bluuebunny/crossref_metadata_2025 huggingface dataset:
Zoonotic tuberculosis knowledge and practices among cattle handlers in selected districts of Bangladesh
Authors: Islam Sk Shaheenur , Rumi Tanzida Begum , Kabir S. M. Lutful , Rahman A. K. M. Anisur , Faisal Md. Mahmudul Hasan , Islam Robiul , van der Zanden Adri G. M. , Ward Michael P. , Ross Allen G. , Rahim Zeaur
Published: April 2021

We assessed zoonotic tuberculosis (zTB) knowledge and prevention and control practices of 404 cattle handlers via a survey in three dairy-intensive districts of Bangladesh. Most respondents were aged 30–49 (52%) and male (95%). Almost all (99%) recognized the important public health burden of tuberculosis in Bangladesh, however, most (58%) had inadequate knowledge about zTB transmission to humans. Inappropriate practices such as: not using protective equipment (98%); smoking, drinking or eating food whilst working with cattle (69%); and sharing the same premises with animals (83%) were identified. Cattle handlers educated at secondary or higher levels were 2.82- (95% CI: 1.59–5.10) and 5.15 times (95% CI: 1.74–15.20) more likely to have adequate knowledge of control and prevention activities compared to those with no formal education. Those who had reared animals for 1–5 years were 2.67 times (95% CI: 1.44–4.91) more likely to have adequate knowledge, compared to those who reared animals for >15 years. Cattle handlers with a monthly incomes of 10,000–20,000 taka were significantly (Odds Ratio = 0.36, 95% CI: 0.14–0.92) less likely to have adequate knowledge compared to those with monthly incomes <10,000 taka. Cattle handlers with high school or higher education were 6.98 times (95% CI: 2.47–19.71) more likely to use appropriate zTB control and prevention practices compared to those without formal education. Those who had reared animals for 1–5 years, 6–10 years and 11–15 years were 2.72- (95% CI: 1.42–5.24), 2.49- (95% CI: 1.29–4.77) and 2.86 times (95% CI: 1.13–7.23) more likely to apply appropriate practices compared to those who reared animals for >15 years. Overall, education, duration of cattle rearing and monthly income predicted zTB knowledge and practices. There is an urgent need to educate those at high-risk of zTB transmission on issues including the handling of infected animals, and general hygiene. A One Health approach, to support the Sustainable Development Goals and the End TB strategy, appears to be the way forward.
Refining pairwise sequence alignments of membrane proteins by the incorporation of anchors
Authors: Staritzbichler René , Sarti Edoardo , Yaklich Emily , Aleksandrova Antoniya , Stamm Marcus , Khafizov Kamil , Forrest Lucy R.
Published: April 2021

The alignment of primary sequences is a fundamental step in the analysis of protein structure, function, and evolution, and in the generation of homology-based models. Integral membrane proteins pose a significant challenge for such sequence alignment approaches, because their evolutionary relationships can be very remote, and because a high content of hydrophobic amino acids reduces their complexity. Frequently, biochemical or biophysical data is available that informs the optimum alignment, for example, indicating specific positions that share common functional or structural roles. Currently, if those positions are not correctly matched by a standard pairwise sequence alignment procedure, the incorporation of such information into the alignment is typically addressed in an ad hoc manner, with manual adjustments. However, such modifications are problematic because they reduce the robustness and reproducibility of the aligned regions either side of the newly matched positions. Previous studies have introduced restraints as a means to impose the matching of positions during sequence alignments, originally in the context of genome assembly. Here we introduce position restraints, or “anchors” as a feature in our alignment tool AlignMe, providing an aid to pairwise global sequence alignment of alpha-helical membrane proteins. Applying this approach to realistic scenarios involving distantly-related and low complexity sequences, we illustrate how the addition of anchors can be used to modify alignments, while still maintaining the reproducibility and rigor of the rest of the alignment. Anchored alignments can be generated using the online version of AlignMe available at www.bioinfo.mpg.de/AlignMe/.
Achalasia is associated with a higher incidence of depression in outpatients in Germany
Authors: Loosen Sven H. , Kandler Jennis , Luedde Tom , Kostev Karel , Roderburg Christoph
Published: April 2021

Background and aim

Achalasia represents a chronic motility disorder of the esophagus featuring an impaired lower esophageal sphincter relaxation and loss of esophageal peristalsis. By causing dysphagia, regurgitation, aspiration and chest pain, achalasia might tremendously affect life quality of patients. However, the impact of achalasia on the development of mood disorders including depression has largely remained unclear. The aim of this study was to evaluate the incidence of depression in achalasia patients.

Methods

We analyzed a large primary care cohort database in Germany capturing data from 7.49 million patients.

Results

A total of n = 1,057 patients with achalasia diagnosed between January 2005 and December 2018 were matched to a cohort of n = 3,171 patients without achalasia controlling for age, sex, physician, index year, and the Charlson comorbidity index. Interestingly, while the frequency of depression prior to the diagnosis of achalasia was comparable in both groups, new diagnoses of depression were significantly higher within one year after the diagnosis of achalasia compared to the control group, suggesting a direct and previously unrecognized association between achalasia and depression.

