bluuebunny/crossref_metadata_2025 huggingface dataset:
Response to Lapatinib-Capecitabine combination in a young patient with recurrent HER2-positive breast cancer refractory to two lines of therapy with anti-HER2 drugs
Authors: Savastano Clementina , Lombardi Fortuna
Published: December 2018

HER2-positive breast cancer is an aggressive tumour that affects approximately one in five breast cancer women. Clinical studies have shown that HER2-positive cancer have different characteristics from other mammary tumors: a more rapid progression of the disease, an earlier age of onset (women of childbearing age between 30 and 45 are also affected to a large extent), a different response to chemotherapyand, in general, an unfavorable prognosis. Breast cancer with overexpression of the HER2 protein may benefit from the latest generation of target treatments (monoclonal antibodies and anti-HER2 tyrosine kinase inhibitors). Not all HER2-positive tumors, however, respond to therapies, and some responders may later become resistant. We report the case of a young woman with HER2-positive mammary carcinoma who presented resistance to the first two treatment lines with anti-HER2 drugs (trastuzumab-pertuzumab and TDM1) and responded to the combination lapatinib-capecitabine in third line (Oncology).
About ESUS…
Authors: Baule Antonio
Published: December 2018

Five subtypes of Ischemic stroke are classified based on therir causes. ESUS (Embolic Stroke of Undetermined Source) stands for a non-lacunar cerebral infarct, in the absence of stenosis of large arteries or causes of cardioembolic stroke. It is estimated that ESUS accounts for about 25% of all ischemic strokes. A multidisciplinary, multistep diagnostic investigation is needed for a correct diagnosis, in order to exclude other possible causes of stroke. At present there are limited indications on how to plan secondary prevention of ischemic stroke in patients with ESUS. In the patient described, cortical ischemia, probably arising following an arterial embolization, represents an index event that could be classified as ESUS: in this case dabigatran was administered off-label, althoughin this type of patient this could be soon supported by the results of the RESPECT-ESUS study, a randomized trial comparing dabigatran and ASA in patients with recent ESUS, to test whether anticoagulant therapy can improve the outcome of patients in this clinical condition (Cardiology).
Oral anticoagulant therapy in a patient with CHA₂DS₂-VASc score 1
Authors: Cherubini Stefania , Ciolli Andrea
Published: December 2018

Controlled studies of new oral anticoagulants (NOACs) in patients with atrial fibrillation have included above all patients at high risk of stroke, providing solid evidence on the benefits of anticoagulant therapy with such drugs in male patients with CHA2DS2-VASc score ≥2 and in women with a score of ≥3. Although estimates of stroke risk in patients with lower scores predominantly come from studies in patients not receiving NOAC, in many of these subjects anticoagulant therapy still seems able to provide clinical benefit. The current guidelines therefore recommend oral anticoagulant therapy in patients with CHA2DS2-VASc ≥1 in men and ≥2 in women. However, the use of this therapy must be carefully weighted with the expected reduction in the risk of stroke, the risk of bleeding and the patient's preferences. The paradygmatic case of a patient with CHA2DS2-VASc score 1 is reported in which acetylsalicylic acid therapy is substituted with dabigatran 150 mg / day in order to guarantee the patient maximum protection against the risk of stroke, without exposing him to an excessive risk of bleeding (Cardiology).
DINAMIKA KELOMPOK DAN TINGKAT ADOPSI PENGELOLAAN TANAMAN TERPADU (PTT) PADI PADA KELOMPOK TANI DI DESA ARJASA KECAMATAN ARJASA KABUPATEN JEMBER
Authors: Susilowati Anik , Widjayanti Lenny , Soejono Djoko
Published: December 2018

Food crops, especially rice, are the main crops cultivated by most Indonesian farmers. One of the strategies taken by the government to increase rice production in Indonesia is through Integrated Crop Management Field School (ICMFS) program. The success of the development program can be seen from the approach within the group. Farmer groups have a strategic position in realizing the application of integrated cultivation, therefore every farmer has different adoption level in applying ICM. The purpose of this study is to: (1) the dynamics of groups in farmer groups in Arjasa, (2)  the adoption of Integrated Crop Management of rice at farmer group at  in Arjasa, (3) the relationship between socio-economic factors with the adoption ICM of rice in Arjasa. Determination of research area using Purposive Method. The method used in this research is descriptive and correlation. Sampling method using Purposive Sampling and Proporsinate Random Sampling. Methods of data collection using structured interviews, observation, document. Analyzer used is Likert scale and Rank Spearman correlation. The results showed: (1) the dynamics of farmer groups in Arjasa as a whole is dynamic. (2) the adoption of Integrated Crop Management (ICM) of rice in the farmer group in Arjasa as a whole is high (3) there is a significant correlation between age factor and experience with ICM adoption. While the factors of education, land area, income, and information sources do not have a significant relationship with the adoption of ICM
ANALISIS EFISIENSI HARGA DAN BIAYA USAHATANI CABAI MERAH (CAPSIUM ANNUUM L) DI KECAMATAN WULUHAN KABUPATEN JEMBER
Authors: Ni'mah Nihliatun , Hariyati Yuli , Agustina Titin
Published: December 2018

