bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relative CT number of periappendiceal fat stranding may be an applicable index for estimating the severity of acute appendicitis
Authors: Song Xinhong , Shi Mingqi , Liu Wei , Ge Yansong , Wang Peiyuan 
Published: March 2021

Objectives:
To investigate the feasibility of relative CT numbers to periappendiceal fat attenuation as an applicable index for estimating the severity of acute appendicitis.

Methods:
In total, 308 consecutive surgery-confirmed acute appendicitis patients and 243 controls with available preoperative CT were analyzed retrospectively. The radiological parameters were appendix diameter, length, and wall thickness as concurrent appendicitis signs. CT numbers of periappendiceal fat, mesenteric fat, subcutaneous fat in the anterior and posterior abdominal wall, retroperitoneal fat, gluteal subcutaneous fat and psoas major muscle were measured, as well as the relative CT numbers of periappendiceal fat compared with other locations.

Results:
There were 287 suppurative acute appendicitis (SAA) and 21 gangrenous or perforated acute appendicitis (GPAA) cases confirmed by pathology. The CT number of periappendiceal fat was significantly higher in patients than in controls (P＜0.01) although there was a wide overlap (−72.33 HU–117.43 HU). Significant differences in relative CT numbers were observed between the groups in gluteal subcutaneous fat (RCTgl) and psoas major muscle (RCTps) (P＜0.01). The AUCs of RCTgl and RCTps showed high accuracy to discriminate acute appendicitis from controls (AUC = 0.803, 0.761; 0.854, 0.847) and GPAA from SAA (AUC = 0.905, 0.851).

Conclusions:
Attenuation of periappendiceal fat on CT is related to the severity of appendicitis, and relative CT numbers (RCTgl and RCTps) could be an applicable index for severity determination.

Advances in knowledge:
Periappendiceal fat infiltration is related to the severity of acute appendicitis (especially relative CT number). Other clinical and CT features also need to be considered in the evaluation of inflammation.
Radiographic changes in the temporomandibular joint related to medication in rheumatic diseases
Authors: Şirin Gamze , Amuk Mehmet 
Published: March 2021

Objectives: The purpose of this study was to assess radiographical changes on temporomandibular joint (TMJ) in relation the autoimmune rheumatic diseases and the medicines that treat this diseases with cone beam computed tomography(CBCT). Methods: 65 people with rheumatoid diseases were included in the study and divided into five subgroups according to drugs they used. Condyle height (CH), anteroposterior dimension (APD), mesiolateral dimension (MLD) and superior joint space (SJS) were measured in order to evaluate mandibular condyle dimensions. Further, were evaluated in terms of osteoarthritic changes such as erosion, flattening, osteophyte and subchondral cyst in the mandibular condyle. TMJ measurements were compared between study-control groups and subgroups by using Student’s t-test, Mann-Whitney-U test, one-way analysis of variance (ANOVA) and Kruskal-Wallis test. The association between osteoarthritic features, rheumatoid status was tested by using χ2 test. Observers were blinded to all groups. Cohen κ values (0853–0945) and Spearman’s correlation coefficient (0.959–0.997) indicated high interexaminer reliability. Results: Condylar dimentions were significantly lower in CH and SJS in rheumatic diseases group (p < 0.001), however APD (p = 0,681) and MLD (p = 0,757) was not different significantly. Osteoarthritic changes such as erosion (p < 0.001), flattening (p = 0.005), osteophyte (p = 0.001) and subchondral cyst (p = 0.001) were significantly higher in the patient group. None of the parameters were different significantly according to subgroups determined according to drugs used(p > 0.05). Conclusions: Degenerative changes may cause decrease in condyle size and changes in condyle position. It is a process that can continue despite the use of antirheumatic or immunosuppressive drugs. All of these can become the source of possible TMJ problems.
Is it safe yet? Patient readiness and perceptions about returning to hospital for planned orthopaedic care
Authors: Kinghorn AF , Mercer ST , Yasin T , John A , Trickett RW 
Published: March 2021

