bluuebunny/crossref_metadata_2025_split huggingface dataset:
WHY WE HAVE TO REFORM MIDWIFERY EDUCATION?
Authors: Nugraheny Esti , Yanti Yanti , Joewono Hermanto Tri 
Published: October 2022

Background: Learner, methods and contents are three important parts of the learning variables beside lecturer, academic environment and patients. Facts and new findings show that we need to reform these learning variables accordingly especially in Obstetrics and Midwifery domainGaps:maternal deaths is still high despite higher number of obstetricians, doctors and midwives; as well asthe government has encouraged an increase in the number of institutions providing midwifery study programs. On the other hand, new paradigm in education has been ordered by the Ministry of Education such as student-centred learning, Outcome-based education, and also other approaches suggested by expert in medical education such as holistic education, bedside teaching, feedback & reflection, and problem based learning. Thus modify educational content and method in obstetrics and midwivery inline with new facts and findings and appropriate methods is necessary.Recommendation: One alternative to modify educational content and methods in midwifery education that can be implemented in clinical learning is the continuity of care approach accompanied by continuous feedback. This approach is proven to be able to reduce maternal mortality and as an effort to synergize education in an effort to achieve government program targets. However, in reality, midwifery education institutions have not fully adopted this approach. So there is a need for leadership commitment to carry out learning reforms with a sustainable curriculum approach, continuous feedback, continuous assessment, continuous midwifery care and continuous supervision so that learning outcomes as outputs and reducing maternal mortality as an outcome can be as expected.
Actor’s Social Actions and Their Dynamics in The Social System: A Case Study of Traditional Charcoal-Making Business in The Livelihood of The Akit Community
Authors: Yuliana Dhina , A. Kinseng Rilus , Hadi Dharmawan Arya , Soetaro Endriatmo 
Published: October 2022

The Akit community generally uses mangrove wood as raw material for charcoal. The purpose of this study was to analyze (a) the development of the charcoal-making business, (b) the type of social action in the Akit community's charcoal-making business, and (c) the dynamics of the charcoal-making business. This research was conducted using an ethnographic approach. The results: from the 1980s to 1994, production was initially regulated solely to meet local needs. In the era of 1995 to 2005, it experienced a high market demand for mangrove charcoal along with a flourishing business network with Malaysian toke. After 2005 the charcoal business dimmed again due to government regulations. The actors involved in the charcoal business are workers, owners of very small panglongs, and owners of small panglongs (tokes). The social action run the panglong business as an effort to meet their family needs, and thus they worked based on instrumental rationality. These charcoal-making entrepreneurs operated their businesses based on instrumental and traditional actions. The social action of the toke actor is instrumental rationality and value-oriented rationality. The dynamics of the charcoal business in the Akit community have experienced ups and downs.
Diabetes mellitus Affects Antibody Response to SARS-CoV-2 Vaccination in Older Residents of Long-Term Care Facilities: Data from the GeroCovid Vax Study
Authors: Virgilio Enrico , Trevisan Caterina , Abbatecola Angela , Malara Alba , Palmieri Annapina , Fedele Giorgio , Stefanelli Paola , Leone Pasqualina , Schiavoni Ilaria , Maggi Stefania , Volpato Stefano , Incalzi Raffaele Antonelli , Onder Graziano , group the GeroCovid Vax working 
Published: October 2022

