bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding barriers to implementing referral procedures in the rural and semi-urban district hospitals in Tanzania: Experiences of healthcare providers working in maternity units
Authors: Mselle Lilian , Sirili Nathanael , Anaeli Amani , Massawe Siriel 
Published: August 2021

Introduction
Maternal and perinatal deaths occurring in low and middle income countries could be prevented with timely access to maternal and new-born care. In order to increase access to maternal and child health services, a well-functioning referral system that allows for continuity of care across different tiers of healthcare is required. A reliable healthcare system, with adequate numbers of skilled staff, resources and mechanisms, is critical to ensuring that access to care is available when the need arises.

Material and methods
This descriptive, qualitative study design was used to explore barriers to implementing a reliable referral system. Twelve individual qualitative interviews were conducted with health care providers working in rural and semi-urban district hospitals in the Northern, Western, Eastern and Southern zones of Tanzania. Thematic analysis guided analysis of data.

Results
Three (3) main and interconnected themes were abstracted from the data relating to participants’ experiences of referring women with obstetric complications to adequate obstetric care. These were: 1. Adhering to a rigid referral protocol; 2. Completing the referral of women to an adequate health facility and 3. Communicating the condition of the woman with obstetric complications between the referring and receiving facilities.

Conclusion
Because of referral regulations, assistant medical officers were unable to make referral decisions even when they felt that a referral was needed. The lack of availability of hospital transport as well as the lack of a reliable feedback mechanism, prohibited effective referrals of patients. The Ministry of Health should revise the referral protocol to allow all clinicians to provide referrals, including assistant medical officers- who make up the majority of clinical staff in rural health care facilities. A mechanism to ensure effective communication between the referral facility and the tertiary care hospital should be instituted for quality and continuity of care. Furthermore, health care facilities should put aside budget for fuelling the ambulance for effective referrals.
Uterine leiomyoma is associated with the risk of developing endometriosis: A nationwide cohort study involving 156,195 women
Authors: Lin Kent Yu-Hsien , Yang Chih-Yi , Lam Alan , Chang Cherry Yin-Yi , Lin Wu-Chou 
Published: August 2021

Objective
Evidence for an association between uterine leiomyoma and increased risk of endometriosis is limited by small sample sizes and short follow-up periods. We assessed this association in a large nationwide sample with 14 years of data.

Design
Data were sourced from Taiwan’s Longitudinal Health Insurance Database 2000 (LHID2000).

Materials and methods
We identified 31,239 women aged ≥20 years diagnosed with uterine leiomyoma (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] code 218) between Jan 1, 2000 and Dec 31, 2012, who were matched with 124,956 controls (1:4) by 5-year age groups and year of diagnosis. Follow-up was from the date of LHID2000 entry to the first occurrence of endometriosis, loss to follow-up, insurance termination, or until December 31, 2013, whichever was earlier.

Results
In Cox regression analysis, the adjusted hazard ratio (aHR) for endometriosis in women with uterine leiomyoma was 6.44 (95% CI, 6.18, 6.72) compared with controls. The risk of endometriosis was significantly increased in women with uterine leiomyoma and comorbidities of tube-ovarian infection (aHR 2.86; 95% CI, 1.28, 6.36), endometritis (1.14; 1.06, 1.24), infertility (1.26; 1.16, 1.37), or allergic diseases (1.11; 1.05, 1.17). Having both uterine leiomyoma and endometritis significantly increased the risk of endometriosis (aHR 6.73; 95% CI, 6.07, 7.45) versus having only uterine leiomyoma (6.61; 6.33, 6.91) or endometritis (1.49; 1.31, 1.69). Similarly, having both uterine leiomyoma and infertility significantly increased the risk of endometriosis (aHR 6.95; 95% CI, 6.21, 7.78) versus having only uterine leiomyoma (6.66; 6.38, 6.96) or infertility (1.78; 1.57, 2.02).

