bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 Pandemic and its Implications on Food Systems
Authors: Makroo Hilal A , Majid Darakshan , Siddiqi Mushtaq A , Greiner Ralf , Dar B.N.
Published: August 2020

The outbreak of COVID-19 started in mainland China and has rapidly spread to more than 200 countries and territories around the world (WHO, 2020). The new coronavirus is a respiratory virus and its transmission is known to occur by upper respiratory secretions, including airborne droplets after coughing or sneezing. There is no evidence to support the role of food in the transmission of COVID-19. However, sharing food in public places is not encouraged. Furthermore, standard operating procedures of food safety like thorough washing, avoid cross contamination, keeping raw and cooked foods separated, refrigeration and heating are highly suggested. The pandemic has dramatically increased food insecurity across the countries and threatens the food security and nutrition of millions of people. The review presents information about SARS-CoV-2 with respect to food, including a brief history of coronavirus, its classification and transmission. It further presents the role of food as a carrier of the virus, which looks unlikely so far but cannot be fully ruled out, food contamination and handling followed by prevention and safety measures as per the standard guidelines, and conclusive remarks.
Removal of Ethoxylated Alkylpehol (NPEG) with TiO2/ Au Catalysts: Kinetic and Initial Transformation Path
Authors: Aguilar Claudia , Garcia Mayra , Montalvo Carlos , Moctezuma Edgar , Anguebes Francisco , Abatal Mohamed , Figueroa Sandra
Published: August 2020

Gold nanoparticles, were deposited in titanium oxide (TiO2) Degussa-P25 with the Photodeposition method in the presence of UV light at different concentrations. It was determined by diffuse reflectance (DF), Scanning electron microscopy (SEM), that the Photodeposition method is effective for the inclusion of gold particles on the surface. The catalyst band gap showed a reduction to 2.9 e.V, as well as it was observed that the gold-doped catalyst shows absorption in the visible light range around 500 to 600 nm. The percentage of deposited gold nanoparticles was determined by energy dispersive spectroscopy (EDS). The experimental data were analyzed using different analytical techniques (UV-Vis spectrophotometry, TOC total organic carbon), with these results a carbon-based mass balance and reaction kinetics were generated using the Langmuir-Hinshelwood (LH-HW) heterogeneous catalysis model. For the estimation of the kinetic constants, the non-linear regression of the Levengerd Marquad algorithm was used, with these results, kinetic models of the degradation of the molecule and the generation and consumption of Organic Intermediate Products (OIP) were generated.
New Methods for Improved Prosumer Trading and Energy Poverty Mitigation in Microgrids using Crowdsourcing Concepts and Blockchain Technologies
Authors: Neagu Bogdan-Constantin , Ivanov Ovidiu , Grigoras Gheorghe , Gavrilas Mihai , Istrate Dumitru-Marcel
Published: August 2020

The deregulated markets have replaced the traditional way of trading electricity from the producers to the consumer, via government-owned organizations and regulated tariffs. Nowadays, electricity prices are determined by the offer-demand mechanism and consumers can negotiate tariffs with their supplier of choice. For classic wholesale suppliers, the tariffs are a result of the transactions performed on the wholesale market and the energy mix available in certain geographical regions. In parallel with becoming eligible and participating in retail electricity markets, the consumers use increasingly local generation sources based mostly on renewable energy technologies such as PV panels, and become prosumers. They want to be able to sell back to the market the generation surplus, in order to obtain the maximum benefits from their initial investment. Currently, several trading mechanisms for prosumers are available, ranging from the simplest, selling back the surplus to an aggregator at fixed tariffs, to more complex market schemes. This paper proposed a two-tier local market model for prosumers and consumers connected in microgrids, based on the blockchain technologies and other technologies and concepts such as remote sensing, smart grids, crowdsourcing and energy poverty.
Crisis Deducing All PhysicsLaws, Solution to The Crisis and Its Applications to Improved Variational Principle, Improved Noether Theorem and so on
Authors: Huang C. , Huang Yong-Chang
Published: August 2020

This paper discovers that current variational principle and Noether theorem for both different physics systems and (in)finite freedom systems have missed the double extremum processes of the general extremum functional that is deduced by variational principle and necessarily taken in deducing all the physics laws, but these have not been corrected for over a century since Noether's proposing her theorem, which result in the crisis deducing all the physics laws. Using the double extremum processes of the general extremum functionals, the crisis and the hidden logic cycle problem in current variational principle and current Noether theorem are solved. Furthermore, the new mathematical and physical double extremum processes and their new mathematical and physical pictures for (in)finite freedom systems are discovered. The improved variational principle and improved Noether theorem are given, which are key useful to different branches of science.as key tools of studying and processing them.
Emission Inventory Processing of Biomass Burning from A Global Dataset for Air Quality Modeling
Authors: Pino-Cortés Ernesto , Carrasco Samuel , Díaz-Robles Luis A. , Cubillos Francisco , Vallejo Fidel , Cereceda-Balic Francisco , Fu Joshua
Published: August 2020

