bluuebunny/crossref_metadata_2025 huggingface dataset:
EVALUATION OF IMPLEMENTATION OF COMPREHENSIVE EMERGENCY NEONATAL OBSTETRICS SERVICES PROGRAM (PONEK)
Authors: Irma Irma , Gustina Erni
Published: August 2024

Background: Contributing factors to maternal and infant mortality rates are caused by delays in decision making, late referral and late handling at health facilities or referral sites. One of the efforts to reduce maternal, infant and under-five mortality rates is the provision of comprehensive emergency neonatal obstetric service facilities (PONEK= Program Pelayanan Obstetri Neonatal Emergensi Komprehensif) in hospitals. The key to the success of PONEK is the availability of appropriate healthcare personnel competence, infrastructure, facilities and reliable management.Â Objective: Evaluate the PONEK program at General Hospital PKU Muhammadiyah Yogyakarta City (RSU PKU Muhammadiyah Yogyakarta City)Â Methodology: This research used qualitative approach, case study designed at RSU PKU Muhammadiyah Yogyakarta in September 2017. The subjects were 5 employees of PONEK Team and 3 patients, and using Purposive Sampling technique. Data collection by in-depth interviews and observations. Data analysis consisted of the stages of data reduction, data presentation, drawing conclusions and source triangulation.Â Result: Input program of PONEK in RSU PKU Yogyakarta is good in terms of quantity of good availability of human resources, funds, and infrastructure facilities. The process of planning, organizing and supervision is good, while in the implementation process has not run well, because one of the activities that support the PONEK of education and training has not been 100% running. Output of PONEK that has not been achieved such as training that cannot be implemented in accordance with a predetermined schedule. The service quality of the PONEK program in terms of patients is quite good and satisfied with the services provided.Â Conclusion: The implementation of comprehensive emergency neonatal obstetric service program in PKU Muhammadiyah General Hospital as a whole has been going well even though it is not perfect, because there are some parts that are carried out optimally.
ANALYSIS EFFECT OF QUALITY SERVICE AND PATIENTâ€™S KNOWLEDGE OF PATIENTS ATTITUDE OF AWARENESS OF TREATMENT AND ITS IMPACT ON DENTAL PATIENT VISIT AT PUSKESMAS SITU UDIK BOGOR DISTRICT, WEST JAVA, INDONESIA
Authors: Cahyani Lenny Asyita , Fauziah Munaya
Published: August 2024

Background: Dental and oral disease attacks almost everyone in the world. Nevertheless, majority of people pay less attention to look after their dental and oral health. Therefore, that case gave rise the severe level. The main cause of severity of dental disease is the disobedience of the patients to the determined medical service standards.Â Objective: The purpose of this study is to reveal the impact of the service quality and knowledge of the patients with regards to the treatment awareness behavior and to the re-visit of dental patients at community health center (Puskesmas) Situ Udik, Bogor district, west Java, Indonesia 2018.Â Method: The research design used in this research is quantitative analytics. As for the analysis test, the path analysis is used. The activities were carried out in Dental Polyclinic of Puskesmas Situ Udik in February 2018 where sampling was done by using random sampling system with 143 respondents.Â Result: The statistic test shows that the factors that influence the patient's re-visit are quality of service (p value = 0.011, contribution 22,5%) and behavior of the patients (p value = 0,045, contribution 17,4%). While the factors that influence the behavior of the patients is quality (p value = 0.000, contribution 45.6%). In addition, simultaneously the quality of services, knowledge as well as behavior affect the re-visit (p value = 0.000 and contribution of 11.6%)Â Conclusion: 1) to improve the quality of service at Puskesmas Situ Udik and; 2) to provide the patients with education or health promotion in order to improve their knowledge as well as behavior with regards to dental diseases.Â
Prevalence Study of Pulmonary Tuberculosis in Umbulharjo Sub-District Yogaykarta 2014-2016
Authors: Nurfita Desi , Nurasyiah Fatma , Rahayu Atikah
Published: August 2024

Background : Pulmonary tuberculosis is infectious disease coused by Mycobacterium tuberculosis. Most of Mycobacterium tuberculosis attacks lungs, but it can also attack other body organs (Depkes RI, 2007). Tuberculosis remains one of the deadliest diseases in the world. The World Health Organization (WHO) estimates that each year more than 8 million new cases of tuberculosis occur and approximately 3 million persons die from the disease. The result of Riskesdas in 2007, prevalence of pulmonary tuberculosis increases with age and highest prevalence is over 65 years. The prevalence of pulmonary tuberculosis in men is 20 % higher than woman. Prevalence of pulmonary tuberculosis is three times higher in low education compared to higher education (Riskesdas, 2007).Method : This type of study was quantitative descriptive research. Respondents were tuberculosis program holders at Health Primary Care of Umbulharjo 1 and Health Primary Care of Umbulharjo 2. This reseach used tuberculosis register in Health Primary Care of Umbulharjo 1 and Health Primary Care of Umbulharjo 2. Data analysis was performed by descriptive. Data analysis used frequency distribution analysis.Result : Suspected tuberculosis has increased from 2014 to 2016 in Umbulharjo District. Percentage of tuberculosis patients among the suspects in 2014 was 26.1%. Percentage of TB patients among the suspects in 2015 was 22.3%. Percentage of TB patients among the suspects in 2016 was 25.1%. the result of study foundÂ  pulmonary tuberculosis primer, pulmonary tuberculosis secondary, extrapulmonary tuberculosis, and tuberculosis in children. Treatment success rates reached 89% in 2014, 92% in 2015, and 78% in 2016.Conclusion : Cases of pulmonary tuberculosis fluctuate every year. Increased in 2016, which was 46 cases, compared to the year 2015 as many as 26 cases and in 2014 as many as 28 cases.
GAMBARAN PROSES MANAJEMEN LOGISTIK FARMASI DI GUDANG FARMASI RS PKU MUHAMMADIYAH KOTA YOGYAKARTA
Authors: Maulida Syarifah Auliatul Rizka
Published: August 2024

