bluuebunny/crossref_metadata_2025 huggingface dataset:
Basics in colors, dyes and pigments chemistry: A review
Authors: Int Chem
Published: April 2019

More than one hundred multi choice problems and their solutions in colors, dyes and pigments chemistry are represented in this paper review. Reviewing the basic, fundamental principles and or the knowledge of colors, dyes and pigments chemistry via multi choice problems and their solutions is an interesting type of reviewing and can be considered as a novel and or patent type of reviewing which is lacking in literature. This paper review is informative and acts as a mordant and or stabilizer for the basic information, fundamental understanding, principles and or knowledge in colors, dyes and pigments chemistry, and it may be very interesting to read by a large community of dyers and colorists, and also by professors and teachers in this field. It is valuable both for getting an overview in the field of colors, dyes and pigments chemistry and as a mine of information for the dyestuff chemists. In addition, this paper review can be published and or printed as a thesis and or note book teaching and lectures for undergraduate and graduate students of chemistry departments and or chemistry institutions at any university. Besides, this paper review can be used and or will be most valuable in domestic and or international scientific and or chemistry competitions, in organic chemistry as general and particularly in the field of colors, dyes and pigments chemistry.
Adsorption of copper and lead in single and binary metal system onto Fumaria indica biomass
Authors: Int Chem
Published: April 2019

Among heavy metals, lead and copper pose a significant threat to the due to their toxicity, incremental accumulation in the food chain and persistence in the ecosystem. Lead and copper are introduced into water from various industries and other human activities. Present study was aimed to remove lead and copper from aqueous media using Fumaria indica biomass as a function of metal ions initial concentration. Both metal removal was investigated in single and binary system. For comparison isotherm models i.e., Langmuir and Freundlich were applied on experimental adsorption data. Results showed that the copper behavior was different in single and binary metal system, whereas lead adsorption remained the same in both single and binary metal systems. The Freundlich isotherm model fitted well to the adsorption data of both single and binary metal system. The thermodynamic parameters i.e., ΔG0, was measured to get insight into adsorption phenomenon and negative value of ΔG0 suggest that the adsorption process was spontaneous in nature. Results showed that in multi-metal system the adsorption of specific metal ion may change and during metal adsorption from industrial wastewater this effect must be taken in account before generalization of results.
MENGUAK RAHASIA PRIBADI ABRAHAM ATAS KUALITAS KEIMANANNYA PADA ALLAH BAPA
Authors: Simanjuntak Fredy
Published: April 2019

Abraham adalah salah satu tokoh terpenting dalam Perjanjian Lama. Melalui Abraham, Tuhan menegakkan sebuah perjanjian dengan seluruh umat manusia. Abraham menunjukkan tekad yang besar untuk mematuhi perjanjian Allah yang didirikan melalui dia. Dia menerima apa yang penting untuk menjadi orang benar di mata Tuhan. Abraham menjadi tokoh yang sangat populer dan diklaim sebagai Bapa orang Yahudi, Muslim dan Kristen. Tidaklah berlebihan jika disebut sebagai Bapa segala bangsa karena memang dari keturunnyalah lahir bangsa-bangsa di dunia. Dalam Kejadian 11:27-32 dijelaskan bahwa Abraham merupakan anak dari Terah dan menetap di tanah Ur-Kasdim (bagian timur Irak), mereka adalah keluarga penyembah allah lain atau berhala sama seperti yang dilakukan oleh orang-orang lain yang ada di Ur-Kasdim (Yosua 24:2). David F. Hison menjelaskan, bahwa penduduk Ur dan Haran ternyata menyembah dewa yang sama, yaitu dewa bulan, yang mereka sebut Sin. Dari seluruh kisah kehidupan Abraham dalam Alkitab dan bagaimana Abraham di kenal sebagai tokoh yang bepegaruh dan menginspirasikan iman banyak orang percaya. Kata Kunci: Pribadi, Abraham, Kualitas iman, Allah Bapa
The Isolation and Identification of Mycoplasmas Which cause Contagious Agalactia from Sheep and Goat in Tehran Province
Authors: Niknamian Sorush
Published: April 2019

The Agalactia, has been known as a contagious disease in Mediterranean countries, Africa and Europe, and west Asia e.g. Iran where the livestock were reared massively for approximately several years ago and it has been led to noticeable economic damages and losses. This disease appears by symptoms of fever, inappetence, lameness and loss of milk in dairy ewes, from reduction to total lack of lactation and abortion in pregnant livestock. No study has been so far conducted on isolation of Agalactia disease factor and determining its molecular identity in ovine and caprine herds in Tehran province. The current research aimed to isolate and determine molecular identity of Agalactia disease factor (Agalactiae mycoplasma) in sheep and goat that suffered from Agalactia using culture and PCR methods in Tehran province. Among total 33 taken samples, 14 samples were confirmed as mycoplasma species that showed specific band (bp163) on agarose gel and in one of these 14 given samples, the culture was positive.
RPP Kelas rendah
Authors: Matondang Rahma Wati
Published: April 2019

Tugas mata kuliah PPKn kelas rendah, mulai dari pengertian hingga komponen-komponen sehingga mahasiswa selaku calon tenaga pendidik mampu menyusun RPP
DAMPAK PENERAPAN PSAK 4 (REVISI 1994) DAN PSAK 4 (REVISI 2009) TERHADAP LAPORAN KEUANGAN KONSOLIDASIAN PERUSAHAAN
Authors: Sugita Dea
Published: April 2019

