bluuebunny/crossref_metadata_2025 huggingface dataset:
People are Willing to Do Crazy Stuff
Authors: Koželj Boštjan
Published: October 2020

Everybody has some time to spare during their days. No one is so occupied that he/she cannot take time for their health. Especially in this coronavirus time, some understand how important our health is, others stay oblivious of this fact. I realised that health is important years ago when I didn’t feel fine with myself and also with my time management. I needed a change in my life. So I began running. The first few steps were hard, then as the time flew by, I enjoyed it more and more. In this essay, I will explain how it all began, and how I invested my free time into running.
My trip to Mongolia
Authors: Krizman Matija
Published: October 2020

This article discusses my trip to Mongolian capital Ulaanbataar and its surroundings. The first part is mainly about Ulaanbataar and its blend of communist regime remnants and new influences of globalization, clash of traditions and trends, and about the offer of food and drinks in the city. This section also touches the Mongolian way of life, prevalently tied to the city conditions. The second part deals with hiking to Bogd Khaan Mountain. This environment without too many people brought an opportunity to get to know some of them on a personal level and to learn more about Mongolian customs and traditions. This is emphasized in the third part where the main weekend getaways for people of Ulaanbataar are described along with the first-handed experience of the people, food and traditional way of life in the steppes.
ЭФФЕКТИВНОСТЬ КОМБИНИРОВАНИЯ ТЕХНОЛОГИЙ ВЫЕМКИ РУД В ПРЕДЕЛАХ РУДНОГО ПОЛЯ
Authors: Голик Владимир Иванович , Лукьянов Виктор Григорьевич , Качурин Николай Михайлович , Стась Галина Викторовна
Published: October 2020

Актуальность исследования. Статья посвящена актуальной проблеме совершенствования технологии разработки сложно-структурных месторождений скального типа для увеличения производства содержащихся в рудах редких и ценных металлов, дефицитность которых возрастает с развитием научно-технического прогресса. Цель исследования – определение условий совмещения систем разработки разных классов для увеличения возможностей селективизации добычных работ при использовании различных вариантов извлечения руд в смежных добычных участках. Методика исследования. Основу исследования составляет экономический расчет возможных вариантов совмещения в пределах рудного поля на основе полученных экспериментально сведений о рудовмещающем массиве. Результаты. Дана характеристика условий залегания руд на конкретном скальном месторождении сложной структуры. Произведено инженерно-геологическое районирование рудовмещающего массива с дифференцированной оценкой геолого-структурных нарушений по величине и направленности. Дан прогноз возможного по аналогии с практикой поведения горных выработок под влиянием разломных структур и макротрещин. На уровне экспертной оценки определена целесообразность применения слоевой или камерной систем разработки с закладкой технологических пустот твердеющими смесями. Выводы. Эффективность выемки руд достигается селективизацией выемки запасов в пределах одного рудного поля при комбинировании систем разработки при максимальном учете геолого-структурных факторов локализации руд и механо-физических свойств рудовмещающих пород.
Use of mobile applications in collocation teaching
Authors: ÖZCAN Muhammed Sayid , Kert Serhat Bahadır
Published: October 2020

In this study, the importance of vocabulary knowledge in language education and the use of mobile applications in the teaching of collocations are emphasized. The application of collocation was realized through a mobile instant messaging application. It has been determined that students use a mobile application in a word learning process to provide more meaningful learning than in classroom learning. In this study, which was applied to 54 people using experimental and controls grouped research design, the experimental group was given mobile cards and the control group was given word cards in the class. In quantitative aspect, the study aimed to see the difference between the academic achievements of both group. At the end of the process, an academic achievement test was applied to the students, and a significant difference was found between the groups in favor of the experimental group. In qualitative aspect, the students opinions was given on use of mobile applications in teaching vocabulary. Individual interviews were conducted with the students at the end of the process accordingly and these interviews were used in the evaluation of the process.

 

Keywords: Educational technology; language learning, mobile learning; teaching collocations.
Insights on media literacy and social engineering vulnerability predictors: Lifelong learning gravity
Authors: Nugraha Michelle Adi , Banglali Nadhia Prili , Abraham Juneman , Ali Moondore Madalina , Andangsari Esther Widhi
Published: October 2020

Effective learning in the current 4.0 Industrial Revolution era may not happen if a learner is insensitive to two types of social engineering, namely phishing and tailgating. This study aims at investigating the predictors of vulnerability to phishing and tailgating from the psychological perspective. The study was conducted on a sample of Indonesians (125 males, 137 females; Mage = 28 years old, SDage = 8.319 years); considered as the ‘millennial’ age group. Multiple linear regression analyses covering seven predictors of the vulnerabilities, i.e. insufficient knowledge/media literacy, excitement of victory, fear of authority, desire to be helpful, fear of loss, laziness, and appeal to ego, showed that the psychological models predicting vulnerability of experiencing phishing and tailgating were confirmed, with an effect size range between 18.5% to 19%. Media literacy alone was proven to be inadequate in managing/deterring the variables that embrace vulnerability to the two social engineering techniques. The relevance of this study to lifelong learning gravity is discussed throughout this article.

