bluuebunny/crossref_metadata_2025 huggingface dataset:
Gestational Diabetes Mellitus Knowledge Among Women of Reproductive Age in Southern Nigeria: Implications for Diabetes Education
Authors: Ogu Rosemary N. , Maduka Omosivie , Agala Vetty , Alamina Folusho , Adebiyi Obelebra , Edewor Ufuoma , Porbeni Ibimonye , Abam Claribel
Published: September 2019

Background

Diabetes mellitus (DM) has attained the status of an epidemic in slow motion. Gestational DM (GDM) is a subtype of DM, which occurs in pregnancy. As part of a baseline assessment, the knowledge of GDM was determined among women of reproductive age.

Methods

The study was a descriptive cross-sectional household survey involving 2,595 women of reproductive age residing in five local government areas in Southern Nigeria. It employed a multistage sampling technique to collect data using an interviewer administered questionnaire built using Open Data Kit software uploaded on android mobile phones.

Results

The response rate was 100%. Mean age was 29.25 ± 7.11 years. The majority (2,351; 90.6%) had heard about DM but only 991 (38.2%) knew that diabetes can occur for the first time in pregnancy. Only 747 (28.8%), 929 (35.8%), and 790 (30.4%) respondents had good knowledge scores for GDM definition and risk factors, GDM screening diagnosis and treatment, and GDM complications, respectively. Only 681 (26.2%) had good overall knowledge of GDM. The major sources of knowledge of GDM were from friends (49.8%), health workers (34.6%), and mass media (10.4%). Residence in two urban local government areas (adjusted odds ratio [adj OR] = 1.79; 95% confidence interval [CI] = 1.36–2.34 and adj OR = 1.89; 95% CI = 1.37–2.61), being married (adj OR = 1.50; 95% CI = 1.16–1.95), and having been pregnant (adj OR = 2.69; 95% CI = 1.99–3.64) positively predicted good overall knowledge of GDM.

Conclusion

These results underscore the need for diabetes information and education activities on a large scale targeted at women of reproductive age and their partners for the prevention and control of GDM.
The relationship of thyroid nodule size on malignancy risk according to histological type of thyroid cancer
Authors: Chung Sae Rom , Baek Jung Hwan , Choi Young Jun , Sung Tae-Yon , Song Dong Eun , Kim Tae Yong , Lee Jeong Hyun
Published: September 2019

Background

Although several studies have examined the value of thyroid nodule size as a malignancy predictor, the results are conflicting.

Purpose

To investigate the relationship between nodule size and malignancy risk and to evaluate the impact of nodule size on the false-negative rate of fine needle aspiration or core needle biopsy according to the histological type of thyroid cancer.

Material and Methods

From January 2013 to December 2013, 3970 thyroid nodules that underwent ultrasound-guided fine needle aspiration or core needle biopsy were retrospectively reviewed. We assessed the relationship between nodule size and malignancy risk according to histological type of thyroid cancer. In addition, we compared the false-negative rate by thyroid nodule size category.

Results

Of 3970 thyroid nodules, 1170 nodules were malignant. For papillary thyroid carcinoma, nodule size was inversely related to malignancy risk, whereas in nodules of follicular carcinoma and follicular variant papillary thyroid carcinoma, nodule size was positively related to malignancy risk ( P < 0.001). The false-negative rate tended to increase as nodule size increased ( P = 0.002) for all nodules and the overall false-negative rate was 2.3%.

Conclusion

Overall, nodule size does not correlate with risk of malignancy, but the relationship between nodule size and malignancy risk depends on the histological type of thyroid cancer.
Stability analysis of rigid rotors supported by gas foil bearings coupled with electromagnetic actuators
Authors: Basumatary Kamal Kumar , Kumar Gaurav , Kalita Karuna , Kakoty Sashindra K
Published: September 2019

Rotors supported on gas foil bearings have low damping characteristics, which limits its application. A possible solution could be an integration of a gas foil bearing with an electromagnetic actuator. This paper discusses the effect of electromagnetic actuators on the stability of a rotor supported on gas foil bearings. A coupled dynamic model combining the dynamics of gas foil bearing and electromagnetic actuator has been developed. The fluid film forces from the gas foil bearings and the electromagnetic forces from the electromagnetic actuators are integrated into the equations of motion of the rotor. The sub-synchronous vibration present in case of conventional gas foil bearings is reduced and the stability band of the rotor is increased due to the implementation of electromagnetic actuator.
Depth of field: Connecting library exhibition space to curriculum and programming
Authors: Fargo Hailley , White Rachel
Published: September 2019

This article focuses on an exhibition curated by library employees at the Pennsylvania State University. Their exhibition, Depth of Field, grew out of a common reading program collaboration. In creating the exhibition, the authors of this article aimed to create a dialogue around the way in which viewers interact with visual and textual imagery, specifically as it relates to war photography. Photojournalism is interdisciplinary and provided the authors with multiple avenues in which to approach themes, thus making it the perfect vehicle to cross boundaries and find common space for visitors to the exhibition. The intent of this article is to provide an example of a cross-campus collaboration that resulted in an engaging exhibition, how to take complex ideas and theories and make them digestible for a first-year student audience, and strategies for academic libraries who are considering a similar project at their institution.
Kenneth Mellanby Commander of the Order of the British Empire (CBE) (1908–1993). The facts about scabies
Authors: Hussain Khawar , Monk Barry Edward
Published: September 2019

