2030. Se presentan estudios de caso sobre cooperación Sur-Sur descentra­lizada y cooperación triangular relacionados con la localización de los ODS.
¿De Qué Otra Forma Analizar Al Proyecto Mesoamérica? Reflexiones Desde La Economía Política Internacional Británica
Authors: Ruiz Valdes Michelle , Vázquez Meneley Sergio
Published: November 2019

El término Mesoamérica emergió en las rela­ciones regionales gracias a diferentes estrategias de cooperación entre México, Centroamérica, Colombia y República Dominicana que han derivado en lo que hoy se conoce como el Pro­yecto de Integración y Desarrollo de Mesoamé­rica. Sin embargo, a diez años de su creación, la mayor parte de los estudios al respecto son des­criptivos y emplean un enfoque institucional que no resalta otros aspectos relevantes, como la inclusión de actores no gubernamentales y su participación en este programa de desarrollo regional. Con el propósito de hacer un primer acercamiento a estos aspectos dentro del Pro­yecto Mesoamérica, en este trabajo se busca explorar el marco teórico de economía política internacional (EPI) de procedencia británica, con los fines de identificar aquellos elementos que permiten ir más allá de los análisis tradi­cionales y profundizar, a partir de ellos, en el conocimiento del mencionado programa.
Ecosistemas Multiactor en la Cooperación Sur-Sur: Un Prerrequisito para Lograr la Apropiación Nacional
Authors: Huitrón Morales Analilia
Published: November 2019

El objetivo de este artículo es estudiar el grado en el que se vinculan los actores no estatales a la gobernanza y práctica de la cooperación Sur-Sur como un prerrequisito en el cumpli­miento de la apropiación nacional. Para ello se realiza un análisis empírico de las experiencias de México, Chile y Colombia, y su oferta de CSS técnica. En primer lugar, se analizan los marcos normativos y de gestión sobre los que descansan la CSS de los tres países, identifican­do en qué medida estimulan la integración de diversos actores y cómo se materializa; y, en segundo lugar, se contrasta el grado de parti­cipación de actores estatales y no estales en las iniciativas de cooperación a partir del análisis de 41 proyectos de CSS técnica de los tres países.
El Brexit y El Futuro De Europa
Authors: Rodríguez Suárez Pedro Manuel
Published: November 2019

Este artículo analiza las relaciones entre el Reino Unido y la Unión Europea (UE), desde la ardua incorporación británica en la enton­ces Comunidad Europea hasta el fenómeno del Brexit. En este orden de ideas, este ensayo posee tres objetivos cardinales. El primero, evalúa las variables que han estado presentes a través de la historia en relación con el histórico distanciamiento británico vis-á-vis el proceso de integración del viejo continente. El segun­do, analiza desde una perspectiva histórica las administraciones de los ex primeros ministros británicos y sus intereses en relación con la membresía del Reino Unido en la UE. El tercer y último objetivo, crea un escenario hipotético inherente a las consecuencias que eventual­mente podrían presentarse para el Reino Uni­do y la UE en relación con el eventual fin de la membresía británica de la UE.
Caffeine Therapy in Preterm Infants: The Dose (and Timing) Make the Medicine
Authors: Rostas Sara E. , McPherson Christopher
Published: November 2019

Caffeine is one of the most commonly utilized medications in the NICU. In preterm infants, short-term and long-term pulmonary and neurodevelopmental benefits of therapy are well documented in the literature. While robust evidence supports the use of standard doses of caffeine for apnea of prematurity or to facilitate successful extubation, much remains unknown regarding the boundaries of efficacy and safety for this common therapeutic agent. Escalating dosing regimens seem to provide additional benefit in select infants, but grave toxicity has also been documented with early utilization of high-dose caffeine. Conflicting data exist surrounding the ideal timing of initiation of therapy. Even the widely adhered to discontinuation point has been challenged by data supporting continued use. Until robust data definitively support change, practice should align with current evidence defining clear, safe, and efficacious dosing and timing of caffeine therapy.
MEDIAÇÃO E O ESTADO DEMOCRÁTICO: COMO SE RELACIONAM
Authors: Coutinho Priscila Portella , Queiroz Yury Augusto dos Santos
Published: November 2019

