bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Balanced Opioid Initiative: Protocol for a clustered, sequential, multiple-assignment randomized trial to construct an adaptive implementation strategy to improve guideline-concordant opioid prescribing in primary care
Authors: Quanbeck Andrew , Almirall Daniel , Jacobson Nora , Brown Randall T. , Landeck Jillian K. , Madden Lynn , Cohen Andrew , Deyo Brienna MF , Robinson James , Johnson Roberta A. , Schumacher Nicholas 
Published: April 2020

Abstract
Background Rates of opioid prescribing tripled in the United States between 1999 and 2015 and were associated with significant increases in opioid misuse and overdose death. Roughly half of all opioids are prescribed in primary care. Although clinical guidelines describe recommended opioid prescribing practices, implementing these guidelines in a way that balances safety and effectiveness vs. risk remains a challenge. The literature offers little help about which implementation strategies work best in different clinical settings or how strategies could be tailored to optimize their effectiveness in different contexts. Systems consultation consists of: (1) educational/engagement meetings with audit and feedback reports, (2) practice facilitation, and (3) prescriber peer consulting. The study is designed to discover the most cost-effective sequence and combination of strategies for improving opioid prescribing practices in diverse primary care clinics.Methods/Design The study is a hybrid type 3 clustered, sequential, multiple-assignment randomized trial (SMART) that randomizes clinics from two health systems at two points, months 3 and 9, of a 21-month intervention. Clinics are provided one of four sequences of implementation strategies: a condition consisting of educational/engagement meetings and audit and feedback alone (EM/AF), EM/AF plus practice facilitation (PF), EM/AF + prescriber peer consulting (PPC), and EM/AF + PF + PPC. The study’s primary outcome is morphine-milligram equivalent (MME) dose by prescribing clinicians within clinics. The study’s primary aim is the comparison of EM/AF + PF + PPC versus EM/AF alone on change in MME from month 3 to month 21. The secondary aim is to derive cost estimates for each of the four sequences and compare them. The exploratory aim is to examine four tailoring variables that can be used to construct an adaptive implementation strategy to meet the needs of different primary care clinics.Discussion Systems consultation is a practical blend of implementation strategies used in this case to improve opioid prescribing practices in primary care. The blend offers a range of strategies in sequences from minimally to substantially intensive. The results of this study promise to help us understand how to cost effectively improve the implementation of evidence-based practices.Trial registration NCT 04044521 (ClinicalTrial.gov). Registered 05 August 2019.
Impact of Smoking Status on Hospital Outcome of Patients with ST-Segment Elevation Myocardial Infarction Either Treated by Pharmacy-invasive Strategy or Primary Percutaneous Coronary Intervention .
Authors: Alaarag Ahmed , Hassan Timoor , Abouomar Mahmoud 
Published: April 2020

Abstract
Background: Smoking is a common public problem with a high health burden. Many studies have shown that there are many hazardous actions of smoking on body systems especially haemostatic, respiratory and circulatory systems.Smoking may increase the thrombus burden in patients with acute coronary syndrome. The ‘smoker’s paradox’ has been described for more than 25 years. Its existence and its effect on patients’ outcome post myocardial infarction are debatable. So we conducted our study to assess the impact of smoking status on outcome of STEMI patients and efficacy of pharmaco-invasive strategy in treating STEMI patients compared to PPCI. Methods: We conducted our prospective observational study in the Cardiology department from-August 2018 to August 2019 on patients who are presented by STEMI with the duration from onset of symptoms to first medical contact were 12 hours or less we included 199 patients in our study.Patients are divided into 4 groups Group 1(Smokers treated by PPCI) Group 2 (Non-smokers treated by PPCI) Group 3 (Smoker treated by pharmaco-invasive strategy)Group 4 (Non-smoker treated by pharmaco-invasive strategy) TIMI flow before and after PCI, acute heart failure and death was assessed in each patient.Results:Smokers are younger than non-smokers and have fewer co-morbidities. Patients treated by primary PCI and pharmaco-invasive strategy either smokers and non-smokers there was no significant difference between the 4 groups in angiographic data and outcome except that smokers treated by pharmaco-invasive strategy had a lower incidence of TIMI flow III at diagnostic angiography before PCI with P value (0.047 ) Conclusion: There is no actual smokers paradox. Pharmaco-invasive strategy is a good option when a PPCI is not available. Finally, early transfer of smokers treated with a pharmaco-invasive strategy to a PCI capable hospital for early intervention may be recommended.
Hypofractionated palliative volumetric modulated arc radiotherapy with the Radiation Therapy Oncology Group 8502 “QUAD shot” regimen for incurable head and neck cancer
Authors: Toya Ryo , Saito Tetsuo , Yamaguchi Kohsei , Matsuyama Tomohiko , Watakabe Takahiro , Matsumoto Tadashi , Yoshida Ryoji , Hirosue Akiyuki , Murakami Daizo , Orita Yorihisa , Nakayama Hideki , Oya Natsuo 
Published: April 2020

