bluuebunny/crossref_metadata_2025 huggingface dataset:
TECHNICAL BACHELOR STUDENTS’ ATTITUDE TO DISTANCE LEARNING
Authors: Фоминых Светлана Олеговна , Александрова Галина Александровна , Филиппова Ирина Владимировна
Published: January 2021

В условиях распространения Covid-19 в нашей стране практически все образовательные учреждения перешли на дистанционные образовательные технологии. У преподавателей и студентов вуза не было возможности плавного перехода к дистанционной форме обучения, а сроки были максимально сжаты. Предметом исследования является отношение студентов ЧГПУ им. И. Я. Яковлева к дистанционному обучению.Исследование проводилось на основе анкетирования студентов очной формы обучения, вынужденных в условиях распространения Covid-19 перейти на новый для них формат обучения. По результатам опроса можно сделать вывод, что основная доля респондентов на сегодняшний день не готова полностью отказаться от традиционных методов обучения в пользу дистанционных образовательных технологий.Проведенное исследование показало увеличение учебной нагрузки на студентов во время дистанционного обучения, а также позволило выявить его положительные стороны (занятия в комфортной и привычной обстановке; гибкость учебного процесса; возможность совмещать работу с учебой и т. д.) и трудности, с которыми пришлось столкнуться студентам в процессе дистанционного обучения (сложность выполнения практических заданий без объяснений преподавателя, большой объем заданий, учебной информации и т. д.

In the context of the spread of Covid-19 in our country, almost all educational institutions have switched to distance educational technologies. University lecturers and students did not have a chance to go to distance learning gradually, and the terms were rather short. The subject of the research is the attitude of Yakovlev University students to distance learning.The study was carried out on the basis of the results of the questionnaire on the transition to a new form of education in the context of Covid-19. This questionnaire was held among full-time students who had experienced that transition. According to the results of the survey, it can be concluded that the majority of the respondents today are not ready to completely abandon the traditional form of learning in favor of distance learning technologies.The study showed an increase in the study load on students during distance learning, and also made it possible to identify its positive aspects (learning in a comfortable and familiar environment; flexibility of the educational process; the ability to combine work with study, etc.) and the difficulties that students were to face in the process of distance learning (the difficulty of completing practical tasks without explanations from the lecturer, a large amount of information asked, etc.).
THE INFLUENCE OF IMPACT SPEED ON CHEST INJURY OUTCOME IN WHOLE BODY FRONTAL SLED IMPACTS
Authors: Xiao Sen , Mo Fuhao , Yang Jikuang , Huang Jing , Xiao Zhi , Crandall Jeff R.
Published: January 2021

While the seatbelt restraint has significantly improved occupant safety, the protection efficiency still needs further enhance to reduce the consequence of the crash. Influence of seatbelt restraint loading on chest injury under 40 km/h has been tested and documented. However, a comprehensive profiling of the efficiency of restraint systems with various impact speeds has not yet been sufficiently reported. The purpose of this study is to analyse the effect of the seatbelt loadings on chest injuries at different impact speeds utilizing a high bio-fidelity human body Finite Element (FE) model. Based on the whole-body frontal sled test configuration, the current simulation is setup using a substitute of Post-Mortem Human Subjects (PMHS). Chest injury outcomes from simulations are analysed in terms of design variables, such as seatbelt position parameters and collision speed in a full factorial experimental design. These outcomes are specifically referred to strain-based injury probabilities and four-point chest deflections caused by the change of the parameters. The results indicate that impact speed does influence chest injury outcome. The ribcage injury risk for more than 3 fractured ribs will increase from around 40 to nearly 100% when the impact speed change from 20 to 40 km/h if the seatbelt positioned at the middle-sternum of this study. Great injuries to the chest are mainly caused by the change of inertia, which indicates that chest injuries are greatly affected by the impact speed. Furthermore, the rib fracture risk and chest deflection are nonlinearly correlated with the change of the seatbelt position parameters. The study approach can serve as a reference for seatbelt virtual design. Meanwhile, it also provides basis for the research of chest injury mechanism.
Rhodnius micki, a new species of Triatominae (Hemiptera, Reduviidae) from Bolivia
Authors: Zhao Yisheng , Galvão Cleber , Cai Wanzhi
Published: January 2021

Rhodnius Stål, 1859 is the second largest genus of Triatominae after Triatoma Laporte, 1832, and includes several important Chagas vectors. Genitalia in Reduviidae are frequently used for species identification, but the current use of terminology for it is inconsistent in Triatominae. Here, Rhodnius mickisp. nov., is described from Bolivia and considered as belonging to the pictipes group based on its morphological characters and distribution. Detailed documentation of the genitalia of Rhodnius mickisp. nov. is provided with emphasis on its everted phallus, especially the endosomal sclerites, which are potentially useful as species-level diagnostic features in Rhodnius. To further verify the validity of this species, the head shapes and wing venation patterns of five species in Rhodnius are compared with morphometric analysis. After reviewing taxonomic and comparative morphology papers of assassin bugs, a vocabulary with a terminology of morphological characters, especially of external male genitalic characters, is assembled with the preferred terms and the synonyms listed. Establishing a consistent terminological framework will greatly facilitate future research on the homology of these structures across Triatominae and will ultimately contribute to our understanding of the evolution of these groups.
Five new genera of the subfamily Cylapinae (Insecta, Heteroptera, Miridae) from Australia
Authors: Namyatova Anna A. , Cassis Gerasimos
Published: January 2021

