bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Decision-Making for Temporal Lobe Epilepsy: Patient Experiences of the Informed Consent Process
Authors: Dewar Sandra R. , Pieters Huibrie C. , Fried Itzhak 
Published: December 2021

Background: Surgical resection is frequently the recommended treatment for drug-resistant temporal lobe epilepsy (TLE), yet many factors play a role in patients' perceptions of brain surgery that ultimately impact decision-making. The purpose of the current study was to explore how people with epilepsy, in their own words, experienced the overall process of consenting to surgery for drug-resistant TLE.Methods and Materials: Data was drawn from in-person, semi-structured interviews of 19 adults with drug-resistant TLE eligible to undergo epilepsy surgery. A systematic thematic analysis was performed to code, sort and compare participant responses. The mean age of these 12 (63%) women and seven (37%) men was 37.6 years (18–68 years), with average duration of epilepsy of 13 years (2–30 years).Results: Meeting the neurosurgeon and consenting to surgery represented an important treatment milestone across a prolonged treatment trajectory. Four themes were identified: (1) Understanding the language of risk; (2) Overcoming risk; (3) Family-centered, shared decision-making, and (4) Building decisional-confidence.Conclusion: Despite living with the restrictions of chronic uncontrolled seizures, considering an elective brain procedure raised unique and complex questions. Personal beliefs and expectations related to treatment outcomes influenced how the consent process was ultimately experienced. Decisions to pursue surgery had frequently been made ahead of meeting the surgeon, with many describing the act of signing as personally empowering. Overall, satisfaction was expressed with the information provided during the surgical visit, despite later inaccurate recall of the facts. These findings support the resultant recommendation that the practice of informed consent be conceptualized as a systematic, structured interdisciplinary process which occurs over time and encompasses three stages: preparation, signing and follow-up after signing.
Involvement of Calcium-Dependent Pathway and β Subunit-Interaction in Neuronal Migration and Callosal Projection Deficits Caused by the Cav1.2 I1166T Mutation in Developing Mouse Neocortex
Authors: Nakagawa-Tamagawa Nao , Kirino Emi , Sugao Kohtaroh , Nagata Hidetaka , Tagawa Yoshiaki 
Published: December 2021

Introduction: Gain-of-function mutations in the L-type Ca2+ channel Cav1.2 cause Timothy syndrome (TS), a multisystem disorder associated with neurologic symptoms, including autism spectrum disorder (ASD), seizures, and intellectual disability. Cav1.2 plays key roles in neural development, and its mutation can affect brain development and connectivity through Ca2+-dependent and -independent mechanisms. Recently, a gain-of-function mutation, I1166T, in Cav1.2 was identified in patients with TS-like disorder. Its channel properties have been analyzed in vitro but in vivo effects of this mutation on brain development remain unexplored.Methods:In utero electroporation was performed on ICR mice at embryonic day 15 to express GFP, wild-type, and mutant Cav1.2 channels into cortical layer 2/3 excitatory neurons in the primary somatosensory area. The brain was fixed at postnatal days 14–16, sliced, and scanned using confocal microscopy. Neuronal migration of electroporated neurons was examined in the cortex of the electroporated hemisphere, and callosal projection was examined in the white matter and contralateral hemisphere.Results: Expression of the I1166T mutant in layer 2/3 neurons caused migration deficits in approximately 20% of electroporated neurons and almost completely diminished axonal arborization in the contralateral hemisphere. Axonal projection in the white matter was not affected. We introduced second mutations onto Cav1.2 I1166T; L745P mutation blocks Ca2+ influx through Cav1.2 channels and inhibits the Ca2+-dependent pathway, and the W440A mutation blocks the interaction of the Cav1.2 α1 subunit to the β subunit. Both second mutations recovered migration and projection.Conclusion: This study demonstrated that the Cav1.2 I1166T mutation could affect two critical steps during cerebrocortical development, migration and axonal projection, in the mouse brain. This is mediated through Ca2+-dependent pathway downstream of Cav1.2 and β subunit-interaction.
Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Univentricular Patients From Birth to Follow-Up After Fontan—Predicting Lymphatic Abnormalities
Authors: Moosmann Julia , Schroeder Christian , Cesnjevar Robert , Rottermann Kathrin , Weigelt Annika , Dittrich Sven 
Published: December 2021