Logistics management in hospitals is one of the important aspects in hospitals. Availability of medicines is currently a demand for health services. Drug logistics management in hospitals includes the stages, namely planning, procurement, storage, distribution, deletion, evaluation and monitoring which are interrelated with each other, so they must be well coordinated so that each can function optimally. Purpose: To knowing the description of the pharmaceutical logistics management process in the pharmaceutical warehouse of PKU Muhammadiyah Hospital Yogyakarta. Methods: This research is qualitative research with observation and interview method for data collection in Pharmacy Logistics at PKU Muhammadiyah Hospital Yogyakarta.Results: The logistics management process in the pharmacy section of PKU Muhammadiyah Hospital is implemented by selecting pharmaceutical preparations, planning, procurement, receiving, storing, distributing, destroying and withdrawing, and controlling. Conclusion: Pharmaceutical logistics management at PKU Muhammadiyah Hospital is carried out by competent officers and in accordance with the hospital's internal regulations.
Pengukuran Kinerja Rumah Sakit Umum Pusat dr. Soeradji Tirtonegoro Klaten dengan Metode Balanced Scorecard Perspektif Bisnis Internal dan Pembelajaran dan Pertumbuhan
Authors: Hastuti Siti Kurnia Widi , Sakti Ratu Bela
Published: August 2024

Central General Hospital dr. Soeradji Tirtonegoro Klaten is a type A hospital an as a referral center hospital. This hospital is required to be able to provide health services in accordance with the standard. During this time the hospital used performance measurement that have been set by the government, measuring performance from the financial aspect alone is not enough so it is also necessary from the non-financial aspects. Performance measurement using the Balanced Scorecard is the right solution because performance measurement is seen from various aspects namely financial and non-financial aspects namely financial and non-financial aspects. This study aims to determine the performance of the central general hospital dr. Soeradji Tirtonegoro Klaten Internal Business Perspective and Learning and Growth Perspective. This study used a qualitative method with  phenomenological research  design. The research  subjects consisted of the head of the HR sub- division, the head of the medical services monitoring and evaluation section, the medical record installation  reporting staff, the head of the training and education sub-office, the employee and a sample of 92 employees consisting of medical and non-medical personnel. The result of performance measurements conducted at the Central General Hospital dr. Soeradji Tirtonegoro Klaten used the Balanced  Scorecard  method of internal business perspective and learning and growth obtained a score of  0 which means good enough. Performance measurement Of The Central General Hospital, dr. Soeradji Tirtonegoro Klaten With the Balanced Scorecard Method viewed from an internal business perspective and Learning and Growth is said to be “Good Enough”
Peran Komite Keperawatan dalam Meningkatkan Mutu Pelayanan Keperawatan di Salah Satu Rumah Sakit Swasta di Yogyakarta
Authors: Miranda Titania , Hidayat Muhammad Syamsu
Published: August 2024

The Nursing Committee is a hospital apparatus that have the task to increase nursing professionalism through credential process, maintaining professional quality, professional ethics and disciplines. The committee plays a major role in increasing professionalism among the nurses, assuring the quality of nursing services in hospital. The purpose of this study is to determine the role of the Nursing Committee in improving the quality of nursing services at a private hospital in Yogyakarta. This is a qualitative research using case study approach. The participants are selected using purposive sampling technique and the data are acquired through in-depth interviews. The sub-committee of credentials has prepared the white paper, carried out the credential and recredential process. However, they lack sufficient assessors and, therefore, lack determination in timekeeping; (2) the sub-committee of professional quality has carried out nursing audits and developing sustainable profession for nurses. However, almost all committee’s member have multiple positions in the hospital. This situation has made it difficult to allocate time for program implementation; (3) the sub-committee of ethics has made ethical guidelines, disseminated the nursing ethics, created ethical reporting system, and audit ethics. However, the activities has not been regularly conducted. The nursing committee has not significantly improved the quality of nursing services as the sub-committee of credential, professional quality, and ethics has not been effective.
Dampak Ketidaklengkapan Rekam Medis Rawat Inap Kasus Covid-19 Terhadap Pelayanan di Rumah Sakit Condong Catur Yogyakarta
Authors: Dehoni Paskalia Gabrielsa , Ningsih Kori Puspita
Published: August 2024