Cylapinae is one of the poorly studied groups within the megadiverse family Miridae (Insecta: Heteroptera). In this paper, five monotypic genera from Australia are described as new to science. Two of those taxa,Dariella rubrocuneatagen. nov.andsp. nov., andLabriella fuscagen. nov.andsp. nov.are assigned to the tribe Cylapini. Three taxa,Callitropisca florentinegen. nov.andsp. nov.,Laetifulvius morganensisgen. nov.andsp. nov.andMicanitropis seisiagen. nov.andsp. nov.are placed into the tribe Fulviini. Habitus images, SEMs of external characters, illustrations of male and female genitalia, and distribution maps are provided for each species where possible. The systematic position and possible relationships of the newly described taxa are discussed.
Les troubles du comportement en maternelle
Authors: Gasparini Rachel
Published: January 2021

Comment expliquer que l’expression « troubles du comportement » soit à la fois si critiquée et pourtant si souvent utilisée par les professionnels de l’école et hors école intervenant auprès d’élèves de maternelle très agités ? À partir des résultats d’une recherche sociologique par entretiens menée entre 2015 et 2017 auprès de 70 professionnels exerçant à l’école et en centre médico-psychologique (CMP), nous retrouvons deux interprétations déjà mobilisées dans d’autres recherches : la « médicalisation » du champ pédagogique et des difficultés scolaires ainsi que la délégation par les enseignants du « sale boulot » vers d’autres professionnels. Nos résultats nous amènent à explorer une troisième piste relative au souci de désigner une réalité pragmatique en vue de partager des soucis professionnels et de chercher des pistes d’action. Ces dernières conduisent en définitive à une activité normative par la mobilisation de régimes de justification permettant de développer des coopérations professionnelles internes à l’établissement ou avec les acteurs des secteurs social et médico-social.
Défis et enjeux des coordinations dans les systèmes alimentaires du milieu (SYAM). Une analyse par la sociologie de la traduction
Authors: Lequin Julie
Published: January 2021

Le champ de recherche des systèmes alimentaires alternatifs foisonne : de nouvelles formes innovantes et hybrides de systèmes alimentaires apparaissent, comme les Systèmes alimentaires du milieu (SYAM). La question des processus qui sous-tendent l’émergence et la stabilisation des coordinations des acteurs au sein de ces systèmes reste encore à approfondir. Pour répondre à cette question, nous analysons grâce à la sociologie de la traduction qui permet de faire un suivi longitudinal de l’action, la construction pas à pas de la mise en réseau d’acteurs participant à une action commune : celle de développer un SYAM. L’article témoigne du caractère non stabilisé des SYAM : il se construit par une alternance de phases d’élargissement et de contraction et au gré de mises en tension liées à des enjeux de coordination et d’hybridation qui leur sont propres. L’article témoigne enfin de comment les SYAM relèvent ou non les défis liés à ces enjeux. Codes JEL : D74
Diversity, Equity, and Inclusion: A Call to Action
Authors: Shinners Jean
Published: January 2021

The year 2020 has been one of challenges and change. Nursing professional development practitioners are being called to action to purposefully address diversity, equity, and inclusion (DE&I). This article provides insight into how practitioners and administrators can work to create an environment of DE&I that starts with awareness and culminates in creating a nursing workforce and practice environment that reflects the values and beliefs of our profession.

[
J Contin Educ Nurs
. 2021;52(2):57–60.]
Relaunching Nurses to the Forefront of the COVID-19 Pandemic: Heeding the Call Through an RN Refresher Program
Authors: Alexander Karen E.
Published: January 2021

Nursing remains the largest health care profession in the nation and RNs comprise one of the largest segments of the U.S. workforce with just under 4 million RNs nationwide. Despite the large number of nurses in practice, a variety of factors contribute to the availability of RNs able to meet health care–related demands, leading out-of-practice nurses to seek reentry into the workforce. To develop the skills and knowledge needed to deliver safe and effective care, nurses seeking to return to practice need access to formally structured continuing education opportunities. Nursing refresher courses have historically filled this gap, effectively supporting the reemployment of nurses by preparing them for clinical practice. The COVID-19 pandemic is among the most recent factors encouraging nurse reentry, thus furthering the need for continuing education in support of license renewal. This article provides insight into the development of a university-based refresher program for Texas nurses seeking to reactivate licensure and gain the theoretical and clinical knowledge needed to return to nursing considering the health care demands produced by this unprecedented crisis.

[
J Contin Educ Nurs
. 2021;52(2)67–71.]
Comparison of Modified Hybrid Brainstorming With a Conventional Brainstorming Program to Enhance Nurses' Innovative Idea Generation
Authors: Boonyoung Nongnut , Kamonmarttayakul Katekanok , Phumdoung Sasitorn
Published: January 2021

Background:

This study investigated the effectiveness of a modified hybrid brainstorming (MHB) program against conventional brainstorming (CB) to achieve idea generation during innovation initiatives in nursing.

Method:

Pretest and posttest outcomes comparing the two brainstorming methods were tested during a training exercise (
N
= 56). The MHB group (
n
= 29) was trained to apply CB for problem identification and MHB for idea generation. The CB group (
n
= 27) was trained to apply only CB.

