bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inequality in institutional delivery of the recent birth among married women in Nepal: a trend analysis
Authors: Adhikari Ramesh , Wagle Aakriti 
Published: September 2020

Abstract
Background The huge discrepancy in health statistics between developed and developing countries occur in the area of maternal mortality, with developing countries contributing most of the figures. Nepal has higher maternal mortality ratio than its South Asian neighbors. This study assesses the trend of institutional delivery of recent birth and compared the inequalities with associated factors that affect institutional delivery in Nepal.Methods The data for this study was obtained from three sequential Nepal Demographic and Health Surveys [NDHS] of 2006, 2011, and 2016. The information was collected from mothers having a child within last five years preceding the survey years. The total number of such mothers was 4066, 4148, and 3998 respectively in the survey of 2006, 2011, and 2016.The association between institutional delivery and the explanatory variables was assessed via bivariate analysis (chi-square test) and multivariate analysis (binary logistic regression).Results The utilization of health service during delivery stepped up from 21% in 2006 to 62% in 2016.Although the proportion of delivery in health facility increased among poorest over the period of 10 years, the disparity between richest and poorest still persisted from 2006 to 2016 and the association was highly significant in all the surveys. Although, government of Nepal has launched the maternity incentive scheme through safe delivery incentive program in 2005, poor women are still deprived from utilizing the service. Poorest and poorer women were 78 percent (aOR=0.22, 95% CI 0.17-0.27) and 71 Percent (aOR=0.23, 95%CI 0.23-0.35) respectively less likely to have institutional delivery than the richest women after controlling the other socio-demographic and culture factors. Furthermore, this study found that education, place of residence, women’s autonomy, religion, number of ANC visits, exposure to newspaper and TV were significant predicators for place of delivery. Conclusion Although there has been three-fold increment in utilization of health services during delivery over the period of 10 years, the discrepancy between rich and poor, educated and uneducated and urban and rural area is highly evident. Overall, our study highlights the necessity of interventions to promote institutional delivery with greater focus on poor, uneducated, and rural women.
Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study
Authors: Foo Chuan De , Surendran Shilpa , Tam Chen Hee , Ho Elaine Qiao Ying , Matchar David Bruce , Car Josip , Koh Gerald Choon Huat 
Published: September 2020

Abstract
Background: The increasing chronic disease burden in developed countries has placed tremendous strain on tertiary healthcare infrastructure and resources. Therefore, there is an urgent need to shift chronic disease management from tertiary to primary care providers to mitigate the increase in demand for chronic care at hospitals. The organization of private general practitioners (GPs) into Primary Care Networks (PCNs) is a pragmatic move by Singapore, a developed and multi-ethnic urban city, to provide private GPs with team-based care capabilities and a platform to track care indicators for better management of chronic patients. As the PCN initiative is still in its embryonic stages, there is a void in research regarding its ability to empower private GPs to manage chronic patients effectively. This qualitative study aims to explore the facilitators and barriers for the management of chronic patients by private GPs in the PCN. Method: We conducted 30 semi-structured in-depth interviews with GPs enrolled in a PCN. Qualitative analysis of audio transcripts was performed to generate themes which highlighted the facilitators and barriers faced by PCN in the early stages of its development. Results: Our results suggest that PCNs facilitated private GPs to more effectively manage chronic patients through 1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a “one-stop-shop”, 2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and 3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions.Conclusion: PCNs demonstrate great promise in empowering and motivating private GPs to manage chronic patients. However, barriers will need to be addressed to ensure the quality and comprehensiveness of PCNs in managing more chronic patients in the face of an ageing population.
Health related QoL in Celiac Disease patients in Slovenia
Authors: Turk Eva , Micetic-Turk Dusanka , Šikić-Pogačar Maja , Tapajner Alojz , Vlaisavljević Veljko , Rupel Valentina Prevolnik 
Published: September 2020

