bluuebunny/crossref_metadata_2025_split huggingface dataset:
Program Director Retention and Attrition Rates in International Graduate Medical Education
Authors: Stadler Dora J. , Ibrahim Halah , Dutta Debalina , Cofrancesco Joseph , Archuleta Sophia 
Published: October 2020

ABSTRACT

Background
Program directors (PDs) are integral to the education of the next generation of physicians. Yet, administrative burdens, substantial patient care responsibilities, and lack of protected time for teaching may contribute to work-life imbalance and physician burnout, leading to high rates of attrition. Data on international residency program leadership turnover are lacking.

Objective
This study aimed to quantify PD turnover in Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programs in Singapore, United Arab Emirates (UAE), and Qatar, and to compare to US PD attrition rates.

Methods
Data on PD turnover in international programs was extracted from the ACGME-I Accreditation Data System for academic years 2010–2011 through 2018–2019 for Singapore and 2013–2014 through 2018–2019 for UAE and Qatar. Rates of PD turnover were calculated by country and by ACGME-I medical-, surgical-, and hospital-based specialty groupings and compared using χ2 test. Annual US PD turnover data was extracted from the ACGME's Data Resource Book.

Results
Seventy programs met inclusion criteria. International PD attrition was high, with 56 programs (80%) changing PDs since program inception, and 16 programs (29%) having 2 or more PD turnovers. There was no significant difference between PD turnover rates in hospital (83%), medical (79%), or surgical (78%) specialties. International PD attrition rates varied from 7% to 20% annually and were comparable to PD turnover in US programs (range 12%–15%).

Conclusions
High PD turnover rates in newly accredited international residency programs were noted, although annual attrition rates were comparable to US residency programs.
Evaluation of the effect of an educational intervention on knowledge and adherence to HIV guidelines among frontline health workers in Alex-Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
Authors: Chizoba Akamike Ifeyinwa , Nkem Okedo-Alex Ijeoma , Jesse Uneke Chigozie , Chukwuemeka Uro-Chukwu Henry , Echefu Chukwu Onyedikachi , Immaculata Ugwu Ngozi , Nnenne Agbo Urudinachi , Ebeh Ezeoha Abel 
Published: October 2020

Background: The aim of this study was to appraise the implementation of the National HIV guidelines and determine the effect of an educational intervention on health worker knowledge and practice of the guidelines.
Methods: A before and after study design without control was carried out using a self-administered questionnaire and key informant interviews. Data was also collected from client record cards. An educational intervention was carried out using pamphlets containing summarized information on the guideline. Data analysis was carried out using IBM-SPSS version 20.
Result: Results showed that 54.5% of the respondents were males and 76% were medical doctors. Baseline knowledge level of respondents was high with 97% of respondents having good knowledge with a mean score of 3.9. This increased to 4.1 out of 5 post-intervention. All respondents had good practice of the guidelines before and after intervention with a mean score of 4.5 out of 5. Client records also showed good practice. Barriers to guideline implementation include: poor knowl- edge, inadequate training, guideline unavailability, poor functioning of the laboratory equipment, poor funding.
Conclusion: HIV guidelines are being implemented in the clinic to a large extent; however, trainings, funding and provision of the guideline in the clinics are recommended.
Keywords: HIV; guideline implementation; health worker.
Medication use among pregnant women at a secondary health institution: utilisation patterns and predictors of quantity
Authors: T Obadeji Stella , Obadeji Adetunji , O Bamidele Janet , T Ajayi Felix 
Published: October 2020