Conclusion

Our data suggest that the clinical management of patients with achalasia should include a careful and structured work-up for mood disorders in order to improve long-term quality of life in these patients.
Epiphytic diatom community structure and richness is determined by macroalgal host and location in the South Shetland Islands (Antarctica)
Authors: Burfeid-Castellanos Andrea M. , Martín-Martín Rafael P. , Kloster Michael , Angulo-Preckler Carlos , Avila Conxita , Beszteri Bánk
Published: April 2021

The marine waters around the South Shetland Islands are paramount in the primary production of this Antarctic ecosystem. With the increasing effects of climate change and the annual retreat of the ice shelf, the importance of macroalgae and their diatom epiphytes in primary production also increases. The relationships and interactions between these organisms have scarcely been studied in Antarctica, and even less in the volcanic ecosystem of Deception Island, which can be seen as a natural proxy of climate change in Antarctica because of its vulcanism, and the open marine system of Livingston Island. In this study we investigated the composition of the diatom communities in the context of their macroalgal hosts and different environmental factors. We used a non-acidic method for diatom digestion, followed by slidescanning and diatom identification by manual annotation through a web-browser-based image annotation platform. Epiphytic diatom species richness was higher on Deception Island as a whole, whereas individual macroalgal specimens harboured richer diatom assemblages on Livingston Island. We hypothesize this a possible result of a higher diversity of ecological niches in the unique volcanic environment of Deception Island. Overall, our study revealed higher species richness and diversity than previous studies of macroalgae-inhabiting diatoms in Antarctica, which could however be the result of the different preparation methodologies used in the different studies, rather than an indication of a higher species richness on Deception Island and Livingston Island than other Antarctic localities.
Environmental influences and individual characteristics that affect learner-centered teaching practices
Authors: Emery Nathan , Maher Jessica Middlemis , Ebert-May Diane
Published: April 2021

Research-based teaching practices can improve student learning outcomes in a variety of complex educational environments. The implementation of learner-centered teaching practices in STEM can both benefit from or be constrained by different factors related to individual instructors and the teaching environment. Additionally, we know little of how the instructional climate varies across institutions and how this climate affects teaching practices. Our study sought to examine the relative importance of environmental influences and individual characteristics on learner-centered teaching practices across institutions. We also assessed differences in our study population and departmental climate for 35 US higher education institutions across the country. We found that self-efficacy in teaching and professional development exert a strong influence on faculty teaching practices in biology. While departmental climate did not emerge as a significant predictor of teaching practices, there was consistently low support for teaching, and institution size was negatively correlated with leadership and evaluation of effective teaching. We also found that intensive professional development programs, such as the Faculty Institutes for Reforming Science Teaching IV program, may prepare instructors to teach learner-centered courses in different collegial teaching climates. Our results suggest that through cultivating self-efficacy and participating in iterative professional development, instructors can implement effective teaching practices in a variety of institutional environments.
Examining the predictors of use of sanitary napkins among adolescent girls: A multi-level approach
Authors: Chauhan Shekhar , Kumar Pradeep , Marbaniang Strong Pillar , Srivastava Shobhit , Patel Ratna , Dhillon Preeti
Published: April 2021

Background

This paper aimed to explore various factors associated with the use of sanitary napkins among adolescent girls in Uttar Pradesh and Bihar.

Methods

The study uses information from the Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey conducted in Uttar Pradesh and Bihar in 2016. The study sample consisted of 14,625 adolescent girls aged 10–19 years. The study sample was selected using a multi-stage systematic sampling design. Multilevel logistic regression (MLR) was used to identify the individual and community level factors associated with the use of sanitary napkins.

Results

The results revealed a wide variation in sanitary napkins’ use across the socio-economic and demographic factors. The use of sanitary napkins was significantly higher among girls with 8–9 (53.2%) and 10 and more (75.4%) years of schooling compared to those who had no formal education (26.4%). The use of sanitary napkins was higher among adolescent girls who were not engaged in paid work (54.7%) than those who did any paid job (40.8%). Adolescent girls reporting frequent exposure to mass media (OR = 2.10), belonging to the richest wealth quintile (OR = 3.76), and whose mothers had 10 or more years of education (OR = 2.29) had a higher propensity to use sanitary napkins than their counterparts. We did not find a significant role of community-level education of mothers on the menstrual hygiene practices of adolescents.

Conclusion

Ensuring that adolescent girls have access to hygienic means to manage their menses is critical from a public health perspective and in enabling them to realize their full potential. Programs to enhance menstrual hygiene are warranted. These programs should involve mothers, who are an important source of knowledge about menstrual hygiene. Facilitating girls’ access to education may also produce tangible menstrual hygiene benefits.
Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study
Authors: Perrottet Nancy , Fernández-Ruiz Mario , Binet Isabelle , Dickenmann Michael , Dahdal Suzan , Hadaya Karine , Müller Thomas , Schaub Stefan , Koller Michael , Rotman Samuel , Moll Solange , Hopfer Helmut , Venetz Jean-Pierre , Aubert Vincent , Bühler Léo , Steiger Jurg , Manuel Oriol , Pascual Manuel , Golshayan Dela ,   and the Swiss Transplant Cohort Study (STCS)
Published: April 2021

Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR. In addition to corticosteroid boluses, most common therapies included plasmapheresis (56.0%), intravenous immunoglobulins (IVIg) (38.7%), rituximab (25.3%), and antithymocyte globulin (22.7%). At least one infectious complication occurred within 6 months from AMR treatment in 63.6% of patients. Plasmapheresis increased the risk of overall (hazard ratio [HR]: 2.89; P-value = 0.002) and opportunistic infection (HR: 5.32; P-value = 0.033). IVIg exerted a protective effect for bacterial infection (HR: 0.29; P-value = 0.053). The recovery of renal function was complete at 3 months after AMR treatment in 67% of episodes. One-year death-censored graft survival was 90.9%. Four patients (6.2%) died during the first year (two due to severe infection). In this nationwide cohort we found significant heterogeneity in therapeutic approaches for acute AMR. Infectious complications were common, particularly among KT recipients receiving plasmapheresis.
Quantitative evaluation of microvacuole formation in five intraocular lens models made of different hydrophobic materials
Authors: Yildirim Timur M. , Schickhardt Sonja K. , Wang Qiang , Friedmann Elfriede , Khoramnia Ramin , Auffarth Gerd U.
Published: April 2021

In this laboratory study, we assessed the resistance to microvacuole (glistening) formation in hydrophobic intraocular lenses (IOLs). Glistenings were induced in five lenses each of five different hydrophobic acrylic IOL models, using an established in vitro laboratory model: 800C (Rayner, Worthing, UK), AcrySof SN60WF (Alcon, Fort Worth, USA), Tecnis ZCB00 (Johnson & Johnson Vision, Santa Ana, USA), Vivinex XY1 (Hoya, Tokyo, Japan) and CT Lucia 611P (Zeiss, Oberkochen, Germany). We evaluated the number of microvacuoles per square millimeter (MV/mm2) in the central part of each IOL. Results were analyzed statistically, and mean glistening numbers were ranked, with the highest in the SN60WF which had 66.0 (±45.5) MVs/mm, followed by the 611P with 30.7 (±8.4) MVs/mm2. The 800C and XY1 showed comparable values of 2.0 (±3.6) and 2.7 (±2.4) MVs/mm2, respectively. ZCB00 had the lowest number with 0.9 (±0.6) MVs/mm2. This study shows that the resistance to glistening formation differs depending on the hydrophobic acrylic copolymer composition of the IOL material. Some IOLs from current clinical use are still prone to develop glistenings whereas others, including the ZCB00, 800C and XY1 show high resistance to microvacuole formation.
Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry
Authors: Lin Ching-Tsai , Huang Wen-Nan , Tsai Wen-Chan , Chen Jun-Peng , Hung Wei-Ting , Hsieh Tsu-Yi , Chen Hsin-Hua , Hsieh Chia-Wei , Lai Kuo-Lung , Tang Kuo-Tung , Tseng Chih-Wei , Chen Der-Yuan , Chen Yi-Hsin , Chen Yi-Ming
Published: April 2021

In this study we aimed to identify the predictors of drug survival for biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) among patients with rheumatoid arthritis (RA) in a real-world setting. Data from RA patients receiving bDMARDs and tsDMARDs between 2007 and 2019 were extracted from the Taiwan Rheumatology Association Clinical Electronic Registry (TRACER). Patients were categorized into tumor necrosis factor-alpha (TNF-α) inhibitors, non-TNF-α inhibitors, and tofacitinib groups. The primary outcome was 3-year drug retention and the causes of bDMARDs and tsDMARDs discontinuation were recorded. Baseline demographic data before the initiation of bDMARDs and tsDMARDs treatment were analyzed to identify the predictors of 3-year drug survival. A total of 1,270 RA patients were recruited (TNF-α inhibitors: 584; non-TNF-α inhibitors: 535; tofacitinib: 151). The independent protective factors for 3-year drug survival were positive rheumatoid factor (RF) (HR: 0.48, 95% CI: 0.27–0.85,p= 0.013) and biologics-naïve RA (HR: 0.61, 95% CI: 0.39–0.94,p= 0.024). In contrast, positive anti-citrullinated protein antibody (ACPA) (HR: 2.24, 95% CI: 1.32–3.79,p= 0.003) and pre-existing latent tuberculosis (HR: 2.90, 95% CI: 2.06–4.09, p<0.001) were associated with drug discontinuation. RA patients treated with TNF-α inhibitors exhibited better drug retention, especially in the biologics-naïve subgroup (p= 0.037). TNF-α inhibitors were associated with lower cumulative incidence of discontinuation due to inefficacy and adverse events (bothp<0.001). Baseline RF and ACPA positivity in abatacept-treated patients were associated with a better 3-year drug survival. However, negative ACPA levels predicted superior drug survival of TNF-α inhibitors and tofacitinib. In conclusion, bio-naïve status predicted better drug survival in TNF-α inhibitors-treated RA patients. RF and ACPA positivity predicted better abatacept drug survival. In contrast, ACPA negativity was associated with superior TNF-α inhibitors and tofacitinib survival.
Low serum albumin and the risk of hospitalization in COVID-19 infection: A retrospective case-control study
Authors: Acharya Roshan , Poudel Dilli , Patel Aakash , Schultz Evan , Bourgeois Michael , Paswan Rishi , Stockholm Scott , Batten Macylen , Kafle Smita , Atkinson Amanda , Sarwar Hafiz
Published: April 2021

Background

The data on the COVID-19 patients who were discharged to self-quarantine is lacking.

Aim

The aim of the study was to investigate the percentage of COVID-19 positive patients that were hospitalized within a three-week period after discharge from ED to self-quarantine.