Kenneth Mellanby was a distinguished biologist specialising in entomology. He helped to establish the first university in Nigeria and undertook pioneering work on the use of insecticides in agriculture. However, he will best be remembered for a series of experiments which he undertook on human volunteers during the Second World War. These experiments established the mechanism of transmission of scabies and allowed its effective control at a time when the condition had reached epidemic proportions, causing a significant adverse effect on public morale and military effectiveness. Mellanby’s wartime monograph on scabies remains to this day the definitive work on the disease and is still studied by dermatologists. His subsequent book Human Guinea Pigs is a remarkable account of the privations to which wartime volunteers willingly submitted themselves in a way that would have never passed any current medical ethics committee.
Voice and resistance: Coalminers’ struggles to represent their health and safety interests in Australia and New Zealand 1871–1925
Authors: Walters David , Quinlan Michael
Published: September 2019

The activism of coalmining unions in Australia, the UK, the USA and elsewhere securing improvements in safety including better legislation in the 19th and 20th centuries, has been widely researched and acknowledged. However, a relatively neglected aspect of this history was a campaign to secure worker inspectors (check-inspectors). These began in coalmining a century before similar measures were introduced for workers more generally as part of overhauling occupational health and safety laws in the 1970s/1980s. We document this struggle for mine safety in Australia and New Zealand, and the activities of check-inspectors in the period to 1925. Notwithstanding strong opposition from coal-owners and conservative governments, check-inspectors played an important role in safeguarding coalminers and improving the regulatory oversight of coalmines. Check-inspectors not only gave coalminers a ‘voice’ in OHS, but they also provided an exemplar of the value and legitimacy of worker’s ‘knowledge activism’. This system remains. Furthermore, the struggle is relevant to understanding contemporary debates about collective worker involvement in occupational health and safety.
Surface effect on deformation around an elliptical hole by surface energy density theory
Authors: Wang Liyuan
Published: September 2019

The finite plane deformation of nanomaterial surrounding an elliptical hole subjected to remote loading is systematically investigated using a recently developed continuum theory. A complex variable formulation is utilized to obtain a closed-form solution for the hoop stress along the edge of the hole. The results show that when the size of the hole reduces to the same order as the ratio of the surface energy density to the applied remote stress, the influence of the surface energy density plays an even more significant role, and the shape of the hole coupled with surface energy density has a significant effect on the elastic state around the hole. Surprisingly, in the absence of any external loading, the hoop stress induced solely by surface effects is identical to that for a hole with surface energy in a linearly elastic solid derived by the Gurtin–Murdoch surface elasticity model. The results in this paper should be useful for the precise design of nanodevices and helpful for the reasonable assessment of test results of nano-instruments.
Multiple-Membership Survival Analysis and Its Applications in Organizational Behavior and Management Research
Authors: Tierens Hans , Dries Nicky , Smet Mike , Sels Luc
Published: September 2019

Multilevel paradigms have permeated organizational research in recent years, greatly advancing our understanding of organizational behavior and management decisions. Despite the advancements made in multilevel modeling, taking into account complex hierarchical structures in data remains challenging. This is particularly the case for models used for predicting the occurrence and timing of events and decisions—often referred to as survival models. In this study, the authors construct a multilevel survival model that takes into account subjects being nested in multiple environments—known as a multiple-membership structure. Through this article, the authors provide a step-by-step guide to building a multiple-membership survival model, illustrating each step with an application on a real-life, large-scale, archival data set. Easy-to-use R code is provided for each model-building step. The article concludes with an illustration of potential applications of the model to answer alternative research questions in the organizational behavior and management fields.
Influence of multiple laser impacts on thin leading edges of turbine blade
Authors: Ayeb M , Frija M , Fathallah R
Published: September 2019

Laser shock peening is a mechanical surface improvement treatment used to enhance the fatigue life of critical components. This paper investigates the influence of multiple square laser impacts to study their special effect on the diverse mechanical behaviours of the thin leading edge surface of turbine blades. Most works existing in the literature have presented experimental investigations. The originality of our paper is to validate and numerically simulate the proposed model. Indeed, a 3D finite element method of a thin leading edge specimen, Ti–6Al–4V, of a turbine blade is numerically simulated using the ABAQUS software. The mechanical surface modifications (residual stresses, equivalent plastic strains and Johnson–Cook superficial damage) induced by the multiple square laser impact are examined in detail. The main purpose of this investigation is to determine the effects of single-sided and double-sided laser shock peening.
Hemodynamic differences among hypertensive patients with and without heart failure using impedance cardiography
Authors: Silva Lopes Bruno , Craveiro Nuno , Firmino-Machado João , Ribeiro Pedro , Castelo-Branco Miguel
Published: September 2019

Background:

Impedance cardiography is a reliable, well-tolerated, and non-invasive method used to obtain hemodynamic measurements and could potentially be useful in heart failure (HF) diagnosis, hemodynamic monitoring of critically ill patients, and help in the choice of antihypertensive therapy. The objective of this study was to determine the differences between hemodynamic parameters in a study population of hypertensive patients with and without HF, using impedance cardiography.