Background: Despite the lack of adequate studies on the safety of drugs in pregnancy, surprisingly, available evidence shows that pregnant women still take large number of drugs.
Objectives: The study aim was to determine drug utilization pattern and predictors of number of medications used by pregnant women.
Methods: This was a cross-sectional survey of 369 pregnant women attending a secondary health facility. Data were collect- ed using interviewer-administered questionnaire. Descriptive and inferential statistics using the Chi-Square test were carried out with level of significance set at p<0.05.
Results: Three hundred and sixty-nine women were interviewed. Their mean age was 27.7 years (SD± 4.78) and the mean number of pregnancies was 2.46 (SD± 1.34). On average, 2.62 medications were taken, with the lowest being 1 and the highest being 12 different medications during the course of pregnancy. Those who were on more than 2 medications were more likely to be older than 30 years, had lower education and with history of associated medical conditions. All participants were on one form of supplements or the other, nearly half had used antimalarials, 12.8%, 5.8% 2.4% were on antibiotics, anti-hypertensive and anti-retroviral medications respectively. All the medications prescribed were from category A, B, C, N, and none from category D and X.
Conclusion: Varieties of medications were used during the course of pregnancy among this population, however, most of these drugs were still within safety profile.
Keywords: Medications; pregnancy; pattern; predictors; co-morbidity.
Determination of expression profile of p53 gene in different grades of breast cancer tissues by real time PCR
Authors: Sadia Haleema , Ahmad Bhinder Munir , Irshad Asma , Zahid Beenish , Ahmed Rais , Ashiq Sana , Malik Kausar , Riaz Muhammad , Nadeem Tariq , Ashiq Kanwal , Akbar Ali 
Published: October 2020

Background: Pakistan has a high incidence of breast cancer in Asia, where annually 16,232 deaths are reported. There are many exogenous and endogenous risk factors that affect the tumor suppressor genes and oncogenes. The p53 gene is a tumor suppressor gene and it has a role to protect the whole genome from external and internal stresses, which causes damages to the genome.
Objective: The aim of the current study was to investigate the p53 gene expression by using the real-time PCR technique in different grades of breast cancer as compared to the normal tissue.
Methods: Fresh Modified Radical Mastectomy (MRM) samples (grade1-grade3) were collected from different hospitals of the Lahore. The project was approved by an ethical review committee of Jinnah Hospital, Lahore. And before sampling an informed consent was obtained from patients and clinicians. RNA from fresh biopsies was extracted by Qiagen extraction kit and cDNA was formed. Real time PCR performed by using SYBR green master mix (ABI) and the data was evaluated by using Livak method. Statistical analysis was done by using Microsoft Excel.
Results: There was an abnormal gene expression of p53 in all grades of the breast tumors. Non-significant (p>0.05) differ- ence of down and up regulation of p53 in different grades of breast tumor was found. However, as a whole up-regulation was more than down-regulation with significant difference (p<0.0011).
Conclusion: The abnormal expression of p53 shows that there are some genetic and epigenetic factors which are the primal cause of an abnormal gene expression. It is recommended that perform next generation sequencing (NGS) of the gene to find out the mutations causing the abnormal behavior of p53 gene.
Keywords: Breast cancer; up-regulation; down-regulation; real-time PCR; Punjab; Pakistan; p53 gene.
Prevalence and associated factors of intestinal parasite infection by HIV infection status among asymptomatic adults in rural Gabon
Authors: Vanessa Koumba Lengongo Jeanne , Pongui Ngondza Bedrich , Moutombi Ditombi Bridy , Patrick M’Bondoukwé Noé , Mari Ndong Ngomo Jacques , Mongo Delis Arnaud , Bouyi Lekounga Princilia , Bouyou-Akotet Marielle , Patricia Mawili-Mboumba Denise 
Published: October 2020

Introduction: Intestinal parasites infections are endemic in Gabon. Nevertheless, they are rarely described in people living with HIV (PLHIV).
Objective: The frequency of intestinal parasite infection was estimated and compared between HIV-positive and HIV un- infected individuals in Gabon; factors associated with intestinal parasites were also analysed.
Material and Methods: Using a cross-sectional study design sociodemographic data, life style habits, antiretroviral therapy, cotrimoxazole use and CD4 cell count were recorded.. Stool samples from participants living in Koulamoutou and Oyem were analysed using microscopy. Chi-squared or fisher’s exact tests and logistic regression were performed.
Results: Among participants (n=332), female gender was predominant (73.7%; n=135/183) and the median age was 45 [33-57] years old. Among 183 samples, 53.6% (n = 98/183) were infected by intestinal parasites. The proportion was higher (72.1%) in HIV negative participants compared to PLHIV (42.6%) (p <0.01). PLHIV were more frequently poly-infected. Infection was frequent in patients using external toilets and tap water (>70.0%).
Conclusion: Prevalence of intestinal parasites is higher in seronegative participants but polyparasitism is more frequent in PLHIV. Strategies are focused on HIV negative population, but this study shows the importance of sensitization for PLHIV to improve their quality of life.
Keywords: Intestinal parasites; Human immunodeficiency virus; cotrimoxazole; CD4 cell; Gabon.
Clinical predictors and outcome of bowel resection in paediatric intussusception
Authors: E Ajao Akinlabi , A Lawal Taiwo , O Ogundoyin Olakayode , I Olulana Dare 
Published: October 2020