A well-written and complete medical record have many uses, including aspects of administration, legal, finance, research, education and documentation (ALFRED). Therefore, incomplete medical records will have an impact on hospital services. To find out the benefits of medical records from users in RSCC and to know the type of medical record form to claim Covid-19 patients at RSCC. Also, to find out the impact of incomplete inpatient medical records for Covid-19 cases from the aspects of Administration, Legal, Finance, Research, Education, Documentation (ALFRED) at RSCC. This study used a qualitative descriptive method with a case study design. The informants in this study are 11 people consisting of 1 medical record officer, 1 distribution officer, 1 covid-19 claim officer, 1 claim verification doctor, 1 head of medical services, 1 head of medical support, 1 head of ICU officer, 1 head of inpatient care officer, 2 heads of ward officers and 1 head of nursing. The object of this study used 8 inpatient medical records of Covid-19 patients in the period January-March 2021 at RSCC. In addition, the head of RSCC medical record carried out data validation as triangulation. The benefits of medical records for health care workers at the RSCC are knowing the activities of health care providers in treating patients, BPJS/insurance claims and predicting hospital income, as a source of data for research, learning materials about service activities in hospitals, to know about patient medical history and hospital reports. In claiming Covid-19 patients, the RSCC uses medical resumes, Covid-19 screening, laboratory results, isolation certificates, CPPT sheets, medical prescriptions, and inpatient approval sheets. However, the incompleteness of medical records from the administrative aspect causes delays in the administrative process, the financial aspect causes claims to be disputed, and the documentation aspect causes delays in the making of hospital reports. Incompleteness of medical records at RSCC have impacts on administrative aspects, financial aspects, and documentation aspects.
Faktor-Faktor Yang Mempengaruhi Kinerja Karyawan Di Rumah Sakit Jiwa Grhasia Selama Pandemi COVID-19
Authors: Worowulan Santi Hapsari , Mudayana Ahmad Ahid
Published: August 2024

Background: The Covid-19 pandemic has caused the hospital workload to increase which causes employees who work in hospitals to experience stress because they are always required to always provide the best service under any conditions. Based on this, efforts are needed in order to improve employee performance by using factors that affect employee performance. This study aims to determine the effect of work motivation, work environment, and organizational culture on employee performance at the Grhasia Mental Hospital during the Covid-19 pandemic.
Methods: This research is quantitative research with a cross sectional approach. The population of this study were employees with the status of State Civil Apparatus who worked in the Grhasia Mental Hospital with 84 research samples that met the inclusion and exclusion criteria.
Results: Based on the results of the Correlation Pearson test, it shows that there is a relationship between work motivation, work environment, and organizational culture on employee performance at the Grhasia Mental Hospital during the Covid-19 Pandemic with a p-value of 0.000 (p < 0.05). Conclusion: There is a relationship between work motivation, work environment, and organizational culture on employee performance at the Grhasia Mental Hospital during the Covid-19 Pandemic. For this reason, hospitals need to maintain motivation, work environment and organizational culture properly so that the performance of employees is maximized.
Analysis of The Increase In National Health Insurance Contributions on The Rights and Obligations of Participants at the Puput Community Health Center (Puskesmas Puput)
Authors: Khoiriyah Salsabila , Hidayat Muhammad Syamsu
Published: August 2024

Background:  A total of 727 visits of JKN participants were served at Puput Bangka Barat Health Center. Based on the number of visits per month in January 2015, there were 1,536 cases served at eight Bangka Barat Health Centers. Based on the agreement, JKN participants in Bangka Barat Regency were budgeted by the Central Government, Bangka Belitung Provincial Government and Askes. The Bangka Barat community of JKN participants funded by the central government were 26,045 people, funded by the provincial government were 11,500 people and PNS, TNI, Polri were 13,865 people or a total of 51,419 people.
Methods: This study used phenomenological research with a qualitative descriptive approach. The subjects of the study were key informants and triangulation informants totaling 10 informants at Puput Health Center. And the research instrument used in-depth interviews and documentation.
Results:  participants did not feel the difference in health services, some of them felt for health services For routine contribution payments, informants pay contributions routinely according to their respective classes. Some complained about the increase in JKN contributions and some of them had no complaints about the increase in contributions. And for the perception of the increase in contributions, participants responded negatively to the government's policy related to the increase in BPJS Health contributions, although on the other hand they still hoped that the JKN contributions could be reduced.
Conclusion: Utilization of Health Services at Puput Health Center, some of the participants were quite satisfied with the health services at Puput Health Center. Level of Compliance of JKN Participants in Making Routine Payments of JKN Contributions, there were participants who did not pay contributions on the grounds that they were due to the increase in contributions. And the perception of participants about the policy of increasing JKN contributions in JKN membership, policies related to BPJS Health, informants strongly objected to this policy.
PEMANFAATAN METODE HVSR UNTUK STUDI KARAKTERISTIK TANAH DI TANJUNG KEMALA DAERAH KABUPATEN TANGGAMUS
Authors: Farduwin Alhada , Pinem Junita Cintia Dewi Br , Styawan Yudha
Published: August 2024