Methods:

A case-control study was designed and named the TARGET study. Participants were enrolled in two study groups: control group C, hypertensive patients without HF and the HF group, hypertensive patients with HF. A descriptive analysis was carried out to characterize the sample and differences in continuous variables were tested for statistical significance by independent sample t test.

Results:

The study included 102 hypertensive outpatients. The control group consisted of 77 individuals (58.4% males; mean age 63.9 ± 12.5 years old) and the HF group consisted of 25 individuals (44.0% males; mean age 74.2 ± 8.7 years old). The mean Cardiac Index (CI) was 2.70 ± 1.02 L.min.m−2 (2.89 ± 1.04 versus 2.12 ± 0.70; p < 0.001), mean Stroke Index (SI) was 35.5 ± 14.7 mL.m−2 (37.7 ± 15.2 versus 28.5 ± 10.8; p = 0.006), mean Ejection Phase Contractility Index (EPCI) was 33.7 ± 12.7 1000 s−2 (35.8 ± 13.1 versus 27.2 ± 9.2; p = 0.003), mean Inotropic State Index (ISI) was 74.3 ± 28.2 100 s−2 (78.8 ± 28.9 versus 60.6 ± 20.7; p = 0.005), and mean Left Stroke Work Index (LSWI) was 51.3 ± 23.1 g.min.m−2 (55.4 ± 23.5 versus 38.9 ± 16.6; p = 0.002).

Conclusions:

In this study, hypertensive patients with HF had significantly lower values of blood flow parameters, contractility, and left work indices compared with hypertensive patients without HF. These differences reflected the incorrect hemodynamic pattern (mostly hypodynamic) of these patients. Impedance cardiography (ICG) seems to be an adequate method to reflect these differences.
Moving Backgrounds Confer Age-Related Positional Uncertainty on Flash-Grab Targets
Authors: Anstis Stuart
Published: September 2019

The flash-grab effect made a stationary flashing cross appear to jump back and forth through a distance of more than 2°. Observers were asked to move a cursor as quickly as possible on to this flashing target. All observers younger than 65 years, and 39% of those over 65 years, could do this without difficulty within 1 second to 2 seconds. But 61% of those over 65 years experienced uncertainty about the exact position of the target and took from 6 to 147 seconds to hit it—about 4 times longer than to hit an actually jumping cross. This loss of hand–eye coordination was probably perceptual, not motor.
Geopolitics of reproduction: Investigating technological mediation of maternity tourism on the Russian web
Authors: Boichak Olga
Published: September 2019

Investigating maternity tourism to the United States from Russia through the lens of technological mediation, this study foregrounds the geopolitical patterns of human reproduction that shape, and are shaped by, individual choices of maternal healthcare in a neoliberal healthcare market. Following the history of a highly popular Russian-language forum, I demonstrate how this online community gets imbricated into communicative biocapitalism – a neoliberal logic that commodifies the voice of an online user, turning networked publics into markets for medical services. Adding to the literature on data colonialism, I explore a case in which data-driven algorithms effectively alter geographical distribution of reproductive bodies, outsourcing the production of new generations of neoliberal subjects through regimes of technological mediation.
Protective effects of Pai-Du-Yang-Shen formula on chronic renal failure in rats
Authors: Pan Ronghua , Rui Guohua , Bai Xiaohui , Teng Zhiyin , Chen Gang , Pang Zhonghua , Hu Chunping , Cao Peng
Published: September 2019

This study aimed to elucidate the therapeutic effects of a traditional Chinese medicine, Pai-Du-Yang-Shen (PDYS) Formula, in 5/6 nephrectomy-induced chronic renal failure (CRF). The CRF model was established via 5/6 nephrectomy (Nx) in rats. Then, PDYS (0.9 and 1.8 g/kg/day), or an equal amount of normal saline, was administrated to the rats in respective groups. Our results showed that PDYS treatment improved degeneration, fibrosis, and histopathological abnormalities of renal tissues in 5/6 Nx rats. Furthermore, the increase in serum creatinine (Scr), blood urea nitrogen (BUN), and total urinary protein (TUP) in 5/6 Nx rats was reduced by PDYS treatment. In addition, the levels of tumor necrosis factor (TNF), fibronectin (FN), and laminin (LN) that were induced in 5/6 Nx rats were also decreased by PDYS treatment. Finally, relative mRNA expression of α-smooth muscle actin (α-SMA), FN, transforming growth factor-β (TGF-β), and TNF as well as protein levels of TGF-β, NF-κB p65, and phosphorylated NF-κB p65 (p-p65) in renal tissues correlated with the concentration of TNF. In conclusion, PDYS shows therapeutic effects against CRF as determined by a reduction in markers for inflammation and fibrosis.
The acceptance of CIRS among orthopedic and trauma surgeons in Germany—Significant gap between positive perception and actual implementation in daily routine
Authors: Sterz Jasmina , Ruesseler Miriam , Seemann Ricarda , Münzberg Matthias , Doepfer Anna Katharina , Stange Richard , Mutschler Manuel , Bouillon Bertil , Egerth Martin
Published: September 2019

Purpose:

Medical errors are the third leading cause of death in the United States after malignant tumors and cardiovascular disease. Handling of errors becomes more and more eclectic due to the implementation of incident reporting systems and the use of checklists. Since 2015, any German hospital would have a critical incident reporting system (CIRS). The aim of this study is to discover the nationwide utilization and attitude toward CIRS of orthopedic and trauma surgeons.

