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bility processes. This has underlined the importance of informal accountability tools and the political-economic context in shaping principal-agent relations. The study has served to demonstrate the use and limitations of agency theory in health governance analysis, and points to the importance of entrenched positions of power in local health systems.BACKGROUND Internationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of the issues involved in such a change in process. METHODS This study employed a systematic review framework in two stems, to integrate literature identified from two searches Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrate review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated.BACKGROUND The systems-scale analysis of cellular metabolites, "metabolomics," provides data ideal for applications in metabolic engineering. However, many of the computational tools for strain design are built around Flux Balance Analysis (FBA), which makes assumptions that preclude direct integration of metabolomics data into the underlying models. Finding a way to retain the advantages of FBA's linear structure while relaxing some of its assumptions could allow us to account for metabolite levels and metabolite-dependent regulation in strain design tools built from FBA, improving the accuracy of predictions made by these tools. We designed, implemented, and characterized a modeling strategy based on Dynamic FBA (DFBA), called Linear Kinetics-Dynamic Flux Balance Analysis (LK-DFBA), to satisfy these specifications. Our strategy adds constraints describing the dynamics and regulation of metabolism that are strictly linear. We evaluated LK-DFBA against alternative modeling frameworks using simulated noisy dat and considers metabolite-dependent regulation while still retaining many computational advantages of FBA. This provides the proof-of-principle for a new metabolic modeling framework with the potential to create genome-scale dynamic models and the potential to be applied in strain engineering tools that currently use FBA.BACKGROUND The health regulatory focus is an application of Higgins' regulatory focus theory to a health-specific context. It explains individual differences in health motivation, strategies, and behavior. Previous research found the Health Regulatory Focus Scale (HRFS) to be a reliable and valid measure for the construct. However, an evaluation of the HRFS in a representative sample has not been performed as of yet. Neither are there any normative values available. METHODS We collected a representative sample from the German general population to perform a confirmatory factor analysis, an analysis of measurement invariance, and to calculate norm values. RESULTS A two-factor model evinced good model fit with a good reliability for the two subscales. We found evidence for strict invariance across gender groups and partial strict invariance across age groups. In addition, we are presenting normative values for the general population. CONCLUSIONS The findings of the present study are in line with previous research in confirming the HRFS as a valid and reliable tool suitable for the assessment of the health regulatory focus. The reported normative values allow for comparisons of individuals with their respective sociodemographic group.BACKGROUND Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is devastating with no established treatment. This phenomenon involves disordered coagulation and excessive inflammatory reactions. As recombinant human soluble thrombomodulin (rhsTM) possesses anti-coagulative and anti-inflammatory properties, the medicine is expected to improve the prognosis of the disease. The aim of this study was to summarize current evidence regarding benefits and harms of rhsTM treatment for AE of IPF. METHOD Patients with AE of IPF were eligible for the review and all of the other types of interstitial pneumonias were excluded. The effect of rhsTM treatment on the outcomes such as all-cause mortality was estimated in comparison to conventional therapy. Primary studies of any design aside from a case report were reviewed. Electronic databases such as Medline and EMBASE were searched from 2002 through August 14, 2019. Two reviewers independently selected eligible reports and extracted relevant data. selleck chemical A risk of bias were no serious adverse events. CONCLUSION The rhsTM treatment was demonstrated to improve 3-month all-cause mortality of AE of IPF with no serious adverse events. However, these findings should be interpreted with caution due to a small number of studies and serious risk of bias.BACKGROUND Increasing smartphone use among adolescents in todays' world has made this handy device an indispensable electronic tool, however, it comes at a price of problematic overuse or addiction. We aim to investigate the prevalence of smartphone addiction among undergraduate medical students and explore its association with various demographic and personal factors. METHODS A pool of 250 undergraduate students completed a survey composed of socio-demographics information, smartphone-use related variables and 10-point Smartphone Addiction Scale-Short Version in February 2019. RESULTS Smartphone addiction among medical students was estimated at around 36.8% with higher percentage of male smartphone addicts. Phubbing was reported by 37.6% participants with more than 60% reporting overuse. Statistically significant association was observed between smartphone addiction and gender and overuse. Self-acknowledgement of addiction was found to be the biggest predictor of smartphone addiction. CONCLUSION This study provides preliminary insights into smartphone use, smartphone addiction and various factors predicting smartphone addiction among early undergraduate medical students from Nepal, which should be extended in future studies.