Conclusions
A diagnosis of uterine leiomyoma appears to increase the risk of endometriosis. Patients presenting with uterine fibroids should be encouraged to give informed consent for possible simultaneous surgical treatment of endometriosis.
Vitamin D and T- regulator cells are not independent factors for RDS in premature neonates
Authors: Marsubrin Putri Maharani Tristanita , Firmansyah Agus , Rohsiswatmo Rinawati , Purwosunu Yuditiya , Munasir Zakiudin , Yuniati Tetty 
Published: August 2021

Background The high morbidity and mortality of premature neonates remain significant problem in Indonesia with respiratory distress syndrome (RDS) as one of the most common problem. Vitamin D plays an important role in lung maturity. Vitamin D deficiency causes epithelial cell inflammation, leading to a higher risk of RDS. Previous studies suggest that T regulatory cells (Treg) in inflammatory diseases, such as RDS in neonates, are possibly linked to vitamin D deficiency. Objective To determine the role of vitamin D on RDS and Treg cells in very premature or very low birth weight neonates. Methods A prospective cohort study conducted on premature neonates in Neonatology Division, Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Umbilical cord blood samples were collected to evaluate total vitamin D 25-OH levels and Treg cells. Subjects with RDS were evaluated until the end of the observation period. Results The mean umbilical cord vitamin D level was 15.79 (SD 6.9) ng/mL, and 53% of the subjects were found to be deficient. As much as 65.1% of neonates had RDS. The mean Treg level was 11.38 (SD 2.45)%. No significant correlation was observed between vitamin D level and the occurrence of RDS (RR 0.87; 95%CI 0.56 to 1.34; P=0.53); vitamin D level and the dysregulation of Treg cells (RR 1.30; 95%CI 0.76 to 2.21; P=0.31) as well as between Treg dysregulation and RDS (RR 1.11; 95%CI 0.70 to 1.75; P=0.64). However, we found that RDS group had a lower gestational age and higher presentation of dysregulation Treg. Conclusion In very premature or very low birth weight neonates, no association between occurence of RDS and vitamin D deficiency as well as Treg cell dysregulation.
Ceftazidime as an empiric therapy for neonatal sepsis
Authors: Indrayady Indrayady , Ramadanti Afifa , Iriani Yulia , Putra Herka Pratama 
Published: August 2021

Background Sepsis is still the leading cause of death in neonates in developing countries. Proper administration of antibiotics is important for managing neonatal sepsis. The microorganisms that cause neonatal sepsis, as well as their sensitivity patterns, change over time and differ from one place to another. Since 2001, ceftazidime has been used as an empirical antibiotic for managing neonatal sepsis at Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, but its effectiveness is questionable.
Objective To evaluate the effectiveness of ceftazidime as an empiric therapy for neonatal sepsis.
Methods This study was pre-experimental, for one group, pre- and post-test, was conducted in 49 neonates with neonatal sepsis in the Neonatal Ward at Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, from April to September 2019. The effectiveness of ceftazidime was determined based on clinical and laboratory improvements 72 hours after ceftazidime administration.
Results Of 49 neonates, 28 experienced clinical and laboratory improvement, while 21 experienced improvement in only one parameter, either clinical or laboratory. Gram positive bacteria were found in 22/49 subjects.
Conclusion There is a significant difference on white blood cell count and CRP level between before and after ceftazidime administration but overall ceftazidime is no longer effective as empiric antibiotic therapy in neonatal sepsis.
Una aproximación a la entrevista en investigaciones sobre música
Authors: Sánchez Nancy Marcela 
Published: August 2021

En este artículo problematizo la entrevista como técnica de recolección de información, como encuentro etnográfico y como proceso de producción de textualidad. Propongo un marco teórico adecuado para examinar los roles que los participantes asumen, las relaciones de poder social y las negociaciones que se llevan a cabo.
Desarrollo conceptos tales como objetivos interaccionales, situación social, marco, entextualización de los discursos y contextualización de las prácticas de performance, que proporcionan una fundamentación apropiada para el análisis de los datos recabados. Comparo distintos tipos de entrevista, diferencio sus propósitos y señalo la relación que cada formato tiene con el diseño de las investigaciones (cualitativa, cuantitativa, mixta). Los ejemplos ayudan a pensar la planificación de las acciones que se llevarán adelante en las entrevistas e informan sobre los problemas que pueden surgir en el proceso. Hago énfasis en la revisión de las nociones de contexto y contextualización.
Pacific Ancient and Modern Language Association
Authors: Clegg Cyndia Susan 
Published: August 2021

