bluuebunny/crossref_metadata_2025 huggingface dataset:
Migration of Junior Doctors: The Case of Psychiatric Trainees in Portugal
Authors: Pinto da Costa Mariana , Moreira Cátia , Castro-de-Araujo Luis F. S. , Da Silva Fábio Monteiro , Dos Santos Renato Antunes
Published: February 2020

Introduction: In the last few decades, the rates of international medical migration have continuously risen. In Psychiatry, there is great disparity in the workforce between high and low-income countries. Yet, little is known about the ‘push’ and ‘pull’ factors and the migratory intentions of trainees. This study aims to assess the factors impacting the decisions of psychiatric trainees in Portugal towards migration.Material and Methods: A questionnaire was developed in the Brain Drain study and was distributed to psychiatric trainees in Portugal.Results: The sample consists of 104 psychiatric trainees (60.6% female). Overall, 40.4% of the trainees had prior experience of living abroad and the majority (96.9%) felt that this experience influenced their attitude towards migration in a positive way. About 75% of trainees had ‘ever’ considered leaving the country, but the majority (70.0%) had not taken any ‘practical steps’ towards migration. The main reasons to stay in Portugal were personal, while the main reason to leave was financial. The majority of the trainees (55.7%) were dissatisfied or very dissatisfied with their income, working conditions and academic opportunities.Discussion: Working conditions, salaries and academic opportunities are the main triggers for the migration of psychiatric trainees from Portugal.Conclusion: These results may inform the decisions of stakeholders in the health and education sectors and point out the necessary investments required and the impact it may have on the workforce.
Pelayanan Izin Lingkungan dalam Mendukung Iklim Usaha yang Kondusif Terkait dengan Sistem Pelayanan Izin Berusaha Terintegrasi (OSS)
Authors: Putri RR. Ayu Maulida
Published: February 2020

Artikel ini mengkaji mengenai pelayanan perizinan lingkungan yang mendukung iklim usaha kondusif terkait dengan adanya peraturan pemerintah baru yaitu sistem pelayanan perizinan berusaha terintegrasi secara elektronik dengan nama lain Online Single Submission (OSS). Pada saat ini masih banyak pejabat yang terjerat hukum akibat penyalahgunaan wewenang dan salah satunya dalam bidang perizinan. Presiden Republik Indonesia meninjau kembali pelayanan perizinan bagi kelancaran kegiatan usaha dan/ atau terhadap perlindungan lingkungan hidup dengan diterbitkannya sistem OSS untuk mengurangi penyalahgunaan wewenang tersebut. Salah satu perizinan dibidang lingkungan yang rentan menimbulkan permasalahan adalah izin lingkungan sebagai perizinan ditahap perencanaan. Penelitian ini menggunakan tipe doctrinal research, yuridis normatif. Hasil yang didapatkan adalah pendalaman mengenai sistem OSS dalam memberikan pelayanan perizinan yang baru di Indonesia dengan tujuan untuk memperlancar perkembangan investasi di Indonesia. Mengacu pada undang-undang, peraturan pemerintah, serta peraturan menteri terkait sehingga mendapatkan pemahaman atas pendalaman izin berusaha terintegrasi secara elektronik, baik dari segi kemanfaatan dan penilaiannya dengan lebih jelas.
Tanggung Gugat Kontraktor dalam Kegagalan Bangunan
Authors: Yushar Yushar,
Published: February 2020

Dalam pengadaan infrastruktur tentunya akan dilakukan pemilihan penyedia jasa konstruksi, baik melalui penunjukan langsung maupun lelang. Namun, pengerjaan jasa konstruksi terkait dengan pembangunan infrastruktur tak selalu berjalan sesuai rencana. Terkadang terdapat kendala berupa kegagalan bangunan. Dalam hal terjadinya kegagalan bangunan, maka pasti akan ada pihak yang dirugikan. Terkait dengan adanya kerugian tersebut, haruslah diketahui siapa pihak yang bertanggung gugat atas kerugian tersebut dan bagaimana batasan tanggung jawab dari kontraktor pelaksana Jasa konstruksi dalam hal terjadi kegagalan bangunan. Penelitian ini memiliki dua tujuan, yaitu pertama untuk mengetahui hubungan hukum antara penyedia jasa dengan pengguna jasa dalam kontrak jasa konstruksi. Kedua, untuk mengetahui tentang kegagalan bangunan dan akibat hukumnya. Penelitian ini merupakan penelitian normatif yang menggunakan dua pendekatan, yaitu, pendekatan perundang-undangan dan pendekatan konseptual. Hasil dari penilitian ini adalah dalam hal terjadi kegagalan bangunan, maka harus dilihat kembali kegagalan tersebut disebabkan atas kesalahan siapa. Namun, apabila jenis kontrak yang digunakan adalah kontrak Lumsum yang berarti pihak Kontraktor menerima untuk menanggung segala risiko yang terjadi, maka kontraktor yang harus bertanggung gugat atas kegagalan bangunan yang terjadi sesuai dengan ketentuan Pasal 27 ayat (3) Peraturan Presiden Nomor 16 Tahun 2018 tentang Pengadaan Barang/Jasa Pemerintah.
Maternal mortality risk factor in pregnancy with heart disease at Dr. Soetomo General Hospital, Surabaya, Indonesia
Authors: Muninggar Laili , Yusuf M , Prasetyo Budi
Published: February 2020

