bluuebunny/crossref_metadata_2025 huggingface dataset:
Culture-Negative and Culture-Positive Sepsis: A Comparison of Characteristics and Outcomes
Authors: Sigakis Matthew J. G. , Jewell Elizabeth , Maile Michael D. , Cinti Sandro K. , Bateman Brian T. , Engoren Milo
Published: March 2019

BACKGROUND:

The primary objective of this study was to compare the characteristics of culture-positive and culture-negative status in septic patients. We also determined whether culture status is associated with mortality and whether unique variables are associated with mortality in culture-positive and culture-negative patients separately.

METHODS:

Utilizing patient records from intensive care units, emergency department, and general care wards in a large academic medical center, we identified adult patients with suspected infection and ≥2 systemic inflammatory response syndrome criteria between January 1, 2007, and May 31, 2014. We compared the characteristics between culture-positive and culture-negative patients and used binary logistic regression to identify variables independently associated with culture status and mortality. We also did sensitivity analyses using patients with Sequential Organ Failure Assessment and quick Sequential Organ Failure Assessment criteria for sepsis.

RESULTS:

The study population included 9288 culture-negative patients (89%) and 1105 culture-positive patients (11%). Culture-negative patients received more antibiotics during the 48 hours preceding diagnosis but otherwise demonstrated similar characteristics as culture-positive patients. After adjusting for illness severity, a positive culture was not independently associated with mortality (odds ratio = 1.01 [95% CI, 0.81–1.26]; P = .945). The models predicting mortality separately in culture-negative and culture-positive patients demonstrated very good and excellent discrimination (C-statistic ± SD, 0.87 ± 0.01 and 0.92 ± 0.01), respectively. In the sensitivity analyses using patients with sepsis by Sequential Organ Failure Assessment and quick Sequential Organ Failure Assessment criteria, after adjustments for illness severity, positive cultures were still not associated with mortality (odds ratio = 1.13 [95% CI, 0.86–1.43]; P = .303; and odds ratio = 1.05 [95% CI, 0.83–1.33]; P = .665), respectively. In all models, physiological derangements were associated with mortality.

CONCLUSIONS:

While culture status is important for tailoring antibiotics, culture-negative and culture-positive patients with sepsis demonstrate similar characteristics and, after adjusting for severity of illness, similar mortality. The most important factor associated with negative cultures is receipt of antibiotics during the preceding 48 hours. The risk of death in patients suspected of having an infection is most associated with severity of illness. This is aligned with the Sepsis-3 definition using Sequential Organ Failure Assessment score to better identify those suspected of infection at highest risk of a poor outcome.
Customizable Curriculum to Enhance Resident Communication Skills
Authors: Mitchell John D. , Ku Cindy , Lutz Brendan , Shahul Sajid , Wong Vanessa , Jones Stephanie B.
Published: March 2019

Communication remains challenging to teach and evaluate. We designed an online patient survey to assess anesthesia residents’ communication skills from August 2014 to July 2015. In December 2014, we implemented a customized, simulation-based curriculum. We calculated an overall rating for each survey by averaging the ratings for the individual questions. Based on the Hodges–Lehmann 2-sample aligned rank-sum test, overall ratings, reported as the median (interquartile range) of residents’ average overall ratings, differed significantly between the preintervention (3.86 [3.76–3.94]) and postintervention (3.91 [3.84–3.95]) periods (P = .025). Future studies should assess the intervention’s effectiveness and generalizability.
A Statistical Timetable for the Sub–2-Hour Marathon
Authors: ANGUS SIMON D.
Published: March 2019

Introduction

Breaking the sub–2-h marathon in an official event has attracted growing interest in recent times with commercial and international momentum building. Here it is shown that predictinghow likelyandwhenthe sub–2-h barrier will be broken are statistically coupled considerations.

Methods

Using a nonlinear limiting exponential model and calculating prediction intervals, a statistical timetable for the sub–2-h event is produced over a range of likelihoods.

Results

At the benchmark odds level (1 in 10, or 10% likely), the expected sub–2-h arrival time is found to be May 2032. By estimating the model for male and female world record progressions, I find that limiting marathon times for males and females (at 1 in 10) are 1 h 58 min 5 s and 2 h 5 min 31 s, respectively. These times equate to a performance gap of 2.9% and 8.6%, respectively. The male estimate has remarkable similarity (~7 s) to Joyner’s 1991 limiting human physiological estimate. Finally, I provide an estimate of the equivalent “sub–2-h” threshold for females and argue that a threshold of 130 min (“sub-130”) could be an appropriate choice.

Conclusion

The study is the first to address all three related aspects of world record marathon performance (sub–2 h, limits, gender equivalence) in a single, unified modeling framework and provides many avenues for further exploration and insight.
Physical Activity and Cerebral Small Vein Integrity in Older Adults
Authors: SHAABAN C. ELIZABETH , AIZENSTEIN HOWARD JAY , JORGENSEN DANA R. , MAHBUBANI REBECCA L. M. , MECKES NICOLE A. , ERICKSON KIRK I. , GLYNN NANCY W. , METTENBURG JOSEPH , GURALNIK JACK , NEWMAN ANNE B. , IBRAHIM TAMER S. , LAURIENTI PAUL J. , VALLEJO ABBE N. , ROSANO CATERINA
Published: March 2019

Identifying promoters of cerebral small vein integrity is important to counter vascular contributions to cognitive impairment and dementia.