The productivity level of red chili in Wuluhan Sub-district in 2010 until 2015 has fluctuated. The level of productivity in red chili commodities in Wuluhan Sub-district is estimated to be influenced by several factors of production (fertilizer, pesticide, labor) and planting season. Some problems experienced by red chili farmers in Wuluhan Sub-district apart from productivity side of unstable but also from unstable selling price side. This research aims to determine (1) the influence of factors of production and planting season on productivity level of red chillies in Wuluhan Sub-district Jember District; (2) the efficiency of the price of the use of production factors at red chili farming in Wuluhan Sub-district, Jember District; (3) cost efficiency at red chili farming in Wuluhan Sub-district, Jember district. Location of research conducted by method of Purposive Method that is determination of research location done intentionally. Data collection methods used for primary data collection is the method of interview and questionnaire (questionnaire) while the data collection method used for secondary data collection is a documentation technique. The analytical tools used include: Cobb-Douglas production function, price efficiency and cost efficiency. The results showed that (1) production factors of pesticide, labor and planting season significantly affect productivity level; (2) The use of fertilizer, pesticide and labor production factor has not reached the price efficiency because the ratio between NPMxi and Pxi is more than one; (3) the use of cost is efficient, the business is run profitable and feasible to cultivate.
ANALISIS NILAI TAMBAH KELAPA DI KECAMATAN PATILANGGIO KABUPATEN POHUWATO PROVINSI GORONTALO
Authors: Dahar Darmiati , Maharani Maharani
Published: December 2018

One of the coconut producing areas in Gorontalo Province is Pohuwato District. Subdistrict Patilanggio is one of subdistrict in Pohuwato District that has a high enough production. Coconut plants are still be the main plant in this area. The purpose of this research is to know coconut productivity and value added obtained by farmers (from the processing of coconuts into copra). Data analysis used is analysis of productivity calculation and value added analysis of coconut with hayami method. The study was conducted in Patilanggio Subdistrict by selecting 3 (three)  villages with the most farmers, namely: Manawa Village, Suka Makmur Village, and Dulomo Village. The results obtained, namely: 1) Productivity of coconut in District Patilanggio based on results if data obtained 1.7 tons / ha. 2). The added value obtained from processing coconut into copra is Rp. 1,547,46 / kg with added value ratio obtained for 55,57%. This means if the value of the product by 1 unit increases the added value obtained at 0.5557 units. An added value ratio of more than 50% is said to be high. It means that the processing of coconut into copra has high added value.
PENGUATAN MODAL SOSIAL BERBASIS KELEMBAGAAN LOKAL MASYARAKAT PESISIR PERSPEKTIF GENDER DI KABUPATEN BANTUL
Authors: Anggraini Oktiva , Agus Muhammad
Published: December 2018

The aims of this research are getting to know: encouraging the creation of social capital empowerment in the empowerment of fisherman based local institution with gender perspective in coastal area of ​​Bantul regency. With descriptive qualitative research design, data collection techniques: in-depth interview; literature study, observation and FGD. The results showed that coastal villages in Bantul district have developed institutions and rules that effectively limit the rate of exploitation of natural resources. Characteristic of social capital of coastal community in research location indicated that dominant group is group of citizen (arisan, RT), pengajian, fisherman group and fisherman. Given that the dominant group resides in the internal environment of the settlement and consists of the settlement community itself, access to outside resources is limited. The level of participation in the group was quite good seen from the presence, material and non-material. The level of trust and solidarity is relatively high. Values ​​are still firmly held and result in collective action and cooperation is relatively good enough. Social capital was more used for the fulfillment of daily needs (subsistence), is temporary and very personal. There was still a less supportive local culture, a wasteful life. Not many types of services could be expanded access because of the existence of a limited group. Social capital that supports the management of tourist destinations and coastal community empowerment in general need strengthening of related institutions, especially DKP, Dinpar and Disperindagkop Bantul regency more integrated. The caution of the coastal empowerment initiators resulted in coastal communities in Bantul district failing to develop social capital in the context of managing government resources such as bangdes funds, etc
PENGARUH INPUT TERHADAP PRODUKSI USAHATANI LADA PUTIH (Muntok White Pepper) DI DESA KUNDI KECAMATAN SIMPANG TERITIP KABUPATEN BANGKA BARAT
Authors: Pranoto Yudi Sapta
Published: December 2018

The development of white pepper in Bangka Belitung Province is an interesting issue to be concerned, because of it has been well-known worldwide as Muntok White Pepper. This research based on the relationship among input, process, and output produced also high operating cost of white pepper farming. The focus of this research are (1) Calculating the amount of production cost, income, and the lowest output farmers’ price in Kundi Village, (2) Analyzing production inputs which allegedly influencing the amount of white pepper production in Kundi Village. The method used in this research was survey method and desk study and field study approach also data analyzing used Break Even Point and regression analysis used production function of Cobb Douglas, therefore the result of this research was (1) The amount of cost spent by the farmers in the first harvest season is Rp. 77.080.861, the income of white pepper farming in the first harvest season is Rp. 99.556.639. while BEP of price of white pepper is Rp.67.615 and BEP of Production of white pepper is Rp. 493  kilograms. (2) There are two variables influencing the amount of production of white pepper farming in Kundi Village, that is fertilizer (X1) and labor (X2).
KERAGAAN USAHATANI PADI GOGO PADA PROGRAM PENGELOLAAN HUTAN BERSAMA MASYARAKAT DI KESATUAN PENGELOLAAN HUTAN INDRAMAYU
Authors: Wulandari Linda , Kusno Kuswarini
Published: December 2018