O presente artigo traz algumas considerações sobre a importância do instituto da mediação, enquanto método adequado de resolução de conﬂitos, para o exercício de cidadania e democracia, no contexto do atual Estado Democrático de Direito brasileiro. Para tanto, parte-se inicialmente de uma contextualização histórica e política, além de serem abordadas algumas das transformações sociais enfrentadas pela sociedade, no que tange à Democracia, até chegar-se modelo contemporâneo adotado pelo Brasil, fundado nas premissas do Estado Democrático de Direito, conforme previsto no artigo 1º da Constituição Federal de 1988. Em seguida, são feitas considerações acerca do instituto da mediação, seu procedimento, legislação aplicável, para finalmente, de modo não exaustivo, expor de que forma a mediação como método adequado de resolução de conﬂitos, pode contribuir para o desenvolvimento da comunidade, como forma de efetivar uma prestação jurisdicional adequada, baseada nos princípios democráticos e à luz dos direitos e garantias fundamentais. O objetivo do trabalho, portanto, é trazer a correlação da mediação a partir do desenvolvimento e da prática da democracia, na busca da melhor solução para as partes envolvidas. Com relação à metodologia utilizada, empregou-se o método indutivo na fase de investigação, o método cartesiano na fase de tratamento de dados e no relatório da pesquisa foi empregada a base indutiva.
A REPERCUSSÃO GERAL, AS HIPÓTESES OBJETIVAS E A ARGUMENTAÇÃO DO RECORRENTE
Authors: Lemos Vinicius
Published: November 2019

Este artigo tem o propósito de analisar o instituto da repercussão geral no CPC/2015 e as hipóteses objetivas de incidência desta, com a interface quanto à argumentação do recorrente no próprio recurso extraordinário, analisando a necessidade formal da preliminar e o aspecto presuntivo dessas hipóteses.
Tendencias temporales de los patrones de búsqueda de información sobre VIH/sida en España = Temporal trends in the search of information about HIV/AIDS in Spain
Authors: Sanz-Lorente María , Sanz-Valero Javier , Wanden-Berghe Carmina
Published: November 2019

Resumen: Introducción: El uso de datos de la Web sobre salud ha demostrado ser útil para evaluar diversos aspectos del comportamiento humano. Objetivo: analizar la tendencia de las búsquedas de información sobre VIH/sida que se realizan, en España, a través de Google. Metodología: Estudio descriptivo. Los datos se obtuvieron mediante acceso online a Google Trends, utilizándose los términos “VIH” y “sida”. Variables estudiadas: consultas relacionadas; hitos; volumen de búsqueda relativo (VBR) y evolución temporal. Fecha de consulta 25 noviembre 2018. Resultados: Se observaron 3 hitos sobre “sida”. El cociente medio entre los dos términos, 1,78 ± 0,13, presentó diferencias significativas (t = 5,29; p < 0,001). El VBR demostró diferencias entre los términos en la 1ª época y la evolución temporal para “sida” fue claramente decreciente (R2 = 0,89; p < 0.001); para “VIH” fue ligeramente creciente (R2 = 0,02; p = 0,087). La relación del VBR entre los términos para el periodo estudiado mostró una relación escasa (R = 0,21; p = 0,005). Conclusiones: La evolución temporal obtenida probablemente se deba a un cambio de preocupación social, del sida al VIH, o a un mayor conocimiento de la enfermedad, que refleja la evolución histórica del VIH y el sida: la infección por el VIH como enfermedad crónica.Palabras clave: Síndrome de Inmunodeficiencia Adquirida; VIH; sida; Acceso a la Información; Google Trends.Abstract: Introduction: The use of health data from the Web has proven useful for evaluating various aspects of human behavior. Objective: to analyze the trend of searches for information on HIV/AIDS carried out in Spain, through Google. Methodology: Descriptive study. The data were obtained through online access to Google Trends, using the terms «HIV» and «AIDS». The variables were: related consultations; milestones; relative search volume (RSV) and temporal evolution. Consultation date 25 November 2018. Results: Users used search terms related to the main terms. There were three milestones in the results of search on «AIDS». The ratio between the two terms, 1.78 ± 0.13, presented significant differences (t = 5.29; p < 0.001). The RSV showed differences between the terms in the first time to study and the time course for ‘AIDS’ was clearly decreasing (R2 = 0.89, p < 0.001), while for ‘HIV’ was slightly increased (R2 = 0.02; p = 0,087). The relation of the RSV, between the two terms, for the entire period studied showed a low relation (R = 0.21, p = 0.005). Conclusions: the temporal evolution obtained is probably due to a change of social concern, from AIDS to HIV, or perhaps to a better understanding of the disease, which reflects the historical evolution of HIV and AIDS: the HIV infection as a chronic disease.Keywords: Acquired Immunodeficiency Syndrome; HIV; AIDS; Access to Information; Google Trends.
Nadir Afonso - o mínimo e o maior
Authors: Lambert Maria de Fátima
Published: November 2019