Background: Reliable laboratory parameters identifying complications after Fontan surgery including the lymphatic abnormalities and the development of protein-losing enteropathy (PLE) are rare. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocte ratio (PLR) are inflammatory markers and have been studied to predict outcome and prognosis in various diseases. The aim of this study was to investigate NLR and PLR from birth to follow-up after Fontan and evaluate their use as prognostic parameters for single ventricle patients regarding the development of lymphatic malformations during follow-up.Materials and Methods: Sixty-six univentricular patients who underwent Fontan surgery and had 6-month follow-up magnetic resonance imaging (MRI) with T2 weighted lymphatic imaging after total cavopulmonary connection (TCPC) surgery were included in the study. NLR and PLR were determined at specific time points, from neonatal age to follow-up after Fontan operation and correlated to data from the MRI 6 months after Fontan.Results: NLR and PLR increase significantly over time from the first surgery during infancy to the follow-up after Fontan (both p &lt; 0.0001), with a significant increase after the Glenn surgery for both ratios (each p &lt; 0.0001). Higher NLR (p = 0.002) and higher PLR (p = 0.004) correlated with higher-grade classification of lymphatic abnormalities in T2-weighted imaging 6 months after Fontan surgery and higher NLR correlated with higher transpulmonary gradient prior to Fontan surgery (p = 0.035) Both ratios showed a significant correlation to total protein at follow-up (NLR p = 0.0038; PLR&lt;0.0001).Conclusion: Increased NLR and PLR correlate with higher degree lymphatic malformations after TCPC and therefore might contribute as valuable additional biomarker during follow-up after TCPC. NLR and PLR are simple, inexpensive and easily available parameters to complement diagnostics after TCPC.
Comparative Efficacy of Pharmacotherapy for Macular Edema Secondary to Retinal Vein Occlusion: A Network Meta-analysis
Authors: Gao Sheng , Zhang Yun , Li Xun , Ge Ge , Duan Jianan , Lei Chunyan , Zeng Yue , Cai Zhaolun , Zhang Meixia 
Published: December 2021

Purpose: This network meta-analysis was conducted to obtain the relative effectiveness of different pharmacotherapy of macular edema secondary to retinal vein occlusion (RVO) by summarizing all available evidences.Methods: PubMed, Embase, and Cochrane Library databases were searched for all relevant randomized controlled trials. The outcomes were estimated through a network meta-analysis, including the mean change in best-corrected visual acuity (BCVA) from baseline, the proportion of patients who gained ≥15 letters in BCVA from baseline, the mean change in central retinal thickness (CRT).Results: We identified 15 randomized controlled trials (RCTs) involving 3,431 patients with RVO in our study. Different therapeutic regimens were compared including three anti-vascular endothelial growth factor (VEGF) agents (ranibizumab, bevacizumab, and aflibercept), ranibizumab with laser, dexamethasone intravitreal implant, and laser. For branch RVO, ranibizumab 0.5 mg monthly [weighted mean difference (WMD) = 11, 95% confidence intervals (CrI) 3.6 to 19], ranibizumab 0.5 mg 3 + pro re nata (WMD = 9.4, 95% CrI 0.43–18) is most effective in terms of changes of BCVA and 15 letters or more of BCVA improvement. For central RVO, three anti-VEGF regimens can improve visual acuity and there is no significant difference of efficacy among ranibizumab, bevacizumab and aflibercept (p &gt; 0.05). Ranibizumab 0.5 mg monthly could achieve additional efficacy in CRT reduction in eyes with branch RVO or central RVO (WMD = -130, 95% CrI -400 to 140 or WMD = -280, 95% CrI -590 to 16)). Dexamethasone intravitreal implant (WMD = 1.7, 95% CrI -4.2 to 7.1 or WMD = 0.38, 95% CrI -9.8 to 8.8)) did not show a significant improvement in visual acuity at the end of 6 months follow-up in eyes with branch RVO or central RVO.Conclusion: In summary, this network meta-analysis demonstrated several anti-VEGF agents had equivalent effects on mean visual acuity changes and anatomical recovery in 6 months in eyes with branch or central RVO. Only one injection of dexamethasone intravitreal implant in 6 months could not maintain the visual benefit. Patients and clinicians could choose pharmacotherapies with further consideration toward personal factors.
Impact of Maximizing Css/MIC Ratio on Efficacy of Continuous Infusion Meropenem Against Documented Gram-Negative Infections in Critically Ill Patients and Population Pharmacokinetic/Pharmacodynamic Analysis to Support Treatment Optimization
Authors: Cojutti Pier Giorgio , Gatti Milo , Rinaldi Matteo , Tonetti Tommaso , Laici Cristiana , Mega Chiara , Siniscalchi Antonio , Giannella Maddalena , Viale Pierluigi , Pea Federico 
Published: December 2021