Results:

The MHB method significantly enhanced idea fluency, flexibility, and originality from pretest to posttest (
p
< .05) and increased idea fluency and originality to a greater extent than the CB method.

Conclusion:

The MHB learning program can enhance nurses' innovative idea generation by promoting idea fluency and originality.

[
J Contin Educ Nurs
. 2021;52(2):72–78.]
Using the RETeval Device in Healthy Children to Establish Normative Electroretinogram Values
Authors: Soekamto Christa D. , Gupta Rishabh , Keck Katie M.
Published: January 2021

Purpose:

To provide normative data of full-field electro-retinogram (ERG) responses in the pediatric population using the RETeval ERG device (LKC Technologies, Inc) in healthy children without evidence of retinal disease.

Methods:

This was a single-site cross-sectional study of healthy pediatric patients with normal dilated fundus examinations and no known retinal diseases. Participants were recruited to undergo dilated full-field ERG using the handheld RETeval device. The International Society for Clinical Electrophysiology of Vision 5-step protocol was used. Photopic and dark-adapted scotopic responses were recorded using skin electrodes.

Results:

Main outcome measures were normative RETeval ERG values and correlation of age with measured ERG parameters. Thirty-eight eyes of 20 healthy patients (aged 4 to 17 years) were included in the study. Of the 20 normal patients, 9 were male and 11 were female. Normative mean, median, and range values were recorded for the measured full-field ERG parameters. Pearson correlation was moderately positive between age and oscillatory potential and scotopic dim flash amplitude (
r
= 0.59,
P
= .006 for both). A positive correlation was also found between age and cone a-wave implicit time (
r
= 0.67,
P
= .001).

Conclusions:

The handheld RETeval system is a useful tool for obtaining full-field ERGs in children without anesthesia. Moderate positive correlations were observed between age and oscillatory potential and scotopic dim flash amplitude. A strong correlation was found between age and cone a-wave implicit time. The current study provides a baseline of normative full-field ERG values in children.

[
J Pediatr Ophthalmol Strabismus
. 2021;58(1):17–22.]
Effects of the Gaze Fixation Position on AS-OCT Measurements of the Limbus and Extraocular Muscle Insertion Site Distance
Authors: Inagaki Risako , Suzuki Hiroko , Haseoka Takashi , Arai Shinji , Takagi Yuri , Hikoya Akiko , Komori Miwa , Hotta Yoshihiro , Sato Miho
Published: January 2021

Purpose:

To investigate the effect of the gaze fixation position on measurement of the limbus and extraocular muscle (EOM) insertion site distance using anterior segment optical coherence tomography (AS-OCT).

Methods:

Patients undergoing horizontal EOM surgeries were enrolled in this prospective experimental study. The distance between the angle recess and the muscle insertion site was measured using AS-OCT while patients fixed their gaze laterally or medially at inner or outer gaze fixation. The distance between the limbus and muscle insertion was intraoperatively measured using calipers.

Results:

A total of 46 lateral rectus muscles and 36 medial rectus muscles of 44 patients were evaluated. Significant differences were observed between intra-operative measurements (6.3 ± 0.7 mm) and AS-OCT measurements (5.8 ± 0.7 mm) for the lateral rectus muscle at inner gaze fixation (
P
= .0017) and medial rectus muscle at outer gaze fixation (
P
= .0003); no difference was observed when the lateral rectus (6.4 ± 0.5 mm) and medial rectus (4.9 ± 0.6 mm) muscles were measured at outer and inner gaze fixation, respectively. Bland-Altman plots showed better consistency at outer gaze fixation than at inner gaze fixation for the lateral rectus muscle; the opposite was observed for the medial rectus muscle. More than 80% of the AS-OCT measurements were within 1 mm of the intraoperative measurements at outer gaze fixation for the lateral rectus muscle and inner gaze fixation for the medial rectus muscle.

Conclusions:

Gaze fixation at outer gaze fixation for the lateral rectus muscle and inner gaze fixation for the medial rectus muscle was an appropriate technique to assess limbus and EOM insertion using AS-OCT.

[
J Pediatr Ophthalmol Strabismus
. 2021;58(1):28–33.]
Actual Visual Acuity Demands in the Classroom
Authors: Adams Carolina , Leach Shelby , Kresch Yocheved S. , Brooks Steven E.
Published: January 2021

Purpose:

To address the knowledge gap regarding the actual acuity requirements needed in typical kindergarten through grade 12 classrooms by determining an actual logarithm of the minimum angle of resolution (logMAR) and contrast sensitivity requirements in a sample of classrooms for kindergarten through grade 12 in New York City.

Methods:

Measurements of classroom dimensions with specific attention to viewing distances were made in public and private school classrooms, at various grade levels from kindergarten through grade 12, in New York City. The dimensions of typical text shown to students on classroom smartboards and whiteboards was measured and the mean and range of logMAR values were calculated for various seating locations within the classrooms. Contrast between text and background was estimated by comparing digital images of actual classroom text to Pelli-Robson contrast sensitivity charts.

