bluuebunny/crossref_metadata_2025 huggingface dataset:
Pengaruh Fasilitas Belajar dan Motivasi Belajar terhadap Hasil Belajar Materi Air Traffic Services Peserta Didik (Taruna) D.III Lalu Lintas Udara Angkatan IX Alpha & IX Bravo pada Akademi Teknik dan Keselamatan Penerbangan Makassar
Authors: Admin Irfan
Published: February 2021

Pencapaian hasil belajar siswa dipengaruhi oleh berbagai faktor, adalah fasilitas belajar dan motivasi belajar.Permasalahan dalam penelitian ini adalah adakah pengaruh fasilitas belajar dan motivasi belajar terhadap hasil belajar siswa mata pelajaran materi Air Traffic Services taruna D.III Lalu Lintas Udara Angkatan IX alpha & bravo pada ATKP Makassar, Tujuan penelitian ini apakah ada pengaruh antara Fasilitas Belajar dan Motivasi Belajar terhadap hasil belajar materi ATS peserta didik D.III LLU angkatan IX Alpha & IX Bravo ATKP Makassar sehingga semua mendapatkan nilai passing grade. Populasi berjumlah total 48 siswa. Peneliti mengambil teknik sensus, yaitu seluruh populasi sebagai objek penelitian. Variabel penelitian terdiri dari variabel bebas yaitu fasilitas belajar (X1) dan motivasi belajar (X2) serta variabel terikat yaitu hasil belajar (Y). Metode pengumpulan data menggunakan angket dan dokumentasi. Analisis data menggunakan analisis deskriptif persentase. Kesimpulan adalah fasilitas belajar dan motivasi belajar berpengaruh terhadap hasil belajar baik secara simultan maupun parsial. Saran penelitian ini untuk fasilitas belajar baik namun peningkatan dan pengoptimalan fasilitas belajar untuk mempertahankan eksistensi perguruan tinggi vokasi serta perawatan yang intensif harus tetap terjaga dan dimonitor secara berkala. pada motivasi belajar, peningkatan motivasi peserta didik dan tenaga pengajar sebagaimana tujuan dari institusi yaitu mengeluarkan lulusan yang berkualitas dan berkompetensi khususnya pada bidang penerbangan sesuai standar internasional.
Analisis Pergerakan Kendaraan di Area Airside terhadap Keselamatan Penerbangan Bandar Udara Domine Eduard Osok Sorong
Authors: Nur Mulyadi
Published: February 2021

Penelitian faktor penunjang pemberian pelayanan lalulintas penerbangan. Faktor penunjang adalah pengaruh aktivitas kendaraan operasional diairside terhadap keselamatan penerbangan. Tujuan mengetahui pengaruh aktivitas kendaraan operasional diairside terhadap keselamatan penerbangan dibandara Sorong.  Pergerakan penumpang diparking stand yang masih menggunakan simple consep (Tidak tersedia marka apron) menyebabkan keraguan pemberian jarak Pergerakan kendaraan diarea airside  diBandara Sorong belum terkoordinir dengan baik karena masih bergerak secara fleksibel karena belum adanya SOP, guidance line dan acces road. Serta potensial konflik antar pesawat yang melakukan taxi dengan vehicles contohnya Bus penumpang proses loading unloading aman antar parking stand. manuvering taxi mencapai gate position dengan bantuan petugas towing tractor yang trampil. Disarankan Pembuatan SOP, kendaraan yang beroperasi diairside, Perubahan aircraft concept parkingstand dari simple concept menjadi line concept dengan system push-back serta Management apron dengan menambahkan marka apron agar tidak terjadi keraguan dalam memberikan jarak aman antar parking stand demi tercapainya keamanan, efisiensi sehingga penggunaan apron lebih optimal.
Alternatif Pola Pengasuhan ( Pendidikan, Pembinaan dan Pengawasan) Taruna ATKP Makassar dan Implikasinya Bagi Ketahanan Pribadi Taruna
Authors: Idyaningsih Nining
Published: February 2021

Berdasarkan masalah yang dikemukakan, masalah pola pengasuhan menjadi perhatian peneliti dan menuntut pemecahan berkaitan dengan (a) Belum optimalnya pola pengasuhan taruna yang berlaku di ATKP ? (b) Belum optimalnya Fasilitas yang ada di ATKP Makassar ? (c) Belum optimalnya Sumber Daya Manusia yang tersedia di ATKP Makassar. Tujuan yang ingin dicapai dalam penelitian ini adalah (a) Mengetahui pola pengasuhan ATKP Makassar. (b) Mengetahui Sumber Daya Manusia yang tersedia di ATKP Makassar (c) Mengetahui Fasilitas yang dapat di gunakan oleh taruna yang ada di ATKP Makassar (d)  Merumuskan strategi optimalisasi pola pengasuhan dan implikasinya bagi ketahanan pribadi taruna. Penelitian ini merupakan penelitian kualitatif deskriptif, dengan metoda pengumpulan data melalui wawancarayang berupa tanya jawab secara langsung kepada informan perwakilan pengasuh maupun taruna dan dengan observasi yang kemudian dilanjutkan analisis data sehingga data akan lebih terarah pada permasalahan yangsudah ditentukan sebelumnya. Adapun upaya optimalisasi pola pengasuhan dilakuan dengan strategi melibatkan taruna dalam segala kegiatan yang dapat menumbuhkan rasa percaya diri dan bersosialisai terhadap sesama taruna dan lingkungan sekitarnya
ANALISA DAN IMPLEMENTASI ASSOCIATION RULE DENGAN ALGORITMA FP-GROWTH DALAM SELEKSI PEMBELIAN TANAH LIAT (STUDI KASUS DI PT. ANVEVE ISMI BERJAYA)
Authors: Mulya DIo Prima
Published: February 2021

