bluuebunny/crossref_metadata_2025 huggingface dataset:
Kepemimpinan Pendidikan
Authors: Fitri Eka
Published: May 2020

Leadership is a complex and unique phenomenon of social interaction, anyone will show leadership behavior when interacting in a format that influences others. Even in personal capacity, in the human body there is capacity or potential as a controller, which essentially facilitates a person to be able to lead himself. Leadership is often given the meaning of degree of influence, while the leader is the person who has the most potential to influence. Leaders who cannot actualize their influence do not have the character of true leadership. Then we must know how educational leadership is so the purpose of this article is to dig deeper into leadership and complete the task. Articles are made with techniques for gathering resources such as reading material and books on leadership.So that we can draw the conclusion that educational leadership as "one ability and process of influencing, guiding, coordinating and mobilizing other people who are related to the development of the science of education and the implementation of education and teaching, so that the activities carried out can be more efficient and effective in achieving educational and teaching goals
Applying the Measurement Model of Derivatives to Evaluate and Refine Measurement Scales in Longitudinal Education Data Using the ECLS-K
Authors: Husmann Kyle , Brick Timothy R. , DiPerna James C.
Published: May 2020

The Measurement Model of Derivatives (MMOD; Estabrook, 2015) provides the opportunity to evaluate and refine measurement scales used in longitudinal education data to clarify their theoretical distinctions and relationship to academic achievement. We demonstrate this using three teacher-rated scales of child self-regulatory behavior obtained from the Early Childhood Longitudinal Study Kindergarten Class of 2010-11 (ECLS-K:2011; Tourangeau et al. 2019). Theoretical measurement structures are compared to data-driven structures on a holdout sample, then compared in their ability to predict academic achievement on a validation sample to externally validate their utility. We discuss theoretical implications for self-regulation, as well as the MMOD’s applicability to other educational data sets.
Correction of medial prefrontal cortex and adrenal gland left/right imbalance by deep brain stimulation for depression in rats
Authors: Sakaguchi Yukitoshi
Published: May 2020

Hemispheric brain asymmetries are related to stress coping in both humans and rodents, and imbalanced neural activity between the left and right medial prefrontal cortexes (mPFCs) is observed in depression disorders. Brain stimulation of the PFC is effective to cure depression symptoms. We therefore hypothesized that the imbalanced activity of the mPFCs as well as depression-like behaviors can be induced by chronic stress in rats, and that deep brain stimulation (DBS) can treat such behavior by correcting the asymmetrical activity of the brain regions. Our results indeed show that chronic stress exposure by social isolation (SI) causes depression-like behavior and left/right mPFC activity changes. SI suppressed the activity of both the prelimbic and the infralimbic cortex; however, the extent of the suppression in these regions was oppositely asymmetric. Two weeks of DBS recovered the depression-like behavior and corrected the imbalanced brain activity. In addition, original weight differences between the left and right adrenal glands (AGs) were decreased by SI and recovered by DBS. The integrated index obtained from the mPFCs and AGs asymmetry scores could be useful for estimating the degree of depression. In conclusion, DBS can recover depression-like behavior accompanied by correcting imbalances in both the mPFCs and the AGs.
Multi-sensory Structured Reading Instruction for Spanish-speaking First Grade Students in Buenos Aires Public Schools
Authors: Braze David , Salvarezza Florencia , Pugh Kenneth R.
Published: May 2020

A multi-sensory structured language reading program was deployed in six first grade public school classrooms (n=150 students) in Buenos Aires, Argentina. Six control rooms usedbusiness-as-usual, whole language, instruction (n=178 students). Control and treatment roomswere well-matched in initial status. Students’ abilities and progress were recorded 3 times over27 weeks using a test battery covering basic pre-reading and reading skills: phonological awareness, decoding, vocabulary, rapid automatized naming, and executive function. At the startof 1st grade, most students have no measurable capacity for decoding. Many struggle withphonological awareness and letter naming. Very high rates of absenteeism and school closures(similar in both groups) meant that planned treatment dosage was not achieved. However, atthe endpoint of the study, students in MSL classrooms show an advantage over those in control classrooms in sentence reading comprehension, but the groups remain at parity in othermeasured skills.
A Deterministic Gated Lognormal Response Time Model to Identify Examinees with Item Preknowledge
Authors: Kasli Murat , Zopluoglu Cengiz , Toton Sarah Linnea
Published: May 2020