 

Keywords: lifelong learning; literacy; phishing; psychological vulnerability; social engineering; tailgating
The implementation of virtual choir recordings during distance learning
Authors: Eren Hakki Cengiz , Öztuğ Emine Kıvanç
Published: October 2020

This study investigates the implementation of virtual choir recordings in a choir class during distance learning. In this particular study, a virtual choir is defined to be a computer-generated sound recording that emulates a realistic choir sound. Students practiced their parts using virtual choir recordings for a period of eight weeks; each student received a recording that excluded his/her own part but included the rest of the parts. After eight weeks of progressive study, students recorded their own voices on top of the virtual choir recordings and submitted them as final projects. Student opinions regarding the virtual choir recordings were obtained through a 12-question survey. In addition, two experts evaluated the final submissions turned in by the students. The data suggests that virtual choir recordings can be helpful to students with efficiency of practice and can provide a suitable audio environment to foster conscious-listening, accurate intonation and perception of pacing. Improvements are suggested to make the virtual choir recordings also more encouraging of musicality, highlighting its future potential not only as a reliable distance education tool, but also as a supplementary device for real-life choir classes, when in-person learning resumes.

 

Keywords: music education, distance learning, choir, virtual choir, music technology
A study on family support perceived by pre-service music teachers in musical instrument education
Authors: Yuksel Gozde , Onur Güçlü
Published: October 2020

The aim of this study is to determine how pre-service music teachers perceive family support during the process of individual musical instrument training. The study group of the research consists of undergraduate pre-service music teachers studying at Necmettin Erbakan University Ahmet Keleşoğlu Faculty of Education Fine Arts Education Department Music Education as a major in the 2019-2020 academic year. The "Perceived Family Support Scale in Instrument Education" developed by Girgin (2015) was used as a measurement tool in the study. Percentage, frequency, arithmetic mean, standard deviation values and Shapiro-Wilk, Mann-Whitney U and Kruskal-Wallis H tests were used in the analysis of the data. As a result of the research, it was determined that pre-service music teachers' perceptions of family support and sub-dimensions in musical instrument training were at a good level. In addition, it was concluded that the pre-service music teachers' perceived level of family support was higher in cases in which the parents were married, any of the parents was engaged in a branch of fine arts, and any of the parents had an instrument experience.

Keywords: family support, musical instrument training, musical education
Effect of khan academy-aided teaching on academic achievement in English course
Authors: Şan İsmail , Aykaç Tuba
Published: October 2020

The purpose of this study is to investigate the effect of Khan-Academy-assisted grammar teaching on academic success in English lesson. The videos used in the study were downloaded from the Khan Academy (n.d) website. The sample of the study consists of 67 students (34: experiment group, 33: control group) in Sadreddin Konevi Anadolu İmam Hatip High School that is located in Yeşilyurt, Malatya, Turkey. Semi-experimental design with control group of pre-test post-test was used. During the experimental procedure, the videos in Khan Academy about present, past and future tense in English were watched by the experiment group. Teaching process of control group was organized in accordance with English Curriculum. "The Achievement Test on Tenses" which was developed by the researchers was used both as the pre-test and the post test. At the end of the study, it was concluded that Khan Academy video-assisted grammar teaching made a significant difference on academic success in English lesson.

 

Keywords: Grammar, video, khan academy, English lesson, academic success.
Developing learning method on post-graduated program: a blended learning based on web-blog and print technology design
Authors: Naro Wahyuddin , Abubakar Achmad , Yani Ahmad , Kurniati Kurniati , Amiruddin Muhammad Majdy , Syatar Abdul
Published: October 2020

This research aims to produce a blended learning model combined with teaching materials that integrate traditional, online, electronic, or digital sources. It uses Research and Development method with the Dick and Carey model. Data collection was conducted through interviews, observations, documentary studies, questionnaires, and tests, while analysis was performed qualitatively. The data obtained were analyzed by condensation, presentation, and verification. The design of Ulumul Qur'an at UIN Alauddin Makassar postgraduate was determined from the learning process and results. Traditional learning involved the use of syllabus sources, including RPS, textbooks, as well as learning media, such as libraries, whiteboards, markers, and erasers. Students were given assignments, examples, and checklist instruments. Moreover, the learning process employed digital sources and media, such as LCDs, laptops, and PowerPoint presentations. Online sources included information search engines, such as Google, and the use of e-mail for assignment submissions. The implementation of Ulumul Qur'an is supported by the development of a blended learning model, using a weblog and printed materials.        