Abstract
Background : To review a single institutional experience of the Radiation Therapy Oncology Group (RTOG) 8502 “QUAD shot” regimen using volumetric modulated arc radiotherapy (VMAT) for incurable head and neck cancer (HNC). Methods : Thirty-four consecutive patients with HNC were treated with at least 1 cycle of the RTOG 8502 regimen. Treatment plans included the use of VMAT with 6 MV photons generated by a linear accelerator. Two daily fractions of 3.7 Gy were delivered with an interval of at least 6 h for 2 consecutive days, totaling 14.8 Gy over 4 fractions. This was repeated every 3–4 weeks for a total of 3 cycles. No concurrent systemic therapy was performed. Results : The number of completed cycles was 1 in 6 (18%) patients, 2 in 5 (15%), and 3 in 23 (68%). Tumor response was achieved in 29 (85%) patients and symptom relief in 20 (77%) of 26 patients. Overall response (tumor response or symptom relief) was achieved in 32 (94%) patients. All patients who received 2 or more treatment cycles achieved overall response. Median overall survival (OS) was 5.7 months. Multivariate analysis revealed that completion of all 3 treatment cycles was significantly associated with better OS ( P = 0.002). Grade 2 toxicity was observed in 4 (12%) patients, but no acute or late toxicities of Grade ≥3 were observed. Conclusions : The RTOG 8502 “QUAD shot” regimen using VMAT is effective for incurable HNC with highly reduced toxicities. Treatment with multiple cycles is recommended for better treatment response and/or survival.
Reducing regional inequality in community-based treatment of childhood pneumonia in Ethiopia: A sub-national distributional cost-effectiveness analysis
Authors: Olsen Maria , Norheim Ole F. , Memirie Solomon Tessema 
Published: April 2020

Abstract
Background

Scaling up coverage of community-based treatment of childhood pneumonia (CCM) is part of the strategy to promote equity and reduce under-five mortality rate (U5MR) in Ethiopia. However, urban children with symptoms of pneumonia are still more than twice as likely to receive treatment compared with rural children having similar symptoms. There are no sub-national cost-effectiveness analyses available to inform decision makers on the most equitable scale-up strategy.

Objectives

To model sub-national cost-effectiveness and inequality impacts of scaling up coverage of CCM in each of the 11 Ethiopian regions. We also explore three different scale-up strategies: reducing geographical inequalities, health maximization and universal scale-up.

Methods

For each region, we developed a Markov model and estimated the cost-effectiveness of scaling up coverage to 90 percent. Data inputs were collected through literature review. Effects were modeled as life years gained and under-five deaths averted. Inputs on unit costs were adjusted to the proportions of rural and urban population in each region. In scenario analysis, we estimated costs, health effects and, by the use of the Gini measure applied to health, the inequality impacts of three different scale-up strategies: 1) maximizing health by prioritizing the regions where the intervention was the most cost-effective, 2) reducing geographical inequality by prioritizing the regions with the highest baseline U5MR and 3) universally scaling up to 90% coverage in all the regions.

Results

Universal scale-up of CCM would cost about 1.3 billion USD and prevent about 90,000 under-five deaths. This is less than 15,000 USD per life saved and translates to an increase in life expectancy at birth of 1.6 years across Ethiopia. The regional incremental-cost effectiveness ratio (ICER) of scaling up the intervention coverage varied from 26 USD per life year gained in Addis to 199 USD per life year gained in the SNNP region. In scenario analysis, we found that prioritizing regions with high U5MR is effective in reducing geographical inequalities, although at the cost of some fewer lives saved.

