bluuebunny/crossref_metadata_2025 huggingface dataset:
Guideline-Enabled Data Driven Clinical Knowledge Model for the Treatment of Oral Cavity Cancer Acquired Through a Refined Knowledge Acquisition Method
Authors: Hussain Maqbool , Afzal Muhammad , M. Malik Khalid , Ali Taqdir , A. Khan Wajahat , Irfan Muhammad , Jamshed Arif , Lee Sungyoung
Published: June 2019

Validation and verification are the critical requirements in the knowledge acquisition method for the clinical decision support system (CDSS). After acquiring the medical knowledge from diverse sources, the rigorous validation and formal verification process are required before creating the final knowledge model. Previously, we have proposed a hybrid knowledge acquisition method for acquiring medical knowledge from clinical practice guidelines (CPGs) and patient data in the Smart CDSS for treatment of oral cavity cancer. The final knowledge model was created by combining knowledge models obtained from CPGs and patient data after passing through a rigorous validation process. However, detailed analysis shows that due to lack of formal verification process, it involves various inconsistencies in knowledge relevant to the formalism of knowledge, conformance to CPGs, quality of knowledge, and complexities of knowledge acquisition artifacts. Therefore, it is required to enhance a hybrid knowledge acquisition method that thwarts the inconsistencies using formal verification. This paper presents the verification process using the Z formal method and its outcome as an enhanced acquisition method – known as the refined knowledge acquisition (ReKA) method. The ReKA method adopted verification method and explored the mechanism of theorem proving using the Z notation. It enables to identify inconsistencies in the validation process used for hybrid knowledge acquisition. Additionally, it refines the hybrid knowledge acquisition method by discovering the missing steps in the current validation process at the acquisition stage. Consequently, ReKA adds a set of nine additional criteria to be used to have a final valid refined clinical knowledge model. The criteria ensure the validity of final knowledge model concerning formalism of knowledge, conformance to GPGs, quality of the knowledge, usage of stringent conditions and treatment plans, and inconsistencies possibly resulting from the complexities. Evaluation, using four medical knowledge acquisition scenarios, shows that newly added knowledge in CDSS due to the addition of criteria by ReKA method always produces a valid knowledge model. The final knowledge model was also evaluated with 1229 oral cavity patient cases, which outperformed with an accuracy of 72.57\% compared to a similar approach with an accuracy of 69.7\%. Furthermore, ReKA method identified a set of decision paths (about 47.8\%) in the existing approach, which results in a final knowledge model with low quality, non-conformed from standard CPGs. In conclusion, ReKA is formally proved method which always yields valid knowledge model having high quality, supporting local practices, and influenced from standard guidelines.
THE SCAFFOLDING CAUSALITIC-THINKING APPROACH TO INCREASE THE PROBLEM-SOLVING ABILITY OF STUDENTS ON FLUIDS
Authors: Rokhmat Joni , Marzuki Marzuki , Hikmawati Hikmawati , Verawati Ni Nyoman Sri Putu
Published: June 2019

Scaffolding causalitic-thinking is a specific approach to facilitate students in analyzing cause and effect of a phenomenon and in establishing reason where some assistance stages are given. Patterns of the assistance include informing number of causes, effects, or both, some example of causes, effects, or both (causes and effects), or some of its arguments. This scaffolding orientation was to facilitate students to increase their Problem-solving Ability (PSA) and had been implemented on fluid in Senior High School (SHS). The PSA includes understanding, selecting, differentiating, determining, applying and identifying. This research aimed to investigate an impact of the approach on the PSA that is related to gender and Junior High School (JHS) origin of the students, Sekolah Menengah Pertama (SMP) and other (non-SMP). This research used mixed method of embedded experimental two-phase design and with sample of 33 students, 22 females and 11 males, for control class and 32 students, 17 females and 15 males, for experiment class. Total score of the six abilities were tested with ANAVA two factor design. The results, among 6 pairs of Fcounted and Ftable showed 67% that indicate Fcounted > Ftable. The results indicated that the approach affects PSA of students and the effect was different between male and female, also the interaction between the origin of JHS students and the approach. Next, patterns of the scaffolding approach are considerably used as reference when arranging worksheet to conduct Physics or other discipline learning with this approach in practice or further research.