 

Keywords: Blended Learning, Web-Blog, Ulumul Qur’an, Online;
lectura comparativa sobre el nivel de satisfacción laboral de los docentes venezolanos entre 1996 y 2018
Authors: Ramírez Tulio , Torres Cruz Dóris Lilia
Published: October 2020

El objetivo de esta investigación es comparar los niveles de satisfacción laboral de una muestra de docentes venezolanos de educación primaria y bachillerato del sector oficial, entre los años de 1996 y 2006. Originalidad: Se evidenciaron altos niveles de insatisfacción laboral en los siete factores que cargan la escala aplicada, cuyos resultados se compararon con los obtenidos entre 1996 y 2006 y se observó una profundización del estado de insatisfacción que hace 24 años ya se percibía, sobre todo en los factores extrínsecos al oficio, como remuneraciones, ambiente de trabajo y sus condiciones, así como con los beneficios. Método: se consideró la investigación de enfoque mixto, con la cual se utiliza la estrategia de la escala de satisfacción laboral, administrada de manera on line y construida desde la Teoría Bifactorial elaborada por Herzberg, Mausner y Snyderman en 1959. La conclusión resalta que los factores intrínsecos o motivadores que tienen que ver con la naturaleza misma del trabajo (reconocimiento de la labor, autonomía profesional y trabajo en sí mismo)presentan niveles de satisfacción muy por debajo de los encontrados en los estudios previos referidos.
SOCIAL AND EMOTIONAL COMPETENCIES AND ACADEMIC ACHIEVEMENT IN ELEMENTARY SCHOOL STUDENTS
Authors: Maglica Toni , Ribičić Ana , Ljubetić Maja
Published: October 2020

Various scientific researches undoubtedly confirm the importance of children's social and emotional competencies in their achievement and the overall life satisfaction. Therefore, the conclusion that logically follows is the premise that children who have developed these competencies tend to be more caring, happy, responsible, with an overall better psycho-physical health and success in life in general. This research aimed to examine social and emotional competencies in elementary school children by using the Behavioural and Emotional Rating Scale – 2nd edition (Epstein, 2004), and to examine their connection to academic achievement. Participants were sixth-grade students from three elementary schools in Split and one elementary school in Šestanovac (N=115). The results pointed out to the average and above-average social and emotional strengths of the majority of participants, while there was no significant correlation found between the overall social and emotional competencies (Strength Index) and the school achievement. There was no positive correlation between the development of social and emotional competencies and the academic achievement, in a way that children with more developed competencies had better success in school. A significant positive correlation was found only with School Functioning subscale and the fifth and sixth-grade school achievement.
VISOKOŠKOLSKO OBRAZOVANJE IZ UGLA KONCEPTA LJUDSKOG KAPITALA
Authors: Bosanac Maja , Mulutinović Jovana
Published: October 2020

U okviru proučavanja odnosa pedagogije i drugih nauka tradicionalno primarni značaj pridaje se odnosu pedagogije prema filozofiji, sociologiji, psihologiji i antropologiji kao predmetno i metodološki bliskim naukama. U radu se polazi od stava da u savremenim uslovima ne treba da se zanemari ni odnos pedagogije i ekonomije. Savremeno obrazovanje suočava se sa brojnim izazovima i promenama koje su prvenstveno uslovljene procesom globalizacije, kao i uticajima neoliberalne ideologije. Kao cilj rada postavlja se sagledavanje značaja teorije ljudskog kapitala kao jednog od teorijskih pristupa u okviru proučavanja globalizacije obrazovanja, a koji sve više dobija na značaju, prvenstveno u oblasti visokoškolskog obrazovanja. Međutim, pridavanje sve većeg značaja ekonomskim aspektima obrazovanja rezultiralo je brojnim kritikama. Kao zaključak rada ističe se da se obrazovanju u celini, a posebno visokoškolskom obrazovanju pristupa sve više iz ugla ekonomskih aspekata. Iako je ovaj proces neizbežan prvenstveno kao posledica globalizacije, u cilju očuvanja humanističke dimenzije obrazovanja značajno je razumevanje i brojnih izazova i promena sa kojima se suočava proces visokoškolskog obrazovanja.
Cross-Linking Modification of Ammonium Polyphosphate via Ionic Exchange and Self-Assembly for Enhancing Fire Safety Properties of Polypropylene
Authors: Pan Yingtong , Luo Zhonglin , Wang Biaobing
Published: October 2020

