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Abstract The aim of this study is to investigate how remote work affects job performance. It suggests that factors such as the work environment, employee productivity, and work-life balance play a role in mediating this impact. The study also explores how remote work influences employee performance through these variables. The findings of this research have practical implications for businesses looking to evaluate the effectiveness of their remote work policies, especially during the ongoing coronavirus crisis. One distinctive feature of this study is its questionnaire, which has been specifically designed to capture the effects of COVID-19. Data were collected through an online survey distributed to workers in Syria. The survey, which utilized a Likert scale, was sent via email to around 2650 employees and was also shared on social media platforms. A total of 300 respondents took part in the survey. To address the research questions, structural equation modelling was employed in this study. The results indicated that remote work resulted in increased enjoyment, satisfaction, and motivation among employees, ultimately improving job performance. It is worth noting that while this research focuses on examining these benefits within the context of Syria, there is potential for external validity among other countries affected by the COVID-19 pandemic.

تم تنفيذ ودراسة مقطعين جيولوجيين ضمن منطقة العمل (مقطع الشيخ حسن -العصفورة، ومقطع أم الطيور). يعتبر مقطع الشيخ حسن -العصفورة من أكثر المواقع، التي يمكن مشاهدة كامل صخور التشكيلة البركانية -الرسوبية بسماكة إجمالية تصل إلى 1000م، فضلاً عن غنى التشكيلات الصخرية في هذا الموقع بخام المنغنيز. بينما يضم موقع أم الطيور مقطعاً متكاملاً للتشكيلة البركانية -الرسوبية والصخور الأفيوليتية. أجريت الدراسات البتروغرافية على العينات الصخرية (20 شريحة مجهرية)، حيث بينت النتائج أن الصخور البركانية -الرسوبية ممثلة بنمطين: النمط الأوّل رسوبي يضم صخور غضارية -سيليكاتية و/أو صخور سيليكاتية -غضارية، صخور سيليكاتية -الراديولاريت، صخور كلسية، وصخور كلسية -بركانية. أمّا النمط الثاني فهو بركاني ويضم صخور الدياباز، صخور اللابا الوسادية، وصخور الطف البركاني والتي تعتبر نواتج البركنة القلوية المندسة والمتوضعة ضمن النمط الرسوبي. أكّدت النتائج تطابق الدراستين الحقلية مع المخبرية. كما أكدت نتائج التحاليل الجيوكيميائية لــــ /10/ عينات صخرية وجود الأنواع البتروغرافية النارية والرسوبية المدروسة.

This research to include a statement of the link between the science of the origins of interpretation and the science of the origins of jurisprudence through three sections that were the subject of extracting the sources of the relationship between them. On one hand based on terms of a scientific title of the origins of jurisprudence and origins of interpretation. Then through the point of view of the concept and scientific purposes of origins of jurisprudence and origins of interpretation. The last one through the point of view of the scientific construction of the origins of jurisprudence and origins of interpretation. In the introduction we started with the origins of jurisprudence before the origins of interpretation do to the precedence of the science of jurisprudence in blogging over the origins of interpretation. The aim of the research was to answer a basic question: What is the relationship between origins of jurisprudence 'Usul al-Fiqh' and origins of interpretation 'Usul al-Tafsir'? The answer was according to the aforementioned investigations. By knowing this relationship, the science of the origins of interpretation may be liberated in its subjects and topics. The method used in the research was the inductive-analytical method, including the descriptive method. One of the most prominent results of this research was that the emergence of the science of origins of interpretation was consistent with the emergence of origins of jurisprudence. Another important result is that the relationship between the science of the origins of jurisprudence and the science of the origins of interpretation is not a part relationship with each of all sides. But, on the fact, that the Qur’an is the first guide studied by the origins of jurisprudence. As for the investigations, objectives, and topics, the science of origins of interpretation is broader and more general than the science of origins of jurisprudence.

Purpose: The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care. Methods: Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July–October 2021. All residents (age ≥ 18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose. Results: Participants received health care in settings ranging from no regular care to primary care providers. Four elements emerged as contributing positively and negatively to health care experiences: 1) ability to access health care financially, physically, and technologically; 2) clarity of communication from providers and staff about appointment logistics, diagnoses, and treatment options; 3) ease of securing timely follow-up services; and 4) respect versus stigma and discrimination from providers and staff. Participants who felt positively toward health care found low- or no-cost care to be widely available and encouraged others to seek care. However, some participants described health care in the United States as greedy, classist, discriminatory, and untrustworthy. Participants reported delaying care and self-medicating in anticipation of discrimination. Conclusions: Findings demonstrate that while people experiencing homelessness can have positive experiences with health care, many have faced negative interactions with health systems. Improving the patient experience for those experiencing homelessness can increase engagement and improve health outcomes.

Objective This study has two objectives: first, to explore the diagnostic experiences of black/African American (BAA) patients with lung cancer to pinpoint pitfalls, suboptimal experiences and instances of discrimination leading to disparities in outcomes compared with patients of other ethnic backgrounds, especially white patients. The second objective is to identify the underlying causes contributing to health disparities in the diagnosis of lung cancer among BAA patients.Methods We employed a phenomenological research approach, guiding in-depth interviews with patients self-identifying as BAA diagnosed with lung cancer, as well as caregivers, healthcare professionals and community advocates knowledgeable about BAA experiences with lung cancer. We performed thematic analysis to identify experiences at patient, primary care and specialist levels. Contributing factors were identified using the National Institute of Minority Health and Health Disparities (NIMHD) health disparity model.Results From March to November 2021, we conducted individual interviews with 19 participants, including 9 patients/caregivers and 10 providers/advocates. Participants reported recurring and increased pain before seeking treatment, treatment for non-cancer illnesses, delays in diagnostic tests and referrals, poor communication and bias when dealing with specialists and primary care providers. Factors contributing to suboptimal experiences included reluctance by insurers to cover costs, provider unwillingness to conduct comprehensive testing, provider bias in recommending treatment, high healthcare costs, and lack of healthcare facilities and qualified staff to provide necessary support. However, some participants reported positive experiences due to their insurance, availability of services and having an empowered support structure.Conclusions BAA patients and caregivers encountered suboptimal experiences during their care. The NIMHD model is a useful framework to organise factors contributing to these experiences that may be leading to health disparities. Additional research is needed to fully capture the extent of these experiences and identify ways to improve BAA patient experiences in the lung cancer diagnosis pathway.