Objectives: This research want to identify some factors that increasing risk of maternal death in pregnant woman with heart disease.Materials and Methods: This study was a retrospective analytic study with cross sectional design, with total sampling 92 patient with heart disease in pregnancy at maternity room Dr. Soetomo hospital, Surabaya, during periode January until December 2017.Results: Prevalency of pregnancy with heart disease in dr. Soetomo hospital about 0,5% with mortality that caused by heart disease 14% from all maternal death. Factors that increase risk of maternal death are non adequate antenatal visit number (OR 1,7;CI 95%), delay of detecting heart disease (OR 2,5;CI 95%), complication such as severe pulmonal hypertension (OR 61,4;CI 95%), Eisenmenger syndrome (OR 2,9;CI 95%), Decompensatio Cordis Functional Class IV (OR 1,2;CI 95%), and Thrombo-embolism (OR 9;CI 95%).Conclusion: Mortality rate in pregnancy with heart disease is 14% of all maternal mortality. Risk of maternal death increased by non adequate antenatal visit and delay in heart disease detection, and also medical complications. Detection of heart disease since before pregnant with pre-conceptional councelling and a good managed multidisciplinary antenatal care supposed to decrease morbidity and mortality.
Characteristics of Peripartum Cardiomyopathy (PPCM) pregnancy and preeclampsia in Dr Soetomo Hospital, Surabaya, Indonesia, 2014-2016
Authors: Arfianda Dibya , Wicaksono Budi , Gumilar Khanisyah Erza , Andrianto Andrianto
Published: February 2020

Objectives: to present data on the characteristics of pregnancy with PPCM and PE. Management of patients with PPCM is almost the same as for patients with acute or chronic heart failure, which uses drug therapy. PPCM and preeclampsia (PE) are two related diseases, although not directly. Both have similar pathophysiological mechanisms.Case Report: We present 25 pregnancy cases with PPCM at Dr. Soetomo Hospital within 3 years. Data were collected from January 2014 to December 2016, consisting of 5 PPCM cases and the other 20 cases were PPCM with PE cases.Conclusion: Pregnancy with PPCM-PE has higher morbidity than PPCM only. The diagnosis of PPCM should be established immediately if heart failure symptoms are found in the third trimester and the patient has risk factors, such as age >30 years, multigravida, obesity, and multiple pregnancy.
Correlation of CTR1, ERCC-1, and HSP70 expressions with cisplastin response in cervical cancer stage IIB
Authors: Askandar Brahmana , Suhatno Suhatno , Hood Juliati
Published: February 2020

Objectives: This study aimed to determine the resistance of cisplatin (chemotherapy drugs) at three point areas including expression of CTR1, ERCC1, and HSP70 in cervical cancer patients.Materials and Methods: This research used a cross sectional approach. The population in this study were patients with stage IIB of cervical carcinoma. The study sample were patients with stage IIB of cervical carcinoma according to the FIGO classification, patients received cisplatin chemotherapy treatment (50 mg/m2 4 times), had good kidney and liver function. The independent variables in this study were the expression of CTR1, ERCC1, and HSP70 and the dependent variable of this study was the response to cisplatin therapy in cervical cancer. Primary data was obtained through MRI examination after the administration of cisplatin 50 mg/m2 every week. The parameters of this study included the expression of CTR1, ERCC1 and HSP70. Data obtained were analyzed using Wilcoxon rank test, Spearman test and categorical regression with a significance level of p <0.05.Results: The treatment of cisplatin therapy in cervical cancer patients had no significant correlation between the expression of CTR1 and ERCC1, but in the expression of HSP70 there was a significant negative correlation which means that the higher the expression of HSP70, the worse the response of therapy.Conclusion: This study showed that HSP70 expression can be used as an indicator in treatment of cisplatin therapy in cancer patients through MRI examination.
The effect of type of sound damper material in the Helmholtz resonator to the output power spectrum of acoustic energy Harvester
Authors: Harindra Hedwigis , Utomo Agung Bambang Setio , Setiawan Ikhsan
Published: February 2020

Acoustic energy harvesting is one of many ways to harness acoustic noises as wasted energy into useful electical energy using an acoustic energy harvester. Acoustic energy harvester that tested by Dimastya (2018) which is consisted of loudspeaker and Helmholtz resonator, produced two-peak spectrum. It is suspected that the first peak is due to Helmholtz resonator resonance and the second peak comesfrom the resonance of the conversion loudspeaker. This research is to experimentally confirm the guess of the origin of the first peak. The experiments are performed by adding silencer materials on the resonator inner wall which are expected to be able to reduce the height of first peak and to know how they affect the output electric power spectrum of the acoustic energy harvester. Three different silencer materials are used, those are glasswool, acoustic foam, and styrofoam, with the same thickness of 12 cm. The results show that glasswool absorbs sound more effectively than acostic foam and styrofoam. The use of glasswool, acoustic foam, and styrofoam with 12 cm thickness lowered the first peak by 90% (from 39 mW to 0,5 mW), 82% (from 39 mW to 0,7 mW), and 82% (from 39 mW to 0,7 mW), respectively. Based on these results, it is concluded that the guess of the origin of the first peak is confirmed.
Metabolic, Inflammatory and Imaging Biomarkers in Evaluation of Coronary Arteries Anatomical Stenosis in Patients with Stable Coronary Artery Disease
Authors: Koshelskaya O. A. , Suslova T. E. , Kologrivova I. V. , Margolis N. Y. , Zhuravleva O. A. , Kharitonova O. A. , Vinnitskaya I. V.
Published: February 2020

Aim. To reveal the statistically significant determinants of the coronary artery (CA) stenosis ≥70% in patients with chronic stable CA disease receiving drug therapy.