Methods

The patients who had confirmed SARS-CoV-2 on RT-PCR of the nasopharyngeal swab and were discharged from ED of a tertiary care hospital in the USA to self-quarantine from March 01- July 31, 2020, were included. Patients were divided into two groups based on serum albumin levels and were followed up for three weeks to see if low level of albumin increased the risk of hospitalization. Univariate and multivariate logistic regression analyses were performed to study the effect of albumin level and outcomes.

Results

A total of 112 patients were included in the study out of which 65 had low serum albumin (<3.5 g/dL) and 47 had normal serum albumin (≥3.5 g/dL). More than 10% of patients discharged to self-quarantine needed hospitalization within three weeks. The Low albumin group had more co-morbidities at baseline. The low serum albumin group had 10 (15.38%) vs 2 (4.26%), p = 0.06 hospitalizations as compared to the normal serum albumin group. The multivariate logistic regression analysis did not reveal lower odds of hospitalization in the group with normal albumin, (OR 0.26, 95% CI 0.03–1.92, p = 0.19) after controlling for age, sex, and various co-morbidities.

Conclusion

The low serum albumin was not associated with the risk of hospitalization in COVID-19 patients who were initially discharged to self-quarantine.
How did beliefs and perceptions about e-cigarettes change after national news coverage of the EVALI outbreak?
Authors: Morgan Jennifer C. , Silver Nathan , Cappella Joseph N.
Published: April 2021

Introduction

Exposure to media content can shape public opinions about tobacco. In early September 2019, the outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI) became headline news in the United States.

Methods

In August and September 2019, we conducted two cross-sectional online surveys with current and former smokers assessing attitudes and beliefs about e-cigarettes. Study one (n = 865) was collected before the EVALI outbreak was widely covered and study two (n = 344) was collected after the outbreak had become nation-wide news. We examined differences in perceptions and beliefs between time points.

Results

E-cigarette harm perceptions increased between study one (mean = 2.67) and study two (mean = 2.90, p < .05). Ever-users of e-cigarettes largely account for this change. Endorsement of the belief that e-cigarettes were risky and more likely to cause lung damage compared to cigarettes increased between studies (p < .05). Seventy eight percent of participants at study two were aware of the vaping illness story. Being aware of the story was associated with more endorsement of the belief that e-cigarettes were risky to use, but not that using e-cigarettes would make the participant more likely to get damaged lungs.

Discussion

When the stories about the health and safety of tobacco products dominate the public information environment, it presents an opportunity to change beliefs that are frequently targeted by paid health campaigns. Changes in participant’s perceptions of e-cigarettes were associated with coverage of this large news story, underscoring the importance of working to ensure that coverage is a scientifically accurate as possible.
Peptide 1018 inhibits swarming and influences Anr-regulated gene expression downstream of the stringent stress response in Pseudomonas aeruginosa
Authors: Wilkinson Lauren V. , Alford Morgan A. , Coleman Shannon R. , Wu Bing C. , Lee Amy H. Y. , Blimkie Travis M. , Bains Manjeet , Falsafi Reza , Pletzer Daniel , Hancock Robert E. W.
Published: April 2021

Pseudomonas aeruginosais a ubiquitous opportunistic pathogen that causes considerable human morbidity and mortality, particularly in nosocomial infections and individuals with cystic fibrosis.P.aeruginosacan adapt to surface growth by undergoing swarming motility, a rapid multicellular movement that occurs on viscous soft surfaces with amino acids as a nitrogen source. Here we tested the small synthetic host defense peptide, innate defense regulator 1018, and found that it inhibited swarming motility at concentrations as low as 0.75 μg/ml, well below the MIC for strain PA14 planktonic cells (64 μg/ml). A screen of the PA14 transposon insertion mutant library revealed 29 mutants that were more tolerant to peptide 1018 during swarming, five of which demonstrated significantly greater swarming than the WT in the presence of peptide. Transcriptional analysis (RNA-Seq) of cells that were inoculated on swarming plates containing 1.0 μg/ml peptide revealed differential expression of 1,190 genes compared to cells swarming on plates without peptide. Furthermore, 1018 treatment distinctly altered the gene expression profile of cells when compared to that untreated cells in the centre of the swarm colonies. Peptide-treated cells exhibited changes in the expression of genes implicated in the stringent stress response including those regulated byanr, which is involved in anaerobic adaptation, indicative of a mechanism by which 1018 might inhibit swarming motility. Overall, this study illustrates potential mechanisms by which peptide 1018 inhibits swarming surface motility, an important bacterial adaptation associated with antibiotic resistance, virulence, and dissemination ofP.aeruginosa.
Hepatitis B virus infection and its determinants among HIV positive pregnant women: Multicenter unmatched case-control study
Authors: Anteneh Zelalem Alamrew , Wondaye Estifanose , Mengesha Endalkachew Worku
Published: April 2021

Background

Hepatitis B virus (HBV) kills millions of people globally; it is worse in pregnant women. HBV and Human Immune Virus (HIV) co-infection is associated with increased liver diseases such as cirrhosis and hepatocellular carcinoma. This study aimed at identifying the determinants of HBV infection among HIV-positive pregnant women.