In tsunami studies, understanding the intricate dynamics in the swash area, characterised by the shoaling effect, remains a challenge. In this study, we employed the adaptive mesh refinement (AMR) method to model tsunami inundation and propagation in the Onagawa town physical flume experiment. Using the open-source flow solver Basilisk, we implemented the Saint-Venant (SV) equations, Serre–Green–Naghdi (SGN) equations, and a nonhydrostatic multilayer (ML) extension of the SGN equations. A hydraulic bore tsunami-like wave was used as the input boundary condition. The objective was to assess the efficiency of the AMR method with nonhydrostatic tsunami models in overcoming limitations in 2D and quasi-3D models in flume experiments, particularly with respect to improving accuracy in arrival time and run-up detection. The results indicate improved performance of the SGN and SV models in determining tsunami arrival times. The ML model demonstrated enhanced wave run-up simulations on complex built-in terrain. The refined roughness coefficient determined using the ML solver captured the arrival time well in the northern section of the Onagawa model, albeit with a 1 s delay. The AMR method offered a computationally stable solution with an 86.3% reduction in computational time compared to a constant grid. While effective, the nonhydrostatic models entail the use of a great deal of computational resources.

Abstract Background During the past three decades, growth charts have become one of the principal tools for monitoring anthropometric development in individuals and populations as well. Growth references by the CDC and other countries have been widely used in our hospitals and healthcare units for clinical assessment of children’s development. The apparent overestimation and underestimation of many children's anthropometrics indicated the need to construct our own references. The objective of this study is to establish the national growth references for the Syrian population 2–20-year-old. Methods A multicenter cross-sectional sample of 13,548 subjects, aged 2–20 years, were recruited from various kindergartens, schools, and universities across the Syrian Arab Republic between February and May-2019. Response variables (stature, weight, and BMI) were fitted against age using P-splines and three empirical distributions: Box-Cox T, Box-Cox Power Exponential, and Box-Cox Cole and Green. Residuals diagnostic Q-tests and worm plots were used to check the validity of fitted models. Results Box-Cox T provided the best fit for stature-for-age, whereas Box-Cox Power Exponential provided the best fit for weight-for-age and BMI-for-age. Residuals diagnostics revealed adequate models fitting. BMI cutoffs revealed an increased prevalence of obesity (4.5% and 3.66%) and overweight (20.1% and 19.54%), for boys and girls respectively, in our population. Conclusions Growth charts are available for use now in our hospitals and healthcare units. For 0–2-year-old children, we recommend using the World Health Organization’s standards.

Objective Lung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs at or prior to diagnosis from electronic health records (EHRs) in the USA. We aimed to identify symptoms and signs in patients prior to diagnosis in EHR data.Design Case–control study.Setting Ambulatory care clinics at a large tertiary care academic health centre in the USA.Participants, outcomes We studied 698 primary lung cancer cases in adults diagnosed between 1 January 2012 and 31 December 2019, and 6841 controls matched by age, sex, smoking status and type of clinic. Coded and free-text data from the EHR were extracted from 2 years prior to diagnosis date for cases and index date for controls. Univariate and multivariable conditional logistic regression were used to identify symptoms and signs associated with lung cancer at time of diagnosis, and 1, 3, 6 and 12 months before the diagnosis/index dates.Results Eleven symptoms and signs recorded during the study period were associated with a significantly higher chance of being a lung cancer case in multivariable analyses. Of these, seven were significantly associated with lung cancer 6 months prior to diagnosis: haemoptysis (OR 3.2, 95% CI 1.9 to 5.3), cough (OR 3.1, 95% CI 2.4 to 4.0), chest crackles or wheeze (OR 3.1, 95% CI 2.3 to 4.1), bone pain (OR 2.7, 95% CI 2.1 to 3.6), back pain (OR 2.5, 95% CI 1.9 to 3.2), weight loss (OR 2.1, 95% CI 1.5 to 2.8) and fatigue (OR 1.6, 95% CI 1.3 to 2.1).Conclusions Patients diagnosed with lung cancer appear to have symptoms and signs recorded in the EHR that distinguish them from similar matched patients in ambulatory care, often 6 months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.

The purpose of the publication is to closer define the essence, role and peculiarities of investment funds and companies. The analysis of researches on the subject of the article identified the lack of clearness concerning the issues of essential differences between the investment fund and the company. The article considers the definition of the studied concepts according to dictionaries and practical examples of the operating investment companies and funds. The peculiarities of the latter and types of specialization of investment funds are specified. There is a fundamental difference between these economic entities, which is that the investment company is a commercial organization with minimal restrictions and maximum freedoms for the implementation of investment and related activities for profit. An investment fund is either a specialized part of such a company or is a public institution with the presence of restrictions that are stipulated by the policy of its founders. It is proved that an investment company can often be both a holding company with a wide range of related activities, harmoniously combined with investment: insurance, consulting, brokerage, banking, credit and depository activities, accounting, etc. In some countries, legal restrictions do not allow a successful combination of investment and other activities, for example, insurance. It is determined that the evolution of investment activities in the global stock market causes a gradual loss of competitiveness of mutual investment funds. Instead, ETF funds have long taken their place. In the global financial market there is a limited number of investment companies – founders of major ETF funds with a significant level of competitiveness, which makes problematic and (or) inappropriate entry into the market of new funds. In addition to accumulating temporarily free funds and professional management of investment resources, the important role of investment companies and funds is the formation of the infrastructure of complementary pension provision.

Plain English Summary Cystic fibrosis (CF) is a rare, genetic disease; meaning people are born with the disease and have it throughout their lives. CF is a multi-system disease, primarily affecting the respiratory system. Daily care for people with CF (PwCF) includes taking many medications and breathing treatments. Many PwCF have experienced participating in research as research subjects, but not as partners on research teams participating as experts with the lived experience. Including patient and caregiver partners on research teams is important to improve quality of research. By working alongside each other, patient and/or caregiver partners and researchers build trust. Together, they pursue research questions deemed most important to patients and through this inclusive process, study findings are more rapidly adapted by patients and their communities. We found in a prior survey that 85% of patients, caregivers, healthcare providers and researchers in the CF community wanted training on how to include patient partners onto research teams. Our researcher and patient-partner team co-developed a four-part virtual pilot online training program focused on how to integrate patients/caregivers into research teams. This study aims to show changes in participants’ perceived knowledge, confidence in engaging stakeholders and satisfaction after participating in our training program. Participants included patients, caregivers, researchers and health care providers. We found that our training program improved knowledge about patient-engaged principles for all participants. This training program stands ready to serve as a model for further development to help increase capacity around patient and stakeholder engagement on research teams in the CF community.

