bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of GRASP on DCE-MRI for assessing response to neoadjuvant chemotherapy in patients with esophageal cancer
Authors: Lu Yanan , Ma Ling , QIN Jianjun , Wang Zhaoqi , Guo Jia , Zhao Yan , Zhang Hongkai , Yan Xu , Liu Hui , Li Hailiang , Kamel Ihab R , Qu Jinrong
Published: September 2019

Background To compare the value of two dynamic contrast-enhanced Magnetic Resonance Images (DCE-MRI) reconstruction approaches, namely golden-angle radial sparse parallel (GRASP) and view-sharing with golden-angle radial profile (VS-GR) reconstruction, and evaluate their values in assessing response to neoadjuvant chemotherapy (nCT) in patients with esophageal cancer (EC).

Methods

EC patients receiving nCT before surgery were enrolled prospectively. DCE-MRI scanning was performed after nCT and within 1 week before surgery. Tumor Regression Grade (TRG) was used for chemotherapy response evaluation, and patients were stratified into a responsive group (TRG1+2) and a non-responsive group (TRG3+4+5). Wilcoxon test was utilized for comparing GRASP and VS-GR reconstruction, Kruskal-Wallis and Mann-Whitney test was performed for each parameter to assess response, and Spearman test was performed for analyzing correlation between parameters and TRGs, as well as responder and non-responder. The receiver operating characteristic (ROC) was utilized for each significant parameter to assess its accuracy between responders and non-responders.

Results

Among the 64 patients included in this cohort (52 male, 12 female; average age of 59.1±7.9 years), 4 patients showed TRG1, 4 patients were TRG2, 7 patients were TRG3, 11 patients were TRG4, and 38 patients were TRG5. They were stratified into 8 responders and 56 non-responders.

A total of 15 parameters were calculated from each tumor. With VS-GR, 10/15 parameters significantly correlated with TRG and response groups. Of these, only AUCmax showed moderate correlation with TRG, 7 showed low correlation and 2 showed negligible correlation with TRG. 8 showed low correlation and 2 showed negligible correlation with response groups. With GRASP, 13/15 parameters significantly correlated with TRG and response groups. Of these, 10 showed low correlation and 3 showed negligible correlation with TRG. 11 showed low correlation and 2 showed negligible correlation with TRG. Seven parameters (AUC ＊ >0.70, P<0.05) showed good performance in response groups.

Conclusions

In patients with esophageal cancer on neoadjuvant chemotherapy, several parameters can differentiate responders from non-responders, using both GRASP and VS-GR techniques. GRASP may be able to better differentiate these two groups compared to VS-GR.
Lack of association between intraoperative handoff of care and postoperative complications: a retrospective observational study
Authors: O'Reilly-Shah Vikas N , Melanson Victoria G , Sullivan Cinnamon L , Jabaley Craig S , Lynde Grant C
Published: September 2019

Background:
The significance of intraoperative anesthesia handoffs on patient outcomes are unclear. One aspect differentiating the disparate results is the treatment of confounding factors, such as patient comorbidities and surgery time of day. We performed this study to quantify the significance of confounding variables on composite adverse events during intraoperative anesthesia handoffs.
Methods:
In this retrospective study, we analyzed data from the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP). We examined the effects of intraoperative handoffs between anesthesia personnel. A total of 12,111 cases performed examined at two hospitals operated by a single healthcare system that were that included in the ACS NSQIP database performed. The presence of attending and anesthetist or resident handoffs, patient age, sex, body mass index, American Society of Anesthesiologists Physical Status (ASA-PS) classification, case length, surgical case complexity, and evening/weekend start time were measured.
Results:
A total of 2,586 of all cases in the NSQIP dataset experienced a handoff during the case. When analyzed as a single variable, attending handoffs were associated with higher rates of adverse outcomes. However, once confounding variables were added into the analysis, attending handoffs and complete care transitions were no longer statistically significant.
Conclusions:
Inclusion of significant covariates is essential to fully understanding the impact provider handoffs have on patient outcomes. Case timing and lengthy case duration are more likely to result in both a handoff and an adverse event. The impact of handoffs on patient outcomes seen in the literature are likely due, in part, to how covariates were addressed.
Willingness to adopt wearable devices with behavioral and economic incentives by health insurance wellness programs: results of a US cross-sectional survey with multiple consumer health vignettes
Authors: Soliño-Fermández Diego , Ding Alexander , Bayro-Kaiser Esteban , Ding Eric L.
Published: September 2019

Background: The number of health-related wearable devices is growing but it is not clear if Americans are willing to adopt health insurance wellness programs based on wearables and the incentives with which they would be more willing to adopt.

Methods: In this cross-sectional study we used a survey methodology, usage vignettes and a dichotomous scale to examine U.S. residents’ willingness to adopt wearables (WTAW) in six use-cases where it was mandatory to use a wearable device and share the resulting data with a health insurance company. Each use-case was tested also for the influence of additional economic incentives on WTAW.

