bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations Between the Use of eHealth and Out-of-Hours Services in People With Type 1 Diabetes: Cross-Sectional Study (Preprint)
Authors: Hansen Anne Helen , Claudi Tor , Årsand Eirik
Published: March 2019

BACKGROUND

Despite the increasing prevalence of diabetes and the increasing use of eHealth, little is known about the association between provider-based health services and eHealth among people with diabetes. This is the second study in a project exploring the associations between the use of eHealth and the use of provider-based health services.

OBJECTIVE

The objective of this study was to investigate which eHealth services are used among out-of-hours (OOH) visitors with type 1 diabetes (T1D), and whether the use of eHealth (eg, apps, search engines, video services, and social media) was associated with the use of OOH services. We also wanted to investigate associations between anxiety, reassurance, and change in doctor-seeking behavior because of health information acquired from the Internet, and the use of OOH services.

METHODS

We used data from a 2018 email survey of members of the Norwegian Diabetes Association (18-89 years old). Respondents with T1D were eligible for analyses. Using descriptive statistics, we estimated the use of OOH services and eHealth. Using logistic regressions, we studied the associations between the use of OOH services and the use of eHealth, as well as associations between the use of OOH services and reported consequences of using Internet-based health information.

RESULTS

In the sample of 523 people with T1D (mean age 47 years), 26.7% (129/484) visited OOH services once or more during the previous year. Among the OOH visitors, search engines were used for health purposes by 86.7% (111/128), apps (health apps in general) by 63.6% (82/129), social media by 45.3% (58/128), and video services by 28.4% (36/127). The use of OOH services was positively associated with self-reported anxiety/depression (odds ratio [OR] 4.53, 95% CI 1.43-14.32) and with the use of apps (OR 1.73, 95% CI 1.05-2.85), but not with other types of eHealth. Those who had felt anxious based on information from the Internet were more likely to visit OOH services compared with those who had not felt anxious (OR 2.38, 95% CI 1.50-3.78). People who had decided to consult a doctor based on information from the Internet were more likely to visit OOH services (OR 2.76, 95% CI 1.64-4.66), compared to those who had not made such an Internet-based decision.

CONCLUSIONS

People with T1D were frequent users of OOH services, and the OOH visitors were frequent users of eHealth. The use of OOH services was positively associated with the use of health apps, with self-reported anxiety/depression, and with feeling anxious based on information from the Internet. Likewise, deciding to consult a doctor based on information from the Internet was positively associated with OOH visits. The use of eHealth seems to have a significant impact on people with T1D.
Adoption of an Electronic Patient Record Sharing Pilot Project: Cross-Sectional Survey (Preprint)
Authors: Wang Jingxuan , Huang Junjie , Cheung Clement Shek Kei , Wong Wing Nam , Cheung Ngai Tseung , Wong Martin CS
Published: March 2019

BACKGROUND

The Public Private Interface–Electronic Patient Record (PPI-ePR) system was implemented as a new electronic platform to facilitate collaboration between the public and private sectors in Hong Kong. However, its barriers to participate and benefits have not been comprehensively assessed.

OBJECTIVE

This study aimed to evaluate the awareness, acceptance, perceived benefits, and obstacles to participation among private doctors and the general public.

METHODS

From December 2012 to January 2013, 2435 telephone interviews were performed by trained interviewers to survey randomly selected patients who were enrolled or not enrolled in the PPI-ePR system. In addition, self-administered surveys were sent by postal mail to 4229 registered doctors in Hong Kong. The questionnaires for both patients and doctors contained questions on subjects’ awareness, acceptance, and perceptions of the PPI-ePR, perceived benefits and obstacles of participating in the program, reasons for not using the system after enrolling, and perceived areas for service improvement of the system.

RESULTS

More than 53.1% (266/501) of enrolled patients believed that the PPI-ePR system would improve health care quality by reducing duplicate tests and treatments, while more than 76.8% (314/409) of enrolled doctors emphasized timely access to patients’ medical records as the biggest benefit of their enrollment. Among nonenrolled patients, unawareness of the project was the most popular obstacle to enrolling in the PPI-ePR system (483/1200, 40.3%). Regarding nonenrolled doctors, the complicated registration process hindered them from participating in the program the most (95/198, 48.0%). Television, newspaper, and magazine advertisements and medical profession newsletters or journals were suggested as the most effective means to encourage participation in the program among surveyed patients (1297/1701, 76.2%) and doctors (428/610, 70.2%), respectively. Lack of clinical indication requiring data extraction from other hospitals was the main reason for low level of PPI-ePR use.

CONCLUSIONS

This study comprehensively assessed the popularity, perceived benefits, and hindering factors of enrolling in the PPI-ePR system in Hong Kong. Low levels of awareness, few privacy concerns, and inactive use of the PPI-ePR system were among the key features for patients and physicians. Public promotions, simplified logistics, and a user-friendly online interface were suggested to improve the coverage and effectiveness of health information exchange between private and public health care sectors.
Internet-based asthma education program in combination with presence education increases asthma knowledge more than conventional presence education: results of a randomized controlled trial (Preprint)
Authors: Kohler Benedikt , Kellerer Christina , Schultz Konrad , Wittmann Michael , Atmann Oxana , Linde Klaus , Hapfelmeier Alexander , Schneider Antonius
Published: March 2019

BACKGROUND

Asthma education programs (AEP) in combination with keeping an asthma diary and usage of an asthma action plan to foster self-management is associated with reduced hospitalization, disability and mortality. However, only few patients are participating in presence educational programs which might be due to time constraints, organizational reasons, and low physiological or psychological strains. Internet-based educational programs might help to increase participation rates.

