bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aspirin Decreases Hepatocellular Carcinoma Risk in Hepatitis C Virus Carriers: A Nationwide Cohort Study
Authors: Liao Yen-Hsiang , Hsu Wen-Lin , Wang Tzu-Hwei , Wu Chen-Ta , Huang Sheng-Yao , Hsu Chung-Y. , Su Yuan-Chih , Liu Dai-Wei 
Published: September 2019

Abstract
Background Aspirin lowered some cancer occurrence rate, through the inhibition of the cyclooxygenase enzyme. The association of aspirin-use and hepatocellular carcinoma (HCC) occurrence rate in hepatitis B virus (HBV) carriers is well known. However, the association in hepatitis C virus (HCV) carriers is not known. Our purpose is comparing the HCC occurrence rate in HCV carriers with or without Aspirin treatment. Methods In this retrospective cohort study, the participants were ones newly-diagnosed with HCV from 2000 to 2012 in Taiwan. These HCV carriers with aspirin treatment were defined as the control group, whereas those without aspirin were defined as a compared cohort. We used a 1:1 propensity score matching by age, sex, comorbidities, drugs, diagnosis year and index year with covariate assessment. Results Our study sample consisted of 2980 aspirin-treated HCV carriers and 7771 non-aspirin-treated HCV carriers. After propensity score matching, each cohort consisted of 1911 HCV carriers. The adjusted hazard ratio (aHR) of HCC incidence in aspirin users (aHR=0.56, 95% CI=0.43-0.72, p < 0.001 ) was significantly lower than that in non-aspirin users. The Kaplan-Meier curves show that among the HCV carriers, aspirin users had a lower cumulative incidence rate of HCC in the first 10-year aspirin treatment course ( p < 0.0001 ). Conclusions The HCC incidence rate was lower in the aspirin users than non- aspirin users among HCV carriers, supporting the aspirin effect may be acting through inhibition of the cyclooxygenase enzyme pathway. Moreover, the patients got HCC protection by aspirin within 1-year treatment course and had best HCC prevention during 1- to 2-year aspirin treatment course. We encourage aspirin treatment to prevent HCC in HCV carriers.
Profile and Outcome of Patients with Upper Gastrointestinal Bleeding Presenting to Urban Emergency Departments of Tertiary Hospitals in Tanzania
Authors: Rajan Shaffin S. , Sawe Hendry Robert , Iyullu Asha J. , Kaale Dereck A. , Olambo Nancy A. , Mfinanga Juma A. , Weber Ellen J. 
Published: September 2019

Abstract
Background: Upper Gastrointestinal Bleeding (UGIB) is a common Emergency Department (ED)presentation with high morbidity and mortality. There is a paucity of data on the profile and outcome of patients who present with UGIB to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania. Methodology: This was a prospective cohort study of consecutive adult (≥18 years) patients presenting to the EDs of Muhimbili National Hospital (EMD-MNH) and MUHAS Academic Medical Centre (EMD-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. We used the clinical Rockall score to assess disease severity. The primary outcome of 7- day mortality was summarized using descriptive statistics. Regression analysis was performed to identify predictors of mortality. Results: During the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42 years (IQR 32-64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7 days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24 hours. There were no ED deaths. About 65.1% of the patients had severe anemia but only 60 (48.8%) received blood transfusion in the ED. Amongst those with h/o esophageal varices 7(41.2%) did not receive octreotide. Only 8 (17.4%) received endoscopy within 24 hours, all of who had a low or moderate clinical Rockall score i.e. <3 and 3-4. Age >40 years was a significant independent predictor of mortality (OR=7.00 (95% CI 1.9-26.4). Receiving UGI endoscopy was independently associated with a lower risk of mortality (OR= 0.27; 95% CI 0.08-0.9.) Conclusion & Recommendations: In this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age < 40 years and endoscopic evaluation during the hospital stay were independent predictors of lower mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy so as to improve outcomes
Investigating the Causal Effect of Socioeconomic Status on Quality of Care under a Universal Health Insurance System – A Marginal Structural Model Approach
Authors: Cho Hoyune E. , Wang Lu , Chen Jung-Sheng , Liu Mochuan , Kuo Chang-Fu , Chung Kevin 
Published: September 2019

