bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing Snake Ladder Game Learning Media to Increase Students’ Interest and Learning Outcomes on Social Studies in Elementary School
Authors: Syawaluddin Ahmad , Afriani Rachman Sidrah , Khaerunnisa  
Published: June 2020

Background and Objective. One of the challenges that social studies presents to teachers in class is the lack of students’ interest in the material. This study aims to develop snakes and ladders learning media for use in the subject of social studies in elementary school. Method. The research design used is the Four-D Research and Development (R&D) model by Thiagarajan (Santoso & Albaniah). The criteria used as a reference for the effectiveness of the learning media are students’ participation, interest, and learning outcomes, whereas for the practicality, the criteria are the implementation and teachers’ ability to use the learning media. The research employed descriptive statistics analysis and inductive-deductive flow analysis. Results. The results show that the snakes and ladders learning media on social studies appear to be valid and practical, and can effectively improve elementary school students’ interest and learning outcomes. The learning media is considered valid based on the experts’ validation with average 4.3 (good). The effectiveness of this learning media meets the criteria: (1) student participation in the learning process is high and (2) student learning outcomes meet the minimum learning mastery standard average at 79.04 of the ideal score of 100 and the completeness test of learning outcomes with the probability value of one sample t-test of 0.00 <0.05. The practicality of the learning media is shown through the observation result of the implementation of the media with an average of 4.4 (good), whereas the results of the student interest questionnaire show that of 25 students (92%) responded that they were happy with the subject matter taught, 80% of students responded that they were happy with the learning. Conclusion. The snakes and ladders learning media on social studies can enhance students’ interest and learning outcomes in elementary education.
Safety and feasibility of rivaroxaban in deferred workup of patients with suspected deep vein thrombosis
Authors: Fronas Synne G. , Dahm Anders E. A. , Wik Hilde S. , Jørgensen Camilla T. , Gleditsch Jostein , Raouf Nezar , Holst René , Klok Frederikus A. , Ghanima Waleed 
Published: June 2020

Abstract
Guidelines suggest using empiric low-molecular-weight heparin if the diagnostic workup of deep vein thrombosis (DVT) is expected to be delayed. The role of direct oral anticoagulants for deferred compression ultrasound imaging (CUS) in patients with suspected DVT remains unexplored. The main objective of the study was to assess the safety of deferring CUS with therapeutic doses of rivaroxaban. We prospectively included consecutive outpatients referred to the Emergency Department at Østfold Hospital, Norway, with suspected first or recurrent lower-extremity DVT between February 2015 and November 2018. Patients were discharged with rivaroxaban 15 mg twice daily while awaiting CUS within 24 hours if D-dimer level was ≥0.5 mg/L fibrinogen-equivalent units. The primary outcome was the rate of major bleeding incidents from study inclusion until DVT was confirmed and anticoagulation therapy continued, or otherwise up to 48 hours following administration of the last tablet of rivaroxaban. The secondary outcome was the rate of progressive DVT symptoms or symptoms or signs of pulmonary embolism between hospital discharge until venous thromboembolism was diagnosed. Six hundred twenty-four of 1653 patients referred with suspected DVT were included (37.7%; 95% confidence interval [CI], 35.4-40.1). DVT was diagnosed in 119 patients (19.1%; 95% CI, 16.1-22.3). There were no major bleeding incidents, yielding an observed major bleeding rate of 0% (1-sided 95% CI &lt;0.4). No patients experienced major complications in the interval that CUS was deferred (0%; 95% CI, 0.0-0.6). Deferring CUS for up to 24 hours in patients with suspected DVT with therapeutic doses of rivaroxaban is a safe strategy. This trial was registered at www.clinicaltrials.gov as #NCT02486445.
Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report
Authors: García-Pérez Daniel , Panero Irene , Eiriz Carla , Moreno Luis Miguel , Munarriz Pablo M. , Paredes Igor , Lagares Alfonso , Alén José F. 
Published: June 2020