Results: A total of 997 Americans across 46 states participated in the study. Most of them were 25 to 34 years old (40.22%), 57.27% were female, and 74.52% were white. On average, 69.5% of the respondents were willing to adopt health-insurance use-cases based on wearable devices, though 77.8% of them were concerned about issues related to economic benefits, data privacy and to a lesser extent, technological accuracy. WTAW was 11-18% higher among consumers in use-cases involving health promotion and disease prevention. Furthermore, additional economic incentives combined with wearables increased WTAW overall. Notably, financial incentives involving providing healthcare credits, insurance premium discount, and/or wellness product discounts had particularly greater effectiveness for increasing WTAW in the consumer use-cases involving participation: for health promotion (RR=1.06 for financial incentive, 95% CI: 1.01-1.11; P=0.018); for personalized products and services (RR=1.11 for financial incentive, 95% CI: 1.01-1.21; P=0.018); and for automated underwriting discount at annual renewal (RR=1.28 for financial incentive, 95% CI: 1.20-1.37; P<0.001).

Conclusions:
Under the adequate economic, data privacy and technical conditions, 2 out of 3 Americans would be willing to adopt health insurance wellness programs based on wearable devices, particularly if they have benefits related to health promotion and disease prevention, and particularly with financial incentives.
Parenchymal central nervous system involvement in aggressive B-cell lymphoma: retrospective analysis of clinical and MRI features in a Chinese population
Authors: Wu Yuchen , Wang Yaming , Sun Xuefei , Bai Xueyan , Qian Jun , Zhu Hong , Cui Qu , Xing Ruixian , Chen Yuedan , Liu Qing , Guo Jiayuan , Ji Nan , Sun Shengjun , Liu Yuanbo
Published: September 2019

Introduction: Secondary central nervous system lymphoma (SCNSL) was defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma. Parenchymal involvement of the CNS in aggressive B-cell lymphoma was rare and remains a diagnostic dilemma. Materials and Methods: In our study, we retrospectively analyzed the clinical and magnetic resonance imaging (MRI) features of 26 parenchymal SCNSL patients. In addition, we compared MRI features between SCNSL and primary CNS lymphoma (PCNSL) patients after 1:1 propensity score matching. Results: Among SCNSL patients, the median CNS relapse time was 3 months, and multiple lesions were found in 76.9% of the cases. In PCNSL, this percentage was 34.8% (p=0.023). None of the SCNSL patients and 11.5% of the PCNSL patients had solitary infratentorial lesions (p=0.011). Conclusions: The majority of parenchymal involvement occurred within the first year of systemic lymphoma, in which mostly cases presenting with multiple and supratentorial locations, unlike what was found in PCNSL.
Knowledge of neonatal danger signs and associated factors among mothers who gave birth during the last four months while attending immunization services in Harar town public health facilities, Ethiopia.
Authors: Tekulu Fissaha welay , Kassa Nega Assefa , Hadera Gebrekiros Aregawi , Assefa Natnael Etsay , Mengesha Meresa Berwo , Weldemariam Mulu Gebretsadik , Gebremeskel Senait Gebreslasie
Published: September 2019

Objective:
The purpose of this study was to assess knowledge about neonatal danger signs and associated factors among mothers who gave birth in the last 4 months attending immunization services.
Result: The study recruited 432 mothers to participate. A knowledge score of neonatal danger signs was found [32.9% (95% CI: 28.9%, 37%)]. Mothers educated to secondary level were 4.9 times more likely to know about neonatal danger signs [(AOR=4.9, 95% CI: (1.15, 21). Similarly, mothers whose husband educated to college and above [AOR=4.95, 95% CI: (1.15, 21)], and being multipara mother [(AOR=2.59, 95% CI: (1.05, 6.6)], were factors significantly associated with good knowledge of mothers about neonatal danger signs.
Keywords: Neonatal danger sign, Mothers' knowledge, Immunization
Efficacy and safety of self-expanding metallic stent placement followed by neoadjuvant chemotherapy and scheduled surgery for treatment of obstructing left-sided colonic cancer
Authors: Han Jia Gang , Wang Zhen Jun , Zeng Wei Gen , Wang Yan Bin , Wei Guang Hui , Zhai Zhi Wei , Zhao Bao Cheng , Yi Bing Qiang
Published: September 2019

BACKGROUND: Stoma is reported to be frequent in self-expanding metallic stent (SEMS) treated patients with obstructing left-sided colon cancer than in those with non-obstructing surgery. This study aimed to evaluate the safety and feasibility of SEMS followed by neoadjuvant chemotherapy prior to elective surgery for obstructing left-sided colon cancer. METHODS: Eleven consecutive patients with obstructing left-sided colon cancer between May 2014 and November 2015 were included retrospectively. All patients received SEMS followed by neoadjuvant chemotherapy. The primary outcome measure was stoma and laparoscopic surgery. RESULTS: Chemotherapy was with two cycles of CAPOX (54.5%) or three cycles mFOLFOX6 (45.5%). Median serum albumin and hemoglobin levels before surgery were significantly higher than before neoadjuvant chemotherapy (p = 0.01 and p = 0.008 respectively) and before SEMS (p = 0.01 and p = 0.003 respectively). Median bowel wall thickness proximal to the upper edge of tumor was significantly more before neoadjuvant chemotherapy than before stent (p = 0.003), and significantly less before surgery than before neoadjuvant chemotherapy (p = 0.003). No patient underwent stoma creation. Laparoscopic surgery was performed in nine (81.8%) patients. No local recurrence or metastases developed over median cancer-specific follow-up of 44 months (range, 37-55 months). CONCLUSION: SEMS followed by neoadjuvant chemotherapy prior to elective surgery appears to be safe and well tolerated in patients with obstructing left-sided colon cancer.NCT02972541; retrospectively registered
The Influence of Marital Status on Survival in Patients with Nasopharyngeal Carcinoma: A Surveillance, Epidemiology, and End Results (SEER) Database Analysis
Authors: Yu Bin , Ning Hong , Xu Shan , Qin Li , Lin Bin-wei , Lin Fei
Published: September 2019