Methods

A multicentre unmatched case-control study was conducted among 109 cases (HBV/HIV co-infected) and 327 controls (HIV positive) pregnant women in seven hospitals of the Eastern Amhara region. Interview and chart review data collection techniques were employed by trained personnel. A binary logistic regression model was used to identify independent predictors of hepatitis B virus infection. Variables with a p-value of <0.05 and 95% confidence interval for odds ratio not containing 1 considered independent predictors of HBV infection.

Results

The findings of this study revealed that history of STI [AOR, 1.97, 95%CI, 1.09–3.56], hospital admission [AOR, 3.08, 95%CI, 1.69–5.61], traditional delivery care [AOR, 3.31, 95%CI, 1.72–6.37], family history of HBV [AOR, 3.33, 95%CI, 1.72–6.37], presence of opportunistic infections [AOR, 0.23, 95%CI, 0.12–0.58], viral load [AOR, 7.58, 95%CI, 3.18–8.01], CD4 count [AOR, 2.15, 95% CI, 1.01–4.59], anaemia [AOR, 3.07, 95% CI, 1.71–5.51] and unsafe sex [AOR, 1.98, 95%CI, 1.09–3.61] had a statistically significant association with HBV infection.

Conclusions

Several exposure variables had statistically significant association with HBV infection. High Viral Load appeared to be the largest predictor of HBV infection in HIV patients. Therefore, targeted interventions such as behavioral change intervention for unsafe sex and STI should be in place, and screening tests and treatment at the early stage of conception for both partners is necessary.
Disparate Health Care in Barrett's Esophagus: The First Step Is Awareness
Authors: Katzka David A.
Published: April 2021

Disparities in medical treatment related to differences in race, gender, and creed are present in all fields of practice. This a complex issue requires multiple perspectives to gain advancements in patient care. This editorial examines the recently published article uses the GI Quality Improving Consortium to investigate disparities in adherence to quality indicators in Barrett's esophagus.
Impact of COVID-19 on Prescribing Trends of Direct-Acting Antivirals for the Treatment of Hepatitis C in Ontario, Canada
Authors: Konstantelos Natalia , Shakeri Ahmad , McCormack Daniel , Feld Jordan J. , Gomes Tara , Tadrous Mina
Published: April 2021

INTRODUCTION:

Direct-acting antivirals (DAAs) are curative treatments for hepatitis C. However, initiation of these treatments requires adequate healthcare access. Coronavirus 2019 (COVID-19) resulted in restrictions to healthcare services in March 2020. We examined the impact of COVID-19 on the number of individuals dispensed DAAs.

METHODS:

This is a cross-sectional study examining the number of individuals dispensed DAAs in Ontario, Canada, from 2018 to 2020. Time-series models determined the impact of healthcare restrictions on DAA dispensations.

RESULTS:

Healthcare restrictions resulted in a 49.3% decrease in DAA dispensations (P = 0.026).

DISCUSSION:

COVID-19-related healthcare restrictions significantly affected access to DAAs. Studies exploring the long-term effects on reduced treatment are needed.
Trends in the Economic Burden of Chronic Liver Diseases and Cirrhosis in the United States: 1996–2016
Authors: Ma Christopher , Qian Alexander S. , Nguyen Nghia H. , Stukalin Igor , Congly Stephen E. , Shaheen Abdel Aziz , Swain Mark G. , Teriaky Anouar , Asrani Sumeet K. , Singh Siddharth
Published: April 2021

INTRODUCTION:

The management of chronic liver diseases (CLDs) and cirrhosis is associated with substantial healthcare costs. We aimed to estimate trends in national healthcare spending for patients with CLDs or cirrhosis between 1996 and 2016 in the United States.

METHODS:

National-level healthcare expenditure data developed by the Institute for Health Metrics and Evaluations for the Disease Expenditure Project and prevalence of CLDs and cirrhosis derived from the Global Burden of Diseases Study were used to estimate temporal trends in inflation-adjusted US healthcare spending, stratified by setting of care (ambulatory, inpatient, emergency department, and nursing care). Joinpoint regression was used to evaluate temporal trends, expressed as annual percent change (APC) with 95% confidence intervals (CIs). Drivers of change in spending for ambulatory and inpatient services were also evaluated.

RESULTS:

Total expenditures in 2016 were $32.5 billion (95% CI, $27.0–$40.4 billion). Over 65% of spending was for inpatient or emergency department care. From 1996 to 2016, there was a 4.3%/year (95% CI, 2.8%–5.8%) increase in overall healthcare spending for patients with CLDs or cirrhosis, driven by a 17.8%/year (95% CI, 14.5%–21.6%) increase in price and intensity of hospital-based services. Total healthcare spending per patient with CLDs or cirrhosis began decreasing after 2008 (APC −1.7% [95% CI, −2.1% to −1.2%]), primarily because of reductions in ambulatory care spending (APC −9.1% [95% CI, −10.7% to −7.5%] after 2011).

DISCUSSION:

Healthcare expenditures for CLDs or cirrhosis are substantial in the United States, driven disproportionately by acute care in-hospital spending.
Colonoscopy Versus Fecal Immunochemical Test for Reducing Colorectal Cancer Risk: A Population-Based Case–Control Study
Authors: Kim Su Young , Kim Hyun-Soo , Kim Yun Tae , Lee Jung Kuk , Park Hong Jun , Kim Hee Man , Kang Dae Ryoung
Published: April 2021

INTRODUCTION:

Use of colonoscopy or the fecal immunochemical test (FIT) for colorectal cancer (CRC) prevention is supported by previous studies. However, there is little specific evidence regarding comparative effectiveness of colonoscopy or FIT for reducing CRC risk. In this study, we compared the association of CRC risk with colonoscopy and FIT using a nationwide database.