PHBM is a system of forest resource management conducted jointly with PerumPerhutani and people from villages forest. One of the village that implement the program is Jatimunggul village. In the implementation, the program facing some trouble because the rural community was not agree with management takeover by Perhutani. As the result the farmers is protesting about forest land which considered belongs to them. The purpose of this study was to determine the performance of upland rice that held by farmers from Perhutani Forrest area at Jatimunggul Village. Qualitative research design is supported by quantitative data with case study research techniques. The results show that the cultivation of upland rice in PHBM Program still using traditional tools. There are some processes upland rice farming that involving another party such as: procurement of capital which is 20% come from self-capital and 80% from capital loan the middleman, site planning process and commodity that involving Perhutani, and marketing of the upland rice products that involving the middleman. The average income of the upland rice farmer per hectare each years is Rp. 23.800.333, meanwhile the income is Rp. 9.402.985 with average of production is 3.543 kg/ha. The average of total cost that the farmer spend is Rp. 15.112.352 consisting of variable cost value of Rp. 14.480.450 and fixed cost Rp. 631.902. when compared with the secondary revenue data of upland rice at Sukasari Villages at 2014 then the revenue from upland rice at Jatimunggul Village is higher Rp. 10.710.333 or differ by 45% compared with revenue from Sukasari Villages. PHBM Program not only give economics benefit, but also benefit at socials such as for employment, but the benefit for the environment not fully completed yet.
PRODUKTIVITAS DAN FAKTOR-FAKTOR YANG BERPENGARUH TERHADAP PRODUKSI USAHATANI TOMAT (SOLANUM LYCOPERSICUM MILL) DI KABUPATEN JEMBER
Authors: Hadi Syamsul , Sita Bagus Rangga
Published: December 2018

The purpose of this study include: 1) measuring the level of farm productivity and comparing among the tomato business scale, and 2) to identify factors that influence the tomato farm production in Jember. This research has been conducted in Jember, covering five District of samples, namely: Ledokombo, Sumberjambe, Ajung, Panti and Umbulsari. The data used are primary data and secondary data. Primary data were obtained from interviews with tomato farmers are guided by a list of questions that had been developed previously. While the secondary data obtained from the literature and agencies associated with this research. Analysis of the data used include quantitative descriptive analysis and regression naturally assuming that the relationship between the independent variables (Xi) and dependent variable (Y) is a Cobb-Douglas production function. The final conclusion is that: 1) The average productivity of farming tomatoes in Jember district, which consists of land productivity amounted to 153.662 ku / ha, labor productivity of 4.906 Kg / JKP, and productivity costs by 0.00047 Kg / USD. Based strata land area, did not show any differences in labor productivity and costs and but on land productivity among business scale narrow and wide, showed a highly significant difference in the confidence level of 99%, and 2) the factors that affect significantly to namely the production of land, labor and seed, while the fertilizers, pesticides and pesticide effect no significant effect on farm production of tomatoes in Jember.
PKM Peningkatan Potensi Batik Melalui Perlindungan HKI Dan Penguatan Manajemen Pemasaran Berbasis TIK Di Desa Silowogo Kecamatan Bungatan Kabupaten Situbondo
Authors: Yulianto Irwan , Uraidy Ali
Published: December 2018

Tujuan dan target yang ingin dicapai dalam PKM ini adalah mendorong serta mendukung usaha batik di daerah Situbondo yang memiliki keinginan yang tinggi untuk mengembangkan usaha batik baik di kawasan lokal maupun internasional yang aman, nyaman dan berkelanjutan yang berpedoman pada kepastian hukum dengan memberikan pengetahuan serta pendampingan guna meningkatkan keterampilan dalam proses pendaftaran hak cipta motif batik serta pendampingan pemasaran batik khas Situbondo. Metode yang digunakan berupa pendampingan pendaftran hak atas hak cipta motif batik khas Situbondo pada Kementerian Hukum dan HAM RI dan peningkatan manajemen pemasaran berbasis teknologi infomasi. Hasil yang dicapai antara lain yaitu keluarnya bukti pendaftaran hak cipta motif batik dan nomor pencatatan pada Kementrian Hukum dan HAM RI.

Kata Kunci : Hak cipta, batik, pemasaran, TIK.
Zahlensysteme der Mathematik
Authors: Kuch Sven , Kuch Sven
Published: December 2018

Auch wenn es noch einige mehr, als von den 24 hier vorgestellten Zahlensystemen gibt, - die imaginären Zahlen werden wegen mangelndem Verständnis heute zu meisst vergessen. Dabei ist deren innere mathematische Logik eher simpel. Deren Tragweite wird jedoch erst bewusst, wenn auch die damalige Vorstellung von Hermann Grassmanns n-dimensionalen Raum mit hinzugezogen wird. Imaginäre Raumeinheiten (Raum-Aspekte) bilden sich aus i hoch 4 Entitäten. Sie sind aber eben auch n-fach beschreibbar.
Die Struktur der chemischen Elemente
Authors: Kuch  , Kuch Sven
Published: December 2018

Die Struktur der Elemente. Besonders interessant für diejenigen, die sich mit den Ausführungen von Peter Plichta beschäftigt haben.
TOE-Modell
Authors: Kuch  , Kuch Sven
Published: December 2018