Purpose

In this preliminary investigation, the effects of a randomized 24-month physical activity (PA) intervention on changes in cerebral small vein integrity were compared to those of a health education (HE) control.

Methods

Cerebral small vein integrity was measured in 24 older adults (n = 8, PA; n = 16, HE) using ultra-high field MRI before and at the end of the 24-month intervention. Deep medullary veins were defined as straight or tortuous; percent change in straight length, tortuous length, and tortuosity ratio were computed. Microbleed count and white matter hyperintensities were also rated.

Results

Accelerometry-based values of PA increased by 17.2% in the PA group but declined by 28.0% in the HE group. The PA group, but not the HE group, had a significant increase in straight vein length from baseline to 24-month follow-up (P = 0.02 and P = 0.21, respectively); the between-group difference in percent change in straight length was significant (increase: median, 93.6%; interquartile range, 112.9 for PA; median, 28.4%; interquartile range, 90.6 for HE; P = 0.07). Between group differences in other markers were nonsignificant.

Conclusions

Increasing PA in late-life may promote cerebral small vein integrity. This should be confirmed in larger studies.
Sedentary Time and White Matter Hyperintensity Volume in Older Adults
Authors: BRONAS ULF G. , STEFFEN ALANA , DION CATHERINE , BOOTS ELIZABETH A. , ARFANAKIS KONSTANTINOS , MARQUEZ DAVID X. , LAMAR MELISSA
Published: March 2019

Purpose

Cerebrovascular disease in the form of white matter hyperintensities (WMH) increases with age and is associated separately with sedentary time and reduced kidney function. A better understanding of the relationships among these variables would help clarify whether sedentary time should be considered more closely in older adults at particular levels of kidney function to reduce the risk of WMH.

Methods

We analyzed information from 94 healthy community-dwelling older adults to determine the association of sedentary time and WMH in nondemented, nondepressed older adults, and whether level of kidney function was an effect modifier of the relationship between sedentary time and WMH. Sedentary behavior was measured using the Sedentary Behavior Questionnaire. White matter hyperintensity was assessed using whole-brain 3T magnetic resonance imaging T1- and T2-weighted images. Kidney function was calculated by the epi-chronic kidney disease formula for estimated glomerular filtration rate (eGFR). Exposures or predictors were sedentary time, age, sex, education in years, Framingham stroke risk 10-yr prediction score, and eGFR. The analytical approach was multiple linear regression.

Results

Adjusting for age, sex, education in years, Framingham stroke risk 10-yr prediction score, greater sedentary time was associated with greater WMH but this effect was dependent on level of eGFR (sedentary time–eGFR interactionb= −0.0005,P= 0.022). At eGFR values of 69, 81, and 93 mL·min−1per 1.73 m2(the 25th, 50th, and 75th percentiles), sedentary timebcoefficients wereb= 0.021 (95% confidence interval [CI], 0.011–0.031),b= 0.015 (95% CI, 0.008–0.022), andb= 0.009 (95% CI, 0.003–0.016). The effect weakened linearly as eGFR increased, with no significant association at eGFR ≥97 mL·min−1per 1.73 m2.

Conclusions

Findings suggest that sedentary time is associated with WMH in persons with an eGFR ≤96 mL·min−1per 1.73 m2and that this association is stronger with lower levels of kidney function.
Effects of Aerobic Exercise during Pregnancy on 1-Month Infant Neuromotor Skills
Authors: MCMILLAN AMY GROSS , MAY LINDA E. , GAINES GEORGEANNA GOWER , ISLER CHRISTY , KUEHN DEVON
Published: March 2019

Purpose

To determine the effects of exercise during pregnancy on the neuromotor development of 1-month-old offspring. We hypothesized that aerobic exercise during pregnancy would be associated with higher neuromotor scores in infants at 1 month of age, based on standard pediatric assessment of neuromotor skills.

Methods

Seventy-one healthy, pregnant women between 18 and 35 yr were randomly assigned to either aerobic exercise intervention or no exercise (control) group. Women in the exercise group performed 50 min of moderate-intensity, supervised aerobic exercise, three times per week; those in control group maintained usual activity. Neuromotor skills were measured at 1 month of age using the Peabody Developmental Motor Scales, 2nd Edition (PDMS-2). Unpairedt-tests were used to compare infants’ PDMS-2 subtest percentiles, Gross Motor Quotients, and Gross Motor Quotient percentile between groups.

Results

Infants of women in the exercise group had higher PDMS-2 scores on four of the five variables analyzed relative to infants of nonexercisers. Female infants tended to have improved scores relative to male infants of controls; this difference was attenuated in infants of exercisers.

Conclusions

Exercise during pregnancy can positively influence developing systems allowing for improved neuromotor development, thus leading to infants who are more adept at movement, and presumably more likely to be active. Because physical activity is a modifiable risk factor of childhood obesity, these findings suggest that exercise during pregnancy may potentially reduce childhood risk of obesity.
Neuromuscular Fatigue and Metabolism during High-Intensity Intermittent Exercise
Authors: FIORENZA MATTEO , HOSTRUP MORTEN , GUNNARSSON THOMAS P. , SHIRAI YUSUKE , SCHENA FEDERICO , IAIA F. MARCELLO , BANGSBO JENS
Published: March 2019

Purpose

To examine the degree of neuromuscular fatigue development along with changes in muscle metabolism during two work-matched high-intensity intermittent exercise protocols in trained individuals.