Penelitian ini bertujuan untuk mengevaluasi dan mengidentifikasi karakteristik tanah di Kabupaten Tanggamus, tepatnya pada Desa Tanjung Kemala, dengan fokus pada parameter penting seperti indeks kerentanan seismik (), amplifikasi (), dan frekuensi natural (). Karakteristik tanah ini sangat penting dalam menentukan zona rawan seismik yang dapat memengaruhi keputusan dalam pemilihan lokasi pembangunan. Data untuk penelitian ini diperoleh melalui pengukuran mikrotremor yang dilakukan menggunakan alat Raspberry Shake 3D pada 24 lokasi observasi, yang tersebar dengan interval sebesar 0,5 km. Analisis data dilakukan dengan menggunakan Horizontal to Vertical Spectral Ratio (HVSR), yang memungkinkan penilaian  dan . Luaran dari analisis ini memperlihatkan  yang bervariasi di antara 0,52 Hz dan 21,73 Hz, sedangkan  berkisar antara 1,97 hingga 7,66 kali, dan nilai 0,71 hingga 37,34 dari . Data ini mengungkapkan bahwa daerah dengan  rendah terletak di bagian timur dan timur laut, sedangkan daerah dengan  tinggi ditemukan di bagian barat laut dan tengah barat daya. Selain itu, pengukuran ketebalan lapisan sedimen berdasarkan nilai kecepatan gelombang geser sepanjang kedalaman 30 meter yang dirata-ratakan () dengan hasil antara 83,67 m/s hingga 1380,82 m/s, dengan dominasi tipe C yang menunjukkan tanah yang sangat padat. Temuan ini sangat berharga untuk memberikan wawasan yang mendalam mengenai potensi risiko seismik dan mempertimbangkan aspek-aspek penting dalam perencanaan dan pembangunan yang lebih aman di kawasan tersebut.
The Folk Phytopoetics in Cai Gao’s Visual Storytelling
Authors: You Chengcheng
Published: August 2024

Abstract: Cai Gao’s illustrations—rooted in childhood memories, Chinese folktales, and botanical fascinations—invite readers worldwide to rediscover their own heritage and find solace in a poetic dwelling where folk sensibilities, art, and nature merge and flourish.
Two-dimensional vortex dipole, tripole, and quadrupole solitons in nonlocal nonlinearity with Gaussian potential well and barrier
Authors: Chen Peijun , Dong Jiangli , Ou Junhui
Published: August 2024

In this work, we investigate the dynamics and stability of two-dimensional (2D) vortex dipole, tripole, and quadrupole solitons with fundamental topological charge (m = 1) and higher topological charge (m > 1) in nonlocal nonlinearity with Gaussian potential well and barrier. Both analytical and numerical methods are applied to explore these vortex solitons. The analytical expressions are derived by utilizing the variational approach. The numerical simulations show that nonlocality cannot stabilize the vortex dipole, tripole, and quadrupole beams with topological charge m = 1. Interestingly, it is found that these vortex solitons remain stable during propagation only when the topological charge is m = 2 and when the propagation constants are below specific thresholds, where the vortex beams can maintain their profile no matter whether the nonlocality is weak, intermediate, or strong or how the Gaussian potential barrier height (well depth) increases. Furthermore, for the solitons with higher topological charge (m = 4), another consistent pattern emerges, that is, vortex dipole, tripole, and quadrupole solitons split into stable petal solitons and fundamental solitons with the number of petal solitons corresponding to the number of vortex solitons present. The analytical results are verified by numerical simulations.
Generation and manipulation of high-order orbital angular momentum in helically twisted dual-core photonic crystal fiber based on filling polyglycerol
Authors: Wu Tiesheng , Feng Zhangpeng , Cheng Xin , Lan Yujing , Li Zhenyu , Huang Yingshuang , Tang Yingtao , Li Hongyun , Peng Yiwei
Published: August 2024

Orbital angular momentum (OAM) technology shows great potential to enhance communication capacity and spectrum utilization. We propose and numerically investigate a polyglycerol-filled dual-core helically twisted photonic crystal fiber (PFH-PCF) for simultaneous realization generating and dynamically manipulating OAM. The proposed structure consists of a hexagonal arrangement of air holes, with the absence of air holes on both sides of the central air hole, forming two solid inner cores, and a filling layer formed by polyglycerol filled in the fourth layer of air holes. Numerical calculations using the finite element method revealed that the higher-order modes of the filling layer couple with different supermodes of the inner cores at the wavelengths of 1101, 1281, 1469, and 1913nm, resulting in OAM generation in the filling layer. The coupling between the dual inner cores and the outer filling core follows the rule of even supermode coupling with even OAM modes and odd supermode coupling with odd OAM modes. The designed fiber can generate OAM modes up to an order of l=+16, with a purity exceeding 94%. Additionally, a temperature change of 20°C results in a spectral shift of 100-200 nm for the OAM operating wavelengths, while a twist rate change of 628.318 rad/m also results in resonance wavelengths shift with a range of 150-250 nm, allowing for free dynamic manipulation of the OAM beam. The excellent results indicate that the presented design has great potential applications in the fields of optical control devices and all-fiber optical communication.
Design method for zoom systems based on magnification ratio modulation of afocal off-axis three-mirror anastigmat systems
Authors: Qi Yunsheng , Meng Qingyu
Published: August 2024

Achieving higher resolution and larger zoom ratio is one of the primary goals of zoom optical systems. To this end, we propose a new zoom configuration that combines a modulatable magnification off-axis three-mirror system with a zoom system to expand the zoom ratio of the system. Since the afocal reflective system can easily achieve large optical apertures, this approach is more conducive to meeting the long focal length and high-resolution performance requirements of zoom systems. In this study, through theoretical analysis of the zoom equation, guided by the need to adapt the pupil matching of the combined zoom system, we derived the configuration equations of the off-axis three-mirror afocal system with the exit pupil position as the boundary condition. We established a zoom optical system design method based on a modulatable magnification ratio off-axis three-mirror subsystem. According to the design concept, theoretical analysis, and design method, we provided two high-resolution long focal length zoom system design schemes with a zoom ratio of 12× by applying an off-axis three-mirror afocal system with zoom ratio modulation ranges of 4×-6×-8×, combined with a 1.5× mechanical compensation zoom system. The achieved zoom ranges are 399 mm–4896 mm and 399 mm–4893 mm, respectively. The results of this study provide a novel approach for achieving high-resolution, large zoom ratio systems.
Real-time sensing approach for optical frequency domain reflectometry using an FPGA-based high-speed demodulation algorithm
Authors: Wang Haomao , Zhai Tong , Wang Yifan , Liu Youze , Zhou Rui , Peng Xin , Zhang Zhiguo
Published: August 2024