The purpose of this study was to determine how the impact of the adoption of SFAS 4 (Revised 1994) and SFAS 4 (Revised 2009) on the consolidated financial statements of PT Tempo Scan Pacific Tbk and its subsidiaries in 2010 and 2012, whether it has been overall implemented or not in the company , In addition, this study also aims to determine how the impact of the difference due to the change due to the convergence of IFRS in the consolidated financial statements in 2010 that is guided by SFAS 4 (Revised 1994) and in 2012 guided by SFAS 4 (Revised 2009) regarding reports the consolidated financial companies, whether these changes benefit the company or even vice versa.The method used in this research is descriptive qualitative method. This research method is done by thoroughly describe or depict the views of the notes to the consolidated financial statements where in the notes to the consolidated financial statements are included discussion of the basis and principles for presenting consolidated with all explanations related to the consolidation were applied in the consolidated financial statements of PT Tempo Scan Pacific Tbk, as well as analyze the impact of differences in the consolidated statement of financial position, consolidated statement of comprehensive income, consolidated statement of changes in equity and cash flows in 2010 to 2012 which is part of the consolidated financial statements of the company. Where these data the authors obtained from secondary data source that the official website of Indonesia Stock Exchange with the year 2010, based on the preparation of SFAS 4 (Revised 1994) and in 2012 guided by SFAS 4 (Revised 2009).The results showed that PT Tempo Scan Pacific Tbk in the preparation and presentation of consolidated financial statements in 2010 and in 2012 has been broadly guided by SFAS 4 (Revised 1994) and SFAS 4 (Revised 2009), but there are still some posts that have not been implemented and there are also some posts that are not disclosed clearly as in the discussion. And based on the results of the analysis of that difference due to changes resulting from the convergence of IFRS on the consolidated financial statements of the company has been mostly profitable companies.
Psychopathic boldness: Narcissism, self-esteem, or something in between?
Authors: Miller Josh , Sleep Chelsea , Crowe Michael L , Lynam Donald
Published: April 2019

Although psychopathy remains to be one of the most well-studied and validated personality disorders, debate remains regarding the necessity and sufficiency of fearless dominance/boldness. The crux of this debate revolves around the robust relations boldness shares with adaptive outcomes (e.g., self-esteem) and the limited relations it evinces with psychopathy’s other features and theoretically-relevant outcomes. Nevertheless, boldness also typically exhibits moderate to large relations with grandiose narcissism; however, these relations are less frequently examined at the factor level. The aim of the present study was to conduct a comprehensive examination of the relations between psychopathic boldness, narcissism, and other adaptive features in a large, Amazon Mechanical Turk sample (N = 591). Consistent with previous findings, boldness exhibited moderate to large relations with grandiose narcissism; however, the use of a trifurcated three-factor model of narcissism demonstrates that boldness is robustly related to an agentic extraversion component of narcissism but evinces small relations with narcissism’s antagonistic and neuroticism-related features. Psychopathic boldness also evinced large, positive relations with self-esteem, and across outcomes, similarity analysis reveal that they exhibit nearly identical trait profiles.
The Long and the Short of it: On the Nature and Origin of Functional Overlap Between Representations of Space and Time
Authors: Srinivasan Mahesh , Carey Susan
Published: April 2019

When we describe time, we often use the language of space (The movie was long; The deadline is approaching). Experiments 1-3 asked whether—as patterns in language suggest—a structural similarity between representations of spatial length and temporal duration is easier to access than one between length and other dimensions of experience, such as loudness. Adult participants were shown pairings of lines of different length with tones of different duration (Experiment 1) or tones of different loudness (Experiment 2). The length of the lines and duration or loudness of the tones was either positively or negatively correlated. Participants were better able to bind particular lengths and durations when they were positively correlated than when they were not, a pattern not observed for pairings of lengths and tone amplitudes, even after controlling for the presence of visual cues to duration in Experiment 1 (Experiment 3). This suggests that representations of length and duration may functionally overlap to a greater extent than representations of length and loudness. Experiments 4 and 5 asked whether experience with and mastery of words like long and short—which can flexibly refer to both space and time—itself creates this privileged relationship. Nine-month-old infants, like adults, were better able to bind representations of particular lengths and durations when these were positively correlated (Experiment 4), and failed to show this pattern for pairings of lengths and tone amplitudes (Experiment 5). We conclude that the functional overlap between representations of length and duration does not result from a metaphoric construction processes mediated by learning to flexibly use words such as long and short. We suggest instead that it may reflect an evolutionary recycling of spatial representations for more general purposes.
A century of economics and engineering at Stanford
Authors: Cherrier Beatrice , Saïdi Aurélien
Published: April 2019