Introduction: Achieving high COVID-19 vaccination coverage in homeless shelters is critical in preventing morbidity, mortality, and outbreaks, however, vaccination coverage remains lower among people experiencing homelessness (PEH) than the general population. Methods: We conducted a cross-sectional study to retrospectively describe attitudes and identify factors associated with change in COVID-19 vaccination intent among shelter residents and staff during March 2020 - August 2021. To identify factors associated with change in COVID-19 vaccine intent becoming more positive overall compared to other attitudes, we utilized a Poisson model to calculate Risk Ratios with robust standard errors, adjusting for confounding by shelter site and demographic variables determined a priori. Results: From July 12 - August 2, 2021, 97 residents and 20 staff participated in surveys across six shelters in Seattle King County, Washington. Intent to be vaccinated against COVID-19 increased from 45.3 % (n = 53) when recalling attitudes in March 2020 to 74.4 % (n = 87) as of August 2021, and was similar among residents and staff. Many participants (43.6 %, n = 51) indicated feeling increasingly accepting about receiving a COVID-19 vaccine since March 2020, while 13.7 % (n = 16) changed back and forth, 10.3 % (n = 12) became more hesitant, and 32.5 % (n = 38) had no change in intent. In the model examining the relationship between becoming more positive about receiving a COVID-19 vaccine compared to all other attitudes (n = 116), we found a 57.2 % increase in vaccine acceptability (RR 1.57; 95 % CI: 1.01, 2.45) among those who reported worsening mental health since the start of the pandemic. Conclusions: Findings highlight opportunities to improve communication with residents and staff about COVID-19 vaccination and support a need for continued dialogue and a person-centered approach to understanding the sociocultural complexities and dynamism of vaccine attitudes at shelters.Clinical Trial Registry Number: NCT04141917.

The fifth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM), was held on May 17, 2022. The theme of this year’s summit was ‘Academic-Community Partnerships: Change Agents for Advancing Health Equity.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity, and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, and individuals involved in talent acquisition and development, such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States as well as from Saudi Arabia. The content in this Book of Abstracts encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows, and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse, encompassing disparities in relation to maternal and child health (MCH), immigrant health, cancers, vaccination uptakes, and COVID-19 infections. Various solutions were ardently presented to address these disparities, including community engagement and partnerships, improvement in health literacy, and the development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research, and cultural competence as they relate to minority health issues and social determinants of health. The year’s summit was a great success! Copyright © 2022 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

The article concretizes dominance of targeting as a phenomenon for keeping inflation at the macro-level, and to improve advertising activities at the micro level. The success of the relevant instrument in anti-inflation and advertising policies actualizes the possibility of targeting key financial indicators of the organization that are important for its owners and financial administration, but are often overlooked on the part of its managers. The article closer defines the theoretical provisions for improving financial planning at the micro level by introducing complimentary targeting in the activities of commercial organizations. An algorithm and a key indicator are proposed, which be the «target» of the corresponding targeting. As such an indicator, the profitability of assets is substantiated, the target value of which in quantitative parameters should exceed the price of using bank loans. It is determined that in modern conditions with regard to commercial organizations in Ukraine, the profitability of assets should be equal to or exceeding 30%. Appropriate targeting at the micro-level is substantiated as a tool for smoothing and harmonization of contradictions between owners of large-scale commercial organizations and their managers of both the medium and the senior level. Ignoring the rule of necessity of exceeding the profitability of assets over bank loan rates is identified in the activities of a number of public joint stock companies that are leaders in terms of tax payments in Ukraine. In addition, the prevalence of the practice of using bank loans by relevant public joint stock companies, even with a «strong» balance sheet and a high level of liquidity and solvency, is specified. The dominance of the use of bank loans in the activities of leading industrial enterprises in the country instead of issuing their own bonds in the absence of exceeding the profitability of the assets of these enterprises over the price of bank loans indicates the underdevelopment of the domestic stock market and further increases the level of relevance of the targeting of the asset profitability indicator.

The purpose of this work is to substantiate the principles of financial stability of investment funds, which are inverse (opposite) to the principles of creating financial pyramids. The elements of scientific novelty include the specification of the peculiarities of compliance with the principles of financial stability of investment funds in modern conditions in Ukraine. An investment fund is also a kind of financial pyramid, but it can be created on the basis of the principles of stability, which are the opposite of the rules of existence of fraudulent financial pyramids. The such principles are defined as: dominance of assets over liabilities and minimization of overhead costs (including advertising); income from assets must exceed the value of liabilities; use of financial leverage or formation of assets according to a certain rule, which cannot be achieved by an individual investor; transparency and controlThe economic reasons for the existence of investment funds are considered, and the reasons for the success of individual financial institutions, which are essentially the relevant funds: Vanguard S&P 500 ETF and Berkshire Hathaway, are analyzed. The structure of the balance sheet of the investment fund is determined, which allows to adhere to certain principles of financial stability and use financial leverage. It is specified that an individual investor (individual) cannot use financial leverage for investment activities in the stock market, as it cannot issue bonds. The use of borrowed funds (broker or bank loans) allows an individual investor to make only short-term speculations that are very risky. At best, the average individual investor will only succeed in reaching the level of the S&P 500 stock index, while the investment fund will be able to exceed this index through the use of financial leverage.

Abstract Background Residency programs have the intricate and complex role of training health care providers. But little is known about what residents and attendings consider norms of practice or the tensions among different values residents are expected to uphold. Thus, dialogical and reflective frameworks are being explored for resident learning. Methods This study examined the use of facilitated conversations with groups of residents and attending physicians while reviewing video-recorded resident–patient interactions. The conversations were recorded, transcribed, and qualitatively analyzed. Results A total of 24 residents and 10 attendings participated in conversations while separately and in parallel groups reviewing 15 resident sessions. Residents explicated the norms of practice and evaluated their performance, which often agreed with those of attending physicians in calling out important learning opportunities. When disagreement occurred, residents’ explications of their reasoning were often relevant and, via reflection and dialogue, helped clarify intentions that were not apparent in the videos. Residents and attendings often judged actions on more than one domain of value. For instance, if a resident addressed problems, built relationships in a timely manner, and acted autonomously without jeopardizing the quality of care, she satisfactorily performed her duty. Conclusions Practice norms and value struggles were addressed by participants during reviews, which provided a promising framework for learning and assessment. Also, the non-hierarchical structure opened space to acknowledge a diversity of positions and for tensions among values to be explicated.

The publication is aimed at closer defining the theoretical-methodical provisions of the State regulation of regional innovation processes and their infrastructure provision, which is the basis for improving the system of the State provision of the researched processes. Attention is drawn to regional innovation processes as a means of getting the region out of the depressive status by deepening and improving specialization in the international division of labor. The features of regulating regional innovation processes and their infrastructure provision are considered. Scientific and technical systems have been identified as elements of the latter. Regional innovation policy is recognized as an important instrument for the State regulation of the researched processes. Its essence, tasks, factors of influence, features, problems and subjects of implementation, objects of influence are specified. The causal relationship of the State provision of regional innovation processes, as well as the components of success of the latter, have been defined. As an important result of the researched processes, a by-product of the multiplied tax effect is considered, which is the economic basis of the State provision of innovative projects. The role of sectors of the economy in the course of implementation of regional innovative projects has been specified, taking into account the issue of risk acceptance and the possibility of taking advantage of the additional benefits of the successful regional innovation projects.