Data Mining aims to draw abstract knowledge of a big database.Data Mining also known as Knowledge Discovery Database. FP-Growth algorithm is one of the very popular algorithms in finding frequent itemset in finding the rule of a large data base. Association rule used to find patterns in market basket analysis. Steps in the process of association rule mining is confidence and support. Clay formed from the weathering of silica by carbonic acid and partly generated by geothermal activity. In this study using FP-Growth Algorithm in purchasing decisions withdrawal clay by PT. ISMI ANVEVE BERJAYA
Discurso do Mestre: O ser e o fazer docente no ensino técnico em enfermagem
Authors: Arantes Ana Luiza Amarante , Rosalen Marilena Souza
Published: February 2021

O livro apresenta a constituição histórica da educação profissional técnica de nível médio em Enfermagem no Brasil e tem como foco apresentar uma análise do que é ser e como é o fazer pedagógico do professor do ensino técnico de nível médio em enfermagem.
Operation Good Neighbor és Izrael szíriaiaknak nyújtott támogatása (2013-2018)
Authors: Paragi Beáta , Papp Lídia
Published: February 2021

E tanulmány célja annak ismertetése és elemzése, hogy Izrael hogyan és milyen (stratégiai) indíttatásból nyújtott segítséget a Golán-fennsíkon zajló Operation Good Neighbor (2013/2016–2018) keretében szíriai civileknek. Az orvosi, orvosetikai lapokban megjelent tanulmányok az orvos–beteg-kapcsolat különféle etikai dimenzióit vizsgálták, és a nemzetközi humanitárius jog elveinek megfelelő misszióként mutatták be a tevékenységet. Az altruista célok, illetve a humanitárius jelleg ugyanakkor egyértelműen megkérdőjeleződött az évek során. Az elérhető forrásokat elemezve, kutatásunk során arra a kérdésre kerestük a választ, hogy hogyan értelmezhető az egyébként ellenséges izraeli–szíriai viszony tükrében az Operation Good Neighbor művelet. Mi volt annak a politikai célja és szerepe a hivatalos humanitárius retorikán túl? Az eredményeink azt mutatják, hogy Izrael szíriai rászorulóknak nyújtott támogatása névleg humanitárius volt, ám a gyakorlatban bonyolultabb megfontolásokat tükrözött.
A Methodology of Discovering Comparable Models. The Case of Investing in Retirement Accounts when Considering Age, Main Residence and Education before 1989 vs. Globalization
Authors: Homocianu Daniel ,   Faculty of Economics and Business Administration, Alexandru Ioan Cuza University of Iasi,   Romania
Published: February 2021

This paper provides a way to discover strong individual influences on investments in retirement accounts. Data are from SHARE-ERIC (Wave7). Principal residences in ex-communist countries or not and full-time education before 1989 served as filters. Two particular models with good classification accuracy resulted based on data mining, variable selection methods, and logistic regressions. A statistical script generated tables with comparable coefficients (average marginal effects). Common influences from the same financial category as the outcome emerged (having life insurance or ever investing in mutual funds or stocks). The younger respondents, those with computer skills or exposed to high stress, are more likely to invest in retirement accounts regardless of the presence of the communist heritage. Specific influences (personality traits and life experiences) also resulted despite the increasing globalization, which, in the case of people over a certain age, was not able to erase some behavioral differences reflected until today.
Brexit: An Exploratory Analysis of the Macroeconomic Effects on the British Economy
Authors: Bento João Alves , Duarte António Portugal ,   University of Coimbra, Faculty of Economics,   Portugal,   University of Coimbra, Faculty of Economics, CeBER; Portugal
Published: February 2021

This paper investigates the effects of the Brexit announcement on the British economy. For this, we use a counterfactual analysis methodology, predicting a set of macroeconomic variables of the British economy in a scenario where the Brexit announcement did not happen and measuring what drifted away from its effective value. To forecast the variables we use the ARIMA method. Our conclusions are that if Brexit had not been announced: i) the exchange rate of the Pound Sterling against the US Dollar would not have had such a sharp depreciation trend; ii) real wage growth would not have been as high after the referendum; iii) the growth rate of the consumer price index would not have had such a strong growth trend and iv) the Gross Domestic Product would have grown at a higher pace and after three years of Brexit announcement it would have been 3% higher.
See Now, Buy Now Model: A Passport to Fashion Brand Equity
Authors: Pinto da Cunha Brandão Amélia Maria , Dourado Pedro , Palma Martos Luis ,   Faculty of Economics, University of Porto,   Portugal,   Faculty of Economics, University of Porto; Portugal,   Faculty of Economics, University of Seville; Spain
Published: February 2021