This paper document the disciplinary exchanges between economists and engineers at Stanford throughout the 20th century. We also elucidate how this cross-fertlization was mediated by the institutional structure of the university. We outline the role of key scholars such as Kenneth Arrow and Robert Wilson, as well as engineers turned administrators like Frederick Terman. We show that engineers largely drew upon successive economic theories of decision and allocation with a view to improving practical industrial management decisions. Reciprocally, economists found in engineering the tools (from linear programming to optimal control theory) they needed to rethink production and growth theory, an epistemology of “application” that emphasized awareness to institutional details, trials and errors and experiments to improve the design of processes and machines, and all sorts of industrial settings to operationalize their theories of decision, strategic interaction and bargaining. By the 2000s, they had turned into economic engineers designing markets and other allocation mechanisms. These cross-disciplinary exchanges were mediated by Stanford’s own institutional culture, notably its use of joint appointments, the development of multidisciplinary “programs” for students, the ability to attract a variety of visitors every year, the entrepreneurial and contract-oriented vision of its administrators, and the close ties with the industrial milieu that came to be called the Silicon Valley.
Evaluation of occurrence of sesamoid bones in the lower extremity radiographs
Authors: Ghimire Indu , Maharjan Surendra , Pokharel Ganesh Bahadur , Subedi Kamal
Published: April 2019

The purpose of this study was to examine the plain AP radiograph of foot and lateral radiograph of knee in order to determine the prevalence and size of sesamoid bone in different part of foot and on the posterior aspect of the knee joint. A cross-sectional study was performed in Department of Radiology and Imaging, Tribhuvan University Teaching Hospital from July to September 2014. A total of 206 radiographs of foot (55) and knee (155) were collected. 121 (58.7%) were female and 85 (41.3%) were male. The most common site of sesamoid bone in foot was in the first metatarsal joint (96.4%) whereas the sesamoid bone in knee joint, fabella was found in 12.3% of total cases. The prevalence is more common in female than in male. The length and breadth of the sesamoid bones were measured and then area of bones was calculated. The size of medial and lateral sesamoid bone in the first MTP Joint was measured 0.6225 cm2 and 0.8261 cm2 respectively. The mean size of sesamoid bone of knee, fabella was 0.2818 cm2.
Factors influencing malnutrition among the children of under 5 years
Authors: Bajracharya Shanti , Subedi Anup
Published: April 2019

Objectives: Childhood is the time of active growth in terms of physical size, mental, emotional and psychological development. Nutritional status is the proxy indicator for assessing the health status of the entire population and one of the major predictors of child survival. Despite the various efforts, malnutrition among children is remaining as one of the major public health problems in Nepal.

Objective: The objective of this study was to assess the factors influencing malnutrition among the mother of the children aged 6 to 59 months.

Method: A descriptive exploratory study using non-probability purposive sampling method was conducted with 79 paired of mother with children, residing in Itahari ward number 2. Data were collected by interview technique using semi-structured questionnaires and analysis was done by using SPSS version 20 using descriptive and inferential statistics.

Results: The mean age of the child was 32 months and standard deviation was 17.05. The prevalence of underweight, wasting and stunting was found to be 16.4%, 11.3 % and 7.6% respectively. Likewise, 17.06 % of the children were found below < -2 S.D on the basis of BMI per age of the children. Furthermore, it was found that there was significant association between educational status of mother with the malnutrition (underweight) as p-value was <0.05.

Conclusion: Malnutrition is the major health problem in under 5 children. The prevalence of malnutrition can be decreased by improving the caretaker’s educational level through different awareness programmes based on the factors responsible for that.
Pemanfaatan Plug-in DataTables untuk Sistem Informasi di Unit Indostamping PT Pura Barutama
Authors: Somya Ramos , Beny Beny
Published: April 2019

Saat ini, PT Pura Barutama unit Indostamping belum memiliki sistem informasi untuk melakukan proses request permintaan perbaikan dan memberikan laporan secara sistematis. Proses pengelolaan data masih menggunakan Microsoft Excel. Hal ini dapat mengakibatkan resiko dicatat secara berulang, dan adanya masalah yang tidak dicatat karena sibuknya staf IT dalam melayani permintaan perbaikan dari user lain. Salah satu cara untuk meminimalisasi permasalahan tersebut adalah dengan membuat sistem informasi helpdesk ticketing system dengan plug-in DataTables. Hasil aplikasi bisa menjadi wadah untuk memberikan laporan secara sistematis dan prosedural, dengan tampilan yang user-friendly dan dapat mengatasi masalah yang ada di PT Pura Barutama unit Indostamping.
Sistem Pengenalan Individu Berbasis Citra Wajah 3D dengan Jaringan Syaraf Tiruan
Authors: Ramadhan Muhammad Sindu , Novamizanti Ledya , Susatio Eko
Published: April 2019

Pengenalan individu adalah sebuah cara yang banyak digunakan dalam bidang medis, teknologi, dan keamanan. Wajah adalah objek biometrika yang sering digunakan untuk pengenalan maupun sistem keamanan. Dalam wajah terdapat beberapa karakteristik yang dapat digunakan dalam pengenalan, seperti ukuran mata, hidung dan bibir, jarak mata, hidung dan bibir, serta pola kedalaman bagian bagian wajah. Penelitian ini, akan dibuat sistem pengenalan individu dengan citra wajah individu dalam bentuk 3 dimensi yang diambil menggunakan kamera Kinect. Citra wajah 3D diambil sebanyak 48 foto, dimana 48 foto tersebut merepresentasikan bentuk wajah secara keseluruhan. Dari 48 foto yang telah diambil akan dipartisi menjadi 3 partisi dan 6 partisi. Partisi tersebut akan digunakan sebagai masukan proses ekstraksi ciri. Metode yang digunakan untuk ekstraksi ciri adalah Iterative Closest Point (ICP) dan diklasifikasikan dengan metode Jaringan syaraf tiruan (JST) yang dirancang menggunakan aplikasi MATLAB. Hasil penelitian ini menghasilkan performansi sebesar 78.57%. Sistem ini dapat menjadi salah satu alternatif pengenalan identitas seseorang dan diharapkan penelitian ini dapat menjadi referensi penelitian lanjut mengenai pengenalan individu berbasis citra 3D di masa mendatang.
Penguat Jembatan sebagai Pengganda Daya Penguat
Authors: Murtianta Budihardja
Published: April 2019