Increased productivity is one of the least studied and challenging aspects of hotel and restaurant business management. The requirement to ensure productivity growth in order to survive and sustain business, including in Syria’s resurgent hospitality industry, is becoming increasingly important for managers. The active work of hotel managers in motivating and controlling staff in hotels should be a relevant and popular element in the development of a modern entrepreneurial culture, and better service. This article discusses what service productivity means, especially in the hospitality industry. This is confirmed by a study of the degree of compliance of the respondent hotels, which have become the object of the study, and labor productivity indicators in order to find a suitable standard of measurement and management system for the hotel industry in Syria. The article also provides an overview of the latest trends in the hotel business of Syria and a detailed analysis of the current tourism situation in Syria, including the study of the productive capacity of the labor force in the field of tourism and hotel in Syria on the basis of age, gender and educational level of workers in this field. This study has an important impact in determining how to increase production capacity in the sector of tourism and hotel in Syria.

Aim of study. The assessment of the postoperatory healing processes in guided tissues regeneration by association of plasma rich in growth factors (PRGF) with xenograft. Materials and method. The study group included 24 edentulous patients, candidates to dental implants (age 30-65); the patients were planned for pro-implant procedures by alveolar augmentation and guided tissues regeneration techniques with delayed implantation (6-8 months). The patients were selected from Clinical Base of Dental Education, Faculty of Dental Medicine, U.M.F. ˝Gr.T.Popa˝ Iasi and 2 private dental practices. The informed consent was obtained. The patients required guided bone regeneration technique to improve alveolar bone parameters in implant sites areas with moderate and severe defects. A combination of xenograft (Hypro-Oss, BioImplon) and Plasma Rich in Growth Factors (PRGF, Endoret) was used as grafting material. The postoperatory healing processes were monitorised by recording of the rate of complications and success rate. Results. The association of plasma rich in growth factors (PRGF) with xenografts materials is associated with postoperatory complications in only 6-12% cases and has 94% success rate în pro-implant alveolar augmentation. Conclusion.PRGF technology can be used for new combinations with potential to increase the clinical effectiveness of the guided tissues regeneration techniques in oral surgery.

Aim of study. The aim of study was to asses the bone volum gain in guided bone regeneration techniques using various grafting materials. Materials and method. Results. The highest mean values for parameter bone height (11,28 mm), in the alveolar augmentation procedures, were recorded in the study group that combined xenograft Hypro-Oss and PRGF, followed by xenograft SmartBone group (9,83 mm), and allogenuous material OsteoBiol (8,55 mm). The highest mean values for parameter bone width (2,00 mm), in the alveolar augmentation procedures, were recorded in the study group that combined xenograft Hypro-Oss and PRGF, followed by allogenuous material OsteoBiol group (1,96 mm), and xenograft OsteoBiol (1,83 mm). The changes of osteodensity, in the alveolar augmentation procedures, were highest in the xenograft SmartBone group (197,5HU) and allogenuous material OsteoBiol group (180HU), and the lowest osteodensity chages were recorded Hypro-Oss & PRGF test group (151,39HU). Conclusions. The use of the mixed graft Hypro-Oss and PRGF conducted to the highest gain of alveolar bone height and width but the lowest osteodensity values, comparing to xenografts from the new generation of graft materials.

The article focuses on the fact of underestimating engineering organizations in the regulatory framework and statistical accounting as an important component of infrastructure support for regional innovation processes. The systemic problems of participation of engineering organizations in the intensification of the processes under study are highlighted, and measures to address them are identified. The aim of the work is to substantiate the hypothesis of the underestimation of engineering organizations as components of infrastructure support of regional innovation processes in Ukraine and clarify the real role of these organizations. The possibility of using performance indicators of engineering organizations as those for identifying the trend of de-industrialization of regions and the national economy is specified. A downturn in the number of employees in engineering organizations and the number of the organizations, which indicates deterioration in infrastructure support for regional innovation processes and decrease in their intensity level, is revealed. The real role of these organizations in regional innovation processes is clarified; the need for their integration with scientific organizations and each other in terms of creating databases and coordinating the implementation of scientific work, as well as improving the statistical accounting of infrastructure support for regional innovation processes in the direction of detailed coverage of engineering industry indicators by region is justified. This allows improving the quality of monitoring state support for regional innovation processes. In the proposed scheme of co-operation of engineering organizations and scientific organizations, the former should become the commissioners of the work aimed at practical implementation of innovative ideas in the design and estimate documentation.

Background Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer.Purpose We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutations.Methods Qualitative interviews were conducted with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations. Patients were recruited from online support groups within the USA. Interviews were conducted remotely or in person. Analysis used an iterative inductive and deductive process. Themes were mapped to the Model for Pathways to Treatment.Results 40 patients (12 male and 28 female) with a median age of 48 were included. We identified nine distinct themes. During the ‘patient interval’, individuals became concerned about symptoms, but often attributed them to other causes. Prolonged or more severe symptoms prompted care-seeking. During the ‘primary care interval’, doctors initially treated for illnesses other than cancer. Discovery of an imaging abnormality was a turning point in diagnostic pathways. Occasionally, severity of symptoms prompted patients to seek emergency care. During the ‘secondary care interval’, obtaining tissue samples was pivotal in confirming diagnosis. Delays in accessing oncology care sometimes led to patient distress. Obtaining genetic testing was crucial in directing patients to receive targeted treatments.Conclusions Patients experienced multiple different routes to their diagnosis. Some patients perceived delays, inefficiencies and lack of coordination, which could be distressing. Shifting the stage of diagnosis of lung cancer to optimise the impact of targeted therapies will require concerted efforts in early detection.

The development of novel bioactive molecules is urgently needed, especially with increasing fatalities occurring due to infections by bacteria and escalating numbers of multiple-drug-resistant bacteria. Several lines of evidence show that the gut microbiome of cockroaches, snakes, crocodiles, water monitor lizards, and other species may possess molecules that are bioactive. As these animals are routinely exposed to a variety of microorganisms in their natural environments, it is likely that they have developed methods to counter these microbes, which may be a contributing factor in their persistence on the planet for millions of years. In addition to the immune system, the gut microbiota of a host may thwart colonization of the gastro-intestine by pathogenic and/or foreign microorganisms through two mechanisms: (i) production of molecules with antibacterial potential targeting foreign microorganisms, or (ii) production of molecules that trigger host immunity targeting foreign microorganisms that penetrate the host. Herein, we discuss and deliberate on the current literature examining antibacterial activities that stem from the gut bacteria of animals such as crocodiles, cockroaches, and water monitor lizards, amongst other interesting species, which likely encounter a plethora of microorganisms in their natural environments. The overall aim is to unveil a potential library of novel bioactive molecules for the benefit of human health and for utilization against infectious diseases.