Auch wichtige Begriffe aus der Physik lassen sich den drei mathematischen Zahlenbereichen zuordnen. Wichtig ist hier der Einbezug der Quantengrenze. So lassen sich kleinste physikalische (und philosophische Einheiten) erstmals mathematisch assoziiert deutlich voneinander unterscheiden.
Die Bedeutung der imaginären Zahlen
Authors: Kuch  , Kuch Sven
Published: December 2018

Bislang als unrelevant eingeschätzt, - die qualitative Bedeutung der wichtigsten imaginären Zahlen. Deren Verständnis erweist sich als wichtiger Schlüssel, weil reelle Zahlen(qualitäten) anders zu interpretieren sind, als die hier vorgestellten imaginären Zahlen.
Obesitas: Pentingkah Memperhatikan Konsumsi Makanan di Akhir Pekan?
Authors: Kandinasti Syafira , Farapti Farapti
Published: December 2018

Background: The prevalence of obesity in all age groups has increased in some countries. Epidemiological studies indicated that the intake of energy and macronutrient over the weekend were increasing rather than on weekdays and contributed to the incidence of obesity. Objectives: The aim of this literature review is to analyze the different between intake of energy and macronutrients in weekdays compared to weekend and how it contributes to obesity . Methode: The literature review method used international journal article that was searched using the electronic database such as Medline NCBI (National Center for Biotechnology Information), embases, and google scholar.Result: The results showed that energy and macronutrient intake were increasing over the weekend than on weekdays. Consumption of unhealthy food on weekend such as foods and beverages with high sugar, high fat and alcohol increase the energy and play a role in the incidence of obesity. Conclusion: The health promotion concerning food intake on weekdays and weekend both in terms of quantity and quality is needed for obesity prevention.ABSTRAKLatar belakang: Prevalensi obesitas pada semua kelompok umur meningkat di hampir seluruh negara di dunia. Studi epidemiologi menunjukkan bahwa asupan energi dan zat gizi makro diakhir pekan meningkat dibandingkan hari biasa dan berperan pada kejadian obesitas.Tujuan: Tujuan dari literatur review ini adalah untuk menganalisis perbedaan asupan energi dan zat gizi makro diakhir pekan dibandingkan hari biasa dan bagaimana kontribusinya terhadap obesitas.Metode: Metode yang digunakan adalah metode penelusuran artikel  jurnal internasional yang ditelusuri menggunakan electronic database seperti medline NCBI (National Center for Biotechnology Information), embase, dan penelusuran dengan google schoolar.Hasil: Hasil telaah beberapa artikel menunjukan bahwa rata-rata asupan energi dan zat gizi makro mengalami peningkatan saat akhir pekan dibandingkan hari biasa. Konsumsi unhealthy food di akhir pekan seperti makanan dan minuman dengan kandungan tinggi gula, tinggi lemak, dan alkohol tampaknya menyebabkan peningkatan kalori dan berperan pada insiden obesitas.Kesimpulan: Diperlukan upaya pencegahan obesitas melalui promosi kesehatan masyarakat dengan memperhatikan asupan makanan saat hari libur baik dari segi kuantitas maupun kualitasnya.
Risk Assessment Ambient Air Quality (NO2 And SO2) and The Respiratory Disorders to Communities in the Kalianak Area of Surabaya
Authors: Masito Ani
Published: December 2018

Air pollutant gas that has a real impact on the respiratory system is NO2 and SO2. Kalianak Surabaya is one of the areas with high traffic density more than 1.500 vehicles every hour. The most affected communities are the people living along the Kalianak highway. This study aims to analyze the ambient air (NO2 and SO2) in Kalianak and the risk of respiratory distress in the surrounding community. This research is descriptive, with cross sectional approach. The sample of this research is 19 respondents was done by purposive sampling. Spirometers were used to determine the status of lung function. The variables studied were age, length of stay, smoking habit, and Body Mass Index. The collected data were analized with environmental health risk assessment. Environmental Health Risk Assessment showed that the people living in this area unsafe with concentration of NO2 as measured. The results showed that more than 50% of respondents have respiratory problems (68,4%) with the mayority of respondenst aged 46-55 years old (31,6%), leght of stay >20 years (47,4%), non smokers (47,4%), and normal Body Mass Index (36,8%). The conclusion from this research is ambient air quality (NO2 and SO2) in Kalianak Surabaya still meet the quality standard, and the RQ>1 for NO2, it means that the risk level is unsafe. It is recommended that there is an efforts to control air pollution caused by motor vehicle activity by planting planst that can reduce ambient air pollutants.
Risk Factors that Affect The Incidence of Dengue Haemorrhagic Fever in The Work Area of Puskesmas Pare
Authors: Widyatama Ericha Fitria
Published: December 2018

Pare Community Health Center or Puskesmas is one of Puskesmas in Kecamatan Pare which has the highest number of Dengue Hemorrhagic Fever incidence that is 64 incidence in 2016. The purpose of this study is to analyze the risk factors that affect the incidence of Dengue Hemorrhagic Fever in the work area of Puskesmas Pare. It was an observational study with cross sectional approach. Interviews and environmental observations were conducted on 100 respondents, randomly, in the working area of Puskesmas Pare, Desa Tulungrejo. The independent variables of the research were larvae existence , maya index status and 4M Plus behavior, with the dependent variable of the research was Dengue Hemorrhagic Fever incidence in 2016.This data was analized by binary logistic regression test.The results of this study indicate that risk factors that affect the incidence of Dengue Hemorrhagic Fever is the action of 4M Plus (p = 0,017).Therefore, the 4M Plus actions should be further improved independently and promoted evenly to the community in order to suppress the incidence of Dengue Hemorrhagic Fever.
Epidemiological Situation and Prognostication of the West Nile Fever Morbidity in the Territory of the Russian Federation
Authors: L’vov D. K. , Savchenko S. T. , Alekseev V. V. , Lipnitsky A. V. , Pashanina T. P.
Published: December 2018