Abstract
Background: Social disparities in healthcare persist in the US despite the expansion of Medicaid under the Affordable Care Act. We investigated the causal impact of socioeconomic status on the quality of care in a setting with minimal confounding bias from race, insurance type, and access to care. Methods: We designed a retrospective population-based study with a random 25% sample of adult Taiwan population enrolled in Taiwan’s National Health Insurance system from 2000 to 2016. Patient’s income levels were categorized into low-income group (<25th percentile) and high-income group (≥25th percentile). We used marginal structural modeling analysis to calculate the odds of hospital admissions for 11 ambulatory care sensitive conditions identified by the Agency for Healthcare Research and Quality and the odds of having an Elixhauser comorbidity index greater than zero for low-income patients. Results: Among 2,844,334 patients, those in lower-income group had 1.28 greater odds (95% CI 1.24 – 1.33) of experiencing preventable hospitalizations, and 1.04 greater odds (95% CI 1.03 – 1.05) of having a comorbid condition in comparison to high-income group. Conclusions: Income was shown to be a causal factor in a patient’s health and a determinant of the quality of care received even with equitable access to care under a universal health insurance system. Policies focusing on addressing income as an important upstream causal determinant of health to provide support to patients in lower socioeconomic status will be effective in improving health outcomes for this vulnerable social stratum.
Δ133p53/FLp53 predicts poor clinical outcome in esophageal squamous cell carcinoma
Authors: Tu Qimin , Gong Hongjian , Yuan Chunhui , Liu Gao , Huang Jinqi , Li Zhichao , Luo Jianfei 
Published: September 2019

Abstract
Background p53 isoform Δ133p53 is directly transactivated by p53 and antagonizes p53 activities in cancer progression. However, its correlation with prognosis and cancer recurrence in esophageal squamous cell carcinoma (ESCC) is still unclear.Methods Expression of Δ133p53 and Δ133p53/full-length p53 (FLp53) in tissues and serums of 180 ESCC patients was evaluated using qRT-PCR.Results Tissue Δ133p53 expression and Δ133p53/FLp53 ratio were significantly increased in ESCC tissue compared with adjacent normal tissue. Pre-operative Δ133p53 expression and Δ133p53/FLp53 ratio in tissue or serum samples were positively associated with TNM stage and post-operative recurrence. Kaplan-Meier curve and multivariate cox regression analyses revealed that the tissue and serum Δ133p53/FLp53 ratio (cutoff value: 2.9160) were independent prognostic factors for overall survival (OS) and progression-free survival (PFS) in ESCC patients, and showed no statistical difference in receiver-operating characteristic (ROC) curve analysis, while serum Δ133p53 showed no significant prognostic value. More importantly, the serum Δ133p53/FLp53 ratio in ESCC patients was significantly decreased within 72 h post tumor resection and patients with a consistently high serum Δ133p53/FLp53 ratio (≥ 2.9160) had higher recurrence rates than those with consistently low ratio values. In addition, dynamic detection in each follow-up timepoint showed that serum Δ133p53/FLp53 ratios were higher than 2.9160 upon recurrence, and they even increased prior to radiologic progression.Conclusion The serum Δ133p53/FLp53 ratio can be a novel predictor for survival outcome and may serve as a real-time parameter for monitoring recurrence in ESCC patients after surgery.
Endoscopic surgical treatment with nasal cavity approach for chondrosarcoma of paranasal sinus and the skull base
Authors: Gao Junxiao , Zhu Zhenchao , Ye Yudong , Qiu Qianhui , Fu Ming 
Published: September 2019

Abstract
Background Chondrosarcoma(ChSa) is a rare malignant tumor. But it’s necessary to discuss the clinical characteristics and treatments for ChSa of paranasal sinus and the skull base.
Methods The clinical characteristics of ChSa of paranasal sinus and skull base in 10 patients (6 males and 4 females) from 2001 to 2017 were analyzed. They all underwent by endoscopic surgery . The patients’ age ranged from 18 to 47 years, with a median of 35 years. Clinical symptoms: stuffy, nose bleeding, runny, headache, diplopia, eye outreach limited, blurred vision and even blindness. Surgery methods：under nasal endoscopy, after the attachment sites of the tumors to normal tissues were confirmed, the tumors were peeled off along the clear boundary between the tumors and normal tissues, and the potential residual tumor tissues on bones were cleared by a drill.
Results All patients were treated with endoscopic surgery，followed up postoperatively for 24 to 108 months, with a median of 36 months. 8 of 10 patients were no recurrence,2 were alive with tumor.
Conclusion ChSa of paranasal sinus and skull base can be treated by nasal endoscopic surgery with good clinical results.
Constructing an Experiential Education Model in Undergraduate Radiology Education by the Utilization of the Picture Archiving and Communication System (PACS)
Authors: Chen Yingqian , Zheng Keguo , Ye Shanshan , Wang Jifei , Xu Ling , Li Ziping , Meng Quanfei , Yang Jianyong , Feng Shiting 
Published: September 2019