Purpose: To assess the influence of marital status on survival in patients with nasopharyngeal carcinoma (NPC). Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to analyze 5477 patients who were diagnosed with NPC from 2004 to 2016. Kaplan–Meier survival analysis and Cox proportional hazard regression were used to analyze the influences of marital status on cause-specific survival (CSS) and overall survival (OS). Subgroup analyses was used to assess the influences of marital status on CSS based on different factors. Results: The 5477 patients were divided into three groups, with 61.5%, 22.4%, and 16.1% of patients being married, single/unmarried, and separated/widowed/divorced, respectively. The separated/widowed/divorced group were more likely to be female ( P <0.001); had the highest proportion of elderly subjects ( P <0.001); were mostly Caucasian ( P <0.001); had pathological grading I/II ( P <0.001); were likely to receive surgery ( P =0.032); and were registered at the northeast, north central, and south ( P < 0.001) regions. The 5-year CSS was 92.6%, 92.4%, and 85.1% in the married, single/unmarried, and separated/widowed/divorced groups, respectively ( P <0.001); and respective 5-year OS was 60.7%, 54.6%, and 40.1% ( P <0.001). Marital status was the independent prognostic factor for NPC. Compared with married patients, separated/widowed/divorced patients had a significantly increased risk of NPC-related death (hazard ratio [HR]=2.180, 95% confidence interval [CI] 1.721–2.757, P <0.001). The single/unmarried ( P =0.355) group had a similar CSS as that of the group. Conclusion: Marital status is an independent prognostic factor for survival of NCP patients. Separated/widowed/divorced status increases the risk of NPC mortality; hence, more social and psychosocial support should be given to patients who are separated, widowed, or divorced.
Discussion on perioperative anesthesia rescue treatment for DIC parturients with severe placental abruption
Authors: Wang Author Shihong , Wang Hua
Published: September 2019

Background: To investigate perioperative anesthesia rescue treatment method and effect of DIC parturients with severe placental abruption. Methods: Designed as a retrospective inductive analysis, the present study included 6 parturients of DIC with severe placental abruption who were admitted to Dalingshan Hospital of Dongguan City from January 2013 to December 2018. The research further studied and analyzed the perioperative anesthesia treatment of 6 DIC parturients with severe placental abruption. Observation indicators included (1) Preoperative evaluation, (2) Intraoperative conditions, and (3) Follow-up after operation. Results: (1) Preoperative evaluation: 25 cases of severe placental abruption were grade III ASA, including 3 stillbirths. (2) Intraoperative conditions: 6 cases of DIC parturients were confirmed to have severe placental abruption, including 3 stillbirths. (3) Postoperative follow-up: All the 6 parturients were cured without any complications. Conclusion: Standardized rescue processing method with multidisciplinary cooperation, rapid and advanced intervention, and simultaneous multiple measures can improve the operative safety of parturients with placental abruption.
Assessment of food taboos and related misconceptions during pregnancy in Mekelle city, Tigray, Northern Ethiopia
Authors: Tela Freweini Gebrearegay , Gebremariam Lemlem Weldegerima , Beyene Selamawit Asfaw
Published: September 2019

Introduction Communities, rural or urban, have their own taboos and misconceptions regarding what type of foods to consume and avoid during pregnancy and why. In Ethiopia, as in many other developing countries, there are misconceptions on specific quality and quantity of food a pregnant woman should or should not eat during pregnancy, affecting their nutritional status. Despite this, information related to food taboos in Ethiopia is lacking. Therefore, this study assessed food taboos and related misconceptions during pregnancy in Mekelle city, Tigray, Northern Ethiopia.Method A cross-sectional study was conducted among 332 pregnant women who were in antenatal care follow-up in selected private clinics starting from January 1st up to June/30/2017. A semi-structured questionnaire consisting of closed and open ended questions was prepared in the way that it can assess the food taboo practices, types of foods avoided, and the perceived reasons for avoidance. Data were entered in to SPSS version 21 for analysis. The results were described using frequency and percentage, and presented using tables. Cross-tabulation (x 2 - test) was used to analyze the association between different socio-demographic variables and food taboo practice. Statistical significance was declared at P -value < 0.05 and 95% confidence interval (CI).Result The results of this study indicate that 11.5% of the pregnant women avoided at least one type of food during their current pregnancy because of different perceptions. The mothers were forbidden from taking food items such as yogurt, banana, legumes, honey, “kollo” (roasted barley and wheat), and spices (mustard). The most common perceptions for the avoidance of these foods were abortion, abdominal cramp to the mother and newborn, prolonged labor, and coating to the body of the fetus. Among the socio-demographic characteristics studied, educational status was found to significantly influence food taboo practices among the study participants (P<0.0001).Conclusion The misconception on the feeding practice during pregnancy should be discouraged, and health providers should promptly counsel pregnant women about appropriate feeding practices during their ANC visits.
Aspirin Decreases Hepatocellular Carcinoma Risk in Hepatitis C Virus Carriers: A Nationwide Cohort Study
Authors: Liao Yen-Hsiang , Hsu Wen-Lin , Wang Tzu-Hwei , Wu Chen-Ta , Huang Sheng-Yao , Hsu Chung-Y. , Su Yuan-Chih , Liu Dai-Wei
Published: September 2019