OBJECTIVE

We developed an electronic AEP (eAEP) conform with accreditation criteria for presence AEPs (pAEPs) and compared the effectiveness of eAEP and pAEP for knowledge gain regarding asthma self-management.

METHODS

The study was a two-armed, single-centre, randomized controlled trial performed between 17th July and 11th October 2018 in a pulmonary rehabilitation in-patient clinic. Due to safety reasons, patients of the eAEP group were obliged to participate in the presence education after finalization of the eAEP. Asthma knowledge was determined with the Asthma Knowledge Test (AKT) comprising 54 items. The total sum score ranges from 0 to 54 points, with higher scoring indicating better knowledge. Group differences were calculated with linear regression adjusting for age, gender, years since asthma diagnosis and AKT baseline values.

RESULTS

In the intervention group, AKT scores increased from 41.57 (standard deviation 5.63) at baseline to 45.82 (3.84) after completion of the eAEP, and again after completion of the pAEP to 47.20 (3.78) (both increases p<0.001). In the control group the scores increased from 41.73 (4.74) at baseline to 45.72 (3.65) after completion of the pAEP (p<0.001). The knowledge gain was similar between the eAEP and pAEP group after completion of the corresponding educational sessions (p=0.881). However, knowledge gain was significantly higher in the eAEP group after participating in the obligatory pAEP group compared to the patients solely participating in the pAEP group (p=0.020). Personal comments highlighted the possibility to use the eAEP for looking up facts about asthma medication and management, or to use it for in-depth learning after pAEP.

CONCLUSIONS

eAEP might lead to similar knowledge gain as pAEP. Thus, an internet-based approach to reach patients for asthma education might be valuable to compensate for the educational deficits of a large amount of patients with asthma. Future studies have to examine optimal ways how to implement eAEPs within clinical settings or primary care, under consideration of the necessity to combine it with regular review, active engagement and training of patients.

CLINICALTRIAL

German Register of Clinical Trials; number DRKS00015078.
The Constitution of Canada as Supreme Law: A New Definition
Authors: St-Hilaire Maxime , Baud Patrick F. , Drouin Elena S.
Published: March 2019

Not only is there no clear answer in Canadian law as to what the 'supreme law' of Canada comprises, but no agreement on how to find that answer. In this short paper, we claim to solve the problem by proposing a new, workable, definition of the Canadian Constitution as supreme law that discards the document list approach of subsection 52(2), Constitution Act 1982, in favour of one that, through subsection 52(3), is based on the constitutional amendment procedure of Part V, which relates to provisions.
Миниатюризация аппаратуры посредством применения специализированных микросборок на основе отечественных микросхем
Authors: Шкопкин М. , Мякочин Ю. , Девликанова С.
Published: March 2019

Рассматриваются технологии Flip-Chip и RDL (Redistribution Layer), которые компания АО «ПКК Миландр» успешно применяет в собственных разработках. Эти подходы позволяют значительно уменьшить габариты конечной аппаратуры. Использование технологий Flip-Chip и RDL чаще всего не требует переработки полупроводниковых кристаллов, а, значит, в микросборках используются проверенные и верифицированные микросхемы.
Обеспечение безопасности коммуникаций промышленных встраиваемых систем с облачными сервисами
Authors: Биньяле Кс.
Published: March 2019

Внедрение инфраструктуры «Индустрии 4.0» и концепции удаленного производства и управления связано с рисками несанкционированного доступа к весьма дорогостоящим ресурсам предприятия. В статье рассмотрены пути обеспечения защиты от потенциальных угроз сетей Интернета вещей с использованием комплексного решения компании Microchip.
Radiologí­a e imagen
Authors: Ramírez-Arias José Luis
Published: March 2019

El Dr. Ramírez-Arias, quien está a cargo de nuestra sección “Haga su diagnóstico”, nos regala una interesante revisión sobre su especialidad. Nos recuerda el sorprendente desarrollo tecnológico de la radiología, y sus descubridores e investigadores merecedores de premios Nobel. A través de este relato vislumbramos el perfeccionamiento de herramientas, así como de las técnicas radiológicas e imagenología, y de manera especial, el conocimiento de los patrones radiológicos de síndromes y distintas enfermedades y su relación con los hallazgos en la cirugía y la anatomía patológica, reconociendo que por ello los radiólogos hoy tienen la oportunidad de contribuir y participar en una atención más eficiente en beneficio del paciente.
Imagen en trauma toracoabdominal. Un diagnóstico diferencial difícil
Authors: Vázquez Minero Juan Carlos , Trueba Lozano Demian , Portillo Pérez Laura
Published: March 2019

Un hombre de 70 años fue atropellado. En urgencias, el signo de Chilaiditi ocurre como un hallazgo casual, lo que enfatiza la importancia de no perder detalle al realizar la correlación del antecedente traumático con la imagen radiológica.
O corpo como componente das formas de participação das crianças na educação infantil
Authors: Agostinho Kátia Adair
Published: March 2019