Abstract
Background: Measurements of health-related quality of life (HRQoL) among celiac disease patients using a validated questionnaire have been lacking in Slovenia. This study aims to measure HRQoL in celiac disease (CD) patients using EQ-5D internationally validated questionnaire and comparing it to the HRQoL of the general population. Methods: In this cross sectional analysis all of the approximately 2,000 members of the Slovenian Celiac Society were invited to take part. We used a 3 step approach for recruitment and data collection. HRQoL was evaluated through the EuroQoL EQ-5D-5L instrument (Slovenian version) and analysed using the ordinal logistic regression. Results: Out of 321 patients who gave their consent, 247 celiac patients were included in the study (77%). 68% of the participants were female and 53% of them lived in an urban setting. Most patients originated from North-East Slovenia, whereas approximately 30% of patients came from other Slovenian regions. The EQ-5D respondents’ self-reported health status at the time of the study show that most patients have slight or no problems when living with CD. The duration of the gluten-free diet, academic education and rare (<1x year) doctor visits affect EQ-5D in a positive way. On the other hand, higher age and chronic rheumatic disease were negatively associated with EQ-5D also when compared to the general population. Conclusion: This is the first Slovenian study to measure the HRQoL of Slovenian CD patients, using an internationally validated questionnaire. The results of our study show that HRQoL is slightly impaired among Slovenian patients with CD. Clinical characteristics are better determinants of their HRQoL than socio-demographic factors. Greater awareness of the impact of CD on patients’ HRQoL would improve the holistic management of CD patients.
Mixed type of total anomalous pulmonary venous connection: diagnosis, surgical approach and outcomes
Authors: Xiang Ming , Wu Chun , Pan Zhengxia , Wang Quan , Xi Linyun 
Published: September 2020

Abstract
Purpose

To summarize the diagnosis and treatment of 13 patients with mixed-type total anomalous pulmonary venous connection (TAPVC) and propose another classification for mixed TAPVC.

Methods

A retrospective review of 13 patients with mixed TAPVC undergoing repair at a single institution was conducted between January 2010 and November 2019. The diagnosis of mixed-type TAPVC was made in all patients using echocardiography combined with computed tomography angiography. According to the mixed TAPVC anatomy, there were 3 patients with type I TAPVC (2+2 veins), 10 patients with type II TAPVC (3+1 veins) and no patients with type III TAPVC. Correspondingly, there was 1 patient with the “SVC+VV” subtype, 2 patients with the “CS+C” subtype, 8 patients with the “CS+VV” subtype, 1 patient with the “CS+SVC” subtype and 1 patient with the “RA+SVC” subtype according to our classification system. All patients underwent cardiopulmonary bypass surgery.

Results

The median weight at surgery was 4.6±1.0 kg (3.4-7.3 kg), and the median age at surgery was 96.2±81.2 days (10-242 days). The median cardiopulmonary bypass time was 132.7±25.1 minutes (range, 100 to 190 min). The cross-clamping time was 69.2±14.4 minutes (range, 45 to 88 min). The hospital mortality rate was 7.7% (1 of 13), with late mortality occurring in 1 patient because of pulmonary venous obstruction (PVO) 7 months after surgery. The average follow-up after surgery was 3.4 ± 2.2 years (range, 5 months to 8 years). The survival rates at 3 and 5 years were both 90.9% ± 8.7% (95% CI: 73.8%-108%). All remaining surviving patients were asymptomatic.

Conclusion

Mixed TAPVC can be repaired with good results in children and can be correctly diagnosed with echocardiography combined with computed tomography angiography. The classification system we propose is pragmatic and can guide the surgical approach.
Time trends in the regional distribution of physicians, nurses and midwives in Europe
Authors: Winkelmann Juliane , Muench Ulrike , Maier Claudia B. 
Published: September 2020

Abstract
Background. Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends.Methods. We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 145 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).Results. There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.5-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tendeds to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives.Conclusions. The study shows for the first time theThe large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data at in sub-national geographic areas in order for workforce planners, employers, educators and others to develop integrated health workforce policies and initiatives that may impact supply offor health professionals at regional levels.
Recent Challenges and Advances in the Sensorless Commutation of Brushless DC Motors
Authors: Soni Umesh K. , Tripathi Ramesh K. 
Published: September 2020

Background:
Brushless DC motors are highly efficient motors due to their high torque to
weight ratio, compact design, high speed operating capability and higher power density. Conventional
Hall sensor based rotor position sensing is affected by the heating, vibration, interference and noise.

Objective:
The innovative, cost-effective and easily implementable sensorless techniques are essential
in order to achieve high efficiency, reduced current and reduced torque pulsations. Furthermore,
a delay free, high load fast startup is also an important issue.