Background: Usability—the extent to which an intervention can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction—may be a key determinant of implementation success. However, few instruments have been developed to measure the design quality of complex health interventions (i.e., those with several interacting components). This study evaluated the structural validity of the Intervention Usability Scale (IUS), an adapted version of the well-established System Usability Scale (SUS) for digital technologies, to measure the usability of a leading complex psychosocial intervention, Motivational Interviewing (MI), for behavioral health service delivery in primary care. Prior SUS studies have found both one- and two-factor solutions, both of which were examined in this study of the IUS. Method: A survey administered to 136 medical professionals from 11 primary-care sites collected demographic information and IUS ratings for MI, the evidence-based psychosocial intervention that primary-care providers reported using most often for behavioral health service delivery. Factor analyses replicated procedures used in prior research on the SUS. Results: Analyses indicated that a two-factor solution (with “usable” and “learnable” subscales) best fit the data, accounting for 54.1% of the variance. Inter-item reliabilities for the total score, usable subscale, and learnable subscale were α = .83, α = .84, and α = .67, respectively. Conclusion: This study provides evidence for a two-factor IUS structure consistent with some prior research, as well as acceptable reliability. Implications for implementation research evaluating the usability of complex health interventions are discussed, including the potential for future comparisons across multiple interventions and provider types, as well as the use of the IUS to evaluate the relationship between usability and implementation outcomes such as feasibility. Plain language abstract: The ease with which evidence-based psychosocial interventions (EBPIs) can be readily adopted and used by service providers is a key predictor of implementation success, but very little implementation research has attended to intervention usability. No quantitative instruments exist to evaluate the usability of complex health interventions, such as the EBPIs that are commonly used to integrate mental and behavioral health services into primary care. This article describes the evaluation of the first quantitative instrument for assessing the usability of complex health interventions and found that its factor structure replicated some research with the original version of the instrument, a scale developed to assess the usability of digital systems.

Objective Lung cancer is increasingly recognised as a heterogeneous disease. Recent advances with targeted therapies for lung cancer with oncogenic mutations have greatly improved the prognosis for this subset of patients, yet little is known about their experiences. This study aimed to identify the needs and explore the healthcare experiences of these advanced patients with oncogenic mutation driven lung cancer.Design Qualitative interviews with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations in anaplastic lymphoma kinase, epidermal growth factor receptor or c-ros oncogene 1.Settings Patients were recruited from online lung cancer support groups within the USA. Interviews were conducted remotely or in person, transcribed verbatim and analysed using an iterative inductive and deductive process.Participants We included 39 patients (11 males and 28 females) with a median age of 48.Results Two primary theme categories emerged: patients' unmet needs and improving healthcare experiences. Unmet needs are related to patients’ desire to view their disease as a chronic illness, aspire to live a meaningful existence without financial devastation, desire for understanding along with emotional support and needing help with practical matters. Improving healthcare experiences involved patients’ desire to trust the expertise of clinical providers, receive reliable care and be treated holistically and as informed partners.Conclusions Patients with lung cancer with oncogenic mutations live uncharted experiences. Targeted therapy brings hope, but uncertainty is daunting. Patients grapple with the meaning and purpose of their lives while day-to-day obligations remain challenging. Healthcare teams are instrumental in their care experiences, and patients desire providers who are up-to-date on advances in the field and treat them as whole persons.

One of the most common comorbid pathology is asthma and arterial hypertension. For experimental modeling of comorbidity we have used spontaneously hypertensive rats with ovalbumin (OVA)-induced asthma. Rats were randomly divided into three groups: control group, OVA-induced asthma group; OVA-induced asthma + IL10 shRNA interference group. Target gene (IL10) was predicted by ANDSystem. We have demonstrated that RNA-interference of IL10 affected cardiovascular (tested using Millar microcatheter system) as well as respiratory functions (tested using force-oscillation technique, Flexivent) in rats. We have shown that during RNA-interference of IL10 gene in vivo there were changes in both cardiac and lung function parameters. These changes in the cardiovascular parameters can be described as positive. But the more intensive heart workload can lead to exhaust and decompensation of the heart functions. Knockdown of IL10 gene in asthma modeling induces some positive changes in respiratory functions of asthmatic animals such as decreased elastance and increased compliance of the lungs, as well as less pronounced pathomorphological changes in the lung tissue. Thus, we provide the data about experimentally confirmed functionality changes of the target which was in silico predicted to be associated with both asthma and hypertension – in our new experimental model of comorbid pathology.

The aim of the article is clarifying the content of the concept “investment potential of a region”, justifying the use of additional terms that reflect the considered essence more precisely; studying subjective and objective factors affecting the investment processes in regions. The work studies the essence of potential of using the investment capacity of a region. It is proposed to use this concept in some cases instead of the term “investment potential of the region”. The proposal is based on the lack of interpretation of the latter in economic dictionaries and various interpretations of it by researchers. It is proved that if the concept “investment potential of a region” is used to denote the maximum capabilities of a region to attract and develop investments, then it is more appropriate to use the term “potential of using the investment capacity of a region”. The investment capacity of a region is defined as the maximum amount of investment that can be made and used during a certain time period in a particular region. Mathematically, the investment capacity of a region is greater than the actual volume of investment in this region within the time period i by the amount of unused potential of the investment capacity of the region within the time period i. It is specified that the larger investment capacity of the region and the potential for its use are, the greater the likelihood of investment in this region in future periods is. The larger the level of specialization of the region in the international division of labor is, the greater its investment capacity is. Innovations also increase the investment capacity of a region, so the innovation investment infrastructure of regions is a subjective factor in increasing the potential of using their investment capacity. In the context of globalization, the assertion that global investment resources exceed the investment capacity of a region becomes relevant. Integration into the world financial market is defined as the main task of the investment infrastructure of a region, and the level of such integration as the main criterion of its quality and efficiency.

The publication considers a number of problems of implementation of electronic document management in organization and ways of their solution. The close relationship between the organization of electronic document management and the main objectives of information management has been specified. Such tasks was considered and the means of solution of them are offered due to the use of widespread software and hardware of information systems. The necessity of electronization of document circulation is proved only in case of separate operations where it is optimal. The tendencies of intensification of introduction of electronic document circulation on the State and regional levels are specified.

Abstract Background Medical billing and coding are critical components of residency programs since they determine the revenues and vitality of residencies. It has been suggested that residents are less likely to bill higher evaluation and management (E/M) codes compared with attending physicians. The purpose of this study is to assess the variation in billing patterns between residents and attending physicians, considering provider, patient, and visit characteristics. Method A retrospective cohort study of all established outpatient visits at a family medicine residency clinic over a 5-year period was performed. We employed the logistic regression methodology to identify residents’ and attending physicians’ variations in coding E/M service levels. We also employed Poisson regression to test the sensitivity of our result. Results Between January 5, 2009 and September 25, 2015, 98,601 visits to 116 residents and 18 attending physicians were reviewed. After adjusting for provider, patient, and visit characteristics, residents billed higher E/M codes less often compared with attending physicians for comparable visits. In comparison with attending physicians, the odds ratios for billing higher E/M codes were 0.58 (p = 0.01), 0.56 (p = 0.01), and 0.63 (p = 0.01) for the third, second, and first years of postgraduate training, respectively. In addition to the main factors of patient age, medical conditions, and number of addressed problems, the gender of the provider was also implicated in the billing variations. Conclusion Residents are less likely to bill higher E/M codes than attending physicians are for similar visits. While these variations are known to contribute to lost revenues, further studies are required to explore their effect on patient care in relation to attendings’ direct involvement in higher E/M-coded versus their indirect involvement in lower E/M-coded visits.