O estudo, uma pesquisa etnográfica com crianças, com o objetivo de conhecer suas formas de participação na educação infantil (identificou a forma intensa e pulsante com que seu corpo participa em seus contextos educativos expressando seus pontos de vista. A partir da empiria e bases teóricas (Ferreira, 2009, 2013; Fingerson, 2009; Gil, 1997; Le Breton, 2009) vimos que o corpo das crianças está na base de toda sua experiência social, mediador das relações, das práticas, dos discursos, das apropriações do Outro e do mundo. Tal ideia precisa ser considerada nas práticas pedagógicas para que respeitemos o corpo da criança ávido por descobrir e descobrir-se na sua relação novidável e embrionária com o mundo.
Prospek Desain Reaktor Berbahan Bakar Cair Molten Salt Reactor
Authors: Suhaemi Tjipta
Published: March 2019

Konsep desain reaktor Generasi IV adalah hasil dari upaya riset teknologi reaktor dan energi nuklir yang melibatkan 10 negara maju dalam Forum Internasional Generasi IV (GIF). Ada beberapa  konsep desain reaktor kandidat yang potensial untuk diimplementasikan untuk memenuhi kebutuhan energi dunia di masa mendatang.  Salah satu dari reaktor Generasi IV adalah reaktor MSR (Molten Salt Reactor). Makalah ini membahas studi dan observasi awal desain reaktor MSR dengan melakukan tinjauan komprehensif terhadap deskripsi dan karakteristik desain bahan bakar, tipe pendingin, aspek keselamatan.  Konsep MSR menawarkan fitur-fitur unik seperti efisiensi dan stabilitas termal tinggi, fleksibilitas spektrum neutron, inherent safe, tekanan operasi rendah, dan beberapa aspek lain. Fitur-fitur itu sangat mendukung untuk operasi reaktor yang murah dan memiliki sistem keselamatan yang lebih baik, sebagai pemenuhan syarat untuk reaktor generasi IV. Reaktor MSR mempunyai keunggulan, antara lain koefisien reaktivitas negatif pada void dan penggunaan bahan bakar cair yang menghindarkan terjadinya steam explosion.  Untuk pengembangan MSR supaya benar-benar siap diproduksi secara komersil, tentu butuh riset dan pengumpulan data lebih lanjut berkenaan dengan keseluruhan bagian reaktor, termasuk mengatasi risiko terjadinya korosi pada material reaktor dan perawatan. Dengan berbagai keunikan dan keunggulan yang ditawarkannya, bisa dikatakan MSR memiliki prospek yang sangat cerah untuk digunakan di masa depan.
Pemanfaatan Panas Buang Atap Seng dengan Menggunakan Generator Termoelektrik sebagai Sumber Energi Listrik Terbarukan
Authors: Putra Aby Elsa , Rifky Rifky , Fikri Agus
Published: March 2019

This research was conducted to utilize waste heat energy zinc roof for a revamped into a source of electrical energy. Waste heat utilization of zinc using thermoelectric generator type of TEC-12706 to convert thermal energy into electrical energy and the fan with speed 5 m/s to hold a low temperature in a cold area of heatsink. This research was conducted using a test simulation tool made by zinc, aluminum and acrilic. Waste heat utilization of testing zinc roof done starting at 09.00 WIB until 15.00 WIB for 3 days, with some measured parameters required as the intensity of  solar radiation (Es), airspeed (v), current (I), power (W) and temperature (T) some of which are found in the system tools of simulation testing. From the results of testing performed, the value of the highest efficiency i.e. of 0,00888% and the largest electrical power generated in the amount of 0,0042 W. A high intensity of the solar radiation it will affect the temperature of the environment which will also have an effect on the temperature in the cold area of heatsink, then the value of the temperature difference will also be affected. Heat resistance value on the system also affects the value of the waste heat energy can be changed into electrical energy.
Tissue response resulting from different force magnitudes combined with corticotomy in rats
Authors: Kraiwattanapong Kriangkrai , Samruajbenjakun Bancha
Published: March 2019

Objectives:

To evaluate the amount of hyalinization and root resorption after application of light and heavy forces during corticotomy-assisted tooth movement.

Materials and Methods:

Forty-eight male Wistar rats were used. Eight animals were the control group (day 0). The other 40 animals were randomly divided into two groups using the split-mouth technique: (1) corticotomy combined light force (CLF) and (2) corticotomy combined heavy force (CHF). Nickel-titanium closed coil springs that generated 10 g (light force) and 50 g (heavy force) were used for maxillary first molar movement. three-dimensional root volume was evaluated at 0, 14, and 28 days. Percent hyalinization was analyzed at 0, 3, 7, 14, 21, and 28 days by histomorphometric analysis.

Results:

The CHF group showed significantly lower cervical root volume than the CLF group at 28 days. Compared with day 0, the CHF group showed significantly less root volume in both distobuccal and distopalatal roots at 28 days. The hyalinization percentages in the CHF group were significantly higher than the CLF group at days 3 and 21.

Conclusions:

Heavy force combined with corticotomy produced more periodontal ligament hyalinization and root resorption than the light force combined with corticotomy.
Surgical Site Infections - A Hospital Havoc: Retrospective Study of Surgical Site Infections in Tertiary Health Care Centre in North East India
Authors: Singh V , W V Lyngdoh A B Khyriem, , Lyngdoh C J
Published: March 2019

Objectives - Surgical site infections (SSI) has turn out to be a major problem even in hospital with most modern facilities and standard protocols of pre -operative preparation and antibiotic prophylaxis. Objective of this study is to know the prevalence of surgical site infection among the postoperative patients and to identify the relationship between SSI and etiological pathogens along with their antimicrobial susceptibility at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong.