Conclusions

Our model results illustrate a trade-off between maximizing health and reducing health inequalities, two common policy-aims in low-income settings.
Intention Matters: Future medical student practice intentions vary by cohort
Authors: Clithero-Eridon Amy , Crandall Cameron , Ross Andrew 
Published: April 2020

Abstract
Background: Primary care is a broad spectrum specialty that can serve both urban and rural populations. It is important to examine the specialties students are selecting to enter, future community size they intend to practice in as well as whether they intend to remain in the communities in which they trained.Aim: The goals of this study were to characterize the background and career aspirations of medical students. Objectives were to (1) explore whether there are points in time during training that may affect career goals and (2) assess how students’ background and stated motivations for choosing medicine as a career related to intended professional practice.Setting: The setting for this study was the Nelson R. Mandela School of Medicine, located in Durban, South Africa.Methods: We conducted a cross-sectional survey of 597 NRMSM medical students in their first, fourth, or sixth-year studies during the 2017 academic year.Results: Our findings show a noticeable lack of interest in primary care, and in particular, family medicine amongst graduating students. Altruism is not as motivating a factor for practicing medicine as it was among students beginning their education.Conclusion: Selection of students into medical school should consider personal characteristics such as background and career motivation. Once students are selected, local context matters for training to sustain motivation. Selection of students most likely to practice primary care, then emphasizing family medicine and community immersion with underserved populations, can assist in building health workforce capacity.
City Lockdown and Nationwide Intensive Community Screening Are Effective In Controlling COVID-19 Epidemic: Analysis Based on A Modified SIR Model
Authors: Peng Tailai , Liu Xinhao , Ni Hefeng , Cui Zhe , Du Lei 
Published: April 2020

Abstract
In December 2019, an outbreak of COVID-19 epidemic occurred in Wuhan, China and this infection has spread rapidly into more than 109 countries around the world. To limit the rapid spread in community and nationwide, Wuhan city lockdown and nationwide intensive community screening were employed by Chinese government. To assess the effectiveness of city lockdown and intensive community screening, we built a modified SIR model by introducing an α value into the classic SIR model. The α value represents the proportion of the infected that is not effectively isolated from the susceptible at a given time point. The α value of China excluding Hubei province was largely reduced by Wuhan city lockdown. Although the α value of Wuhan city dropped a little with city lockdown, but dropped rapidly with intensive community screening. With the decrease of α value, the epidemic in China would be end at the beginning of June 2020. With current epidemiological data, the infection cases in South Korea and Italy are predicted to increase exponentially in the next days, if stringent mitigation measures were not adopted.Authors Tailai Peng and Xinhao Liu contributed equally to this work.
Developing a Web-based decision support system for reservoir flood management
Authors: Ghobadi Mokhtar , Kaboli Hesam Seyed 
Published: April 2020

Abstract
Proper management of reservoirs in flood conditions minimizes flood damage and keeps the reservoir in a stable condition. This paper presents a Web-based decision support system of reservoir flood management (WDRFM) for reservoirs with gated spillways. WDRFM is capable of estimating the current situation of the reservoir and before the flood reaches the reservoir, provides the operator with suggestions to have optimal control over gates, using multistage simulation-optimization models to minimize flood damage downstream. Investigating the possibility of changing the dam's discharge gates, carrying out dam pre-release, and announcing relevant flood control warnings can all be performed by WDRFM, while allowing the operator to determine such observations and make final decisions on a time step basis. To assess the performance of WDRFM, 15 scenarios in four groups for flood management were defined on April 14, 2016 at Dez Dam, Iran. A comparison of one scenario with similar initial conditions with the occurrence of flood event has shown that a daily peak discharge shows 997 m3/s decrease from that recorded by the operator. The ability to examine different scenarios based on the conditions at any time in the WDRFM enables the decision-makers and operators to confront various circumstances.
Research Progress of the UPR Mechanism and its Effect on Improving Foreign Protein Expression
Authors: Wang Bao-Chen , Zhang Si-Tong , Chen Guang 
Published: April 2020