Optical frequency-domain reflectometry (OFDR) is pivotal in structural health monitoring. However, real-time sensing remains challenging owing to the demodulation speed limitations imposed by hardware constraints and intricate processes. To address this, we propose an FPGA-based high-speed demodulation algorithm employing a 2D FFT and frequency-domain cross-correlation algorithm. The experiments demonstrate that our system achieves the following specifications: sensing length of 50 m, spatial resolution of 6.4 mm, strain resolution of 16με, strain range of ±2000με, and real-time sensing rate of 24 Hz. We present what we believe is a novel approach for real-time OFDR sensing with limited hardware resources and potential broader applications.
ECD-CDGI: An efficient energy-constrained diffusion model for cancer driver gene identification
Authors: Wang Tao , Zhuo Linlin , Chen Yifan , Fu Xiangzheng , Zeng Xiangxiang , Zou Quan
Published: August 2024

The identification of cancer driver genes (CDGs) poses challenges due to the intricate interdependencies among genes and the influence of measurement errors and noise. We propose a novel energy-constrained diffusion (ECD)-based model for identifying CDGs, termed ECD-CDGI. This model is the first to design an ECD-Attention encoder by combining the ECD technique with an attention mechanism. ECD-Attention encoder excels at generating robust gene representations that reveal the complex interdependencies among genes while reducing the impact of data noise. We concatenate topological embedding extracted from gene-gene networks through graph transformers to these gene representations. We conduct extensive experiments across three testing scenarios. Extensive experiments show that the ECD-CDGI model possesses the ability to not only be proficient in identifying known CDGs but also efficiently uncover unknown potential CDGs. Furthermore, compared to the GNN-based approach, the ECD-CDGI model exhibits fewer constraints by existing gene-gene networks, thereby enhancing its capability to identify CDGs. Additionally, ECD-CDGI is open-source and freely available. We have also launched the model as a complimentary online tool specifically crafted to expedite research efforts focused on CDGs identification.
PAX6 protein in neuromasts of the lateral line system of salamanders (Eurycea)
Authors: Dobbins Brittany A. , Tovar Ruben U. , Oddo Braden J. , Teague Christian G. , Sindhi Nisa A. , Devitt Thomas J. , Hillis David M. , García Dana M.
Published: August 2024

PAX6 is well known as a transcription factor that drives eye development in animals as widely divergent as flies and mammals. In addition to its localization in eyes, PAX6 expression has been reported in the central nervous system, the pancreas, testes, Merkel cells, nasal epithelium, developing cells of the inner ear, and embryonic submandibular salivary gland. Here we show that PAX6 also appears to be present in the mechanosensory neuromasts of the lateral line system in paedomorphic salamanders of the genus Eurycea. Using immunohistochemistry and confocal microscopy to examine a limited number of larvae of two species, listed by the United States of America’s federal government as threatened (E. nana) or endangered (E. rathbuni), we found that anti-PAX6 antibody labeled structures that were extranuclear, and labeling was most intense in the apical appendages of the hair cells of the neuromast. This extranuclear localization raises the possibility of an as yet undescribed function for PAX6 as a cytoskeleton-associated protein.
A qualitative exploration of barriers to efficient and effective structured medication reviews in primary care: Findings from the DynAIRx study
Authors: Abuzour Aseel S. , Wilson Samantha A. , Woodall Alan A. , Mair Frances S. , Clegg Andrew , Shantsila Eduard , Gabbay Mark , Abaho Michael , Aslam Asra , Bollegala Danushka , Cant Harriet , Griffiths Alan , Hama Layik , Leeming Gary , Lo Emma , Maskell Simon , O’Connell Maurice , Popoola Olusegun , Relton Samuel , Ruddle Roy A. , Schofield Pieta , Sperrin Matthew , Staa Tjeerd Van , Buchan Iain , Walker Lauren E.
Published: August 2024

Introduction

Structured medication reviews (SMRs), introduced in the United Kingdom (UK) in 2020, aim to enhance shared decision-making in medication optimisation, particularly for patients with multimorbidity and polypharmacy. Despite its potential, there is limited empirical evidence on the implementation of SMRs, and the challenges faced in the process. This study is part of a larger DynAIRx (Artificial Intelligence for dynamic prescribing optimisation and care integration in multimorbidity) project which aims to introduce Artificial Intelligence (AI) to SMRs and develop machine learning models and visualisation tools for patients with multimorbidity. Here, we explore how SMRs are currently undertaken and what barriers are experienced by those involved in them.

Methods

Qualitative focus groups and semi-structured interviews took place between 2022–2023. Six focus groups were conducted with doctors, pharmacists and clinical pharmacologists (n = 21), and three patient focus groups with patients with multimorbidity (n = 13). Five semi-structured interviews were held with 2 pharmacists, 1 trainee doctor, 1 policy-maker and 1 psychiatrist. Transcripts were analysed using thematic analysis.