A obra de Nadir Afonso aborda-se com responsabilidade estética, antropológica e historiográfica. Há que ponderar a sua globalidade, a sua polissemia, destacando e identificando os elementos mínimos para atingir o maior. A responsabilidade sociocultural aglutina, portanto, seguindo o raciocínio, as demais, tornando-as partes imprescindíveis de um corpus teórico e poiético.
Solving optimization problems using multi-agent models
Authors: Melnichuk Alexander Vladimirovich , Sivakova Tatiana Vladimirovna , Sudakov Vladimir Anatolievich
Published: November 2019

In the study multi-agent modeling approaches researched for solving optimization problems with constraints. The problem of building a network of interacting agents is considered. Each of the agents manages a certain set of variables and interacts with agents that have common constraints with it. Agents function as independent parallel processes and exchange messages in order to find the optimal value of the objective function. This approach has been successfully applied to the task of scheduling.
Assessment of anti-terrorism security of objects based on the calculation of integrated indicators
Authors: Baluta Victor Ivanovich , Karandeev Alexander Andreevich , Sivakova Tatiana Vladimirovna
Published: November 2019

In this paper, we propose an approach that allows us to obtain a preliminary assessment of the effectiveness of the protection system based on the use of a small number of input parameters by calculating the zoning of the object. The proposed calculation method can also be used to optimize the placement of system elements, taking into account the existing limitations.
Conventional Versus Highly Cross-Linked Polyethylene in Primary Total Knee Replacement
Authors: Partridge Thomas C.J. , Baker Paul N. , Jameson Simon S. , Mason James , Reed Mike R. , Deehan David J.
Published: November 2019

Background:

There is evidence to support the use of highly cross-linked polyethylene (HXLPE) in patients undergoing total hip arthroplasty. However, the benefits for those undergoing total knee arthroplasty are uncertain, with conflicting reports based on previous cohort analyses. The purpose of the present study was to compare the revision rates following primary total knee arthroplasty with use of HXLPE as compared with conventional polyethylene (CPE) using data from the National Joint Registry (NJR) for England, Wales and Northern Ireland.

Methods:

We performed a retrospective analysis of primary total knee arthroplasties recorded in the NJR from 2003 to 2014. Cobalt-chromium (CoCr)-CPE and CoCr-HXLPE bearing surfaces were compared using all-cause revision, aseptic revision, and septic revision as end points. Survival analyses were conducted using rates per 100 years observed, Kaplan-Meier survival estimates, and Cox regression hazard ratios (HRs) adjusted for age, sex, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), lead surgeon grade, and implant constraint. Secondary analyses compared the most commonly used HXLPEs (Zimmer Prolong, DePuy XLK, and Stryker X3) against CPE for the 3 most common total knee arthroplasty systems (NexGen, PFC Sigma, and Triathlon).

Results:

In the present study of 550,658 total knee arthroplasties, the unadjusted aseptic revision rates were significantly lower following procedures performed with CPE (n = 513,744) as compared with those performed with HXLPE total knee replacements (n = 36,914) (0.29 [95% confidence interval (CI), 0.28 to 0.30] compared to 0.38 [95% CI, 0.35 to 0.42], p < 0.01). The 10-year HR associated with CPE was 0.4 (95% CI, 0.1 to 0.8, p = 0.03). There were no significant differences between the adjusted revision rates of HXPLE compared with CPE in individual analyses of the most common total knee arthroplasty systems. However, for the subset of patients who were both <60 years of age and had a BMI of >35 kg/m2, the “second-generation” Stryker X3 HXLPE demonstrated significantly better survival than its respective CPE, with CPE having an HR of 2.6 (95% CI, 1.2 to 5.9) (p = 0.02).