 

 

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THE RELATION OF FORM AND ASPECT OF NON-VERBAL SYMBOL OF GAWAI DAYAK RITUAL WITH DAYAK SOCIETY LIFE TRADITION AND ITS USE IN REGIONAL LITERATURE LEARNING IN WEST KALIMANTAN
Authors: Herlina Herlina , Andayani Andayani , Setiawan Budhi
Published: June 2019

Gawai Dayak ritual is one of cultural products of Dayak tribe. The intended Dayak tribe in this study is Dayak tribe who lives in West Kalimantan. On its performance, this ritual is dominated with various symbols. Whereas what becomes the focus of this study is non-verbal symbol that is physical symbol, symbol that can be seen or even be touched. Through this study, the writer is going to see how is the relation of the form and aspect of symbol with the life tradition of Dayak society in West Kalimantan. Aspect in this study relates to non- verbal symbols as a signal which is signing something, whose presence contains a certain meaning as a cultural system of a group of society. Then, the writer analyzes how is the use of the result of the study on regional literature learning and its kind, remembering that all this time there has not been some utilization of local context to enrich Regional Literature learning and other similar lessons. This study uses descriptive qualitative method with semiotic approach. Whereas the data used in this study is Gawai Dayak ritual. The data source in this study is ritual process of Gawai Dayak. The data collecting technique in this study uses observation and recording technique.

 

 

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Implementing of Character Values in English Language Learning and Teaching
Authors: Pohan Erwin , Malik Abdul
Published: June 2019

Studies of character building have been being discussed in all disciplines involved in language learning and teaching. It means that it has a central position in creating the good human being life generally and teacher, as a model of change, particularly. The main points of character building are its universal values such as trustworthiness, responsibility, respect, caring, fairness, and citizenship. The good teacher's character can be seen from the quality of his/her character personally or inter/intrapersonal. Discussing good charactered teachers and students are still becoming a current and serious issue and challenge in the educational context. Therefore, the purpose is to explore the character building through media and language education. In this case, the focus is on the theoretical review of the implementing of character values in English language learning and teaching in the classroom. The sub-themes are (1) teacher's role in internalizing of character values in English language learning and teaching, (2) internalizing of character values in learning and teaching media and materials, (3) internalizing of character values in learning and teaching processes. So, the integration of the character values in the learning and teaching system is very needed in order to produce the best teacher and students with having high knowledge and best behavior. Then, the character values are not taught but implemented in real action model explicitly and in learning and teaching media and materials implicitly. They are conducted by teachers and students inside and or outside the classroom simultaneously, continuously, and consistently. They are also supported by references from inspiring good character values people from various countries in the world. In another word, they have been successful and consistent with the character values
Investigating The Effectiveness of Computer Assisted Language Learning (CALL) Using Drill in Enhancing Vocabulary-A Study on Junior High School
Authors: Lolita Yuri
Published: June 2019

Vocabulary is one of English components which supports English skill. Teaching English vocabulary by using media has been interesting in research. This study tried to analyze the effect of CALL using drill and non-CALL using drill as media on teaching vocabulary to know whether it could increase students’ vocabulary retention in Junior High School. Computer-Assisted Language Learning (CALL) has evolved through various stages in both technology as well as the pedagogical use of technology (Warshauer & Healay,1998) Studies show that the CALL trend has facilities students in their English language vocabulary with useful tools such as computer based activities and word processing. Students are able to produce higher quality essays in a student-centered nature and less-intimidating manner (Braine, 1997).In line with this research, it was used quantitative design. This study also purposes to find out to how the students’ response towards using CALL. This study was investigated seventh grade students consist of 126 learn. There are A class consist of 30 persons, B class consist of 34 persons, C class consist of 32 persons and D class consist of 30 persons. English vocabulary with CALL using drill and non-CALL using drill. In conclusion, of students’ response toward using CALL, the experimental group students are agree that CALL using drill is effective media for learning vocabulary retention, and have positive response rather than control group students. Therefore, teacher should be more creative to teach the students vocabulary skill because it can give the students impact for teaching and learning process.
Internalization Multicultural Education for the prevention of Children`s Problem Against the Law
Authors: Hakim Fatwa Nurul , Kartono Drajat Tri , Demartoto Argyo
Published: June 2019

Children are next generation of nations need to get education can be used as capital to continue development. Ironically cases of children facing the law is increasing. Implemented school education does not character changes for children. So that the curriculum is needed in which there is knowledge of mutual respect, tolerance and understanding culture between communities. This study aims to reveal the internalization of multicultural education in schools in order to prevent the case of children facing the law. The method used in this study using descriptive qualitative which is intended to deepen the multicultural education is applied and implemented by the students. Data were collected by in-depth interviews with teachers, students involved in criminal cases, the Foundation for Child Protection and parents. Data analysis using descriptive interpretation detail in to the data that have been collected and then done the interpretation, information data that has been collected in the analysis with descriptive interpretative technique that is done interpretation (interpretation) of the object based on data obtained then taken conclusion. The results of this study reveal that the curriculum of moral character development in children is minimal. The child's output at school is merely a value, not looking at the elements of character, behavior and feelings.