Abstract
Background
Medical education in China is in a transitional period changing from passive learning to experiential education models. We have modified an experiential education method for radiology education. The aim of this study is to evaluate the effect of this method on undergraduate radiology education.
Methods
With the help of the picture archiving and communication system (PACS) and RadiAnt DICOM Viewer, we have modified an experiential education method that simulates similar working conditions for undergraduate medical students to take on the role as clinical radiologists and formulate radiology diagnosis. A total of 101 students were allocated into either the experiential education group [Office1] or the control group. The final examination scores and a 5-point Likert scale self-assessment questionnaire of radiologic skills were collected from all the students as an objective assessment and a subjective assessment respectively. A questionnaire was also used to assess the satisfaction with the experiential model in the experiential education group. Mann-Whitney U test was used to compare the ranked data, and t -tests were used to compare the numeric data.
Results
The experiential education group demonstrated significantly higher scores (7.4±1.3) in the short answer type questions on imaging “description and diagnosis” when compared to the control group (6.7±1.5, p <0.05). The self-assessment questionnaire indicated that the experiential education corresponded to an increased familiarity with the diagnostic principles, the imaging sequences and reconstruction methods of computer tomography (CT), which also strengthen participants’ confidence to perform future clinical work (p <0.05). The self-assessment questionnaire from the experiential education group showed great satisfaction with the organization (82.5%), interactivity (85%) and quality (85%) of the learning activity in majority of students. Most students found this model of learning to be helpful for studying radiology (85%) and for understanding anatomy (90%).
Conclusion
Compared with the traditional radiology education approach, the experiential education model showed greater efficacy in improving students’ analytical and diagnostic skills as well as clinical confidence.
Práticas Inovadoras: Difícil Conquista
Authors: Fraga Tutikian Jane 
Published: September 2019

Este artigo traz uma breve visão dos séculos XX e XXI, com suas transformaçõeshistóricas, sociais e culturais. É, acima de tudo, o desenvolvimento tecnológico quesubverte o conceito de Humanismo. Existe, agora, uma nova maneira de estar no mundo. Novas ideias e novas formas de organizar o conhecimento requerem novas práticas pedagógicas. Para isso, podemos pensar em redes de pesquisa educacional global, em experiências de colaboração e de compartilhamento, em inovação no sentido amplo e em processos de aprendizagem capazes de criar novas possibilidades para o desenvolvimento humano. A metodologia destacada aqui é a Aprendizagem Invertida.
Inn i gråsonen: avskrekking som forsvar av cyberspace?
Authors: Muller Lilly Pijnenburg 
Published: September 2019