Methods

In a randomized, counter-balanced, crossover design, 11 endurance-trained men performed high-intensity intermittent cycle exercise protocols matched for total work and including either multiple short-duration (18 × 5 s; SS) or long-duration (6 × 20 s; LS) sprints. Neuromuscular fatigue was determined by preexercise to postexercise changes in maximal voluntary contraction force, voluntary activation level and contractile properties of the quadriceps muscle. Metabolites and pH were measured in vastus lateralis muscle biopsies taken before and after the first and last sprint of each exercise protocol.

Results

Peak power output (11% ± 2% vs 16% ± 8%,P< 0.01), maximal voluntary contraction (10% ± 5% vs 25% ± 6%,P< 0.05), and peak twitch force (34% ± 5% vs 67% ± 5%,P< 0.01) declined to a lesser extent in SS than LS, whereas voluntary activation level decreased similarly in SS and LS (10% ± 2% vs 11% ± 4%). Muscle [phosphocreatine] before the last sprint was 1.5-fold lower in SS than LS (P< 0.001). Preexercise to postexercise intramuscular accumulation of lactate and H+was twofold and threefold lower, respectively, in SS than LS (P< 0.001), whereas muscle glycogen depletion was similar in SS and LS. Rate of muscle glycolysis was similar in SS and LS during the first sprint, but twofold higher in SS than LS during the last sprint (P< 0.05).

Conclusions

These findings indicate that, in endurance-trained individuals, multiple long-sprints induce larger impairments in performance along with greater degrees of peripheral fatigue compared to work-matched multiple short-sprints, with these differences being possibly attributed to more extensive intramuscular accumulation of lactate/H+and to lower rates of glycolysis during multiple long-sprint exercise.
The Impact of Cycling Cadence on Respiratory and Hemodynamic Responses to Exercise
Authors: MITCHELL REID A. , BOYLE KYLE G. , RAMSOOK ANDREW H. , PUYAT JOSEPH H. , HENDERSON WILLIAM R. , KOEHLE MICHAEL S. , GUENETTE JORDAN A.
Published: March 2019

Purpose

The physiological consequences of freely chosen cadence during cycling remains poorly understood. We sought to determine the effect of cadence on the respiratory and hemodynamic response to cycling exercise.

Methods

Eleven cyclists (10 males, 1 female; age, 27 ± 6 yr; V˙O2max = 60.8 ± 3.7 mL·kg−1·min−1) completed four, 6-min constant-load cycling trials at 10% below their previously determined gas exchange threshold (i.e., 63% ± 5% peak power) while pedaling at 60, 90, and 120 rpm, and a freely chosen cadence (94.3 ± 6.9 rpm) in randomized order. Standard cardiorespiratory parameters were measured and an esophageal electrode balloon catheter was used to assess electromyography of the diaphragm (EMGdi) and the work of breathing (W
b). Leg blood flow index (BFI) was determined on four muscles using near-infrared spectroscopy with indocyanine green dye injections.

Results

Oxygen uptake (V˙O2) increased as a function of increasing cadence (all pairwise comparisons, P < 0.05). The EMGdi and W
b were significantly greater at 120 rpm compared with all other conditions (all P < 0.01). Vastus medialis and semitendinosus BFI were significantly greater at 120 rpm compared with 60 and 90 rpm (all P < 0.05). Gastrocnemius BFI was higher at 120 rpm compared with all other cadences (all P < 0.01). No difference in BFI was found in the vastus lateralis (P = 0.06). Blood flow index was significantly correlated with the increase in V˙O2 with increasing cadence in the medial gastrocnemius (P < 0.001) and approached significance in the vastus lateralis (P = 0.09), vastus medialis (P = 0.06), and semitendinosus (P = 0.09). There was no effect of cadence on Borg 0–10 breathing or leg discomfort ratings (P > 0.05).

Conclusions

High cadence cycling at submaximal exercise intensities is metabolically inefficient and increases EMGdi, W
b, and leg muscle blood flow relative to slower cadences.
Bone Biomarker Response to Walking under Different Thermal Conditions in Older Adults
Authors: WHERRY SARAH J. , SWANSON CHRISTINE M. , WOLFE PAMELA , WELLINGTON TOBY , BOXER REBECCA S. , SCHWARTZ ROBERT S. , KOHRT WENDY M.
Published: March 2019

Endurance exercise can cause a decrease in serum ionized calcium (iCa) and increases in parathyroid hormone (PTH) and c-terminal telopeptide of type I collagen (CTX), which may be due to Ca loss in sweat.

Purpose

This study aimed to determine whether exercise in a warm environment exaggerates the decrease in iCa and increases in PTH and CTX compared with a cool environment in older adults.

Methods

Twelve women and men 61–78 yr old performed two identical 60-min treadmill bouts at ~75% of maximal heart rate under warm and cool conditions. Serum iCa, PTH, and CTX were measured every 15 min starting 15 min before and continuing for 60 min after exercise. Sweat Ca loss was estimated from sweat volume and sweat Ca concentration.

Results

Sweat volume was low and variable; there were no differences in sweat volume or Ca concentration between conditions. iCa decreased after 15 min of exercise, and the change was similar in both conditions. Increases in PTH (warm: 16.4, 95% confidence interval [CI] = 6.2, 26.5 pg·mL−1; cool: 17.3, 95% CI = 8.1, 26.4 pg·mL−1) and CTX (warm: 0.08, 95% CI = 0.05, 0.11 ng·mL−1; cool: 0.08, 95% CI = 0.01, 0.16 ng·mL−1) from before to immediately after exercise were statistically significant and similar between conditions. Adjusting for plasma volume shifts did not change the results.