Modified ammonium polyphosphate (MAPP) as a novel mono-component intumescent flame retardant (IFR) was prepared via the ionic exchange between ammonium polyphosphate (APP) and piperazine sulfonate, which is synthesized by self-assembly using 1-(2-Amioethyl) piperazine (AEP) and p-amino benzene sulfonic acid (ASC) as raw materials. This all-in-one IFR integrating three functional elements (carbon, acid, and gas source) showed more efficient flame retardancy and excellent smoke suppression as well as better mechanical properties than the conventional APP. The incorporation of 22.5 wt.% MAPP into polypropylene (PP) eliminated the melt dripping phenomenon and passed the UL-94 V-0 rating. The results of the cone calorimetry test (CCT) revealed that the release of heat, smoke, and CO is significantly decreased, demonstrating that this novel IFR endows PP with excellent fire safety more effectively. For PP/MAPP composites, a possible IFR mechanism was proposed based on the analysis of the pyrolysis gas and char residues.
Ecosystem Functions of Microbial Consortia in Sustainable Agriculture
Authors: Aguilar-Paredes Ana , Valdés Gabriela , Nuti Marco
Published: October 2020

Knowledge of the agricultural soil microbiota, of the microbial consortia that comprise it, and the promotion of agricultural practices that maintain and encourage them, is a promising way to improve soil quality for sustainable agriculture and to provide food security. Although numerous studies have demonstrated the positive effects of beneficial soil microorganisms on crop yields and quality, the use of microbial consortia in agriculture remains low. Microbial consortia have more properties than an individual microbial inoculum, due to the synergy of the microorganisms that make them up. This review describes the main characteristics, ecosystem functions, crop benefits and biotechnological applications of microbial consortia composed of arbuscular mycorrhizal fungi, plant growth promoting bacteria and actinobacteria, to promote the restoration of agricultural soils and, consequently, the quality and health of agricultural crops. The aim is to provide knowledge that will contribute to the development of sustainable and sufficiently productive agriculture, which will adapt in a good way to the pace of the growing human population and to climate change.
Unusual Faces of Bladder Cancer
Authors: Manini Claudia , López José I.
Published: October 2020

The overwhelming majority of bladder cancers are transitional cell carcinomas. Albeit mostly monotonous, carcinomas in the bladder may occasionally display a broad spectrum of histological features that should be recognized by pathologists because some of them represent a diagnostic problem and/or lead prognostic implications. Sometimes these features are focal in the context of conventional transitional cell carcinomas, but some others are generalized across the tumor making its recognition a challenge. For practical purposes, the review distributes the morphologic spectrum of changes in architectural and cytological. So, nested and large nested, micropapillary, myxoid stroma, small tubules and adenoma nephrogenic-like, microcystic, verrucous, and diffuse lymphoepithelioma-like, on one hand, and plasmacytoid, signet ring, basaloid-squamous, yolk-sac, trophoblastic, rhabdoid, lipid/lipoblastic, giant, clear, eosinophilic (oncocytoid), and sarcomatoid, on the other, are revisited. Key histological and immunohistochemical features useful in the differential diagnosis are mentioned. In selected cases, molecular data associated with the diagnosis, prognosis, and/or treatment are also included.
PENGEMBANGAN MEDIA PEMBELAJARAN BERBASIS ANDROID PADA MATERI ARITMETIKA SOSIAL MENGGUNAKAN PENDEKATAN SAINTIFIK BERBANTUAN SOFTWARE CONSTRUCT 2 DI KELAS VII SMP NEGERI 137 JAKARTA
Authors: Anisah Siti , Sampoerno Pinta Deniyanti , Hajizah Mimi Nur
Published: October 2020

Penelitian ini dilatarbelakangi oleh analisis kebuutuhan siswa yang dilakukan pada tanggal 28 November 2018 di SMP Negeri 137 Jakarta. Siswa mengalami kesulitan pada materi aritmetika sosial sebesar 43,85%. Sebanyak 54,71% siswa berpendapat bahwa materi tersebut seharusnya diajarkan dengan menggunakan media pembelajaran berbasis android. Penelitian ini bertujuan untuk mengembangkan media pembelajaran berbasis android menggunakan pendekatan saintifik yang dibuat dengan software Construct 2 pada materi aritmetika sosial. Untuk mencapai tujuan di atas, digunakan jenis penelitian pendidikan Research and Development (RnD) yang mengacu pada model penelitian Borg and Gall. Uji coba media dilaksanakan di SMP Negeri 137 Jakarta dengan melibatkan 31 siswa kelas VII. Media pembelajaran yang dihasilkan berupa aplikasi yang dapat dioperasikan menggunakan smartphone android. Media pembelajaran tersebut telah melalui validasi ahli media dengan nilai persentase rata-rata 77,19% dan dikategorikan valid. Hasil penilaian ahli materi dan bahasa diperoleh persentase rata-rata 83,77% dan dikategorikan sangat valid. Hasil penilaian oleh guru diperoleh persentase rata-rata 89,02% dan dikategorikan sangat valid. Sedangkan hasil akhir penilaian oleh siswa pada uji coba skala kecil dan skala besar masing-masing diperoleh nilai rata-rata 97,20% dan 96,90%. Sehingga, rata-rata keseluruhan adalah 88,77% yang berarti media pembelajaran yang dihasilkan layak dan dapat dimanfaatkan sebagai media pembelajaran matematika untuk kelas VII SMP.
Design Research: Mengembangkan Pembelajaran Konsep Peluang Dengan Pendekatan Pendidikan Matematika Realistik Indonesia Pada Siswa Kelas IX di SMPN 220 Jakarta
Authors: Prihartini Neni , Puspita Sari  , Ibnu Hadi
Published: October 2020