Results:

Fourteen classrooms in five schools were evaluated. Classroom dimensions varied from 8 × 10 feet to 23 × 23 feet. Mean logMAR values of lower case text on smartboards and whiteboards varied from 0.93 ± 0.29 (range: 0.83 to 1.32) in the center of the front row to 0.46 ± 0.21 (range: 0.10 to 0.79) in the center of the back row (
P
< .001). Contrast was also variable, being highest for black markers on whiteboards (0.00) and lowest on smartboards (0.15 to 0.60). Neither logMAR nor contrast sensitivity values varied significantly by grade level or school (
P
> .50 for both).

Conclusions:

The data reveal that logMAR demands and contrast vary substantially from classroom to classroom and within a classroom based on room dimensions and seating. Although generally supporting current acuity-based pediatric vision screening referral guidelines, the data also provide insight into the potential impact of reduced visual acuity and seating location on visual performance in the classroom. These findings suggest the need to develop logMAR and contrast standards that optimize visual content in classrooms while accommodating a wider range of visual capabilities.

[
J Pediatr Ophthalmol Strabismus
. 2021;58(1):48–54.]
Mobile Application Design for Ordering Clean Water Using UCD Method in Indonesia
Authors: Watomakin Dominikus Boli , Pramajuri Baltra Agusti , Suyoto Suyoto
Published: January 2021

Clean water is an essential basic requirement for humans. In eastern Indonesia, especially the provinces of East Nusa Tenggara (NTT), Maluku and Southeast Sulawesi, the need for clean water is quite urgent. The socio-cultural conditions, geographical conditions, low rainfall levels, and the distribution of freshwater from the Regional Water Company (PDAM) is still not right. Communities in the three provinces utilise clean water buying and selling services using tank cars to fulfil their daily needs for clean water in reservoirs and water tanks. Orders still use telephone or SMS, so it seems slower. Thus the design of mobile ordering applications for clean water was proposed in this study and was named Go-Water. With the Go-Water app, users can order clean water by choosing the closest shelter model and driver, and then the order is forwarded to the driver for processing. The User-Centered Design (UCD) method use for Go-Water application design. The Go-Water application can help users to order clean water quickly and help improve business quality for service providers. The results of the usability perspective analysis on the Go-Water application design obtained an average percentage of 83%. The result shows the design of the Go-Water app, can be accepted according to user needs. The contribution in this study is the design of the proposed mobile application centred on the user, previously there was no system for ordering 5,000 litres and 6,000 litres of clean water using a tank car and the price offered was more beneficial for both parties.
Automatic Plants Watering System for Small Garden
Authors: Astutiningtyas Maria Beata Inka , Nugraheni Monika Margi , Suyoto Suyoto
Published: January 2021

Background: Automation is starting to dominate the world today. We are enter-ing a new era of computing technology, the Internet of Things (IoT), which is experiencing rapid development. IoT is a worldwide neural network in the cloud that connects a mixture of things, aiming to maximise the benefits of internet con-nectivity in transferring and processing data. Using IoT, one can monitor and control a device remotely with a computer or smartphone. IoT can apply in vari-ous fields, one of which is the smart garden. Objective: This research aims to design an automatic plant's watering system used to small gardens in houses. Smart Garden is an electronic control and garden monitoring system for the pro-cess of watering plants so that it can help people care for plants. Method: This paper presents a design of the Internet of Things for small gardens inside houses using Wireless networks and sensors.  In automatic watering plants, information about soil moisture needed for plants. Sensors are devices used for smart agricul-ture. Arduino Uno will control all system operations as monitoring the plant wa-tering system. Result: The result of this paper is a Plants Watering System De-sign for Small Garden at Homes.
The Use of M-Learning: A Perspective of Learners’ Perceptions on M-Blackboard Learn
Authors: AlKhunzain Abdulmohsin Suliman , Khan Raja Muhammad Ishtiaq
Published: January 2021

The life of the common to the students have changed due to spread of COVID-19 9 all around the globe. All the educational institutions were also set to be functioned remotely following the global instructions to meet the challenges to combat the COVID-19. The of current inquiry is the explore the male and female learners on the use of mobile phones for Blackboard learn. The Study survey method to collect the data. 68 participants of the medical majors of the CFY formed the sample for the present study. The findings of the study indicate that learners preferred to use M-blackboard. The results also indicated that backboard which is a form of e-learning can be beneficial if it is used with the traditional classroom teaching to get the potential benefits of the software.
Encryption System for Hiding Information Based on Internet of Things
Authors: Naman Hala A. , Hussien Naseer Ali , Al-dabag Mohand Lokman , Alrikabi Haider Th.Salim
Published: January 2021

One of the unexpected intelligence tactics known in World War II was to conceal the data in images that were reduced to the size of a point that was used in every text and transported in front of the enemy's eyes. In the new age, and after the expansion of Internet science and the use of the Internet worldwide, we will establish a security feature of the IOT service that will work more reliably and more effectively to deal with the Internet of Things and ensure the work of the services that the customer interacts with. A secret-key stenographic scheme that embeds four gray-scale secret size (128*128) pixel images into a size (512*512) pixel cover image in this work. Wavelet transform is the method used in this project to analyze the cover into its frequency components. In this work, combinations of steganography and cryptography were made to increase the level of safety and make the device more difficult for attackers to beat. The resulting stego-image that will be transmitted did not raise any suspicion by both objective and subjective evaluation, so the primary objective of Steganography is achieved. The proposed system was designed by using (MATLAB R2018b) and running on a Pentium-4 computer. The Internet of Things works with the encryption system for data in a synchronized manner with the technological development, and in order to maintain the stability of any Internet of things service, whether it is information signal services, visual or audio data, a remote control system, or data storage in the Internet cloud, we must focus on data preservation from internet pirates and internet system hackers. The picture Figure 4 below shows the method of encryption and dealing with the Internet of things system..
Fotografie contro la nazione. L’uso della fotografia come prova del crimine negli anni dell’Estado Novo brasiliano: il caso degli immigrati tedeschi (1937-1945).
Authors: Zega Fulvia
Published: January 2021