AbstractBackgroundPartially thrombosed giant aneurysms at the basilar apex (BA) artery are challenging lesions with a poor prognosis if left untreated. Here we describe a rare case of extensive brain edema after growth of a surgically treated and thrombosed giant basilar apex aneurysm.Case presentationWe performed a proximal surgical basilar artery occlusion on a 64-year-old female with a partially thrombosed giant BA aneurysm. MRI showed no ischemic lesions but showed marked edema adjacent to the aneurysm. She had a good recovery, but 3 months after surgical occlusion, her gait deteriorated together with urinary incontinence and worsening right hemiparesis. MRI showed that the aneurysm had grown and developed intramural hemorrhage, which caused extensive brain edema and obstructive hydrocephalus. She was treated by a ventriculoperitoneal shunt placement. Follow-up MRI showed progressive brain edema resolution, complete thrombosis of the lumen and shrinkage of the aneurysm. At 5 years follow-up the patient had an excellent functional outcome.ConclusionsDelayed growth of a surgically treated and thrombosed giant aneurysm from wall dissection demonstrates that discontinuity with the initial parent artery does not always prevent progressive enlargement. The development of transmural vascular connections between the intraluminal thrombus and adventitial neovascularization by the vasa vasorum on the apex of the BA seems to be a key event in delayed aneurysm growth. Extensive brain edema might translate an inflammatory edematous reaction to an abrupt enlargement of the aneurysm.
Self–reported specific learning disorders and risk factors among Hungarian adolescents with functional abdominal pain disorders: a cross sectional study
Authors: Major János , Ádám Szilvia 
Published: June 2020

Abstract
Background
Despite its increasing clinical significance and diagnostic challenges, little is known about functional abdominal pain disorders (FAPDs) in Central-Eastern Europe. In this paper, the prevalence and potential sociodemographic correlates of FAPDs among Hungarian adolescents are explored.

Methods
A cross-sectional, nationwide, questionnaire study in a representative sample of 657 adolescents has been conducted. With a response rate of 80.2%, 522/527 (99.1%) questionnaires were eligible for data analysis (N = 267, 51.1% girls, mean age 14.8, SD 2.4 years). The questionnaire included sociodemographic variables (age, sex, place of residence, marital status of the parents, family income, religion, educational level of parents), questions regarding self–reported specific learning disorders and the Questionnaire for Paediatric Gastrointestinal Symptoms Rome ΙΙΙ Edition.

Results
The prevalence of FAPDs was 11.9% (N = 62). FAPDs were significantly associated with female sex. Living in a county town showed a negative correlation with FAPD. Adolescents with self–reported arithmetic learning disorders had an 8.7-fold likelihood of FAPD (OR, 8.7; 95% CI (3.5–21.9). Adolescent girls reported pain in all subtypes of FAPDs more frequently than adolescent boys except functional abdominal pain syndrome. The most prevalent FAPD was abdominal migraine (N = 32, 6.1%), followed by irritable bowel syndrome (N = 24, 4.6%).

Conclusions
The prevalence of FAPDs in Hungary is similar to that reported worldwide, however, contrary to international data, abdominal migraine is the most frequently encountered FAPD in Hungary. In addition to well-known correlates of FAPDs, such as female sex and place of residence, arithmetic learning disorders have also been identified as correlating with the prevalence of FAPDs. Our results suggest culture-specific differences in the distribution of FAPDs, and confirm the significance of school performance indicators such as specific learning disorders as a correlate of FAPDs.
Frequency and correlates of violence against patients with schizophrenia living in rural China
Authors: Wang Qian-Wen , Hou Cai-Lan , Wang Shi-Bin , Huang Zhuo-Hui , Huang Ying-Hua , Zhang Ji-Jie , Jia Fu-Jun 
Published: June 2020

Abstract
Background
Violence against patients with schizophrenia is very common, however it is rarely studied in China, especially in primary health care institutions of rural areas. Therefore, we investigated the frequency of violence against patients with community-living schizophrenia in rural China and examined its associated factors and impact on quality of life (QoL) and social function.

Method
A survey was conducted among 487 patients with schizophrenia living in rural communities. Data about violent victimization experiences in the past 6 months, demographic information, and clinical characteristics were collected by questionnaires.

Results
We found that 92 (18.9%) of 487 subjects experienced at least one type of violent event in the past 6 months. Logistic regression analysis suggested that a history of conducting dangerous behaviors(OR = 1.702, P = 0.02, 95%CI: 1.05–2.73), higher Brief Psychiatric Rating Scale (anxiety domain) score (OR = 1.15, P = 0.02, 95%CI: 1.01–1.304) and lower hospitalization rates (OR = 0.89, P = 0.04, 95%CI: 0.81–0.99) were significantly associated with violent victimization in patients with schizophrenia. Analysis of covariance showed the victims of violence tended to have worse social function in patients with schizophrenia living in rural communities of China (P = 0.04).