Introduction: optimal treatment of Gram-negative infections in critically ill patients is challenged by changing pathophysiological conditions, reduced antimicrobial susceptibility and limited therapeutic options. The aim of this study was to assess the impact of maximizing Css/MIC ratio on efficacy of continuous infusion (CI) meropenem in treating documented Gram-negative infections in critically ill patients and to perform a population pharmacokinetic/pharmacodynamic analysis to support treatment optimization.Materials and Methods: Classification and regression tree (CART) analysis was used to identify whether a cutoff of steady-state meropenem concentration (Css)-to-minimum inhibitory concentration (MIC) (Css/MIC) ratio correlated with favorable clinical outcome. A non-parametric approach with Pmetrics was used for pharmacokinetic analysis and covariate evaluation. The probability of target attainment (PTA) of the identified Css/MIC ratio was calculated by means of Monte Carlo simulations. Cumulative fraction of response (CFRs) were calculated against common Enterobacterales, P. aeruginosa and A. baumannii as well.Results: a total of 74 patients with 183 meropenem Css were included. CART analysis identified a Css/MIC ratio ≥4.63 as cutoff value significantly associated with favorable clinical outcomes. Multivariate regression analysis confirmed the association [OR (95%CI): 20.440 (2.063–202.522); p &lt; 0.01]. Creatinine clearance (CLCR) was the only covariate associated with meropenem clearance. Monte Carlo simulations showed that, across different classes of renal function, dosages of meropenem ranging between 0.5 and 2 g q6h over 6 h (namely by CI) may grant PTAs of Css/MIC ratios ≥4.63 against susceptible pathogens with an MIC up to the EUCAST clinical breakpoint of 2 mg/L. The CFRs achievable with these dosages were very high (&gt;90%) against Enterobacterales across all the classes of renal function and against P. aeruginosa among patients with CLCR &lt; 30 ml/min/1.73 m2, and quite lower against A. baumannii.Discussion: our findings suggest that Css/MIC ratio ≥4.63 may be considered the pharmacodynamic target useful at maximizing the efficacy of CI meropenem in the treatment of Gram-negative infections in critically ill patients. Dosages ranging between 0.5 g q6h and 2 g q6h by CI may maximize the probability of favorable clinical outcome against meropenem-susceptible Gram-negative pathogens among critically ill patients having different degrees of renal function.
Knowledge, Attitudes, and Practices Toward COVID-19 Among the General Public in the Border Region of Jazan, Saudi Arabia: A Cross-Sectional Study
Authors: Almalki Mohammed J. 
Published: December 2021