The association's most significant news is its change in name from PAPC to PAMLA to strengthen its identification with the Modem Language Association and to maintain the historic presence of classical languages.
The association's ninety-third annual meeting will be held 3-5 November 1995 at the University of California, Santa Barbara, hosted by the College of Letters and Science with its Division of the Humanities, and cosponsored by the Interdisciplinary Humanities Center, the Department of Classics, the Comparative Literature Program, the Department of English, the Department of Germanic, Semitic, and Slavic Studies, and the Department of Spanish and Portuguese. Gerhart Hoffmeister, professor of German, is serving as chair of the local committee.
First results of active observation of patients with prostate cancer and low oncological risk
Authors: Gasanov E. N. , Chinenov D. V. , Akopyan G. N. , Shpot’ E. V. , Kodzokov M. A. , Golovnya P. I. , Magomedov A. A. , Karayev D. K. , Chernov Ya. N. , Rapoport L. M. 
Published: August 2021

The study objective is to improve results of treatment of patients with prostate cancer (PC) and low oncological risk.Materials and methods. Since November of 2019 at the Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University 40 patients with PC and low oncological risk were included in the protocol of active observation. In all patients, the level of prostate-specific antigen was evaluated every 3 months, digital rectal examination was performed every 6 months, magnetic resonance tomography of the pelvis with intravenous contrast was performed every 12 months. Confirming biopsy of the prostate was performed once, 1 year after the beginning of observation. Every 6 months patients' quality of life was evaluated using the SF-36 (Short Form 36 Health Quality Survey), IIEF-5 (International Index of Erectile Function), IPSS (International Prostate Symptom Score), EPIC-26 (Expanded Prostate Cancer Index Composite) questionnaires.Results. Two (5 %) patients underwent surgical treatment due to PC progression. One (2.5 %) patient preferred treatment due to oncological anxiety. Mean value per the SF-36 questionnaire at the beginning of the study was 63.2 ± 11.5 for psychological component of health and 57.1 ± 9.8 for physical component of health. At the moment, the assessment of the psychological and physical components of health according to SF-36 is 69.5 ± 12.4 and 66.3 ± 8.9 points, respectively. Mean IIEF-5 value at the beginning of the study was 18.8 ± 4.2, currently it is 18.6 ± 3.9. At the beginning of the study mean IPSS value was 9.1 ± 2.1, currently it is 9.4 ± 1.9. For the EPIC-26 questionnaire mean value for all criteria initially was 56.1 ± 5.1, currently it is 68.2 ± 4.6.Conclusion. First results of active observation of patients with PC and low oncological risk demonstrated that this approach allows to avoid unnecessary treatment of patients who do not require immediate intervention and to start treatment on time in cases where it is required while preserving high quality of life for the patients.
Analisis Spasial Kesesuaian Lahan Sapi Aceh dan Padang Penggembalaan di Kabupaten Aceh Besar
Authors: Samadi Samadi , Rusdi Muhammad , Saputra Ridwan 
Published: August 2021