In a market accentuated by globalization and digital consolidation, high fashion brands start to rethink the way of producing, communicating and distributing their supply, adopting the See Now, Buy Now (SNBN) model to guarantee the possibility of instant gratification. Literature has been scarce concerning SNBN as a new paradigm of contemporary fashion, more particularly, in what concerns its relationship with brand equity. This study seeks to identify the critical variables of SNBN and analyze its feasibility in production and consumption of fashion. It has applied a mixed and sequential methodology. The Portuguese case is worth analysing because of its similarities with countries where the fashion and creative industries' role is still uncertain, but still often mentioned and talked about. The results suggested that there is a positive relation between its adoption and brand equity – in particular a more hybrid strategy of adoption, considering its risks and investments.
Features of applying Maple in school mathematics course
Authors:   South Kazakhstan State Pedagogical University, Baimakhan Nursaule , Ibragimov Raskul
Published: February 2021

This article discusses the features of using the Maple package in a school math course. The school mathematics course consists of basic mathematical concepts, ideas and principles. The scientific nature of the course content and the abstract nature of the topics studied make this course difficult to study in the classroom. The current situation with the coronavirus pandemic has completely eliminated full-time education and made distance education more relevant. The share of independent work of students has increased significantly. This negatively affects the ability to read and understand very complex material. In this regard, the choice of the Maple package as a method of computer technology and its technological possibilities for the organization of independent work of students in school mathematics courses are justified. The authors of the article developed a technology of teaching using the Maple package for school mathematics courses on the basis of the South Kazakhstan State Pedagogical University. This teaching method is aimed at organizing the independent work of students in the study of school mathematics. Examples of the use of the Maple package to solve some problems in a school math course are presented. Taking into account the specifics of the tasks of teaching mathematics at school, the possibilities and advantages of the technology of organizing students' independent work with the help of the Maple package are considered in detail.
The role of social interpersonal communication on abortion decision making: A review of literature
Authors: Wahome Mercy , Mberia Dr Hellen K. , Sikolia Dr Geoffrey
Published: February 2021

Purpose: The objective of the study was to role of social interpersonal communication on abortion decision making.Methodology: This study used a Desk top review. The analysis was largely based on literature review from previous surveys, program reports and internet search on secondary information relating to the social, interpersonal and communication.Results: From the reviewed literature, the study found out that sexual health education can help provide adolescents with decision-making information skills and Peer-reviewed programs, strategies, and resources for sexual health, mental and emotional health, injury prevention, tobacco and substance abuse, and exercise and healthy eating and issues of abortion. It was found out that programs which included knowledge, perceived risks, values, attitudes, perceived norms, and self-efficacy were found to be effective in guiding behavioural change. Adolescents showed that they are aware of the use of contraceptives but they are not easily accessible and the main reason for them to terminate the unwanted pregnancy was due to fear of rejection in the society and family. Worldwide, the most commonly reported reason women cite for having an abortion is to postpone or stop childbearing. The second most common reason - socioeconomic concerns - includes disruption of education or employment; lack of support from the father; desire to provide schooling for existing children; and poverty, unemployment or inability to afford additional children. In addition, relationship problems with a husband or partner and a woman's perception that she is too young constitute other important categories of reasons. Women's characteristics are associated with their reasons for having an abortion: With few exceptions, older women and married women are the most likely to identify limiting childbearing as their main reason for abortion.Recommendation: Since the findings of this study was based on literature review/desktop review, the study recommends for the use of semi structured questionnaires and unstructured interview guides to obtain both quantitative and qualitative data respectively. In so doing, it will enable the researcher to compare the findings with those obtained from the desk top review. This research recommends the use of Convergent Parallel research design to arrive at an integrated summary of the predictors (quantitative research), and views and personal experiences (qualitative research) on decision making on abortion.
Coronavirus and Pregnancy: A Literature Review of Maternal and Fetal Outcomes
Authors: Hussein Dr. Suha Majeed Mohammed , Abdelmageed Dr. Rasha M.Mohammed , Ahmed Sabah Ramadan Hussein
Published: February 2021

Purpose: This study aimed to conduct a literature review of the maternal and fetal outcomes reported for pregnant women with coronavirus disease.Methodology: This articles were searched using a diversity of key words such as “Coronavirus and/or pregnancy,” “COVID-19 and/or pregnancy,” “SARS-CoV-2 and/or pregnancy,”  “COVID-19 disease and/or pregnancy,” and “COVID-19 pneumonia and/or pregnancy”, “Coronavirus and/or maternal and fetal outcomes”, “COVID-19 and/or maternal and fetal outcomes”, without restriction of language to document assembling of as various cases as possible. Those articles were derivative from the World Health Organization (WHO) agendas and rules. Other data related to COVID-19 and reported cases were conducted utilizing seven electronic databases (CINAHL, MEDLINE, ProQuest, PubMed, Scopus, Science Direct, and Cochrane) for studies published in various languages from May 2020 to September 2020. Results: Pregnant women don't seem to be further vulnerable to penalties of infection of coronavirus than overall people. Clinical research information are anticipated for better appreciative of any morbid effect of this new straining and its health threats on both the mother and neonates. There are no documents to notify whether pregnancy upsurges vulnerability to coronavirus. Fever and cough are the supreme symptoms of coronavirus, with more than eighty percent of hospitalized women donating with these symptoms. As regards to inadequate information and the accessible documents from other respiratory pathogens such as SARS, MERS and influenza, it is indefinite whether pregnant women with coronavirus will involvement extra severe ailment.Unique Contribution to theory, practice and policy: Coronavirus ailment severity in pregnant women is mild, moderate, and critical seems alike to that in non-pregnant women. Extra studies are required to comprehend and recognize the accurate greatness of jeopardies and improve management about maternal and fetal outcomes
La Finlande et la Suède, des pays non-alliés ? Cultures et politiques de sécurité à l’épreuve des tensions régionales dans l’espace baltique
Authors: Enos-Attali Sophie
Published: February 2021