 
The Effect of Watching English Movies with Subtitles on ESP Students’ Content and Vocabulary Comprehension. A Study Conducted at an Indonesia Polytechnic Engineering
Authors: Kusumawati Eny
Published: June 2019

This research is focusing on the impact of English movies with subtitles on content comprehension of English movies and vocabulary comprehension. With fifty-six (56) students of Politeknik Elektronika Negeri Surabaya was selected randomly of English subject. Activate the quasi-experimental study, a movie with tittle Transcendence was selected based on the ESP content and language level difficulty.  With two intact groups, they were group A and group B. They watched the same movie, class A watched it with English subtitles and class B without subtitles. After watching the movie, the participants answered the relevant multiple-choice vocabulary, content comprehension questions, and questioners. The data gathered were subjected to the statistical procedure of paired sample t-test. The results showed that subtitles have a positive impact on content comprehension of English movies. It can be concluded that the participants comprehend the subtitled movie better than the one without it. Moreover, in this statistical study, it is found that the subtitles did not have an effect on participants’ vocabulary comprehension. The pedagogy of this study is to allow the lecturer use some film to enrich the teaching materials for reading class in ESP.

This research is focusing on the impact of English movies with subtitles on content comprehension of English movies and vocabulary comprehension. With fifty-six (56) students of Politeknik Elektronika Negeri Surabaya was selected randomly of English subject. Activate the quasi-experimental study, a movie with tittle Transcendence was selected based on the ESP content and language level difficulty.  With two intact groups, they were group A and group B. They watched the same movie, class A watched it with English subtitles and class B without subtitles. After watching the movie, the participants answered the relevant multiple-choice vocabulary, content comprehension questions, and questioners. The data gathered were subjected to the statistical procedure of paired sample t-test. The results showed that subtitles have a positive impact on content comprehension of English movies. It can be concluded that the participants comprehend the subtitled movie better than the one without it. Moreover, in this statistical study, it is found that the subtitles did not have an effect on participants’ vocabulary comprehension. The pedagogy of this study is to allow the lecturer use some film to enrich the teaching materials for reading class in ESP.
Introduction to Simultaneous Localization and Mapping
Authors: Tsubouchi Takashi ,   Faculty of System and Information Engineering, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
Published: June 2019

Simultaneous localization and mapping (SLAM) forms the core of the technology that supports mobile robots. With SLAM, when a robot is moving in an actual environment, real world information is imported to a computer on the robot via a sensor, and robot’s physical location and a map of its surrounding environment of the robot are created. SLAM is a major topic in mobile robot research. Although the information, supported by a mathematical description, is derived from a space in reality, it is formulated based on a probability theory when being handled. Therefore, this concept contributes not only to the research and development concerning mobile robots, but also to the training of mathematics and computer implementation, aimed mainly at position estimation and map creation for the mobile robots. This article focuses on the SLAM technology, including a brief overview of its history, insights from the author, and, finally, introduction of a specific example that the author was involved.
The Educational Effects of Practical Manufacturing Activities in Graduation Research
Authors: Kawata Junji ,   Faculty of Science and Engineering, Tokushima Bunri University 1314-1 Shido, Sanuki, Kagawa 769-2193, Japan, Morimoto Jiro , Higuchi Mineo , Fujisawa Shoichiro
Published: June 2019

In recent years, in many educational institutions, PBL leaning has been introduced and there have been many cases of robots being used as learning material. The educational attempts using robot contests and the effects have been reported. One robot contest, the NHK Student Robocon, tests the skills of university, technical college, and polytechnic students. The contest challenges of the NHK Student Robocon require an extremely high level of skill. A research group of authors has worked at the NHK Student Robocon since 2009. In this article, our ten years of activity at the NHK Robocon is summarized, and we will give a description of the technical background of the mechanism and the control methods of manufactured robots. In addition, the contest’s educational effects during both a fiscal year of entry and a fiscal year of non-entry are verified through a comparison of the scores of a Robocon-related subject group before and after participating in the NHK Student Robocon. Consequently, we will report the results (knowledge).
Teaching Material Imitating the Advanced Driver-Assistance System for Measurement and Control Education
Authors: Umeno Takatoshi , Shimoto Takeshi ,   University of Teacher Education Fukuoka 1-1 Akamabunkyo-machi, Munakata, Fukuoka 811-4192, Japan,   Fukuoka Institute of Technology 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka-shi, Fukuoka 811-0295, Japan
Published: June 2019