The questions of spreading of West Nile fever in the territory of theRussian Federationand abroad are considered. The information on the main carriers and vectors of this infection and their interaction with virus population is presented. The tendency of spreading of the West Nile fever virus in theRussian Federationand the possibilities of its maintenance during the inter-epidemic period are shown. Recommendations are given on the organization of serologic monitoring ofWest Nilefever in natural and anthropurgic biocenoses.
Forecasting of morbidity of the enteric infections with water-borne transmission for the population of Saratov
Authors: Narkaitis L. I. , Danilov A. N. , Yashechkin Yu. I. , Kouklev E. V. , Kozhanova O. I. , Minaeva M. E. , Yeliseev Yu. Yu.
Published: December 2018

The system for forecasting of the incidence of the enteric infections with water-borne transmission for Saratov city was created. It is based on analytical methods of estimation of sanitary indicators of water quality in the central water supply.
Dynamics of Leptospiroses Morbidity in the Federal Districts of the Russian Federation
Authors: Toporkov V. P. , Velichko L. N.
Published: December 2018

A retrospective epidemiologic analysis of leptospiroses for the period from 2001 to 2006 revealed the most intensive morbidity in the Southern, Central and Volga Districts with their mean intensive indices being 1.7+0.3, 1.0+0.3, 0.8+0.4, their respective portions of the total sickness rate for Russia constituting 31.5, 27.6, 25.5 percent respectively. A tendency to decreased leptospiroses morbidity was observed in all seven federal districts and in the Russian Federation as a whole.
Russian Anti-Plague Research Institute “Mocrobe” (to the 90-th anniversary)
Authors: Editorial Article
Published: December 2018

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Medicaid Payer Status Is Associated with Increased 90-Day Morbidity and Resource Utilization Following Primary Total Hip Arthroplasty
Authors: Shau David , Shenvi Neeta , Easley Kirk , Smith Melissa , Bradbury Thomas , Guild George
Published: December 2018

Background:

Medicaid payer status has been shown to affect risk-adjusted outcomes and resource utilization across multiple medical specialties. The purpose of this study was to examine resource utilization via readmission rates, length of stay, and total cost specific to Medicaid payer status following primary total hip arthroplasty.

Methods:

The Nationwide Readmissions Database (NRD) was utilized to identify patients who underwent total hip arthroplasty in 2013 as well as corresponding “Medicaid” or “non-Medicaid” payer status. Demographic data, 14 individual comorbidities, readmission rates, length of stay, and direct cost were evaluated. A propensity-score-based matching model was utilized to control for baseline confounding variables between payer groups. Following propensity-score matching, the chi-square test was used to compare readmission rates between the 2 payer groups. The relative risk (RR) with 95% confidence interval (CI) was estimated to quantify readmission risk. Length of stay and total cost comparisons were evaluated using the Wilcoxon signed-rank test.

Results:

A total of 5,311 Medicaid and 144,814 non-Medicaid patients managed with total hip arthroplasty were identified from the 2013 NRD. A propensity score was estimated for each patient on the basis of the available baseline demographics, and 5,311 non-Medicaid patients were matched by propensity score to the 5,311 Medicaid patients. Medicaid versus non-Medicaid payer status yielded significant differences in overall readmission rates of 28.8% versus 21.0% (p < 0.001; RR = 1.37 [95% CI, 1.28 to 1.46]) and 90-day hip-specific readmission rates of 2.5% versus 1.8% (p = 0.01; RR = 1.38 [95% CI, 1.07 to 1.78]). Mean length of stay was greater in the Medicaid group than in the non-Medicaid group at 4.5 versus 3.3 days (p < 0.0001), as was the mean total cost at $71,110 versus $65,309 (p < 0.0001).

Conclusions:

This study demonstrates that Medicaid payer status is independently associated with increased resource utilization, including readmission rates, length of stay, and total cost following primary total hip arthroplasty. Providers may have a disincentive to treat patient populations who require increased resource utilization following surgery. Risk adjustment models accounting for Medicaid payer status are necessary to avoid decreased access to care for this patient population and to avoid financial penalty for physicians and hospitals alike.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Clinical Use of Opportunistic Computed Tomography Screening for Osteoporosis
Authors: Anderson Paul A. , Polly David W. , Binkley Neil C. , Pickhardt Perry J.
Published: December 2018

* Opportunistic use of computed tomography (CT) allows assessment of bone status from studies obtained for other purposes.

* The linear x-ray attenuation coefficient is known as the Hounsfield unit (HU).

* HU values can be determined for any region of interest using standard imaging software.

* HU values strongly correlate with bone mineral density.

* A threshold of <135 HU for the L1 vertebral body indicates a risk for osteoporosis.

* HU values have been used to assess other bone regions, including the wrist, proximal and distal end of the femur, and sacrum, to predict future fracture and the presence of osteoporosis.