Introduction COVID-19 has necessitated significant changes to healthcare delivery but little is known regarding patient opinions of risks compared with benefits. This study investigates patient perceptions concerning attendance for planned orthopaedic surgery during the COVID-19 pandemic. Materials and methods A total of 250 adult patients from the elective orthopaedic waiting list at Cardiff and Vale University Health Board were telephoned during lockdown. They were risk stratified for COVID-19 based on British Orthopaedic Association guidance and a discussion was held to determine patient willingness to proceed with surgery. The primary outcome measure was patients’ willingness to proceed. Results Of the total number telephoned, 196 patients were included in the study, with a mean age of 57.4 years; 129 patients were willing to attend for surgery, leaving over one-third wishing to cancel or defer. The most frequent reason given for not wishing to attend was fear of contracting COVID-19. There was a statistically significant difference in the willingness to proceed observed with increasing clinical risk (χ2(3) = 50.073, p = .000) with almost double the expected count of unwilling to proceed in the high and very high risk groups, equalled by half the expected count in the low risk group. Discussion This study illustrates the variable and personal decisions that patients are making about orthopaedic care because of COVID-19. It highlights the need for change to departmental processes regarding recommencement of planned surgical lists. It also reconfirms the importance of regular communication and shared decision making between a well-informed patient and a holistic orthopaedic team.
Where have all the appendicectomies gone?
Authors: Mowbray NG , Hurt L , Powell-Chandler A , Reeves N , Chandler S , Walters E , Cornish J. 
Published: March 2021

Introduction The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. Methods A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. Results A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score (p = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, p = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% (p < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% (p < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% (p < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (p < 0.001). Conclusions The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.
Gender differential in low psychological health and low subjective well-being among older adults in India: With special focus on childless older adults
Authors: Patel Ratna , Marbaniang Strong P. , Srivastava Shobhit , Kumar Pradeep , Chauhan Shekhar , Simon David J. 
Published: March 2021

Background
Gender and health are two factors that shape the quality of life in old age. Previous available literature established an associaton between various demographic and socio-economic factors with the health and well-being of older adults in India; however, the influence of childless aged is neglected. Therefore, the study examined the gender differential in psychological health and subjective well-being among older adults, focusing on childless older adults.

Methodology
This study utilized data from Building a Knowledge Base on Population Aging in India (BKPAI). Psychological health and subjective well-being were examined for 9541 older adults aged 60 years & above. Descriptive statistics and bivariate analysis were used to find the preliminary results. Further, multivariate analysis has been done to fulfill the objective of the study.

Results
Around one-fifth (21.2%) of the men reported low psychological health, whereas around one-fourth (25.5%) of the women reported low psychological health. Further, around 24 per cent of men and 29 per cent of women reported low subjective well-being. Results found that low psychological well-being (OR = 1.87, C.I. = 1.16–3.01), as well as low subjective well-being (OR = 1.78, C.I. = 1.15–2.76), was higher in childless older women than in childless older men. Higher education, community involvement, good self-rated health, richest wealth quintile, and residing in urban areas significantly decrease the odds of low subjective well-being and low psychological well-being among older adults.

Conclusion
There is a need to improve older adults’ psychological health and subjective well-being through expanded welfare provisions, especially for childless older adults. Moreover, there is an immediate requirement to cater to the needs of poor and uneducated older adults.
Dietary diversity and its correlates among pregnant adolescent girls in Ghana
Authors: Gyimah Linda Afriyie , Annan Reginald Adjetey , Apprey Charles , Edusei Anthony , Aduku Linda Nana Esi , Asamoah-Boakye Odeafo , Azanu Wisdom , Lutterodt Herman 
Published: March 2021