Abstract Background Prescription opioids have been linked to over half of the 28,000 opioid overdose deaths in 2014. High rates of prescription opioid non-medical use have continued despite nearly all states implementing large-scale prescription drug monitoring programs (PDMP), which points to the need to examine the impact of state PDMP’s on curbing inappropriate opioid prescribing. In the short-term, PDMPs have been associated with short-term prescribing declines. Yet little is known about how such policies differentially impact patient subgroups or are interpreted by prescribing providers. Our objective was to compare volumes of prescribed opioids before and after Indiana implemented opioid prescribing emergency rules and stratify the changes in opioid prescribing by patient and provider subgroups. Methods An interrupted time series analysis was conducted using data obtained from the Indiana PDMP. Prescription level data was merged with census data to characterize patient socioeconomic status. Analyses were stratified by patients’ gender, age, opioid dosage, and payer. The primary outcome indicator was the total morphine equivalent dose (MED) of dispensed opioids per day in the state of Indiana. Also considered were number of unique patients, unique providers, and prescriptions; MED per transaction and per day; and number of days supplied. Results After controlling for time trends, we found that total MED for opioids decreased after implementing the new emergency rules, differing by patient gender, age, and payer. The effect was larger for males than females and almost 10 times larger for 0–20 year olds as compared to the 60+ age range. Medicare and Medicaid patients experienced more decline in prescribing than patients with private insurance. Patients with prescriptions paid for by workers’ comp experienced the most significant decline. The emergency rules were associated with decline in both the number of prescribers and the number of day supply. Conclusions Although the Indiana opioid prescribing emergency rules impacted statewide prescribing behavior across all individual patient and provider characteristics, the emergency rules’ effect was not consistent across patient characteristics. Further studies are needed to assess how individual patient characteristics influence the interpretation and application of state policies on opioid prescribing.

Abstract Background The overarching purpose of this study is to examine the current trends in interprofessional education (IPE) within graduate medical education in the Unites States. Methods A survey was sent to program directors across with different specialties between March and April 2016. The survey was completed by 233 out of 1757 program directors, which represents a response rate of 13.3%. Results IPE is currently being used by over 60% of the GME program directors that completed the survey. The median number of IPE hours is 60. Classroom learning (70.8%) and team-based approaches (70.1%) to patient care are the two most common forms of IPE. The two most prevalent reasons for implementing IPE are improving collaboration (92.2%) and communication (87%). More than half of the program directors agreed or strongly agreed that lack of time both for teachers (54.4) and for residents (51.5%) are barriers to IPE. About one third of the respondents whose programs do not include IPE are interested in implementing some IPE in the future. Conclusion IPE in its varying formats has been implemented as a training model by many residency programs. Further studies are needed to explore the comparative effectiveness of the different modalities of IPE.

The article is aimed at substantiating the perspectivity of information systems and technologies as a direction of the State support for the conditionally depressive regions. The article clarifies the assumption that an increase in the number of freelancers in region (even evaders from taxation), causes the growth of both the regional enterprises’ revenues and the tax revenues to budgets. Such freelancers become customers of works, services and goods, and, accordingly, employers for other persons who work officially. The State support for the concentration of such persons in the region contributes to reducing the «brain drain» abroad. The article substantiates prospective directions of the State support for the conditionally depressive regions by means of information systems, the basic elements of which are IT-specialists; as well as economic expediency of priority of the State support for the regions with presence of high level of unemployment of working population. The ways of solution of contradictions between the State and the freelancer in the part of payment of taxes and accrual of the insurance period for the future pension have been suggested. The ultimate goal of the State support for the conditionally depressive regions with use of information systems has been defined, which is to achieve the stage of the multiplied effect of growth of income of economic entities and tax revenues to the budget due to the implementation of innovation projects as result of the concentration of IT specialists in region.

Crocodiles are remarkable animals that have the ability to endure extremely harsh conditions and can survive up to a 100 years while being exposed to noxious agents that are detrimental to Homo sapiens. Besides their immunity, we postulate that the microbial gut flora of crocodiles may produce substances with protective effects. In this study, we isolated and characterized selected bacteria colonizing the gastrointestinal tract of Crocodylusporosus and demonstrated their inhibitory effects against three different cancerous cell lineages. Using liquid chromatography-mass spectrometry, several molecules were identified. For the first time, we report partial analyses of crocodile’s gut bacterial molecules.

Terrestrial laser scanning (TLS) technology is a powerful tool for assessing tree growth based on time series analysis, as it allows a level of scrutiny not achievable using established destructive techniques. We applied TLS technology to 21 wild cherry trees grown in a research plot near Breisach (southern Germany) in order to build quantitative structure models (QSMs) for each tree. Scans were carried out over three subsequent years (2012-2014), so that three QSMs per each tree were constructed. Using the above approach, we were able to assess the annual growth of the individual wild cherry trees in terms of diameter and height, stem and branch volume, and the merchantable timber fraction. In addition, the growth of single branches of sample trees was detected and quantified. The availability of QSMs based on TLS-derived data allowed the accurate determination of crown length and width, as well as the volume reduction as the result of the tree pruning applied after the first scan (2012). The aboveground biomass (AGB) was assessed for each tree based on the QSM-derived volume and published wood density values for wild cherry, and then compared with AGB values estimated with standard allometric methods, obtaining a very high correlation (r2adj = 0.941). We concluded that the proposed approach is an effective non-destructive technique to accurately assess the increase of tree biomass, and discuss its future application in the forestry sector.

Despite intensive research, cancer incidence and mortality continue to rise. Consequently, the necessity to develop effective anti-cancer therapy is apparent. We have recently shown that the gut bacteria of animals living in polluted environments, such as crocodiles, are a potential source of novel anti-tumor molecules. To extend this work to other resilient species, we investigated the anti-tumor effects of gut bacteria of Heterometrus spinifer (a scorpion). Bacteria from the feces and gut were isolated, identified and evaluated for their anti-tumor effects. Bacterial-conditioned media was prepared in Roswell Park Memorial Institute (RPMI) 1640 media, and cytotoxicity and growth inhibitory properties were examined against cervical (HeLa) cancer cells. Liquid chromatography–mass spectrometry (LC-MS) was conducted to establish the identity of the molecules. Eighteen bacteria species from the gut (HSG01-18) and ten bacteria species from feces (HSF01-10) were tested for anti-tumor effects. Bacterial-conditioned media from scorpion gut and feces exhibited significant growth inhibitory effects against HeLa cells of 66.9% and 83.8%, respectively. Microscopic analysis of cancer cells treated with conditioned media HSG12 and HSG16 revealed apoptosis-like effects. HSG12 was identified as Pseudomonas aeruginosa and HSG16 was identified as Bacillus subtilis. Both conditioned media exhibited 100% growth inhibitory effects versus a selection of cancer cells, comprising cervical, breast and prostate cancer cells. LC–MS indicated the presence of 72 and 38 compounds, detected from HSG12 and HSG16, respectively. Out of these compounds, 47 were successfully identified while the remainder were unidentified and are possibly novel. This study suggests that the fecal and gut microbiota of scorpions might possess molecules with anti-cancer properties, however, further intensive research is needed to assess these expectations.