Response time (RT) information has recently attracted a significant amount of attention in the literature as it may provide meaningful information about item preknowledge. In this study, a Deterministic Gated Lognormal Response Time (DG-LNRT) model is proposed to identify examinees with potential item preknowledge using RT information. The proposed model is applied to a real experimental dataset provided by Toton and Maynes (2019) in which item preknowledge was manipulated, and its performance is demonstrated. Then, the performance of the DG-LNRT model is investigated through a simulation study. The model is estimated using the Bayesian framework via Stan. The results indicate that the proposed model is viable and has the potential to be useful in detecting cheating by using response time differences between compromised and uncompromised items.
Understanding the impacts of video-guided activities on parent-child interaction
Authors: Kachergis George , Hembacher Emily , Cristiano Veronica , Zhang Vivian , Frank Michael C.
Published: May 2020

Early parenting practices play an important role in shaping children’s future outcomes. In particular, high-quality early interactions can facilitate language learning and school performance. The rise of phone-based parenting applications (“apps”) could deliver low-cost interventions on parenting style to a wide variety of populations, especially the parents of very young children, who are often difficult to reach in other ways. Yet little is known about the effects of communicating to parents through app-based interventions. In two studies (one preregistered), we showed parents short videos depicting age-appropriate parent-child activities from a parenting app. We found that after watching the video, parents spoke more and made more bids for joint attention, as compared with controls who watched no video (experiment 1) or a science video (experiment 2). These results suggest that activity videos can lead to positive changes in parent engagement, providing support for the use of such videos in parenting interventions.
Extrinsic factors underlying food valuation in the human brain
Authors: Motoki Kosuke , Suzuki Shinsuke
Published: May 2020

Subjective value for food rewards guide our dietary choices. There is growing evidence that value signals are constructed in the brain by integrating multiple types of information about flavour, taste, and nutritional attributes of the foods. However, much less is known about the influence of food-extrinsic factors such as labels, brands, prices, and packaging designs. In this mini review, we outline recent findings in decision neuroscience, consumer psychology, and food science with regard to the effect of extrinsic factors on food value computations in the human brain. To date, studies have demonstrated that, while the integrated value signal is encoded in the ventromedial prefrontal cortex, information on the extrinsic factors of the food is encoded in diverse brain regions previously implicated in a wide range of functions: cognitive control, memory, emotion and reward processing. We suggest that a comprehensive understanding of food valuation requires elucidation of the mechanisms behind integrating extrinsic factors in the brain to compute an overall subjective value signal.
Reduction of hippocampal new-born neurons survival by working memory training with delayed non-matching to sample task in rats
Authors: Sakaguchi Yukitoshi
Published: May 2020

Adult neurogenesis in the hippocampus is important for learning and memory, and the survival of new-born neurons is modulated by stress, exercise, learning, etc. It has been reported that survival of new-born neurons is also affected by working memory training (WMT). However, the behavioral task for WMT used in previous studies was the task with Morris water maze, in which effects of severe stress and exercise by forced swimming should be considered. Therefore, it is unclear whether WMT effect is due to working memory use alone or not. In the present study, we subjected rats to fourteen days of WMT using a delayed non-matching to sample task with reward in an operant chamber in which no severe stress and exercise were required. The results showed that the number of BrdU positive cells after WMT was decreased without any increase of the movement activity during the WMT and the plasma corticosterone level after WMT. In conclusion, this study suggests for the first time that WMT reduces the survival of hippocampal new-born neurons independently of stress and exercise.
RANCANGAN PELAKSANAAN LAYANAN KONSELING INDIVIDU BIDANG AKADEMIK UNTUK MENGATASI PROKRASTINASI AKADEMIK DENGAN PENDEKATAN COGNITIVE BEHAVIORAL THERAPY
Authors: Lewoleba Magdalena Palang
Published: May 2020

Prokrastinasi akademik menjadi satu masalah bidang akademik yang sering dialami siswa. Prokrastinasi akademik dapat membawa dampak sebagai penyebab atau akibat dari timbulnya masalah lain. Melalui pendekatan Cognitive Beharioral Therapy, konseling individu diberikan kepada konseli yang mengalami prokrastinasi akademik untuk mengatasi masalah yang dihadapinya sehingga dapat kembali produktif dalam mengerjakan setiap tugas akademik yang dimilikinya.
Nonsymbolic Estimation of Big and Small Ratios with Accurate and Noisy Feedback
Authors: Morton Nicola J. , Grice Matt , Kemp Simon , Grace Randolph C
Published: May 2020