<p> </p>
<p><strong>ABSTRACT</strong></p>
<p><strong>OBJECTIVE: </strong>Type 2 Diabetes mellitus may affect the humoral immune response following vaccinations, but data concerning COVID-19 vaccines are scarce. We evaluated the impact of diabetes mellitus on antibody response to the SARS-CoV-2 vaccination in older long-term care facilities (LTCF) residents and tested for differences according to anti-diabetic treatment.</p>
<p><strong>RESEARCH DESIGN AND METHODS: </strong>555 older LTCF residents participating in the GeroCovid Vax study were included for this analysis. SARS-CoV-2 trimeric S Immunoglobulin G (anti-S-IgG) concentrations using chemiluminescent assays were tested before the first dose and after 2- and 6-months. The impact of diabetes on anti-S-IgG levels was evaluated using linear mixed models, which included the interaction between time and the presence of diabetes. A second model considered also diabetes treatment: no insulin therapy (including dietary only or use of oral anti-diabetic agents) and insulin therapy (alone or in combination with oral anti-diabetic agents).</p>
<p><strong>RESULTS: </strong>The sample's mean age was 82.1 years, 68.1% were women and 25.2% were diabetic. In linear mixed models, the presence of diabetes mellitus was associated with lower anti-S-IgG levels 2 (β=-0.20, 95%CI:-0.34,-0.06) and 6 months (β=-0.22, 95%CI:-0.37,-0.07) after the first vaccine dose. Compared to those without diabetes, diabetic residents not using insulin had lower IgG levels at 2- and 6-month assessments (β=-0.24, 95%CI:-0.43,-0.05, and β=-0.30, 95%CI:-0.50,-0.10, respectively), while no differences were observed for those under insulin. </p>
<p><strong>CONCLUSION: </strong>Older LTCF residents with diabetes tended to have weaker antibody response to COVID-19 vaccination. Insulin treatment might buffer this effect and establish a humoral immunity similar to non-diabetic individuals.</p>
ANALISIS TINGKAT PELAYANAN PENYEBERANGAN KAPAL FERRY BENGKULU- ENGGANO
Authors: Andriyani Cristy Pujianti , Edito Dwi Antoro  , Tri Sefrus  
Published: October 2022

Sebagai moda transportasi utama antar pulau di Bengkulu, maka dibutuhkan pelayanan dan fasilitas penunjang yang baik, untuk menciptakan keadaan aman dan nyaman bagi pengguna jasa. Penelitian ini bertujuan untuk mengetahui pelayanan dan fasilitas yang diberikan PT ASDP Indonesia Ferry (Persero) Cabang Provinsi Bengkulu berdasarkan kepuasan penumpang. Analisis dilakukan dengan metode Importance and Performance Analysis (IPA) dan Customer Satisfaction Index (CSI), yang kemudian diolah menggunakan aplikasi SPSS 21. Dari metode Importance and Performance Analysis (IPA) didapatkan nilai kepuasan penumpang (X) rata-rata sebesar 45,25 dan nilai harapan (Y) sebesar 54,73. Hal ini menunjukkan bahwa lebih besar harapan dari pada kepuasan penumpang. Artinya, pelayanan perusahaan harus lebih ditingkatkan lagi . Beberapa faktor yang prioritas untuk diperbaiki yaitu kondisi jalan akses ke pelabuhan, lampu penerangan, daya tampung kapal/luas parkir di dalam kapal, ketepatan jadwal keberangkatan, jarak dan ketersediaan angkutan umum dari pelabuhan, serta kesesuaian tarif angkut kendaraan dan barang. Sedangkan dengan metode Customer Satisfaction Index (CSI), didapatkan nilai sebesar 7,3%. Nilai ini berada pada rentang nilai 0,66-0,80; yang berarti bahwa konsumen merasa puas secara keseluruhan terhadap pelayanan yang diberikan. Disarankan bahwa perusahaan harus lebih meningkatkan lagi pelayanan untuk memaksimalkan tingkat kepuasan kosumen terhadap perusahaan.
POREĐENJE EFIKSNOSTI TRETMANA KOMUNALNIH OTPADNIH VODA KORIŠĆENJEM MBBR-MBR I SBR SISTEMA
Authors: Galipidu Evdokia , Stasinakis Athanasios , Radonić Jelena 
Published: October 2022

U okviru rada ispitane su inovativne metode za prečišćavanje komunalne otpadne vode. Njiho­vo proučavanje izvedeno je na osnovu analiza naučnih radova drugih autora i istraživača, kao i na osnovu izvršenog eksperimenta. Opisani su eksperimentalno isptivani sistemi i dobijeni rezultati. Prvi sistem činio je kombinaciju anaerobnog reaktora sa pokretnim biofilmom (AnMBBR) i aerobni membranski bioreaktor (AeMBR), a drugi kombinaciju sekvencijalnog šaržnog reaktora (SBR) i mikroalge Chlorella sorokiniana. Određena je efikasnost prečišćavanja oba sistema, kao i njihovo poređenje sa ciljem predstavljanja prednosti i nedostataka.
Simulation and Regression Modeling of NASA’s X-59 Low-Boom Carpets Across America
Authors: Doebler William J. , Wilson Sara R. , Loubeau Alexandra , Sparrow Victor W. 
Published: October 2022