Conclusion

The increases in PTH and CTX, despite the low sweat volume, suggest that dermal Ca loss is not a major factor in the decrease in iCa and increases in PTH and CTX observed during exercise in older adults.
Immunophenotypic characterisation of morphologically diagnosed cases of Acute Myeloid Leukaemia (AML)
Authors: Basharat Maria , Khan Saleem Ahmed , Ud din Nasir , Ahmed Dawood
Published: March 2019

Objective: To determine immunophenotypic pattern in newly diagnosed cases of acute myeloid leukaemia by flow cytometry and its correlation with morphological findings.

Methods: This study was conducted at Haematology (Pathology) department, Army Medical College, in collaboration with Immunology Department Armed Forces Institute of Pathology, Rawalpindi from 16 November 2016 to 16 November 2017. One hundred and six patients of both genders and all age groups diagnosed as acute myeloid leukaemia were included in the study. Demographic data was noted. Complete blood counts, bone marrow examination and cytochemical stains were carried out and evaluated microscopically for blast percentage and morphology. Immunophenotyping was performed by flow cytometry using standard panel on peripheral blood or bone marrow samples. The surface and cytoplasmic antigens of interest were analysed and correlated with morphological findings.

Results: The most commonly expressed antigens were CD13, CD33, CD45 and HLA-DR. Almost all blasts expressed CD45 with no remarkable difference among the subtypes of AML. The mean positivity for CD13 among all AML subtypes was 57% and for CD33 was 67%. Aberrant expression of CD7 and CD19 were expressed in 26.4% and 1.1% of all cases respectively. There was concordance rate of 90% between morphology and FCM in our study.

Conclusion: Flow cytometric analysis of acute leukaemia done by a combination of patterns and intensity of antigen expression improves diagnostic yield in AML. CD13, CD33 and CD45 are the most frequently expressed antigens in AML. Our findings suggest a 90% concordance between morphology and flow cytometry. It is pertinent to conclude that flow cytometry results interpreted with morphology are complementary.

How to cite this:Basharat M, Khan SA, Nasir ud Din, Ahmed D. Immunophenotypic characterisation of morphologically diagnosed cases of Acute Myeloid Leukaemia (AML). Pak J Med Sci. 2019;35(2):470-476. doi: https://doi.org/10.12669/pjms.35.2.614

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Efficacy of Therapeutic Endoscopy for Gastrointestinal Lesion (GI): A network meta-analysis
Authors: Wang Tian-xi , Zhang Jun , Cui Li-hong , Tian Jingjing , Wei Rongna
Published: March 2019

Objective: Endoscopic therapy can reduce the risks of rebleeding, continued bleeding, need for surgery, and mortality. The objective of this systematic review was to compare the different modalities of endoscopic therapy for GI bleeding.

Methods: Studies were identified by searching electronic databases MEDLINE. We selected all available clinical studies published after 2000 that assessed efficacy and/or safety of different endoscopic hemostatic techniques in treating GI bleeding. The outcomes evaluated included initial hemostasis, rebleeding rate, and 30-day all-cause mortality. Network meta-analyses were performed to summarize the treatment effects.

Results: Total 20 studies involving 1845 patients were evaluated. Ten different treatment categories including mechanic, ablative, injection, and combined therapy were compared in our analysis in terms of their efficacy in stopping bleeding and complications. Band ligation [rate: 0.757; 95% Credible Interval (0.565, 0.887)] and injection therapy [rate: 0.891; 95% CI (0.791, 0.944)] had inferior efficacy in attaining initial hemostasis compared to others. Combined therapy of band ligation and HPC and hemoclip may represent the best options for preventing rebleeding and mortality respectively. No significant difference was found among other treatments in terms of complications.

Conclusions: We recommend the application of hemoclips in treating GI bleeding due to its high hemostasis efficacy and low risk of 30-day mortality.

How to cite this:Wang TX, Zhang J, Cui LH, Tian JJ Wei R. Efficacy of Therapeutic Endoscopy for Gastrointestinal Lesion (GI): A network meta-analysis. Pak J Med Sci. 2019;35(2):561-568. doi: https://doi.org/10.12669/pjms.35.2.636

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Grooming and etiquette as part of nurse’s professionalism: An essential curricular competency
Authors: Safdar Sachal Aqeel , Safdar Lubna
Published: March 2019

Objective: The B.Sc. Nursing has limited hours dedicated to grooming and personal development. A smartly turned out, trained empathetic and efficient nurse helps in alleviating the miseries of the patients. The objective of this study was to see the acceptability and perceived usefulness of a course on grooming and etiquette.

Methods: A proforma based qualitative study was carried out at College of Nursing, AFPGMI & National University of Medical Sciences (NUMS), Rawalpindi, from Jan to Dec, 2017. An eight week course, with weekly lectures was conducted for first to fourth year classes. At the end a semistructured proforma with simple open ended questions was administered. The questions were both in English and Urdu. The results were analyzed by finding percentages of positive and negative responses. The descriptive responses were grouped in recurring themes and analyzed for content and their constructive value.