Il presente saggio, attraverso lo studio della fotografia giudiziaria, si propone di mettere in luce come l’immagine abbia svolto un ruolo centrale di agente politico e di educazione del pensiero collettivo durante gli anni dell’Estado Novo brasiliano (1937-1945). Partendo da un corpus di fotografie riguardanti la collettività tedesca e sequestrate dalla polizia politica nel corso di perquisizioni volte a stanare l’esistenza di un presunto pericolo nazista in Brasile, si mostrerà come il potere politico e le sue istituzioni abbiano sfruttato la polisemia intrinseca al medium fotografico per trasmettere alla società una decodificazione guidata di scatti in origine privati che, una volta piegati agli interessi della propaganda, si sono stati trasformati in pubblici atti d’accusa. Documenti iconografici che, facendo seguito ad una costruzione retorica finalizzata a creare l’idea di una minaccia interna dovuta al migrante non assimilato, rafforzano e rendono tangibile quel senso di accerchiamento e pericolo che serve ai regimi autoritari per giustificare pratiche di controllo e contenimento sociale.
Investigating household poverty determinants of the micro, small and medium enterprise sector in rural Sri Lanka
Authors: Sarath H. K. , Atapattu D. , Sumanarathne B. M.
Published: January 2021

Poverty in Sri Lanka is a predominantly rural phenomenon with more than 70 percent of the rural population. Even though rural poverty has shown a significant decrease in recent years, still many people are just above the poverty line and hence the risk of slipping back into poverty is high. Micro, small and medium enterprises (MSMEs) in the rural economy in Sri Lanka play an effective role as a means of income and employment generation resulting in a significant contribution towards reducing poverty. However, the real contribution is debated. Therefore, the main objective of this paper is to investigate the significant contribution of MSMEs towards household poverty reduction in the rural sector in Sri Lanka. This study utilized the questionnaire survey method and interview method to collect primary data. A multi-stage cluster sampling was employed to select a sample of 390 MSMEs in the Southern Province. Descriptive analysis revealed that manufacturing is the most popular business activity. The majority of entrepreneurs are sufficiently educated and experienced and finance through formal banking is the main source of capital. Key constraints demonstrated are demand problems, macroeconomic issues such as inflation, lack of finance, inadequate infrastructure and resources, and high competition. The main purpose of enterprising is the provision of basic needs for families and the majority of households generate sufficient earnings and living above the poverty line. Results of a binary logistic model showed that administrative issues; firm size, experience and business awareness, financial support, time to market, internal locus of control and entrepreneurial self-efficacy, are significant in reducing poverty in the rural sector. It is suggested to trigger MSME activities in the rural sector with necessary assistance i.e. increasing the availability of formal credit or financial access, provision of necessary infrastructure, implementing programs to improve entrepreneurial skills etc., would influence in triggering entrepreneur supply in the sector which, in turn, raises a positive impact on household wellbeing.
Grey-zone nel trattamento del paziente con Piede Diabetico. I risultati di una Delphi survey italiana multidisciplinare condivisa tra esperti
Authors: Anichini Roberto , Brocco Enrico , Cavallini Marco , Da Ros Roberto , Uccioli Luigi , Pempinello Ciro , Salutini Elisabetta , Volpini Maurizio , Volpini Alice , Monge Luca
Published: January 2021

Il piede diabetico rappresenta una delle complicanze più severe del Diabete Mellito (DM) oltre che la prima causa di amputazione non traumatica degli arti inferiori; si stima, infatti, che ogni anno più di un milione di persone con DM siano sottoposte a trattamento demolitivo come conseguenza di questa condizione. Nonostante l’esistenza di linee guida nazionali ed internazionali sul management del piede diabetico, per alcuni aspetti gestionali le raccomandazioni proposte non raggiungono un forte livello di evidenza. Ciò rappresenta una potenziale fonte di incertezza decisionale, ma anche uno spunto da cui partire per chiarire aspetti legati al management del piede diabetico nella realtà italiana. L’obiettivo del presente documento è, quindi, quello di riadattare le raccomandazioni internazionali sulla gestione del piede diabetico alla luce dell’opinione di esperti italiani.
The –250G>A polymorphism in the hepatic lipase gene promoter influences plasma lipid profile and lipoprotein ratio in patients with ischemic stroke
Authors: Momoh Johnson Oshiobugie , Osuntoki Akinniyi Adediran , Ebuehi Osaretin Albert Taiwo , Ajibaye Olusola
Published: January 2021

Objective:

To evaluate the influence of –250G>A (rs2070895) polymorphism in hepatic lipase gene (LIPC) promoter on plasma lipid parameters of ischemic stroke patients.