Background Aspirin lowered some cancer occurrence rate, through the inhibition of the cyclooxygenase enzyme. The association of aspirin-use and hepatocellular carcinoma (HCC) occurrence rate in hepatitis B virus (HBV) carriers is well known. However, the association in hepatitis C virus (HCV) carriers is not known. Our purpose is comparing the HCC occurrence rate in HCV carriers with or without Aspirin treatment. Methods In this retrospective cohort study, the participants were ones newly-diagnosed with HCV from 2000 to 2012 in Taiwan. These HCV carriers with aspirin treatment were defined as the control group, whereas those without aspirin were defined as a compared cohort. We used a 1:1 propensity score matching by age, sex, comorbidities, drugs, diagnosis year and index year with covariate assessment. Results Our study sample consisted of 2980 aspirin-treated HCV carriers and 7771 non-aspirin-treated HCV carriers. After propensity score matching, each cohort consisted of 1911 HCV carriers. The adjusted hazard ratio (aHR) of HCC incidence in aspirin users (aHR=0.56, 95% CI=0.43-0.72, p < 0.001 ) was significantly lower than that in non-aspirin users. The Kaplan-Meier curves show that among the HCV carriers, aspirin users had a lower cumulative incidence rate of HCC in the first 10-year aspirin treatment course ( p < 0.0001 ). Conclusions The HCC incidence rate was lower in the aspirin users than non- aspirin users among HCV carriers, supporting the aspirin effect may be acting through inhibition of the cyclooxygenase enzyme pathway. Moreover, the patients got HCC protection by aspirin within 1-year treatment course and had best HCC prevention during 1- to 2-year aspirin treatment course. We encourage aspirin treatment to prevent HCC in HCV carriers.
Profile and Outcome of Patients with Upper Gastrointestinal Bleeding Presenting to Urban Emergency Departments of Tertiary Hospitals in Tanzania
Authors: Rajan Shaffin S. , Sawe Hendry Robert , Iyullu Asha J. , Kaale Dereck A. , Olambo Nancy A. , Mfinanga Juma A. , Weber Ellen J.
Published: September 2019

Background: Upper Gastrointestinal Bleeding (UGIB) is a common Emergency Department (ED)presentation with high morbidity and mortality. There is a paucity of data on the profile and outcome of patients who present with UGIB to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania. Methodology: This was a prospective cohort study of consecutive adult (≥18 years) patients presenting to the EDs of Muhimbili National Hospital (EMD-MNH) and MUHAS Academic Medical Centre (EMD-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. We used the clinical Rockall score to assess disease severity. The primary outcome of 7- day mortality was summarized using descriptive statistics. Regression analysis was performed to identify predictors of mortality. Results: During the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42 years (IQR 32-64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7 days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24 hours. There were no ED deaths. About 65.1% of the patients had severe anemia but only 60 (48.8%) received blood transfusion in the ED. Amongst those with h/o esophageal varices 7(41.2%) did not receive octreotide. Only 8 (17.4%) received endoscopy within 24 hours, all of who had a low or moderate clinical Rockall score i.e. <3 and 3-4. Age >40 years was a significant independent predictor of mortality (OR=7.00 (95% CI 1.9-26.4). Receiving UGI endoscopy was independently associated with a lower risk of mortality (OR= 0.27; 95% CI 0.08-0.9.) Conclusion & Recommendations: In this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age < 40 years and endoscopic evaluation during the hospital stay were independent predictors of lower mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy so as to improve outcomes
Investigating the Causal Effect of Socioeconomic Status on Quality of Care under a Universal Health Insurance System – A Marginal Structural Model Approach
Authors: Cho Hoyune E. , Wang Lu , Chen Jung-Sheng , Liu Mochuan , Kuo Chang-Fu , Chung Kevin
Published: September 2019

Background: Social disparities in healthcare persist in the US despite the expansion of Medicaid under the Affordable Care Act. We investigated the causal impact of socioeconomic status on the quality of care in a setting with minimal confounding bias from race, insurance type, and access to care. Methods: We designed a retrospective population-based study with a random 25% sample of adult Taiwan population enrolled in Taiwan’s National Health Insurance system from 2000 to 2016. Patient’s income levels were categorized into low-income group (<25th percentile) and high-income group (≥25th percentile). We used marginal structural modeling analysis to calculate the odds of hospital admissions for 11 ambulatory care sensitive conditions identified by the Agency for Healthcare Research and Quality and the odds of having an Elixhauser comorbidity index greater than zero for low-income patients. Results: Among 2,844,334 patients, those in lower-income group had 1.28 greater odds (95% CI 1.24 – 1.33) of experiencing preventable hospitalizations, and 1.04 greater odds (95% CI 1.03 – 1.05) of having a comorbid condition in comparison to high-income group. Conclusions: Income was shown to be a causal factor in a patient’s health and a determinant of the quality of care received even with equitable access to care under a universal health insurance system. Policies focusing on addressing income as an important upstream causal determinant of health to provide support to patients in lower socioeconomic status will be effective in improving health outcomes for this vulnerable social stratum.
Δ133p53/FLp53 predicts poor clinical outcome in esophageal squamous cell carcinoma
Authors: Tu Qimin , Gong Hongjian , Yuan Chunhui , Liu Gao , Huang Jinqi , Li Zhichao , Luo Jianfei
Published: September 2019