Results

Two key themes limiting the effectiveness of SMRs in clinical practice were identified: ‘Medication Reviews in Practice’ and ‘Medication-related Challenges’. Participants noted limitations to the efficient and effectiveness of SMRs in practice including the scarcity of digital tools for identifying and prioritising patients for SMRs; organisational and patient-related challenges in inviting patients for SMRs and ensuring they attend; the time-intensive nature of SMRs, the need for multiple appointments and shared decision-making; the impact of the healthcare context on SMR delivery; poor communication and data sharing issues between primary and secondary care; difficulties in managing mental health medications and specific challenges associated with anticholinergic medication.

Conclusion

SMRs are complex, time consuming and medication optimisation may require multiple follow-up appointments to enable a comprehensive review. There is a need for a prescribing support system to identify, prioritise and reduce the time needed to understand the patient journey when dealing with large volumes of disparate clinical information in electronic health records. However, monitoring the effects of medication optimisation changes with a feedback loop can be challenging to establish and maintain using current electronic health record systems.
The role of construction of healthcare consortium on the allocation of human resources for primary care resources and its equity in China: A quantitative study
Authors: Li Shijie , Liao Changze , Zhang Shengli
Published: August 2024

Objectives

This study aims to measure the effect of Construction of Healthcare Consortium (CHC) on the allocation and equity of human resources (HR) for primary health care (PHC) in China, at the same time, it provides some data to support the government’s policies improvement in the next stage.

Methods

Changes in the equity of allocation of HR for PHC by population are demonstrated through a three-stage approach to inequality analysis that includes the Gini coefficient (G), the Theil index (T), the Concentration index (CI) and Concentration curves. Trends in resource allocation from 2021 to 2030 were projected using the GM (1, 1) model.

Results

The average rate of growth in volume of HR for PHC accelerates following the release of CHC in the 2016. Whilst some regions have seen their G and T rise between 2012 and 2016, their levels of inequality of allocation for resource shave gradually declined in the years following 2016, but there are exceptions, with the regions of northeast and northwest seeing the opposite. Eastern and northern region accounted for a larger contribution to intra-regional inequality. Concentration index and concentration curves indicate HR for PHC is related to economic income levels. GM (1, 1) projects a growing trend in allocation of resources from 2021 to 2030, but different regions differ in the average rate of growth of resources.

Conclusions

The inequality of HR for PHC in China is low, however, the inequality between regions has not been eliminated. We still need to take a long-term view to monitor the impact of CHC on the allocation of HR for PHC and its equity in China.
Health impact assessment of port-sourced air pollution in Barcelona
Authors: Mueller Natalie , Cirach Marta , Ambros Albert , Daher Carolyn , Nieuwenhuijsen Mark , Basagaña Xavier
Published: August 2024

Introduction

Air pollution is a major health risk factor. Ports might be an understudied source of air pollution.

Methods

We conducted a spatial health impact assessment (HIA) of port-sourced air pollution for Barcelona for 2017 at the neighbourhood level. Total NO2 and PM10 and port-sourced NO2, PM10 and PM2.5 concentrations were available through the ADMS-Urban model. Population data, mortality and morbidity data, and risk estimates were obtained. We followed standard HIA methodologies and calculated relative risks and impact fractions for 1.35 million adults living in 73 neighbourhoods.

Results

The city-wide mean total NO2 and PM10 concentrations were 37.88 μg/m3 (range: 19.61–52.17 μg/m3) and 21.68 μg/m3 (range: 17.33–26.69 μg/m3), respectively, of which 7% (range: 2–36%) and 1% (range: 0–7%) were port-sourced, respectively. The mean port-sourced PM2.5 concentration was 0.19 μg/m3 (range: 0.06–1.38 μg/m3). We estimated that 1,123 (PI: 0–3,060) and 1,230 (95% CI: 0–2,566) premature deaths were attributable to total NO2 and PM10, respectively, of which 8.1% (91; PI: 0–264) and 1.1% (13; 95% CI 0–29) were attributable to port-sourced NO2 and PM10, respectively. 20 (95% CI: 15–26) premature deaths were attributable to port-sourced PM2.5. Additionally, a considerable morbidity burden and losses in life expectancy were attributable to port-sourced air pollution. Neighbourhoods closest to the port in the south-east were most adversely affected, gradually decreasing towards the north-west.

Conclusions

The port is an understudied air pollution source in Barcelona with strong health impacts. Cities need local insight into health risk factors, their sources, attributable burdens and distributions for defining targeted policies.
Management of food socialization for children with Prader-Willi Syndrome: An exploration study in Malaysia
Authors: Wan Puspa Melati , Ali Affezah , Mognard Elise , Jegathesan Anasuya Jegathevi , Lee Soon Li , Ganesan Rajalakshmi , Noor Mohd Ismail , Rochedy Amandine , Valette Marion , Tauber Maïthé , Thong Meow-Keong , Poulain Jean-Pierre
Published: August 2024