Selv om det kan hevdes at de ulike elementene som utgjør cyberoperasjoner – undergraving, sabotasje, manipulering, tyveri og desinformasjon – ikke er noe nytt, sprer de seg i dag med en hastighet og i et omfang som er uten historisk sidestykke. Cybersikkerhet er tett sammenvevd med det 21. århundres politiske og militære konflikter. Som NATOs generalsekretær Jens Stoltenberg påpeker, har de fleste konflikter og kriser i våre dager en cyberdimensjon, og det er vanskelig å forestille seg en militær konflikt i dag uten (Stoltenberg, 2016). Av denne grunn har såkalt cyberavskrekking blitt tema for en omfattende militær, politisk og akademisk debatt som kretser rundt et sett av viktige operasjonelle konsepter og overveielser. Et sentralt tema er hvorvidt det kan avskrekkes i cyberspace, gitt attribusjons utfordringene som preger etterdønningene av et cyberangrep. Denne artikkelen stiller spørsmål ved om «cyberavskrekking» er mulig og hensiktsmessig, og drøfter nye mulige måter å tenke rundt avskrekking i cyberspace på.
Abstract in English
Cybersecurity is deeply intertwined with every aspect of today’s political and military conflict. In conjunction with the growing acceptance of cyberspace as a military domain, so called “cyber deterrence” has become the subject of extensive military, political and academic debates. Revolving around a set of important strategic and operational concepts the debates are questioning whether deterrence can be achieved in cyberspace. In line with current debates, this article examines if “cyber deterrence” is possible, appropriate, and desirable, yet extends the debate by including new possible ways to think about deterrence and defense in cyberspace. By drawing attention to cyberspace’s idiosyncrasies while questioning the orthodoxy of deterrence as a concept, a reconceptualization of “cyber deterrence” that focuses on cyberspace itself is argued for, one which incorporates new outlooks and ideas, some of which may challenge the established boundaries of deterrence theory.
STRATEGI IMPLEMENTASI KEBIJAKAN TENTANG PROGRAM KAMPUNG KELUARGA BERENCANA MENUJU KELUARGA SEJAHTERA DI KABUPATEN CIREBON
Authors: Muliawaty Lia , . Maharto 
Published: September 2019

Sejak bergulirnya program keluarga berencana di Indonesia, sudah banyak membuahkan hasil dan pengaruh yang signifikan terhadap pengendalian dan pertumbuhan penduduk. Indikasi yang terlihat dalam implementasi kebijakan tentang program kampung keluarga berencana belum efektif diantaranya sarana lingkungan yang kumuh, pencapaian kontrasepsi jangka panjang masih rendah, kegiatan bina keluarga yang belum maksimal, kurangnya evaluasi dan pelaporan serta kurang maksimalnya koordinasi dari instansi terkait, keterbatasan jumlah pengelola/penyuluh, partisipasi masyarakat masih rendah serta keterbatasan sarana pendukung, kurangnya pembinaan terhadap institusi masyarakat, kurangnya sosialisasi keluarga sejahtera, dan respon dari pengelola program belum maksimal. Metode penelitian yang digunakan adalah metode kualitatif, yang berarti bahwa penelitian untuk memahami fenomena tentang apa yang dialami oleh subyek penelitian secara holistik dan dengan cara deskripsi dalam bentuk kata-kata dan bahasa pada suatu konteks khusus yang dialami dengan memanfaatkan berbagai metode ilmiah. Jenis pendekatan kualitatif dalam penelitian ini adalah studi kasus. Implementasi kebijakan tentang program kampung keluarga berencana menuju keluarga sejahtera di Kabupaten Cirebon belum terwujud, disebabkan oleh faktor content of policy (isi kebijakan) dan context of implementation (konteks implementasi) yang belum maksimal. Strategi yang efektif untuk dapat mengoptimalkan implementasi kebijakan tentang program kampung keluarga berencana menuju terwujudnya keluarga sejahtera di Kabupaten Cirebon adalah cenderung ke strategi deversifikasi atau strategi ST, dimana dalam strategi ini menggunakan atau memanfaatkan kekuatan untuk mengatasi ancaman yang dihadapi, dengan inovasi menambah program lain supaya tidak jenuh.
Crowdfunding in the Wider Perspective Investment Crowdfunding: Competition Between Regulations, Institutions, and Economic Freedom
Authors: Dziawgo Leszek , Dziawgo Danuta 
Published: September 2019

Abstract
The aim of this article is to present Investment Crowdfunding (ICF) in a perspective wider than merely as a new form of financing a certain category of business ventures. Selected aspects of ICF as a phenomenon that is a manifestation of the conflict between economic freedom and regulations and financial market institutions will be emphasized. New concepts of the part of the modern economy in the period of digitization, referred to as the collaborative economy, mesh economy, or sharing economy, should also be taken into account. The issues of excessive and restrictive regulation of the financial market will be presented in this context, as well as the constraints and risk factors of ICF operation and the Polish ICF experience.
The study hypothesises that Investment Crowdfunding is a viable alternative for financing micro and small economic projects, if compared to the traditional and over-regulated forms of financing. The usefulness of Investment Crowdfunding concerns primarily economic projects of the start-up category. The study uses the following research methods: critical analysis of the literature of the issue, descriptive and comparative analysis, case study, and deduction.
The theoretical considerations and examples presented in the article should be treated with appropriate research caution. However, they make it possible to positively verify the hypothesis.
Choice of Practical Subjects: Is It Still a Gendered Phenomenon? A Case of Selected Co-educational Secondary Schools in Bulawayo Metropolitan Province, Zimbabwe
Authors: Nani G. V. , Sibanda L. 
Published: September 2019