Background p53 isoform Δ133p53 is directly transactivated by p53 and antagonizes p53 activities in cancer progression. However, its correlation with prognosis and cancer recurrence in esophageal squamous cell carcinoma (ESCC) is still unclear.Methods Expression of Δ133p53 and Δ133p53/full-length p53 (FLp53) in tissues and serums of 180 ESCC patients was evaluated using qRT-PCR.Results Tissue Δ133p53 expression and Δ133p53/FLp53 ratio were significantly increased in ESCC tissue compared with adjacent normal tissue. Pre-operative Δ133p53 expression and Δ133p53/FLp53 ratio in tissue or serum samples were positively associated with TNM stage and post-operative recurrence. Kaplan-Meier curve and multivariate cox regression analyses revealed that the tissue and serum Δ133p53/FLp53 ratio (cutoff value: 2.9160) were independent prognostic factors for overall survival (OS) and progression-free survival (PFS) in ESCC patients, and showed no statistical difference in receiver-operating characteristic (ROC) curve analysis, while serum Δ133p53 showed no significant prognostic value. More importantly, the serum Δ133p53/FLp53 ratio in ESCC patients was significantly decreased within 72 h post tumor resection and patients with a consistently high serum Δ133p53/FLp53 ratio (≥ 2.9160) had higher recurrence rates than those with consistently low ratio values. In addition, dynamic detection in each follow-up timepoint showed that serum Δ133p53/FLp53 ratios were higher than 2.9160 upon recurrence, and they even increased prior to radiologic progression.Conclusion The serum Δ133p53/FLp53 ratio can be a novel predictor for survival outcome and may serve as a real-time parameter for monitoring recurrence in ESCC patients after surgery.
Endoscopic surgical treatment with nasal cavity approach for chondrosarcoma of paranasal sinus and the skull base
Authors: Gao Junxiao , Zhu Zhenchao , Ye Yudong , Qiu Qianhui , Fu Ming
Published: September 2019

Background Chondrosarcoma(ChSa) is a rare malignant tumor. But it’s necessary to discuss the clinical characteristics and treatments for ChSa of paranasal sinus and the skull base.
Methods The clinical characteristics of ChSa of paranasal sinus and skull base in 10 patients (6 males and 4 females) from 2001 to 2017 were analyzed. They all underwent by endoscopic surgery . The patients’ age ranged from 18 to 47 years, with a median of 35 years. Clinical symptoms: stuffy, nose bleeding, runny, headache, diplopia, eye outreach limited, blurred vision and even blindness. Surgery methods：under nasal endoscopy, after the attachment sites of the tumors to normal tissues were confirmed, the tumors were peeled off along the clear boundary between the tumors and normal tissues, and the potential residual tumor tissues on bones were cleared by a drill.
Results All patients were treated with endoscopic surgery，followed up postoperatively for 24 to 108 months, with a median of 36 months. 8 of 10 patients were no recurrence,2 were alive with tumor.
Conclusion ChSa of paranasal sinus and skull base can be treated by nasal endoscopic surgery with good clinical results.
Constructing an Experiential Education Model in Undergraduate Radiology Education by the Utilization of the Picture Archiving and Communication System (PACS)
Authors: Chen Yingqian , Zheng Keguo , Ye Shanshan , Wang Jifei , Xu Ling , Li Ziping , Meng Quanfei , Yang Jianyong , Feng Shiting
Published: September 2019

Background
Medical education in China is in a transitional period changing from passive learning to experiential education models. We have modified an experiential education method for radiology education. The aim of this study is to evaluate the effect of this method on undergraduate radiology education.
Methods
With the help of the picture archiving and communication system (PACS) and RadiAnt DICOM Viewer, we have modified an experiential education method that simulates similar working conditions for undergraduate medical students to take on the role as clinical radiologists and formulate radiology diagnosis. A total of 101 students were allocated into either the experiential education group [Office1] or the control group. The final examination scores and a 5-point Likert scale self-assessment questionnaire of radiologic skills were collected from all the students as an objective assessment and a subjective assessment respectively. A questionnaire was also used to assess the satisfaction with the experiential model in the experiential education group. Mann-Whitney U test was used to compare the ranked data, and t -tests were used to compare the numeric data.
Results
The experiential education group demonstrated significantly higher scores (7.4±1.3) in the short answer type questions on imaging “description and diagnosis” when compared to the control group (6.7±1.5, p <0.05). The self-assessment questionnaire indicated that the experiential education corresponded to an increased familiarity with the diagnostic principles, the imaging sequences and reconstruction methods of computer tomography (CT), which also strengthen participants’ confidence to perform future clinical work (p <0.05). The self-assessment questionnaire from the experiential education group showed great satisfaction with the organization (82.5%), interactivity (85%) and quality (85%) of the learning activity in majority of students. Most students found this model of learning to be helpful for studying radiology (85%) and for understanding anatomy (90%).
Conclusion
Compared with the traditional radiology education approach, the experiential education model showed greater efficacy in improving students’ analytical and diagnostic skills as well as clinical confidence.
A Collaborative Initiative to Strengthen Sustainable Public Health Capacity for Polio Eradication and Routine Immunization Activities in the Eastern Mediterranean Region
Authors: Al Gunaid Magid , Lami Faris , Jarour Najwa
Published: September 2019