This study aims to explore the food management strategies among caregivers/family members of children with Prader–Willi Syndrome (PWS) using the lens of ‘familialisation’ of a health problem and the sociology of food socialization. Food intake among individuals with PWS is a main concern for parents, caregivers, and medical practitioners as it affects their physical, mental, and social well-being throughout their lives. Earlier studies on PWS and food intake centered around dietary management, dietary intake and growth, nutritional treatment and pharmacological approaches, nutritional phases, and weight gain. However, little has been done to understand the challenges of managing children with PWS from the sociological lens of food management strategies and socialization among families in Malaysia. This study is based on an investigation involving eight children with PWS and 46 family members and caregivers through lab observations and reflexive interviews. Ten food management strategies were identified that were adopted by the caregivers and families, which were influenced by cultural factors, family norms, and formal and informal support systems. The findings will influence future behavioral interventions to ensure the empowerment and well-being of individuals with PWS and their families.
Characterization and individual-level prediction of cognitive state in the first year after ‘mild’ stroke
Authors: Saa Juan Pablo , Tse Tamara , Koh Gerald Choon-Huat , Yap Philip , Baum Carolyn M. , Uribe-Rivera David E. , Windecker Saras M. , Ma Henry , Davis Stephen M. , Donnan Geoffrey A. , Carey Leeanne M.
Published: August 2024

Background

Mild stroke affects more than half the stroke population, yet there is limited evidence characterizing cognition over time in this population, especially with predictive approaches applicable at the individual-level. We aimed to identify patterns of recovery and the best combination of demographic, clinical, and lifestyle factors predicting individual-level cognitive state at 3- and 12-months after mild stroke.

Methods

In this prospective cohort study, the Montreal Cognitive Assessment (MoCA) was administered at 3–7 days, 3- and 12-months post-stroke. Raw changes in MoCA and impairment rates (defined as MoCA<24 points) were compared between assessment time-points. Trajectory clusters were identified using variations of ≥1 point in MoCA scores. To further compare clusters, additional assessments administered at 3- and 12-months were included. Gamma and Quantile mixed-effects regression were used to predict individual MoCA scores over time, using baseline clinical and demographic variables. Model predictions were fitted for each stroke survivor and evaluated using model cross-validation to identify the overall best predictors of cognitive recovery.

Results

Participants’ (n = 119) MoCA scores improved from baseline to 3-months (p<0.001); and decreased from 3- to 12-months post-stroke (p = 0.010). Cognitive impairment rates decreased significantly from baseline to 3-months (p<0.001), but not between 3- and 12-months (p = 0.168). Nine distinct trajectory clusters were identified. Clinical characteristics between clusters at each time-point varied in cognitive outcomes but not in clinical and/or activity participation outcomes. Cognitive performance at 3- and 12-months was best predicted by younger age, higher physical activity levels, and left-hemisphere lesion side.

Conclusion

More than half of mild-stroke survivors are at risk of cognitive decline one year after stroke, even when preceded by a significantly improving pattern in the first 3-months of recovery. Physical activity was the only modifiable factor independently associated with cognitive recovery. Individual-level prediction methods may inform the timing and personalized application of future interventions to maximize cognitive recovery post-stroke.
Knowledge and perception of mHealth medication adherence applications among pharmacists and pharmacy students in Jazan, Kingdom of Saudi Arabia
Authors: Rehman Wajiha , Thanganadar Hemalatha , Idrees Sumaira , Mehmood Asim , Azeez Fahad Khan , Almaimani Hanan Abdullah , Rajpoot Pushp Lata , Mustapha Mohammed
Published: August 2024

The advances in digital health, including mobile healthcare (mHealth) medication adherence applications (MApps), have been demonstrated to support medication adherence and improve health outcomes. This study aims to evaluate the knowledge and perception of the MApps among pharmacists and pharmacy students. An online cross-sectional survey was conducted among 223 pharmacists and pharmacy students in the Jazan region of Saudi Arabia between 1st and 30th April 2023. The survey collected information about the participants’ socio-demographics, knowledge, and perception of the MApps. Among the 223 participants included in the study, 105 (47.1%) were pharmacists and 118 (52.9%) were pharmacy students. Most participants were females (72.6%) and aged 18–30 (70.4%). About half of the participants had poor knowledge of the MApps [pharmacists (48.0%) and students (42.0%)] and mainly encountered Medisafe (18.1%) or Pills (17.0%) MApps, respectively. Pharmacy students showed significantly higher knowledge of MApps (p = 0.048), especially the Pills (p = 0.022) than pharmacists. However, the pharmacists had significantly higher knowledge of MyMeds (p = 0.001) than pharmacy students. Most participants had a positive perception of the usefulness of the MApps (pharmacists, 79.0%; students 80.0%). Notably, over 85% of the participants expressed willingness to know and provide guidance on MApps, with over 50% willing to recommend it to the patients. There was no significant difference in perception between the pharmacists and pharmacy students (p>0.05). In conclusion, the study demonstrates limited knowledge with a positive perception of mHealth medication adherence applications among pharmacists and pharmacy students. Integrating digital adherence tools like the MApps into pharmacy training could significantly improve professional practice mHealth competencies, and optimize healthcare delivery and patient outcomes.
Exercise-induced response of proteinogenic and non-proteinogenic plasma free amino acids is sport-specific: A comparison of sprint and endurance athletes
Authors: Kusy Krzysztof , Matysiak Jan , Kokot Zenon J. , Ciekot-Sołtysiak Monika , Klupczyńska-Gabryszak Agnieszka , Zarębska Ewa Anna , Plewa Szymon , Dereziński Paweł , Zieliński Jacek
Published: August 2024