Results: There were 186 nursing cadets who completed the course and filled the proforma (55, 52, 45 and 34 from first year to fourth year, respectively). Out of 186, 98.9% (184) thought that this was a useful course. All topics were considered useful. Most liked were communication skills, teaching visits to wards, hostels and balancing home and work. About 7% disagreed about the strict dress codes, but agreed with the proper demeanor. Many suggested that senior nurses also have a dire need of these grooming lectures as many used derogatory language. Also pointed out was absence of a mechanism to report a lapse in ethical conduct seen in a colleague or a senior.

Conclusion: Nursing is a demanding profession. It is important that our training includes sensitization to the non-technical attributes. They have to be groomed to become role models for young talented girls to join this noble profession. Even a short course may help to sensitize these young ladies to a very important aspect of their lives and profession.

How to cite this:Safdar SA, Aqeel L. Grooming and etiquette as part of nurse’s professionalism- An essential curricular competency. Pak J Med Sci. 2019;35(2):404-408. doi: https://doi.org/10.12669/pjms.35.2.647

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Prevalence of antenatal depression among women receiving antenatal care during last trimester of pregnancy in a tertiary care private institute of Lahore
Authors: Sabir Mahrukh , Farrukh Nagi Muhammad Luqman , Kazmi Tahseen Haider
Published: March 2019

Objective: Pregnancy and depression affect each other. The main objective of our study was to find out frequency of antenatal depression during last trimester and associated risk factors among pregnant female visiting a tertiary care private institution of Lahore, Pakistan.

Methods: This study was conducted at Shalamar Hospital a private tertiary care institution of Lahore during May 2017 to June 2018. Assuming 18% prevalence with design effect 1.5 and 97% confidence interval the calculated sample size was 417. To avoid dropouts the questionnaire was administered to 450 pregnant females in their last trimester that is with gestational age above 28 weeks. In this study we used a modified version of Goldberg’s depression scale in Urdu language for data collection. Wherever needed the data collection team read out aloud the questionnaire to the participants who did not know how to read and write. Informed consent in a written form (in Urdu language) was taken from every study participant after explaining the participants about the research. If the participant did not know how to read and write, the interviewers narrated out aloud the script of informed consent for them and got it signed later by the participants. The confidentiality, anonymity and privacy of the study participants were preserved. Ethical approval of this study was obtained from Institutional Review Board of Shalamar Institute of Health Sciences. Data entry and analysis was finalized by using SPSS version 20.

Results: The prevalence of depression among women seeking antenatal care during their last trimester according to Goldberg Depression Scale was 40.89% (n=184).Whereas, 30.4% (n=137), 8.67% (n=39) and 1.78% (n=8) suffered from mild, moderate and severe depression respectively. The associations between passive smoking (p < 0.01), family history of preeclampsia (p < 0.05) and depression among family members (p < 0.05) with antenatal depression during last trimester were significant.

Conclusion: According to Goldberg Depression Scale, 40.89% (n=184) of pregnant women seeking antenatal care in private tertiary care institution of Lahore suffered from depression.

How to cite this:Sabir M, Nagi MLF, Kazmi TH. Prevalence of antenatal depression among women receiving antenatal care during last trimester of pregnancy in a tertiary care private institute of Lahore. Pak J Med Sci. 2019;35(2):527-531.   doi: https://doi.org/10.12669/pjms.35.2.649

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Navigation and navigation: collection of tasks for practical work
Authors: Белокур Геннадий , Belokur Gennadiy , Сухина Михаил , Suhin Mihail , Скворцов Сергей , Skvorcov Sergey
Published: March 2019

For each topic of the practical training, tasks are developed. The topics of the tasks correspond to the working program of the discipline "Navigation and NAVIGATION".
The workshop is intended for practical training of students of full-time and correspondence forms of training in the specialty 26.05.05 "Navigation" in the study of the discipline "Navigation and sailing".
The basic machines
Authors: Зайчиков Юрий , Zaychikov Yuriy
Published: March 2019

The manual is written in accordance with the training programs in the disciplines of "Device tanks" and "Device base machines."
This manual is intended to assist students in self-study of the General device, power plant, transmission and chassis of the t-72 tank, methodological training. In detail, the training manual presents the purpose, technical characteristics, device, maintenance of the power plant, transmission and chassis of the t-72 tank.
How to get out of the Stanford Prison Experiment: Revisiting Social Science Research Ethics
Authors: PERLSTADT HARRY
Published: March 2019

The Stanford Prison Experiment has continued to raise questions about social science research ethics. Male student volunteers were randomly assigned to be prisoners or guards in a simulation in which the guards became sadistic and the prisoners showed extreme stress. Two ethical issues are the ability of the participants to leave the experiment and the failure to provide adequate oversight and intervening to limit the abuse of the prisoners. In 2018, these issues were revisited and some declared the experiment unscientific and untrustworthy. However, the experiment was carried out before many social science research ethics were established. A detailed description of the experiment reveals insights on how group dynamics and social structure can encourage normal individuals to harm one another in a prison environment. The study is a cautionary tale that should be included in textbooks to improve social science research, demonstrate the need for research ethics, and prevent outrageous treatment of prisoners in the real world.
Is Task-Based Instruction Approach Apt for Journalism Education?
Authors: HUSSAIN SHAFAAT , HUSSAIN SADAQUAT
Published: March 2019