Wildfires generate large amounts of atmospheric pollutants yearly. The development of an emissions inventory for this activity is a challenge today, mainly to perform modeling of air quality. There are free available databases with historical information about this source. The main goal of this study was to process the results of biomass burning emissions for the year 2014 from the Global Fire Assimilation System (GFAS). The pollutants studied were the black carbon, the organic carbon, fine and coarse particulate matter, respectively. The inputs were pre-formatted to enter to the simulation software of the emission inventory. In this case, the Sparse Matrix Operator Kernel Emissions (SMOKE) was used and the values obtained in various cities were analyzed. As a result, the spatial distribution of the forest fire emissions in the Southern Hemisphere was achieved, with the polar stereographic projection. The highest emissions were located in the African continent, followed by the northern region of Australia. Future air quality modeling at a local level could apply the results and the methodology of this study. The biomass burning emissions could add a better performance of the results and more knowledge on the effect of this source.
Classification of Amber Gemstone Objects by Shape
Authors: Ostreika Armantas , Pivoras Marius , Misevičius Alfonsas , Skersys Tomas , Paulauskas Linas
Published: August 2020

The article describes a classification solution for amber stones. The problem of classifying amber is known for a long time among jewelers and artisans of amber art. Existing solutions can classify amber pieces according to color, but a need to classify by shape and texture is not satisfied up to now. The proposed solution is capable of classifying the gemstones according to a shape. Amber can be considered as a specific object since the form is difficult to define unambiguously. Data for amber experiments was gathered from amber art craftsmen. In the proposed solution amber form can be classified into 10 different classes (7 classes chosen during the experiment).
Should A Good Organic Solar Cell Be A Good Organic LED?
Authors: Kozyreff Gregory , Godefroid Blaise
Published: August 2020

We revisit the argument that link the efficiency of a solar cell to its reverse operation as a LED, in the case where the material is organic. In organic cells, exciton transport is an intermediate process between sunlight absorption and the generation of electric current. We show that quenching exciton radiation can be beneficial to cell efficiency, without contradicting the general rule prevailing for semiconductor cells. Our treatment allows us to discuss both bulk heterojunction and planar junctions.
Marching Cubes and Histogram Pyramids for 3D Medical Visualization
Authors: Visutsak Porawat
Published: August 2020

This paper aims to implement histogram pyramids with marching cubes method for 3D medical volumetric rendering. The histogram pyramids are used for feature extraction by segmenting the image into the hierarchical order like the pyramid shape. The histogram pyramids can decrease the number of sparse matrixes that will occur during voxel manipulation. The important feature of the histogram pyramids is the direction of segments in the image. This feature will be then used for connecting pixels (2D) to form up voxel (3D) during marching cubes implementation. The proposed method is fast and easy to implement and it also produces a smooth result (compared to the traditional marching cubes technique). The experimental results show that time consuming for generating 3D model can be reduced by 15.59% in average. The paper also shows the comparison between the surface rendering using the traditional marching cubes and the marching cubes with histogram pyramids. Therefore, for the volumetric rendering such as 3D medical models and terrains where a large number of lookups in 3D grids are performed, this method is a particularly good choice for generating the smooth surface of 3D object.
‘I Can’t Breathe’: Anxiety and Emotion Awareness in Older Adolescents at The Time of Covid-19
Authors: Smirni Pietro , Lavanco Gioacchino , Smirni Daniela
Published: August 2020

The COVID-19 appears as a catastrophic health risk with psychological, emotional, social and relational implications. From the early stages of the virus spread, the elderly population was identified as the most vulnerable and the health authorities have rightly focused on such frailest population. Conversely, less attention was paid to emotional and psychological dimension of children and adolescents. Actually, they were less at risk quoad vitam or quoad valetudinem, nevertheless they had to face a reality of anxiety, fears and uncertainties. The current study investigated state anxiety and emotion awareness in a healthy sample of older adolescents, 84 females and 64 males, aged 17 to 19, during the pandemic lockdown, using Self-rating Anxiety Scale and the Italian Emotion Awareness Questionnaire. An unexpected anxious phenomenology, impacting the anxiety ideo-affective domain, was found, while the somatic symptomatology appeared to be less severe. The highest anxiety symptom were the breathing difficulties. These findings supported the hypothesis that the COVID-19 pandemic may be a risk condition for an increased state anxiety in older adolescents and suggest the need to provide 1. an effective, empathic communication system with the direct participation of older adolescents, 2. a psychological counseling service for stress management of adolescents.
A Novel Anti-Environmental Forest Experience Scale to Predict Preferred Pleasantness Associated with Forest Environments
Authors: Bielinis Ernest , Xu Jianzhong , Omelan Aneta Anna
Published: August 2020