NASA’s X-59 aircraft is predicted to produce a significantly quieter cruise sonic boom than traditional [Formula: see text]-wave-producing aircraft. A propagation simulation study was undertaken to quantify loudness levels, exposure size, and variability of the X-59’s low-boom carpet using realistic atmospheric profiles across the contiguous United States of America (CONUS). Near-field pressure data of the X-59 in supersonic cruise from NASA’s fully unstructured Navier–Stokes three-dimensional (known as FUN3D) computational fluid dynamics code were propagated using NASA’s PCBoom code, which solves an enhanced Burgers equation along acoustic rays. Atmospheric profiles from the National Oceanic and Atmospheric Administration’s Climate Forecast System Version 2 database were used for propagation at 138 locations across the CONUS. Carpets at each location were generated for aircraft headings in the four cardinal directions. Over one million X-59 carpets were generated in total. The effects of the heading, season, geography, and climate zone on boom levels and exposure size are presented. Multiple linear regression models were developed to estimate carpet width and loudness metrics across the CONUS. These results inform regulators and mission planners on expected variations in boom levels and carpet extent from atmospheric variations. Understanding potential carpet variability is important when planning community noise surveys using the X-59.
Caregiving strain is associated with cardiac autonomic imbalance in primary oncology caregivers: A cross-sectional analytical study
Authors: Pant Arjun , Rajasegaran Rajalakshmi , Dubashi Biswajit , Jagadesan Pandjatcharam , Ganapathy Sachit 
Published: October 2022

Objectives:
Oncology caregivers often endure a significant amount of psychosocial stress while going through the experience of caregiving for their dependents. Exposure to chronic stress disrupts the cardiac autonomic balance and increases the risk of cardiovascular events. There is a paucity of research on the association between caregiving strain and cardiac autonomic status of primary oncology caregivers. This study aimed to assess the cardiac autonomic balance and its association with the levels of perceived strain and quality of life (QOL) of primary oncology caregivers.

Materials and Methods:
Forty-six individuals (30 males and 16 females) who have been primary caregivers of patients under the treatment for cancer at the Regional Cancer Centre over the past 3 months–1 year were recruited in this cross-sectional study. Cardiac autonomic status was assessed by heart rate variability (HRV) technique. The level of strain perceived and QOL of the study participants were assessed using the Modified Caregiver Strain Index (MCSI) and Caregiver QOL-Cancer (CQOL-C) questionnaires, respectively. Comparison of study parameters based on MCSI scores (low strain vs. moderate-high strain) was done using the Independent Student’s t-test. Spearman rank correlation coefficient test was performed to assess the correlation between sympathovagal balance (Low frequency [LF]/high frequency [HF]) and other study parameters. Multiple linear regression analysis was performed to predict the LF/HF ratio with independent variables MCSI score and CQOL-C score. P < 0.05 was considered statistically significant.

Results:
Significantly high blood pressure, LF power, LF nu (LF normalised units) and LF/HF ratio were observed among caregivers with moderate-to-high caregiving strain as compared to those with low strain levels, while significantly low HF nu (HF normalised units) and CQOL-C scores were noted among the moderate-to-high caregiving strain subgroup as compared to the low caregiving strain subgroup. LF/HF ratio revealed a significant positive correlation with the level of caregiving strain (r = 0.563, P < 0.001) and a significant negative correlation with the QOL (r = −0.489, P = 0.001) of caregivers. However, on regression analysis, the level of caregiving strain was found to be a significant predictor of autonomic dysfunction unlike the caregivers’ QOL.

Conclusion:
Increased caregiving strain is associated with cardiac autonomic imbalance in primary oncology caregivers.
Effect of dual blockade of renin-angiotensin system on renal nephrin and vascular endothelial growth factor – A expression in diabetic-hypertensive rats
Authors: Mobarak Asmaa Hussien Elsayed , Sayed Nesrine Salah El Dine El , Maklad Yousreya Aly Aly , Kenawy Sanaa Abdel-Baky 
Published: October 2022

Objectives:
The effects of early renin-angiotensin system (RAS) blockade using angiotensin-converting enzyme (ACE) inhibitor lisinopril and/or angiotensin receptor blocker valsartan on renal nephrin and vascular endothelial growth factor (VEGF)-A gene expression were investigated in diabetic-hypertensive rats.