METHODS:

This population-based case–control study used colonoscopy and FIT claims data from the Korean National Health Insurance System from 2002 to 2013. Data were analyzed from 61,221 patients with newly diagnosed CRC (case group) and 306,099 individuals without CRC (control group). Multivariable logistic regression models were used to evaluate the association between CRC and colonoscopy or FIT.

RESULTS:

Colonoscopy was associated with a reduced subsequent CRC risk (adjusted odds ratio [OR] 0.29). Stronger associations were found between colonoscopy and distal CRC, compared with proximal CRC (0.24 vs 0.47). In an analysis stratified by sex, the association was weaker in female subjects compared with male subjects (0.33 vs 0.27). Any FIT exposure was associated with CRC risk with an OR of 0.74; this association was stronger for distal cancer. As the frequency of cumulative FIT assessments increased (from 1 to ≥5), the OR of FIT exposure for CRC gradually decreased from 0.81 to 0.45.

DISCUSSION:

The association of colonoscopy or FIT with reduced CRC risk was stronger for distal CRC than for proximal CRC. FIT showed less CRC risk reduction than colonoscopy. However, as the frequency of cumulative FIT assessments increased, the association with CRC prevention became stronger.
SIMULATION OF A MANEUVERING AIRCRAFT USING A PANEL METHOD
Authors: Schoř Pavel , Kouřil Martin , Daněk Vladimír
Published: April 2021

We present a method for numerical simulations of a maneuvering aircraft, which uses a first-order unsteady panel method as the only source of aerodynamic forces and moments. By using the proposed method, it is possible to simulate a motion of an aircraft, while the only required inputs are geometry and inertia characteristics, which significantly reduces the time required to start the simulation. We validated the method by a comparison of recordings of flight parameters (position, velocities, accelerations) from an actual aerobatic flight of a glider and the results obtained from the simulations. The simulation was controlled by deflections of control surfaces recorded during the actual flight. We found a reasonable agreement between the experimental data and the simulation. The design of our method allows to evaluate not only the integral kinematic quantities but also instant local pressure and inertia loads. This makes our method useful also for a load evaluation of an aircraft. A significant advantage of the proposed method is that only an ordinary workstation computer is requiredto perform the simulation.
Política agrícola no Brasil e na Alemanha
Authors: De Pintor Eduardo , Piacenti Carlos Alberto
Published: April 2021

A agricultura ocupa papel fundamental na sociedade, tanto nas economias desenvolvidas quanto nas em desenvolvimento. No Brasil, ela tem cumprido suas funções básicas, estando fortemente ligada à dinâmica econômica e a segurança alimentar. Na União Europeia (UE) a agricultura também tem ocupado papel de destaque que, após a Segunda Guerra Mundial, se desdobrou na formulação de uma Política Agrícola Comum (PAC) que esteve principalmente pautada em proporcionar segurança alimentar no âmbito de seu território. Porém, durante sua trajetória a política sofreu forte influência dos interesses particulares de seus países-membros ligados a questões comerciais, as quais foram componentes importantes nas decisões tomadas no aspecto econômico da política agrícola, o que acabou por elevar a relevância econômica da agricultura para as relações comerciais da UE. Neste contexto que se insere o estudo, o qual está norteado em discutir os objetivos estrutura da política agrícola no Brasil e na Alemanha e suas implicações na Mesorregião Oeste do Paraná e o Estado de Nordrhein-Westfalen. Logo, foi possível perceber que o arranjo institucional da política de crédito rural brasileira foi formatado para responder a incentivos via preços de mercado, os quais são ditados pelo comércio internacional de commodities. Enquanto a PAC ocupou-se de manter o status quo no campo pela via pública desvinculada do mercado de preços agrícolas. Processo este, que foi sustentado via transferências de recursos da sociedade para os agricultores por meio de custosos subsídios e acabaram por auxiliar na manutenção do espaço rural em ambos os territórios.
Multiterritorialidades e espacialidades da comunidade quilombola Vereda dos Anacletos, Esperantina (PI)
Authors: Moura Fé Elisângela Guimarães , Alcobaça Gomes Jaira Maria , Do  Nascimento José Edilson
Published: April 2021

Esta pesquisa versa sobre a relação de territorialidade construída pelas comunidades quilombolas e a organização de seus espaços socioprodutivos, levando em conta os problemas históricos de acesso à terra que marcam a estrutura fundiária no Brasil. As pequenas comunidades quilombolas presentes no Território dos Cocais, no Estado do Piauí, revelam, em sua multiterritorialidade e microterritorialidade, marcas das temporalidades espacializadas nas formas de acesso e uso da terra. Nessa perspectiva, designou-se como área de estudo a Comunidade Vereda dos Anacletos, localizada no município de Esperantina (PI), onde se promoveram oficinas de mapeamento participativo (ACT BRASIL, 2018) envolvendo trabalhadores rurais da comunidade, além de pesquisa documental e aplicação de questionários. O território dessa comunidade é marcado pela sociobiodiversidade da palmeira carnaúba, embora poucos moradores tenham acesso aos carnaubais. Os resultados apontaram que a concentração fundiária e a submissão às normas impostas pelos proprietários de terras marcam a organização do espaço socioprodutivo, com baixa produtividade e pouca inserção nas políticas públicas voltadas ao fortalecimento da economia local.
Comfortable Room Condition for Working and Resting
Authors: Wardana Jovina Evangeline , Dewi Ova Candra , Sari Joice Sandra
Published: April 2021