Methods:

A total of 100 stroke patients and 100 control subjects matched for sex (59 men and 41 women) and age were selected. Hepatic lipase activity and lipid profiles were measured while lipoprotein ratios were calculated. Genotyping of the –250G>A promoter polymorphism of the LIPC was performed by the polymerase chain reaction and restriction fragment length polymorphism method combined with 2% gel electrophoresis and then confirmed by direct sequencing. The LIPC promoter gene sequencing data were compared with refseqNG011465.1 LIPC from GenBank.

Results:

The frequencies of GG, GA and AA genotypes of LIPC rs2070895 polymorphism were 39%, 45% and 16% for the control, 10%, 37% and 53% for the stroke subjects (P<0.000 1), respectively. The frequencies of G and A alleles were 61.5% and 38.5% for the control, and 28.5% and 71.5% for the stroke subjects (P<0.000 1). Our study shows that the mutant allele of the LIPC promoter was associated with dyslipidemia, lower hepatic lipase activity, and this variation contributed to the increased defective plasma high-density lipoprotein-cholesterol (HDL-C), HDL2-C and HDL3-C concentration for both subjects. The control subjects had 6 single nucleotide polymorphism and 6 amino acid substitutions while the stroke subjects had 32 single nucleotide polymorphism and 20 amino acid substitutions.

Conclusions:

LIPC –250G>A polymorphism can influence plasma lipid profiles and lipoprotein ratios in patients with ischemic stroke.
A comparative study of factors for interruption of antitubercular treatment among defaulters in urban and rural areas of Kamrup District, Assam
Authors: Ahmed Mustaque , Mohan Roopshekhar
Published: January 2021

Background:

Defaulting from treatment is an important challenge for tuberculosis (TB) control. As per the Revised National Tuberculosis Control Programme quarterly reports of Kamrup District (Assam), among the registered cases default rate was 13.3%(2008) & 13.1 % (2009).

Objectives:

To elicit reasons & factors responsible for interruption of treatment from a cohort of TB defaulters of urban & rural areas in Kamrup District.

Methods:

The cross-sectional study was conducted among 1/3rd of all defaulters who were put on Directly Observed Treatment Short-course chemotherapy in 2011 under 1 urban Tuberculosis Unit (TU) & 2 rural TUs of Kamrup District. From these 3 TUs, total 210 patients interrupted treatment in 2011; so 70 defaulters (35 from 1 urban TU & 35 from 2 rural TUs) were interviewed in their residences by using a pretested and predesigned schedule. Study was conducted in January - June, 2012.

Results:

Majority of the defaulters was illiterate (51.4%) in rural areas but in urban areas majority studied upto high school level (37.1%). Maximum defaulters were in the age group 25-44 years (55.7% in urban areas & 62.9% in rural areas). The number of defaulters decreased uniformly with increasing income in the rural areas & but not so in urban areas. More number of new cases defaulted in rural areas (82.8%) compared to urban areas (57.1%). Improvement in symptoms was found to be the most common reason (45.7% in urban areas & 40 % in rural areas), leading to treatment interruption.

Conclusions:

Early improvement in symptom was the most common reason leading to treatment interruption. Continuous health education should be provided to TB patients emphasizing the need to continue treatment despite early improvement in symptoms.
Comparison of distal radiocephalic fistula vs proximal radiocephalic fistula
Authors: Mishra Biswajit
Published: January 2021

Background:

Distal radiocephalic fistula (DRCF) at wrist is the first option of vascular access in patients undergoing hemodialysis. In patients with a failed DRCF or unsuitable for DRCF the current recommendation is to perform a brachiocephalic fistula. Proximal forearm radiocephalic fistulas (PRCF) are created less frequently. The aim of the present study was to evaluate the outcomes of PRCF and DRCF.

Material and Methods:

A longitudinal study was conducted in the department of MKCG Medical College from January 2018 to July 2019. Data was collected and entered in Microsoft excel. The analysis was done by R version 3.6.1. Quantitative data were presented in the form of Mean and SD and were tested by unpaired t-test. Categorical data were presented as count and proportion and was tested by Chi-square test or if applicable Fischer's exact test. Comparison between two procedures was done by Kaplan-Meier method and evaluated by the log-rank test. With the 95% of Level of significance, P value <0.05 was consider statistically significant during analysis.

Results:

The demographic data of the two patient groups were similar except that those with PRCF were more likely to have had a previous access and caliber of distal vessel was less. Early failure was lower for PRCF than DRCF (6.06% vs 15%). Primary patency rate at one year was 87.87% in PRCF vs 70% in DRCF.

Conclusion:

A PRCF can be a suitable alternative to a brachiocephalic fistula in patients who cannot receive a DRCF.
Can Sever Acute Malnourished children be effectively rehabilitated physically, biochemically and developmentally at nutritional rehabilitation centers
Authors: Bhujade Rashmi , Mishra Badrin N. , Ibrahim Tarique , Sinha Abhinav , Chouhan Dharampal S.
Published: January 2021

Background:

Under-nutrition has got serious and lasting impact on health, development, society and economy. It may result in poor growth, development of child and can cause increase mortality, morbidity, health care cost, low productivity and economic growth. Nutritional rehabilitation is one of key intervention to address the under nutrition. It is questionable that nutritional intervention has potential to improve multiple domains.