Material and methods. The study included 68 patients (aged 59.6±6.4 years) with stable CA disease and optimal cardioactive therapy. Coronary angiography was performed in all patients. Basic serum parameters of carbohydrate and lipid metabolism were evaluated; serum concentration of cytokines, adipokines and high sensitive C-reactive protein (hsCRP) were determined by ELISA. The epicardial adipose tissue (EAT) thickness was measured by B-mode echocardiography.

Results. The patients’ classification model was created. It allowed to determine probability P for CA stenosis of 70% or more for each patient using formula Р, where L=0.89-1.09×gender+ 0.51×triglycerides–0.28×HDL+0.24×hsCRP (HDL – high density lipoproteins). If calculated P value falls into interval (0; 0.228) the patient should be classified into the group with the risk of CA stenosis ≥70%, while if calculated P value falls into interval (0.228; 1), the patient should be classified into group with CA stenosis below 70%. Even though EAT thickness was indistinguishable determinant of CA stenosis ≥70% in our study, its inclusion into the model as a fifth variable allowed to increase the model quality: area under ROC-curve (AUC) in the model without EAT thickness constituted 0.708 (p=0.009), and increased up to 0.879 (p=0.011) after EAT thickness inclusion.

Conclusions. Male sex, level of triglycerides, HDL and hsCRP are statistically significant determinants of CA stenosis ≥70%. The presence of the triglycerides level in the created model underscores an important contribution of this lipid fraction, even when elevated only up to the moderate values, into modulation of the residual cardiovascular risk in patients receiving statins.
ANALISIS PEMAHAMAN PEKERJA KONTRAK OUTSOURCING TERHADAP HAK-HAK PEKERJA YANG TERCANTUM DALAM UNDANG-UNDANG NOMOR 13 TAHUN 2003 TENTANG KETENAGAKERJAAN DI WILAYAH KOTA SURABAYA
Authors: Boong Vicariya Retnowati , Ritonga Rena Zefania
Published: February 2020

The appearance of outsourcing companies shows that the high needs of companies and factories that exist for the use of labor in Indonesia. Security and cleaning service is a type of work that much needed in business world. The legal relationship between a company and an outsourced worker is fixed by a certain time work agreement (PKWT) which is regulated in Law No. 13/2003. The position of the outsourced contract workers is due to this kind of work is a complementary and the contract is only within a certain period. The outsourced contract workers have fundamental rights as stipulated in Law 13/2003, but this creates certain legal issues when in practice there are pros and cons due to differences of opinion between contract workers and companies and law understanding of outsourcing contract workers itself of their rights, whether rights at the end of their contratcs, rights obtained by workers if the agreement expires before the contract period is over, the right to rest and the right to obtain health insurance (BPJS).

            Key words : PKWT, outsourced workers, workers rights in Law 13/2003
Karakteristik Ukuran Tubuh Kambing Peranakan Ettawa Pada Periode Dara dan Laktasi 1 Di Kelompok P4S Agribisnis Assalam Indihiang Kabupaten Tasikmalaya
Authors: Christi Raden Febrianto
Published: February 2020

Kambing perah peranakan ettawa merupakan jenis tipe ternak dwiguna dimana menghasilkan produk utama susu kemudian daging. Sifat karakteristik kuantitatif pada ternak perah menentukan produktivitas dari suatu ternak. Penelitian dilaksanakan di Kelompok P4S Agribisnis Assalam Kecamatan Indihiang, Kabupaten Tasikmalaya pada bulan November 2019. Tujuan penelitian adalah mengetahui karakteristik kuantitaif pada kambing perah peranakan ettawa berbagai umur yang meliputi panjang badan, lingkar dada, dan tinggi badan. Metode penelitian yang digunakan adalah analisis deskriptif kuantitatif. Sampel yang digunakan sebanyak 15 ekor betina kambing yang terdiri atas periode dara 7 ekor, laktasi 1 sebanyak 8 ekor. Hasil menunjukkan bahwa pada periode dara didapatkan rata-rata panjang badan 64,14 cm koefisien variasi 0,14%, lingkar dada 73,21 cm koefisien variasi 0,12%, dan tinggi badan 54,42 cm koefisien variasi 0,008%, pada laktasi 1 rata-rata panjang badan 71,75 cm koefisien variasi 0,077%, lingkar dada 84,06 cm koefisien variasi 0,085%, tinggi badan 55,53 cm koefisien variasi 0,010%. Kesimpulan menyatakan bahwa karakteristik ukuran tubuh kambing perah pada periode dara dan laktasi 1 sesuai dengan Standar Nasional Indonesia (SNI) yang ada.