The rapid growth of the information technology industry in recent decades requires an increasing number of programmers and engineers, as well as an excellent training environment for relevant human resources. Currently, school curricula promote information education and, since 2012, “measurement and control by programs” have become compulsory topics of study in the technology and home economics (technological field) class in junior high schools. In addition, it has been determined that programming education will be made a compulsory topic in elementary schools from 2020 onward. Thus, programming education is included in the mandatory education program and, accordingly, various associated teaching materials have been developed and distributed to date. However, adequate steps have not been taken to improve the information education skill of the teachers who use the aforementioned teaching materials. In particular, only very few teachers understand the essence of programming control, such as the role played by a program in measurement and control. Hence, there is an urgent need to train teachers to make them capable of providing programming education in school settings. Hence, in this study, we develop a teaching material that helps teachers understand the flow of measurement and control by program using an optical distance sensor and an actuator and design a class practice for the students in the faculty of education. Finally, based on this education practice, we discuss an educational effect of the aforementioned teaching material and its applicability in junior high school settings.
Development of Basic Training for Teaching Measurement and Control to Junior High School Students
Authors: Tamai Teruyuki , Ohnishi Yoshihiro , Kawada Kazuo ,   Faculty of Education, Ehime University 3 Bunkyo-cho, Matsuyama, Ehime 790-8577, Japan,   Hiroshima University 1-1-1 Kagamiyama, Higashi-hiroshima, Hiroshima 739-8524, Japan
Published: June 2019

In 2017, the government announced the course of study guidelines. It showed the necessary qualification and ability for junior high school students and guidance on junior high school technology education. Because new content is included there, training of incoming teachers at junior high school is required. This paper proposes a training curriculum on measurement and control of junior high school technology. This training was practiced for junior high school teachers in Ehime. These members showed high evaluation. This training will enhance educational practice for junior high school students.
Evaluation for Task Achievement of Robotics Programming Based on Image Information
Authors: Ohnishi Yoshihiro , Takechi Shogo , Tamai Teruyuki , Mori Shinnosuke , Kawada Kazuo ,   Faculty of Education, Ehime University 3 Bunkyo-cho, Matsuyama, Ehime 790-8577, Japan,   Hiroshima University 1-1-1 Kagamiyama, Higashi-hiroshima, Hiroshima 739-8524, Japan
Published: June 2019

It is difficult to make an evaluation based solely on whether programming has been achieved. However, appropriate evaluation according to the achievement level leads to learners’ subjective programming learning, and to learning support that corresponds to individuals. Therefore, the quantitative evaluation of programming learning is as important as teaching and educational methods. Since programming education is being introduced to elementary and junior high schools, a programming evaluation method for this age is necessary. Therefore, this paper proposes a new concept of quantitatively evaluating the degree of achievement of tasks by programming. It assumes a unit in junior high school technology classes for learning measurement control, and uses teaching materials that have an autonomous cleaning robot as a theme. It is aimed at quantitatively evaluating the degree of accomplishment of a task by evaluating the extent to which the robot ran in a field, as seen in the room from a still picture taken multiple times.
A Study on Developmentally Appropriate Programming Education Learning	Materials for Lower-Elementary School Students
Authors: Kawada Kazuo , Okamoto Katsuya , Tamai Teruyuki , Ohnishi Yoshihiro ,   Graduate School of Education, Hiroshima University 1-1-1 Kagamiyama, Higashi-hiroshima, Hiroshima 739-8524, Japan,   Onomichi City Nagae Junior High School 3-10-4 Nagae, Onomichi, Hiroshima 722-0046, Japan,   Faculty of Education, Ehime University 3 Bunkyo-cho, Matsuyama, Ehime 790-8577, Japan
Published: June 2019

In Japan, programming education will be introduced in the Courses of Study for Elementary School from FY2020. Although various studies have been conducted on this topic, very few have examined Japanese elementary school computational thinking in terms of the developmental stages of elementary school children. Thus, we developed programming learning materials using concrete objects that can be understood by lower-elementary students. Specifically, we divided program-oriented thinking into three steps: concrete, logical, and abstract thinking; we then made the pupils carry out work in this order to encourage them to think of the sequence of actions necessary to implement the intended act, which involved the measurement and control of an illumination system. Furthermore, we discuss the validity of the proposed material based on questionnaire results of student participants and their parents of a workshop.
Path Planning in Outdoor Pedestrian Settings Using 2D Digital Maps
Authors: Farid Ahmed ,   Graduate School of Information, Production and Systems, Waseda University 2-7 Hibikino, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0135, Japan, Matsumaru Takafumi
Published: June 2019