:
The unfolded protein response (UPR) is a protective mechanism against endoplasmic
reticulum (ER) stress that induces a series of signal transduction pathways to eliminate misfolded
proteins. The UPR mechanism is highly conserved in fungi, higher organisms, plants and mammals.
The UPR pathway is activated to stabilize ER functions when there are too many unfolded
proteins or misfolded proteins in the ER. However, stress continues when ER proteins are stimulated
by toxic substances that affect the balance of the UPR pathway, which causes changes in the
structure and function of the ER and other organelles. These ultimately disrupt homeostasis in the
body and cause pathological reactions that can be fatal. The UPR mechanism has clear effects on
stabilizing the protein-folding environment. Dysfunction or disruption of the UPR mechanism is associated
with numerous disorders, including neurodegenerative diseases, loss of control of protein
secretion, cerebral ischemia and epilepsy, neuropsychiatric diseases, eye diseases, skin diseases,
metabolic and inflammatory diseases, atherosclerosis, and heart disease. Thus, characterization of
UPR function and its dysfunction has significant importance and has broad application prospects,
which make research into the UPR a research hotspot.
Quantificação da Severidade das Queimadas e da Perda de Sequestro Florestal de Carbono em Unidades de Conservação do Distrito Federal (Measurement of Severity of Fires and Loss of Carbon Forest sink in the Conservation Units at Distrito Federal)
Authors: Teobaldo Débora , Baptista Gustavo Macedo de Mello 
Published: April 2020

O objetivo desse trabalho foi avaliar o grau de severidade das queimadas e da perda do sequestro de carbono nas principais Unidades de Conservação do Distrito Federal nos anos de 2010 e 2011. Para determinar o grau de severidade utilizou-se índices espectrais antes e depois da queimada, como o índice de queimada por razão normalizada (NBR) e o índice relativo diferenciado de queimada por razão normalizada (RdNBR). O sequestro de carbono perdido pela queimada foi comparado antes, depois da queimada e na rebrota pelo índice espectral CO2flux. A relação entre a severidade e o sequestro de carbono também foi determinada por meio das imagens de pré-fogo, pós-fogo e da rebrota e a comparação temporal do CO2flux. As regressões obtidas para o ano de 2010 foram bastante de acordo com o esperado, com baixa relação antes da queimada, alta após, e menor na rebrota. Já para 2011, como ocorreram queimadas ao longo de todo o período, não foi possível verificar relações favoráveis. A B S T R A C T The aim of this study was to assess the burn severity and carbon sink in the Conservation Units at Distrito Federal in the 2010 and 2011. For the burn severity index was used to quantify biomass before and after burning, such as a Normalized Burn Ratio - NBR and relative differenced Normalized Burn Ratio - RdNBR indices. Carbon sink lost by the burning was compared before and after fire by regrowth CO2flux spectral index. The relationship between the burn severity and carbon sink were also made by means the pre, post-fire and regrowth images, and temporal comparison of CO2flux. The regressions obtained for the 2010 were largely in agreement with expectations, with a low pre-fire, after high and low in regrowth. Already in 2011, as fires occurred throughout the period, it was not possible to verify favorable relationships. Keywords: Biomass, burn severity, RdNBR, carbon sink, CO2flux.
Pengaruh Media Pembelajaran Berbasis Komputer Dengan Model Tutorial Untuk Meningkatkan Hasil Belajar Siswa Pada Mata Pelajaran Tik
Authors: Lestari Ayu , Suryadi Andri , Ismail Ali 
Published: April 2020