The many challenges in the Eastern Mediterranean region put the involved countries at risk of polio transmission and affect their ability to meet progress targets in eliminating vaccine-preventable diseases. The Global Health Development (GHD) and Eastern Mediterranean Public Health Network (EMPHNET) are working together on the project “Strengthening sustainable public health capacity in the Eastern Mediterranean region for polio eradication and routine immunization activities” with an overall goal of improving routine immunization, eradicating poliovirus, and controlling/eliminating or eradicating other vaccine-preventable diseases in the Eastern Mediterranean region. The aim of this manuscript is to describe the project and the achievements of GHD/EMPHNET over the last 3 years (2016-2018) to build effective surveillance and immunization systems in the Eastern Mediterranean region through the development of a sustainable and competent public health system to eradicate polio and control/eliminate vaccine-preventable diseases. This project assists the targeted Eastern Mediterranean region countries to build effective surveillance and immunization systems in an effort to expand their capacities to eradicate polio and control/eliminate other vaccine-preventable diseases. The project is streamlined with the Global Polio Eradication Initiative, the Centers for Disease Control and Prevention’s Strategic Framework for Global Immunization 2016-2020, and the Polio Eradication and Endgame Strategic Plan 2013-2018. The project also supports the Global Health Security Agenda by focusing on efforts to accelerate progress toward a world safe and secure from infectious disease threats. Project activities were designed to respond to countries’ needs and assist them in building their institutional and workforce capacity to effectively plan, implement, and evaluate activities to eradicate polio and strengthen routine immunization activities. The project activities covered a set of areas including surveillance of acute flaccid paralysis and other vaccine-preventable diseases, family and community engagement, workforce capacity building, improvement of data quality, management and use of information systems, use of polio assets to control/eliminate other vaccine-preventable diseases, support of countries to develop national strategies, piloting of innovative initiatives, program evaluation and accountability, and immunization strengthening. The project adopts the Global Polio Eradication Initiative strategies for assisting countries to strengthen routine immunization services, maintain highly sensitive acute flaccid paralysis surveillance, and sustain polio eradication functions.
Práticas Inovadoras: Difícil Conquista
Authors: Fraga Tutikian Jane
Published: September 2019

Este artigo traz uma breve visão dos séculos XX e XXI, com suas transformaçõeshistóricas, sociais e culturais. É, acima de tudo, o desenvolvimento tecnológico quesubverte o conceito de Humanismo. Existe, agora, uma nova maneira de estar no mundo. Novas ideias e novas formas de organizar o conhecimento requerem novas práticas pedagógicas. Para isso, podemos pensar em redes de pesquisa educacional global, em experiências de colaboração e de compartilhamento, em inovação no sentido amplo e em processos de aprendizagem capazes de criar novas possibilidades para o desenvolvimento humano. A metodologia destacada aqui é a Aprendizagem Invertida.
Perception of Preparers and Users on Sustainability Reporting in Singapore
Authors: Chiat Hwang Soo , . Wong Dan Chi
Published: September 2019

The trend of sustainability reports has increased inexorably as the clamor by various stakeholders including NGOs have been growing louder and louder. In Singapore only a small percentage of listed companies are voluntary providing sustainability reporting but this number is set to increase in line with the world trend. This study attempts to address the perceptions of the importance and usefulness of sustainability reporting, the reporting framework and the training needs of both users and preparers to provide such reports. The results from a survey suggest that the respondents (both undergraduates and managers) perceive sustainability reporting positively and there is a need to provide training especially in the area of integrating financial reporting with sustainability reporting.
A Study of Required English Skills for Healthcare Personnel in Bangkok-Based International Hospitals
Authors: Pandey Inthira
Published: September 2019

The effective use of English skills is required for the Thai healthcare personnel. This study therefore aims to explore: 1) the use of the four English language skills by Thai healthcare personnel, 2) the minimum framework of effective interaction involvement for their situational contexts, and 3) the problems encountered when they communicate with foreign patients. This study revealed the following findings. Firstly, English speaking and listening skills were the two most important skills especially needed for healthcare personnel in their workplace. Secondly, grammatical errors and varieties of accents and pronunciation were seen as major communication problems. Lastly, the culture, social etiquettes, and values between healthcare personnel and foreign patients are required to build an internationally accepted reputation and meet patientsâ€™ social, cultural, and linguistic needs. This study indicates that intensive practice of the language skills is needed for healthcare personnel in preparing Thailand for the medical hub, AEC and the global market.
National Scarce Skills within the Professional Chefâ€™s Sector in South Africa
Authors: Balkaran Rishidaw , Giampiccoli Andrea
Published: September 2019

Since 1994, South Africa has witnessed an exceptional growth of the tourism sector. The hospitality sector is following a same positive trend however, there is not an appropriate growth of its human resources. South Africa, as many other countries, suffers a skills shortage of catering employees such as executive chefs and cooks. In addition, the historical context of South Africa has produced a specific skewed demographic picture of kitchen staff that now needs to be rebalanced. The skills shortage of kitchen staff could seriously affect the quality of service of the growing hospitality sector. This paper intends to investigate the context and problems related to kitchen staff shortages in South Africa. A literature review of factors such as low wages, unsociable and long hours will be outlined. Thereafter, the specific context of South Africa will be investigated. The specific history of the country has influenced also the hospitality (and kitchen staff) milieu, thus issues in the transformation of the sector will need to be put forward. The paper will conclude with some possible suggestion to decrease the skill shortage in kitchen staff in South Africa.
Conflict Resolution in the Senior High Schools in Ghana and its Implications for Educational Administration: A Case Study of Ashanti Region, Ghana
Authors: Gyan Ernest Kwabena
Published: September 2019