Methods:
In this paper, an extensive review of various techniques based on the detection of freewheeling
diode current, phase back EMF zero crossing point detection, back EMF integration method
and third harmonic back EMF was done. The effect of various PWM strategies on back EMF
detection were studied. Later on, the sensorless schemes based on flux linkage estimation and flux
linkage increment were introduced. The load torque observers, unknown input observers, sliding
mode observers, L∞ − induced observers, H∞ − deconvolution filter for back EMF estimation were
also reviewed. As the brushless DC motors have no back EMF at starting and for back EMF based
commutation, minimum speed is required for sufficient back EMF. Therefore various strategies of
an open and close-loop reduced current startup have been studied to achieve effective commutation
without reverse torque. Initial Position Detection (IPD) schemes, which are mostly based on saliency
and current response to inductance variation, are effective where reverse torque is strictly prohibited.
A detailed review of these Initial Position Detection techniques (IPD) has also been presented.

Results:
The detailed mathematical and graphical analysis has been presented here in order to understand
the working of the state-of-the-art sensorless techniques.

Conclusion:
The back EMF detection using direct and indirect methods of terminal voltage filtering
has the problem of delay and attenuation. PWM noise, freewheeling diode spikes and disturbance in
detected back EMFs are also major drawbacks. The problems such as, parameter detuning, underestimation
and overestimation, offset problem, system noise and observer gain variation, etc. limit the
applicability of observer based technique. Therefore, a more robust and precise position estimation
scheme is essential.
Surface Water Purification Using Blended Coagulant’s -A Sustainable Approach
Authors: Saritha Vara , Karnena Manoj Kumar , Dwarapureddi Bhavya Kavitha 
Published: September 2020

Background:
Solutions to challenges of access to potable water have been the
focus of many studies around the world, which also is one of the goals of sustainable development.

Objective:
This study attempts to address this issue wherein we tested the efficiency of
blended coagulants in removing pollutants from surface water. Previous studies have reported
and suggested the requirement of blended coagulants that are tailor-made for treating
geographically specific water samples since single coagulants will not be effective in
removing all pollutants.

Methods:
Three coagulants, two natural and one chemical, were blended for the present
study in various ratios. Turbidity removal of the bi and tri-blend coagulants of water samples
with initial turbidity of 70 and 150NTU was above 95% - 100%.

Results:
Removal of Physico-chemical parameters by blended coagulants in surface waters
was up to 48% for electrical conductivity, 80% for total solids, 36% for hardness,
40% for alkalinity and 57% for chlorides. The results are supported with analysis from
SEM images showing adsorbed floc on to coagulant and FTIR spectra presenting the
functional groups responsible for coagulation.

Conclusion:
Hence, it can be concluded that the natural coagulants tested in the present
study are promising solutions for the challenges of water quality.
SARS-CoV-2 and its Predicted Potential Natural Inhibitors: A Review and Perspective
Authors: Samji Priyanka , Rajendran Manoj Kumar , Warrier Vidya P. 
Published: September 2020

:
SARS-CoV-2, a novel coronavirus, has caused the pneumonia outbreak in the entire world
and every day, the number of cases is increasing in an exponential manner. Unfortunately, there is no
clinically approved drug or vaccine specific for SARS-CoV-2 to date, and analysis of the current rate of
spread of infection suggests that there is no time to wait for the approval of drugs and vaccine production.
The sequence and phylogenetic analysis of SARS-CoV-2 has shown that it is very much similar to
SARS/SARS-like coronaviruses and belongs to the betacoronavirus genera and bats are likely to be the
native host of the SARS-CoV-2. Interestingly, the SARS-CoV-2 S protein and SARS-CoV S protein
shared an almost identical 3-D structure in the RBD domain and the SARS-CoV-2 S protein was found
to have a significant binding affinity to human ACE2. Further, RdRp and 3CLpro protease of SARSCoV-
2 share over 95% of sequence similarity with those of SARS-CoV. Recently, various molecular
docking studies have been carried out to search for natural compounds that can target S protein, RdRp,
3CLpro, and nsp proteins of SARS-CoV-2. This review is an attempt to give a comprehensive idea of
the different natural products that can be used to target SARS-CoV-2. However, further research is necessary
to investigate the potential uses of these predicted SARS-CoV-2 inhibitors in combating the
COVID-19 pandemic.
Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial
Authors: Steinberg Dori M , Kay Melissa C , Svetkey Laura P , Askew Sandy , Christy Jacob , Burroughs Jasmine , Ahmed Hira , Bennett Gary G 
Published: September 2020

Background
Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed.