Methods:

Follow up study evaluated the multi-domain impact of nutritional interventions on 204 admitted Severe Acute Malnutrition (SAM) children. Data was analyzed with SPSS version 20.

Results:

Significant positive changes were observed in physical, biochemical, developmental domains. Macnemar, paired t- test, co relation, z test were applied for data analysis.

Conclusion:

Nutritional intervention was found to be effective in improving selected physical, biochemical and developmental parameters. After discharge rate of improvement in anthropometric parameters was less. Actual quantification of recovery especially in biochemical and developmental parameters due to nutritional intervention is difficult.
A qualitative exploratory study of delay in the presentation of gastrointestinal cancer
Authors: Sathoo Saarat , Nachiappan Deivanai Sundaram , Sureshkumar Sathasivam , Anandhi Amaranathan
Published: January 2021

Introduction:

Patients with gastrointestinal (GI) cancers often present late in the advanced stages, due to various reasons and may experience delays in treatment. Hence, we have attempted to find the factors leading to this delay.

Methods:

This was an exploratory qualitative study, in a tertiary care hospital, including 20 patients with advanced GI cancers. They were interviewed to assess the reasons for delays in presentation, diagnosis and treatment, and the factors were analysed based on the interval of delay and the cause.

Results:

This study found that there was an interval of delay of 8 months from the onset of symptoms till primary treatment, more than half of which occurred in the pre-hospital phase (56.4%). We classified the causes for the delay into different intervals such as the appraisal interval, health-seeking interval, diagnostic interval and the pre-treatment interval. Lapses at the individual, societal and institutional level lead to the delay. The major causes included ignorance, substance abuse, poverty, social stigma, vague symptoms and missed diagnosis, miscommunication, resource constrain, very poor doctor-patient ratio and delay in investigation and treatment.

Conclusion:

This study noted a significant delay in the treatment of patients with advanced gastrointestinal cancers. Reasons for delay have been noted at various levels. Further action based on this study, at the community and hospital level could potentially reduce the delay and result in better survival and improved quality of life.
Acute encephalitis syndrome and Bihar health profile
Authors: Kumar Pratyush
Published: January 2021

Acute encephalitis syndrome(AES) represents long term public health challenge with recurrent seasonal outbreak in many districts of Bihar for the past two decades. Multiple hypothesis has been postulated linking it as cause of acute encephalitis syndrome. Agrochemicals, lychee toxins, heat stroke, infectious causes and environmental factors have been postulated as AES cause. Although association have been found but no definite causation ascertained yet. Bihar heath performance on various indicators have been poor for past many years. Health index 2019 released by Niti Ayog with ministry of health and family welfare ranked Bihar on 20th place out of 21 large states based on various health indicators. Early access to nearest PHC may significantly improve outcome. As most of the children are from rural areas it's imperative to strengthen rural health care. Rural urban disparity and inequitable distribution of resources, lack of well-trained health workforce has been widely reported. Primary healthcare is the essential foundation of emergencies outbreaks. PHC is the best strategy and most cost-effective investment to provide high quality care ensuring equitable access to all. PHC reduces morbidity and makes public health system resilient to absorb sudden increase in number of cases, rising health demands putting health workforce at stress and strain to available resources.
Digital health
Authors: Rani Ruchika , Kumar Rajesh , Mishra Rakhi , Sharma Suresh K
Published: January 2021

The whole world is in the grip of the coronavirus disease (COVID-19) outbreak. This pandemic brought visible changes in the life of humans around the globe. Likewise, the medical health sector is forced to use digital technology to continue to provide medical health services by preventing themselves. COVID-19 pandemic highlighted the significance of digitalization in every sphere of life. By focusing on virtual care at a large scale, health care delivery becomes possible and convenient even for remote places. The use of artificial intelligence concepts in this pandemic, like robots replaced human movements and function automatically to guide the patients in the reception area and found helpful to prevent and manage the crowd in a few countries. Similarly, the use of e-earning platform has emerged as a digital solution to impart medical education to medical students in this corona outbreak.
Communication, Counseling and Compassionate Care
Authors: Raman Praveena
Published: January 2021

Background:

Globally, the sixth most common malignancy is oral cancer, which is predominantly due to consumption of potent, proven carcinogens which includes smoking and smokeless form of tobacco and areca nut. Habits associated oral malignancies are mostly preceded by clinically asymptomatic oral lesions collectively referred under the umbrella term as oral potentially malignant disorders (OPMDs). There is a delayed presentation of oral pre cancer and oral cancer in India, as approximately 50% of patients are diagnosed at last stage since the asymptomatic pre cancer lesions are missed by oral physicians/dentists either due to lack of timely communication and habit counseling, lack of knowledge, or inappropriate attitude, putting all in a nut shell --- sheer lack of empathy and commitment towards patient care and society. Early diagnosis greatly increases patient's chances of survival. Patient awareness is much spoken in literature; however, the flip side of the coin lies within the attitude of the primary care physician. They play a pivotal role in effective communication and timely counseling of patients with OPMDs and should prevent malignant transformation to improve quality of life of patients. Poor compliance to attend for oral cancer screening links to the attitude and ignorance of the primary care physician. Palliative care concepts should be integrated to dentistry especially to oral medicine speciality.