Kata kunci: ukuran tubuh, kambing peranakan ettawa, dara, laktasi 1, tasikmalaya
Software Kunjungan Mahram Santri Berbasis Qr -Code dan Private Question
Authors: Zakiyuddin Ahmad , Izzuddin Muhammad Andik , Amin Faris Mushlihul
Published: February 2020

Kunjungan mahram santri merupakan kegiatan rutin yang ada di lingkungan pesantren. Untuk meningkatkan kualitas pelayanan kepada walisantri, pesantren dapat memanfaatkan teknologi informasi yang inovatif.  Banyak sekali alat yang sudah ditemukan untuk memudahkan pekerjaan manusia, salah satunya adalah quick response code (QR code). QR code adalah salah satu kode matriks atau kode batang dua dimensi yang dibuat untuk mempermudah alat pemindai untuk menyampaikan respon dengan cepat dan menerima data dengan cepat pula. Didalam penelitian ini QR code dimanfaatkan untuk pengelolahan data kunjung mahram santri dalam proses kunjungan di pesantren, private question merupakan salah satu fitur kode verifikasi yang dapat menyimpan sebuah data pribadi seorang user, hal ini penulis memanfaatkan private question  sebagai alat verifikasi mahram santri dalam proses kunjungan guna meningkatkan kualitas pelayanan mahram santri berkunjung di pesantren. Penelitian ini bertujuan, mengusulkan suatu aplikasi sistem menggunakan QR code dan private question untuk mengetahui sistem kerja QR code pada kartu identitas mahram sebagai pengelolahan data aktivitas kunjungan mahram santri. Komponen utama dalam sistem ini adalah webcam sebagai alat scanner pembaca  QR code yang akan diisi primary key dari data santri dan private question. Untuk menjalankan aplikasi ini dirancang dengan bahasa pemograman hypertext prepocessor (PHP) dan MYSQL untuk pembuatan database.
Trends in Stillbirths and Stillbirth Phenotypes in the United States: An Analysis of 131.5 Million Births
Authors: Dongarwar Deepa , Aggarwal Anjali , Barning Kenneth , Salihu Hamisu Mohammed
Published: February 2020

We examined the trends in stillbirth across gestational age in the United States (US).We conducted a trend analysis using the U.S. Natality and Fetal Death datasets covering 1982 and 2017. We compared the incidence and rates of stillbirth for term, all preterm, moderate-to-late preterm, very preterm, and extreme preterm phenotypes. The incidence of stillbirth decreased for the entire birth cohort over the 36-year period. The rates of overall, term, all preterm, very preterm and moderate-to-late preterm stillbirth decreased from 1982 to 2017; however, the rates for extreme preterm stillbirth increased by about 7.6% over the same study period.

Key words: • Trends in stillbirth • Stillbirth phenotypes • Stillbirth in US
Risk of Stillbirth after Infertility Treatment in the United States: 2014-2017
Authors: Dongarwar Deepa , Salihu Hamisu Mohammed
Published: February 2020

To estimate the risk of stillbirth following infertility treatment in the United States (US), we analyzed data from the US Natality and Fetal Death files from 2014 to 2017. We built Cox proportional regression models to generate adjusted hazard ratios (HR) for the risk of stillbirth among women who utilized various modalities of infertility treatment within the study period. Women who used any infertility treatment and, specifically, assisted reproductive technology (ART), had an elevated risk of stillbirth (HR: 1.21, 95% CI:1.09 -1.33) compared to women who did not use ART. We concluded that in this population, the risk of stillbirth was elevated among women using infertility treatment.

Key words: • ART • Infertility treatment • Fertility enhancing drugs • Stillbirth in US

 

Copyright © 2020 Dongarwar and Salihu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Peran Brand Awereness terhadap Keputusan Pembelian Produk
Authors: Ramadayanti Firda
Published: February 2020

Pada saat ini, persaingan pasar di dunia sangatlah bebas. Hal ini pula yang menuntut pelaku usaha untuk lebih kreatif dan saling bersaing dalam menjual juga memasarkan produknya. Perusahaan harus menciptakan strategi-strategi apa saja yang paling efektif dan efisien untuk mempertahankan produk yang ditawarkan agar digunakan oleh konsumen secara berkelanjutan. Maka perlu adanya Brand awereness (kesadaran merek) yang harus dimiliki oleh setiap konsumen. Brand awereness adalah Kesadaran merek (brand awareness) adalah kesanggupan seorang calon pembeli untuk mengenali atau mengingat kembali bahwa suatu merek merupakan bagian dari kategori produk tertentu. Tujuan dari penelitian mengetahui peran brand awereness terhadap keputusan pembelian konsumen.
Mechanical Calculation of Flexible Wires of Spans with Different Tensioning Insulator Strings
Authors: Bladyko Yu. V.
Published: February 2020

In design activities, technical solutions are practiced, which provide for the use of different tension strings of insulators in a single span. The present paper considers the calculation of the sag and load factors for a span with two different tensioning insulator strings that are of identical suspension heights. The system of “the first tension insulators string – the wire – the second tension insulators string” was described by the equations of a parabola. A relationship has been established between the sag increase factor and the coefficients that take into account the presence of tensioning insulators strings. The resulting compact formula for sag increase is generally suitable for any combination of strings in a span. The coincidence of the calculation is shown for particular cases known from the literature. The formula for calculating the load factor for the equation of state was derived, taking into account the presence of different strings in the span. The reliability of the formula has been proved by the coincidence of results for particular cases of the arrangement of strings. The obtained expressions can be used both for vertical (weight and ice) loads and for horizontal (wind) ones. In the case of loads in two planes, the equation of state must take into account all the components when calculating the resulting reduced load on the wire along the inclined plane. Calculations were performed for different lengths of spans of switchgear with different wires and strings of insulators. A span with one and two tensioning strings of insulators, with the same suspension heights, in the absence of wind and ice is considered. The curves of the sagging wires to different strings have been plotted. It is demonstrated that when calculating sags and tensions, the difference between strings must not be neglected.
Conversion of cast carbon steel into composite material
Authors: Marukovich E. I. , Usherenko S. M. , Yazdani-Cherati Javad , Usherenko Yu. S.
Published: February 2020