In this study a method for predicting the preferred pleasantness induced by different forest environments, represented by virtual photographs, was proposed and evaluated using a novel Anti-Environmental Forest Experience Scale psychometric test. The evaluation questionnaire contained twenty-one items divided into four different subscales. The factor structure was assessed in two separate samples collected online (sample 1: N = 254, sample 2: N = 280). The internal validity of the four subscales was confirmed using an exploratory factor analysis. Discriminant validity was tested and confirmed using the Amoebic Self Scale (Spatial-Symbolic domain). Concurrent validity was confirmed using the Connectedness to Nature Scale. Predictive validity was based on assessment of pleasantness induced by nine different photographs (control – urban landscapes, forest landscapes, dense forest landscapes), with subscales differently correlated with the level of pleasantness assessed for each photograph. This evaluation instrument is appropriate for predicting preferred pleasantness induced by different forest environments.
Geochemistry Acidic Water of Banyupait River Effect Seepage of Crater Water Ijen Volcano, Asembagus, Situbondo, East Java, Indonesia
Authors: Yudiantoro Dwi Fitri , Irawan Bambang Agus , Haty Intan Paramita , Sayudi Dewi Sri , Suproboriniaru Arum , Sekarwati Bawaningrum , Ismaya Paramita , Abdurrachman Mirzam , Takashima Isao
Published: August 2020

The Ijen volcano has Pleistocene age (294.00 ± 0.03 Ma), and this stratovolcano was very acidic crater water with a pH of 0-1. The acidic crater water seeps into the Banyupait river flow. Asembagus is a research area located on the northern slope of the Ijen volcano, and the Banyupait River drains this. The acidic river water flows from the Ijen Crater Lake, so the pH of the water river was very acidic. This study used several different analytic methodologies with some previous researchers, namely using the method of geological mapping, pH measurement, spectrophotometry, IRMS (Isotope Ratio Mass Spectrometer), and the technique of Induced Coupled Mass Spectrometry (ICP-MS). Besides, the petrographic analysis is used to determine the composition of rock minerals due to rocks interacting with acidic water. Banyupait River water in the Asembagus area has a pH of river water around 3-7.3, SO4 (220-683 ppm), and the type of water is meteoric water. Also, concentrations of Ca, K, Mg in the west Banyupait river irrigation water flow showed higher levels when compared to the eastern Banyupait River water flow. Likewise, REE elements from the Asembagus region showed lower concentrations compared to Ijen Crater water. This change in the level of chemical elements is caused by the acidity of the Banyupait River being diluted or mixed with water from other water. However, the spring was not affected by acidic water. The process of acidic water interaction with rocks can also be observed from rocks traversed by the Banyupait River flow. Chalcedony and hematite replace the primary minerals of basaltic rocks. This research is expected to improve the quality of water needed by the Asembagus community so that people can live healthily.
Irrigation Control Through Acoustic Proximal Sensing of the Onset of Surface Water
Authors: Bradley Stuart , Radionova Anna , Ghimire Chandra , Grundy Laura , Laurenson Seth , Snow Val
Published: August 2020

Irrigation is a useful crop enhancement procedure up to the point where free surface water appears. Thereafter, water can begin to flow into waterways, leaching nutrients and giving rise to environmental damage, as well as being a waste of a precious resource. The current work addresses the problem of measuring free water on the surface of agricultural soils by a real-time acoustic remote sensing method. Directional acoustic transmitter and receiver arrays are used to define a ‘footprint’ on the ground from which changes in reflectance are sensed. These arrays are mounted on a moving irrigator. Chirp signals are used to provide along-path resolution and to ensure robustness against unwanted acoustic background noise from farm machinery and the irrigator. Field measurements have been conducted above a well-defined ‘quadrat’ with controlled and measured water content, and also with the instrument mounted on an operational irrigator. A structured light camera mounted above the footprint is used to validate surface water fraction. It is found that the areal fraction of free water on the soil surface can be reliably estimated from changes in the amplitude of the reflected sound waves. The mechanism giving rise to the observed acoustic reflectivity changes is discussed and a model is developed which agrees with normalized intensity observations with a coefficient of determination R2 between 0.65 and 0.83. The rms error between model predictions and observations is comparable to the rms variation of the measurements, indicating that there is insignificant error due to the choice of model.
Feasibility, Process, and Effects of Short-Term Calorie Reduction in Cancer Patients Receiving Chemotherapy: An Integrative Review
Authors: Tang Chia-Chun , Chen Hsi , Huang Tai-Chung , Wu Wei-Wen , Lin Jing-Mei , Tien Feng-Ming
Published: August 2020