Introduction: Surgery remains the mainstay in treating intussusception in developing countries, with a correspondingly high bowel resection rate despite a shift to non-operative reduction in high-income countries.
Objective: To assess factors associated with bowel resection and the outcomes of resection in childhood intussusception.
Methods: A review of children with intussusception between January 2006 and December 2015 at the University College Hospital, Ibadan, Nigeria. The patients were categorized based on the need for bowel resection and analysis done using the SPSS version 23.
Results: 121 children were managed for intussusception during this period. 53 (43.8%) had bowel resection, 61 (50.4%) did not require resection and 7 (5.8%) were unknown. 40 (75.5%) of the resections were right hemi-colectomy. The presence of fever, abdominal pain, distension, rectal mass, age < 12 months, heart rate > 145/min and duration of symptoms > 2 days were associated with the need for bowel resection (p < 0.05). However, only age and abdominal pain independently predicted need for resection. Bowel resection was more associated with development of post-operative complications and prolonged hospital stay (p < 0.05).
Conclusion: Infants presenting with abdominal pain and abdominal distension after two days of onset of symptoms were more likely to require bowel resection. Resection in intussusception significantly increased post-operative complications and length of hospital stay.
Keywords: Paediatric intussusception; bowel resection; developing countries.
Household and individual risk factors of anaemia among under-5 children in Lesotho
Authors: Letuka Teboho , Frade Sasha 
Published: October 2020

Background: Anaemia among under-5 children is a major public health issue worldwide. Some countries with a high prev- alence of anaemia also have high prevalence of malaria. Even though Lesotho does not have a high prevalence of malaria, its prevalence rate of anaemia is as high. According to the 2014 Lesotho Demographic and Health Survey (DHS), the prevalence of anaemia among children under-5 was 51%. Other factors could be influencing the prevalence of anaemia in Lesotho.
Objectives: This study examined the household and individual risk factors of anaemia among children under-5 in Lesotho.
Methods: Data from the 2014 Lesotho DHS which included 924 children under-5 years were analysed. Descriptive statistics, chi-square cross-tabulations and ordered logistic regression models were run using Stata v15.
Results: Twenty-one percent (21%) of children under-5 had mild anaemia while 7% had severe-moderate anaemia. Children residing in households cooking with biogas (aOR=4.88, CI: 1.28-18.58) and those living in households that cook with bio- mass (aOR=4.22, CI: 1.40-12.67) had higher odds of severe-moderate anaemia.
Conclusion: Using solid fuels for cooking increases the vulnerability of children under-5 developing anaemia. Therefore, knowledge of renewable energy resources should be increased. This will help reduce levels of anaemia among under-5 chil- dren in Lesotho.
Keywords: Household and individual risk factors; anaemia; under-5 children; Lesotho.
Reasons for migrating to Ho Chi Minh City
Authors: Ha Nguyen Minh , Tai Vo Phuoc , Thai Nguyen Quang 
Published: October 2020