The specific objective of this research is to look at conflict resolution in institution as being experienced in Ghanaian Senior High School. The researcher used descriptive research design to collect data from forty-three (43) Senior High Schools in the Ashanti Region of Ghana. The result indicated that when conflict is managed well, there is performance and better output; increasing effectiveness and efficiency in the school system. Despite limitations of the study, the general results depicted the core role conflict resolution plays in achieving institutional aims, objectives, aspiration and goals
Sources of Information Referred for Higher Education Institution Selection
Authors: Mohd Noor Ismawati
Published: September 2019

In response to the increase in demand on tertiary education, number of higher education institution raised dramatically over the past few decades. The scenario creates competition environment leading to the needs for understanding how studentsâ€™ decision were made. Recent literature on higher education has been acknowledging the role of marketing in attracting potential students. This paper explores the decision process of selecting higher education institution within the framework of marketing communication. From the perception of students who are successfully accepted in a higher education institution, the analysis was done to investigate what was the source of information being referred. Analysis was also done to identify which source perceived by the students as their most influential source of information in deciding which institution to apply for. The finding suggests that traditional marketing tools such as news paper and magazine advertisement or publication is still effective as compared with other interactive marketing approach such as websites and education fair. The influence of their significant others such as parents, siblings and peers is also discussed.
NATOs offensive cyberspaceoperationer. Muligheder og udfordringer ved NATOs forespørgselsdrevne og effektbaserede tilgang
Authors: Jacobsen Jeppe Teglskov
Published: September 2019

NATO har i det seneste årti orienteret sig mod de defensive aktiviteter i cyberspace, men i slutningen af 2017 gjorde alliancen det klart, at fremtidig planlægning af militære operationer også kommer til at indeholde muligheden for offensive cyberspaceoperationer (OCO). Inklusionen af OCO sker ved hjælp af en såkaldt ”effektbaseret model”. Ifølge denne model efterspørger NATOs øverstkommanderende – igennem det nyoprettede NATO Cyber Operations Centre – en specifik cybereffekt hos medlemsstaterne. Nærværende artikel peger på modellens muligheder og udfordringer. For selvom OCO indeholder et potentiale som redskab for løbende forstyrrelser af modstanderens netværk, så indeholder OCO også en række begrænsninger og faldgruber, når de skal integreres i en forespørgselsdreven og effektbaseret model: Det gælder i særlig grad manglende koordination omkring effekter (risiko for kollisioner) samt vanskeligheder ved inddæmning og vurdering af effekter. Disse begrænsninger svækker signalet om, at alliancen nu mestrer og for alvor vil gøre brug af cyberdomænet. Ønsker NATO at sende et klart signal, bør alliancen drøfte internt, hvordan man forholder sig til de aktiviteter, der ikke blot knytter sig til væbnet konflikt, som cyberspace også – og primært – tilbyder.
Absract in English
For the past decade, NATO has prioritised a strengthened cyber defence. However, at the end of 2017, the alliance made it clear that future operational planning will include the possibility of offensive cyberspace operations (OCO). The integration of OCO will happen through an effect-based model where the NATO commander – through the new NATO Cyber Operations Centre – requests a specific effect from member states. This article assesses the risks and opportunities of this model. It argues that even though OCO holds much potential for constant disruptions of an adversary’s networks, OCO comes with several limitations and pitfalls when integrated through a request- and effect-based model. These include the risk of confliction and the difficulty of containing and assessing cyber effects. Such limitations weaken the ability to signal that NATO has the capacity to master this new domain. If NATO wants a to send a clear signal to adversaries, then the alliance needs to start discussing how it can utilise the possibilities below the threshold of armed conflict, which cyberspace primarily offers.
Avskrekke hvem? Betydningen av strategisk kultur for cybersikkerhet
Authors: Gjesvik Lars , Øverbø Emil Jørgensen
Published: September 2019