Conclusions
Individuals with schizophrenia living in rural China had a high risk of being exposed to violence and violent victimization of patients with schizophrenia had adverse consequences for social function. More attention is needed for those patients experiencing violent events, because they are simultaneously possible to conduct dangerous behaviors.
Human Toxoplasma gondii infection in Nigeria: a systematic review and meta-analysis of data published between 1960 and 2019
Authors: Karshima Solomon Ngutor , Karshima Magdalene Nguvan 
Published: June 2020

AbstractBackgroundOver 70% of the worlds’ population is infected byToxoplasma gondii; a pathogen capable of causing cerebral toxoplasmosis in HIV patients and neonatal complications like miscarriage, chorioretinitis, hydrocephalus, cerebral calcification and foetal death in the third trimester of pregnancy. In spite of this, the burden of this zoonotic pathogen is poorly understood in Nigeria. The aim of the present study therefore, is to determine the burden ofT. gondiiamong normal individuals, HIV patients and pregnant women as well as the distribution of the infection across Nigeria.MethodsUsing the PRISMA guidelines, we conducted a systematic review and meta-analysis of data retrieved from six electronic databases (AJOL, Google Scholar, PubMed, Scopus, Science Direct and Web of Science). Pooled prevalence (PP) and heterogeneity were determined by the random-effects model and the Cochran’s Q-test respectively. The quality of each study and publication bias were assessed by the 9 point Joanna Briggs Institute Critical Appraisal Instrument and the Egger’s regression asymmetry test respectively, while the robustness of a pooled estimate was tested by the single study omission analysis.ResultsExactly 5834 of the 16,230 individuals examined forT. gondiiinfection by 50 studies across 17 Nigerian States were positive for the infection. Overall PP was 32.92% (95% CI: 27.89, 38.37), with a range of 14.41% (95% CI: 5.32, 33.54) to 86.82% (95% CI: 66.13, 95.69) across sub-groups. Pooled prevalence was significantly higher (p < 0.001) among pregnant women (40.25%; 95% CI: 33.19, 47.73) and HIV patients (31.68, 95% CI: 20.53, 45.41) than normal individuals (23.32, 95% CI: 17.25, 30.75).T. gondiiprevalence declined by over 58% during the 59 years reviewed.ConclusionToxoplasma gondiiinfection is moderately prevalent in Nigeria. Highest prevalence estimates were observed among pregnant women and in the south-south region. For effective control of the disease in Nigeria, a holistic approach involving on-farm, environmental, public health and animal components are suggested.
Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis — a long-term retrospective study of 106 cases
Authors: Zhang Zhifa , Hao Yongyu , Wang Xiangyu , Zheng Zhirong , Zhao Xuelin , Wang Chunguo , Zhang Xifeng , Zhang Xuesong 
Published: June 2020

Abstract
Background
Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy.

Methods
A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI).

Results
The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination.

Conclusion
MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
Utilization of the national cluster of district health information system for health service decision-making at the district, sub-district and community levels in selected districts of the Brong Ahafo region in Ghana
Authors: Odei-Lartey Eliezer Ofori , Prah Rebecca Kyerewaa Dwommoh , Anane Edward Apraku , Danwonno Harry , Gyaase Stephaney , Oppong Felix Boakye , Afenyadu Godwin , Asante Kwaku Poku 
Published: June 2020

Abstract
Background
There is growing interest in the use of reliable evidence for health decision-making among low-and middle-income countries. Ghana has deployed DHIMS2 to replace the previously existing manual data harmonization processes.

Methods
This cross-sectional study was conducted in 12 districts comprising 12 district directorates, 10 district hospitals, 29 sub-district health centers, and 38 community health facilities in the Brong-Ahafo Region. Data collection tools were developed based on the Measure Evaluate assessment tools designed for evaluating the performance of routine information systems management tools. Utilization was assessed based on documented evidence and data was analyzed using STATA version 14.

Results
Although 93% of the health facilities studied submitted data unto the DHIMS2 platform, evidence suggested low use of this data in decision-making, particularly at the community level facilities where only 26% of the facilities used data from DHIMS2 to inform annual action plans and even less than 20% examined findings and issued directives for action. At the district level, 58% issued directives based on DHIMS2 information, 50% used DHIMS2 information for Advocacy purposes and 58% gave feedback reports based on DHIMS2 data for action. Functional computers were lacking across all facilities.

Conclusions
Activities relating to the use of DHIMS2 information skew towards data quality checking with less focus on examining findings, making comparisons, and taking action-based decisions from findings and comparisons. Improving factors like internet access, availability of functional ICTs, frequency of supervisory visits, staff training and the provision of training manuals may facilitate the use of DHIMS2 in decision-making at all levels of the district health system.
Measuring the benefits of the integration of health and social care: qualitative interviews with professional stakeholders and patient representatives
Authors: Crocker Helen , Kelly Laura , Harlock Jenny , Fitzpatrick Ray , Peters Michele 
Published: June 2020

Abstract
Background
Integrated care has the potential to ease the increasing pressures faced by health and social care systems, however, challenges around measuring the benefits for providers, patients, and service users remain. This paper explores stakeholders’ views on the benefits of integrated care and approaches to measuring the integration of health and social care.