Experimental estimates of the strength properties of a composite material based on carbon steel 45, created by piercing matrix steel in the mode of superdeep penetration by streams of powder particles, have been performed. Pulsed dynamic action by streams of powder particles and subsequent heat treatment converts steel into a fiber composite material.
Changer in the texture orientation of electrolytic nickel by cold air plasma
Authors: Anisovich A. G. , Urban T. P. , Filatova I. I. , Buynitskaya A. S. , Goncharik S. V.
Published: February 2020

The effects of cold air plasma influence on the change in the microstructure, stress state and texture of the cathode nickel brand H-1 were studied. By the method of target metallography it has been established that the microstructure does not change under exposure to the cold air plasma. A decrease in the level of micro- and macrostress is shown. By the method of inverse pole figures it has been established that the pole density of the orientations (111), (200) and (311) decreases when exposed to plasma; orientation (311) changes the least intensively. The pole density of the orientation (220) increases from 4.42 in the initial state to 13.3 after plasma treatment, which means an increase in the electrolytic deposition texture. The causes of the observed effects are being discussed. It is assumed that the changes introduced by the plasma occur at a scale level that is much smaller than the size of the coherent scatter blocks.
Development and implementation of an automated system of optimal bar cutting at the mill 370/150 at OJSC «BSW – Management Company of the Holding «BMC»
Authors: Pankovets I. A.
Published: February 2020

The actual problem of production of long products in bars at the current production of mill 370/150 of OJSC «BSW – Management Company of the Holding «BMC» is considered, a brief technological model of obtaining long products in bars is given, an algorithm for determining the optimal cutting of long products is developed. The developed algorithm will help to reduce the cost of production per one ton and increase the competitiveness of the company’s products. The mechanism of formation of rods of non – dimensional length, which in turn significantly affect the consumption coefficient of metal in production, is revealed.
Suppliers management tactics as a concept of sustainable enterprise development
Authors: Krasyuk O. P.
Published: February 2020

The article deals with issues related to the work of OJSC “BSW Management Company of the Holding “BMC” with suppliers. Information on the developed concept of stakeholders between supplier and consumer is given. The types and structure of the procurement process are described, the gradation of the material in the procurement process is carried out. The method of evaluating supplier, starting with the calculation of the quality index of the material supplied, depending on the ratio value of the type of inconsistencies discussed logistics, but also on the basis of partnership relations provides information on the assessment of loyalty of the supplier. The report is also based on the developed activities, 8D, i.e. 8 step-by-step actions to eliminate inconsistencies. Perception of the supplier-consumer relationship is evaluated.
Early upregulation of AR and steroidogenesis enzyme expressions after 3 months of androgen-deprivation therapy.
Authors: Hamid Agus Rizal A.H. , Putra Harun Kusuma , Sari Ningrum Paramita , Diana Putri , Sesari Saras Serani , Novita Eka , Gultom Fajar Lamhot , Saraswati Meilania , Tanurahardja Budiana , Asmarinah Asmarinah , Umbas Rainy , Mochtar Chaidir Arief
Published: February 2020

Background: Androgen-Deprivation Therapy (ADT) is a standard treatment for advanced prostate cancer (PCa). However, there is a high recurrence or progression rate during ADT. Until now, there is no evidence on when the progression starts. This study would like to evaluate the early response of intraprostatic androgen receptor (AR) and steroidogenic enzyme gene expressions in ADT.Methods: Prostate tissue samples were taken from PCa patients with urinary retention, who had ADT (ADT- PCa; n=10), and further grouped into ≤12 months (n=4) and ADT >12 months (n=6). ADT-PCa group were then compared with BPH (n=12) and primary (no treatment) PCa tissues (n=16). AR and steroidogenic enzyme genes were extracted from Formalin Fixed Paraffin embedded (FFPE) tissues and analysed using rtPCR. Protein expressions were evaluated by immunohistochemistry of specific antibodies. Results: AR gene expression was found higher in ADT-PCa group compared to BPH and primary PCa. Both ADT ≤12 and > 12 months subgroups had significantly higher relative gene expression of AR (p 0.01 and 0.03) compared to primary PCa. AR protein expression in ADT-PCa group showed an increase trend in ADT ≤12 months subgroup and a significantly elevated expression AR protein in ADT >12 months subgroup compared with PCa (100%; p <0.01). Half (50%) of ADT ≤12 months patients were found to have upregulation of AR, and one undergone upregulation from only 3 months of ADT. A trend of elevating relative gene expression of SRD5A3 were also found within the groups given ADT. Conclusion: There are upregulation of AR and steroidogenic enzymes in ADT-PCa patients, as early as 3 months without showing PSA elevation. Steroidogenic enzyme, especially SRD5A3 expression was also showing upregulation before PSA rises.
Morphologic and biochemical changes in the retina and sclera induced by form deprivation high myopia in guinea pigs
Authors: zi yingxin , Deng Yu , Zhao Jingru , Ji Meiqi , Qin Yali , Deng Tingting , Jin Ming
Published: February 2020