Peluang adalah salah satu materi yang dipelajari dikelas IX. Berdasarkan hasil tes pendahuluan, siswa masih mengalami kesulitan dalam menyatakan ulang suatu konsep peluang, mengalami kekeliruan dalam menentukkan contoh dan bukan contoh peluang, hubungan antara peluang teoritik dan peluang empirik, dan juga siswa masih mengalami kesulitan dalam mengeksplorasi pemahamannya tentang peluang empirik. Hal tersebut, mungkin dapat disebabkan karena pembelajaran yang dilakukan siswa kurang bermakna. Oleh karena itu, hal ini mendukung pelaksanaan penelitian bagaimana mengembangkan pembelajaran konsep peluang di kelas IX dengan pendekatan PMRI di SMPN 220 Jakarta.  Penelitian ini menggunakan metode design research yang terdiri dari tiga fase yaitu, fase persiapan dan desain, fase pelaksanaan, dan fase analisis retrospektif. Subjek penelitian ini adalah enam siswa kelas IX SMP Negeri 220 Jakarta. Instrumen yang digunakan pada penelitian ini antara lain dokumentasi berupa rekaman suara dan foto, lembar wawancara, lembar aktivitas siswa, lembar catatan lapangan, dan Hipotesis Lintasan Belajar (HLB). Berdasarkan hasil analisis retrospektif, menunjukkan bahwa dengan menggunakan pendekatan PMRI dapat mengembangkan pembelajaran konsep peluang pada siswa. Siswa dapat memahami hubungan antara peluang teoretik dan peluang empirik, siswa dapat membandingkan nilai peluang pada suatu kejadian, dan siswa dapat memahami frekuensi harapan pada peluang empirik.  Melalui karakteristik PMRI, dapat membantu siswa dalam berpikir melalui konteks, menggunakan model, menggunakan hasil konstruksi siswa, melalui interaktivitasa, dan keterkaitan dengan materi lainnya.
Pengaruh Model Pembelajaran Creative Problem Solving dengan Teknik Scaffolding Terhadap Kemampuan Pemecahan Masalah Matematis Siswa di SMA Negeri 12 Jakarta
Authors: Rosselyne  , Ellis Salsabila  , Dwi Antari Wijayanti
Published: October 2020

Penelitian ini bertujuan untuk mengetahui apakah terdapat pengaruh model pembelajaran Creative Problem Solving dengan teknik Scaffolding terhadap kemampuan pemecahan masalah matematis siswa di SMA Negeri 12 Jakarta. Metode penelitian yang digunakan adalah eksperimen semu dengan desain Posttest Only Control Group Design. Populasi pada penelitian ini adalah siswa kelas X SMA Negeri 12 Jakarta tahun ajaran 2018/2019. Teknik pengambilan sampel menggunakan Cluster Random Sampling dan terpilih kelas X MIPA 1 dan X MIPA 2. Uji hipotesis menggunakan uji-t untuk dua sampel independen dengan taraf signifikansi α = 0,05. Berdasarkan hasil perhitungan diperoleh  thitung = 2,038 dan  ttabel = 1,670 sehingga thitung > ttabel  maka
Could health information systems enhance the quality of Aboriginal health promotion? A retrospective audit of Aboriginal health programs in the Northern Territory of Australia
Authors: Percival Nikki Ann , Boucher Priscilla , Conte Kathleen , Robertson Kate , Cook Julie
Published: October 2020

Background: In Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory’s publicly funded healthcare system introduced the Quality Improvement Program Planning System (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion. Methods: A retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion. Results: 39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, ‘needs assessment’ findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded. Conclusion: This is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems.
Increasing system-wide implementation of opioid prescribing guidelines in primary care: findings from a non-randomized stepped-wedge quality improvement project.
Authors: Zgierska Aleksandra E , Robinson James M , Lennon Robert P , Smith Paul D , Nisbet Kate , Ales Mary W , Boss Deanne , Tuan Wen-Jan , Vidaver Regina M , Hahn David L
Published: October 2020

Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations. Methods: Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4-6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p<0.05, 95% confidence intervals and/or Cohen’s d. Results: Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1,255 patients in the QI and 1,632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%, p=0.019) and prescribed ≥90mg/day MED (23.0% vs 15.5%, p=0.038). The stepped-wedge analysis did not show statistically significant changes in outcomes in the QI clinics, when accounting for the comparison clinics’ trends. The Cohen’s d values favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p=0.02), but not other outcomes (p³0.05). Conclusions: Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented.Trial Registration – Not applicable
Cost-effectiveness analysis of flucytosine as induction therapy in the treatment of cryptococcal meningitis in HIV-infected adults in South Africa
Authors: Miot Jacqui , Leong Trudy , Takuva Simbarashe , Parrish Andrew , Dawood Halima
Published: October 2020

Background: Cryptococcal meningitis in HIV-infected patients in sub-Saharan Africa accounts for three-quarters of the global cases and 135 000 deaths per annum. Current treatment includes the use of fluconazole and amphotericin B. Recent evidence has shown that the synergistic use of flucytosine improves efficacy and reduces toxicity, however affordability and availability has hampered access to flucytosine in many countries. This study investigated the evidence and cost implications of introducing flucytosine as induction therapy for cryptococcal meningitis in HIV-infected adults in South Africa. Methods: A decision analytic cost-effectiveness analysis and cost impact model was developed based on survival estimates from the ACTA trial and local costs for flucytosine as induction therapy in HIV-infected adults with cryptococcal meningitis in a public sector setting in South Africa. The model considered five treatment arms: (a) standard of care; 2-week course of amphotericin B/fluconazole (2wk AmBd/Flu), (b) 2-week course of amphotericin B/flucytosine (2wk AmBd/5FC), (c) short course; 1-week course amphotericin B/flucytosine (1wk AmBd/5FC) (d) oral course; 2-week oral fluconazole/flucytosine (oral) and e) 1-week course amphotericin B/fluconazole (1wk AmBd/Flu). A sensitivity analysis was conducted on key variables. Results: The highest total treatment costs are in the 2-week AmBd/5FC arm followed by the 2-week oral regimen, the 1-week AmBd/5FC, then standard of care with the lowest cost in the 1-week AmBd/Flu arm. Compared to standard of care the 1-week flucytosine course is most cost-effective at USD106/QALY. The cost impact analysis shows that the 1-week flucytosine course has an incremental cost of just over USD293 per patient per year compared to what is currently spent on standard of care Sensitivity analyses suggest that the model is most sensitive to the probability of survival at 12 months and hospital costs, particularly length of stay. Conclusions: The addition of flucytosine as induction therapy for the treatment of cryptococcal meningitis in patients infected with HIV is cost-effective when it is used as a 1-week AmBd/5FC regimen. Savings could be achieved with early discharge of patients as well as a reduction in the price of flucytosine.
Effects of environmental distractors on nurse emergency triage accuracy: a pilot study protocol
Authors: delmas philippe , fiorentino Assunta , antonini matteo , Vuilleumier severine , Stotzer guy , Kollbrunner Aurélien , Jaccard Dominique , Hulaas Jarle , Rutschmann Olivier , simon josette , Hugli Olivier , de Keranflec’h Charlotte Gilart , pasquier jerome
Published: October 2020

Background: The clinical decisions of emergency department triage nurses need to be of the highest accuracy. However, studies have found repeatedly that these nurses over- or underestimate the severity of patient health conditions. This has major consequences for patient safety and patient flow management. Workplace distractors such as noise and task interruptions have been pointed to as factors that might explain this inaccuracy. The use of a serious game reproducing the work environment during triage affords the opportunity to explore the impact of these distractors on nurse emergency triage accuracy, in a safe setting. Methods/Design: A pilot study with a factorial design will be carried out to test the acceptability and feasibility of a serious game developed specifically to simulate the triage process in emergency departments and to explore the primary effects of distractors on nurse emergency triage accuracy. Eighty emergency nurses will be randomized into four groups: three groups exposed to different distractors (A: noise, B: task interruptions, C: noise and task interruptions) and one control group. All nurses will have to complete 20 clinical vignettes within two hours. For each vignette, a gold standard assessment will be determined by experts. Pre-tests will be conducted with clinicians and certified emergency nurses to evaluate the appeal of the serious game. Discussion: Study results will inform the design of large-scale investigations and will help identify teaching, training and research areas that require further development.
Reducing regional health inequality: A sub-national distributional cost-effectiveness analysis of community-based treatment of childhood pneumonia in Ethiopia
Authors: Olsen Maria , Norheim Ole F. , Memirie Solomon Tessema
Published: October 2020