Penguat audio mempunyai daya maksimual tertentu karena besar tegangan atau arus keluaran terbatas pada suatu nilai tertentu. Tegangan keluaran maksimum terbatas pada besar tegangan catu dayanya dan arus keluaran maksimum terbatas pada batas arus   dari transistor daya atau penguat operasi pada penguat akhirnya. Ada 2 cara untuk memperbesar daya keluaran penguat akhir (power amplifier) audio tersebut, yaitu memperbesar tegangan keluaran (bridged modes) atau memperbesar arus keluaran (paralleled modes) penguat akhir audio. Pada tulisan ini akan dibahas tentang memperbesar daya penguat akhir audio dengan metode jembatan atau bridged modes. Prinsip Penguat Jembatan ini juga dikenal dengan Bridge -Tied Load (BTL) atau Bridged Transformerless. Penguat akhir audio yang dipergunakan adalah cepis TDA2050. Besaran yang akan dilihat dan diukur adalah bati, masukan, keluaran dan impedansi penguat jembatan dibandingkan dengan penguat biasa. Secara teoritis pada penguat jembatan tegangan keluarannya bisa ditingkatkan 2x, maka dayanya akan meningkat 4x dengan beban yang sama.
The Practice of Nonviolence: Teaching an Undergraduate Course in Nonviolent Communication
Authors: Lauricella Sharon
Published: April 2019

This Best Practices article outlines 10 tips relative to teaching a course in Nonviolent Communication (NVC). It outlines suggestions for readings, activities, and projects throughout a semester-long undergraduate course. The article addresses how students can learn both the theory and practice of nonviolence by means of readings and activities that address social problems such as sexism, racism, bias, and violence against oneself and the earth. Specific suggestions are provided for creative ways in which students can be engaged with readings so that they have ownership of their in-class experience. Details regarding an independent long-term project providing freedom of creativity in out-of-class work are included, as well as suggestions for interactive, face-to-face activities in class.
Retrobulbar Hemorrhage: A Critique
Authors: Hauch Adam
Published: April 2019

Introduction: Retrobulbar hemorrhage is a rare, progressive, sight-threatening emergency. Standardized
treatment algorithms for it exist in the literature; however, their efficiency is uninterpretable in most nonophthalmic settings. This paper reviews retrobulbar bleeding, the pathophysiology of vision loss, and the
therapeutic modalities and their efficacy in addressing such visual damage.
Case Report: We present the unfortunate case of an 82-year-old male with coronary artery disease on
anticoagulants who presented for a vitrectomy for a vitreous hemorrhage secondary to eccentric disciform
degeneration under general anesthetic with an accompanying retrobulbar block. He subsequently developed
a retrobulbar hemorrhage at some point post-operatively. He presented to his surgeon 18-hours after the
operation with no light perception on ophthalmologic examination as well as facial ecchymosis and
proptosis. Efforts to reduce his intraocular pressure were successful, but there was no return of vision.
Conclusion: Retrobulbar hemorrhage can be a devastating visual event. Standardized treatment algorithms
have been described, however, the effectiveness or need of such treatments can only best be evaluated by
an ophthalmologist and are often performed too late to provide meaningful recovery
Kearifan Lokal Budaya Minang “dima bumi dipijak, disitu langit dijunjung” dalam Konteks Etnopedagogi: Kasus Perantau Minang di Kota Surabaya
Authors: Trisa Yosi
Published: April 2019

Artikel ini berbasis penelitian kualitatif dengan pendekatan etnografi yang dilakukan selama tiga bulan (Agustus-Oktober 2018) pada para perantau Minangkabau di kota Surabaya. Tujuan penelitian adalah untuk memhami bagaimana penerapan nilai-nilai Kearifan Lokal Budaya Minang “dima bumi dipijak, disitu langit dijunjuang” dalam Konteks Etnopedagogi oleh Perantau Minang di Kota Surabaya. Hasil penelitian menunjukkan bahwa terdapat paling tidak lima nilai-nilai budaya Minangkabau yang sangat penting untuk dimasukkan sebagai bagian dari materi etnopedagogi. Kelima nilai budaya tersebut adalah: 1) Saling menghormati (toleransi), saling menghargai, tenggang rasa, dan inklusif (“Dima bumi dipijak, disitu langik dijunjuang”); 2) Hidup mandiri, (“Karatau madang di hulu, Babuah babungo balun; Marantau Bujang dahulu, Di rumah baguno balun”); 3) Pantang menyerah (“Baraja ka na manang, mancontoh ka nan sudah” dan “Takuruang nak dilua, taimpik nak diateh”); 4) Nilai-nilai agama (“Adat basandi syarak, syarak basandi kitabullah”), dan 5) Mempertahankan bahasa lokal. Sebagai konsekuensi dari hidup merantau, peran dan fungsi mamak tidak dapat dilaksanakan sepenuhnya sehingga pihak orangtua (ayah/bapak) yang mengambil alih.
Shaping Edits, Creating Fractals
Authors: Cutting James E. , Pearlman Karen
Published: April 2019