Recent preclinical studies have shown the potential benefits of short-term calorie reduction (SCR) on cancer treatment. In this integrative review, we aimed to identify and synthesize current evidence regarding the feasibility, process, and effects of SCR in cancer patients receiving chemotherapy. PubMed, Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, PsychINFO, and Embase were searched for original research articles using various combinations of Medical Subject Heading terms. Among the 311 articles identified, seven studies met the inclusion criteria. The majority of the reviewed studies was small randomized controlled trials or cohort study with fair quality. The results suggest that SCR is safe and feasible. SCR is typically arranged around the chemotherapy with the duration ranging from 24 to 96 hours. Most studies examined the protective effects of SCR on normal cells during chemotherapy. The evidence supports that SCR had the potential to enhance both physical and psychological wellbeing of patients during chemotherapy. SCR is a cost-effective intervention with great potential. Future well-controlled studies with sufficient sample sizes are needed to examine the full and long-term effects of SCR and its mechanism of action.
Bucket-Handle Meniscus Repair in a Below-Knee Amputee
Authors: Massey Patrick A. , Miller Benjamin C. , Perry Kevin , McClary Kaylan , Chauvin Brad , Barton R Shane
Published: August 2020

Case:

We report a case of a right knee lateral bucket-handle meniscal tear repair in a 25-year-old woman bilateral below-knee amputee. At the 4-year follow-up, the patient was ambulatory in a prosthesis with a successful outcome.

Conclusion:

Meniscus repair in below-knee amputees requires careful evaluation and surgical management. Specific consideration should be given to evaluating limb alignment, maintaining the stump integrity, surgical technique, modified bracing, and rehabilitation. This case report demonstrates that bucket-handle meniscus repair can be successful in a below-knee amputee.
Injury to the Popliteal Artery and Vein During Open Fibular Collateral Ligament Reconstruction
Authors: Naylor William M. , Johnson Daniel J. , Welter Jessica M. , Dunn Albert S.M.
Published: August 2020

Case:

We present a case involving a 26-year-old male who sustained an iatrogenic injury to the right popliteal artery and vein during open fibular collateral ligament reconstruction. The lesions were repaired immediately and required subsequent procedures on postoperative day 1.

Conclusions:

Iatrogenic vascular injuries during knee surgery can be devastating for patients and may lead to increased medical costs, unexpected hospital admissions, and additional surgical procedures. Surgeons should scrutinize preoperative imaging to identify the anatomic location of the popliteal artery and vein, which may be at risk during posterolateral knee reconstruction.
Surgical Treatment for Toe Deformities in Stiff-Person Syndrome
Authors: Takeda Ryutaro , Isawa Kazuya , Matsumoto Takumi , Tanaka Sakae , Yasui Tetsuro
Published: August 2020

Case:

Stiff-person syndrome is a rare neurological disorder characterized by rigidity and painful spasms of the trunk and limbs, and patients sometimes have difficulty in walking due to rigid toe deformities. This is a case report of a 76-year-old woman suffering from stiff-person syndrome with painful rigid toe deformities regained walking ability after metatarsal osteotomy and cutting of the toe extensors for all toes in the left foot.

Conclusion:

For patients with stiff-person syndrome, surgical intervention is a powerful treatment option when they have developed rigid and painful toe deformities despite adequate pharmacological treatment.
Extensor Pollicis Longus Tendon Rupture After a Pediatric Distal Radius Fracture
Authors: Patel Harshadkumar A. , Lee Mark C. , Chaudhry Sonia
Published: August 2020

Case:

A 16-year-old boy underwent closed reduction and pinning of a Salter-Harris II distal radius fracture (DRF). Extensor pollicis longus (EPL) rupture occurred 6 weeks after the injury. Extensor indicis proprius transfer was performed using wide-awake local anesthesia no tourniquet (WALANT) technique. Active thumb range of motion was restored, and the patient returned to all activities, including sports, after 2 months.

Conclusion:

Although delayed attritional EPL rupture after DRF is a well-known complication in adults, this is the first reported case in a truly skeletally immature patient. Awareness of this complication prompts monitoring for prodromal signs and symptoms. The WALANT technique is feasible in selected children.
Ethical issues encountered by medical school students during the physical examination of female genitalia
Authors: Özcan Müesser , Yeniceri Emine Neşe , Küçük Mert
Published: August 2020

Background The aim of the study was to identify the ethical issues encountered during the physical examination of the female genitalia, which can be deemed culturally intimate, by medical school students who have practiced genital examination so far on a limited number of models and find out the reasons of such issues. Methods The study was conducted with 120 voluntary medical school students in clinical years who completely filled out and delivered the forms. Results Students stated that while performing genital examinations on real patients during their clinical years, they faced various issues including the importance of taking patient's consent, disclosing their identity and proficiency, fearing to harm the patient due to lack of knowledge and skills, failing to perform genital examination, and having emotional problems. The rate of encountering such problems differed depending on students' gender and grade. Conclusions In clinical education, while they are equipped with self-confidence and proficiency, students should also be integrated in an environment where patient's comfort, ethical principles and values are preserved. This subject should be examined when ethical dilemmas constrain learning. In order to avoid ethical concerns during this process and ensure that the process can be managed positively by both parties, medical schools should put forth official policies and guidelines concerning the practice of genital examination in particular which is considered intimate by patients and share such policies and rules with both parties.
Implementation of a National Electronic Health Information System in Gabon: A Survey of Healthcare Providers’ Perceptions.
Authors: Bagayoko C.O. , Tcheente Jack , Traoré Diakaridia , Moukoumbi Gaetan , Ondzigue Raymond , Koumamba Aimé Patrice , Ondjani Myriam Corille , Ndjeli Olive Lea , Gagnon Marie-Pierre
Published: August 2020