This paper aims to determine the comfortable room condition in terms of room organization, lighting and room temperature. Due to the pandemic, many workers are forced to bring their outside home activities back home.  Many of them struggle in finding one suitable and comfortable space as they do not have a dedicated space to do the work from home. A bedroom, as one of the potential rooms to maintain the balance between work and rest at home, are observed for space adjustment, especially the organisation of space, lighting and room temperature to maintain the comfort. The comfortable room condition needs to support the bedroom as a working and relaxing space. This study consists of literature review about space, lighting and temperature and observation of two study case studies. This study concludes that the room organization, lighting and room temperature affects the user physically and psychologically which results in the comfort of the user. As a worker, to increase comfort level and have good rest balance, the user needs to adjust the variables of lighting, room temperature and room organization to achieve the optimum comfort level.
In Searching Architecture and City Pattern as the Mark of Old Coastal Semarang, Indonesia
Authors: Rukayah R Siti , Abdullah Muhammad
Published: April 2021

Based on the previous research on the former of Semarang capital city, Kanjengan, there is a supposition that the area is a coastal city. As the consequence of the sedimentation process occurred by Java Island, Semarang city, and some cities in Java are no longer on the seashore. The cities that are archived in the Map of Indonesia in the 15th century and some records from foreign sailors, absolutely have several different conditions compared to the past and the present condition.  How the architecture and the city’s patterns of the Old Semarang? The method of this research was conducted by exploring historical articles, toponyms, maps, and old pictures which were then compared with the remaining architecture and spatial patterns. The reading of old maps and pictures was done by using the seeing by believing approach. The analysis was performed by using the manual sketch. The architectural heritage like the former lighthouse, commercial corridors in the north of the square, and toponyms were tools to prove that the area was a seaport and a waterfront city. Old Coastal Semarang has an Architecture and urban design concept as the main gate from the sea to the city center at the time. Surrounding the main gate, they were the existence of the former lighthouse (the Menara Layur Mosque), multi-ethnics houses, toponyms indicating that some places were a former harbor, and the remaining trade corridor connecting the port and the local government center. This concept is similar to the Islamic Sultanates on the north coast of Java and the waterfront-based cities in the interior of Java. It is assumed that Semarang Old city has a similar role with the other Islamic Sultanates. This area is proper to be a city conservation area and become a part that is integrated into future urban planning.
Faktor - Faktor yang Mempengaruhi Komitmen Dokter di Puskesmas untuk Tidak Merujuk Kasus Non-Spesialistik Pasien BPJS di Kota Semarang
Authors: Sucipto Hendro , Suryawati Chriswardani , Jati Sutopo Patria
Published: April 2021

Patients who should be able to be treated at the health center (puskesmas) but because of some matters referred to and handled in a hospital, it is a waste of health costs. Hence, BPJS will pay more according to INA CBG's tariff. 3       Advanced Health Facilities, in this case a hospital, is also object to having to deal with non-specialist cases, while the case can actually be completed at the first health facility. Handling non-specialist cases in hospitals leads to health services being less well targeted. The hospital will be very busy handling patients who are not supposed to, while patients who really need treatment in the hospital can be neglected. 2       This study aims to analyze factors which influence the commitment of doctors not to refer to non-specialist cases in health centers in the city of Semarang       The study was conducted with a cross sectional quantitative research design. The data were collected by calculating the total results of the questionnaire measurements on each variable with a Likert scale on 73 doctors in 37 health centers spread across the city of Semarang. The study was conducted during March to May 2018.       The results showed that the number of non-specialist cases of BPJS Health participant patients was still relatively high. This has to do with the commitment of doctors at the health center not to refer to non-specialist cases. The most influence factor to the commitment of doctors not to refer to non-specialist cases was the doctor's perception of the completeness of facilities and infrastructure and the doctor's perception of his competence
Analisis Mutu Pelayanan Nifas Pertama (Kf1) oleh Bidan di Puskesmas di Kabupaten Pemalang Tahun 2018
Authors: Pamungkas Ragil Sri , Suryawati Chriswardani , Kartini Apoina
Published: April 2021