We investigated physical changes over three versions in the production of the short historical drama, Woman with an Editing Bench (2016, The Physical TV Company). Pearlman, the film’s director and editor, had also written about the work that editors do to create rhythms in film (Pearlman 2016), and, through the use of computational techniques employed previously (Cutting et al. 2018), we found that those descriptions of the editing process had parallels in the physical changes of the film as it progressed from its first assembled form, through a fine cut, to the released film. Basically, the rhythms of the released film are not unlike the rhythms of heartbeats, breathing, and footfalls—they share the property of “fractality.” That is, as Pearlman shaped a story and its emotional dynamics over successive revisions, she also (without consciously intending to do so) fashioned several dimensions of the film— shot duration, motion, luminance, chroma, and clutter—so as to make them more fractal.
The Eisenstein-Vygotsky-Luria Collaboration
Authors: Vassilieva Julia
Published: April 2019

This article analyzes the unique historical collaboration between
the revolutionary Russian film director Sergei Eisenstein (1898–1948), the cultural
psychologist Lev Vygotsky (1896–1934), and the founder of contemporary
neuropsychology, Alexander Luria (1902–1977). Vygotsky’s legacy is associated
primarily with the idea that cultural mediation plays a crucial role in the emergence
and development of personality and cognition. His collaborator, Luria,
laid the foundations of contemporary neuropsychology and demonstrated
that cultural mediation also changes the functional architecture of the brain.
In my analysis, I demonstrate how the Eisenstein-Vygotsky-Luria collaboration
exemplifies a strategy of productive triangulation that harnesses three disciplinary
perspectives: those of cultural psychology, neuropsychology, and film
theory and practice.
Acoustic Startles in Horror Films
Authors: Sbravatti Valerio
Published: April 2019

The acoustic blast is one of the most recurrent sound devices in horror cinema. It is designed to elicit the startle response from the audience, and thus gives them a “jump scare.” It can occur both in the form of a diegetic bang and in the form of a nondiegetic stinger (i.e., a musical blare provided by the score). In this article, I will advance the hypothesis that silence plays a crucial role in contemporary horror films, both perceptually, since it leaves the sound field free for the acoustic blast, and cognitively, since it posits the audience in an aversive anticipatory state that makes the startle more intense. I will analyze the acoustic startle using a neurofilmological approach, which takes into account findings from experimental sciences in order to better understand the relationship between physiological and psychological factors that make such an effect possible during the filmic experience.
Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: an international multicenter study
Authors: Kano Hideyuki , Urgosik Dusan , Liscak Roman , Pollock Bruce E. , Cohen-Inbar Or , Sheehan Jason P. , Sharma Mayur , Silva Danilo , Barnett Gene H. , Mathieu David , Sisterson Nathaniel D. , Lunsford L. Dade
Published: April 2019

OBJECTIVE

The goal of this study was to evaluate the outcomes of Gamma Knife stereotactic radiosurgery (SRS) when used for patients with intractable idiopathic glossopharyngeal neuralgia.

METHODS

Six participating centers of the International Gamma Knife Research Foundation identified 22 patients who underwent SRS for intractable glossopharyngeal neuralgia between 1998 and 2015. The median patient age was 60 years (range 34–83 years). The median duration of symptoms before SRS was 46 months (range 1–240 months). Three patients had unsuccessful prior surgical procedures, including microvascular decompression (MVD) (n = 2) and balloon compression (n = 1). The radiosurgical target was the glossopharyngeal meatus. The median maximum dose was 80 Gy.

RESULTS

The median follow-up was 45 months after SRS (range 6–120 months). Twelve patients (55%) had < 4 years of follow-up. Thirteen patients (59%) had initial complete pain relief at a median of 12 days after SRS (range 1–60 days). Three patients (14%) had partial pain relief at a median of 70 days after SRS (range 60–90 days). Six patients (27%) had no pain relief. Among 16 patients with initial pain relief, 5 maintained complete pain relief without medication (Barrow Neurological Institute [BNI] pain intensity score Grade I), 1 maintained occasional pain relief without medication (BNI Grade II), 3 maintained complete pain relief with medication (BNI Grade IIIb), and 7 patients had pain recurrence at a median of 20 months after SRS (range 6–120 months). The rates of maintenance of adequate pain relief (BNI Grades I–IIIb) were 63% at 1 year, 49% at 2 years, 38% at 3 years, 38% at 5 years, and 28% at 7 years. When 7 patients without pain recurrence within 4 years of follow-up were excluded, the rates of maintenance of adequate pain relief were 38% at 5 years and 28% at 7 years. Ten patients required additional procedures (MVD, n = 4; repeat SRS, n = 5; glossopharyngeal nerve block, n = 1). Four of 5 patients who underwent repeat SRS maintained pain relief (BNI Grade I, n = 3; and BNI Grade IIIb, n = 1). No adverse effects of radiation were observed after a single SRS. Two patients developed hyperesthesia in the palatoglossal arch 5 and 8 months after repeat SRS, respectively.