Methods - A retrospective case study conducted at NEIGRIHMS, among patients admitted to the surgical departments during the period between January 1st and December 31st 2016. Swabs from the surgical sites were collected under sterile conditions and standard bacteriological tests were performed for identification and appropriate statistical methods were employed to look for association between SSI and etiological pathogens.

Results - Out of the 1284 samples included in the study, 192 samples showed evidence of SSI yielding an infection rate of 14.9%. The most commonly isolated bacteria were: Escherichia coli, Acinetobacter baumanii and Staphylococcus aureus, of the gram negative isolates 6.2% were multidrug resistant of which 19% were carbapenem resistant.

Conclusion - SSI with multiple drug resistance strains and polymicrobial etiology reflects therapeutic failure. The outcome of the SSI surveillance in our hospital revealed that in order to decrease the incidence of SSI we would have to: a) incorporate a proper antibiotic stewardship  b) conduct periodic surveillance to keep a check on SSI d) educate medical staffs regarding the prevention of surgical site infection.
Sensitive and Reliable Indicator between Broca’s Index and Metropolitan Life Insurance Height - Weight Charts in First Year Medical Student
Authors: D. Godia Dr. Haresh , Nikam Dr. Lalit H
Published: March 2019

Aims: This study was confined to healthy groups. Care was taken to exclude persons suffering from obvious disease and/ or recent history of illness Aims and Objective of present study are:-

To assess out a sensitive and reliable indicator between Broca’s Index and Metropolitan Life Insurance Height - Weight charts.

Materials and Methods: The present study were carried out on 100 1st M.B.B.S. students of GSMC Mumbai and Tertiary Care Hospital Mumbai (50 males and 50 females) not suffering from any major illness.

Conclusion: Broca’s Index does not take build into consideration. It therefore gives high values for weight. On the other hand Metropolitan Life Insurance Tables give more accurate estimate of person’s nutritional status and they should be used as a reliable indicator for nutritional assessment. Adolescence, being an important period of physiological and psychological changes occurring in the body; is important since these changes can have effect in diet and nutrition of an individual leading to improper consumption of food and various deficiency diseases. Studies carried out on adolescents are very limited and it is needed to assess the nutritional status of adolescents
Attitudes of Nursing Students towards Suicide Prevention: A Study from Central India
Authors: Ghormode Deepak , Gupta Pramod , Ratnani Devendra , Singh S. K.
Published: March 2019

Background: Managing patients with suicide attempts effectively requires overcoming barriers to their care. The attitudes and beliefs of the healthcare professionals have significant effect on the outcome of the treatment and implementation of the preventive strategies.

Objectives: Aim of the study was to assess the attitude of nursing students toward suicide prevention.

Materials and Methods: The study had a cross sectional design of 284 nursing students who were randomly recruited from the two institutions. Attitude toward suicide prevention scale was administered. 

Results: Most were young single females, from rural locality, who were pursuing either BSc Nursing or GNM courses. Very few had previous exposure to suicide prevention training programmes. Nearly half of the students showed favourable attitude towards patients with suicidal attempt, considering it as their responsibility and their efforts as rewarding. Nearly half students also showed empathy towards these patients not considering the attempts as just attention seeking ones. Nearly one third were uncertain whether the patients reveal their plans of attempt and whether the suicide prevention measures were draining of the resources. Half of the subjects showed pessimism towards modifying the risk factors of unemployment and poverty.

Conclusions: Only half of the nursing students showed favourable attitude working with patients with suicide attempts. More educational and training programs on suicide prevention are therefore needed in these students for better prevention and management of these patients.
Reasons for Non-Compliance to Inhaled Medications among Adult Asthma Patients Attending Referral Chest Hospital in North India
Authors: Dar Mohd Yousoof , Shah Naveed Nazir
Published: March 2019

Introduction: Asthma is a major public health problem affecting a large number of individuals of all ages, characterized bychronic airway inflammation and inhaled medications are main stay of treatment but compliance to these medications is poor.Aim: This study was conducted to look for common reasons for non-compliance to inhaled medications (MDI and DPI) in asthmapatients attending out-patient department of a referral chest hospital. Material and methods: The study was conducted on 150diagnosed asthma patients on follow based on an open labeled questionnaire in a hospital from North India. Results: Overallcompliance of the patients to inhaled medications (MDI and DPI) was only 34.6% (52 /150 patients) and 65.4 % (98 out of 150) were found to be noncompliant. Among reason for non-compliance, belief that medications were not needed during symptom freeperiod was found in 43.8% (43/98), followed by feeling that they may become dependent/ develop addiction if used for long timein  32.6% (32/98) and social embarrassment in using inhalers found in  14.2%(14/98). All other reasons accounted for onlyaround 9% of non-compliance. Conclusion: The data indicates that despite strict instructions for adherence to medicationcompliance rate was poor, although majority of the patients believed that compliance was extremely important. This studysuggests that besides continued health education new health care initiatives are needed to be designed to improve the complianceof asthma patient for inhaled medications.
Update Treatment for Prolactinoma
Authors: María Margarita Chávez Hernández , María Valeria Jiménez Báez , María Fernanda Armijo Medina , Jorge Miguel Domínguez Leyva , Alejandra Góngora Valencia Karen , Karen Alejandra Góngora Valencia , Sergio Geovanni Guerra Rentería , Jurado Luis Sandoval
Published: March 2019