The university teaching and learning of Journalism and Communication in Ethiopia offers many challenges equally both for the teachers and students. One of the challenges is that the undergraduates usually face language difficulties in an English-medium setting. Task based instruction (TBI) as a panacea refers to an approach based on the use of tasks as the core unit of planning and instruction in the teaching learning process. This article critically reviews the fuzzy concept of ‘task’ and how it is different from ‘activities’; the evolution of TBI as an approach; how the objectives are formulated in task based approach; how sequencing and grading of syllabus content is organized in the task format; what is the modus operandi of teachers and learners in task based instruction; which varieties of instructional materials are required to run the show of task-based classroom; and how the learners’ performance and syllabus itself will pass through the process of evaluation. At the end, the article attempts to propose advantages, disadvantages and challenges of TBI for the curriculum/syllabus developers.
The Effects of Land use Change on the Some Soil Properties in Gbonyin Local Government Area of Ekiti State, Nigeria
Authors: W. O. ADEBAYO, , E. O. OLOFIN,
Published: March 2019

The aim of this research is to examine the response of some soil properties to the changes in land cover/land use in Gbonyin Local Government Area of Ekiti State, Nigeria. Land use changes as a result of human activities have been identified as one of the greatest pressures to soil and forest resources. The change from natural vegetation land use to built-up and agricultural land uses is becoming rampant in Gbonyin Local Government Area of Ekiti State, Nigeria. The objective of this study was to examine the effects of land use change on the some soil properties. Two major land use types which include forest lands and residential lands uses were explored. Soil samples were collected at the depth of 0 on 30cm through the use of soil auger from ten different locations in each of the two land use types in the study area making twenty soil samples. The use of t-test statistical tool was implored on the laboratory results in order to test for the differences between the soil in forest and residential land use types. Results revealed that the soil physico-chemical properties differed significantly between the sites. Chemical properties of the soil were found to be generally low in residential land use while they were high in vegetation land use. Bulk density was high in residential land use while it was low in forest land use.
Misplaced ECG electrodes and the need for continuing training
Authors: Bickerton Martin , Pooler Alison
Published: March 2019

More than 1 million ECGs are recorded every day. This literature review examined the accuracy of electrode placement (EP) when acquiring a standard 12-lead electrocardiograph recording (STLER), and the consequences of inaccuracy. The findings showed that EP accuracy varies from 16–90%, and standards and guidelines on EP are not being adhered to. Poor EP can mean under- or overdiagnosis, which can increase morbidity and mortality, or mean that patients receive unnecessary treatment or hospitalisation. Mandatory, appropriate training and assessment, including before an operator is allowed to acquire a STLER and refresher training for ECG operators, are recommended.
Compression therapy and exercise: enhancing outcomes
Authors: Rooney Louise , Cooper-Stanton Garry , Cave-Senior Jayne
Published: March 2019

Compression therapy is the main method used in treating lymphoedema and chronic oedema. When combined with exercise, the authors found that patients in their practice had improved outcomes; making it vital for health professionals to keep up-to-date with this practice

Compression therapy is the main method used in the treatment and management of lymphoedema and chronic oedema. The increasing prevalence of the condition, which has multiple causes, such as genetic factors, age and external factors, require the effective management of the condition, and to enhance the management methods used to contain the condition. The use of exercise alongside the mainstay method of treatment (compression therapy) has been an underutilised area. The application of a structured exercise programme in conjunction with multi-layer lymphoedema bandaging combined with an adjustable velcro wrap-based systems led to a decrease in limb volume in one case study. The results of the programme indicate that the approach is beneficial and requires embedding further in Walsall lymphoedema service, due to improved patient outcomes, and cost effectiveness in terms of resources.
MPs call for expanded Pupil Premium to boost social mobility
Authors: Henshaw Pete
Published: March 2019

Cross-party report recommends a ‘Social Mobility Premium’ to address regional attainment gaps and foster school collaboration
Aspiration & wellbeing
Authors: Stafford Clare
Published: March 2019

The statistics tell us that Black African Caribbean children face many barriers to their education and wellbeing. Continuing her series, Clare Stafford looks at the challenges and what schools might be able to do to tackle these barriers
Poverty-proofing the school day
Authors: Lee-Potter Emma
Published: March 2019

The one place where it can be particularly miserable to be poor is in school. The Poverty Proofing the School Day initiative seeks to help schools identify and tackle the many financial barriers that prevent pupils from fully partaking in school life. Emma Lee-Potter explains
The configuration management requirements for aviation, space and defense organizations
Authors: RUSU Manuela
Published: March 2019

Certification of the quality management system for aviation, space and defense organizations, according to EN 9100: 2016 / AS 9100D standard requires compliance with the configuration management requirements. This article presents the implementation of Configuration management and documents control throughout the entire life cycle of product realization. Configuration management establishes a language of understanding between the client and the supplier both in predefined relationship (such as Built to Print) and those in which the supplier is given some freedom (such as Built to Spec), described in SR EN 16601-40: 2015 standard.
Development and Validation of a Prognostic Score to Predict Covert Hepatic Encephalopathy in Patients With Cirrhosis
Authors: Labenz Christian , Toenges Gerrit , Huber Yvonne , Nagel Michael , Marquardt Jens U. , Schattenberg Jörn M. , Galle Peter R. , Labenz Joachim , Wörns Marcus-Alexander
Published: March 2019

OBJECTIVES:

Diagnosis of covert hepatic encephalopathy (CHE) is challenging and often neglected in clinical practice. The aim of this study was to develop an easy-to-perform score to predict CHE in patients with cirrhosis.