The ratio of two magnitudes can take one of two values depending on the order theyare operated on: a ‘big’ ratio of the larger to smaller magnitude, or a ‘small’ ratio of thesmaller to larger. Although big and small ratio scales have different metric properties andcarry divergent predictions for perceptual comparison tasks, no psychophysical studies havedirectly compared them. Two experiments are reported in which subjects implicitly learned to compare pairs of brightnesses and line lengths by non-symbolic feedback based on the scaled big ratio, small ratio or difference of the magnitudes presented. Results of Experiment 1 showed all three operations were learned quickly and estimated with a high degree of accuracy that did not significantly differ across groups or between intensive and extensive modalities, though regressions on individual data suggested an overall predisposition towards differences. Experiment 2 tested whether subjects learned to estimate the operation trained or to associate stimulus pairs with correct responses. For each operation, Gaussian noise was added to the feedback that was constant for repetitions of each pair. For all subjects, coefficients for the added noise component were negative when entered in a regression model alongside the trained differences or ratios, and were statistically significant in 80% of individual cases. Thus, subjects learned to estimate the comparative operations and effectively ignored or suppressed the added noise. These results suggest the perceptual system is highly flexible in its capacity for non-symbolic computation, which may reflect a deeper connection between perceptual structure and mathematics.
The mental health impact of non-pharmacological interventions aimed at impeding viral transmission during the COVID-19 pandemic in a general adult population and the factors associated with adherence to these mitigation strategies
Authors: Ebrahimi Omid V. , Hoffart Asle , Johnson Sverre Urnes
Published: May 2020

This epidemiological investigation assesses the prevalence of depression and anxiety symptoms during the COVID-19 pandemic. A total of 10,061 adults participated in the study. Symptoms of depression and anxiety were two to three times higher compared to pre-pandemic samples. Those who predominantly socially distanced themselves revealed substantially higher symptoms than their counterparts. Females, ethnic and sexual orientation minorities, younger adults, unemployed individuals, and those with a psychiatric diagnosis reported higher prevalence of psychological symptoms. Worry about prolonged duration of physical distancing protocols and frustration of autonomy was associated with elevation in symptoms of depression and anxiety. Increased competence to deal with the crisis was associated with less adverse symptoms. Physical exercise, experiencing nature, and distraction with activities were associated with less depressive symptoms, but not anxiety. The extent of information access about the pandemic was associated with reduced anxiety symptoms. Furthermore, adherence to mitigation protocols was investigated. Younger adults and males reported lowest adherence. Altruistic attitudes, in addition to mandatory as opposed to voluntary adherence was associated with higher adherence. Worrying about significant others’ health was associated with higher, while worry about duration of pandemic protocols was associated with lower adherence rates.
Visual working memory items drift apart due to active, not passive, maintenance
Authors: Scotti Paul S. , Hong Yoolim , Leber Andrew B. , Golomb Julie
Published: May 2020

How are humans capable of maintaining detailed representations of visual items in memory? When required to make fine discriminations, we sometimes implicitly differentiate memory representations away from each other to reduce inter-item confusion. However, this separation of representations can inadvertently lead memories to be recalled as biased away from other memory items, a phenomenon termed repulsion bias. Using a non-retinotopically specific working memory paradigm, we found stronger repulsion bias with longer working memory delays, but only when items were actively maintained. These results suggest that (1) repulsion bias can reflect a mnemonic phenomenon, distinct from perceptually driven observations of repulsion bias, and (2) mnemonic repulsion bias is ongoing during maintenance and dependent on attention to internally maintained memory items. These results support theories of working memory where items are represented interdependently and further reveals contexts where stronger attention to working memory items during maintenance increases repulsion bias between them.
Estimation of premorbid intelligence and executive cognitive functions with lexical reading tasks
Authors: Pluck Graham
Published: May 2020

Introduction: Estimation of premorbid function is essential to accurate assessment of cognitive impairments in clinical neuropsychology and behavioral neurology, and has numerous research applications. However, current methods are rudimentary and imperfect. We explored how lexical tasks can be best used to accurately and precisely estimate intelligence and executive functions.Methods: We studied lexical word pronunciation, lexical decision, and stem-completion naming in the estimation of cognitive ability, in samples of healthy adults (n = 143), and patients with cognitive impairment due to neurological illness (n =15). Cognitive assessments included intelligence (WAIS-IV), episodic memory, and eight tests of executive functioning, including Theory of Mind.Results: When examined at the group level, single word pronunciation was particularly robust in the presence of cognitive impairment in patients with dementia. However, as a case series, patients showed idiosyncratic patterns of preservation of lexical skills including on tests of pronunciation, lexical decision and stem-completion naming. All of these tasks were highly correlated with IQ scores in a non-clinical sample, suggesting that they could be used as estimators of premorbid intelligence. Simulated impairments in non-clinical controls suggested that the median score from the three different tasks had the highest correlation with, and provided the most accurate and precise estimates of, intelligence, and was also the least sensitive to impairment. Finally, we show that these methods also predict executive functions, in particular, strong correlations were found for proverb interpretation, phonemic/semantic alternating verbal fluency, and working memory span performance. Conclusions: Several lexical tasks are potentially useful in predication of pre-illness cognitive ability in patients with neurological or psychiatric illness. However, due to the heterogeneity of impairments between patients, estimation of premorbid levels could be improved by the use of the median estimated values from multiple tests. This could potentially improve diagnostic accuracy and quantification of neuropsychological impairments.
The Effect of Item Preknowledge on Response Time: Analysis of an Experimental Dataset Using the Multiple-Group Lognormal Response Time Model with a Gating Mechanism
Authors: Zopluoglu Cengiz , Kasli Murat , Toton Sarah Linnea
Published: May 2020