Prolactinomas are the most common type of functional pituitary tumor. The present manuscript is an update on the treatment modalities for prolactinomas. Effective hyperprolactinemia treatment is of great importance, due to its potential deleterious effects including infertility, gonadal dysfunction and osteoporosis. Dopamine agonist therapy is the first line of treatment for prolactinomas; recurrence of disease after cessation of the drug may occur in patients. Its safety profile remains high, allowing its use during pregnancy.
Study of pulmonary function test in newly diagnosed diabetes in a tertiary care teaching hospital, Kishanganj, Bihar
Authors: Bharat Dr Ichchhit , Singh Dr Raghwendra , Sehgal Dr Chandni , Sharma Dr. Sumit , Saha Dr. Anuj Kumar , Paul Dr. Uttam Kumar
Published: March 2019

Background: Diabetes mellitus (DM) is accompanied by wide spread biochemical, morphological, and functional abnormalities which may precipitate certain complications that affect the neural, cardiovascular, renal systems, and also organs and tissues like skin, liver, collagen, and elastic fibers. This study was thus conducted to determine the pattern of pulmonary function abnormalities among patients with newly diagnosed diabetes mellitus (DM) at the outpatient clinic of M.GM Medical College. Materials & Methods: Pulmonary function tests (PFTs) were recorded in 50 diabetic patients and 50 normal healthy controls aged 30-60 years by using Helios 702 spirometer. The PFTs recorded were - FVC, FEV1, FEV1/FVC, FEF25, FEF50, FEF75, FEF25–75, and peak expiratory flow rate (PEFR). HbA1c of all the patients was estimated by ion exchange resin method. PFTs of diabetic patients and controls were compared by applying Student′s unpaired t test. Associations between FVC and FEV1 and HbA1c and duration of illness in diabetic patients were analyzed by applying Pearson′s coefficient. Results: Mean & SD value of fasting plasma glucose 149.2 ±75.6 for case and for control group the value was 92.8 ±17.6. For case group we found 66% (33) patients in restriction category and for control group the number was 7 (14%) and the found in statistically significant. We found 12 patients with mild, 25 patients with moderate and 13 patients with high severity. Conclusion: In the present study all the pulmonary parameters, that is, FVC, FEV1, PEF, FEF25-75, MVV and FEV1/ FVC were statistically significant. On correlating the FVC and FEV1 with duration of illness and HbA1c, we found that there was no significant correlation between them.
Journey of Gliomas- from Morphology to Genetics
Authors: Chatterjee Dr Debajyoti
Published: March 2019

Gliomas are the commonest brain tumors, both in adults and children. In the past one decade there is a massive development in the understanding in the pathogenesis and genetics of glial tumors. With the incorporation of the molecular information, gliomas are now classified based both on their morphology and genetics. These changes have been adapted in the current (2016) world health organization (WHO) revised classification of tumors of central nervous system. Incorporation of the molecular information has helped in the accurate classification of glial tumors, which provides important prognostic and predictive information. In this review article, we shall have a brief look at the morphology of the glial tumors with their molecular pathology, in the light of the current literature.
Ventilator Associated Pneumonia: Continuous Versus Intermittent Administration of Piperacillin-Tazobactam in Intensive Care Unit Of
Authors: Sawarkar Dr. Mahendra M. , Sawarkar Dr. Shushrut Mahendra
Published: March 2019

Introduction: Ventilator-associated pneumonia (VAP) can be defined as pneumonia occuring 48-72 hours or thereafter following endotracheal intubation, it is characterized by the presence of a new or progressive infiltrate, signs of systemic infection like fever, altered white blood cell count, changes in sputum characteristics. Duration of mechanical ventilation determines the type of organism that causes VAP. Early VAP is caused by pathogens that are sensitive to most of the antibiotics, whereas late onset VAP may be caused by multi-drug resistant bacteria. There is no gold standard diagnostic criterion for VAP. Many clinical methods have been recommended but there is no sensitivity or specificity to identify this disease. In this study we tried to compare the clinical outcomes of continuous and intermittent administration of Piperacillin-tazobactam. Material and Methods: For diagnosis of VAP following criteria were considered: white blood cell count more than10,000 cells/mm 3 or less than 4000 cells/ mm 3 ; new onset of purulent sputum or a change in sputum character; body temperature >38°C or <35.5°; chest X ray showing new or progressive infiltrate and a significant quantitative pathogen culture from respiratory secretions (tracheal aspirate >106 colony-forming units/ml or growth of ≥104 colony-forming units/mL of microorganism on bronchoscopic bronchoalveolar lavage (BAL) culture or isolation of the same microorganism in blood and respiratory secretions on third day and eighth day. APACHE II score were recorded on admission and CPIS was measured at the onset of VAP symptoms and at third and eighth day. Demographic and other variable of the patients were recorded. Results: 50 patients were included in the study of which 25 were placed in continuous Infusion (CI) group and 25 in intermittent infusion (II) group. APACHE II score on admission in CI and II was 19. 9 ± 4.9 and 21.4 ± 5.6 respectively. Duration of mechanical ventilation in CI group was 39.1 ± 20.5 days. Total number of antibiotics administered in CI group was 5.5 ± 2.0 and II group was 5 ± 1.5. Duration of piperacillin – tazobactum treatment was 21 ± 11.6 (days) in CI group and 19 ± 9.6 in II group. Mortality rate observed in CI was 8 (32%) and in II was 9 (36%). No significant difference was observed in CPIS scores of both the group in Day 1, day 3 and day 8. Conclusion: There is significant morbidity in critically ill patients with VAP and there is lack of gold standard criteria for diagnosis. No significant difference was observed in CI and II group in term of clinical outcome.
Effect of Stress Management in Over-weight and Obese Women
Authors: Kotwani Dr Shweta , Mehta Dr. Amita
Published: March 2019