Conclusions:

Alternative bearings are marketed as having improved wear properties over traditional CoCr-CPE. This registry-based analysis demonstrated no overall survival benefit of HXLPE after a maximum duration of follow-up of 12 years. Because of their increased cost, the routine use of HXLPE bearings may not be justified. However, they may have a role in specific “higher demand” groups such as patients <60 years of age and/or those with a BMI of >35 kg/m2.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete list of levels of evidence.
Variation in the Cost of Care for Different Types of Joint Arthroplasty
Authors: Carducci Michael P. , Gasbarro Gregory , Menendez Mariano E. , Mahendraraj Kuhan A. , Mattingly David A. , Talmo Carl , Jawa Andrew
Published: November 2019

Background:

Lower-extremity arthroplasty constitutes the largest burden on health-care spending of any Medicare diagnosis group. Demand for upper extremity arthroplasty also continues to rise. It is necessary to better understand costs as health care shifts toward a bundled-payment accounting approach. We aimed (1) to identify whether variation exists in total cost for different types of joint arthroplasty, and, if so, (2) to determine which cost parameters drive this variation.

Methods:

The cost of the episode of inpatient care for 22,215 total joint arthroplasties was calculated by implementing time-driven activity-based costing (TDABC) at a single orthopaedic specialty hospital from 2015 to 2018. Implant price, supply costs, personnel costs, and length of stay for total knee, total hip, anatomic total shoulder, reverse total shoulder, total elbow, and total ankle arthroplasty were analyzed. Individual cost parameters were compared with total cost and volume.

Results:

Higher implant cost appeared to correlate with higher total costs and represented 53.8% of the total cost for an inpatient care cycle. Total knee arthroplasty was the least-expensive and highest-volume procedure, whereas total elbow arthroplasty had the lowest volume and highest cost (1.65 times more than that of total knee arthroplasty). Length of stay was correlated with increased personnel cost but did not have a significant effect on total cost.

Conclusions:

Total inpatient cost at our orthopaedic specialty hospital varied by up to a factor of 1.65 between different fields of arthroplasty. The highest-volume procedures—total knee and hip arthroplasty—were the least expensive, driven predominantly by lower implant purchase prices.

Clinical Relevance:

We are not aware of any previous studies that have accurately compared cost structures across upper and lower-extremity arthroplasty with a uniform methodology. The present study, because of its uniform accounting process, provides reliable data that will allow clinicians to better understand cost relationships between different procedures.
Variation in both host defense and prior herbivory can alter plant-vector-virus interactions
Authors: Shi Xiaobin , Preisser Evan L. , Liu Baiming , Pan Huipeng , Xiang Min , Xie Wen , Wang Shaoli , Wu Qingjun , Li Chuanyou , Liu Yong , Zhou Xuguo , Zhang Youjun
Published: November 2019

Background: While virus-vector-host interactions have been a major focus of both basic and applied ecological research, little is known about how different levels of plant defense interact with prior herbivory to affect these relationships. We used genetically-modified strains of tomato ( Solanum lycopersicum ) varying in the jasmonic acid (JA) plant defense pathways to explore how plant defense and prior herbivory affects a plant virus (tomato yellow leaf curl virus , 'TYLCV'), its vector (the whitefly Bemisia tabaci MED), and the host.
Results: Virus-free MED preferred low-JA over high-JA plants and had lower fitness on high-JA plants. Viruliferous MED preferred low-JA plants but their survival was unaffected by JA levels. While virus-free MED did not lower plant JA levels, viruliferous MED decreased both JA levels and the expression of JA-related genes. Infestation by viruliferous MED reduced plant JA levels . In preference tests, neither virus-free nor viruliferous MED discriminated among JA-varying plants previously exposed to virus-free MED. However, both virus-free and viruliferous MED preferred low-JA plant genotypes when choosing between plants that had both been previously exposed to viruliferous MED. The enhanced preference for low-JA genotypes appears linked to the volatile compound neophytadiene, which was found only in whitefly-infested plants and at concentrations inversely related to plant JA levels.
Conclusions: Our findings illustrate how plant defense can interact with prior herbivory to affect both a plant virus and its whitefly vector, and confirm the induction of neophytadiene by MED. The apparent attraction of MED to neophytadiene may prove useful in pest detection and management.
Competitive Endogenous RNA (ceRNA) Regulation Network of lncRNA-miRNA-mRNA in Wilms tumor
Authors: tang fucai , Lu zechao , wang jiamin , Li zhibiao , Wu weijia , Duan Haifeng , He zhaohui
Published: November 2019