Det er en pågående debatt i akademia om hvorvidt og hvordan man kan benytte avskrekkingsteori i cyberdomenet. Avskrekking var originalt en teori utviklet for å unngå konvensjonell eller nukleær krig. I diskusjonen om cybersikkerhet har det blitt påpekt en rekke tekniske problemer med å overføre en teori fra den fysiske verden til cyberdomenet. Vi anerkjenner disse tekniske utfordringene ved avskrekking i cyberdomenet, men i denne artikkelen ønsker vi å belyse et annet aspekt ved avskrekking, nemlig samspillet mellom sosiale og tekniske faktorer ved avskrekking i cyberdomenet. I denne artikkelen vil vi diskutere hvordan avskrekking som strategi i cyberdomenet vil påvirkes av den spesifikke strategiske kulturen i et land. For å belyse argumentet vil vi benytte Kina som en casestudie. Motsetninger mellom kinesisk og «vestlig» strategisk kultur resulterer i konkrete forskjeller i hvordan Kina og vestlige land agerer i cyberdomenet. Ved å benytte fire komponenter av avskrekkingsteori (nektelse, gjengjeldelse, gjensidig avhengighet og normer) ønsker vi å vise hvordan en dyptgående innsikt i en stats sikkerhetspolitikk og strategiske kultur kan anvendes til å skreddersy en mer effektiv avskrekkingsstrategi og styrke evnen til å forhindre uønsket aktivitet.
Abstract in English
There is an ongoing debate in academia about if and how deterrence theory may be used in cyberspace. Deterrence was originally a theory developed for avoiding conventional and nuclear war. In the current discussion on cyber security, there has been pointed out a range of technical problems of transferring a theory about the physical world to cyberspace. We recognize these challenges of deterrence in cyberspace, but in this article we want to shed light on a different aspect of deterrence. That is the interplay between social and technical factors of deterrence in cyberspace. In this article we will discuss how deterrence as a strategy in cyberspace is influenced by the specific strategic culture of a country. We will use China as a case study to showcase our argument. Contrasts between Chinese and “Western” strategic culture results in concrete differences in how Chinese and Western countries act in cyberspace. By utilizing four components of deterrence theory (denial, punishment, entanglement and norms), we will show how an in-depth knowledge of a state’s security policy and strategic culture may be used to tailor a more effective deterrence and enforce the capacity of hindering unwanted activity.
Inn i gråsonen: avskrekking som forsvar av cyberspace?
Authors: Muller Lilly Pijnenburg
Published: September 2019

Selv om det kan hevdes at de ulike elementene som utgjør cyberoperasjoner – undergraving, sabotasje, manipulering, tyveri og desinformasjon – ikke er noe nytt, sprer de seg i dag med en hastighet og i et omfang som er uten historisk sidestykke. Cybersikkerhet er tett sammenvevd med det 21. århundres politiske og militære konflikter. Som NATOs generalsekretær Jens Stoltenberg påpeker, har de fleste konflikter og kriser i våre dager en cyberdimensjon, og det er vanskelig å forestille seg en militær konflikt i dag uten (Stoltenberg, 2016). Av denne grunn har såkalt cyberavskrekking blitt tema for en omfattende militær, politisk og akademisk debatt som kretser rundt et sett av viktige operasjonelle konsepter og overveielser. Et sentralt tema er hvorvidt det kan avskrekkes i cyberspace, gitt attribusjons utfordringene som preger etterdønningene av et cyberangrep. Denne artikkelen stiller spørsmål ved om «cyberavskrekking» er mulig og hensiktsmessig, og drøfter nye mulige måter å tenke rundt avskrekking i cyberspace på.
Abstract in English
Cybersecurity is deeply intertwined with every aspect of today’s political and military conflict. In conjunction with the growing acceptance of cyberspace as a military domain, so called “cyber deterrence” has become the subject of extensive military, political and academic debates. Revolving around a set of important strategic and operational concepts the debates are questioning whether deterrence can be achieved in cyberspace. In line with current debates, this article examines if “cyber deterrence” is possible, appropriate, and desirable, yet extends the debate by including new possible ways to think about deterrence and defense in cyberspace. By drawing attention to cyberspace’s idiosyncrasies while questioning the orthodoxy of deterrence as a concept, a reconceptualization of “cyber deterrence” that focuses on cyberspace itself is argued for, one which incorporates new outlooks and ideas, some of which may challenge the established boundaries of deterrence theory.
Internett som geopolitisk arena?
Authors: Svenungsen Bjørn
Published: September 2019

Internett er i dag verdens viktigste infrastruktur. Dets formidable suksess er bygget på prinsipper om åpenhet, frihet, robusthet og sikkerhet. Dette er prinsipper som viser seg stadig vanskeligere å forene. Internetts grunnleggende arkitektur er i liten grad konstruert for å ta hensyn til geografiske grenser. Staters behov for suverenitetshevdelse, kontroll og sikkerhet har likevel skapt en utvikling i retning av «cybersuverenitet» som er i ferd med å endre internett slik vi kjenner det, hvor nettverkene og deres underliggende arkitektur i økende grad inngår i staters geopolitiske ambisjoner. Dette er fortellingen om den viktigste globale konflikten du aldri har hørt om.
Abstract in English
The internet is the world’s most important infrastructure. Its vast success has been built on principles of openness, freedom, resilience and security. These are principles that are increasingly difficult to combine. States’ demand for control and security has developed the concept of “cyber sovereignty” which is about to change the internet as we know it, where the networks and their underlying architecture play an increasing role in the geopolitical ambitions of states.
Forord: Cybersikkerhet
Authors: Schia Niels Nagelhus
Published: September 2019

Den teknologiske utviklingen og framveksten av digitale nettverk har ført til noen av de mest dramatiske endringene vi har sett på flere generasjoner. Dette gjelder endringer både i sosial samhandling, men også for den mer generelle samfunnsmessig utviklingen. Disse framskrittene har også hatt viktige implikasjoner for sikkerhetspolitikk, internasjonal politikk og forhold mellom stormakter. Dette har igjen ledet til framveksten av cybersikkerhet som et empirisk forskningsfelt for samfunnsvitere. I denne fokusspalten har vi invitert samfunnsvitere til å belyse hvordan cybersikkerhet bidrar til å endre forhold mellom stater, internasjonale organisasjoner, og internasjonal politikk.
Analisis Potensi Daerah untuk Mengembangkan Wilayah di Eks-Karesidenan Surakarta menggunakan Teori Pusat Pertumbuhan
Authors: Setyowati Erma , Trisnawati Rina
Published: September 2019

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