Methods:

Between April 10, 2015 and May 22, 2015, a web-based questionnaire, which was designed by an expert team consisting of orthopedic and trauma surgeons, aeronautic human factors specialists, and psychologists (Lufthansa Aviation Training), was sent to all members of the German Society for Orthopedic and Trauma Surgery. The survey consisted of three questions regarding CIRS and its use in German hospitals.

Results:

A total of 669 orthopedic and trauma surgeons working in German hospitals completed the questionnaire. All participants rated CIRS as useful, although 71.3% of participants did not report a critical incident in the last 12 months. In that time period, only 13.4% of participating residents reported at least one incident, but 44.7% of chief physicians reported one incident within the same period.

Conclusion:

The present study demonstrates that even though CIRS as a tool is positively appreciated by orthopedic and trauma surgeons working in German hospitals, many do not know about its existence at their own hospital. This can be a reason for the low number of critical incidents reported.
A Case of Idiopathic Non-Cirrhotic Portal Hypertension in a Patient With a Left Ventricular Assist Device
Authors: Kothari Shana , Kalinowski Michael , Shah Natasha , Raddawi Hareth
Published: September 2019

Idiopathic non-cirrhotic portal hypertension is a rare diagnosis caused by an unknown etiology with elevated intrahepatic portal pressures in the absence of underlying liver disease. We present a unique case of a 57-year-old male with a left ventricular assist device and preserved right ventricular function that was found to have an elevated hepatic venous pressure gradient and sequelae of portal hypertension without underlying liver disease. There is limited treatment available as management is primarily aimed toward preventing complications of the disease. This case highlights the need for further investigative research of this disease entity and its pathogenesis.
Building an organizational culture of patient safety
Authors: Tan Kok Hian , Pang Nguk Lan , Siau Chuin , Foo Zann , Fong Kok Yong
Published: September 2019

This article shares the experiences of a new institute for patient safety and quality in Asia in building an organization culture of patient safety. Since its launch in June 2017, the SingHealth Duke-NUS Institute for Patient Safety & Quality in Singapore has been active in integrating cluster-wide efforts in patient safety and quality within the SingHealth Duke-NUS Academic Medical Centre. Institute for Patient Safety & Quality focuses on eliminating preventable errors and harm, and improving patient outcomes by building and cultivating a strong patient safety culture. A culture where healthcare professionals strive for implementation of strong safety management systems requires strong leadership, which prioritizes safety above financial and operational goals; encourages the identification, communication and resolution of safety issues and provides appropriate resources, structure and accountability to maintain effective safety systems. A strong patient safety and quality culture requires a virtuous patient safety and quality ecosystem that takes time to develop. We believe that it is necessary when building this ecosystem to promote the various contributing constituent cultures, including Speak Up Culture, Reporting Culture, Learning Culture, Patient Centric Culture and Just Culture. Leadership commitment is paramount for developing this ecosystem. This entails co-creation of organizational strategies and co-development of a professional education framework to enhance capability and capacity for patient safety and quality.
Ublituximab and umbralisib in relapsed/refractory B-cell non-Hodgkin lymphoma and chronic lymphocytic leukemia
Authors: Lunning Matthew , Vose Julie , Nastoupil Loretta , Fowler Nathan , Burger Jan A. , Wierda William G. , Schreeder Marshall T. , Siddiqi Tanya , Flowers Christopher R. , Cohen Jonathon B. , Sportelli Peter , Miskin Hari P. , Weiss Michael S. , O’Brien Susan
Published: September 2019

Key Points

U2 exhibited low rates of immune-mediated toxicities associated with other PI3K-δ, including diarrhea, colitis, pneumonia, and hepatic toxicity. This combination had promising preliminary activity across a broad range of B-cell malignancies, including a 17% complete response rate.
Heterogeneity in top management teams and outward foreign direct investment: evidence from Chinese listed companies
Authors: Meng Shuai , Yan Jiayan , Cao Xuebing
Published: September 2019

Drawing upon the knowledge-based view and team learning, we investigated how heterogeneity in top management teams (TMTs) in China influences global expansion strategies. Using panel data from Chinese listed firms from 2008 to 2014, we found that TMT functional background heterogeneity could positively affect firms’ commitment to outward foreign direct investment (OFDI), as the diversification of TMT members can enrich the team’s knowledge, facilitate efficient team learning, and enhance the decision-making capacity on overseas expansion. However, tenure heterogeneity may hinder knowledge acquisition and team learning among TMT members, hence undermining firms’ OFDI commitment.
Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion
Authors: Zhang Tianli , Wang Xiaolong , Wen Chao , Zhou Feng , Gao Shengwei , Zhang Xiaodong , Lin Shiqin , Shi Jing , Li Weirong
Published: September 2019

Background

Endovascular treatment (EVT) is advocated for acute ischaemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging. This study investigated the relationship between post-EVT short-term blood pressure variability (BPV) and early outcomes in LVO patients.