In this article, a framework for planning sidewalk-wise paths in data-limited pedestrian environments is presented by visually recognizing city blocks in 2D digital maps (e.g., Google Maps, and OpenStreet Maps) using contour detection, and by then applying graph theory to infer a pedestrian path from start to finish. Two main problems have been identified; first, several locations worldwide (e.g., suburban / rural areas) lack recorded data on street crossings and pedestrian walkways. Second, the continuous process of recording maps (i.e., digital cartography) is, to our current knowledge, manual and has not yet been fully automated in practice. Both issues contribute toward a scaling problem, in which the continuous monitoring and recording of such data at a global scale becomes time and effort consuming. As a result, the purpose of this framework is to produce path plans that do not depend on pre-recorded (e.g., using simultaneous localization and mapping (SLAM)) or data-rich pedestrian maps, thus facilitating navigation for mobile robots and people with visual impairment. Assuming that all roads are crossable, the framework was able to produce pedestrian paths for most locations where data on sidewalks and street crossings were indeed limited at 75% accuracy in our test-set, but certain challenges still remain to attain higher accuracy and to match real-world settings. Additionally, we describe certain works in the literature that describe how to utilize such path plans effectively.
MACROTIS: Cubic Robot with Snap-Through-Buckling Mechanisms for Achieving High Freedom of Movement
Authors: Mak Kwanwai ,   Department of Mechanical Engineering, Osaka University 2-1 Yamadaoka, Suita, Osaka 565-0871, Japan, Osuka Koichi , Sugimoto Yasuhiro , Wada Teruyo
Published: June 2019

Based on the design of an inertia-driven modular robot, this paper proposes a new design of cubic robot using snap-through-buckling mechanisms as actuators for achieving translational and rotational motion in multiple directions. Through experiments, the characteristics of the mechanism were obtained, and performance of the robot was assessed.
Compared with conventional procedures performed via the occipital horn, an intraoperative navigation system for ventriculoperitoneal shunting improves outcomes in patients with hydrocephalus
Authors: Peng AiJun , Zhao Hai , Wu YongKang , Zhao Yi , Zhou LiangXue
Published: June 2019

Background: Ventriculoperitoneal shunting (VPS) is a common neurosurgical procedure used to treat hydrocephalus. Catheter obstruction is one of the most common factors that influences patient prognosis. We therefore evaluated the accuracy of proximal catheter placement and explored the probable relationship between ventricular catheter obstruction and both symptom grade and postoperative Evans index between an intraoperative navigation system for VPS and conventional surgery via the occipital horn.
Methods: We performed a retrospective study of 33 patients with VPS (the navigation surgery group) and 26 patients with VPS (the conventional surgery group) seen between January 2012 and August 2018. The clinical data, follow-up times, catheterization accuracy, postoperative outcomes, cumulative survival times and correlations between catheter placement and obstruction, symptom grade and the postoperative Evans index were analyzed.
Results: Thirty-one patients experienced optimal ventricular catheter placement (grade 1), 2 experienced suboptimal placement (grade 2), and none experienced poor ventricular catheter placement (grade 3) in the navigation surgery group, whereas 6, 14, and 6 patients, respectively, had these results in the conventional surgery group. Greater improvement was observed in postoperative symptoms (P=0.017), including less catheter readjustment (P<0.001), in the navigation surgery group. A Kaplan-Meier survival analysis showed that the cumulative catheter obstruction-free survival time was longer in the navigation surgery group than in the conventional surgery group (P=0.028). Moreover, catheter placement was significantly correlated with catheter obstruction (P<0.001). In addition, catheter obstruction was significantly correlated with the symptom grade (P=0.001) and postoperative Evans index (P<0.001).
Conclusions: An intraoperative navigation system for VPS improved patient outcomes and the accuracy of ventricular catheter placement. Catheter obstruction-free survival times were longer in the navigation surgery group, and catheter placement was significantly correlated with catheter obstruction.
In Silico Investigation of Mitragynine and 7-Hydroxymitragynine Metabolism
Authors: Limpanuparb Taweetham , Noorat Rattha , Tantirungrotechai Yuthana
Published: June 2019

Objective: Mitragynine is the main active compound of Mitragyna speciose (Kratom in Thai). The understanding of mitragynine derivative metabolism in human body is required to develop effective detection techniques in case of drug abuse or establish an appropriate dosage in case of medicinal uses. This in silico study is based upon in vivo results in rat and human by Philipp et al. (J. Mass Spectrom., 2009, 44, 1249.) Results: The gas-phase structures of mitragynine, 7-hydroxymitragynine and their metabolites were obtained by quantum chemical method at B3LYP/6-311++G(d,p) level. Results in terms of standard Gibbs energies of reaction for all metabolic pathways are reported with solvation energy from SMD model. We found that 7-hydroxy substitution leads to changes in reactivity in comparison to mitragynine: position 17 is more reactive towards demethylation and conjugation to a glucuronide and position 9 is less reactive towards conjugation to a glucuronide. Despite the changes, position 9 is the most reactive for demethylation and position 17 is the most reactive for conjugation to a glucuronide for both mitragynine and 7-hydroxymitragynine. Our results suggest that 7-hydroxy substitution could lead to different metabolic pathways and raise an important question for further experimental studies of this more potent derivative.
The effect comparisons of different exercise interventions on blood glucose and insulin resistance relative indicators for prediabetes: a network meta-analysis
Authors: Tang Lijun , Fang Yingjie , Yin Jianchun
Published: June 2019