BackgroundDietary diversity, a qualitative measure of dietary intake, which reflects the variety of foods consumed has been recommended to assuage nutritional problems related to insufficient micronutrients, and food insecurity. To better understand the underlying factors for poor birth outcomes in Ghana, we assessed factors associated with dietary diversity among rural and urban pregnant adolescents in the Ashanti Region of Ghana.MethodsAs part of a larger longitudinal cohort of 416 pregnant adolescents, the FAO minimum dietary diversity for women index was used to determine the dietary diversity score (DDS) of the participants from a previous days’ 24-hour dietary recall data. The household hunger scale (HHS) and lived poverty index (LPI) were used to determine hunger and socioeconomic status. Eating behavior and socio-demographic data were gathered using interviewer-administered questionnaires.ResultsThe mean age of the participants was 17.5 (±1.4) years with an MDD-W of 4.4 and 56% recording inadequate MDD score. More rural (63.6%) than urban dwellers (50.6%) had inadequate DDS (p = 0.008). Among all the multiple variables tests of associations on dietary diversity, only hunger status (p = 0.028) and both food aversion and poverty status (p = 0.003) had a significant effect on the adolescents’ dietary diversity. Rural dwelling adolescents (AOR = 1.7, p = 0.035, 95% CI = 1.0–2.6) recorded higher odds for inadequate DD compared with the urban respondents. Pregnant adolescents with severe hunger had higher odds (Unadjusted OR = 1.9, p = 0.053, 95% CI 1.1–3.8) for inadequate dietary diversity compared with those with no hunger.ConclusionsInadequate DD is common among pregnant adolescents in this study and is associated with rural living, food insecurity, poverty, and food craving. Livelihood support for pregnant teenagers and nutrition education are recommended interventions to improve dietary quality and limit the consequences of poor dietary diversity.
(In)Visible illness: A photovoice study of the lived experience of self-managing rheumatoid arthritis
Authors: Donnelly Susie , Wilson Anthony G. , Mannan Hasheem , Dix Claire , Whitehill Laura , Kroll Thilo 
Published: March 2021

BackgroundChronic illnesses, such as Rheumatoid Arthritis (RA), are a growing burden on health care systems worldwide. Self-management emphasises the patient’s central role in managing their illness. This is pertinent given the majority of care is provided by the individual themselves; yet how individuals make sense of self-management in everyday life is largely unseen.ObjectiveThe purpose of this study was to capture the strengths and concerns of individuals with RA in self-managing their illness, raise awareness of their lived experience and spark a dialogue among stakeholders.MethodsA community-based participatory approach, Photovoice, was adopted. A purposive sample of participants were tasked with taking photographs to represent the challenges and solutions to living with RA. Group workshops and semi-structured interviews were conducted to facilitate reflection, dialogue and analysis. Data analysis followed Braun and Clarke’s thematic analysis. Public exhibitions were held throughout the Autumn of 2019.ResultsEight women and three men (n = 11) across suburban and urban regions of Ireland were recruited (mean age 57 years, disease duration 4–21 years). Participants identified four main themes which reflected the lived experience of self-managing RA: (i) I’m Here but I’m Not, (ii) Visible Illness, (iii) Medicine in All its Forms, (iv) Mind Yourself. These themes captured the challenge of reduced agency, limited contribution and participation, and a complex relationship between visible and invisible illness. Solutions focused on improving psychological and emotional resilience, particularly through personal reflection and increased agency.ConclusionsOur findings suggest that RA is experienced as a fluid relationship between states of masking and surfacing of illness shaped by contextual and situational factors. Photovoice was a highly effective tool to capture and communicate this complexity. Supporting increased agency among individuals with RA to control the (in)visibility of illness and disability can inform the development of future self-management support.
Association between the type of provider and Cesarean section delivery in India: A socioeconomic analysis of the National Family Health Surveys 1999, 2006, 2016
Authors: Lee Hwa-Young , Kim Rockli , Oh Juhwan , Subramanian S. V. 
Published: March 2021