Methods

We retrospectively reviewed 72 LVO patients undergoing EVT between June 2015 and June 2018. Hourly systolic and diastolic blood pressures (SBP and DBP, respectively) were recorded in the first 24 h post-EVT. BPV were evaluated as standard deviation (SD), coefficient of variation (CV), and successive variation (SV) separately for SBP and DBP. Functional independence at 3 months was defined as a modified Rankin Scale (mRS) score of 0–2.

Results

For 58.3% patients with favorable outcomes, the median National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores on admission were 14 and 8, respectively. The maximum SBP ([154.3 ± 16.8] vs. [163.5 ± 15.6], P = 0.02), systolic CV ([8. 8% ± 2.0%] vs. [11.0% ± 1.8], P < 0.001), SV ([11.4 ± 2.3] vs. [14.6 ± 2.0], P < 0.001), and SD ([10.5 ± 2.4] vs. [13.8 ± 3.9], P < 0.001) were lower in patients with favorable outcomes. On multivariable logistic regression analysis, systolic SV (OR: 4.273, 95% CI: 1.030 to 17.727, P = 0.045) independently predicted unfavorable prognosis. The area under the curve was 0.868 (95% CI: 0.781 to 0.955, P < 0.001), and sensitivity and specificity were 93.3% and 73.8%, respectively, showing excellent predictive value for 3-month poor-outcomes.

Conclusions

Decreased systolic SV following intra-arterial therapies result in favorable outcomes at 3 months. Systolic SV may be a novel predictor of functional prognosis in LVO patients.
Pregnancy related risk perception in pregnant women, midwives & doctors: a cross-sectional survey
Authors: Lee Suzanne , Holden Des , Webb Rebecca , Ayers Susan
Published: September 2019

Background

Risk perception in relation to pregnancy and birth is a complex process influenced by multiple personal, psychological and societal factors. Traditionally, the risk perception of healthcare professionals has been presented as more objective and authoritative than that of pregnant women. Doctors have been presented as more concerned with biomedical risk than midwives. Such dichotomies oversimplify and obscure the complexity of the process. This study examines pregnancy-related risk perception in women and healthcare professionals, and what women and professionals believe about each other’s risk perception.

Methods

A cross sectional survey of set in UK maternity services. Participants were doctors working in obstetrics (N = 53), midwives (N = 59), pregnant women (N = 68). Participants were recruited in person from two hospitals. Doctors were also recruited online. Participants completed a questionnaire measuring the degree of perceived risk in various childbirth-related scenarios; and the extent to which they believed others agreed with them about the degree of risk generally involved in childbirth. Main outcome measures were the degree of risk perceived to the mother in baby in pregnancy scenarios, and beliefs about own perception of risk in comparison to their own group and other groups.

Results

There were significant differences in total risk scores between pregnant women, doctors and midwives in perception of risk to the mother in 68/80 scenarios. Doctors most frequently rated risks lowest. Total scores for perceived risk to the baby were not significantly different. There was substantial variation within each group. There was more agreement on the ranking of scenarios according to risk. Each group believed doctors perceived most risk whereas actually doctors most frequently rated risks lowest. Each group incorrectly believed their peers rated risk similarly to themselves.

Conclusions

Individuals cannot assume others share their perception of risk or that they make correct assessments regarding others’ risk perception. Further research should consider what factors are taken into account when making risk assessments,
Understanding unplanned readmissions for children undergoing surgery in a single pediatric general surgical department
Authors: Zheng Chao , Zhou Hong , Zhu Hai , Chen Bailin , Qiu Lin , Guo Chunbao
Published: September 2019

Background

The aim of the current research was to investigate the unplanned readmission rates and identify the risk factors of unplanned readmissions in pediatric general surgical specialties.

Methods

A retrospective review of unplanned readmissions following initial surgery from July 1, 2010, to June 30, 2017, in the general surgical specialties at an academic tertiary care hospital was performed. The main outcome of interest was unplanned readmission rates, the common causes for readmission. The risk factors involved in the unplanned readmissions were further investigated using univariate and multivariate analyses.

Results

Of the 3263 patients who underwent surgery and discharge, 176 (9%) were unplanned readmissions. The most frequent surgical operation related to readmission was appendectomy, and the common readmission causes were associated with treatment of gastrointestinal complaints/complications. Multivariable analysis demonstrated that emergency surgery (p = 0.016, odds ratio [OR] = 2.73; 95% CI = 1.35–6.19), major complications (p = 0.042, OR = 2.43; 95% CI = 1.12–4.71) and the initial hospital length of stay (p = 0.036, OR = 3.46; 95% CI = 1.67–7.53) were independent risk factors for readmission.