Background: The Saudi government had implemented unprecedented preventive measures to deal with COVID-19. These measures included intermittent curfews, bans on public gatherings, limitations on many services, temporary suspension of Hajj, Umrah, and visit and launching awareness campaigns. Therefore, this study aimed to assess the KAP toward COVID-19 among residents of the border region of Jazan, Saudi Arabia.Methods: An online cross-sectional survey was distributed from May 4 to May 21, 2020, using a Google Form. The survey questionnaire covered demographic characteristics and KAP toward COVID-19. The KAP questions consisted of 17 items on knowledge, four items on attitude, and six items on practice.Results: A total of 597 participants responded to the survey questionnaire. Overall, participants demonstrated a good knowledge of COVID-19, correctly answering 77% of the knowledge questions. Most of the participants exhibited good attitudes and acceptable practices toward COVID-19. Multiple regression analysis revealed that participants with a university education (B = 1.75) or post-graduate education (B = 2.24), those with an income &gt;SR 10,000–20,000 (B = 1.38) or &gt;SR 20,000 (B = 2.07), and those who had received a personal health education (B = 1.19) had higher COVID-19 knowledge scores (p &lt; 0.05). The ordinal logistic regression analysis found that compared to being female, being male was significantly associated with worrying about COVID-19 (p = 0.024, OR = 1.78), willingness to receive a COVID-19 vaccine (p = 0.003, OR = 1.81), and willingness to report potential symptoms of COVID-19 (p = 0.046, OR = 2.28). Worrying about COVID-19 was significantly associated with pre-university education vs. post-graduate education (p ≤ 0.001, OR = 7.94) and university education vs. post-graduate education (p ≤ 0.001, OR = 4.17). The binary logistic regression analysis found that compared to being female, being male was significantly associated with less face mask wearing in public (p = 0.009, OR = 0.31): Females were 3.23 times more likely to wear a face mask than were males.Conclusions: Most of the study participants had good knowledge, positive attitudes, and effective practices toward COVID-19. The findings of this study may help guide future awareness resources to the groups most in need in the Jazan region, particularly as the COVID-19 situation develops and changes. Further assessment should consider the groups omitted from this study, including immigrants and the elderly who have not adopted social media and technology.
Análisis del comportamiento económico financiero de los sectores empresariales de Milagro, Ecuador
Authors: Moreira Macías María Fernanda , Carvajal Salgado Ana , Barreno Salinas María Mercedes 
Published: December 2021

El análisis del comportamiento económico-financiero del sector empresarial de Milagro, Ecuador tiene la necesidad de responder ¿Cómo afecta el comportamiento económico-financiero de los sectores empresariales en la población de esta ciudad? En el presente trabajo se estableció como objetivo analizar el comportamiento económico-financiero de los sectores empresariales que tienen acción en este sector; para ello se utilizó como recurso la búsqueda de información mediante el estudio de bases de datos de las empresas más rentables del cantón y cómo estas han logrado diferenciarse de la competencia que proviene de fuera de la ciudad, así como también mediante el SRI se determinó la cantidad de empresas en el cantón y campo de acción y contribución en la economía. Se planteó qué tipos de sectores empresariales intervienen con más fuerza en la economía de Milagro y cómo estos generan rentabilidad que es distribuida por los habitantes del sector.

Palabras clave: sector empresarial; sector económico-financiero; rentabilidad.
El impacto económico del turismo en la Provincia de Loja, Ecuador. Evaluación histórica y prospectiva
Authors: Vallejo Ramírez Jorge Baltazar , Malla Alvarado Franklin Yovani , Lalangui Lima Maritza Silvana , Ochoa Herrera Johanna Maribel 
Published: December 2021

El objetivo que persigue la investigación tiene relación con el análisis de la relación del turismo y la economía en la provincia de Loja, Ecuador, sitio que cuenta con varias alternativas para el desarrollo de esta actividad económica por su privilegiada ubicación geográfica y calidad humana de su población; el estudio está fundamentado en información del Ministerio de Turismo del Ecuador, razón por la cual son datos objetivos en función a su entorno; en los resultados se destaca la romería de la Virgen del Cisne desde su Basílica hasta la ciudad de Loja o el festival internacional de artes vivas que cada año cobra mayor interés en la comunidad nacional como internacional permitiendo la entrada de divisas a los comerciantes y tributos al Estado, contando con un presupuesto de $ 3.000.000 en anteriores ediciones, dando a entender la importancia que revierte su ejecución.