Abstact—This study aims to determine the increase in student learning outcomes using computer-based learning media tutorial models. This type of research used in this study is a quasi-experimental study. This quasi-experimental study aims to explain the causal relationship by involving the control group in addition to the experimental group. The population in this study were all students of SMPN 1 Cisurupan. Determination of the sample using a random technique (random), the sample obtained was class VIII-F as a control class with 30 students and VIII-C as an experimental class with 30 students. The research instrument in this study uses multiple choice questions that have been tested for validity, reliability, distinguishing features and difficulty levels. Research Results obtained in this study the comparison of the gain score between the experimental class and the control class is 31.26: 18.67. Meanwhile, the change of Gain transferring the experimental class with the control class is 0.65: 0.35 and the standard deviation of improvement of student learning outcomes about the experimental class Blog material is 9.93 and the control class is 9.60. It can be concluded that the Computer Based learning model with Tutorial Model can significantly improve student learning outcomes in ICT lessons compared to conventional learning models. Keywords —student learning outcomes, Computer Based Learning, Model Tutorials. Abstrak—Penelitian ini bertujuan untuk mengetahui peningkatan hasil belajar siswa sesudah menggunakan media pembelajaran berbasis komputer model tutorial. Jenis Penelitian yang digunakan dalam penelitian ini adalah penelitian kuasi eksperimen. Penelitian kuasi eksperimen ini bertujuan untuk mengungkapkan hubungan sebab akibat dengan cara melibatkan kelompok kontrol disamping kelompok eksperimen. Populasi dalam penelitian ini adalah seluruh siswa SMPN 1 Cisurupan. Penentuan sampel menggunakan teknik random (acak), sampel yang diperoleh adalah kelas VIII-F sebagai kelas kontrol dengan jumlah siswa 30 siswa dan VIII-C sebagai kelas eksperimen dengan jumlah siswa 30 siswa. instrumen penelitian dalam penelitian ini menggunakan instrumen soal dengan bentuk pilihan ganda yang sudah di uji validitas, reliabilitas, daya pembeda dan tingkat kesukaran. Hasil Penelitian yang diperoleh dalam penelitian ini yaitu perbandingan Gain skor antara kelas eksperimen dengan kelas kontrol adalah 31,26 : 18,67. Sedangkan, perbandingan Gain ternormalisasi antara kelas eksperimen dengan kelas kontrol adalah 0,65 : 0,35 dan standar deviasi peningkatan hasil belajar siswa mengenai materi Blog kelas eksperimen adalah 9,93 dan kelas kontrol adalah 9,60. Dapat disimpulkan bahwa model pembelajaran Berbasis Komputer dengan Model Tutorial secara signifikan dapat lebih meningkatkan hasil belajar siswa pada pelajaran TIK dibandingkan dengan model pembelajaran konvensional. Kata Kunci —hasil belajar siswa, media Pembelajaran Berbasis Komputer, Model Tutoriala
PENGARUH PARTISIPASI ANGGARAN, ASIMETRI INFORMASI, TEKANAN ANGGARAN DAN KOMITMEN ORGANISASI TERHADAP SENJANGAN ANGGARAN DI PEMERINTAH KABUPATEN BANYUMAS
Authors: Permana Ody Tegar , Herwiyanti Eliada , Mustika I Wayan 
Published: April 2020

This study aims to determine the effect of budgetary participation, information asymmetry, budget pressure, and organizational commitment to budgetary slack. Population in this research is all government institution in Banyumas Regency. The sample selection was conducted by census method. Dependent variable used in this research is budget slack, while the independent variable used in this research is budget participation, information asymmetry, budget pressure, and organizational commitment. The data has been collected through questionnaires, then processed with the help of SPSS software. Based on the results of multiple linear regression analysis concluded that budgetary participation, information asymmetry, and organizational commitment affect the budget slack while budget pressure has no effect. The results of this study increasingly complement previous studies in the field of management accounting, especially in the scope of budgeting.

Penelitian ini bertujuan untuk mengetahui pengaruh partisipasi anggaran, asimetri informasi, tekanan anggaran, dan komitmen organisasi terhadap senjangan anggaran. Populasi dalam penelitian ini adalah seluruh instansi pemerintahan di Kabupaten Banyumas. Pemilihan sampel dilakukan dengan metode sensus. Variabel dependen yang digunakan dalam penelitian ini adalah senjangan anggaran, sedangkan variabel independen yang digunakan dalam penelitian ini adalah partisipasi anggaran, asimetri informasi, tekanan anggaran, dan komitmen organisasi. Data yang telah dikumpulkan melalui isian kuesioner, selanjutnya diolah dengan bantuan software SPSS. Berdasarkan hasil analisis regresi linear berganda disimpulkan bahwa partisipasi anggaran, asimetri informasi, dan komitmen organisasi berpengaruh terhadap senjangan anggaran sedangkan tekanan anggaran tidak berpengaruh. Hasil penelitian ini semakin melengkapi penelitian-penelitian sebelumnya di bidang akuntansi manajemen khususnya di lingkup penganggaran.