BackgroundPrevalence of Cesarean section (C-section) is unequally distributed. Since both extremely low and high levels of C-section can not only cause adverse birth outcomes but also impose a double burden of inefficiency within maternal health care, it is important to monitor the dynamics of key factors associated with the use of C-section.ObjectivesTo examine the association between type of provider and C-section in India in three-time points: 1999, 2006, and 2016, and also to assess whether this association differed across maternal education and wealth level.MethodsData were from three waves of cross-sectional and nationally representative Indian National Health Family Survey: Wave II (1999), III (2006), and IV (2016). Target population is women aged 15 and 49 who had an institutional delivery for the most recent live birth during the three or five years preceding the survey (depending on the survey round). Multivariate logistic regression models adjusting for state cluster effect were performed to determine the association between the type of providers and C-section. Differential association between the type of providers and C-section by maternal education and wealth level was examined by stratified analyses.ResultsThe prevalence of C-section among institutional delivery increased from 20.5% in 1999 to 24.8% in 2006 while it declined to 19.4% in 2016. The positive association between private providers and C-section became stronger over the study period (Odds Ratio (OR) = 1.39, 95% Confidence Interval (CI) 1.18–1.64 in 1999, OR = 3.71 95% CI 2.93–4.70 in 2016). The association was consistently significant across all states in 2016. The gap in C-section between public and private providers was greater among less-educated and poorer women. The ORs gradually increased from the poorest to the richest quintiles, and also from the least educated group (no formal education) to the most educated group (college graduate or above)ConclusionsOur results suggest that disparity in C-section between private and public providers has increased over the last 15 years and was higher in lower SES women. The behavior of providers needs to be closely monitored to ensure that C-section is performed only when medically justified.
Bahan Ajar Matakuliah Pemodelan Matematika untuk Memfasilitasi Kemampuan Berpikir Kritis Mahasiswa
Authors: Khasanah Uswatun , Nurnugroho Burhanudin Arif 
Published: March 2021

Kemampuan berpikir kritis mahasiswa perlu diajarkan sebagai bekal dalam menghadapi tantangan dunia kerja. Kemampuan ini perlu dilatihkan melalui kegiatan perkuliahan di perguruan tinggi. Matakuliah Pemodelan Matematika merupakan salah satu matakuliah pada program studi Pendidikan Matematika Universitas Ahmad Dahlan yang dapat digunakan untuk mengembangkan kemampuan berpikir kritis mahasiswa. Karakteristik dari matakuliah pemodelan matematika yang memerlukan kemampuan berpikir tingkat tinggi menjadi salah satu alasannya. Penelitian ini bertujuan untuk mengembangkan bahan ajar matakuliah pemodelan matematika yang dapat meningkatkan k emampuan berpikir kritis mahasiswa. Dalam menggembangkan bahan ajar matakuliah pemodelan matematika, prosedur penelitian yang digunakan adalah 4-D model. Model pengembangan 4-D meliputi empat tahap yaitu, define, design, develop, dan disseminate. Instrumen yang digunakan dalam penelitian ini berupa lembar penilaian bahan ajar oleh ahli dan juga soal tes kemampuan berpikir kritis. Hasil penelitian menunjukkan bahwa bahan ajar matakuliah pemodelan matematika dikatakan dapat memfasilitasi peningkatan kemampuan berpikir kritis mahasiswa. Berdasarkan penilaian ahli terhadap bahan ajar matakuliah pemodelan matematika diperoleh skor rata-rata 80,02 (kategori sangat baik). Selain itu hasil tes kemampuan berpikit kritis mahasiswa menunjukkan adanya peningkatan terhadap kemampuan berpikir kritis mahasiswa secara kualitatif. Kata Kunci: bahan ajar, pemodelan matematika, kemampuan berpikir kritis
Penerapan Model Problem Based Learning untuk Meningkatkan Penguasaan Konsep Siswa pada Topik Persamaan Linier
Authors: Suryadi Suryadi 
Published: March 2021