Clinical Significance:

The author believes that the three most important, least explored and challenging palliative care approaches namely, “Communication,” “Counseling,” and “Compassionate care,” should be effectively practiced by a primary care physician, to improve their level of commitment to society and attitude towards patient care which can help in early diagnosis of OPMDs and decreased incidence of oral cancer, thus improving quality of life of patients.
Family physicians/GP and Internist opinions, familiarity and practice behaviour regarding clinical practice guidelines (CPGs) of common medical conditions in Nigeria
Authors: Desalu Olufemi O. , Adeoti Adekunle O. , Makusidi Muhammad A. , Fadare Joseph O. , Aremu Gbolahan O. , Amao Emmanuel A. , Opadijo Oladimeji G.
Published: January 2021

Background:

Few studies exist on physicians' opinions, attitudes, familiarity and practice behaviour regarding clinical practice guidelines in sub-Saharan Africa.

Objectives:

To determine the opinions, familiarity, and practice behaviour regarding clinical practice guidelines (CPGs) and factors associated with their use among internists and family physicians/GP in Nigeria.

Methods:

A semi-structured questionnaire regarding guidelines of five common medical conditions: hypertension, diabetes mellitus, tuberculosis, asthma and hepatitis B encountered in everyday medical practice were self-administered by 183 doctors across the country.

Results:

Over 90% of respondents believed that guidelines were evidence-based, improved management outcomes, and quality of care, nevertheless, 57.4% were against using them in litigations against doctors. The majority (>70%) of the respondents were familiar with the guidelines except that of hepatitis B. Overall, guidelines were used regularly by 45.9%, used in part by 23.5% and 30.6% never used it. Approximately 50% of physicians had immediate accessibility to them at the point of care. The proportions of respondents reporting a change in practice behaviour ranged from 37.7-57.9% depending on the guideline. The factors associated with guideline-related behaviour change were familiarity with its contents, postgraduate educational training, increased helpfulness score, and practiced >5 years.

Conclusions:

The present study shows that most physicians have favourable opinions and are familiar with these guidelines, however, the proportions reporting changes in their patient management because of the guidelines are not satisfactory. It is important to ensure guidelines accessibility and promotes factors that encourage their implementation in medical practice.
Prevalence and risk factors of asthma among school going children in urban area of North India
Authors: Patra Pratap Kumar , Bhattarai Dharmagat , Prasad Arun , Jain Hansmukh , Ranjan Suprabhat , Ranjan Alok
Published: January 2021

Introduction:

Bronchial asthma is a chronic respiratory illness of global importance. Recent reports depict the increasing prevalence of this disorder in urban areas.

Methods:

An observational study was designed with a sample size of 1163 children from grade 4 to grade 12, involving 8 randomly selected schools in 2015-2016. Modified International Study of Asthma and Allergy in Childhood [ISAAC] questionnaire in local language [Hindi version] was used for data collection. The data of assessed risk factors were collected and analysed.

Results:

Prevalence of asthma in the studied population was 2.8%. Multivariate analysis revealed a significant association of risk of asthma with use of firewood kitchener for cooking, keeping pet animals at home, high body mass index (BMI), absence of ventilator measures like chimney and aero-vent. Logistic regression analysis revealed use of firewood kitchener for cooking (odds ratio (OR) = 4.9, 95% confidence interval (CI) = 2.93-11.3), absence of smoke outlet (OR 2.8, 95% CI 1.3-5.8) and keeping pet animals (OR 3.2, CI 1.6-6.8) at home were observed to be significantly associated with asthma.

Conclusion:

Prevalence of asthma in our cohort was significantly lesser than that of developed world. Household smoke was the most conspicuous risk factor contributory to childhood asthma in this part of world.
Clinicopathological features of hemophilia in a tertiary care centre of India
Authors: Pawan Pandey K. , Mahima Yadav , Vijai Tilak , Manjula Lader
Published: January 2021

Context:

Inherited bleeding disorders are common in India and hemophila and von Willebrand diseases are the most common among them. These patients can present in any department including paediatrics, medicine, orthopaedics and even gynaecology so knowledge about hemophilias and facilities for specialized tests for diagnosis are required. Few centres of north-eastern part of India perform these tests so hemophilias remain an underdiagnosed and underreported disease.

Aims:

The objective of this study was to estimate the prevalence of hemophilia in patients referred to this tertiary care centre and study the clinicopathological profile of these patients.

Settings and Design:

Prospective study.

Methods and Material:

Patients referred with suspicion of bleeding disorders in a time period of 4 years were evaluated. Complete clinical details, family history was retrieved and tests like complete blood counts, bleeding time, prothrombin time, activated partial thromboplastin time and factor assays were performed.

Results:

A total of 1126 patients with suspected bleeding disorder were tested and 237 were diagnosed of inherited bleeding disorders. Hemophilia A (HA) was diagnosed in 151 patients (63.7%), Hemophilia B (HB) in 31 (13%). Mean age was 10 years in HA and 11 years in HB patients. Clinical features of hemophilia varied according to Factor VIII levels. Coagulation type of bleeding such as hemarthrosis and hematoma were much more frequent than mucosal type bleeding.

Conclusions:

The present study is one of the very few studies from the north-eastern part of India estimating the prevalence and clinicopathological features of hemophilia, highlighting the need of specialized diagnostic facilities in this part of India.