Conclusions

This study identified potential risks for readmission, which should be targeted for interventions to improve quality and resource allocation.
Functional abdominal pain disorders in adolescents in Indonesia and their association with family related stress
Authors: Oswari Hanifah , Alatas Fatima Safira , Hegar Badriul , Cheng William , Pramadyani Arnesya , Benninga Marc Alexander , Rajindrajith Shaman
Published: September 2019

Background

Functional abdominal pain disorders (FAPD) have been widely reported as a major group of gastrointestinal disorders across the world. This study describes the prevalence, related factors, symptomatology and its relationship to emotional stress in Indonesian adolescents.

Methods

This is a cross-sectional study. Adolescents aged 10 to 17 years from nine randomly selected state schools from five districts of Jakarta, Indonesia, were invited to participate. A translated and validated Rome-III self-administered-questionnaire was used to collect data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal as well as extra-intestinal symptoms, and exposure to stressful life events were also collected using a separate validated questionnaire.

Results

A total of 1813 questionnaires were included in the analysis [males 739 (40.8%) mean age of 13.54 years + 0.89]. Of them, 209 children (11.5%) fulfilled Rome III criteria of FAPD. Functional abdominal pain (FAP) was reported as the most prevalent subtype (5.8%), followed by functional dyspepsia (3.3%), irritable bowel syndrome (2%) and abdominal migraine (0.4%). The prevalence was higher in girls (p < 0.05) and those exposed to family-related stressful life events (p < 0.05). They include divorce or separation of parents (adjusted OR 2.55, 95% CI 1.75–3.7,p = < 0.001), death of a close family member (adjusted OR 2.24, 95% CI 1.39–3.59,P = 0.001), and father’s alcoholism (adjusted OR 1.94, 95% CI 1.22–3.1,P = 0.005).

Conclusions

FAPD are common paediatric entities among Indonesian adolescents with a prevalence of 11.5%. FAPD were noted to be higher in girls and adolescents exposed to family-related stressful life events.
Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients
Authors: Ko Ryoung-Eun , Na Soo Jin , Huh Kyungmin , Suh Gee Young , Jeon Kyeongman
Published: September 2019

Background

The prevalence of pneumocystis pneumonia (PCP) and associated hypoxic respiratory failure is increasing in human immunodeficiency virus (HIV)-negative patients. However, no prior studies have evaluated the effect of early anti-PCP treatment on clinical outcomes in HIV-negative patient with severe PCP. Therefore, this study investigated the association between the time to anti-PCP treatment and the clinical outcomes in HIV-negative patients with PCP who presented with hypoxemic respiratory failure.

Methods

A retrospective observational study was performed involving 51 HIV-negative patients with PCP who presented in respiratory failure and were admitted to the intensive care unit between October 2005 and July 2018. A logistic regression model was used to adjust for potential confounding factors in the association between the time to anti-PCP treatment and in-hospital mortality.

Results

All patients were treated with appropriate anti-PCP treatment, primarily involving trimethoprim/sulfamethoxazole. The median time to anti-PCP treatment was 58.0 (28.0–97.8) hours. Thirty-one (60.8%) patients were treated empirically prior to confirmation of the microbiological diagnosis. However, the hospital mortality rates were not associated with increasing quartiles of time until anti-PCP treatment (P = 0.818, test for trend). In addition, hospital mortality of patients received early empiric treatment was not better than those of patients received definitive treatment after microbiologic diagnosis (48.4% vs. 40.0%, P = 0.765). In a multiple logistic regression model, the time to anti-PCP treatment was not associated with increased mortality. However, age (adjusted OR 1.07, 95% CI 1.01–1.14) and failure to initial treatment (adjusted OR 13.03, 95% CI 2.34–72.65) were independently associated with increased mortality.

Conclusions

There was no association between the time to anti-PCP treatment and treatment outcomes in HIV-negative patients with PCP who presented in hypoxemic respiratory failure.
CD146 T cells in lung cancer: its function, detection, and clinical implications as a biomarker and therapeutic target
Authors: Olajuyin Ayobami Matthew , Olajuyin Adefunke Kafayat , Wang Ziqi , Zhao Xingru , Zhang Xiaoju
Published: September 2019

CD146 alternatively called melanoma cell adhesion molecule (MCAM), is a biomarker and therapeutic target of clinical significance. It is found on different cells including the endothelial cells and lymphocytes which participate in heterotypic and homotypic ligand-receptor. This review concentrated on the CD146 expression T cells (or lymphocytes) centering on Treg in lung cancer. Here, we have also considered the vigorous investigation of CD146 mainly acknowledged new roles, essential mechanisms and clinical implications of CD146 in cancer. CD146 has progressively become a significant molecule, particularly recognized as a novel biomarker, prognosis and therapy for cancer. Hence, targeting CD146 expression by utilization of methanol extracts ofCalotropis proceraleaf may be useful for the treatment of carcinogenesis.
‘An uneasy compromise’: strategies and dilemmas in realizing a permissive abortion law in Ethiopia
Authors: Tadele Getnet , Haukanes Haldis , Blystad Astrid , Moland Karen Marie
Published: September 2019

Introduction

At the turn of the century, when the Millennium Development Goals placed maternal mortality reduction high on the global agenda, Ethiopia relaxed its restrictive abortion law to expand grounds on which a woman could legally obtain an abortion. This radical policy shift took place within a context of predominant anti-abortion public opinion shaped by strong religious convictions. Drawing upon Walt and Gilson’s policy analysis framework, this paper explores the tension between public policy and religious dogma for the strategies chosen by the Ethiopian Ministry of Health and its partners implementing the new policy, and for access to safe abortion services.