Background: To study the morphologic and biochemical changes in the retina and sclera induced by form deprivation high myopia (FDHM) in guinea pigs and explore the possible mechanisms of FDHM formation.Methods: Forty 3-week-old guinea pigs were randomized into the blank control (Group I, 20 cases) and model groups (20 cases). In the model group, the right eyes of the guinea pigs were sutured for 8 weeks to induce FDHM (Group II) and the left eyes were considered a self-control group (Group III). The refractive errors were measured with retinoscopy. The anterior chamber depth (AC), lens thickness (L), vitreous chamber depth (V) and axial length (AL) were measured using ultrasonometry A. Retinal and scleral morphology and ultrastructural features were observed with light and electron microscopy. The malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in the retina and sclera were detected with a chemical colorimetric assay.Results: After eight weeks of stitching, the refractive errors of Group II changed from (+3.59±0.33) D to (-7.96±0.55) D, and these values were significantly higher than those of Group I (+0.89±0.32) D and Group III (-0.55±0.49) D (P < 0.05). The vitreous chamber depth (4.12±0.13) mm and axial length (8.93±0.22) mm of Group II were significantly longer than those of Group I [(3.71±0.23) mm and (7.95±0.37) mm, respectively] and Group III [(3.93±0.04) mm and (8.01±0.15) mm, respectively] (P < 0.05). With the prolongation of form deprivation (FD), the retina and scleral tissues showed thinning, the ganglion cell and inner and outer nuclear layers of the retina became decreased, and the arrangement was disordered. In Group II, the SOD activity was significantly lower than that in Group I and Group III; the MDA content was significantly higher than that in Group I and Group III. The differences were statistically significant (P < 0.05).Conclusions: These findings suggested that in the FDHM guinea pigs model, the refractive errors, the vitreous chamber depth, and axial length increased significantly with prolongation of monocular FD time, and morphological structural changes in the retina and sclera were observed. Oxygen free radicals might participate in the formation of FDHM.
Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: Analysis of multinational real-world data
Authors: Haalen Heleen van , Jackson James , Spinowitz Bruce , Milligan Gary , Moon Rebecca
Published: February 2020

Background Reductions in health-related quality of life (HRQoL) in patients with chronic kidney disease (CKD) are thought to be exacerbated by the low hemoglobin (Hb) levels that define anemia, a common complication of CKD. The current analysis evaluated the impact of anemia on HRQoL and work productivity in patients with non-dialysis dependent and dialysis-dependent CKD using real-world data. Methods Data were collected in France, Germany, Italy, Spain, the UK, the USA and China in 2012–2018 in the Adelphi Real World Disease Specific Programme™ for CKD, a large, cross-sectional, survey of physicians and their patients. Patients completed three patient-reported outcomes (PRO) instruments: the EuroQol 5-Dimension 3-level (EQ-5D-3L), the Kidney Disease Quality of Life (KDQOL-36) instrument and the Work Productivity and Activity Impairment questionnaire. PROs were assessed by CKD stage and Hb levels, and regression analyses were performed with CKD stage and Hb level as independent variables and PROs as outcome variables, while adjusting for age, sex, CKD stage, comorbidities and cardiovascular risk. Results Overall, 5276 patients participated in the survey, including 28% stage 4 and 36% dialysis patients. Patients with lower Hb levels more often reported problems/issues on all EQ-5D-3L domains (p<0.0001). Regression analyses showed significant associations between lower Hb levels and the probability of low (<0.8) EQ-5D-3L utility scores (p<0.0001) and low visual analog scale scores (p<0.05), indicating poorer health status. Associations were seen even when adjusting for CKD stage and other potential confounding factors. Significant associations were observed between Hb level and the 12-Item Short-Form Health Survey (SF-12) Physical Component Summary, SF-12 Mental Component Summary and the three KDQOL-36 subscales (all p<0.0001), and were confirmed using linear regression analyses adjusting for CKD stage and other potential confounders. Numerically greater work productivity losses and greater activity impairment were observed with lower Hb levels. Conclusions Lower Hb levels worsen the impact of CKD on HRQoL, and are associated with lower work productivity in patients with CKD. Assessment and treatment of anemia should be recognized as a key component of integral CKD management throughout all stages of the disease.
How can we support best practice? A situational assessment of injury prevention practice in public health.
Authors: Richmond Sarah A. , Carsley Sarah , Prowse Rachel , Manson Heather , Moloughney Brent
Published: February 2020

Background:To effectively impact the significant population burden of injury, we completed a situational assessment of injury prevention practice within a provincial public health system to identify system-wide priorities for capacity-building to advance injury prevention in public health.

Methods: A descriptive qualitative study was used to collect data on the current practice, challenges and needs of support for injury prevention. Data was collected through semi-structured interviews (n=20) and focus groups (n=19). Participants included a cross-section of injury prevention practitioners and leadership from public health units reflecting different population sizes and geographic characteristics, in addition to public health researchers and experts from academia, public health and not-for-profit organizations. Thematic analysis was used to code all of the data by one reviewer, followed by a second independent reviewer who coded a random selection of interview notes. Major codes and sub codes were identified and final themes were decided through iterations of coding comparisons and categorization. Once data were analysed, we confirmed the findings with the field, in addition to participating in a prioritization exercise to surface the top three needs for support.