Background: In order to recommend the optimum type of exercise for type 2 diabetes prevention, the effect of different exercise interventions on glycaemic control and insulin resistance relative indicators were compared.
Methods: The studies involving the curative effect of aerobic exercise trailing (AET) or resistance trailing (RT) for prediabetes were searched with pre-established strategy . The Body Mass Index (BMI), fasting blood glucose (FBG), glycated haemoglobin (HbA1c), Insulin and homeostasis model assessment-insulin resistance index (HOMAIR) were used as outcomes indictors. Q statistic was calculated to evaluate the heterogeneity within studies. A fixed effects model was chosen for pooling data with p > 0.05, otherwise, a random effects model was chosen. The consistency test in this network meta-analysis was conducted by Node-splitting analysis.
Results: A total of 12 eligible studies were included into this network meta-analysis. According to p score values, prediabetes individuals in AET group had better curative effect in BMI (p score = 0.7525), Insulin (p score = 0.6411) and HOMAIR (p score = 0.6411) value controls than in other groups, while the curative effect of RT on FBG (p score = 0.8465) and HbA1c (p score = 0.8550) values were optimum. The rank of P-scores for each indicator under above two effect models was basically consistent, indicating that our results of network meta-analysis were stable.
Conclusions: AET might be a better intervene method for improving insulin resistance to prediabetes, while RT was more effective than AET, AET+RT or CT for glycaemic control in prediabetes.
Factors associated with non-vaccination against measles among 12-23 months old children in Yirgachefe district of SNNPR, Ethiopia, 2016
Authors: Degife Luna Habtamu , Worku Yoseph , Tadesse Muse
Published: June 2019

Immunization is an effective and proven tool for controlling and eliminating life-threatening vaccine preventable infectious diseases. In Ethiopia 5% of childhood mortalities are due to measles. In 2015, 85% of children had received 1 dose of measles vaccine by their second birthday. Despite the availability of a safe and effective vaccine, measles outbreaks secondary to non-vaccination are occurring in southern Ethiopia especially in Yirgachefe district.This study was done to assess the risk factors associated with non-vaccination against measles.

A Community-based unmatched case control study was conducted in Yirgachefe district from December 1-31, 2016.Cases were defined as children in the age group of 12- 23 months of age who did not take measles vaccination. The study was done in 6 randomly selected kebeles and cases and controls were selected randomly by probability proportional to size sampling. A structured questionnaire was used for data collection and data was analyzed by using Epi info version 7 and SPSS version 20. Statistical significance was interpreted using Odds ratio with 95% confidence interval and P value <0.05.

A total of 320 individuals (107 cases and 214 controls) were approached for interview with a response rate of 93.75%. Of the cases, 57% were males and more than half fall in the 12-18 months age group. Lack of Ante Natal Care follow up (Adjusted Odds Ratio (AOR) =3.57; 95% Confidence Interval (CI): 1.22-10.44), lack of knowledge on the importance of vaccination, who should be vaccinated and if measles is contagious with an AOR and CI of (AOR=6.81; 95% CI: 1.56-29.64), (AOR=4.29; 95% CI: 1.83-10.04) and (AOR=8.97; 95%CI: 3.15-25.58) respectively were independent risk factors.

Lack of ANC follow up, lack of knowledge about who should get vaccinated, the importance of vaccination and contagiousness of the disease were identified as risk factors for non-vaccination against measles. Education and awareness about measles and its immunization should be given to the community. Additionally, ANC follow up should also be strengthened.
Strengthening routine immunization in Papua New Guinea: implications for post-polio renewal from a cross-sectional provincial assessment of front-line services
Authors: Morgan Christopher , Saweri Olga PM , Larme Nicholas , Peach Elizabeth , Melepia Pele , Au Lucy , Michelle Scoullar JL , Mohammad Reza S , Lisa Vallely M , McPake Barbara A , Beeson James G
Published: June 2019

Background

Routine immunization programs face challenges in settings such as Papua New Guinea: dispersed rural populations, rugged geography, and limited resources for transport and health. Low routine coverage contributes to outbreaks such as measles and the polio that re-appeared in 2018. Diversion of resources to the necessary emergency response can risk further weakening of the routine system. We report on an in-depth local assessment that documented immunization service provision so as to review new national strategy, and consider how emergency polio responses could simultaneously strengthen routine immunization.

Methods

In East New Britain Province, over 2016 and 17, we carried out a cross-sectional assessment of 12 rural health facilities, staff and clients. The study was timed to follow implementation of a new national strategy for strengthening routine immunization. We used interview, structured observation, and records review, informed by theory-based evaluation, a World Health Organization quality checklist, and other health services research tools.