Materials and Methods:
Diabetes and hypertension were induced in adult Wistar rats using streptozotocin (45 mg/kg, i.p.) and Nω-nitro-L-arginine methyl ester (60 mg/kg/12 h) for 4 consecutive days. Experimental animals were allocated into six groups (n = 6): normal control, diabetic control, diabetic-hypertensive control and lisinopril-, valsartan- and combination-treated diabetic-hypertensive groups (5 mg/kg/drug/day, p.o., for 21 days). Blood glucose, blood pressure, body weight, kidney weight to body weight ratio, serum albumin, creatinine, total protein and urea were measured and recorded every week. Nephrin and VEGF-A gene expression were measured using real-time polymerase chain reaction. Renal nephrin protein was measured using ELISA as well as nephrin immunostaining.

Results:
Blood pressure was significantly decreased by all treatments (P ≤ 0.05). All treatments normalised serum albumin and urea. Serum creatinine significantly decreased, while total protein significantly increased (P ≤ 0.05). Nephrin gene expression had a non-significant decrease in diabetic-hypertensive rats, yet it was statistically increased with individual treatments (P ≤ 0.05) and normalised with combined treatment. Renal nephrin protein significantly decreased in diabetic-hypertensive rats, normalised by lisinopril and significantly increased by valsartan and combined treatments (P ≤ 0.05). VEGF-A expression significantly increased in diabetic-hypertensive rats and significantly decreased with lisinopril and valsartan monotherapy and normalised with combined treatment (P ≤ 0.05). Immunostaining of nephrin also showed an obvious increase in the case of combined treatment.

Conclusion:
Early dual blockade of RAS in diabetic-hypertensive rats protected against renal damage and improved renal nephrin and VEGF-A gene expression as well as renal nephrin protein expression.
EEG microstates in resting condition in young indians
Authors: Tayade Prashant , Kaur Simran , Muthukrishnan Suriya Prakash , Sharma Ratna , Saini Gaurav 
Published: October 2022

Objectives:
The map topography analysis gives an idea of temporal dynamics of electric fields, which is reference independent, making the results unambiguous. These topographic maps remain stable for 80 to 100 milliseconds, abruptly shifting to a new topographic map configuration and remains stable in that state are called the ‘functional microstates’ as described by Lehmann et al (1987). There has been no study done in the resting state eye closed and eye open conditions showing the microstate maps in healthy Indian subjects in resting eyes open and resting eyes closed condition using 128 channel EEG. So our study aim was to assess the microstates in resting eyes closed and eyes open condition. And to compare the microstate parameters such as mean duration, global explained variance (GEV) and time coverage between eyes closed and eyes open condition.

Materials and Methods:
A cross-sectional and observational study on 20 indian subjects (Mean age- 26.65 and (SD) - 2.78 years) was done on resting eyes closed and eyes open conditions. After EEG acquisition using 128 channel EEG machine, EEG was preprocessed and microstate analysis using CARTOOL software was performed on the EEG data.

Results:
After microstate analysis four maps topography were obtained. There was statistically non-significant difference observed in microstate maps between resting eyes closed and resting eyes open condition for the all parameters i.e. mean duration, time coverage and GEV.

Conclusion:
Our findings suggests that, both eyes closed and eyes open conditions were similar to each other in terms of stability and predominance of Maps.
A study of changing trends in consumer preferences and perspectives towards health-care services during the pandemic
Authors: Medimpudi Srikanth , Medimpudi Lucklin , Ayyagari Lakshmana Rao , Araveti Jeswanth , Kadiri Mahesh 
Published: October 2022

Objectives:
The novel coronavirus disease 2019 (COVID-19) pandemic has caused a turmoil in the health-care delivery system and challenged consumers’ sense of well-being. This study examines the evolving consumer expectations and explores the key interventions that health-care providers can employ to increase engagement with consumers and prepare organisations to cope with post-pandemic challenges.

Materials and Methods:
We conducted a cross-sectional survey of 715 randomly selected patients visiting three secondary diabetes care centres across Andhra Pradesh – Vijayawada, Tenali and Tirupati between December 2020 and January 2021. We collected participants demographic data and history of comorbidities.

Results:
During lockdown, 59.3% of the respondents were concerned about health management, 63.9% expressed fear of contracting infections while visiting hospitals. Majority (70%) did not prefer visiting hospitals treating COVID-19 patients, while 18.3% reluctantly consider only if COVID-19 ward was kept isolated. Measures such as wearing personal protective equipment sanitisation and thermal screening and social distancing in outpatient settings/waiting areas were demanded by 89.7%, 84.5% and 60% of respondents, respectively. Concurrently, there is an increasing trend (from 2.8% to 24.9%) in teleconsultation. About 31.7% show an inclination to continue teleconsultations even after COVID-19 era with 51.7% recognising telemedicine as a time-saving option. Among interested patients (54%) with no prior experience of telemedicine, 41.5% reported concerns due to lack of technical equipment and improper training. About 23.1% were skeptical of effective personalised treatment. Sample collections at home (75.3%), home monitors (63.3%), medication delivery (47.3%) and telemedicine (31.7%) are preferred choices.