« Petits pays » d’Europe du Nord, la Finlande et la Suède ont chacune fait le choix de la neutralité pour assurer leur sécurité dans un contexte où elles se sentaient fragilisées par leur voisinage avec la Russie. Après l’effondrement de l’Union soviétique au sortir de la Guerre froide, elles ont mené une politique originale, associant la participation pleine et entière à la politique étrangère et de sécurité commune de l’Union européenne et la non-participation à des alliances militaires. Toutefois, bouleversant en profondeur l’équilibre en Europe du Nord, la crise ukrainienne a conduit la Finlande et la Suède à prendre leurs distances avec l’objectif de neutralité dans un conflit armé, qui avait été au cœur de leur politique sécuritaire depuis les années 1950. Par-delà ce qui apparaît comme une rupture avec leur tradition sécuritaire, la Finlande et la Suède demeurent en réalité fidèles à leur culture de sécurité : comme par le passé, c’est l’image qu’elles ont chacune d’elles-mêmes, une image demeurée inchangée, qui continue d’encadrer leurs choix sécuritaires.
Spanish Exemplary Rulership? Antonio de Guevara’s Relox de Príncipes (1529) in English (1557) and Dutch (1578) Translation
Authors: Waasdorp Sabine
Published: February 2021

The mirror-for-princes Relox de príncipes (1529) by Antonio de Guevara (1481-1545) compared Holy Roman Emperor and King of Spain Charles V (1500-1558) to the celebrated stoic Roman emperor Marcus Aurelius, with the two being equal in wisdom, sense of justice and clemency, and exemplary rulership. Thereafter, royal and higher-class Spaniards fashioned themselves as contemporary Aurelii, making the book a symbol of the superiority of Spaniards and Spain. However, countries where the Relox was read in translation had more nuanced or negative perspectives on Spaniards. This chapter delves into how proto-national attitudes towards Spaniards are decisive for the English (1557) and Dutch (1578) translations of the Relox, fashioning Aurelius as an exemplar for their own non-Spanish rulers and negotiating Hispanophilic and Hispanophobic Spanish representations.
From Hispanophobia to Quixotephilia : The Politics of Quixotism in the British Long Eighteenth Century
Authors: Pardo Pedro Javier
Published: February 2021

This chapter explores the reception of Don Quixote in the British long eighteenth century in the context of the tension between traditional political Hispanophobia and emerging literary Quixotephilia. It first speculates on how the former may have influenced the negative conception of Don Quixote dominating the seventeenth century, epitomized by Edmund Gayton’s Hispanophobic Quixote. It then focuses on political appropriations by Sir William Temple and Lord Carteret and how they negotiated this tension in the eighteenth century: through reinterpretation and canonization they turned Don Quixote into a classic, but, in so doing, they separated it from its national background and turned the text and even Cervantes against Spain. Finally, the chapter briefly considers a later, Romantic means of resolving the tension, Lord Byron’s Hispanophilic Quixote.
Together all the bad things will disappear, I find my partner: Phenomenology study of online dating
Authors: Afdilla Trisna
Published: February 2021

The use of online dating applications has become a phenomenal social norm that is popular among the community of active social media users. Online dating activities are supported by the advancement of technology which resulted in an abundance of affordable smartphones, hence everybody can easily find and meet locals as well as foreigners, which eventually might establish a more serious relationship. This research aims to explore how an individual who is online dating addresses all the constraints and barriers the users experience and the motivation underlying the user in online dating to establish a relationship with the partner, which is certainly different from offline (classic) relationships. The research method used is a qualitative approach to the type of descriptive phenomenology. The number of subjects in this study was 8 people (3 men and 5 women), who had an online dating relationship with someone from abroad. The results showed that some couples chose to learn to understand the culture and their limitations in establishing the relationship. Besides, some subjects chose to learn the language of their partner and spending more time with their partner who had a regional time difference. The subjects had almost the same motivation in deciding to go for online dating. The fundamental thing that becomes a driver of an online dating relationship comes from the individual's owns’ desire to fulfill the needs of establishing a relationship with others to gain much-needed attention, love, care, and compassion.
Nonlinear turnover rates of soil carbon following cultivation of native grasslands and subsequent afforestation of croplands
Authors: Hernandez-Ramirez Guillermo , Sauer Thomas J. , Chendev Yury G. , Gennadiev Alexander N.
Published: February 2021