Background: Competitive endogenous RNA (ceRNA) have revealed a new mechanism of interaction between RNAs. However, such comprehension of the ceRNA regulatory network in Wilms tumor remains limited.Methods: The expression profiles regarding mRNAs, miRNAs and lncRNAs on Wilms tumor samples and normal samples were obtained from Therapeutically Applicable Research to Generate Effective Treatment (TARGET) database. EdgeR package was applied to identify differentially expressed lncRNAs, miRNAs and mRNAs. Functional enrichment analyses via the ClusterProfile R package was done. following which the lncRNA–miRNA–mRNA interaction ceRNA network was established in Cytoscape . Subsequently, correlation between ceRNA network and overall survival prognosis were analyzed. Results: A total of 2,037 lncRNAs, 154 miRNAs and 3,609 mRNAs were identified as differentially expressed RNAs in Wilms tumor. 205 lncRNAs, 26 miRNAs and 143 mRNAs were included in ceRNA regulatory network. The result of Gene Ontology analysis revealed that DEGs were enriched mainly in response to mechanical stimulus, transcription factor complex, and transcription factor activity (RNA polymerase II proximal promoter sequence-specific DNA binding). The result of the Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that DEGs were enriched mainly in cell cycle. Survival analysis results showed that 14 out of the 205 lncRNAs, 1 out of 26 miRNAs and 8 out of 143 mRNAs were associated with overall survival in Wilms tumor patients (P < 0.05). Conclusions: CeRNA networks played an important role in Wilms tumor. This might provide effective novel insights for further understanding of the mechanisms underlying Wilms tumor.
Youth StepCare: A pilot study of an online screening and recommendations service for depression and anxiety among youth patients in general practice.
Authors: Parker Belinda , Achilles Melinda Rose , Subotic-Kerry Mirjana , O'Dea Bridianne
Published: November 2019

Background: General Practitioners (GPs) are ideally placed to identify and manage emerging mental illness in young people, however, many report low levels of confidence in doing so. A web-based universal screening service delivered via a mobile tablet, Youth StepCare, was developed to assist GPs in identifying depression and anxiety symptoms in youth patients. This service also provided evidence-based treatment recommendations and fortnightly monitoring of symptoms. The current study assessed the feasibility and acceptability of delivering the Youth StepCare service in Australian general practices. Methods: A 12-week uncontrolled trial was undertaken between August 2018 and January 2019 in two general practices in NSW, Australia. The service was offered to all youth patients aged 14-17 years who visited a participating GP during the screening period with their parent or guardian. Youth patients reported the presence of depressive and anxiety symptoms using the self-report Patient Health Questionnaire-9 and the Generalised Anxiety Disorder Questionnaire-7. New cases were defined as those who reported symptoms but were not currently seeking help from their GP, nor had sought help in the past. Feasibility and acceptability among GPs and practice staff were assessed using a battery of questionnaires. Results: Five GPs and 6 practice staff took part. A total of 46 youth patients were approached, 28 consented, and 19 completed the screener (67.9%). Nine reported symptoms of anxiety or depression, two of which were new cases (22.2%). GPs and practice staff were satisfied with the service, reporting that there was a need for the service, and that they would use it again. Conclusions: The Youth StepCare service appears to be a useful tool for identifying youth with unidentified symptoms of mental illness that can be easily embedded into general practice. Further research would benefit from exploring the factors affecting initial GP uptake and a larger trial is required to determine the efficacy of the service on young people’s symptom reduction.
The Visitor and Migrant Cost Recovery Programme – A threat to health?
Authors: Potter Jessica Louise , Burman Matthew , Tweed Conor D , Vaghela D , Kunst H , Swinglehurst D , Griffiths CJ
Published: November 2019

Background
In April 2014 the UK government launched the ‘NHS Visitor and Migrant Cost Recovery Programme Implementation Plan’ which set out a series of policy changes to recoup costs from ‘chargeable’ (largely non-UK born) patients. In England, approximately 75% of tuberculosis (TB) cases occur in people born abroad. Delays in TB treatment increase risk of morbidity, mortality and transmission in the community. We investigated whether diagnostic delay has increased since the Cost Recovery Programme (CRP) was introduced.