ABSTRAK. Analisis kesesuaian lahan terutama bagi ternak ruminansia erat kaitannya dengan penetapan kawasan penyebaran dan pengembangan peternakan. Kabupaten Aceh Besar memiliki salah satu komoditi unggulan yaitu plasma nutfah sapi Aceh sebagai kekayaan sumber daya genetik ternak lokal Indonesia yang perlu dilindungi dan dilestarikan dengan cara mempertahankan populasi ternak hidup. Tujuan penelitian ini adalah menilai kesesuaian fisik lingkungan untuk pengembangan peternakan sapi Aceh yang digembalakan di padang penggembalaan. Penelitian ini telah dilaksanakan di wilayah Kabupaten Aceh Besar. Metode yang digunakan dalam penelitian ini adalah metode analisis deskriptif dengan penerapan sistem informasi geografis (SIG). Pengolahan data menggunakan aplikasi QGIS 3.10.14 dan analisis data geospasial yang disusun sesuai dengan standar kesesuaian lahan FAO berdasarkan parameter kesesuaian jenis tanah, ketinggian, kemiringan, iklim, curah hujan, suhu dan ph tanah yang dapat diamati dan diukur berdasarkan kebutuhan fisik lingkungan sapi Aceh pada padang penggembalaan. Hasil penelitian menunjukkan bahwa hampir semua wilayah 95,26% dari total luas wilayah kajian sesuai untuk kawasan peternakan sapi Aceh pada padang penggembalaan, dan hanya 4,74% lahan yang tidak sesuai untuk kawasan peternakan sapi Aceh pada padang penggembalaan. (Spatial analysis of land and pasture suitability for Aceh cattle in Aceh Besar district) ABSTRACT. Analysis of land suitability for livestock is strongly related to distribution and livestock development Aceh Besar District has one of the leading commodities, namely Aceh cow germplasm as a wealth of genetic resources of Indonesian local livestock that need to be protected and preserved by keeping the number of livestock population the objective of this study is to assess the physical suitability of the environment for the development of Aceh Cows that are grazed in pastures. This research was conducted in the Aceh Besar District area. The method applied in this study was description analysis methods by evaluating the area topography to determine the land suitability for cattle and pasture and its potency as a tool to determine land suitability for livestock production. The focus of the study was based on application of a GIS geographic information system in handling spatial data on soil types, altitude, slope, climate, rainfall, temperature, and soil pH in accordance with FAO land suitability standards. All data were analyzed by using QGIS 3.10.14 software. The results showed that almost all areas of 95.26% of the total area of the study area were suitable for the Aceh cattle breeding area in grazing areas, and only 4.74% of the land was unsuitable for the Aceh cattle breeding area in pastures.
A clinical profile of liver function tests in COVID-19 patients at tertiary care centre from north India
Authors: Priyadarshi B. P , Kumar Avdhesh , Singh Vipul , Varma Sanjay Kumar , Yadav Ravi , Pandey Pankaj , Tripathi Sanjeev 
Published: August 2021

Background: The coronavirus is a large group of virus, which spread rapidly as an epidemic in china and was named initially as 2019 novel corona virus and subsequently named as Coronavirus disease 2019 (COVID-19) by World Health Organization (WHO). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a dramatic loss of human life globally and manifests a variety of clinical symptoms varying from fever, cough, headache, myalgias, nausea, vomiting to more severe pneumonia, ARDS, septic shock and multiorgan failure. SARS-CoV-2, primarily affect respiratory system but COVID-19 patients also have varying levels of liver injuries or liver dysfunction. This retrospective study was designed to analyze the clinical features, liver function and duration of hospital stay with confirmed cases of covid-19 in a tertiary care centre.Methods: We conducted a cross-sectional study in the Isolation ward, Level -2 Covid Hospital, Government Medical College, Kannauj, Uttar Pradesh (India), from April to June 2021. A detailed history and examination was carried out as per the pre-designed proforma. The liver function test included alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and total bilirubin. Patients were considered with abnormal LFTs when any value of these tests was higher than upper limit of normal.Results: One hundred and ten patients with covid-19 were enrolled during the study period. There were 74 males (67.2%) and 36 (32.7%) females. The mean age of study population was 49.07±12.05 years. In present study, the mean value of serum bilirubin, SGPT, SGOT and ALP were 0.85±0.47 mg/dl, 74.6±66.9 IU/L, 48.45±36.86 IU/L and 229.25±69.79 IU/L, respectively. In present study, the abnormal liver function was seen in 67.2 % cases with COVID-19 patients. The mean duration of hospital stay among normal LFT and abnormal LFT patients group were 13.33±2.12 and 17.10±2.07 days, respectively.Conclusions: The present study highlighted that abnormal liver function was observed in 67.2% cases with COVID-19 patients. Further research should focus on the cause of liver injury in covid 19 and on treatment and outcome.
A prospective study of prognostic factors predicting outcome of surgery in chronic pancreatitis at a tertiary care centre in India
Authors: Samantaray Satya Prasad , Dutta Tanmay 
Published: August 2021