Methods

The study employed a qualitative research methodology. It targeted organizations that are key stakeholders in the field of reproductive health. These included policy makers and policy implementers like ministries, UN agencies and international and national NGOs as well as religious organizations as key opinion leaders. The data collection took place in Addis Ababa between 2016 and 2018. A total of 26 interviews were conducted, transcribed, and analyzed using the principles of qualitative content analysis.

Results

Our analysis showed that the implementing organizations adopted a strategy of silence not to provoke anti-abortion sentiments and politicization of the abortion issue which was seen as a threat to the revised law and policy. This strategy has facilitated a rollout of services and has improved access to safe abortion care. Nevertheless informants were concerned that the silence strategy has prevented dissemination of knowledge about the revised law to the general public, to health workers and to the police. In turn this has caused confusion about eligibility to legal and safe abortion procedures.

Conclusions

While silence as a strategy works to protect the law enhancing the health and survival of young women, it may at the same time prevent the law from being fully effective. As a long term strategy, silence fails to expand awareness and access to safe abortion services, and may not sufficiently serve to fulfill the potential of the law to prevent abortion related maternal deaths.
Why teach sexuality education in school? Teacher discretion in implementing comprehensive sexuality education in rural Zambia
Authors: Zulu Joseph Mumba , Blystad Astrid , Haaland Marte E. S. , Michelo Charles , Haukanes Haldis , Moland Karen Marie
Published: September 2019

Background

Reproductive health problems such as HIV, unwanted pregnancy and unsafe abortion among adolescents are closely linked to insufficient knowledge about sexuality and reproduction and lack of access to contraceptives. Supported by international agencies, Zambia has introduced an ambitious nation-wide program for comprehensive sexuality education (CSE) to be implemented into ordinary school activities by teachers. The curriculum is firmly based in a discourse of sexual and reproductive rights, not commonly found in the public debate on sexuality in Zambia. This paper explores how teachers perceive the curriculum and practice discretion when implementing the CSE in mid-level schools in Nyimba district in Zambia.

Methods

Using a case study design, data were collected through in-depth interviews with 18 teachers and analyzed thematically drawing upon theories of discretion and policy implementation.

Results

Individual teachers make decisions on their own regarding what and when to teach CSE. This discretion implies holding back information from the learners, teaching abstinence as the only way of preventing pregnancy or cancelling sexuality education sessions altogether. Teachers’ choices about the CSE program were linked to lack of guidance on teaching of the curriculum, especially with regards to how to integrate sexuality education into existing subjects. Limited prioritization of CSE in the educational sector was observed. The incompatibility of CSE with local norms and understandings about adolescent sexuality combined with teacher-parent role dilemmas emerged as problematic in implementing the policy. Limited ownership of the new curriculum further undermined teachers’ motivation to actively include CSE in daily teaching activities. Use of discretion has resulted in arbitrary teaching thus affecting the acquisition of comprehensive sexual and reproductive health knowledge among learners.

Conclusion

The CSE had limited legitimacy in the community and was met with resistance from teachers tasked with its’ implementation. In order to enhance ownership to the CSE program, local concerns about the contents of the curriculum and the parent-teacher role dilemma must be taken into consideration. Not addressing these challenges may undermine the policy’s intention of increasing knowledge about sexuality and reproduction and empowering adolescents to access contraceptive services and avoid unwanted pregnancies.
Can patient and fracture factors predict opioid dependence following upper extremity fractures?: a retrospective review
Authors: Sabesan Vani Janaki , Chatha Kiran , Goss Lucas , Ghisa Claudia , Gilot Gregory
Published: September 2019

Background

Since the early 1990s, opioids have been used as a mainstay for pain management surrounding fracture injuries. As opioid dependence has become a major public health issue, it is important to understand what factors can leave patients vulnerable. The purpose of this study was to examine what risk factors, patient or injury severity, contribute most to postoperative opioid dependence following surgical treatment of proximal humerus fractures (PHFs).

Methods

A retrospective review of all patients who underwent an open reduction and internal fixation of PHF was performed within a large multisite hospital system. Recorded variables included age, gender, ASA class, BMI, fracture type, time to surgery, pre- and postoperative opioid prescriptions, physical and psychological comorbidities, smoking status, and complications. Pre- and postoperative opioid dependence was defined as prescription opioid use in the 3 months leading up to or following surgery. Odds ratio calculations were performed for each variable, and a multivariate logistic regression was used to compare all predictors.