Abstract. Land use conversions can strongly impact soil organic matter (SOM) storage, which creates paramount opportunities for sequestering atmospheric carbon into the soil. It is known that land uses such as annual cropping and afforestation can decrease and increase SOM, respectively; however, the rates of these changes over time remain elusive. This study focused on extracting the kinetics (k) of turnover rates that describe these long-term changes in soil C storage and also quantifying the sources of soil C. We used topsoil organic carbon density and δ13C isotopic composition data from multiple chronosequences and paired sites in Russia and United States. Reconstruction of soil C storage trajectory over 250 years following conversion from native grassland to continual annual cropland revealed a C depletion rate of 0.010 years−1 (first-order k rate constant), which translates into a mean residence time (MRT) of 100 years (R2 ≥ 0.90). Conversely, soil C accretion was observed over 70 years following afforestation of annual croplands at a much faster k rate of 0.055 years−1. The corresponding MRT was only 18 years (R2 = 0.997) after a lag phase of 5 years. Over these 23 years of afforestation, trees contributed 14 Mg C Ha−1 to soil C accrual in the 0 to 15 cm depth increment. This tree-C contribution reached 22 Mg C Ha−1 at 70 years after tree planting. Over these 70 years of afforestation, the proportion of tree-C to whole soil C increased to reach a sizeable 79 %. Furthermore, assuming steady state of soil C in the adjacent croplands, we also estimated that 45 % of the prairie-C existent at time of tree planting was still present in the afforested soils 70 years later. As intrinsic of k modelling, the derived turnover rates that represent soil C changes over time are nonlinear. Soil C changes were much more dynamic during the first decades following a land use conversion than afterwards when the new land use system approached equilibrium. Collectively, results substantiated that C sequestration in afforested lands is a suitable means to proactively mitigate escalating climate change within a typical person's lifetime, as indicated by MRTs of few decades.
Analysis for torsion employing provisions of NZRS 4203:1974
Authors: Poole R. A.
Published: February 2021

This paper is the result of deliberations of the Society's discussion group on seismic design of ductile moment resisting reinforced concrete frames.
Improving Disturbance-Rejection by Using Disturbance Estimator
Authors: Vrančić Damir , Huba Mikuláš
Published: February 2021

The main tasks of control in various industries are either tracking the setpoint changes or rejecting the process disturbances. While both aim at maintaining the process output at the desired setpoint, the controller parameters optimised for setpoint tracking are generally not suitable for optimal disturbance rejection. The overall control performance can be improved to some extent by using simpler 2-DOF PID controllers. Such a controller structure allows the disturbance rejection to be optimised, while it also improves the setpoint tracking performance with additional controller parameters (usually through the setpoint weighting factors). Since such 2-DOF structures are usually relatively simple, the optimization of tracking performance is usually limited to the reduction of process overshoots instead of achieving an optimal (fast) tracking response. In this chapter, an alternative approach is presented in which the parameters of the PID controller are optimised for reference tracking, while the performance of the disturbance rejection is substantially increased by introducing a simple disturbance estimator approach. The mentioned estimator requires adding two simple blocks to the PID controller. The blocks are the second-order transfer functions whose parameters, including the PID controller parameters, can be calculated analytically from the process characteristic areas (also called process moments). The advantage of such an approach is that the mentioned areas can be analytically calculated directly from the process transfer function (of any order with time delay) or from the time response of the process when the steady state of the process is changed. Both of the above calculations are absolutely equivalent. Moreover, the output noise of the controller is under control as it is considered in the design of the controller and compensator. The closed loop results on several process models show that the proposed method with disturbance estimator has excellent tracking and disturbance rejection performance. The proposed controller structure and tuning method also compare favourably with some existing methods based on non-parametric description of the process.
Heraclitus the Jock
Authors: Hyland Drew A. ,   Philosophy Documentation Center
Published: February 2021

The ancient Ephesian thinker Heraclitus, in his aphoristic writings, described the dynamic coming-to-be of things according to a number of obscure metaphors. In this essay, Hyland ponders whether there is a paradigmatic experience according to which a number of these metaphors can best be understood. Gathering together and thoughtfully retranslating a number of Greek terms including polemos (often translated as “war”), eris (“strife”), agon (“contest”), and paidia (“play”), Hyland argues that Heraclitus’s metaphors can be understood as referring to an experience of athletic play. Hyland explores the significance of athletic play, with its stance of responsive openness, as a paradigm for thinking and living.
Measuring Extent of Ductal Carcinoma In Situ in Breast Excision Specimens: A Comparison of 4 Methods
Authors: Grin Andrea , Horne Garnet , Ennis Marguerite , O'Malley Frances P.
Published: February 2021

Context.—Measuring the extent of nonpalpable ductal carcinoma in situ (DCIS) in a breast specimen is challenging but important because it influences patient management. There is no standardized method for estimating the extent of DCIS, although serial sequential sampling with mammographic correlation is considered an accurate method.

Objective.—To estimate the extent of DCIS using various methods and to compare these estimations with the extent as determined by the serial sequential sampling method.

Design.—A total of 78 primary breast excisions with DCIS were retrospectively reviewed. All specimens had been sampled using the serial sequential sampling method, which involved mapping the location of each block on the sliced specimen radiograph and calculating the extent through 3-dimensional reconstruction. The other measures for estimating extent included (1) calculating size based on areas of calcification, (2) recording the number of blocks involved by DCIS and multiplying that number by 0.3 cm, and (3) measuring the largest extent of DCIS on a single slide.

Results.—All 3 alternative methods tended to underestimate the DCIS. Discrepancies became more pronounced as size increased. The percentage of cases estimated to within 1 cm of the serial sequential sampling method were 81%, 72%, and 50%, respectively, for the calcification, blocks, and single-slide methods; differences of more than 2 cm were seen in 9%, 8%, and 30% of cases, respectively.