Methods
Twenty-five semi-structured qualitative interviews were conducted with professional stakeholders (n = 19) and patient representatives (n = 6). Interviews focused on the benefits of integrated care and how it should be evaluated. Data was analysed using framework analysis.

Results
Three overarching themes emerged from the data: (1) integrated care and its benefits, with stakeholders defining it primarily from the patient’s perspective; (2) potential measures for assessing the benefits of integration in terms of system effects, patient experiences, and patient outcomes; and (3) broader considerations around the assessment of integrated care, including the use of qualitative methods.

Conclusions
There was consensus among stakeholders that patient experiences and outcomes are the best measures of integration, and that the main measures currently used to assess integration do not directly assess patient benefits. Validated health status measures are readily available, however, a substantial shift in practices is required before their use becomes commonplace.
Saccharomyces cerevisiae nutrient signaling pathways show an unexpected early activation pattern during winemaking
Authors: Vallejo Beatriz , Matallana Emilia , Aranda Agustín 
Published: June 2020

Abstract
Background
Saccharomyces cerevisiae wine strains can develop stuck or sluggish fermentations when nutrients are scarce or suboptimal. Nutrient sensing and signaling pathways, such as PKA, TORC1 and Snf1, work coordinately to adapt growth and metabolism to the amount and balance of the different nutrients in the medium. This has been exhaustively studied in laboratory strains of S. cerevisiae and laboratory media, but much less under industrial conditions.

Results
Inhibitors of such pathways, like rapamycin or 2-deoxyglucose, failed to discriminate between commercial wine yeast strains with different nutritional requirements, but evidenced genetic variability among industrial isolates, and between laboratory and commercial strains. Most signaling pathways involve events of protein phosphorylation that can be followed as markers of their activity. The main pathway to promote growth in the presence of nitrogen, the TORC1 pathway, measured by the phosphorylation of Rps6 and Par32, proved active at the very start of fermentation, mainly on day 1, and ceased soon afterward, even before cellular growth stopped. Transcription factor Gln3, which activates genes subject to nitrogen catabolite repression, was also active for the first hours, even when ammonium and amino acids were still present in media. Snf1 kinase was activated only when glucose was exhausted under laboratory conditions, but was active from early fermentation stages. The same results were generally obtained when nitrogen was limiting, which indicates a unique pathway activation pattern in winemaking. As PKA remained active throughout fermentation, it could be the central pathway that controls others, provided sugars are present.

Conclusions
Wine fermentation is a distinct environmental situation from growth in laboratory media in molecular terms. The mechanisms involved in glucose and nitrogen repression respond differently under winemaking conditions.
Oleic acid and derivatives affect human endothelial cell mitochondrial function and vasoactive mediator production
Authors: Bass Virginia L. , Soukup Joleen M. , Ghio Andrew J. , Madden Michael C. 
Published: June 2020

Abstract
Background
Inhalation of common air pollutants such as diesel and biodiesel combustion products can induce vascular changes in humans which may contribute to increased mortality and morbidity associated with fine particulate matter exposures. Diesel, biodiesel, and other combustion byproducts contain fatty acid components capable of entering the body through particulate matter inhalation. Fatty acids can also be endogenously released into circulation following a systemic stress response to some inhaled pollutants such as ozone. When in the circulation, bioactive fatty acids may interact with cells lining the blood vessels, potentially inducing endothelial dysfunction. To examine whether fatty acids could potentially be involved in human vascular responses to air pollutants, we determined the effects of fatty acids and derivatives on important vascular cell functions.

Methods
Human umbilical vein endothelial cells (HUVEC) were exposed in vitro to oleic acid (OA) or OA metabolites for 4-48 h. Cytotoxicity, vasodilator production (by ELISA measurement), mitochondrial function (using Sea Horse assays), and iron metabolism (inferred by ICP-OES measurements) were examined, with standard statistical testing (ANOVA, t-tests) employed.

Results
Dose-dependent cytotoxicity was noted at 24 h, with 12-hydroxy OA more potent than OA. Mitochondrial stress testing showed that 12-hydroxy OA and OA induce mitochondrial dysfunction. Analysis of soluble mediator release from HUVEC showed a dose-dependent increase in prostaglandin F2α, a lipid involved in control of vascular tone, at 24 h (85% above controls) after OA-BSA exposure. RT-PCR analysis revealed OA did not induce changes in gene expression at noncytotoxic concentrations in exposed HUVEC, but 12-OH OA did alter ICAM and COX2 gene expression.

Conclusions
Together, these data demonstrate that FA may be capable of inducing cytotoxic effects and altering expression of mediators of vascular function following inhalation exposure, and may be implicated in air pollutant-induced deaths and hospitalizations. (267 of max 350 words).