Background: Increasing the coverage of community-based treatment of childhood pneumonia (CCM) is part of the strategy to improve child survival, increase life-expectancy at birth and promote equity in Ethiopia. However, full coverage of CCM has not been reached in any regions of the country. There are no sub-national cost-effectiveness analyses available to inform decision makers on the most equitable scale up strategy.Objectives: Our first objective is to estimate the sub-national cost-effectiveness and the interindividual inequality impacts of scaling up CCM coverages to 90 percent in each region. Our second objective is to explore the costs, health effects, and geographical inequality impacts associated with three scale-up scenarios promoting different policy-aims: maximizing health, reducing geographical inequalities, and achieving 90% universal coverage.Methods: We used Markov modelling to estimate the sub-national cost-effectiveness of CCM in each region. All data were collected through literature review and adjusted to the region-specific proportions of the rural population. Health effects were modeled as life years gained and under-five deaths averted. Interindividual and geographical inequality impacts were measured by the GINI index applied to health. In scenario analysis we explored three different scale-up strategies: 1) maximizing health by prioritizing the regions where the intervention was the most cost-effective, 2) reducing geographical inequalities by prioritizing the regions with high baseline under-five mortality rate (U5MR), and 3) universal upscaling to 90% coverage in all the regions.Results: The regional incremental-cost effectiveness ratio (ICER) of scaling up the intervention coverage varied from 26 USD per life year gained in Addis to 199 USD per life year gained in the Southern Nations, Nationalities, and Peoples' region. Universal upscaling of CCM in all regions would cost about 1.3 billion USD and prevent about 90,000 under-five deaths. This is less than 15,000 USD per life saved and translates to an increase in life expectancy at birth of 1.6 years across Ethiopia. In scenario analysis, we found that prioritizing regions with high U5MR is effective in reducing geographical inequalities, although at the cost of fewer lives saved as compared to the health maximizing strategy.Conclusions: Our model results illustrate a trade-off between maximizing health and reducing health inequalities, two common policy-aims in low-income settings.
Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer
Authors: ye yunlin , Chen Zhuang-fei , Bian Jun , Liang Hai-tao , Qin Zi-ke
Published: October 2020

Background: Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy exposure for those children. Methods: The decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as relapse rates of different groups during surveillance or after chemotherapy were collected from literatures. And a survey to urologist was performed to evaluate the toxicity of the first-line and second-line chemotherapy. Using decision analysis model, chemotherapy exposure between risk-adapted treatment and surveillance were compared based on this series of clinical utilities. One-way and two-way tests were administrated to check the feasibility. Results: In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤0.10 and the relapse rate of high-risk group ≥0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to first-line chemotherapy. Conclusions: Using decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients and precious evaluation after orchiectomy was critical to this process. Further clinical study was needed to validate this statement.
Brief psychotherapy administered by non-specialised health workers to address risky substance use in inpatients with multi-drug resistant tuberculosis: A feasibility and acceptability study
Authors: Calligaro Gregory , De Wit Zani , Cirota Jacqui , Orrell Catherine , Myers Bronwyn , Decker Sebastian , Stein Dan , Sorsdahl Katherine , Dawson Rodney
Published: October 2020

Background: Only 55% of multi-drug resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use among MDR-TB patients in general, and on their delivery by non-specialist health workers in particular. Objectives: To explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge. Methods: Between December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the four weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered three-months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n=10). Results: Sixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants’ perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment. Conclusion: In this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation. Trial registration: South African National Clinical Trials Register (DOH-27-0315-5007) on 01/04/2015 (http://www.sanctr.gov.za). Funding: National Institute for Drug Abuse (NIDA), AIDS Clinical Trials Group (ACTG).
Advance Directives and End-of-Life Care: Knowledge and Preferences of Patients with Brain Tumours from Anhui, China
Authors: Wang Yi Xin , Zhang Yong Kang , Hong Yang , Zeng Ping , Hu Zong Tao , Xu Xiu Li , Wang Hong Zhi
Published: October 2020