Palabras clave: estudios sectoriales; servicio; economía; recursos; divisas; tributos.
La cadena de valor en el proceso agrícola de maracuyá
Authors: Durán Salazar Galo Mauricio , Alcívar Mayor José Adrián 
Published: December 2021

La investigación se realizó en la comuna Julio Moreno ubicada en la provincia de Santa Elena, productora agrícola de maracuyá y vende su cosecha a intermediarios. El objetivo de la investigación fue proponer estrategias para que los agricultores puedan obtener mayores ingresos por sus ventas, para ello, se usó el análisis de la de cadena de valor. Los instrumentos utilizados para la investigación fueron entrevistas a personas de la comuna, lo cual permitió conocer los procesos aplicados para la siembra y cosecha de la fruta, dicha información se usó para estimar los costos y gastos de los procesos y determinar el margen de ganancia promedio que se obtienen por hectárea de siembre de maracuyá. La aplicación de la cadena de valor para la comuna, solo corresponde en este caso al primer eslabón que es la producción, ya que la cosecha no se procesa, se vende internamente en estado natural a intermediarios; por ello, se planteó que ofrecer el producto en otras ciudades, generaría aumento de las ventas, además de fomentar el empleo en el recinto; también la comuna puede formar su propia asociación de productores, lo cual tributariamente le exonera del pago del impuesto a la renta, teniendo que redistribuir las utilidades dentro de la comuna.

Palabras clave: economía de la empresa; cadena de valor; agricultores; recurso naturales ; costo-beneficio

Abstract
The research was done in the commune Julio Moreno located in the province of Santa Elena, agricultural producer of maracuyá and sells its harvest to middleman. The aim of the research was to propose strategies for farmers to earn higher revenue from their sales, for this purpose, the value chain analysis was used. The tools used for research were interviews with people in the commune, which allowed to know the processes applied for the sowing and harvesting of the fruit, this information was used to estimate the costs and expenses of the processes and determine the average profit margin obtained per hectare of fruit sowing. The application of the value chain for the commune, only corresponds in this case to the first link which is production, because the harvest is not processed, it is sold internally to intermediaries; for this reason, it was proposed that offering the product in other cities would generate increased sales, in addition to promoting employment on the premises; The commune can also form its own producer association, which exonerates them from payment of income tax, having to redistribute profits within the commune.

Keywords: business Economics; value chain; farmers; natural resource; cost-benefit.
El mercado de capitales y su impacto en la economía ecuatoriana en el periódo 2001-2019
Authors: Vásquez Obando Fabricio Javier , Muñoz Vera Hilda Ramona , Ortega Medranda Wendy Michelle 
Published: December 2021

El Mercado de valores en el Ecuador, representa una fuente de financiamiento para las empresas y el país, analizando así el periodo 2001-20109. Para ello se consideró la metodología descriptiva, comparativa y bibliográfica, conociendo el impacto que el Mercado de capitales a tenido a través de las emisiones de bonos soberanos. De esta forma se conoció que el Mercado de valores es una alternativa de financiamiento para empresas e inversionistas del país. En Ecuador, el valor efectivo negociado resultó insignificante con una variación de 3% por año, teniendo resultados desfavorables en términos de desarrollo. El Mercado de valores representa desarrollo para el país, considerado así uno de los mecanismos de financiamiento para solventar la deuda pública, dinamizando de esta forma la economía. El Ecuador todavía no ha desarrollado este mercado debido a la poca inserción del sector privado y la limitada emisión de valores registrados.

Palabras clave: emisión de bonos; Ecuador; inversionista; crecimiento económico.

ABSTRACT
The Stock Market in Ecuador represents a source of financing for companies and the country, thus analyzing the Stock Market the period 2001-20109. For this, the descriptive, comparative and bibliographic methodology was considered, knowing the impact that the capital market has had through the issuance of sovereign bonds. In this way it became known that the Stock Market is a financing alternative for companies and investors in the country. In Ecuador, the effective value traded was insignificant with a variation of 3% per year, having unfavorable results in terms of development. The stock market represents development for the country, thus considered one of the financing mechanisms to solve the public debt, thus boosting the economy. Ecuador has not yet developed this market due to the limited insertion of the private sector and the limited issuance of registered securities.

Keywords: bond issue; ecuador, investor; economic growth.