BackgroundThe Health Information System (HIS) is a set of computerized tools for the collection, storage, management, and transmission of health data. The role of such tools in supporting the modernization of health systems, improving access to quality healthcare, and reducing costs in developing countries is unquestionable, but their implementation faces several challenges. In Gabon, a unique national electronic HIS has been launched. It will connect healthcare institutions and providers at all levels in the whole country.ObjectiveThis study aims to explore and identify the factors influencing healthcare providers’ perceptions of the national electronic HIS in Gabon. MethodsA 44-item questionnaire based on the Information System Success Model (ISSM) was administered between February and April 2018 among 2,600 healthcare providers across the country. The questions assessed the different aspects of the HIS that could influence its perceived impact on a 5-level Likert scale (from fully agree to totally disagree). The reliability and construct validity of the questionnaire were checked using Cronbach alpha and congeneric reliability coefficients. A logistic regression was used to identify the factors influencing healthcare providers’ perceptions of the system.ResultsA total of 2,327 questionnaires were completed (i.e. 89.5% response rate). The logistic regression identified five elements that significantly influenced perceived system impact: System Quality (Odds Ratio–OR=1.70), Information Quality (OR=1.69), Actual Use (OR=1.41), Support Quality (OR=1.37), and Useful Functions (OR=1.14). The model explained 30% of the variance in providers’ perception that the national HIS leads to positive impacts. DiscussionThe results show that healthcare providers’ perceptions regarding the positive impact of the national HIS in Gabon are influenced by their previous use of an HIS, the scope of their usage, and the quality of the system, information, and support provided to users. These results could inform the development of strategies to ensure adequate change of management and user experience for the implementation of the national HIS in Gabon, and eventually in other low resource environments.
Consumers’ satisfaction factors mining and sentiment analysis of B2C online pharmacy reviews
Authors: liu jingfang , zhou yingyi , jiang xiaoyan , zhang wei
Published: August 2020

BackgroundIn recent years, online pharmacies have been accepted by increasingly more consumers, and the prospects for online pharmacies are optimistic. This article explores the consumers’ satisfaction factors addressed in Business to Customer (B2C) online pharmacy reviews and analyzes the sentiments expressed in the reviews. The goal of this work is to help B2C online pharmacy enterprises identify consumers’ concerns, continuously improve the health services level.MethodsThis article was based on the Latent Dirichlet Allocation (LDA) topic model. From a third-party platform-based B2C online pharmacy and a proprietary B2C online pharmacy (JD Pharmacy and J1.COM, respectively), 136,630 pieces of over-the-counter (OTC) drug review data posted from January 1, 2015 to December 31, 2018 were selected as samples and used to explore the satisfaction factors of B2C online pharmacy consumers regarding the entire drug purchasing process. Then, the sentiments expressed in the drug reviews were analyzed with SnowNLP.ResultCategorization of the 12 factors identified by LDA showed that 5 factors were related to logistics; these 5 factors, which also included the most drug reviews, made up 38.5% of the reviews. The number of factors related to drug prices was second, with 3 factors, and reviews of drug prices made up 25.5% of the reviews. Customer service and drug effects each had two related factors, and a smaller percentage of these reviews (13.95%) were related to drug effects. Consumers still maintain positive opinions of JD Pharmacy and J1.COM. However, some opinions on logistics and drug prices are expressed.Conclusion The most important task for online pharmacies is to improve logistics. It is better to develop self-built logistics. Both types of B2C online pharmacies can improve consumer viscosity by implementing marketing strategies. With regard to customer service, focusing on improving employees' service attitudes is necessary.
A practice improvement package at scale to improve management of birth asphyxia in Rwanda: A before-after mixed methods evaluation
Authors: Umunyana Jacqueline , Sayinzoga Felix , Ricca Jim , FAVERO RACHEL , Manariyo Marcel , Kayinamura Assumpta , Tayebwa Edwin , Khadka Neena , Molla Yordanos , Kim Young-Mi
Published: August 2020

Background: Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials. This “system-oriented” approach was implemented in all public health facilities (n=172) in ten districts in Rwanda from 2015 to 2018. Methods: A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to one year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach.Results: Nearly forty percent (n= 772) of health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n=456), sixty percent demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of five months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 minutes of birth (19% reduction, p=0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions: Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.
Potentialities of multi-b-values diffusion-weighted imaging for predicting efficacy of concurrent chemoradiotherapy in cervical cancer patients
Authors: Liu Bing , Ma Wan-Ling , Zhang Guang-Wen , Sun Zhen , Wei Meng-Qi , Hou Wei-Huan , Hou Bing-Xin , Wei Li-Chun , Huan Yi
Published: August 2020