Methods
There were 3,342 adult TB cases notified on the London TB Register across Barts Health NHS Trust between 1st January 2011 and 31st December 2016. Cases with missing relevant information were excluded. The median time between symptom onset and treatment initiation before and after the CRP was calculated according to birthplace and compared using the Mann Whitney test. Delayed diagnosis was considered greater or equal to median time to treatment for all patients (79 days). Univariable logistic regression was used to manually select exposure variables (p value <0.10) for inclusion in a multivariable model to test the association between diagnostic delay and the implementation of the CRP.

Results
We included 2,237 TB cases. Among non-UK born patients, median time-to-treatment increased from 69 days to 89 days following introduction of CRP (p<0.001). Median time-to-treatment also increased for the UK-born population from 75.5 days to 89.5 days (p=0.307). The multivariable logistic regression model showed non-UK born patients were more likely to have a delay in diagnosis after the CRP (adjOR 1.37, 95% CI 1.13-1.66, p value 0.001)

Conclusion
Since the introduction of the CRP there has been a significant delay for TB treatment among non-UK born patients. Further research exploring the effect of policies restricting access to healthcare for migrants is urgently needed if we wish to eliminate TB nationally.
Implementation Study of a 5-component Pediatric Early Warning System (PEWS) in an Emergency Department in British Columbia, Canada, to inform provincial scale up
Authors: McElroy Theresa A , Swartz Erik N. , Hassani Kasra , Waibel Sina , Tuff Yasmin , Marshall Catherine , Chan Richard , Wensley David , O'Donnell Maureen
Published: November 2019

Background: The rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, and to guide provincial scale up. Methods: We used a before-and-after design to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid, and communication framework). Sources of data included patient charts, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches. Results: The majority of charts had documented PEWS scores at triage (80%) and first bedside assessment (81.2%), indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (>100% increase), in improving staff’s self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of the PEWS system and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED. Conclusion: Our study shows that high-fidelity implementation of PEWS in the ED is feasible. We also show that a multi-component PEWS can be effective in improving pediatric care and be well-accepted by staff. Results and lessons learned from this pilot study are being used to scale up implementation of PEWS in ED settings across the province of British Columbia.
Clinical, genetic and microbiological characterization of pediatric patients with Cystic Fibrosis in a Public Hospital in Ecuador
Authors: Lascano-Vaca Yazmina , Ortiz-Prado Esteban , Gomez-Barreno Lenin , Simbaña-Rivera Katherine , Vasconez Eduardo , Lister Alexander , Arteaga-Espinosa María Emilia , Perez Geovanny F
Published: November 2019

Objective: To carry out a complete clinical, pathological, genetic and microbiological characterization of pediatric patients with molecular confirmed CF attending the Carlos Andrade Marín Hospital within the study period. Methods: A cross-sectional analysis of the pediatric population with a confirmed diagnosis of cystic fibrosis (CF) disease, who attended one of the largest tertiary-level hospitals in Ecuador between 2017 and 2018 was conducted. All demographic, clinical and genetic variables were obtained from the electronic medical records (EMR) stored by the hospital. Results: 47 patients with CF were included in the study. Gender distribution was similar between male (48.9%, n = 23) and female patients (51.1%, n = 24). The Tiffeneau-Pinelli index (FEV1/FVC) changed significantly after nine months post-diagnosis (85.55 ± 13.26; p <0.05). The most common pathogenic genetic mutations were F508del, found in 52.78% of the cohort (n = 19); H609R, found in 36.11% (n = 13); g.204099A>C, found in 14.1% (n = 7), followed by G85E and the N1303K with 11.11% (n = 3) each. Conclusions: To our best knowledge, this is the first study exploring the clinical, genetic and bacteriological profile of CF’s patients in Ecuador. Due to the lack of universal screening in the country, a large proportion of individuals are being diagnosed or misdiagnosed later than expected, jeopardizing their treatments and prognosis. It is relevant to establish that the presence of the g.204099A> C and the c.206359C>A homozygous mutation variants have only been reported among Ecuadorians. These patients appear to show a less severe CF disease and a better prognosis.
Methods for Diagnosing Bile Acid Malabsorption: A Systematic Review
Authors: Lyutakov Ivan Aleksandrov , Ursini Francesco , Penchev Plamen Ivanov , Caio Giacomo , Carroccio Antonio , Volta Umberto , De Giorgio Roberto
Published: November 2019