Results

A total of 198 surgically treated PHFs were included in the cohort with an average age of 59.9 years. Thirty-nine cases were determined to be preoperatively opioid dependent while 159 cases were preoperatively opioid naïve. Preoperative opioid dependence was found to be a significant risk factor for postoperative narcotic dependence, carrying a 2.42 times increased risk. (CI 1.07–5.48, p = 0.034). Fracture type was also found to be a risk factor for postoperative dependence, with complex 3- and 4-part fracture patients being 1.93 times more likely to be opioid dependent postoperatively compared to 2 part fractures (CI 1.010–3.764, p = 0.049). All other factors were not found to have any significant influence on postoperative opioid dependence.

Conclusions

Our results demonstrate that the most important risk factors of postoperative opioid dependence following proximal humerus fractures are preoperative dependence and fracture complexity. It is important for orthopedic surgeons to ensure that patients who have more complex fractures or are preoperatively opioid dependent receive adequate education on their increased risk and support to wean off of opioids following surgery.

Level of evidence

III
Chaos, control, and synchronization in some fractional-order difference equations
Authors: Khennaoui Amina-Aicha , Ouannas Adel , Bendoukha Samir , Grassi Giuseppe , Wang Xiong , Pham Viet-Thanh , Alsaadi Fawaz E.
Published: September 2019

In this paper, we propose three fractional chaotic maps based on the well known 3D Stefanski, Rössler, and Wang maps. The dynamics of the proposed fractional maps are investigated experimentally by means of phase portraits, bifurcation diagrams, and Lyapunov exponents. In addition, three control laws are introduced for these fractional maps and the convergence of the controlled states towards zero is guaranteed by means of the stability theory of linear fractional discrete systems. Furthermore, a combined synchronization scheme is introduced whereby the fractional Rössler map is considered as a drive system with the response system being a combination of the remaining two maps. Numerical results are presented throughout the paper to illustrate the findings.
PBDEs Concentrate in the Fetal Portion of the Placenta: Implications for Thyroid Hormone Dysregulation
Authors: Ruis Matthew T , Rock Kylie D , Hall Samantha M , Horman Brian , Patisaul Heather B , Stapleton Heather M
Published: September 2019

During pregnancy, the supply of thyroid hormone (TH) to the fetus is critically important for fetal growth, neural development, metabolism, and maintenance of pregnancy. Additionally, in cases where maternal and placental TH regulation is significantly altered, there is an increased risk of several adverse pregnancy outcomes. It is unclear what may be disrupting placental TH regulation; however, studies suggest that environmental contaminants, such as polybrominated diphenyl ethers (PBDEs), could be playing a role. In this study, Wistar rats were gestationally exposed to a mixture of PBDEs for 10 days. THs and PBDEs were quantified in paired maternal serum, dissected placenta, and fetuses, and mRNA expression of transporters in the placenta was assessed. Significantly higher concentrations of PBDEs were observed in the fetal portion of the placenta compared with the maternal side, suggesting that PBDEs are actively transported across the interface. PBDEs were also quantified in 10 recently collected human maternal and fetal placental tissues; trends paralleled observations in the rat model. We also observed an effect of PBDEs on T3 levels in dam serum, as well as suggestive changes in the T3 levels of the placenta and fetus that varied by fetal sex. mRNA expression in the placenta also significantly varied by fetal sex and dose. These observations suggest the placenta is a significant modifier of fetal exposures, and that PBDEs are impacting TH regulation in a sex-specific manner during this critical window of development.
Frustration Is a Feature
Authors: Walsh Brandon
Published: September 2019

This article argues that the primary role of the instructor is to help students understand and work with the difficult emotional states that arise from struggling to learn. Drawing on Sianne Ngai’s theorization of “ugly feelings” and using his own experience with digital humanities instruction as a case study, the author offers ways to center emotional work, especially work involving frustration and anxiety, in the classroom. Asking students to develop failed prototypes and reflect on the process, for example, can provide them with a better sense of what it might mean to succeed. Giving the same exercise twice, with artificially imposed difficulties the second time, might help them learn concrete steps for working through mounting irritation. In short, frustration and anxiety are not things that emerge from time to time—they are ever-present. The author argues that it is the job of instructors to develop ways to prepare students not for the unexpected failure but for the inevitable frustration that comes even with success.
Cholesterol metabolism plays a crucial role in the regulation of autophagy for cell differentiation of granular convoluted tubules in male mouse submandibular glands
Authors: Suzuki Akiko , Shim Junbo , Ogata Kenichi , Yoshioka Hiroki , Iwata Junichi
Published: September 2019

It has been long appreciated that sex-hormone receptors are expressed in various non-gonadal organs. However, it remains unclear how sex hormones regulate the morphogenesis of these non-gonadal organs. To address this question, we used a male mouse model of androgen-dependent salivary gland morphogenesis. Mice with excessive cholesterol synthesis in the salivary glands exhibited defects in the maturation of granular convoluted tubules (GCTs), which is regulated through sex hormone-dependent cascades. We found that excessive cholesterol synthesis resulted in autophagy failure specifically in the duct cells of salivary glands, followed by the accumulation of NRF2, a transcription factor known as one of the specific substrates for autophagy. The accumulated NRF2 suppressed the expression of Foxa1, which forms a transcriptional complex with the androgen receptor to regulate target genes. Taken together, our results indicate that cholesterol metabolism plays a crucial role in GCT differentiation through autophagy.