Conclusion:
On a real-time basis, participants are willing to share their health status-related data with their health-care team. Succumbing to the worldwide COVID-19 experience, both health-care providers and patients need to adopt and devise a ‘new normal’, a paradigm for addressing both health-care providers’ and patients’ requirements.
A simulation study to compare physiological responses to hypoxia and exercise between anaemic subjects and healthy controls
Authors: Kumar Ashwini , Sinha Biswajit , SR Santhosh , Mishra Pratibha 
Published: October 2022

Objectives:
Military flying is a complex task and requires high level of physical fitness of aviators. Various aviation stressors such as acceleratory force, hypoxia, cold weather conditions and decompression sickness place enormous stress on human physiological systems of the aviators. Individuals with Hb <13 g/dL (males) are being placed in the lower medical category which makes them unfit to fly. The present study was undertaken to assess the implication of low haemoglobin (Hb) on exercise capacity and hypoxia tolerance.

Materials and Methods:
Twenty-five individuals with anaemia and 15 healthy controls participated in the study. The participants were subjected to normobaric hypoxia (NH) equivalent to an altitude of 15,000 feet. Different physiological parameters such as heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), respiratory rate (fR) and arterial oxygen saturation (SpO2) were measured during NH. Participants also performed maximal aerobic capacity (VO2 max) and maximal anaerobic capacity test in bicycle ergometer.

Results:
HR, SBP, DBP and fR in anaemic subjects were higher than healthy controls during NH, whereas SpO2 in anaemic subjects was lower as compared to healthy controls. Anaemic individuals had a lower VO2 max than their healthy counterparts. Critical power and anaerobic work capacity were lower in anaemic subjects than healthy controls.

Conclusion:
There is a deterioration in exercise capacity and hypoxia tolerance in individuals with low Hb levels. Adequate precaution should be exercised for permitting military aviators to fly with low Hb level.
Flipped pedagogical approach in teaching skeletal muscle physiology for undergraduate medical students
Authors: Prabhu Rekha , Prabhu Girish 
Published: October 2022

Objectives:
Medical teachers need to use different pedagogical approaches to enhance student learning. Students are exposed to the flipped classroom (FC) in addition to the other teaching approaches which may enhance the comprehension, interpretation, and analytic skills of the students. The objective of this study was to compare the test scores obtained after the FC teaching session with the test scores obtained after a traditional classroom teaching session on a topic in skeletal muscle physiology delivered to 1st-year undergraduate medical students.

Materials and Methods:
Twenty-one 1st-year undergraduate medical students, undergoing a musculoskeletal system module at a private medical college were involved in this study. Students in the flipped pedagogical method were required to read the notes and power-point slides provided in addition to watching the prerecorded lecture videos before class. During the class, there was a topic review session followed by a small case discussion in groups. In the traditional classroom, students were advised to attend the lectures but there were no recorded videos to watch before the session. The effectiveness of the two types of pedagogical approaches was tested through pre-test and post-test using multiple-choice questions. The students’ perception of FC was collected through a semi-structured validated questionnaire.

Results:
The pre-test mean score was higher for FC (5.48 ± 1.44) when compared to the traditional classroom (3.19 ± 1.4). In our study, the scores from pre-test to post-test in a traditional classroom showed statistically significant improvement (P = 0.0014) but were not statistically significant in the FC. In the flipped pedagogical approach, the difference between mean correct responses for question number 5 (P = 0.031) in pre-test and post-test was statistically significant. There was an improvement in the mean scores in all the eight questions between pre-test and post-tests in the traditional pedagogical method of teaching. About 79.6% of students agreed that they watched all the assigned videos and 78.6% of students completed reading the assigned power-point presentation slides before coming to the FC. About 78.5% agreed to learn more topics in FC format and 78.6% of students agreed that FC was more engaging and interesting in comparison to a traditional class.

Conclusion:
Our study showed that flipped and traditional pedagogical approaches both enhance student learning.