Circulating blood is an important plasma free amino acids (PFAAs) reservoir and a pivotal link between metabolic pathways. No comparisons are available between athletes with opposite training adaptations that include a broader spectrum of both proteinogenic and non-proteinogenic amino acids, and that take into account skeletal muscle mass. We hypothesized that the levels of the exercise-induced PFAAs concentration are related to the type of training-related metabolic adaptation. We compared highly trained endurance athletes (n = 11) and sprinters (n = 10) aged 20‒35 years who performed incremental exercise until exhaustion. Venous blood was collected before and during the test and 30-min recovery (12 samples). Forty-two PFAAs were assayed using LC-ESI-MS/MS technique. Skeletal muscle mass was estimated using dual X-ray absorptiometry method. Glutamine and alanine were dominant PFAAs throughout the whole exercise and recovery period (~350‒650 μmol∙L-1). Total, combined proteinogenic, non-essential, and non-proteinogenic PFAAs levels were significantly higher in endurance athletes than sprinters (ANOVA group effects: p = 0.007, η2 = 0.321; p = 0.011, η2 = 0.294; p = 0.003, η2 = 0.376; p = 0.001, η2 = 0.471, respectively). The exercise response was more pronounced in endurance athletes, especially for non-proteinogenic PFAAs (ANOVA interaction effect: p = 0.038, η2 = 0.123). Significant between-group differences were observed for 19 of 33 PFAAs detected, including 4 essential, 7 non-essential, and 8 non-proteinogenic ones. We demonstrated that the PFAAs response to incremental aerobic exercise is associated with the type of training-related metabolic adaptation. A greater turnover and availability of circulating PFAAs for skeletal muscles and other body tissues is observed in endurance- than in sprint-trained individuals. Non-proteinogenic PFAAs, despite low concentrations, also respond to exercise loads, indicating their important, though less understood role in exercise metabolism. Our study provides additional insight into the exercise-induced physiological response of PFAAs, and may also provide a rationale in discussions regarding dietary amino acid requirements in high-performance athletes with respect to sports specialization.
Comparison of a hand-held high-end resolution infrared thermography (FLIR P640) and a smartphone infrared thermographic device (FLIR One) for the assessment of skin surface temperature after anaesthetising the median nerve in Healthy horses
Authors: Ferlini Agne Gustavo , Adamson Kellie , McGlinchey Leah , Kravchuk Olena , Santos Luiz , Schumacher John
Published: August 2024

Accuracy of a median nerve block is normally assessed by testing skin sensitivity on the medial and dorsal aspects of fetlock and pastern. The present study evaluated subjective and objective analysis of skin surface temperature obtained with two different infrared (IR) thermography cameras (a high-end [FLIR P640] and a smartphone IR thermography device [FLIR One®]) before and after anaesthesia of the median nerve. Thermographic images were obtained at 0, 30, 60 and 90 minutes after performing a median nerve block with 2% mepivacaine hydrochloride. The subjective analysis of thermographic images using the FLIR P640 camera found assessors had >50% agreement for the presence of a nerve block (p<0.01) based on assessment of skin temperature within the expected dermatome of the median nerve. The objective analysis found skin temperature increases in the treated leg using the FLIR One® in the dorsal fetlock, dorsal pastern and medial pastern at 60 minutes, and the lateral pastern at 90 minutes (p<0.05). The treated leg, imaged using the FLIR P640 camera, had increases in skin temperature at the medial aspect of the fetlock at 60 minutes and lateral pastern at 90 minutes (p<0.05). Images obtained with the P640 camera had higher resolution and finer thermal detail. The images obtained with the FLIR One® camera had a wider temperature range with overall higher temperature measurements than the images obtained using the P640 camera (p<0.001). Skin temperatures in horses should be interpreted with caution when using the FLIR One® camera. Furthermore, the FLIR One® device detected an increase in skin surface temperature in both treated and non-treated legs and should not be used for assessment of a median nerve block. Infrared thermography appears to be useful for determining the presence of a high regional nerve block such as the median nerve block by observing increased temperatures of the skin surface after perineural anaesthesia. Further studies with a larger sample size as well as investigating the use of thermography for assessment of other regional nerve blocks are warranted.
Data element investment strategy: How can leaders and followers innovate in dynamic market environments
Authors: Fang Yinhai , Wei Wei , Su Rengang
Published: August 2024

In the era of the digital economy, the data element investment strategy decisions and game mechanisms of leaders and followers are crucial issues to be studied. To explore the environment in which digital collaboration between enterprises benefits both parties, this study initially proposes a three-stage game model of leaders and followers based on the sequential game method. Subsequently, we analyze the investment strategy choices for leading and following enterprises across six scenarios within dynamic market environments. Finally, numerical simulations are employed to examine the effect of both strategies on the industry and society as a whole. The simulation shows that (1) The cooperation strategy is a more effective approach for enhancing data-driven innovation performance, but when it comes to mature markets, this strategy may conflict with the interests of followers. (2) Followers can benefit from the cooperation strategy by significantly boosting the growth rate of data elements, but it may cause enterprises to lose their original market scale. (3) Excessively high initial production costs can negatively affect the innovative performance of the industry and social wealth, whereas mature industries can achieve greater industry performance and social welfare through investment in data elements. Considering the environmental characteristics of the digital economy, the findings of this study elucidate the ramifications of innovation strategies on enterprises, industries, and society, providing positive insights for two types of enterprises with different strengths to make apt decisions regarding digital cooperation.