METHODS:

For the development or validation cohort of the proposed clinical CHE score, 142 or 96 consecutive patients with cirrhosis were prospectively enrolled. The Psychometric Hepatic Encephalopathy Score was used to detect minimal hepatic encephalopathy. All patients were examined with the simplified animal naming test and were asked to complete the Chronic Liver Disease Questionnaire. We followed the TRIPOD guideline for development, validation, and reporting of the proposed score.

RESULTS:

The clinical covert hepatic encephalopathy score containing the variables—clinically detectable ascites, history of overt hepatic encephalopathy (OHE), albumin serum level, activity subdomain of the Chronic Liver Disease Questionnaire, and simplified animal naming test—discriminated best between patients with and without CHE. We generated 2 cutoff values for the identification of the high-, intermediate- (with need for additional specialized testing), and low-risk groups for CHE. By applying these cutoffs, the sensitivity, specificity, positive predictive value, and negative predictive value were 90%, 91%, 85%, and 94%, respectively. The AUC was 0.908 or 0.872 for the development or the validation cohort, respectively. Higher scores were further associated with poorer quality of life, and the high-risk group was predictive for first-time OHE within 180 days.

CONCLUSIONS:

We developed an easy-to-perform score to identify patients with cirrhosis at risk of CHE, which correlates with quality of life and risk of first-time OHE.
ACG Clinical Guideline: Ulcerative Colitis in Adults
Authors: Rubin David T. , Ananthakrishnan Ashwin N. , Siegel Corey A. , Sauer Bryan G. , Long Millie D.
Published: March 2019

Ulcerative colitis (UC) is an idiopathic inflammatory disorder. These guidelines indicate the preferred approach to the management of adults with UC and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. In instances where the evidence was not appropriate for GRADE, but there was consensus of significant clinical merit, “key concept” statements were developed using expert consensus. These guidelines are meant to be broadly applicable and should be viewed as the preferred, but not only, approach to clinical scenarios.
Supplementation With Lactoferrin and Lysozyme Ameliorates Environmental Enteric Dysfunction: A Double-Blind, Randomized, Placebo-Controlled Trial
Authors: Cheng William D. , Wold Karl J. , Bollinger Lucy B. , Ordiz M. Isabel , Shulman Robert J. , Maleta Kenneth M. , Manary Mark J. , Trehan Indi
Published: March 2019

INTRODUCTION:

Environmental enteric dysfunction (EED) predisposes children throughout the developing world to high rates of systemic exposure to enteric pathogens and stunting. Effective interventions that treat or prevent EED may help children achieve their full physical and cognitive potential. The objective of this study is to test whether 2 components of breast milk would improve a biomarker of EED and linear growth during the second year of life.

METHODS:

A prospective, randomized, double-blind, placebo-controlled clinical trial among children aged 12–23 months was conducted in rural Malawi. The experimental group received a daily supplement of 1.5 g of lactoferrin and 0.2 g of lysozyme for 16 weeks. The primary outcome was an improvement in EED, as measured by the change in the percentage of ingested lactulose excreted into the urine (Δ%L).

RESULTS:

Among 214 children who completed the study, there was a significant difference in Δ%L between the control and experimental groups over 8 weeks (an increase of 0.23% vs 0.14%, respectively; P = 0.04). However, this relative improvement was not as strongly sustained over the full 16 weeks of the study (an increase of 0.16% vs 0.11%, respectively; P = 0.17). No difference in linear growth over this short period was observed. The experimental intervention group had significantly lower rates of hospitalization and the development of acute malnutrition during the course of the study (2.5% vs 10.3%, relative risk 0.25; P < 0.02).

DISCUSSION:

Supplementation with lactoferrin and lysozyme in a population of agrarian children during the second year of life has a beneficial effect on gut health. This intervention also protected against hospitalization and the development of acute malnutrition, a finding with a significant clinical and public health importance. This finding should be pursued in larger studies with longer follow-up and optimized dosing.
Home Blenderized Tube Feeding: A Practical Guide for Clinical Practice
Authors: Weeks Caroline
Published: March 2019

Although commercial enteral formulas have been available on the market for several decades, a cultural shift toward consuming unprocessed foods with minimally added sugar has sparked interest in the preparation of home blenderized tube feedings for enteral feeding-dependent patients. Recent surveys, however, indicate lack of clinical awareness or familiarity in the management of this method of nutrition support. This article aims to equip the gastroenterologist with a guide for initiation, monitoring, and evaluation of a blenderized tube feedings regimen, and provides insights into an opportunity for greater partnership between the gastrointestinal provider and registered dietitian.
Risk of Upper Gastrointestinal Bleeding and Gastroduodenal Ulcers in Persons With Schizophrenia: A Danish Cohort Study
Authors: Cotton Cary C. , Farkas Dóra K. , Foskett Nadia , Sørensen Henrik T. , Milosavljevic-Ristic Smiljana , Balas Bogdan , Ehrenstein Vera
Published: March 2019

INTRODUCTION:

There is little evidence about gastrointestinal (GI) disorders in patients with schizophrenia. We examined association of schizophrenia with upper GI bleeding (UGIB) and nonbleeding ulcers and associated risk factors and mortality.

METHODS:

We used the data linked from population-based registries in Denmark. Among patients with incident schizophrenia in 1980–2011, we computed cumulative incidences and standardized incidence ratios of UGIB, bleeding ulcers, and nonbleeding ulcers compared with the general population; evaluated risk factors for the 3 GI endpoints, including somatic and psychiatric comorbidity; and examined subsequent all-cause mortality.