Keywords: obesity, stress management, relaxation, PMR, Diaphragmatic breathing, over-weight women, BMI.
ISW for the Treatment of Deviated and Rotated Teeth
Authors: HUANG Chun-shuo , YU Jian-hong
Published: March 2019

The objective of the case study is for the treatment of deviated and rotated teeth by ISW (Improved Super-elastic Ti-Ni alloy wire, developed by Tokyo Medical and Dental University). An adult female (37 years old) came to our clinic with a chief complaint of abnormal tooth axis of lower arch combined with spacing and rotation of other teeth. This patient mentioned she didn’t care about the problem of facial asymmetry. By using ISW, lower deviated teeth were corrected rapidly. Rotation of lower left and right premolars were corrected simply by ISW leveling. For correction of rotated upper left second premolar, we placed a bracket on the mesial surface of #25 temporarily and Ni-Ti open coil-spring was placed in between #25 and #26 in order to increase inter-bracket span so as to create space for bracket bonding on the buccal surface. ISW was fully engaged into #25 and then rotation was corrected by further leveling. After 18 months of active treatment, a stable occlusion and a desirable esthetic outcome was achieved and the patient was pleased with the treatment result after the active treatment.
Safety and Efficacy of the Combination of Amitriptyline and Pregabalin SR in Severe Neuropathic Pain: Data of Logic Trial
Authors: Kiran Dr. Mayuresh Dilip , Pawaskar Lalit , Sheikh Shaheen Naseem
Published: March 2019

Objective: To evaluate the safety and efficacy of the combination of Amitriptyline and Pregabalin SR in patients of severe neuropathic pain not controlled on monotherapy of a neuroanalgesic. Methods: LOGIC Study was conducted at 120 centres on 1269 patients across India. Patients above 18 years with severe neuropathic pain not controlled on monotherapy of a neuroanalgesic and who satisfied the inclusion and exclusion criteria were enrolled in the study. A combination of Amitriptyline and Pregabalin SR was given once daily. Patients were evaluated for the efficacy by visual analogue scale (VAS) and score was noted at 3 visits. Safety was evaluated through noting the adverse events occurring during the study. Change in mean VAS score, percentage of patients achieving ≥ 50 % reduction in pain at every visit and Number Needed to Treat (NNT) was assessed. Results: Mean VAS score was 7.87 at baseline, 5.6 at day 7 and 3.42 at day 21. 46.4 % and 84.6 % of total patients at day 7 and 21 respectively had a reduction in pain of ≥ 50 % from the baseline. NNT was calculated to be 1.19 for achieving ≥ 50 % pain relief. Reduction in pain intensity was irrespective of blood glucose control, age and gender of the patient. Adverse effects were observed in 15 % patients of patients - Sedation, Dizziness, Dry Mouth and Constipation were predominant. Conclusion: Combination of Amitriptyline and Pregabalin SR is safe and efficacious in the treatment of severe neuropathic pain.
PENERAPAN ETIKA EKOSENTRISME PADA DESA ADAT RAGI HOTANG MEAT DI KABUPATEN TOBA SAMOSIR, SUMATERA UTARA
Authors: Saraswati Titien , Pinem Feby Astrid br.
Published: March 2019

Abstract: Ragi Hotang Meat Traditional Village in Tampahan District, Toba Samosir Regency, North Sumatera Province, already inaugurated as a traditional village by the Ministry of Education and Culture's Director General of Culture on 11 February 2017. In the village there were some traditional houses that had been revitalized, some original traditional houses, ulos woven crafts and the typical sarong of the village, as well as traditional dances. After being inaugurated as a traditional village, the community was asked to do the development of the village themselves as a tourist destination. As an academician, it was a must to contribute to the local government and to the villagers about the development of the village. The question was: how to develop Ragi Hotang Meat Traditional Village into a tourist destination that would not be damaging the nature, but could provide benefits to the nature and its inhabitants? The purpose of this study was to contribute to the local government and villagers on how to develop their village that would not be damaging the nature, but could provide benefits to the nature and its inhabitants. Analysis by examining the data related to Tourism theory and Deep Ecology. Keywords: traditional village, tourism, Deep EcologyAbstrak: Desa Adat Ragi Hotang Meat, di Kecamatan Tampahan, Kabupaten Toba Samosir, Provinsi Sumatera Utara, telah diresmikan sebagai desa adat oleh Dirjen Kebudayaan Kemendikbud pada 11 Februari 2017. Di desa itu terdapat beberapa rumah adat yang telah direvitalisasi, rumah adat asli, kerajinan tenun ulos dan sarung khas desa itu, serta tarian adat. Setelah diresmikan sebagai desa adat, masyarakat diminta untuk melakukan sendiri pengembangan desa itu sebagai destinasi wisata. Sebagai akademisi, dituntut untuk bisa memberikan masukan, baik bagi pemerintah setempat maupun bagi penduduk desa itu. Pertanyaannya: bagaimana Desa Adat Ragi Hotang Meat dikembangkan menjadi destinasi wisata yang tidak merugikan, namun bisa memberikan keuntungan bagi alam dan penduduknya? Tujuan studi ini ialah memberikan masukan kepada pemerintah setempat maupun penduduk desa itu cara mengembangkan desanya agar menjadi destinasi wisata yang tidak merugikan alam maupun penduduknya. Analisis dengan mengeksaminasi data dikaitkan dengan teori Pariwisata dan Deep Ecology.Kata Kunci: desa adat, pariwisata, Deep Ecology
ONLINE COLLABORATION PRINCIPLES
Authors: Garrison Randy
Published: March 2019