Background: To testify whether multi-b-values diffusion-weighted imaging (DWI) can be used to ultra-early predict treatment response of concurrent chemoradiotherapy (CCRT) in cervical cancer patients and to assess the predictive ability of concerning parameters.Methods: Fifty-three patients with biopsy proved cervical cancer were retrospectively recruited in this study. All patients underwent pelvic multi-b-values DWI before and at the 3rd day during treatment. The apparent diffusion coefficient (ADC), true diffusion coefficient (Dslow), perfusion-related pseudo-diffusion coefficient (Dfast), perfusion fraction (f), distributed diffusion coefficient(DDC) and intravoxel diffusion heterogeneity index(α) were generated by mono-exponential, bi-exponential and stretched exponential models. Treatment response was assessed based on Response Evaluation Criteria in Solid Tumors (RECIST v1.1) at 1 month after the completion of whole CCRT. Parameters were compared using independent t test or Mann-Whitney U test as appropriate. Receiver operating characteristic (ROC) curves was used for statistical evaluations.Results: ADC-T0 (p=0.02), Dslow-T0 (p<0.01), DDC-T0 (p=0.03), ADC-T1 (p<0.01), Dslow-T1 (p<0.01), ΔADC (p=0.04) and Δα (p<0.01) were significant lower in non-CR group patients. ROC analyses showed that ADC-T1 and Δα exhibited high prediction value, with area under the curves of 0.880 and 0.869, respectively. Conclusions: Multi-b-values DWI can be used as a noninvasive technique to assess and predict treatment response in cervical cancer patients at the 3rd day of CCRT. ADC-T1 and Δα can be used to differentiate good responders from poor responders.
Young Medical Doctors’ Perspectives on Professionalism: A Qualitative Study Conducted in Public Hospitals in Pakistan
Authors: Jalil Aisha , Mehmood Qaisar Khalid , Fischer Florian
Published: August 2020

Background: Professionalism is amongst the major dimensions determining the competence of medical doctors. Poor professionalism affects the overall outcome of healthcare services. This study explores the perspectives of young medical doctors on professionalism in Pakistan.Methods: A qualitative study based on in-depth interviews was conducted with 60 young medical doctors, aged less than 40 years, who had studied medicine in Pakistani universities, were Pakistani nationals, and were employed at various hierarchical levels, from house officer to consultant specialist, in public tertiary hospitals in Pakistan. The respondents were identified through a multistage maximum heterogeneity sampling strategy. A semi-structured interview guide was developed based on a previous extensive literature review. Written consent was obtained from the hospitals and study participants. Qualitative thematic analysis was applied to analyse the data. Results: The data analysis revealed that rigidity of opinions, unacceptability of contrasting perspectives, false pride, and perceived superiority over other professions and patients were major components of poor medical professionalism. Most of the young doctors believed that there is no need to include professionalism and humanity course modules in the medical curriculum, because topics related to social sciences are deemed irrelevant to medicine and judged to be common sense. The doctors recognised good professionalism in themselves, while reporting unprofessional behaviour demonstrated by their colleagues and paramedics. Other factors contributing to poor medical professionalism included the use of social media applications during duty hours, ridiculing patients, substance use such as smoking cigarettes in the office, referrals of complicated cases to other hospitals, freeing up beds before holidays, lack of cooperation from paramedical staff, and inadequate role models. Conclusions: Poor medical professionalism among young doctors needs to be addressed by policymakers. There is a need to revisit the medical curriculum to strengthen professionalism. It is essential to develop the qualities of tolerance, teachability, and acceptance in doctors in order to facilitate interprofessional collaborations and avoid medical errors.
Effect of Bone Morphogenetic Protein-2/Hydroxyapatite on Ankle Fusion with Bone Defect in a Rabbit Model: A Pilot Study
Authors: Dang Le Hoang Nam , Lee Kwang-Bok
Published: August 2020