Objective
This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension.

Methods
We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure.

Results
The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: –2.8 mmHg, 95% CI –1.8 to 7.4; P=.23) and diastolic (mean difference: –3.6 mmHg, 95% CI –0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals.

Conclusions
A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH.

Trial Registration
ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472
EVALUATION OF MYRICETIN NANOPHYTOSOME WITH THIN-SONICATION LAYER HYDRATION METHOD USING ETHANOL AND ACETONE SOLVENTS
Authors: PURNAMASARI NUR AINI DEWI , DZAKWAN MUHAMMAD , PRAMUKANTORO GANET EKO , MAULUDIN RACHMAT , ELFAHMI  
Published: September 2020

Objective: Nano-phytosome is a nanotechnology that is used to improve the bioavailability of active ingredients contained in plants by binding to active ingredients with phospholipids which have properties that resemble cell membranes. The active ingredient used in the nano-phytosome formulation is myricetin. Myricetin is a natural flavonoid compound that has antioxidant properties with low bioavailability and permeability. The purpose of this study was to determine the characterization of the nano-phytosome myricetin formulation with different solvents using ethanol and acetone.
Methods: Nano-phytosome was made using a thin-sonication hydration method by comparing the acetone and ethanol solvents as well as the variation of the myricetin: phosphatidylcholine: cholesterol ratio. Characterization of nano-phytosome includes particle size, polydisperse index, zeta potential, absorption efficiency and antioxidant activity, and TEM test.
Results: Characterization and evaluation of myricetin nano-phytosome using two different solvents, acetone and ethanol. The particle size of all formulas has a size between 10-1000 nm, the use of ethanol solvent produces the smallest particle size of 198.1 ± 1,74 nm and the lowest polydispersity index of 0.175 ± 0,020 in ethanol solvent.
Conclusion: The ethanol solvent is better compared to the acetone solvent, and the best formula is formula 4 with the ratio of myricetin: phosphatidylcholine: cholesterol (1: 1: 0.4).
BORON-SILICA BASED MESOPOROUS FOR CURCUMINOID ISOLATION FROM TURMERIC EXTRACT
Authors: FIRMANSYAH ADANG , NUGRAHANI ILMA , WIRASUTISNA KOMAR RUSLAN , IBRAHIM SLAMET 
Published: September 2020

Objective: The purpose of this study was to develop the isolation method for curcuminoid from turmeric extract using boron-silica based mesoporous as an adsorbent.
Methods: The formation of mesoporous materials were conducted using the sol-gel technique. The characterization of mesoporous materials was analyzed using a scanning electron microscope (SEM), transmission electron microscope (TEM), and Fourier transforms infrared spectrometry (FTIR). The extraction of turmeric was done by solvent extraction using ethanol 96 %. The isolation of curcuminoid was achieved by the adsorption method using mesoporous materials, both for silica-based mesoporous (MCM) and boron-silica based mesoporous (BMCM). The elution of curcuminoid-loaded mesoporous was conducted using various solvents. The concentration of total curcuminoid and its compounds was measured by visible spectrometry and high-performance liquid chromatography (HPLC).
Results: Morphology of MCM and BMCM shows the homogenous regular spherical shape, but having a different size. MCM has a smaller diameter particle size (500-600 nm) compared to BMCM (700-900 nm). On the other hand, BMCM has a smaller pore size (1-5 nm) compared to MCM (5-20 nm). The FTIR spectra of BMCM shows the additional vibration at 1400-1600 cm for B-O-H bond. Visible spectrometry measurement shows that the highest concentration of curcuminoid eluted from BMCM is 65.411±0.056 ppm by using ethyl acetate as a solvent, while the concentration of curcuminoid eluted from MCM is 11.503±0.054 ppm by using the same solvent. The results of curcuminoid adsorption and elution, indicating that ethyl acetate is the best solvent to elute curcuminoid due to its 98.83 % purity using HPLC analysis.
Conclusion: It was concluded that boron-silica based mesoporous showed stronger curcuminoid adsorption than silica-based mesoporous therefore found to be a potential adsorbent for curcuminoid isolation from turmeric extract.