Results

We documented strengths and weaknesses across six categories of program performance relevant to national immunization strategy and global standards. We found a functional immunization service with an operational level of staff, equipment and procedures in place; but one that could reach only half to two thirds of its target population. Stronger routine services require improvement in: understanding of population catchments, tracking the unvaccinated, reach and efficiency of outreach visits, staff knowledge of vaccination at birth and beyond the first year of life, handling of multi-dose vials, and engagement of community members. Many local suggestions to enhance national plans, including more reliable on-demand services, integration of other family health services and increased involvement of men.

Conclusions

The national strategy addresses most local gaps, but implementation and resourcing was insufficient. Emergency polio campaigns could support a stronger routine program by building local planning capacity, identifying new outreach sites, sharing intelligence on local population characteristics, integrating high-demand services and other vaccines, distributing educational materials, and modelling better involvement of trained lay health workers. Long-term strengthening requires a major increase in centrally-allocated resources, however there are immediate locally feasible steps within current resources that could boost coverage and quality of routine immunization.
Psychosocial Syndemic Associated with Magnifying Effect of Suicidal Ideation Among Sexually Transmitted infection Patients in Shanghai, China
Authors: Wang Suping , Ni Yang , Gong Ruijie , Shi Yuan , Cai Yong , Ma Jin
Published: June 2019

Background

We sought to verify whether psychosocial health problems among patients with sexually transmitted infections (STIs) were associated with these patients’ suicidal ideation, and to examine the magnifying effect of a syndemic of multiple psychosocial conditions on suicidal ideation.

Methods

This was a cross-sectional study of 519 STI patients at the Shanghai Skin Disease Hospital. Sociodemographic, psychosocial, and suicidal ideation information on the participants was collected. Logistic regressions were performed to detect the association between sociodemographic variables and suicidal ideation, as well as each individual psychosocial variable and suicidal ideation, and to verify the syndemic effect of psychosocial factors.

Results

Of the participants, 25.0% reported having suicidal thoughts. In univariate analysis, low self-esteem, loneliness, depression, entrapment, defeat, and unsatisfied interpersonal needs were associated with suicidal ideation. Multivariable analysis found depression (risk ratio [RR] 2.614; 95% confidence interval [CI]: 1.603–4.262) and entrapment (RR: 4.457; 95%CI: 2.649–7.496) remained significant. STI patients who experienced two or more psychosocial health problems had approximately five times the odds of suicide ideation (adjusted risk ratio [ARR]: 4.643; 95%CI: 2.882–7.481) compared with those in the non-syndemic group, especially in the high-level (five or more psychosocial problems) group (ARR: 6.072; 95%CI: 3.307–11.152).

Conclusions

The study confirmed that STI patients have a high rate of suicidal ideation and suffer from severe psychosocial problems. The results confirm a syndemic effect of psychosocial problems on increasing the odds of suicidal ideation. This suggests greater attention should be paid to STI patients’ psychosocial wellbeing in both nursing and interventions. Efforts to prevent suicidal ideation among STI patients are therefore urgently needed to ameliorate the social and health conditions of this population.
Examining validity and reliability of Objective Structured Clinical Examination for evaluation of clinical skills of midwifery undergraduate students: a descriptive study
Authors: Kolivand Mitra , Esfandyari Marzieh , Heydarpour Sousan
Published: June 2019

BACKGROUND: Clinical evaluation is one of the main pillars of medical education. The Objective Structured Clinical Examination is one of the commonly adopted practical tools to evaluate clinical and practical skills of medical students. Validity and reliability of the tool to evaluate clinical skills of midwifery undergraduate students in Kermanshah Midwifery Nursing School were examined.
METHODS: Seven clinical skills were evaluated in this descriptive correlative study using a performance checklist. Thirty-two midwifery students performed the skills at seven stations each monitored by an observer using an evaluation checklist. Criterion-related validity was obtained through determining the correlation between the clinical courses point and the Objective Structured Clinical Evaluation score. The collected data was analyzed in SPSS (v.20) and logistic regression test.
RESULTS: The correlation score of Objective Structured Clinical Examination was significantly related to the mean score of clinical course “Normal Pregnancy I” (0.319, p=0.075), the mean score of clinical course “Normal and Abnormal delivery I” (0.399, p=0.024), the mean score of clinical course “gynaecology “ (0.419, p=0.017) and total average scores(0.23, p=0.200).
The correlation between the total score and mean score of students at the stations showed that out of the seven stations, the correlations of the stations three (communication and collecting medical history) and four (childbirth) were not significant.
CONCLUSION: Although it appeared that Objective Structured Clinical Examination was one of the effective and efficient ways to evaluate clinical competencies and practical skills of students, the tool could not evaluate all the aspects.
Propofol attenuated the effect of TNF-α on occludin expression by inhibiting HIF-1α/VEGF/VEGFR-2/ERK signaling pathway in hCMEC/D3 cells
Authors: Zhang Yue , Ding Xiaowei , Miao Changhong , Chen Jiawei
Published: June 2019