CONCLUSIONS

Stereotactic radiosurgery for intractable, medically refractory glossopharyngeal neuralgia provided lasting pain reduction in 55% of patients after 1 or 2 SRS procedures. Patients who had a poor response or pain recurrence may require additional procedures such as repeat SRS, MVD, nerve blocks, or nerve section. No patient developed changes in vocal cord function or swallowing disorders after SRS in this study.
Three-dimensional assessment of the effects of high-density embolization material on the absorbed dose in the target for Gamma Knife radiosurgery of arteriovenous malformations
Authors: Watanabe Yoichi , Sandhu Divyajot , Warmington Leighton , Moen Sean , Tummala Ramachandra
Published: April 2019

OBJECTIVE

Arteriovenous malformation (AVM) is an intracranial vascular disorder. Gamma Knife radiosurgery (GKRS) is used in conjunction with intraarterial embolization to eradicate the nidus of AVMs. Clinical results indicate that patients with prior embolization tend to gain less benefit from GKRS. The authors hypothesized that this was partly caused by dosimetric deficiency. The actual dose delivered to the target may be smaller than the intended dose because of increased photon attenuation by high-density embolic materials. The authors performed a phantom-based study to quantitatively evaluate the 3D dosimetric effect of embolic material on GKRS.

METHODS

A 16-cm-diameter and 12-cm-long cylindrical phantom with a 16-cm-diameter hemispherical dome was printed by a 3D printer. The phantom was filled with radiologically tissue-equivalent polymer gel. To simulate AVM treatment with embolization, phantoms contained Onyx 18. The material was injected into an AVM model, which was suspended in the polymer gel. The phantom was attached to a Leksell frame by standard GK fixation method, using aluminum screws, for imaging. The phantom was scanned by a Phillips CT scanner with the standard axial-scanning protocol (120 kV and 1.5-mm slice thickness). CT-based treatment planning was performed with the GammaPlan treatment planning system (version 10.1.1). The plan was created to cover a fictitious AVM target volume near the embolization areas with eleven 8-mm shots and a prescription dose of 20 Gy to 50% isodose level. Dose distributions were computed using both tissue maximum ratio (TMR) 10 and convolution dose-calculation algorithms. These two 3D dose distributions were compared using an in-house program. Additionally, the same analysis method was applied to evaluate the dosimetric effects for 2 patients previously treated by GKRS.

RESULTS

The phantom-based analyses showed that the mean dose difference between TMR 10 and convolution doses of the AVM target was no larger than 6%. The difference for GKRS cases was 5%. There were small areas where a large dose difference was observed on the isodose line plots, and those differences were mostly at or in the vicinity of the embolization materials.

CONCLUSIONS

The results of both the phantom and patient studies showed a dose reduction no larger than 5% due to the embolization material placed near the target. Although the comparison of 3D dose distributions indicated small local effects of the embolic material, the clinical impact on the obliteration rate is expected to be small.
Dosimetric characterization of hypofractionated Gamma Knife radiosurgery of large or complex brain tumors versus linear accelerator–based treatments
Authors: Dong Peng , Pérez-Andújar Angélica , Pinnaduwage Dilini , Braunstein Steve , Theodosopoulos Philip , McDermott Michael , Sneed Penny , Ma Lijun
Published: April 2019

OBJECTIVE

Noninvasive Gamma Knife (GK) platforms, such as the relocatable frame and on-board imaging, have enabled hypofractionated GK radiosurgery of large or complex brain lesions. This study aimed to characterize the dosimetric quality of such treatments against linear accelerator–based delivery systems that include the CyberKnife (CK) and volumetric modulated arc therapy (VMAT).

METHODS

Ten patients treated with VMAT at the authors' institution for large brain tumors (> 3 cm in maximum diameter) were selected for the study. The median prescription dose was 25 Gy (range 20–30 Gy) in 5 fractions. The median planning target volume (PTV) was 9.57 cm3 (range 1.94–24.81 cm3). Treatment planning was performed using Eclipse External Beam Planning V11 for VMAT on the Varian TrueBeam system, Multiplan V4.5 for the CyberKnife VSI System, and Leksell GammaPlan V10.2 for the Gamma Knife Perfexion system. The percentage of the PTV receiving at least the prescription dose was normalized to be identical across all platforms for individual cases. The prescription isodose value for the PTV, conformity index, Paddick gradient index, mean and maximum doses for organs at risk, and normal brain dose at variable isodose volumes ranging from the 5-Gy isodose volume (V5) to the 15-Gy isodose volume (V15) were compared for all of the cases.

RESULTS

The mean Paddick gradient index was 2.6 ± 0.2, 3.2 ± 0.5, and 4.3 ± 1.0 for GK, CK, and VMAT, respectively (p < 0.002). The mean V15 was 7.5 ± 3.7 cm3 (range 1.53–13.29 cm3), 9.8 ± 5.5 cm3 (range 2.07–18.45 cm3), and 16.1 ± 10.6 cm3 (range 3.58–36.53 cm3) for GK, CK, and VMAT, respectively (p ≤ 0.03, paired 2-tailed t-tests). However, the average conformity index was 1.18, 1.12, and 1.21 for GK, CK, and VMAT, respectively (p > 0.06). The average prescription isodose values were 52% (range 47%–69%), 60% (range 46%–68%), and 88% (range 70%–94%) for GK, CK, and VMAT, respectively, thus producing significant variations in dose hot spots among the 3 platforms. Furthermore, the mean V5 values for GK and CK were similar (p > 0.79) at 71.9 ± 36.2 cm3 and 73.3 ± 31.8 cm3, respectively, both of which were statistically lower (p < 0.01) than the mean V5 value of 124.6 ± 67.1 cm3 for VMAT.