Background: In Mainland China, the advance directives (ADs) and end-of-life care of patients with tumours, especially patients with brain tumours who may have lost consciousness or the ability to speak at the early stage of their illness, have been poorly acknowledged. Thus, this study aims to clarify the knowledge and preferences of the ADs and end-of-life care of patients with brain tumours and to investigate the predictors of patients’ preferences.Methods: This was a population-based cross-sectional survey that was conducted via face-to-face interviews. Information on the sociodemographic factors, brain tumour illness, knowledge and preferences of the advance decisions and end-of-life care of the patients were collected.Results: A total of 88.61% of the participants had never heard of ADs, but 65.18% would like to make ADs. Knowledge of ADs, receiving surgical treatment or radiotherapy, less than 70 years old, male, educational qualifications of college or beyond, childless, had medical insurance for nonworking or working urban residents and self-payment of medical expenses were predictors of preference for making ADs. A total of 79.43% participants would like to discuss end-of-life arrangements with medical staff, and 63.29% of participants were willing to receive end-of-life care although it could not delay death. A total of 65.82% patients with brain tumours wanted resuscitation, and as high as 45.45% of the patients thought that they did not need life support if they were in a persistent vegetative state. Brain primary tumours, ages of less than 70 years old, male, educational qualification of junior middle school or below, had children, had new rural cooperative medical insurance and had medical expenses paid by children or spouses were predictors of choosing appropriate palliative care.ConclusionsADs and end-of-life care have been poorly acknowledged amongst patients with brain tumours in mainland China. Additional efforts should be encouraged amongst patients with primary brain tumours, those are undergoing surgery and radiotherapy and those who have low socioeconomic status. A longitudinal and comprehensive study is encouraged to promote a disease-specific ADs amongst Chinese patients with brain tumours.
Advantage of laparoscopy surgery for elderly colorectal cancer patients without compromising oncologic outcome
Authors: Chern Yih Jong , Hung Hsin-Yuan , You Jeng-Fu , Hsu Yu-Jen , Chiang Jy-Ming , Hsieh Pao-Shiu , Tsai Wen-Sy
Published: October 2020

Background: Laparoscopic surgery has achieved good results in elderly patients with colorectal cancer (CRC). In this study, we compared the short-term and long-term outcomes of open surgery and laparoscopic surgery in CRC patients aged above 75 years at a single tertiary medical center.Methods: Between January 2009 and December 2015, we studied 967 patients who underwent curative resection for primary colorectal adenocarcinoma without distant metastasis in a single institution. Of the enrolled subjects, 305 underwent laparoscopic surgery, and 662 received open laparotomy surgery.Results: Compared to the patients who received open surgery, those received laparoscopic surgery had prominent shorter postoperative stay (10.3 vs. 13.5 days p < 0.001) and similar postoperative mortality (p = 0.082) and morbidity (p = 0.354). In the laparoscopy cohort, 6 of 305 patients were converted to open surgery and 1 died. The long-term overall survival, cancer-specific survival and recurrence rate were all similar between both cohorts in each stage.Conclusions: Laparoscopic surgery is suitable for elderly patients due to shorter postoperative stay, similar long-term outcomes with open surgery and acceptably low conversion rates. For long-term overall and oncological outcome, the results of laparoscopic surgery were similar to that of open surgery in each TNM stage.
Hair cortisol-a method to detect chronic cortisol levels in patients with Prader-Willi syndrome
Authors: Shukur Hasanain Hamid , de Rijke Yolanda B , Rossum Elisabeth FC van , Hussain-Alkhateeb Laith , Höybye Charlotte
Published: October 2020

Background: Prader-Willi syndrome (PWS) is a multisymptomatic, rare, genetic, neurodevelopmental disorder in adults mainly characterized by hyperphagia, cognitive dysfunction, behavioral problems and risk of morbid obesity. Although endocrine insufficiencies are common, hypocortisolism is rare and knowledge on long-term cortisol concentrations is lacking. The aim of this study was to evaluate long-term cortisol levels in PWS by measurements of hair cortisol.Methods: Twenty-nine adults with PWS, 15 men and 14 women, median age 29 years, median BMI 27 kg/m2, were included. Scalp hair samples were analyzed for cortisol content using liquid-chromatography tandem-mass spectrometry. In addition, a questionnaire on auxology, medication and stress were included. For comparison, 105 age- and sex-matched participants from the population-based Lifelines Cohort study were included as controls. The mean hair cortisol between the groups were compared and associations between BMI and stress were assessed by a generalized linear regression model.Results: In the PWS group large variations in hair cortisol was seen. Mean hair cortisol was 12.8±25.4 pg/mg compared to 3.8±7.3 pg/mg in controls (p=0.001). The linear regression model similarly showed higher cortisol levels in patients with PWS, which remained consistent after adjusting for BMI and stress (p=0.023). Furthermore, hair cortisol increased with BMI (p=0.012) and reported stress (p=0.014).Conclusion: Long-term cortisol concentrations were higher in patients with PWS compared to controls and increased with BMI and stress, suggesting an adequate cortisol response to chronic stress. Hair cortisol demonstrate promising applications in the context of PWS treatment and disease management.