During the last 20 years, Vietnam has had a prompt economic development, the people have the trend for emigrating from the rural to urban areas, industrial zones and the trading-service centre where it is essential for labor needs to serve for the industrial and service development in order to look for the better jobs. The wave of emigrants have not only contributed to an increase in population in Ho Chi Minh City (HCMC) and other urban centers in Vietnam but also augmented pressure in the infrastructure system and the issues of social life.
With the method of Exploratory Factor Analysis (EFA), this research had indicated the main factors impacting on making a decision for migration to the Ho Chi Minh City, by the collected data directly from 277 surveyed forms of immigrants to HCMC. There are 6 decisive factors including: (1) HCMC‟s politics and policies; (2) the family situation and the embroilment of the
friends and fellow-countrymen; (3) better quality needs of life and individual aspirations; (4) the job opportunities and occupational development conditions; (5) the job demands with stable incomes; and (6) the marriage and living with relatives.
Título en español.
Authors: H. Irizarry  , J. Howard Ellison  , Portia Orton  
Published: October 2020

El 11 de noviembre, cuando el follaje de las demás plantas era amarillo o pardo, se seleccionaron en un campo de New Jersey dos plantas de espárrago, cuyo follaje era de un color verde obscuro, el cual se designó como "verde-persistente". Para estudiar este carácter genético las dos plantas se cruzaron entre sí y luego también se cruzó cada una con otras plantas de color normal. El estudio tuvo como propósito secundario el determinar mediante el uso del espectrofotómetro, el efecto que el gene o genes responsables del color puedan tener sobre el sistema de pigmentación de las plantas de espárrago. También se trató de identificar en plántulas en el invernadero los imitantes de color verde-persistente. El estudio del fenotipo de 17 progenies F1, F2 y del retrocruce1, indicó que el color verde-persistente en el follaje de la planta de espárrago se hereda como un gene recesivo simple. Se observó una gran diferencia cuantitativa de clorofila y carotina entre las plantas de follaje verde-persistente y las de color normal en el mes de octubre, pero no en julio. Aparentemente, los mutantes retienen la clorofila y la carotina hasta más tarde en el otoño que las plantas de color normal. No se observaron diferencias cualitativas entre los pigmentos en ambos tipos de planta durante julio u octubre. Fue fácil diferenciar entre las plantas de espárrago de color verde-persistente (follaje verde) y las de color normal (follaje amarillo) en el invernadero cuando tenían 6 semanas de nacidas.
Investigation of Wind Energy Potential at Selected Locations in the Volta Region of Ghana
Authors: Nii Laryea Gabriel , A. Otu-Danquah Kwabena 
Published: October 2020

The cost of extending electrical power systems to remote areas is expensive and the option is to decentralise small scale energy power systems that could meet the demand in those areas. Wind potential at selected locations in Ghana has been studied for wind energy purpose since there is an increase in socio-economic development in the country. Four (4) of the three-cup anemometers and data-loggers were installed on a 20-m and 30m masts at Amedzofe, Anloga, Areeba-Nkwanta and Kue-Nkwanta (all in the Volta region). The recorded data were analyzed using STATISTICAL software and calculations were made to obtain the Weibull distribution two-parameters and prediction for hourly, monthly mean wind speeds and mean wind power densities were predicted at 50 m above ground level. Among the selected sites, the mean wind power density of Amedzofe and Anloga fell into Classes 3 and 6 of the commercially international system of wind classification respectively, while Areeba-Nkwanta and Kue-Nkwanta fell into Class 2. Anloga is therefore a suitable site for wind power generation to serve the community.
Keywords: Wind power potential; Wind atlas analysis and application program (WAsP); Weibull distribution; Wind speed; Wind power density.
Drive Cycle Performance of Hybrid-Electric Vehicles
Authors: Kafui Ayetor Godwin , Gyamfi George Bright , Tetteh Larnor Ebenezer 
Published: October 2020