CONCLUSIONS

Significantly better near-target normal brain sparing was noted for hypofractionated GK radiosurgery versus linear accelerator–based treatments. Such a result supports the use of a large number of isocenters or confocal beams for the benefit of normal tissue sparing in hypofractionated brain radiosurgery.
Stereotactic diffusion tensor imaging tractography for Gamma Knife radiosurgery
Authors: Gavin Cormac G. , Ian Sabin H.
Published: April 2019

OBJECTIVE

The integration of modern neuroimaging into treatment planning has increased the therapeutic potential and safety of stereotactic radiosurgery. The authors report their method of integrating stereotactic diffusion tensor imaging (DTI) tractography into conventional treatment planning for Gamma Knife radiosurgery (GKRS). The aim of this study was to demonstrate the feasibility of this technique and to address some of the technical limitations of previously reported techniques.

METHODS

Twenty patients who underwent GKRS composed the study cohort. They consisted of 1 initial test case (a patient with a vestibular schwannoma), 5 patients with arteriovenous malformations, 9 patients with cerebral metastases, 1 patient with parasagittal meningioma, and 4 patients with vestibular schwannoma. DT images were obtained at the time of standard GKRS protocol MRI (T1 and T2 weighted) for treatment, with the patient's head secured by a Leksell stereotactic frame. All studies were performed using a 1.5-T magnet with a single-channel head coil. DTI was performed with diffusion gradients in 32 directions and coregistered with the volumetric T1-weighted study. DTI postprocessing by means of commercially available software allowed tensor computation and the creation of directionally encoded color–, apparent diffusion coefficient–, and fractional anisotropy–mapped sequences. In addition, the software allowed visualized critical tracts to be exported as a structural volume and integrated into GammaPlan as an “organ at risk” during shot planning. Combined images were transferred to GammaPlan and integrated into treatment planning.

RESULTS

Stereotactic DT images were successfully acquired in all patients, with generation of correct directionally encoded color images. Tract generation with the software was straightforward and reproducible, particularly for axial tracts such as the optic radiation and the arcuate fasciculus. Corticospinal tract visualization was hampered by some artifacts from the base of the stereotactic frame, but this was overcome by a combination of frame/MRI volume adjustment and DTI seeding parameters. Coregistration of the DTI series with the T1-weighted treatment volume at the time of imaging was essential for the generation of correct tensor data. All patients with the exception of the vestibular schwannoma cases had treatment pathology in the vicinity of eloquent tracts and/or the cortex. No new neurological deficits due to radiation were recorded at the short-term follow-up.

CONCLUSIONS

Recent reports in the medical literature have suggested that white matter tracts (particularly the optic radiation and arcuate fasciculus) are more vulnerable to radiation during stereotactic radiosurgery than previously thought. Integration of stereotactic tractography into GKRS represents a promising tool for preventing GKRS complications by reduction in radiation doses to functional organs at risk, including critical cortical areas and subcortical white matter tracts.
Single-session Gamma Knife radiosurgery for optic pathway/hypothalamic gliomas
Authors: El-Shehaby Amr M. N. , Reda Wael A. , Abdel Karim Khaled M. , Emad Eldin Reem M. , Nabeel Ahmed M.
Published: April 2019

OBJECTIVE

Because of their critical and central location, it is deemed necessary to fractionate when considering irradiating optic pathway/hypothalamic gliomas. Stereotactic fractionated radiotherapy is considered safer when dealing with gliomas in this location. In this study, the safety and efficacy of single-session stereotactic radiosurgery for optic pathway/hypothalamic gliomas were reviewed.

METHODS

Between December 2004 and June 2014, 22 patients with optic pathway/hypothalamic gliomas were treated by single-session Gamma Knife radiosurgery. Twenty patients were available for follow-up for a minimum of 1 year after treatment. The patients were 5 to 43 years (median 16 years) of age. The tumor volume was 0.15 to 18.2 cm3 (median 3.1 cm3). The prescription dose ranged from 8 to 14 Gy (median 11.5 Gy).

RESULTS

The mean follow-up period was 43 months. Five tumors involved the optic nerve only, and 15 tumors involved the chiasm/hypothalamus. Two patients died during the follow-up period. The tumors shrank in 12 cases, remained stable in 6 cases, and progressed in 2 cases, thereby making the tumor control rate 90%. Vision remained stable in 12 cases, improved in 6 cases, and worsened in 2 cases in which there was tumor progression. Progression-free survival was 83% at 3 years.

CONCLUSIONS

The initial results indicate that single-session Gamma Knife radiosurgery is a safe and effective treatment option for optic pathway/hypothalamic gliomas.
Clinical predictors of symptom resolution for children and adolescents with sport-related concussion
Authors: Howell David R. , Potter Morgan N. , Kirkwood Michael W. , Wilson Pamela E. , Provance Aaron J. , Wilson Julie C.
Published: April 2019

OBJECTIVE

The goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients.