Background: Revision ankle-fusion surgery after a failure of total ankle arthroplasty has a problem with bone-defect management by implant removal. For the reconstruction of bone defects, autogenous bone often causes minor and major complications. Recombinant human-bone morphogenetic protein-2 (rhBMP-2) plays essential roles in bone regeneration strategies and Hydroxyapatite (HA) is beneficial as the rhBMP-2 carrier. In this study, we evaluate whether rhBMP-2/HA can replace autogenous bone in a rabbit ankle-fusion model with distal tibia bone defect. Methods: The bone defect was created in the distal tibia. The ankle fusion was performed by a cannulated screw from lateral malleolus and various treatments on bone defect. Thirty male white New Zealand rabbits were divided into three groups of 10 animals on each group dependent on treatment methods as control group (no treatment into defect), auto-bone group (autogenous bone treatment), and rhBMP-2/HA group (40 μL of 1 μg/mL rhBMP-2/ 100 μL HA). Bone formation on defect and the union of the ankle joint were evaluated by X-ray, micro-CT and histological analysis at 8 weeks and 12 weeks, postoperatively. Results: Radiographic assessment found the control and auto-bone groups still had the bone defect present, but rhBMP-2/HA group showed complete replacement of the defect with newly formed bone at 12 weeks. Micro-CT showed significantly higher new bone formation within the defect in the rhBMP-2/HA group than in the auto-bone and control groups at 8 weeks (p > 0.05 and p < 0.01, respectively) and 12 weeks (p < 0.05, p < 0.001, respectively). Fusion rate (%) analysis of micro-CT showed a higher percentage of union in the rhBMP-2/HA group than in the auto-bone and control groups at 8 weeks (p > 0.05, p < 0.001, respectively) and 12 weeks (p < 0.001 and p < 0.001, respectively). The histological showed the highest osteointegration between distal tibia and talus in the rhBMP-2/HA group at 12 weeks. Conclusions: This study indicated that rhBMP-2/ HA showed much better bone fusion than did the autogenous bone graft and was effective in promoting fusion rate and improving the quality of the ankle joint fusion.
The Multi-biomarker Disease Activity test for assessing response to treatment strategies using methotrexate with or without prednisone in the CAMERA-II Trial
Authors: Jurgens Maud , Safy-Khan Mary , de Hair Maria , Bijlsma Johannes , Welsing Paco , Tekstra Janneke , Lafeber Floris , Sasso Eric , Jacobs Johannes
Published: August 2020

Objectives The CAMERA-II trial compared two tight-control, treat-to-target strategies, initiating methotrexate with prednisone (MTX+pred) or MTX with placebo (MTX+plac), in early RA-patients. The multi-biomarker disease activity (MBDA) blood test objectively measures RA disease activity with a score of 1−100. In CAMERA-II, response profiles of the MBDA score, its individual biomarkers and DAS28 were assessed.Methods We evaluated 92 patients from CAMERA-II of whom clinical data and serum for MBDA testing at baseline and ≥1 timepoint from months 1, 2, 3, 4, 5, 6, 9 or 12 were available. Changes (∆) from baseline for DAS28 and MBDA score and comparisons of ∆DAS28 and ∆MBDA score over time within the MTX+pred versus the MTX+plac strategy, were tested for significance with t-tests. Changes in biomarker concentration from baseline to months 1−5 were tested with Wilcoxon signed rank test and tested for difference between treatment arms by Mann-Whitney U test. Results MBDA and DAS28 showed similar response profiles, with gradual improvement over the first 6 months in the MTX+plac group, and in the MTX+pred group faster improvement during month 1, followed by gradual improvement. The 12 MBDA biomarkers could be grouped into 4 categories of response profiles, with significant responses for 4 biomarkers during the MTX+plac strategy and 9 biomarkers during the MTX+pred strategy.Conclusions MBDA tracked treatment response in CAMERA-II similarly to DAS28. More individual MBDA biomarkers tracked treatment response of MTX+pred than of MTX+plac. Four response profiles could be observed. TRIAL REGISTRATIONCAMERA-II International Standard Randomised Controlled Trial Number: ISRCTN 70365169. Registered 29 March 2006, retrospectively registered.
Validity and reliability of a simplified food frequency questionnaire: A cross sectional study among physical health examination adults in southwest region of China
Authors: Cheng Zhengyan , Shuai Ping , Qiao Qichuan , Li Tingxin
Published: August 2020

Background: In China, many people are suitable for participating in regular physical examination for prevention. Some simplified food frequency questionnaires have been designed and used. However, the accuracy of questionnaire is absent. This study aimed to examine the reliability and validity of simplified food frequency questionnaire (SFFQ) used among physical examination adults in southwest region of China.Methods: This was a cross-sectional study conducted among physical health examination adults in Southwest region of China. A total of 239 participants aged 20-65 were included from February 2019 to June 2019. The performance of SFFQ was evaluated by means of a three-day 24-hour dietary record (3R24). The relative validity and agreement was assessed by Pearson`s correlation and intra-class correlation coefficients (ICC), respectively. Results: The median energy-adjusted ICC of food groups between SFFQ2 and SFFQ1 was 0.59 (range: 0.49-0.73) and the ICC of nutrients was 0.47(range: 0.39-0.76). The Pearson correlation showed a validity between SFFQ1 and 3R24, which ranged from -0.086 to 0.93 for food and 0.21 to 0.71 for nutrition, respectively. The energy-adjustment slightly increased the correlation coefficients.Conclusions: The reliability and validity of SFFQ was acceptable. It could be an appropriate dietary assessment tool for future epidemiological studies among physical health examination adults in southwest China.Trial registration:CHiCTR, ChiCTR1900020934, Registered 22 January 2019, http://www.chictr.org.cn/edit.aspx?pid=35414&htm=4.
In vitro virucidal activity of Echinaforce®, an Echinacea purpurea preparation, against coronaviruses, including common cold coronavirus 229E and SARS-CoV-2
Authors: Signer Johanna , Jonsdottir Hulda R. , Albrich Werner C. , Strasser Marc , Züst Roland , Ryter Sarah , Ackermann-Gäumann Rahel , Lenz Nicole , Siegrist Denise , Suter Andreas , Schoop Roland , Engler Olivier B.
Published: August 2020