Conclusions.—The single-slide method performed poorly and should be used only when DCIS is limited to a single slide. Although the calcification and the blocks methods gave better estimates, both produced substantial underestimates and/or overestimates that could affect clinical decision making.
Impact of Digital Image Manipulation in Cytology
Authors: Pinco Jeffery , Goulart Robert A. , Otis Christopher N. , Garb Jane , Pantanowitz Liron
Published: February 2021

Context.—Digital images have become an important component of cytology practice. They are used in telecytology, automated screening, educational material, and Web sites and have potential for use in proficiency testing. However, there has been no formal evaluation to date to determine if digital image manipulation (intentional or unintentional) can affect their interpretation.

Objective.—To investigate whether alteration of digital cytology images affects diagnosis.

Design.—Acquired digital images of ThinPrep Papanicolaou test slides were manipulated (rotated 90;dg and brightness, contrast, red-green-blue color, and luminosity adjusted) using Photoshop. A test composed of these altered images, along with their original (unaltered) image and exact duplicates was given to 22 cytologists (13 cytotechnologists, 8 cytopathologists, and 1 fellow). All images were rated as negative, atypical (atypical squamous cells of undetermined significance), low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or positive for cancer. Weighted κ and heterogeneity χ2 statistics were used to measure levels of agreement and assess concordance between groups.

Results.—The level of agreement for identical duplicate images was excellent (κ = 0.81), compared with the poor agreement for manipulated image pairs (κ = 0.21), a statistically significant difference (P < .001). For all altered image types agreement was poor. There was no significant difference between cytotechnologists and cytopathologists in level of agreement (P = .56).

Conclusions.—Manipulation of a Papanicolaou test digital image, irrespective of the specific category of cytologic material photographed, significantly affects its interpretation by both cytotechnologists and cytopathologists. This suggests that care needs to be taken when digital cytology images are used, to specifically ensure that their alteration does not affect diagnosis.
Ovarian Cancer Update: Lessons From Morphology, Molecules, and Mice
Authors: Cho Kathleen R.
Published: February 2021

Ovarian carcinomas are a heterogeneous group of neoplasms. Pathologists currently employ a morphology-based classification system to divide ovarian carcinomas into major subgroups based on degree (tumor grade) and type of differentiation (eg, serous, endometrioid, clear cell, or mucinous). Molecular studies have shown that specific genetic defects are likely to be present in certain histologic types of ovarian carcinomas and unlikely to be present in others. Within the serous and endometrioid carcinomas, the molecular defects in low-grade versus high-grade tumors also appear to be largely distinct. Recently, mouse models of ovarian carcinoma have been developed that recapitulate many of the morphologic features and biologic behavior of selected subtypes of ovarian cancer. It is expected that these mouse models will yield new insights into ovarian cancer pathogenesis and prove useful for preclinical testing of novel strategies for ovarian cancer treatment.
Adenocarcinoma in Barrett Mucosa Treated by Endoscopic Mucosal Resection
Authors: Appelman Henry D.
Published: February 2021

Adenocarcinoma and dysplasias are recognized complications of Barrett mucosa. In the past, the treatment for this carcinoma was esophagectomy. However, new techniques, including endoscopic mucosal resection, sometimes replace esophagectomy and are becoming standard procedures in clinical practice, not just in major medical centers. Pathologists must learn to handle these specimens, which have extensive artifacts. Also, Barrett mucosa has duplicated stromal layers beneath the mucosa that include a new lamina propria and a new muscularis mucosae. We must be aware of these peculiarities because of staging implications. Regardless of new technology, the diagnostic approach to dysplasia depends on the light microscopic interpretation, which is not as reliable or consistent as one would wish. Hopefully, better diagnostic criteria will arise, and perhaps a new histologic stain or a molecular or genetic test will emerge that complements “our eyeballs.”
Unexpected Neoplasia in Autopsies: Potential Implications for Tissue and Organ Safety
Authors: Sens Mary Ann , Zhou Xu Dong , Weiland Timothy , Cooley A. Marvin
Published: February 2021

Context.—Medical examiner cases are increasingly used as tissue donor referral sources to meet the ever-growing need for transplant tissues. The assumption is often made that traumatic and sudden deaths have minimal risk of unsuspected neoplasia. An autopsy of a registered tissue donor with strong preautopsy clinical assessment of a saddle pulmonary embolus revealed unsuspected acute lymphoblastic leukemia, prompting a review of the incidence of unsuspected neoplasia from a regional forensic autopsy practice.

Objective.—To determine the incidence of (1) unsuspected neoplasia, (2) clinical concordance of known neoplasia, and (3) potential donor referral in a regional forensic autopsy service.

Design.—A retrospective, 5-year review of 412 autopsies from a regional, primarily forensic, autopsy service to determine the incidence of unsuspected neoplasia, clinical concordance of known neoplasia, and the preautopsy assessment of potential donor referral suitability.

Results.—Unsuspected neoplasia rate at autopsy was 7% (29 of 412 patients); cancer was the cause of death in 41% (12 of 29 patients) of these individuals. In patients with a history of cancer, the discordance of cancer diagnosis was 44% (4 of 9 patients [11 patients with known cancer, 2 who refused medical evaluation were excluded from the study]). Nearly 60% (17 of 29 patients) of the unsuspected cancer cases had no apparent reason for deferral of tissue procurement before the autopsy examination.