Results: Major themes that were identified from the data included: current public health practice challenges; capacity and resource constraints, and; injury as a low priority area. Overall, injury prevention is a broad, complex topic that competes with other areas of public health. Best practices are challenged by system-wide factors related to resources, direction, coordination, collaboration, and emerging injury public health issues. Injury is a reportedly under prioritized and under resourced public health area of practice. Practitioners believe that increasing access to data and evidence, and improving collaboration and networking is required to promote best practice.

Conclusions: The results of this study suggest that there are several system level needs to support best practice in public health injury prevention in Ontario including reducing research to practice gaps and supporting opportunities for collaboration. Our research contributes to the literature of the complexity of public health practice, and presents several mechanisms of support to increase capacity at a system level to improve injury prevention practice, and eventually lessen the population burden of injury.
Defining the short-term disease recurrence after Loop Electrosurgical Excision Procedure (LEEP)
Authors: Papalia Nicholas , Rohla Amanda , Tang Selphee , Nation Jill G. , Nelson Gregg
Published: February 2020

Background
The goal of cervical cancer screening is to identify dysplastic lesions for subsequent excision in order to prevent invasive disease. There is clinical equipoise, on how to best follow women for disease surveillance after treatment with some Canadian provinces exclusively performing colposcopy and some utilizing Human Papilloma virus (HPV) testing in addition to cervical cytology. Loop Electrosurgical Excision Procedure (LEEP) is used to treat pre-invasive HPV-mediated disease and patients are typically followed for 12 months after disease excision. This study aims to quantify the prevalence of high-grade disease at the time of the second follow-up colposcopy visit, in a practice setting that utilizes laser ablation in addition to LEEP.
Methods
In a retrospective cohort study, consecutive patient charts were accessed through the electronic medical record system, ARIA, at the Tom Baker Cancer Centre, in Calgary, Alberta, from January 2010 to December 2015. Data was extracted and a REDCap database was used to compile pertinent information from charts meeting inclusion criteria. Descriptive and analytic statistics were performed.
Results
Of the 303 patients identified, 221 patients met inclusion criteria. 86% of these patients met discharge criteria from colposcopy after the second follow up visit. 31 (14%) were seen in a subsequent visit for abnormal findings. Of these, 7 (3.2%) underwent further treatment for high-grade disease (Cervical Intraepithelial Neoplasia, CIN 2/3). Of the 31, 23 (10.6%) had a third – negative – visit, resulting in discharge from colposcopy. One patient had a repeat LEEP for persistent Low-Grade Squamous Intraepithelial Lesion (LSIL).
Conclusion
In summary, our data demonstrates a prevalence of 3.2% of high-grade disease at the time of a second colposcopic follow up visit after treatment, in a setting which frequently utilizes laser ablation in combination with LEEP, for large lesions. This recurrence rate is consistent with most published literature on recurrence rates of CIN2/3.
Three-hour post-ERCP amylase level: a useful indicator for early prediction of post-ERCP pancreatitis
Authors: Lv Ze-Hui , Kou Da-Qing , Guo Shi-Bin
Published: February 2020

Background: To evaluate the value of the 3-hour post-ERCP serum amylase level for early prediction of post-ERCP pancreatitis (PEP).
Method:
A study of 206 patients performed ERCP was analysed. The patients with PEP were recorded. ROC curves were used to statistically analyze the data.

Results: PEP occurred in 21 patients (10.19%). The 3-hour post-ERCP pancreatic amylase level was used as the test variable, and the PEP occurrence as the state variable to plot ROC curve. The area under the curve (AUC) was 0.816 , and was statistically significant (P<0.001). The standard error (SE) was 0.0507, the 95% confidence interval (CI) was 0.756-0.866, and the optimal cut-off value was 351U/L (sensitivity 76.19%, specificity 83.24%, positive likelihood ratio 4.55, negative likelihood ratio 0.29, Youden index 59.43%). The ROC curves were plotted for both serum amylase and lipase respectively. The areas under the ROC curves were statistically significant(P<0.001). The area under the ROC curve for the 3-hour post-ERCP lipase was 0.778, the 95% confidence interval was 0.673-0.862, and optimal cut-off value was 1834 U/L. The area under the ROC curve for the 3-hour post-ERCP serum amylase was 0.780, and the 95% confidence interval was 0.676-0.864. The optimal cut-off is 380U/L, and there was no statistically significant difference between the two for diagnostic accuracy. According to gender, there was no statistically significant difference in the diagnostic accuracy. In the male group, 436 U/L serum amylase provided the greatest diagnostic accuracy with sensitivity(SE) of 70.5%, specificity(SP) of 89.2%, positive predictive value (PPV) 87.5%, and negative predictive value (NPV) 78.1%. Whereas, in the female group, 357U/L serum amylase provided the greatest diagnostic accuracy with sensitivity of 76.9%, specificity of 81.2%, positive predictive value of 80.4%, negative predictive value of 77.9%.