* Opportunistic use of CT aids in the identification of patients who are not otherwise suspected to be at risk for osteoporosis.
O diálogo mudo dos corpos: representações de casais heterossexuais acerca da sexualidade e seus efeitos no contexto organizacional
Authors: Fontainhas Iolanda Maciel
Published: December 2018

Nas sociedades contemporâneas, a sexualidadeassume-se como uma dimensão da vida quotidiana importante  para a realização pessoal e manutenção do edifício conjugal. No entanto, esta tendência não traduz, necessariamente, que os casais expressem da mesma forma os afetos, desejos, condutas sexuais e usos corporais. Adotando uma perspetiva construtivista da sexualidade, o presente estudo procurou conhecer quais as representações acerca da sexualidade e das práticas sexuais que estão na base da vida em comum. A partir de uma abordagem metodológica qualitativa e de cariz iminentemente indutivo, construtivista e interpretativo, a entrevista semidiretiva foi aplicada junto de casais heterossexuais com o intuito de perceber qual o argumento mobilizado para justificar a adoção (ou não) de diferentes práticas sexuais. Entre os principais resultados destacamos a existência de uma visão hedonista e erótica da sexualidade, que a reconhece como um meio de se obter prazer, ultrapassando os aspetos ligados à procriação. As representações acerca da sexualidade orientam-nos para uma nova configuração dos modos de viver o sexo conjugal: assiste-se a um alargamento de práticas sexuais, privilegiam-se os valores da reciprocidade, do envolvimento e do prazer mútuo e nos discursos (e práticas) inserem-se ideais mais igualitários entre os géneros. Apesar disto, parece que determinadas práticas sexuais continuam a ser alvo de uma filtragem de atitudes e comportamentos que são regulados pela situação conjugal, por valores morais e religiosos e pelas representações sociais e sexuais de género que se encontram enraizadas na sociedade portuguesa.
Pattern and Sweep Visual Evoked Potential in the Objective Determination of Visual Acuity
Authors: Hamurcu Mualla
Published: December 2018

Background: To investigate the effects of pattern visual evoked potential (pVEP) and sweep visual evoked potential (sVEP) on the accurate visual acuity (VA) measurement in adults.
Methods: Medical files of 282 eyes of 141 patients who underwent VA measurement in our electrophysiology laboratory and did not undergo simulation were retrospectively analyzed. The VA was measured using the Snellen chart. Only those with a VA of higher than 1/10 on the Snellen chart were included in the study. The VA was assessed and reported by the pVEP (VA-pVEP) and sVEP test (VA-sVEP). The correlation analysis was performed using the Pearson correlation analysis.
Results: Of 141 patients, 92 were males and 49 were females with a mean age of 37.7±18.4 years. There was a strong positive correlation between the VA values obtained from both eyes by pVEP (VA-pVEP) (r=0.858, p<0.001). There was a weak positive correlation (r=0.267, p<0.001) between the VA measured by the Snellen chart and the VA measured by the sVEP (VA-sVEP). A weak positive correlation was found for the VA-pVEP and VA-sVEP (r=0.313, p<0.001).
Conclusions: For the measurement of the degree of the VA, it seems reasonable to use pVEP initially, while sVEP should be used in cases with short attention span and those who are non-cooperative and in infants.
Expert panel process to optimise the design of a randomised controlled trial in chronic rhinosinusitis (the MACRO programme).
Authors: Vennik Jane , Blackshaw Helen , Philpott Carl , Thomas Mike , Eyles Caroline , Carpenter James , Clarke Caroline S , Morris Steve , Schilder Anne , Lund Valerie , Little Paul , Durham Stephen , Denaxas Spiros , Williamson Elizabeth , Beard David , Cook Jonathan , Conte Steffi Le , Airey Kim , Boardman Jim , Hopkins Claire
Published: December 2018

Background
MACRO (Defining best Management for Adults with Chronic RhinOsinusitis) is an NIHR-funded programme of work designed to establish best practice for adults with chronic rhinosinusitis (CRS). The 7-year programme comprises three consecutive workstreams, designed to explore NHS care pathways through analysis of primary and secondary data sources, and to undertake a randomised controlled trial to evaluate a longer-term course of macrolide antibiotics and endoscopic sinus surgery for patients with CRS. A number of outstanding elements still required clarification at the funding stage. This paper reports an expert panel review process designed to agree and finalise the MACRO trial design, ensuring relevance to patients and clinicians whilst maximising trial recruitment and retention.
Methods
An expert panel consisting of the MACRO programme management group, independent advisors, and patient contributors, was convened to review current evidence and the mixed method data collected as part of the programme, and reach agreement on MACRO trial design. Specifically, agreement was sought for selection of macrolide antibiotic, use of oral steroids, inclusion of CRS phenotypes (with/without nasal polyps), and overall trial design.
Results
A 12-week course of clarithromycin was agreed as the main trial comparator, due to its increasing use as a first and second line treatment for patients with CRS, and the perceived need to establish its role in CRS management. Oral steroids will be used as a rescue medication during the trial, rather than routinely either pre or post trial randomisation, to limit any potential effects on surgical outcomes and better reflect current UK prescribing habits. Both CRS phenotypes will be included in a single trial to ensure the MACRO trial is both pragmatic and generalisable to primary care. A modified 3-arm trial design was agreed after intense discussions and further exploratory work. Inclusion criteria were amended to ensure that patients recruited would be considered eligible for the treatment offered in the trial, due to having already received appropriate medical therapy as deemed suitable by their ENT surgeon. A proposed 6-week run-in period prior to randomisation was removed due to the new criteria prior to randomisation.
Conclusion
The expert panel review process resulted in agreement on key elements and an optimal design for the MACRO trial, considered most likely to be successful in terms of both recruitment potential and ability to establish best management of patients with CRS.
Experience of outpatient treatment of trophic foot ulcers complicating the course of diabetes
Authors: Burleva E. P. , Babushkina Yu. V.
Published: December 2018