METHODS

Data collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable.

RESULTS

The sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85–0.96]), headache frequency (HR 0.83 [95% CI 0.71–0.96]), confusion (HR 0.79 [95% CI 0.69–0.92]), forgetfulness (HR 0.79 [95% CI 0.68–0.92]), attention difficulties (HR 0.83 [95% CI 0.72–0.96]), trouble remembering (HR 0.84 [95% CI 0.72–0.98]), getting tired often (HR 0.86 [95% CI 0.76–0.97]), getting tired easily (HR 0.86 [95% CI 0.76–0.98]), dizziness (HR 0.86 [95% CI 0.75–0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40–0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44–0.98]; p = 0.038).

CONCLUSIONS

For children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.
Arachnoid web of the spine: a systematic literature review
Authors: Nisson Peyton L. , Hussain Ibrahim , Härtl Roger , Kim Samuel , Baaj Ali A.
Published: April 2019

OBJECTIVE

An arachnoid web of the spine (AWS) is a rare and oftentimes challenging lesion to diagnose, given its subtle radiographic findings. However, when left untreated, this lesion can have devastating effects on a patient’s neurological function. To date, only limited case reports and series have been published on this topic. In this study, the authors sought to better describe this lesion, performing a systematic literature review and including 2 cases from their institution’s experience.

METHODS

A systematic literature search was performed in September 2018 that queried Ovid MEDLINE (1946–2018), PubMed (1946–2018), Wiley Cochrane Library: Central Register of Controlled Trials (1898–2018), and Thompson Reuters Web of Science: Citation Index (1900–2018), per PRISMA guidelines. Inclusion criteria specified all studies and case reports of patients with an AWS in which any relevant surgery types were considered and applied. Studies on arachnoid cysts and nonhuman populations, and those that did not report patient treatments or outcomes were excluded from the focus review.

RESULTS

A total of 19 records and 2 patients treated by the senior authors were included in the systematic review, providing a total of 43 patients with AWS. The mean age was 52 years (range 28–77 years), and the majority of patients were male (72%, 31/43). A syrinx was present in 67% (29/43) of the cases. All AWSs were located in the thoracic spine, and all but 2 (95%) were located dorsally (1 ventrally and 1 circumferentially). Weakness was the most frequently reported symptom (67%, 29/43), followed by numbness and/or sensory loss (65%, 28/43). Symptoms predominated in the lower extremities (81%, 35/43). It was found that nearly half (47%, 20/43) of patients had been experiencing symptoms for 1 year or longer before surgical intervention was performed, and 35% (15/43) of reports stated that symptoms were progressive in nature. The most commonly used surgical technique was a laminectomy with intradural excision of the arachnoid web (86%, 36/42). Following surgery, 91% (39/43) of patients had reported improvement in their neurological symptoms. The mean follow-up was 9.2 months (range 0–51 months).

CONCLUSIONS

AWS of the spine can be a debilitating disease of the spine with no more than an indentation of the spinal cord found on advanced imaging studies. The authors found this lesion to be reported in twice as many males than females, to be associated with a syrinx more than two-thirds of the time, and to only have been reported in the thoracic spine; over 90% of patients experienced improvement in their neurological function following surgery.
Natural history of neuromodulation devices and therapies: a patient-centered survival analysis
Authors: Teton Zoe E. , Blatt Daniel , AlBakry Amr , Obayashi James , Ozturk Gulsah , Hamzaoglu Vural , Magown Philippe , Selden Nathan R. , Burchiel Kim J. , Raslan Ahmed M.
Published: April 2019

OBJECTIVE

Despite rapid development and expansion of neuromodulation technologies, knowledge about device and/or therapy durability remains limited. The aim of this study was to evaluate the long-term rate of hardware and therapeutic failure of implanted devices for several neuromodulation therapies.

METHODS

The authors performed a retrospective analysis of patients’ device and therapy survival data (Kaplan-Meier survival analysis) for deep brain stimulation (DBS), vagus nerve stimulation (VNS), and spinal cord stimulation (SCS) at a single institution (years 1994–2015).

RESULTS

During the study period, 450 patients underwent DBS, 383 VNS, and 128 SCS. For DBS, the 5- and 10-year initial device survival was 87% and 73%, respectively, and therapy survival was 96% and 91%, respectively. For VNS, the 5- and 10-year initial device survival was 90% and 70%, respectively, and therapy survival was 99% and 97%, respectively. For SCS, the 5- and 10-year initial device survival was 50% and 34%, respectively, and therapy survival was 74% and 56%, respectively. The average initial device survival for DBS, VNS, and SCS was 14 years, 14 years, and 8 years while mean therapy survival was 18 years, 18 years, and 12.5 years, respectively.

CONCLUSIONS

The authors report, for the first time, comparative device and therapy survival rates out to 15 years for large cohorts of DBS, VNS, and SCS patients. Their results demonstrate higher device and therapy survival rates for DBS and VNS than for SCS. Hardware failures were more common among SCS patients, which may have played a role in the discontinuation of therapy. Higher therapy survival than device survival across all modalities indicates continued therapeutic benefit beyond initial device failures, which is important to emphasize when counseling patients.