Conclusions.—The 7% incidence of unsuspected cancer in a forensic autopsy practice raises concern for the potential introduction of neoplastic tissue in the donor pool. To ensure the safety of this vital resource, mandatory complete autopsies on deceased donors are advocated as well as a tissue-recipient registry to track donor-related neoplasia.
Adequate Histologic Sampling of Breast Magnetic Resonance Imaging–Guided Core Needle Biopsy
Authors: Cornea Virgilius , Jaffer Shabnam , Bleiweiss Ira J. , Nagi Chandandeep
Published: February 2021

Context.—The increasing use of contrast-enhanced magnetic resonance imaging (MRI) of the breast as a valuable adjunct to mammography and ultrasound in the detection of breast lesions, in association with needle core biopsy taken from the suspicious areas, has major workload implications for histopathology laboratories wherever breast MRI is practiced.

Objective.—To establish the number of histologic levels necessary for the evaluation of breast MRI-guided needle core biopsy specimens taken from suspicious areas on breast MRI examination.

Design.—Retrospective histologic review of a series of breast MRI-guided core needle biopsies, initially examined routinely at 4 levels, in the Pathology Department at Mount Sinai School of Medicine in New York, New York.

Results.—Accurate diagnostic classification was possible after examination of the first level in 95.4% of cases. For a small group of patients (4.4%), 4 levels were considered to provide additional useful information, although this information did not alter the diagnosis. In only a single case (0.2%) was it likely that routine examination of 4 levels could have led to an incidental finding of a very small intraductal papilloma (0.15 cm) present only at the second histologic level. However, this incidental finding would have not changed the patient outcome.

Conclusions.—Needle core biopsies for MRI-detected abnormalities should be routinely examined at only 1 level. Further levels may be needed in occasional cases to identify more conclusively an associated pathologic abnormality and may be of particular value when assessing atypical intraductal proliferative epithelial lesions.
Sins of Our Fathers: Two ofThe Four Doctorsand Their Roles in the Development of Techniques to Permit Covert Autopsies
Authors: Wright Jr James R.
Published: February 2021

Context.—Sir William Osler, MD, and Howard Kelly, MD, were probably the preeminent practitioners of their respective specialties, internal medicine and gynecology, during the late 19th and early 20th centuries. Both were passionately interested in pathology. Although not widely known, during the 1880s, both allegedly pioneered “arm's length” methods to perform covert autopsies that involved removing abdominal and even thoracic organs via the anus, vagina, or a small perineal incision hidden behind the scrotum. These techniques were allegedly used, at least occasionally, to circumvent autopsy-consent regulations and to procure teaching specimens for medical museums.

Objective.—To examine the historical evidence for these alleged events and to examine these behaviors within the context of (1) the need to obtain pathologic specimens for teaching gross pathology and clinical pathologic correlation to medical trainees, (2) the loose interpretation of autopsy-consent regulations at “charity hospitals” during the late 19th century, (3) the medical museum movement, and (4) the paternalistic approach to the practice of medicine typical of the times.

Design.—To address these issues, standard historiographic methods were used to examine available primary and secondary historical sources.

Results.—The evidence suggests that Kelly developed and published 3 arm's length methods for covert autopsies while a resident in Philadelphia, Pennsylvania, and that both Kelly and Osler pioneered the use of these methods in the 1880s. The brief history of these “minimally invasive” autopsy techniques is also examined by reviewing 19th and 20th century textbooks of autopsy technique.

Conclusions.—Howard Kelly, MD, and William Osler, MD, pioneered arm's length methods for covert autopsies. In fact, this activity appears to have initiated the 2 doctors' long professional relationship.
Renal Disease in Systemic Lupus Erythematosus With Emphasis on Classification of Lupus Glomerulonephritis: Advances and Implications
Authors: Seshan Surya V. , Jennette J. Charles
Published: February 2021

Context.—Systemic lupus erythematosus is an autoimmune disease with protean clinical and pathologic manifestations involving almost all organs in the body. There is a high incidence of renal involvement during the course of the disease, with varied renal pathologic lesions and diverse clinical features. A renal biopsy examined by routine light microscopy, immunofluorescence, and electron microscopy contributes toward diagnosis, prognostic information, and appropriate management.

Objectives.—(1) To review the clinical and various pathologic features of renal lesions in systemic lupus erythematosus patients. (2) To introduce the International Society of Nephrology and Renal Pathology Society Classification of Lupus Glomerulonephritis.

Data Sources.—A literature review, illustrations with original artwork, and tabulation of clinical and pathologic data of cases obtained from the authors' renal biopsy files examined during the last 8 years were used.