This paper focuses on the effects of HEV (Hybrid-Electric Vehicles) Powertrains on fuel economy and overall system efficiency. Three different hybrid-electric powertrains: Series; Parallel and Combined have been simulated on ADVISOR by the use of MATLAB platform. Three drive cycles, Urban Dynamometer Driving Schedule (UDDS), New European Driving Cycle (NEDC) and Highway Fuel Economy Transport Cycle (HWFET), were used to determine best Fuel Economy, Overall System Efficiency and Energy usage for each Powertrain.While Parallel Powertrain showed best fuel economy and system efficiency at lower speeds (20 mph) during frequent start-stops, Combined Hybrid showed much more significant fuel savings at constant speeds above 48 mph. In situations where both battery and engine power were required simultaneously, Combined Hybrid showed much higher system efficiency giving credence to its PowerSplit device. In conclusion, the selection of the preferred Powertrain for Hybrid Electric application depends strictly on the application required. The results clearly show that advantages of both Series and Parallel powertrains have not been effectively harnessed in the Combined Powertrain as expected. This highlights the need for a Powertrain which effectively saves fuel at all speeds irrespective of number of idle times or stops.
Keywords: Hybrid electric vehicle; zero emissions; combined hybrid; series hybrid; parallel hybrid; electric vehicles; fuel cells
Agribusiness Strategy: Adding Value to the Mushroom Value Chain
Authors: Ahenkora Kwaku , Yarhands Arthur Dissou , Banahene Stephen 
Published: October 2020

Strategy should begin with the understanding of customer needs which can be determined through perceptions of channel partners or direct research. In line with this, the study conducts a qualitative value chain audit of the mushroom industry with a view to understanding priorities. Structured and semi-structured interviews were conducted with value chain players of the 'mushroom growers and export association'. Value chain participants prioritised changing customerperceptions to improve demand, and to grow the market through penetration and the management of factors that influence the marketing mix, and the provision of quality inputs to improve production and influence the need to address the problem of access to finance and a strong association that advocates for matters of the industry. The study concludes that qualitative value chain analysis of participants' perspectives provides the means for understanding of priority activities for value creation. The study recommends further quantitative value chain analysis that measures the actual value that prioritised value chain activities could generate.
Keywords: Agribusiness; mushroom; value chain, strategy, qualitative.
Strategic Repositioning of Koforidua Polytechnic
Authors: Okae-Adjei Samuel 
Published: October 2020

The study seeks to find out what changes are taking place in strategy in Koforidua Polytechnic and why? The methodology used in the study is based on qualitative approaches of documentary analysis. Data is collected through a content analysis of relevant documents. The scope of the study is limited to the researcher's interpretation of the strategic changes identified and articulated in official polytechnic documents. A framework for assessing and modeling changes in strategy provided by Ginsberg (1988) is adapted to suit the higher education context and applied in the analysis. The adapted framework is used as a tool to conceptualize changes in strategy in Koforidua Polytechnic. The findings indicate significant changes in strategy in Koforidua Polytechnic. The leadership of the polytechnic has introduced new strategic directions for the polytechnic, focusing on the provision of infrastructure facilities, improving financial resource mobilization, promoting research, strengthening collaborative partnership at home and abroad, and promoting good governance and planning. External and internal conditions provide pressure for the shift in strategic direction. The change in direction is a necessary measure which ensures the future of the polytechnic.
Keywords: Strategy, Strategic change, Strategic planning, Higher education, Koforidua Polytechnic.
A dynamic framework for managing the complexities of risks in megaprojects
Authors: Boateng Prince , Chen Zhen , Ogunlana Stephen O. 
Published: October 2020

The future of mega infrastructure projects is certain - there will be more risks to manage! The challenge is being met through research and innovation combining current approaches with new. This research adopted a dynamic approach through the combination of Analytical Network Process (ANP) and system dynamics (SD) as an innovative methodology known as SDANP to model complexity in megaprojects design and construction. Wecommunicate how the SDANP model could explore problems caused by Social, Technical, Economic,Environmental and Political (STEEP) risks to construction cost, time and performance and provide insights thatlead to organizational learning. We proceed to exemplify by means of a real-life case project in the City ofEdinburgh and offer suggestions on what front-ended stakeholders could do to improve the management of risks in megaprojects. The results of the application showed that, when compared to traditional risks assessment methods, this SD model with integrated ANP revealed improvements in managing risks according to STEEP risks criteria. The new framework appears to be a superior solution for solving the dynamic complexities of risks during megaproject design and construction. The findings of the study contribute to the project management theoretical development within the field of megaproject management.
Keywords: Analytical Network Process, megaprojects, risk complexity, system dynamics