RESULTS:

Among 39,998 patients with schizophrenia, the standardized incidence ratios were 2.92 (95% confidence interval (CI), 2.76–3.08) for UGIB, 2.36 (95% CI, 2.15–2.58) for bleeding ulcers, and 2.00 (95% CI, 1.87–2.15) for nonbleeding ulcers. Risk factors for UGIB and nonbleeding ulcers included age, somatic comorbidity, and medication use. UGIB and nonbleeding ulcers were associated with the subsequent increase in mortality.

CONCLUSIONS:

Schizophrenia is associated with an increased risk of UGIB and nonbleeding ulcers, whose risk factors in patients with schizophrenia are similar to those in the general population.
Impact of Non-Alcoholic Fatty Liver Disease on Cardiovascular Outcomes in Patients With Stable Coronary Artery Disease: A Matched Case–Control Study
Authors: Liu Hui-Hui , Cao Ye-Xuan , Sun Di , Jin Jing-Lu , Guo Yuan-Lin , Wu Na-Qiong , Zhu Cheng-Gang , Gao Ying , Dong Qiu-Ting , Zhao Xi , Li Sha , Zhang Yan , Liu Geng , Li Jian-Jun
Published: March 2019

INTRODUCTION:

Whether non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular risk has still been controversial. The reasons for this disparity may be associated with subject selection, events definition, diagnostic criteria of NAFLD, or research methods. The aim of this study was to determine the relationship of NAFLD to cardiovascular disease (CVD) outcomes in patients with stable, new-onset coronary artery disease (CAD).

METHODS:

A matched case–control study based on the cohort with stable, new-onset CAD was implemented in 162 cases (patients who developed all-cause death, non-fatal myocardial infarction and stroke during an average of 11,484 patient-years of follow-up) and 162 controls without cardiovascular events matched with the same sex, the age difference ≤3 years old, and the admission date within 3 months. Abdominal ultrasonography and coronary angiography were performed at admission. COX proportional hazard models and conditional logistic regression analysis were used to assess the effect of NAFLD on CVD outcomes.

RESULTS:

NAFLD was more common in the event group than in the control group (P = 0.012). Kaplan-Meier analysis showed a significant association between NAFLD and CVD outcomes (P = 0.007). Moreover, Cox regression (hazard ratios 1.56; 95% confidence interval, 1.04–2.34, P = 0.031) and conditional logistic regression (odds ratio 2.72, 95% confidence interval, 1.16–6.39, P = 0.022) analyses further demonstrated that NAFLD was an independent risk factor for CVD outcomes.

Conclusions:

NAFLD is indeed an independent predictor of CVD outcomes in patients with stable, new-onset CAD. Further randomized controlled trials may be needed to confirm our findings.
Wędrując śladami umarłych. Foto-teksty Dašy Drndić
Authors: Giergiel Sabina
Published: March 2019

Punktem wyjścia niniejszego tekstu jest przekonanie, że chorwacka autorka Daša Drndić w kolejnych swoich książkach konsekwentnie eksploatuje tematykę pamięci i zapomnienia o Holokauście oraz o ofiarach z czasów drugiej wojny światowej. W artykule zestawione zostają fragmenty z dwóch książek April u Berlinu z 2009 r. i EEG z 2016 r. W obu autorka umieszcza rodzaj foto-tekstów, w których dochodzi do połączenia warstwy wizualnej z językową. W pierwszej z nich ten związek jest oczywisty (mamy tam bowiem zestawienie fotografii i tekstu), w drugiej zaś nie jest jednoznaczny, choć staram się wykazać, że Drndić udało się przy pomocą języka stworzyć niezwykle plastyczne „obrazy w ruchu”, w których nałożone zostają na siebie sceny z dzisiejszego Zagrzebia i z lat 40 XX w. Interpretacja tego rodzaju fragmentów zostaje ponadto uzupełniona o rozważania na temat przestrzeni chorwackiej stolicy, w której brakuje znaków świadczących o „trudnym dziedzictwie” (termin Sharon Macdonald).
Elity Raguzy w perspektywie francuskich administratorów Prowincji Iliryjskich
Authors: Sajkowski Wojciech
Published: March 2019

Szlacheckie rody i mieszczaństwo Raguzy oceniane były przez francuskich administratorów Prowincji Iliryjskich (1809-1813) bardzo pozytywnie. Z małymi wyjątkami próżno doszukiwać się w pozostawionych świadectwach śladów stereotypów, które można by połączyć z obrazami Bałkanów, Orientu, czy Europy Wschodniej. Choć szlachta Raguzy była opisywana jako dumna, lub nawet wyniosła, to duma ta została przedstawiona jako uzasadniona, ponieważ więź najznamienitszych rodzin z republiką sięgała czasów średniowiecza, a także z powodu przedsiębiorczego ducha, który przyniósł dobrobyt całemu miastu. Z obrazem tym kontrastowały opisy dalmatyńskich Włochów, przedstawianych jako intruzi, którzy nie przyczyniali się do rozwoju regionu. Różnica między percepcją włoskich i dubrownickich elit była związana z pojęciem narodu, które stało się jednym z kluczowych elementów polityki napoleońskiej w Europie.
FL instruction and interaction in formal settings
Authors: Zybert Jerzy
Published: March 2019

FL instruction and interaction in formal settings