Penelitian ini bertujuan untuk meningkatkan penguasaan konsep matematika siswa kelas X pada materi Persamaan Linier tahun pelajaran 2018/2019, melalui penerapan Model Pembelajaran Problem Based Learning (PBL). Subjek dalam penelitian ini adalah siswa kelas XI MIPA2 SMAN 1 Cikijing Kabupaten Majalengka yang berjumlah 31 orang siswa dengan 15 siswa laki-laki dan 16 siswa perempuan. Instrumen yang digunakan dalam pengumpulan data adalah lembar observasi siswa dan guru serta naskah soal tes penguasaan konsep, dokumentasi data yang diperoleh berupa nilai siswa sebagai data primer dan hasil observasi serta dokumentasi sebagai data pendukung. Penelitian dilaksanakan dalam 2 siklus. Terdapat peningkatan penguasaan konsep ditunjukan dengan nilai yang diperoleh pada setiap siklusnya. Pada pratindakan nilai rata-rata penguasaaan konsep siswa 52,5. Pada siklus I nilai rata-rata penguasaaan konsep siswa 66,5, dan siklus II nilai rata-rata penguasaaan konsep siswa meningkat menjadi 76. Tingkat ketuntasan belajar siswa pada kondisi awal atau pratindakan sebanyak 9 orang atau 29%, pada siklus I ketuntasan belajar siswa yaitu 20 orang atau 65%, dan pada siklus II ketuntasan belajar sebanyak 25 orang atau 81 %. Simpulan, penerapan model Pembelajaran PBL dapat meningkatkan penguasaaan konsep siswa pada pelajaran matematika topik sistem persamaan linier. Disarankan kepada guru matematika dan mapel lainnya untuk mencoba menerpakan PBL dalam pembelajaran.Kata Kunci: Problem Based Learning, Penguasaan Konsep, Sistem Persamaan Linier
Education as a Strategy for Active Aging Learning Center in Taiwan
Authors: LIN ANTI , Wei Hui-Chuan 
Published: March 2021

The population of individuals who are over 65 years-old in Taiwan has grown from less than 10% in 2008 to 14% in 2018. Since 2008, Taiwan has officially been an aging nation as defined by the World Health Organization. With the current rate of growth, we expect the country to become a super-aged society with 20% of the population being older than 65 years of age in 2025. The challenge Taiwan currently faces in bracing for a rapidly aging society is more difficult than ever. In response to a rapidly aging population, universities have been cooperating with the government since 2008 in promoting a community-based lifelong learning-oriented "active aging" education policy, of which we collectively call "Senior Learning" (“Le-Ling Learning” in Mandarin, meaning “Active Aging Learning”). 12 years into implementing the program, 369 senior learning centers have been established in Taiwan by 2020. These established centers with their extensions can be found throughout Taiwan, including 360 towns and cities as well as 3,175 villages. These centers, supported by local resources (e.g. schools, and non-governmental organizations), provide senior learning courses and activities. There are thousands of community volunteers participating every year, as well as over 200,000 hours of Active Aging Learning course duration prepared by the government; moreover, there are currently 200 instructors trained for teaching these programs. Active Aging Learning program has truly become a “zeitgeist” in Taiwan in response to the elderly society. In caring for the elderly, meaningful educational learning has become the best strategy as reflected by the public.
The purpose of this article is to report on the developmental background, promotion model, effectiveness of, and the prospects of Active Aging Learning in Taiwan. The contents of this article include: (1) the conceptual basis of Active Aging Learning, (2) the practice mode and strategy of Active Aging Learning, (3) the implementation effect of Active Aging Learning, and (4) the future progress of Active Aging Learning. The research data in this article originate from policy documents, both qualitative and quantitative data for the implementation of the Active Aging Learning program, as well as my 12 years of practical observations and experience as the overall project principal investigator. Through reading this article, the readers can quickly understand the implementation process, effectiveness, and problems of senior learning in Taiwan, as well as the key findings of our 12 years of experience. We found that the best strategy for an aging society is not to emphasize "care" in the context of traditional pathology, but to learn in order to "prevent". Educational strategies and talent cultivation are the broad directions of our active efforts.