Background

Bile acid malabsorption (BAM) and bile acid-related diarrhea represent an under-recognized cause of chronic diarrhea mainly because of limited guidance on appropriate diagnostic and laboratory tests.Objective

We aimed to perform a systematic review of the literature in order to identify and compare the diagnostic accuracy of different diagnostic methods for patients with BAM, despite a proven gold standard test is still lacking.Design

A PubMed literature review and a manual search were carried out. Relevant full papers, evaluating the diagnostic accuracy of different methods for BAM, were assessed. Available data were analyzed to estimate the sensitivity and specificity of each published test.Results

Overall, more than one test was considered in published papers on BAM. The search strategy retrieved 574 articles; of these, only 16 were full papers (with a total of 2.332 patients) included in the final review. Specifically, n=8 studies used 75 Selenium-homotaurocholic-acid-test ( 75 SeHCAT) with a <10% retention threshold; n=8 studies evaluated fasting serum 7-α-hydroxy-4-cholesten-3-one (C4); n=3 studies involved total fecal bile acid (BA) excretion over 48h; n=4 studies assessed fibroblast growth factor 19 (FGF19). 75 SeHCAT showed an average sensitivity and specificity of 87.32% and 93.2%, respectively, followed by serum C4 (85.2% and 71.1%) and total fecal BA (66.6% and 79.3%). Fasting serum FGF19 had the lowest sensitivity and specificity (63.8% and 72.3%). All the extracted data were associated with substantial heterogeneity.Conclusions

Our systematic review indicates that 75 SeHCAT has the highest diagnostic accuracy for BAM, followed by serum C4 assay. The diagnostic yield of fecal BA and FGF19 assays is still under investigation. Our review reinforces the need for novel biomarkers aimed to an objective detection of BAM and therefore improving the management of this condition.
Effects of Physical Activity and Counselling Interventions on Health Outcomes among Working Women in Shanghai
Authors: Wang Hongying , Xiao Yi , Ren Xiaoling , Zhang Pei , Lu MiaoMiao , Zhang Tao
Published: November 2019

Background ：Working women in Shanghai are a special group with a high risk of suffering work stress and burnout. They were disturbed by the work-family conflicts, which results in lower health-related quality of life (HRQoL), higher job stress and burnout. This study evaluated the potential physical activity and counselling intervention effects on health outcomes of working women in Shanghai participating in a group- or an individual-based physical activity and counselling intervention compared to a control group.
Methods ：Participants were randomly recruited from eight communities of Shanghai using the stratified cluster sampling method. A sample of 121 female workers was used in this study. They are randomly divided into three groups: a control group and two intervention groups (individual-based and group-based intervention). The two intervention groups accepted 12-week moderate physical activity and counselling intervention. Subjective perceptions of work stress, burnout, and HRQoL were measured before and after the intervention.
Results ：In the control group, no significant difference was found between participants for stress ( p = 0.752) and burnout ( p = 0.622) before and after the experiment. However, the HRQoL value decreased after the experiment, with the mean value falling from 91.59 to 87.10. After the experiment, the value of stress and burnout decreased, and the value of HRQoL increased in the two intervention groups. At the intervention’s completion, there were significant differences compared the two intervention groups to the control group separately regarding changes in burnout and HRQoL (all p = 0.000). For stress, the group-based intervention group exhibited a significant difference compared to the control group ( p = 0.000), while the individual-based intervention group did not exhibit a significant difference compared to the control group ( p = 0.128).
Conclusion: Physical activity and counselling intervention delivered either in a group or individual format could reduce stress, burnout, and improve HRQoL of working women in Shanghai, and the group interventions were more effective than those targeted at individuals.