This paper uses the community of inquiry model to describe the principles of collaboration. The principles describe social and cognitive presence issues associated with the three functions of teaching presence—design, facilitation and direction. Guidelines are discussed for each of the principles.
IDENTIFYING STUDENT ATTITUDES AND LEARNING STYLES IN DISTANCE EDUCATION
Authors: Valenta Annette , Therriault David , Dieter Michael , Mrtek Robert
Published: March 2019

As universities and businesses move toward the use of online education and training, there is need to discover how to make this alternative both more attractive and viable for different populations. Our research efforts examined the cluster of opinions held by students, with respect to technology and its application to education, across two populations: traditional college undergraduate students and adult learners (nontraditional graduate students). None of the students had any experience with online coursework. Q-methodology was used to identify opinions, shared among students, on issues they considered important about the application of technology to course instruction. This research suggests approaches on how an educational program might fine tune its online delivery for maximum suitability and acceptability to the broadest group of learners in post-secondary education.
BEYOND STUDENT PERCEPTIONS: ISSUES OF INTERACTION, PRESENCE, AND PERFORMANCE IN AN ONLINE COURSE
Authors: Picciano Anthony G.
Published: March 2019

The research literature on Web-based learning supports the assumption that interaction is important for a successful course, yet questions exist regarding the nature and extent of the interaction and its effects on student performance. Much of the research is based on student perceptions of the quality and quantity of their interactions and how much they have learned in an online course. The purpose of this study is to examine performance in an online course in relationship to student interaction and sense of presence in the course. Data on multiple independent (measures of interaction and presence) and dependent (measures of performance) variables were collected and subjected to analysis. An attempt was made to go beyond typical institutional performance measures such as grades and withdrawal rates and to examine measures specifically related to course objectives.
ASYNCHRONOUS DISCUSSION GROUPS IN TEACHER TRAINING CLASSES: PERCEPTIONS OF NATIVE AND NON-NATIVE STUDENTS
Authors: Biesenbach-Lucas Sigrun
Published: March 2019

This paper discusses students’ perceptions of an asynchronous electronic discussion assignment implemented shortly after the technology had been introduced to the university. In addition to the weekly face-to-face class meetings, students in two graduate level teacher training courses were assigned to small groups for an entire semester and made weekly contributions to their group’s course web discussion forum in which they discussed course content. Students were to make explicit references to course readings and postings by their group members. The instructor evaluated students' postings on a weekly basis. At the end of the course, students completed a survey assessing their satisfaction and asking for their suggestions for modification of the particular assignment type and format. For all students, the extension of course-related discussions outside the regular face-to-face class meetings offered benefits in the form of greater social interaction with other class members; for the non-native speakers among the students, the asynchronous discussions facilitated assimilation of course content, but it was not perceived as providing additional language practice. For all students, the two main issues perceived as negative related to their perceptions of forced, unnatural interaction promoted by the asynchronous discussions and lack of topic prompts, the requirement to make connections to prior postings, and the frequency of required contributions to discussions. Possible reasons for students’ perceptions are explored and suggestions for further research are provided.
STUDENT ROLE ADJUSTMENT IN ONLINE COMMUNITIES OF INQUIRY: MODEL AND INSTRUMENT VALIDATION
Authors: Garrison Randy , Cleveland-Innes Martha , Fung Tak
Published: March 2019

The purpose of this study is to validate an instrument to study role adjustment of students new to an online community of inquiry. The community of inquiry conceptual model for online learning was used to shape this research and identify the core elements and conditions associated with role adjustment to online learning (Garrison, Anderson and Archer, 2000). Through a factor analytic process it is shown that the instrument did reflect the theoretical model. It was also useful in refining the items for the questionnaire. The instrument is for use in future research designed to measure and understand student role adjustment in online learning.
FACTORS THAT INFLUENCE STUDENTS’ DECISION TO DROPOUT OF ONLINE COURSES
Authors: Willging Pedro A. , Johnson Scott D.
Published: March 2019