The work was aimed at analysing the annual results of outpatient observation of patients with trophic ulcers (TU) on the background of diabetes mellitus while applying modern principles of general and differentiated local treatment in the Diabetic Foot Room (DFR) environment. The authors carried out a retrospective analysis in a cohort of patients with diabetic foot syndrome (DFS), who visited a practitioner to receive advice and treatment in the DFR in 2015–2017 (n = 570). Of which, only 308 people have been treated on an outpatient basis. Neuropathic form (n = 194): diabetic osteoarthropathy (DOAP) (A0) = 63, DOAP + TU = 34; TUs without DOAP = 131 (AI 105, BI 26). Neuroischemic form (n = 114), all had TUs (CI 107, D I 7). The patients received glucose-lowering therapy correction, feet relief and differentiated local effects on TUs in accordance with the wound process stages. All options of modern wound dressing were used for indications. As a result, out of 83 patients with neuropathic DFS form, who were regularly observed in DPT, 65 (78.3%) patients achieved healing within 1 year. Of 103 patients with the neuroischemic form regularly observed in DFR, 76 (73.8%) patients achieved epithelialization, 19 patients (18.4%) reported unhealed TUs, 3.9 and 3,9% of patients had small and high amputations, respectively. 96.1% of patients achieved preservation of the supporting limb. Differentiated treatment and dynamic observation in the DFR environment made it possible to reduce the number of high limb amputations in patients with diabetic TUs within 1 year of observation to the minimum.
“Quem não deve, não teme(r)”
Authors: Amorim Marcelo Da Silva , Barbosa Ricardo Alexandre Peixoto
Published: December 2018

Neste artigo, desenvolvemos pesquisa e reflexão quanto ao emprego do détournement “Quem não deve, não teme(r)”, objetivando discernir as formações discursivas em que se inserem seus locutores e enunciadores. Adotando uma metodologia qualiquantitativa, debruçamo-nos sobre um corpus constituído por duas crônicas: “‘Quem não deve não teme’ é uma frase fascistóide”, de Reinaldo Azevedo, e “Quem não deve, não Temer”, de Agamenon Mendes Pedreira. Como fundamentação teórica, seguimos referenciais da Análise de Discurso de linha francesa, dando especial destaque a autores como Maingueneau (1997; 2004; 2008); Charaudeau e Maingueneau (2016); e Ducrot (1987). Dentre os resultados obtidos por meio de nossa pesquisa, apontamos a distinção das relações interdiscursivas que permeiam tanto o enunciado proverbial quanto o détournement analisados, bem como o discernimento de movimentos discursivos e de estratégias argumentativas a estes atrelados.
Research of operational dependability of automotive engines
Authors: Bazhenov Yu. V. , Bazhenov M. Yu.
Published: December 2018

The problem of increasing the dependability of the engine, which is the most complex and expensive unit of an automotive vehicle, cannot be solved without objective and reliable information on the failures and malfunctions of its components, their causes, actual life, as well as the factors affecting such indicators in real operational conditions. Manufacturing factories do not always have such information, hence design deficiency failures associated with design and development flaws are among the most common causes of loss of engine operability.

The aim of this paper is to study the engine operational dependability using the results of their maintenance and repair.

The methods are based on operational tests of engines that yield the most complete and objective information on their dependability, as they were conducted in typical operational conditions of automobile operating companies in the course of vehicle maintenance and repair. The results of the studies processed with the standard Statistica 6.0 are represented in the form the statistical evaluations of the dependability of primary structural engine components (times to failure, changes in the probability of nofailure depending on the travelled distance). The analysis of the obtained information allows estimating the level of actual dependability of the engine, identifying design flaws, developing specific measures aiming to increase operational dependability. Information obtained during such tests is useful not only to the engine manufacturers, but to the operators as well, as it enables a scientific substantiation of the norms of operability. For the purpose of identification and localization in the process of maintenance and repair of specific engine malfunctions, the paper substantiates a set of diagnostic parameters and their standard values.

Conclusions. The research allowed elaborating a set of diagnostic parameters for evaluation of the technical condition of primary engine systems (cylinder-piston group, crank and gas distributing mechanisms) that define and limit its dependability. The application of the findings in the automobile maintenance and repair processes enables a significant improvement of the engines’ operational dependability and reduction of the costs of ensuring their operability.
Professor Paul Singer e a economia solidária
Authors: Souza André Ricardo de
Published: December 2018

O professor Paul Singer foi um dos principais intelectuais brasileiros, com produção científica amplamente reconhecida, trajetória de vida, da infância à senioridade, marcada por corajosa coerência em importantes processos de construção institucional, militância política e gestão pública. Este artigo aborda especificamente sua contribuição na concepção teórica e construção do universo da economia solidária, desde suas ações na Universidade de São Paulo até a saída da Secretaria Nacional de Economia Solidária. Aspectos de sua personalidade educativa, apontados a partir de convivência pessoal, são destacados em seu grande legado.
Cyclin-Dependent Kinase 2 in Cellular Senescence and Cancer. A Structural and Functional Review
Authors: Volkart Priscylla Andrade , Bitencourt-Ferreira Gabriela , Souto André Arigony , de Azevedo Walter Filgueira
Published: December 2018

Background: Cyclin-dependent kinase 2 (CDK2) has been studied due to its role in the
cell-cycle progression. The elucidation of the CDK2 structure paved the way to investigate the molecular
basis for inhibition of this enzyme, with the coordinated efforts combining crystallography with
functional studies.