Conclusions.—The International Society of Nephrology/ Renal Pathology Society–sponsored Classification of Lupus Glomerulonephritis proposes standardized definitions of the various pathologic findings, describes clinically relevant lesions, incorporates prognostic parameters, and recommends a uniform way of reporting the renal biopsy findings. Lupus glomerulonephritis is divided into 6 classes primarily based on the morphologic lesions, extent and severity of the involvement, immune complex deposition, and activity and chronicity. Special emphasis is laid on describing qualitative as well as quantitative morphologic data and to include the accompanying tubulointerstitial disease and different vascular lesions, which have prognostic and therapeutic significance. This classification is intended to facilitate a higher degree of reproducibility, resulting in better patient care and more effective future clinical and translational research. Renal biopsy findings in systemic lupus erythematosus add new and independent parameters of prognostic significance to established clinical and genetic factors.
Genetic Heterogeneity in HER2 Testing in Breast Cancer: Panel Summary and Guidelines
Authors: Vance Gail H. , Barry Todd S. , Bloom Kenneth J. , Fitzgibbons Patrick L. , Hicks David G. , Jenkins Robert B. , Persons Diane L. , Tubbs Raymond R. , Hammond M. Elizabeth H.
Published: February 2021

Context.—Intratumoral heterogeneity of HER2 gene amplification has been well documented and represents subclonal diversity within the tumor. The reported incidence of intratumor HER2 amplification genetic heterogeneity ranges in the literature from approximately 5% to 30%. The presence of HER2 genetic heterogeneity may increase subjectivity in HER2 interpretation by the pathologist.

Objectives.—To define HER2 genetic heterogeneity and to provide practice guidelines for examining and reporting breast tumors with genetic heterogeneity for improvement of HER2 testing in breast cancer.

Design.—We convened an expert panel to discuss HER2 gene amplification testing by fluorescence in situ hybridization. Components addressed included a definition of HER2 amplification heterogeneity, practice guidelines for examination of the tissue, and reporting criteria for this analysis.

Results.—Genetic heterogeneity for amplification of HER2 gene status in invasive breast cancer is defined and guidelines established for assessing and reporting HER2 results in these cases. These guidelines are additive to and expand those published in 2007 by the American Society of Clinical Oncology and the College of American Pathologists.

Conclusion.—Standardized methods for analysis will improve the accuracy and consistency of interpretation of HER2 gene amplification status in breast cancer.
Fatal Head Injury in Children Younger Than 2 Years in New York City and an Overview of the Shaken Baby Syndrome
Authors: Gill James R. , Goldfeder Lara B. , Armbrustmacher Vernon , Coleman Andrea , Mena Hernando , Hirsch Charles S.
Published: February 2021

Context.—Shaken baby syndrome is a controversial topic in forensic pathology. Some forensic pathologists state that shaking alone is insufficient to explain death and that an impact must have occurred even if there is no impact site on the head.

Objective.—To examine a large cohort of fatal, pediatric head injuries for patterns of specific autopsy findings and circumstances that would support or dispute pure shaking as the cause of death.

Design.—We retrospectively reviewed 59 deaths due to head injuries in children younger than 2 years certified in our office during a 9 year period (1998–2006). The review included autopsy, toxicology, microscopy, neuropathology, and police and investigators' reports.

Results.—There were 46 homicides, 8 accidents, and 1 undetermined death from blunt-impact injury of the head. In 10 (22%) of the homicides, there was no impact injury to the head, and the cause of death was certified as whiplash shaking. In 4 (40%) of these 10 deaths, there was a history of shaking. In 5 (83%) of the other 6, there was no history of any purported accidental or homicidal injury. All 8 accidental deaths had impact sites. Of the 59 deaths, 4 (6.7%) had only remote injuries (chronic subdural hematomas, remote long bone fractures) that were certified as undetermined cause and manner. These 4 deaths were excluded from the study.

Conclusions.—We describe a subset of fatal, nonaccidental head-injury deaths in infants without an impact to the head. The autopsy findings and circumstances are diagnostic of a nonimpact, shaking mechanism as the cause of death. Fatal, accidental head injuries in children younger than 2 years are rare.
Update on Diagnostic Practice: Tumors of the Nervous System
Authors: Pytel Peter , Lukas Rimas V.
Published: February 2021

Context.—Changes in the practice of diagnosing brain tumors are formally reflected in the evolution of the World Health Organization classification. Beyond this classification, the practice of diagnostic pathology is also changing with the availability of new tests and the introduction of new treatment options.

Objective.—Glioblastomas, oligodendrogliomas, glioneuronal tumors, and primitive pediatric tumors are discussed in an exemplary way to illustrate these changes.

Data Sources.—Review of relevant publications through Medline database searches.

Conclusions.—The example of glioblastomas shows how new predictive markers may help identify subgroups of tumors that respond to certain therapy regimens. The development of new treatment strategies also leads to different questions in the assessment of brain tumors, as seen in the example of pseudoprogression or the changes in tumor growth pattern in patients taking bevacizumab. Oligodendrogliomas illustrate how the identification of 1p/19q loss as a cytogenetic aberration aids our understanding of these tumors and changes diagnostic practice but also introduces new challenges in classification. Glioneuronal tumors are an evolving group of lesions. Besides a growing list of usually low-grade entities with well-defined morphologic features, these also include more poorly defined cases in which a component of infiltrating glioma is often associated with focal neuronal elements. The latter is biologically interesting but of uncertain clinical significance. Oligodendrogliomas and glioneuronal tumors both illustrate the importance of effective communication between the pathologist and the treating oncologist in the discussion of these patients. Finally, the discussion of primitive pediatric tumors stresses the clinical importance of the distinction between different entities, like atypical teratoid rhabdoid tumor, “central” (supratentorial) primitive neuroectodermal tumor, “peripheral” primitive neuroectodermal tumor, and medulloblastoma. In medulloblastomas, the recognition of different variants is emerging as a prognostic factor that may in the future also predict therapy responsiveness.