جمعت 66 عينة من العوالق السمكية والعوالق الحيوانية باستخدام شبكة بلانكتونية WP2 قطر ثقوبها 350 ميكرون بشكل دوري وبطريقة الجمع الأفقي من ثلاثة مواقع: برج إسلام، وادي قنديل وأم الطيور ومن محطتين في كل موقع (الأولى قريبة من الشاطئ والثانية بعيدة عنه) تختلف بخصائصها البيئية، وذلك على امتداد 15كم2 تقريباً، كما تم قياس درجة الحرارة والملوحة والحموضة لـ. 264 عينة خلال الفترة الواقعة بين 12\5\2009 و 12\1\2011. أثبتت نتائج الدراسة وجود تغيّرات زمانية ومكانية في توزع و غزارة العوالق السمكية والعوالق الحيوانية وكانت منطقة برج إسلام أكثر غنىً بقيم غزارة اليرقات السمكية (9,40فرد\1000م3) تلتها منطقة وادي قنديل ثم منطقة أم الطيور بمتوسط 4.70 فرد\1000م3 لكل منهما، وكانت مياه المنطقة القريبة من الشاطئ أكثر غزارة من تلك البعيدة عنه. كما تم خلال الدراسة تحديد مدى تأثير عدد من العوامل الهيدرولوجية وكذلك غزارة العوالق الحيوانية على حركية العوالق السمكية في مواقع الدراسة، وكان تأثير درجة الحرارة أكثر أهمية من العوامل البيئية الأخرى. 66 samples of Ichthyoplankton and zooplankton were carried out by WP2 net with mesh size 350µm as periodicity were done using horizontal collection method from three locations; Berj-Islam, Wadi-Kandeel and Am-Attiyor with two stations chosen from each location (inshore-offshore) to represent different environments and extending nearly 15k.m2, temperature, salinity and pH were measured for 264 samples during the period between 12.5.2009 and 12.1.2011. According to the present results, temporal and spatial variations distribution and abundance of Ichthyoplankton and zooplankton were observed. More abundant of fish larva was found at Berj-Islam (9.40 individuals\1000m3), followed by Wadi-Kandeel and Am-Altyor with mean 4.70 individuals\1000m3 for each, conclude that fish larva were more abundant at the inshore than offshore water stations. Also, the effect of some hydrological parameters and zooplankton abundance on monitoring of Ichthyoplankton were detected along locations, temperature factor was more significant than other parameters.

Babatunde O Adedokun,1 Imran O Morhason-Bello,2 Oladosu A Ojengbede,2 Ngozi S Okonkwo,1 Charles Kolade21Department of Epidemiology, Medical Statistics, and Environmental Health, College of Medicine, University of Ibadan, Oyo state, Nigeria; 2Department of Obstetrics and Gynecology, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Oyo state, NigeriaObjective: We examined help-seeking behaviors and factors influencing their choice of hospital care in women currently leaking urine.Materials and methods: This study was part of a multistage community survey conducted among 5001 women in Nigeria who participated in the Ibadan Urinary Incontinence Household Survey. Help-seeking behavior was analyzed among 139 respondents currently leaking urine within the population surveyed.Results: The mean age of those currently leaking urine was 35.7 years (standard deviation = 15.8). Only 18 (12.9%) had ever sought help, of which 15 had received hospital care. Logistic regression analysis showed that the odds of seeking hospital care was higher among less educated women (odds ratio [OR] = 4.05, 95% confidence interval [CI]: 1.17–13.89) and among those with severe incontinence (OR = 4.20, 95% CI: 1.24–14.29). Reasons mentioned for not seeking hospital care include a belief that the condition is not life-threatening (51.2%), do not believe there is treatment (18.2%), lack of funds (1.7%), too shy to disclose (2.5%), afraid of complications (1.7%), other (2.5%), and no reason (22.3%).Conclusion: This study shows that very few women, currently experiencing urinary incontinence have sought medical care (approximately 1 in 10); and that the barriers identified are similar to those identified in previous studies, except that these women lack the necessary funds to seek care.Keywords: urinary incontinence, help (health)-seeking behavior, women, Nigeria

Ngozi S Okonkwo1, Oladosu A Ojengbede2, Imran O Morhason-Bello1, Babatunde O Adedokun31Department of Obstetrics and Gynecology, University College Hospital; 2Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan; 3Department of Epidemiology, Medical Statistics, and Environmental Health, College of Medicine, Ibadan, Oyo State, NigeriaBackground: Contrary to the widely reported aversion to cesarean section in the West African subregion, maternal demand for cesarean section (MDCS) seems to be on the increase, and there is little evidence to explain this trend. The purpose of this study was to determine the perception and attitudes of Nigerian antenatal clients towards MDCS, their willingness to request MDCS, and the relationship between willingness to request MDCS and sociodemographic characteristics.Methods: A cross-sectional survey was undertaken among 843 antenatal clients at Agbongbon/Orayan primary health care centers (PHCs), Adeoyo Maternity Hospital (SHC), and UCH Ibadan (THC), representing the three different levels of health care in Nigeria, ie, primary, secondary, and tertiary.Results: The proportion of women aware of MDCS was 39.6%. Predictors of awareness were education and type of health facility. Women from THC and those with tertiary education and above were more likely to be aware of MDCS than others (P = 0.001). Doctors were major sources of information on MDCS (30.8%) as well as friends (24.3%). Common reasons reported for MDCS were fear of labor pains (68.9%), and fear of poor labor outcome (60.1%), and fear of fecal (20.2%) and urinary incontinence (16.8%). More women from the THC than other facilities believed that requests for MDCS should be granted (P < 0.001). However, willingness to request MDCS was low (6.6%). More than 50% of those willing to request MDCS would likely be criticized, mainly by their husbands. On multiple logistic regression, respondents at the THC were significantly more likely than those at the SHC or the PHCs to request cesarean section and to favor a woman’s right of autonomy to choose her mode of delivery.Conclusion: The decision for MDCS is a difficult one, because willingness is low and criticism by partners of those who choose MDCS is high. Provision of epidural anesthesia and improved safety of vaginal delivery is recommended. This may prevent Nigerian women from making a difficult choice for MDCS based on fear of pain and poor labor outcome. The role of the male partner should be taken into consideration in order to make sustainable policies or guidelines for MDCS in developing countries.Keywords: maternal demand cesarean section, perception, antenatal, clients, Nigeria