Abstract
The purpose of this study was to find out whether the selection of practical subjects in schools was still a gendered phenomenon. The motivators were findings of an investigation on business imitations in the Bulawayo Metropolitan Province, which revealed that men and women still participated in gender based entrepreneurial activities. A qualitative approach, which utilised the case study design was adopted for this study. Self-administered open-ended questionnaires were used as data collection instruments. The sample comprised 5 Heads of Departments, 15 practical subject educators and 75 students from 2 purposively selected co-educational schools in the Bulawayo Metropolitan Province. Data were analysed according to research questions. Findings showed that there were attempts to break the gender barriers as some girls were now studying subjects that were previously male dominated and some boys had enrolled for subjects that were in the past the preserve of girls. The study concluded that there was a gradual paradigm shift in the mind-sets of school authorities, learners and some parents. Recommendations were that school authorities should continue to intensify campaigns on de-constructing the learners’ gender stereo typed mind-sets and engage various stakeholders in the change process to enable learners to comfortably fit in a globally competitive environment.
Testing the Association between State Capacity and Primary Schooling in the Middle East and North African (MENA) Region, 1971–2014
Authors: Ping Szu-Ning , Chang Wen-Yang 
Published: September 2019

Abstract
Although the Middle East and North Africa (MENA) region has exhibited substantial progress over the past 40 years in improving primary schooling, marked variations in these achievements are evident within the region. This is an interesting puzzle if we recognize the MENA region is highly homogeneous in terms of religion, politics and socio-economic structure. We argue that in this paper, differences in state capacity–the degree to which MENA states attains desired primary education goals–contribute to these variations. To substantiate our argument, we applied different state capacity indicators and tested their impacts on primary schooling for the period 1971–2014. Empirical findings largely support our observations and results still hold with alternative indicators and model specifications. These findings have policy and academic implications for the study of state capacity, primary education and the MENA region.
Sleeping Behavior and Its Importance in Albanian Children and Teenagers Living in Tirana
Authors: Shatku Saimir , Aliaj Blerina , Bilali Afrim , Muca Kliton 
Published: September 2019

Abstract
Sleep is one of the most important biological needs for us humans. Sleep hours vary by age and lack of sleep affects daily functioning of children and adults. The purpose of this study is to determine the hours of waking and sleeping of children and teenagers during the days they go to school in the Tirana. We will determine if there are gender differences. We will determine if the age of the children affects the hours of sleep. This study was conducted in Tirana. The main conclusions of the study are that the largest percentage of Albanian children and teenagers wake up before 8:00 am and sleep after 22:00 darkness. There is no statistically significant difference between girls and boys in their waking and sleeping hours. Teenagers sleep later than children and wake up later than they do.
An Investigation Study of TV Watching for Albanian Children and Teenagers Living in Tirana
Authors: Aliaj Blerina , Nurja Fatjon , Tahiri Ermal , Muca Florian 
Published: September 2019

Abstract
The time children and teens spend in front of TV is one of the most disturbing phenomenon of parents not only in Albania but around the world. Watching TV for a considerable amount of hours is associated with a variety of problems in children, such as obesity, behavioral problems, sleep problems, insufficient engagement in the accomplishment of academic tasks and many other problems. The purpose of this study is to provide a broader overview of the amount of time Albanian children and teenagers in 1st, 5th, 9th and 12th grades spend watching TV. Do they watch more TV before they go to school or when they return from school? Is there a difference between boys and girls in the time they spend in front of the TV? But is there a difference between different age groups in this regard? The study was conducted in Tirana where (n = 698) children and teenagers participated in this study. It turned out that the children and teenagers interviewed watched more TV as they returned from school compared to before going to school. No statistically significant differences were observed between the boys and girls interviewed. No statistically significant differences were observed even between the classes taken in the study, but teenagers were found to watch slightly more TV than children. Important study resolutions are that before going to school most of them do not watch TV at all and after returning from school the highest percentage of the participants watch 1 to 2 hours of TV per day, which is acceptable for their age.