Background: Coronaviruses (CoVs) were long thought to only cause mild respiratory and gastrointestinal symptoms in humans but outbreaks of Middle Eastern Respiratory Syndrome (MERS)-CoV, Severe Acute Respiratory Syndrome (SARS)-CoV, and the recently identified SARS-CoV-2 have cemented their zoonotic potential and their capacity to cause serious morbidity and mortality, with case fatality rates ranging from 4 to 35%. Currently, no specific prophylaxis or treatment is available for CoV infections.Therefore we investigated the virucidal and antiviral potential of Echinacea purpurea (Echinaforce®) against human coronavirus (HCoV) 229E, highly pathogenic MERS- and SARS-CoVs, as well as the newly identified SARS-CoV-2, in vitro.Methods: To evaluate the antiviral potential of the extract we pre-treated virus particles and cells and evaluated remaining infectivity by limited dilution. Furthermore, we exposed cells to the extract after infection to further evaluate its potential as a prophylaxis and treatment against coronaviruses. We also determined the protective effect of Echinaforce® in re-constituted nasal epithelium.Results: In the current study, we found that HCoV-229E was irreversibly inactivated when exposed to Echinaforce® at 3.2mg/ml IC50. Pre-treatment of cell lines, however, did not inhibit infection with HCoV-229E and post-infection treatment had only a marginal effect on virus propagation at 50 mg/ml. However, we did observe a protective effect in an organotypic respiratory cell culture system by exposing pre-treated respiratory epithelium to droplets of HCoV-229E, imitating a natural infection. The observed virucidal activity of Echinaforce® was not restricted to common cold coronaviruses, as both SARS-CoV-1 and MERS-CoVs were inactivated at comparable concentrations. Finally, the causative agent of COVID-19, SARS-CoV-2 was also inactivated upon treatment with 50ug/ml Echinaforce®.Conclusions: These results show that Echinaforce® is virucidal against HCoV-229E, upon direct contact and in an organotypic cell culture model. Furthermore, MERS-CoV and both SARS-CoV-1 and SARS-CoV-2 were inactivated at similar concentrations of the extract. Therefore we hypothesize that Echinacea purpurea preparations, such as Echinaforce®, could be effective as prophylactic treatment for all CoVs due to their structural similarities.
Flipping the Paradigm: A Qualitative Exploration of Research Translation Centres in the UK and Australia
Authors: Robinson Tracy Elizabeth , Skouteris Helen , Burns Prue , Melder Angela , Bailey Cate , Croft Charlotte , Spyridonidis Dimitrios , Teede Helena
Published: August 2020

Background: Over the past decade Research Translation Centres (RTC’s) have been established in many countries. These Centres (sometimes referred to as Academic Health Science Centres) are designed to bring universities and health care providers together in order to accelerate the generation and translation of new evidence that is responsive to health service and community priorities. This has the potential to effectively ‘flip’ the traditional research and education paradigms because it requires active participation and continuous engagement with stakeholders (especially service users, the community and frontline clinicians). Although investment and expectations of RTCs are high, the literature confirms a need to better understand the processes RTCs use to mobilise knowledge, build workforce capacity and co-produce research with patients and the public to ensure population impact and drive healthcare improvement is needed. Methods: Semi structured interviews were conducted with selected leaders and members from select RTCs in England and Australia. Convenience sampling was utilised to identify RTC’s, based on their geography, accessibility and availability. Purposive sampling and a snowballing approach was employed to recruit individual participants for interviews that were conducted face to face or via videoconferencing. Interviews were recorded, transcribed verbatim and analysed using a reflexive and inductive approach. This involved two researchers comparing codes and interrogating themes that were analysed inductively against the study aims and through meetings with the research team. Results: A total of 41 participants, 22 from England and 19 from Australia were interviewed. Five major themes emerged including (1) dissonant metrics, (2) different models of leadership (3) public-patient involvement and research co-production (4) workforce development (5) barriers to collaboration.Conclusions: Participants identified the need for performance measures that capture community impact. Better aligned success metrics, enhanced leadership, strategies to partner with patients and the public, enhanced workforce development and strategies to enhance collaboration were all identified as crucial for RTCs to succeed.