Objective: Our goal here is to review recent functional and structural studies directed to understanding
the role of CDK2 in cancer and senescence.

Methods: There are over four hundreds of crystallographic structures available for CDK2, many of
them with binding affinity information. We use this abundance of data to analyze the essential features
responsible for the inhibition of CDK2 and its function in cancer and senescence.

Results: The structural and affinity data available CDK2 makes it possible to have a clear view of the
vital CDK2 residues involved in molecular recognition. A detailed description of the structural basis
for ligand binding is of pivotal importance in the design of CDK2 inhibitors. Our analysis shows the
relevance of the residues Leu 83 and Asp 86 for binding affinity. The recent findings revealing the
participation of CDK2 inhibition in senescence open the possibility to explore the richness of structural
and affinity data for a new era in the development of CDK2 inhibitors, targeting cellular senescence.

Conclusion: Here, we analyzed structural information for CDK2 in combination with inhibitors and
mapped the molecular aspects behind the strongest CDK2 inhibitors for which structures and ligandbinding
affinity data were available. From this analysis, we identified the significant intermolecular
interactions responsible for binding affinity. This knowledge may guide the future development of
CDK2 inhibitors targeting cancer and cellular senescence.
Synthesis and Anti Lung Cancer Activity of 3-Arylspiro[oxirane-2,3'- thiochroman]-4'-one Derivatives
Authors: Pandya Dhananjay , Naliapara Yogesh
Published: December 2018

A series of 3-arylspiro[oxirane-2,3'-thiochroman]-4'-one derivatives were synthesized and
characterized by spectroscopy like 1H NMR, 13C NMR, mass spectrometry and elemental analysis.
They were evaluated for their anti-lung cancer activity on human lung cancer cell line A-549 in
DMSO. Compounds under study were found to be potent anti-lung cancer agents with GI50 values less
than 10 with respect to positive control adriamycin.
Unraveling the Mechanism of Tricyclic Bis-spiroketal Formation from Diyne Diol by DFT Study
Authors: Sharma Kamlesh
Published: December 2018

The mechanism of addition of nucleophiles to the π-acid complexed alkynes has been studied
successfully by the assessment of energy of intermediates and activation parameters. To elucidate
the origin of stereoselectivity and predict the reaction pathways, the geometry optimizations of reactants,
products, intermediates and transition states, were calculated by using density functional theory
(DFT) at the B3LYP/6-31+G(d) method. The reaction mechanism of hydration of alkynes in the
catalyzed synthesis of bis-spiroketal by DFT calculations is explored. The pyranyl enol ether was
formed regioselectively by the first ring closure. Further, bis-enol ether was formed by second 6-exodig
addition. Then, dehydration, followed by dehydrative ring closure finally gave bis-spiroketal product.
It is concluded that one of the most feasible reaction pathways comprises pyranyl enol ether and
bis-enol ether formation as intermediates. The final cyclization step of product formation is endothermic.
In terms of stereochemistry, the trans-product is found to be energetically more stable than cisproduct
and hence supports the electivity of the reaction.
Tualang Honey and its Methanolic Fraction Improve LPS-induced Learning and Memory Impairment in Male Rats: Comparison with Memantine
Authors: Yaacob Wan M.H.W. , Long Idris , Zakaria Rahimah , Othman Zahiruddin
Published: December 2018

Background:

Tualang honey (TH) has been shown to exert beneficial effects on learning and
memory function in various animal models. However, its learning and memory effects in lipopolysaccharide
(LPS) rat model have not been elucidated.

Objective:

The present study aimed to investigate the cognitive-enhancing effects of TH and its methanolic
fraction in comparison to the clinically approved N-methyl-D-aspartate (NMDA) receptor
antagonist (memantine) using LPS rat model.

Methods:

A total of ninety male Sprague Dawley rats were divided into 5 groups: (i) control, (ii) untreated
LPS (iii) LPS treated with 200 mg/kg TH, (iv) LPS treated with 150 mg/kg methanol fraction of TH
(MTH) and (v) LPS treated with 10 mg/kg memantine. All treatments were administered intraperitoneally
once daily for 14 days. Morris water maze (MWM) and novel object recognition (NOR) tests were
performed to assess spatial and recognition memory function.

Results:

The present study confirmed that LPS significantly impairs spatial and recognition memory and
alone treatment with TH or MTH improved spatial and recognition memory comparable to memantine.

Conclusion:

Both TH and its methanolic fraction improved spatial and recognition memory of LPS rat
model comparable to memantine. Thus, TH and its methanolic fraction have potential preventivetherapeutic
effects for neurodegenerative diseases involving neuroinflammation.