Although there are many reasons why students dropout of college courses, those reasons may be unique for students who are enrolled in an online program. Issues of isolation, disconnectedness, and technological problems may be factors that influence a student to leave a course. To understand these factors, an online survey was developed to collect data from students who dropped out of an online program. Logistic regression analysis was used to compare various factors between those who persist in the program and those who dropout. The results, based on the dropouts from three cohorts in an online graduate program, show that demographic variables do not predict likelihood of dropping from a program. Instead, the students’ reasons for dropping out of an online program are varied and unique to each individual. Recommendations for further study are incorporated in the conclusions.
QUESTIONING THE HYBRID MODEL: STUDENT OUTCOMES IN DIFFERENT COURSE FORMATS
Authors: Reasons Saxon G. , Valadares Kevin , Slavkin Michael
Published: March 2019

Current literature suggests that a hybrid model of distance education supports student learning more effectively than any other format. It also seems likely that the hybrid format can be used in most courses. The purpose of our study was to examine the strength of these assertions. This study examined the outcomes of two introductory courses in teacher education and health services employing similar pedagogical methods within three delivery formats (face-to-face, internet-based, and hybrid) in an effort to compare each of these modes of instruction. Results demonstrate that significant differences exist among the various formats and that the internet-based format could possibly lead to better student outcomes compared to face-to-face and hybrid formats.
ON THE NATURE AND DEVELOPMENT OF SOCIAL PRESENCE IN ONLINE COURSE DISCUSSIONS
Authors: Swan Karen , Shih Li Fang
Published: March 2019

“Social presence,” the degree to which participants in computer-mediated communication feel affectively connected one to another, has been shown to be an important factor in student satisfaction and success in online courses. This mixed methods study built on previous research to explore in greater depth the nature of social presence and how it develops in online course discussions. The study combined quantitative analyses of survey results from students enrolled in four online graduate courses, and qualitative comparisons of students with the highest and lowest perceptions of social presence. Quantitative results revealed significant correlations between perceived social presence and satisfaction with online discussions, and teased apart the respective influences of the perceived presence of instructors and peers. The findings indicate that the perceived presence of instructors may be a more influential factor in determining student satisfaction than the perceived presence of peers. Correlations with other course and learner characteristics suggest that course design may also significantly affect the development of social presence. Qualitative findings support the quantitative results. In addition, they provide evidence that students perceiving the highest social presence also projected themselves more into online discussions,and reveal meaningful differences in perceptions of the usefulness and purpose of online discussion between students perceiving high and low social presence.
La Colección de etnografía e historia de América y el embajador Roberto Levillier en México, 1934-1939
Authors: Pita González Alexandra
Published: March 2019

En 1934 el diplomático e historiador argentino Roberto Levillier propuso a la Sociedad de Naciones (SDN) crear una colección de etnografía e historia de América dedicada a los siglos XV a XVII, la cual quedaría bajo el control de Cooperación Intelectual. Dado que Levillier fue embajador de Argentina en México durante esos años, la cancillería mexicana siguió con atención el itinerario de la colección y las peripecias por las que pasó su mentor, puesto que temían que su fuerte tono hispanista perjudicara la interpretación del pasado colonial y que las opiniones que daba el argentino en la prensa dañaran la imagen internacional que el país buscaba proyectar. A partir de numerosa documentación diplomática se reconstruyó este proceso, el cual, más allá del caso puntual, nos ayuda a entender las tensiones en el campo diplomático entre México y Argentina, así como entre éstos, la SDN y Cooperación Intelectual. Como intentaremos mostrar, aunque se trató de una propuesta académica, los comentarios a favor o en contra de su realización no se vincularon con un debate disciplinar ni con la conformación de una Historia de América como línea de investigación. Primó la mirada política y los intereses de una diplomacia preocupada por un complejo panorama pre guerra, donde los actores involucrados buscaban solucionar simultáneamente problemas nacionales, regionales e internacionales.
Macrófitas acuáticas vasculares del sistema de drenaje del Alto Valle de Río Negro, Patagonia (Argentina)
Authors: Jocou Adriel Ian , Fernández Cristina , Gandullo Ricardo
Published: March 2019

El presente trabajo tuvo como objetivo identificar la composición florística del sistema de drenaje en el Alto Valle de Río Negro y comprender aspectos taxonómicos y biológicos. El listado florístico se obtuvo de 150 censos de vegetación (Braun-Blanquet, 1979) cuyas especies se registraron con valores de cobertura. Las macrófitas acuáticas vasculares se clasificaron según Sculthorpe (1967) y Schmidt-Mumm (1998). Los desagües fueron catalogados en rurales y urbanos según su ubicación y el origen de sus efluentes. Se evaluaron las diferencias florísticas de cada ambiente por medio de la diversidad ? -calculada través de la riqueza (S)-, índice de Shannon (H), índice de equidad de Pielou (J), valor de importancia por especie y diversidad ? a través del índice de similitud de Sørensen. El catálogo florístico exhibe 45 especies distribuidas en 32 géneros correspondientes a 23 familias, de las cuales las más representativas son Poaceae, Cyperaceae y Typhaceae. Se amplía el área de distribución de ocho especies para la provincia de Río Negro. Predominan las plantas de ciclo perenne, hábito herbáceo, tipo emergente y biotipo helophyta (82%). El mayor valor de importancia en los ambientes urbanos corresponde a Stuckenia pectinata, mientras que en los rurales a Nasturtium officinale y Azolla filiculoides. Esta investigación presenta información de base para estudios posteriores sobre el potencial bioindicador y fitorremediador de las macrófitas acuáticas vasculares del sistema de drenaje.