Identification of factors predicting the outcome of surgery for chronic pancreatitis and preparation of a scoring system to predict the outcome following surgery. A total number of 76 patients who had undergone surgery for chronic pancreatitis were prospectively followed at Department of General Surgery, S.C.B. Medical College, Cuttack during the period from 2010-2013. Data on demographic details, pain score, opioid addiction, exocrine and endocrine insufficiency, insulin requirement and morphology of pancreas on imaging were recorded. On follow up, improvement in pain score and exocrine and endocrine insufficiency were recorded. Factors affecting surgical outcome were determined and a scoring system was done. The mean age of patients was 39.7±7.9 years (range 18-58 years). Chronic alcohol intake was the predominant cause accounting for 56% (n=34) cases. Mean pain score at admission on Visual Analogue Scale (VAS) was 5.98. Twenty-six patients (43.3%) were found to have endocrine insufficiency and 22 (36.6%) patients had exocrine insufficiency. Forty-two patients underwent Partington-Rochelle procedure, and 18 patients underwent Frey’s procedure. Eighty percent of patients (n=48) had significant pain relief. On logistic regression, preoperative VAS score, number of previous admissions, opioid dependence, main pancreatic duct (MPD) diameter, number and site of calcifications were found to be significant in predicting pain relief. Cohort of patients with chronic pancreatitis likely to get benefit from surgery can be predicted preoperatively.
Cardiorespiratory changes during robotic pelvic surgeries- A prospective observational Study
Authors: Saigal Deepti , Shoaib Mohammad , Kale Suniti 
Published: August 2021

Robot assisted pelvic surgeries are associated with cardiorespiratory changes due to conjunction of carboperitoneum and steep Trendelenburg position for prolonged durations. To determine the changes in cardiovascular and respiratory systems in patients undergoing elective robot assisted pelvic surgeries under general anesthesia. A prospective observational study was conducted in 35 patients scheduled for elective robot assisted pelvic surgeries. Patients belonging to ASA class I and II were included and their intraoperative hemodynamic and respiratory parameters were noted post induction (baseline), at pneumoperitoneum, at and every 15 minutes after steep Trendelenburg positioning, at resuming supine position, at deflation of pneumoperitoneum and post-deflation. Primary outcome was mean arterial pressure. Secondary outcomes were systolic and diastolic blood pressures, heart rate, central venous pressure, airway pressures (peak, plateau and mean), pulmonary compliance, minute ventilation, end tidal carbondioxide levels and blood gas values. On assuming steep Trendelenburg position, there was significant increase in systolic, mean and diastolic blood pressures. There was significant increase in peak, plateau and mean airway pressures and significant decrease in pulmonary compliance which led to increase in end tidal carbondioxide levels and minute ventilation. On resuming supine position and deflation of pneumoperitoneum, there was significant decrease in mean arterial pressure. Although the pulmonary compliance improved, it continued to be significantly lower than the post-induction baseline value. Robot-assisted pelvic surgeries are associated with significant changes in hemodynamic and respiratory parameters of patients.
Comparative study of efficacy of platelet rich plasma injection versus corticosteroid injection in conservative management of periarthritis shoulder
Authors: Kumar  Panda Sambit , Soren Surai , Kumar Nayak Ashok , Nayak Rabindra , Swain Sabyasachi 
Published: August 2021

Analysis of eighty patients with periarthritis shoulder was done. Patients were thoroughly evaluated and were divided into two groups in a randomized trial. Forty patients were in group-A who received 3doses of injection of PRP (4ml) 2 weeks apart within a duration of 6weeks. Equal number of patients were in group-B. They received 2ml of Injection corticosteroid 2weeks apart within a duration of 6 weeks. All participants were advised to perform a home-based hot fomentation and 15min exercise therapy. One participant from group A and 2 from group B were lost to follow up. There were 35 male and 42 female who completed the study. Analysis of 77 subjects who completed the study was done. Participant were evaluated for range of motion of shoulder as main outcome measure. Visual Analogue Scale (VAS) and (Quick DASH) was used to measure pain and functions of the shoulder. The evaluation of Participants was done at 0,3,6 and 12 weeks. ANOVA test and Chi-square test, was repeatedly used to measure the differences.Participants who were given PRP injections showed significant improvements in active and passive range of shoulder motion as measured by VAS and Quick DASH over corticosteroid injection. This was also reflected statistically. No major adverse reactions were observed during 12 weeks of intervention.In our study, the injection of PRP showed marked improvement in the range of motion of shoulder over corticosteroid injection but it needs other study to be treatment of choice. It emerged as an option for treatment in diabetes patient and condition where steroid is contraindicated.