Omolola M Atalabi1, Imran O Morhason-Bello2, Ademola J Adekanmi1, Anthony O Marinho3, Babatunde O Adedokun4, Adegoke O Kalejaiye3, Kayode Sogo3, Sikiru A Gbadamosi31Department of Radiology; 2Department of Obstetrics and Gynaecology, College of Medicine/University College Hospital, University of Ibadan, Ibadan; 3St Gregory's Specialist Clinic and Ultrasound Diagnostic Centre, Yemetu, Ibadan; 4Department of Epidemiology, Medical Statistics, and Environmental Health, College of Medicine, Ibadan, NigeriaObjective: To determine the acceptability of transvaginal ultrasonography (TVU) and associated factors among Nigerian women.Method: A cross-sectional survey was conducted among 3137 women who presented for transabdominal ultrasound scan between August and November 2010 in two referral hospitals in Nigeria. Data were obtained using a questionnaire. Descriptive and multivariate analysis was performed applying logistic regression analysis; predictors of willingness of participants regarding transvaginal ultrasound were identified using SPSS Statistics (SPSS Inc, Chicago, IL) version 17 software.Results: The mean age of the women was 33.8 years (standard deviation = 7.9), with 88.8% currently married. About 84% were willing to have TVU, while 54.2% were indifferent about the gender of the sonologist. About 17.3% believed that the procedure is painful. Significant predictors of willingness to have TVU were previous sexual experience and douching, prior painful vaginal examination, and vaginal surgery.Conclusion: The majority of Nigerian women expressed a willingness to have the TVU procedure without necessarily opting for any gender preference of the operator. Women should be adequately counseled on the operations of the procedure so as to be able to psychologically prepare for them.Keywords: transvaginal ultrasound, willingness, Nigeria, Africa

In this work, the essential work of fracture concept (EWF) has been applied to untreated and silane- treated glass bead-filled EPDM. It has been proved that this theory is not applicable to pure EPDM due to its high elastic character, but being possible in glass bead-filled EPDM, thus the presence of these particles induces certain plasticity on the EPDM. The results show that the higher adhesion between matrix and particles, the higher value of plastic work of fracture, and the higher final instability of crack propagation. Moreover the influence of processing temperature on the mechanical characteristics of these materials has been studied, noticing a marked drop of stiffness and strength from a temperature processing of 200 ºC. The higher adhesion obtained between EPDM matrix and glass beads through surface treatment has been confirmed by scanning electron microscopy.En el presente trabajo se ha aplicado el concepto de trabajo esencial de fractura (EWF) a una serie de compuestos de EPDM y microesferas de vidrio, sin tratamiento superficial y tratadas con silanos. Se ha comprobado que esta teoría no es aplicable al EPDM puro debido a su elevado carácter elástico, pudiéndose en cambio aplicar a sus compuestos cargados con microesferas de vidrio, pues la presencia de estas partículas induce cierta plasticidad en el EPDM. Los resultados indican que una mayor adhesión entre partícula y matriz se traduce en un mayor valor de trabajo plástico de fractura, así como en una mayor inestabilidad final en la propagación de la grieta. Asimismo se ha estudiado la influencia de la temperatura de procesado sobre las características mecánicas de estos materiales, observándose una caída acusada de la rigidez y de la resistencia a la tracción en todos los compuestos a partir de una temperatura de procesado de 200 ºC. La mayor adhesión que se consigue entre la matriz de EPDM y las microesferas de vidrio mediante el tratamiento superficial con silanos se ha confirmado a través de la microscopía electrónica de barrido.

This paper presents an approach to assess and measure bark characteristics as indicators of wood quality using terrestrial laser scan data. In addition to the detection and measurement by use of the intensity information of the scan data a new approach was established. Bark surface models are calculated for each tree. They offer the representation of the bark as a height model. The reference is the tree stem approximated by a chain of cylinders. Minimal deviations of the bark surface can be detected and visualized and the geometrical properties of bark scars and branched knots can be assessed. Results of the measurement of 18 scars are presented using the two approaches: (1) a method using intensity data or (2) using bark surface models. The selection of the adequate approach depends on the stem characteristics. In a next step, methods for automatic measurement of bark scars will be developed.

Background Incompetence of the internal uterine cervical os is associated with recurrent pregnancy loss. Different surgical techniques are in practice to correct the defect. Objective: The objective of this study therefore was to review the outcome of pregnancies following cervical using either of the two procedure among patients diagnosed as having incompetence of the cervix. Methods A comparative study of 2 standard methods of cerclage used in our hospital, McDonald & Shirodkar, in a group of 80 patients was done. All the patients had cervical cerclage insertion done between the 14th & 16th weeks of gestation using either of the two methods. Results There was no significant morbidity with either of the 2 methods. The overall success rates, as measured by continuation of the pregnancy to term, were smilar. Conclusion Both methods of cervical cerclage are equally effective in producing the desired outcome, but since the McDonald method is technically simpler to perform, it may be desirable to adopt this approach more frequently.

Background: There is a growing concern among parturient women to have labour management modified to accommodate some of their preferences based on their previous experience of information obtained from others. Objectives: As service care providers, we sought to identify women's attitude to some important aspects of childbirth, namely: the preferred place or environment of delivery; reasons for dislike of modern labour management; as well as attitudes (cognitive, affect and behaviour) to operative delivery, particularly caesarean deliv ery. Methods: A survey of women's attitude to some important aspects of childbirth was carried out with the use of questionnaires among women attending antenatal clinic at the University College Hospital, Ibadan, Nigeria. Results:The study showed a great desire by women to have someone they already know in labour (spouses 58.80%; mother/mother figure 88.68%). Forty percent of those who prefer to deliver outside hospital settings would do so due to unfriendly attitudes of doctors and midwives. Conclusion:There is the need to appropriately train doctors and midwives who attend to women in labour as regards the anxieties and needs of the women in labour.

Abstract Background As life expectancy increases, dementia incidence will also increase, creating a greater need for physicians well-trained to provide integrated geriatric care. However, research suggests medical students have limited knowledge or interest in pursuing geriatric or dementia care. The purpose of this study is to evaluate the PAIRS Program and its effectiveness in enhancing medical education as a service-learning activity and replication model for the Buddy ProgramTM. Methods Between 2007 and 2011, four consecutive classes of first year Boston University School of Medicine students (n = 45; 24 ± 3 years, 58% female, 53% White) participated in a year-long program in which they were paired with a patient with early-stage Alzheimer’s disease (AD). Assessments included pre- and post-program dementia knowledge tests and a post-program reflective essay. Results Program completion was 100% (n = 45). A paired-sample t-test revealed a modest improvement in dementia knowledge post-program (p Conclusions Quantitative and qualitative findings suggest that the PAIRS Program can enhance the acquisition of knowledge, skills, and positive attitudes regarding geriatric healthcare in future generations of physicians, a skill set that is becoming increasingly relevant in light of the rapidly aging population. Furthermore, results suggest that The Buddy ProgramTM model can be successfully replicated.