Conclusions: 1. The 3-hour post-ERCP serum amylase level is a useful measurement for predicting post-ERCP pancreatitis. 2. There was no significant difference between serum amylase and lipase 3-hour post-ERCP for predicting PEP. 3. There was no statistically significant difference between male and female using the 3-hour post-ERCP serum amylase level to predict PEP. For female, the optimal cut-off value was 357 U/L, whereas male 436U/L .
Health Service Utilization and Out-Of-Pocket Health Expenditure Among Insured and Uninsured: A Comparative Study in Baglung District, Nepal
Authors: Bhatt Laxman Datt , Dhami Shankar Singh , Yadav Dipendra Kumar
Published: February 2020

Background Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Method A community based cross-sectional comparative study was conducted in Baglung district of Nepal to find out and compare the health service utilization and direct out-of-pocket health care expenditure among the 225 insured and 225 uninsured households under the national health insurance program of Nepal. Insured households were randomly chosen from study area and uninsured households were selected by using neighborhood method. Result The study focused that insurance status was strongly associated with heath service utilization with odds ratio 1.774 (95% CI = 1.127-2.791, P = 0.013). The study also depicts that insurance status was major determinants of out of pocket health expenditure. The median out-of-pocket health expenditure among insured households Nepalese Rupees 200 while among uninsured was 1225, which was statistically significant (p = <0.001 MW-U test). Among uninsured group, non-dalit were 2.846 times more likely to utilize health services compared to the dalit (p = 0.003) but it was not significant (p = 0.47) among insured group. Conclusion Nepal’s Health Insurance Board is responsible for purchasing the quality health care service and make available at possible nearest point of its member. Our study reveals that Occupation, perceived health status, wealth status played significant role with health service utilization among uninsured group while it was not significant among insured group. Among both insured and uninsured group none of the study variables were found significant with out-of-pocket health expenditure.
Concurrence of ocular infection with Demodex folliculorum
Authors: Kosik-Bogacka Danuta Izabela , Pyzia Joanna , Galant Katarzyna , Czepita Maciej , Kot Karolina , Lanocha-Arendarczyk Natalia , Czepita Damian
Published: February 2020

Background: The ectoparasite Demodex spp. is the most common human parasite detected in skin lesions such as rosacea, lichen, and keratosis. It is also an etiological factor in blepharitis. As Demodex spp. is involved in the transmission of pathogens that can play a key role in the pathogenesis of demodecosis, the aim was to assess the concurrence of Demodex folliculorum and bacterial infections.Methods: The study involved 232 patients, including 128 patients infected with Demodex folliculorum and 104 non-infected patients. The ophthalmological examination consisted of examining the vision of the patient with and without ocular correction, tonus in both eyes) and a careful examination of the anterior segment of both eyes with special emphasis on the appearance of the eyelid edges and the structure and appearance of eyelashes from both eyelids of both eyes. The samples for microbiological examination were obtained from the conjunctival sac. The bacterial culture was obtained by inoculating the samples on chocolate agar and agar with 5% sheep blood. After 24-48 h of incubation at 37 °C, the growth of various colonies of bacteria was identified based on morphological evaluation of the colonies on the media and preparations stained by the Gram method. Species identification was performed biochemical examination ex. coagulase test or VITEK Compact (bioMerieux, Poland).Results: Physiological flora was found in all patients infected with D. folliculorum and 9 (8.7%) participants from the control group.Only in patients infected with D. folliculorum we isolated Staphylococcus aureus (9 patients, 7%), Acinetobacter baumannii (one patient, 0.8%), Streptococcus pneumoniae (one patient, 0.8%), Klebsiella oxytoca (one patient, 0.8%), and Bacillus spp. (one patient, 0.8%) in the conjunctival sac.Conclusions: The occurrence of symptoms: dryness and burning sensation in the eye, tearing, conjuctival redness, foreign body sensation, eyelash loss, blockage of the Meibomian glands, cylindrical dandruff, and chalazia may suggest infection with Demodex spp. Patients infected with Demodex spp. should also undergo microbiological examination of conjunctival swabs. The treatment of each patient should be individualized, adapted to the clinical condition, and in cases of bacterial co-infection. Furthermore, daily hygiene of the eyelid margins should be recommended.
Facilitators and Barriers of Managing Patients with Multiple Chronic Conditions in the Community: A Qualitative Study
Authors: Foo Kah Mun , Sundram Meena , Legido-Quigley Helena
Published: February 2020

Background: Approximately one-third of all adults worldwide are diagnosed with multiple chronic conditions (MCCs). The literature has identified several challenges facing providers and patients coping with managing MCCs in the community, yet few studies have considered their viewpoints in combination. A qualitative study involving healthcare providers and users was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore.Methods: This study involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provide subsidised primary care services. Topic guides were developed with reference to the literature review, Chronic Care Model (CCM) and framework for patient-centred access to healthcare.Results: Despite the perceived affordability and availability of the support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nation-wide medical savings scheme to cover outpatient treatment and medications. Half of healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those who did not visit the clinics might not receive timely care. Furthermore, patients reported long consultation waiting time.Physicians were able to propose and drive quality improvement projects to improve care quality. However, there were challenges to delivering safe and quality care with limited consultation duration due to the need to manage high patient load and waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients.Although providers could equip patients with self-management and lifestyle-related guidelines, patients’ actions are influenced by multiple factors, including work requirements, beliefs and environment.Conclusions: There were barriers on care access, delivery and self-management. It is crucial to adopt a whole-of-society approach involving individuals, community, institutions and policymakers to improve and support MCC management. This study has also highlighted the importance of considering the different viewpoints of healthcare providers and users in policy formulation and community care planning.