Background: The levels of tight junction proteins (TJs), especially occludin, correlate with blood-brain barrier (BBB) disruption caused by inflammation in central nervous system (CNS). It has been reported that propofol, the most commonly used anesthetic, could inhibit inflammation response in CNS. In this study, we investigated the effects of tumor necrosis factor-α(TNF-α) and propofol on occludin expression in human cerebral microvascular endothelial cell line, D3 clone (hCMEC/D3 cells), and explored the underlying mechanisms.
Methods: The hCMEC/D3 cells were treated with propofol, followed by TNF-α. The expression and phosphorylation of Hif-1α, VEGF, VEGFR-2, ERK, p38MAPK and occludin were measured by Western blot analysis. The cell viability of hCMEC/D3 cells was measured by cell counting kit-8.
Results: TNF-α (10 ng/ml, 4 h) significantly decreased the expression of occludin, which was attenuated by propofol (25 μM). TNF-α induced Hif-1α/VEGF/VEGFR-2/ERK signaling pathway, while propofol could inhibit it. TNF-α induced the phosphorylation of p38MAPK, while propofol had no effect on it. In addition, the inhibitors of Hif-1α, VEGFR-2, and ERK could reduce the effect of TNF-α on occludin expression.
Conclusion: TNF-α could decrease the expression of occludin via activating Hif-1α/VEGF/VEGFR-2/ERK signaling pathway, which was attenuated by propofol.
An Outbreak of Epidemic Keratoconjunctivitis Caused by Human Adenovirus Type 8 in Primary School, Southwest China
Authors: Li Duo , Zhou Jie-Nan , Li Hong , He Cun-Ying , Dai Qing-Shan , Li Xiang-Lan , He Jian-Fang , He Hong , Li Ming-Bao , Jiang LI-Li , Chen Yao-Yao , Xu Wen
Published: June 2019

Background: Two outbreaks of epidemic keratoconjunctivitis (EKC) occurred successively with an interval of five days in two primary boarding schools in Weixi Lisu Autonomous County, Diqing, and Tibetan Autonomous Prefecture, Yunnan. The aims of this study were to determine the intensity and characteristics of the outbreaks, as well as the clinical manifestations in the patients, the risk factors for infection and the pathogen responsible for the two outbreaks.
Methods: An outbreak investigation was conducted in two primary schools, and a case-control study including patients from the Weixi County Ethnic Primary School was performed. Relevant specimens were collected according to the case definition, and next-generation sequencing was employed to identify the pathogen. An epidemiological investigation method was used to analyse the related epidemiological characteristics, such as risk factors. The phylogenetic tree was constructed by MEGA 7.0.
Results: A total of 331 acute conjunctivitis cases, including probable cases of EKC, were reported in the two schools, and the attack rates were 30.59% (171/559, 95%CI: 26.76-34.42) and 20.41% (160/784, 95%CI: 17.58-23.24), respectively. Cases occurred in all grades and classes in both schools, and only one staff member in each school presented illness. The epidemics lasted for 54 days and 45 days, respectively. The patients had typical manifestations of EKC, such as acute onset, follicular hyperplasia, pseudomembrane formation, preauricular lymphadenopathy, corneal involvement and blurred vision, and a relatively long disease course (average 9.40 days, longest 23 days and shortest 7 days). The risk factor for infection was close contact with a patient or personal items contaminated by a patient. The pathogen responsible for the outbreaks was HAdV-8. The virus was highly similar to the 2016 HAdV-8 strain from Tibet, China.
Conclusions: This study strongly suggests that HAdV-8 could lead to serious consequences. This is the second report of a HAdV-8-associated EKC outbreak in mainland China. Tibetan HAdV-8 might be circulating in southwest China; therefore, it is necessary to monitor the pathogens causing acute conjunctivitis in this area.
Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study
Authors: Guinot Pierre-Grégoire , Spitz Alexandra , Berthoud Vivien , Ellouze Omar , Missaoui Anis , Constandache Tiberiu , Grosjean Sandrine , Radhouani Mohamed , Anciaux Jean-Baptiste , Parthiot Jean-Philippe , Merle Jean-Pierre , Nowobilski Nicolas , Nguyen Maxime , Bouhemad Belaid
Published: June 2019

Background: No study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course.
Methods: We performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 hours after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS).
Results: 110 patients were matched (OFA: n=55; OA: n=55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6-34) vs 5 mg (2-18), p=0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66-115) vs 77 mmol/l (IQR: 69-95), p=0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p=0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1-5) vs 5 (3-6) hours, p=0.001 and 2 (1-3) vs 3 (2-5) days, p=0.037).
Conclusion: The use of OFA was associated with lower morphine consumption and shorter ICU stays. Further randomized studies are needed to confirm these results.