Maternal Mortality Rate (MMR) in Pemalang Regency in 2017 is still high and happens a lot during childbirth time period (72%). One of the efforts for reducing MMR is the quality service of childbirth for the process of mother and baby recovery, early detection of complications, taking care of and referral of complications. The aim of the study is to determine and analyze the quality of the first childbirth service (KF1) and factors related to the service quality of first childbirth (KF1) by midwives at Health Centres in Pemalang Regency.Quantitative research method used cross sectional research type, sample selection by simple random sampling at 100 civil servant of midwives working period of at least three years in 14 health centres in each sub-district in Pemalang Regency. Data collections were done by questionnaires and observations, data analysis with chi-square statistical tests and multivariate with multiple logistic regression.Research results showed that the service quality of the first childbirth (KF1) is lacking (53%), lacking motivation (54%), less reward (65%), less supervision (50%) and workload according to the standard (57%). Variables related to the service quality of the first childbirth (KF1) are motivation (p-value = 0.018) and rewards (p-value = 0.003). While the variables not related to the service quality of the first childbirth (KF1) are supervision (p-value = 0.229) and workload (p-value = 0.774). The factors that influence the service quality of the first childbirth (KF1) are rewards (value p = 0.031 and OR = 3,466).Suggestions for improving the service quality of the first childbirth (KF1) are midwives have to be more optimal in giving childbirth care and health education, head of health centres can divide the tasks equally among all midwives, midwives in working have to create a positive attitude, the head of the health centres praises the success of childbirth care, the head of the health centres can allocate funds for the transportation of home visits, the implementation of supervision is carried out on a scheduled and routine for all midwives.
Spekulatywny zwrot czy powrót do źródeł? O „kwartetach” Martina Heideggera i Grahama Harmana
Authors: Żywiołek Artur
Published: April 2021

The article contains reflections on the “speculative realism”, a direction in 21st century philosophy initiated by Graham Harman, whose books (The Quadruple Object, Object-Oriented Ontology. A New Theory of Everything) continue and process Martin Heidegger’s concept of “the quadruple” (das Geviert), and they also use the ideas of such thinkers as Edmund Husserl and Bruno Latour. The basic problem formulated in this text arises from the following questions: is speculative realism another turn in scientific research, or rather a return to those sources of thinking that take into account the complexity and the irreducibility of reality to any metaphysical instance? What is the role of the “speculative turn” in cultural studies, in various interpretative practices?
Niewidoma kobieta, niewidoma pisarka. Tożsamości Jadwigi Stańczakowej
Authors: Ładoń Monika
Published: April 2021

The article concerns Jadwiga Stańczakowa, a blind journalist and writer, and friend of Miron Białoszewski. The author analyses Stańczakowa’s writing as an independent literary phenomenon deserving its own interpretation. Drawing on autobiographical and autoethnographic work by Maria Reimann, who is also an author with a disability, the author observes the emancipatory meaning of blindness. The text present three identities of Jadwiga Stańczakowa. First, the author shows her as a woman and asks if her blindness affected her femininity and sexuality. Secondly, the author interprets fragments of texts written by Stańczakowa during depression. Finally, she describes the writer’s identity, the most autonomous, although they all depend on Białoszewski.
Filmowe reprezentacje seksualności osób niepełnosprawnych – przykład polski
Authors: Otto Wojciech
Published: April 2021

Disability in Polish films is not a marginal issue. As a film topic, it has been explored in many different ways and contexts due to a nexus of diverse relations, trends and social phenomena. All of which have revealed the degree of intensity of the phenomenon as well as its historic changeability. On the one hand, such images have been a reflection of the filmmakers’ interests and, on the other, a source of knowledge on disability and a kind of catalyst for socio-moral transformation shaping the attitudes and behaviour of society towards the disabled. The problem is presented by,, images of disabled film characters, which are widely used in Polish cinematography and often built on socialstereotypes, as well as by the communicative strategies used by filmmakers in their works on disability. In this context, films about disability have played an opinion-forming role, contributing greatly to an enhanced image of disabled people in society and widening their area of activity. The sexuality of people with disabilities is portrayed as asexuality and hypersexuality, and in Polish cinema it mainly concerns the emotional sphere, and less so the physical.
Biały bez. Pożegnanie Profesora Sylwestra Dworackiego
Authors: Krajewska Anna
Published: April 2021

A text dedicated to the memory of Professor Sylwester Dworacki, a member of the Editorial Committee of the journal „Przestrzenie Teorii” [Spaces in Theory].
Biomitografia zakwestionowana. Sendlerowa. W ukryciu Anny Bikont jako performans tekstualny
Authors: Żarnecka Paulina
Published: April 2021

The article is a performative interpretation of Sendlerowa. W ukryciu, a biography of Irena Sendlerowa by Anna Bikont. The author of the article presents the biography as a textual performance, whose aim is to contest the well-known image of Irena Sendlerowa (described within the category of biomythography introduced by Michael Benton). The author analyses how Anna Bikont distances herself from the biomythography and reintroduces the parts of Sendlerowa’s biography that had been omitted for years through being incompatible with the role of a national hero. She also evaluates the extent to which biography can serve as a critical tool with respect to Polish historical policy.
Dublin na (tekstualnej) scenie. O dramatyzacji przestrzeni w Ulissesie Jamesa Joyce’a
Authors: Kozłowski Paweł
Published: April 2021

The author investigates how James Joyce stylizes the space in his novel Ulysses for drama. For this purpose he carries out a comparative analysis of some episodes in this book. This analysis leads to the conclusion that Joyce transposes some dramatic genres and specifically dramatic writing techniques, especially associated with August Strindberg. Kozłowski emphasizes the dramatic character of some motifs that create spatial conditions in Joyce’s novel. Furthermore, he compares these motifs with the literary works of the greatest modern dramatists.
Why wait until residency? Competency-based education in longitudinal integrated clerkships
Authors: Gentles John Quinn
Published: April 2021

This essay was selected as the winner of the 2015 Canadian Undergraduate Surgical Education Committee student essay competition. It was written in response to the prompt: “How is your school preparing you for residency — be it surgical or medical?”.