Response time information has recently attracted a significant amount of attention in the literature as it may provide meaningful information about item preknowledge. The methods that propose the use of response time information in identifying examinees with potential item preknowledge make an implicit assumption that the examinees with item preknowledge differ in their response time patterns compared to other examinees without item preknowledge. In this study, we analyzed the differences in response time of examinees with potential item preknowledge and examinees without item preknowledge based on a real experimental dataset provided by Toton and Maynes (2019). A multiple-group extension of van der Linden’s Lognormal Response Model with a gating mechanism was used to capture the differences in latent speed for control and experimental groups on disclosed and undisclosed items. The model used in the study and estimated parameters from this experimental dataset may inform future simulation studies in this area of research to simulate realistic datasets with item preknowledge behavior.
Cutting of the rat hippocampal commissure impairs short-term memory but not long-term memory
Authors: Sakaguchi Yukitoshi
Published: May 2020

Split-brain experiments, which have been actively conducted since the twentieth century, have provided a great deal of insight into inter-hemispheric functional laterality and interactions. However, how communication between the left and right hippocampi directly contributes to memory formation is still poorly understood. To address this issue, we cut the rat hippocampal commissure (HC) connecting the left and right hippocampi prior to behavioral tests, which comprised of four memory tasks. The result showed that cutting the HC impairs short-term memory but not long-term memory. This suggests that the HC contributes mainly to the appropriate formation of short-term memory by mediating communication between the left and right hippocampi. Our findings would help to elucidate dynamic memory formation in the hippocampus and contribute to the development of therapeutics for some neurological diseases which cause a reduction in the inter-hemispheric interaction.
Bayesian Preference Inference in Dialogue
Authors: Achimova Asya , Eisemann Ellas , Butz Martin V.
Published: May 2020

An utterance is referentially ambiguous if it has several potential referents. Observing how listeners make choices among those referents can reveal their hidden beliefs and preferences, besides giving hints at their responding processes. We asked subjects to observe how one of the objects is chosen following a possibly ambiguous utterance and to infer which preferences the listener may have had in mind when choosing the particular object. In order to adjust this interaction to a dialogue-like setting, we extended the traditional one-shot reference game to a round of 4-trial games. Moreover, we modeled the process within the Rational Speech Act framework, implementing iterative inference over multiple trials, where posteriors from previous trials carry over to the next trial as priors. The model predicts human inference behavior better than a baseline model as well as better than a non-iterative model. The results imply that, in principle, humans are able to compute Bayesian-like inferences in dialogue, learning about the beliefs and preferences of others in an iterative, cumulative manner.
Exploring the use of Social Media by Australian Small Business managers
Authors: Leong Benjamin
Published: May 2020

Small business managers face a constantly changing technological environment. Overthe past decade, Facebook achieved mainstream adoption and became the dominantsocial media platform used in Australia, with Twitter and LinkedIn also experiencingrapid uptake among Australian users. Today, there is a constant stream of new socialmedia services, and existing services continue to evolve. These have the potential to helpsmall business managers enhance traditional strengths and mitigate weaknesses,providing a competitive advantage to small, agile businesses that could quickly takeadvantage of opportunities that these new tools make available.
The Role of Democratic Governance and Indirect Expropriation in International Investment Treaty Violations
Authors: Ziegler Jeffrey , Carlson David
Published: May 2020

Democracies are thought to violate treaties less frequently than non-democracies, yet democracies violate bilateral investment treaties (BITs) just as often as non-democracies. Though democratic governments may intend to meet their international obligations, and though democratic institutions provide greater political constraints to encourage compliance, investment agreements may conflict with the goal of maintaining domestic public support. Specifically, we argue that credible elections create strong incentives for governments to side with domestic voters over foreign business interests, and to pass legislation that violates investment agreements. We use a data set of BIT violation complaints that better captures potential indirect expropriation to confirm prior findings that show a difference in violations by regime type. Since policies are not passed immediately and companies do not file arbitration complaints instantly when a potential violation occurs, democratic governments are only more likely to be sued as their time in office increases. The results suggest that the ability of voters to sanction leaders is an important mechanism that incentivizes governments to pass legislation that potentially violates investment treaties through indirect expropriation.
Property Crime during the COVID-19 Pandemic: A comparison of recorded offence rates and dynamic forecasts (ARIMA) for March 2020 in Queensland, Australia
Authors: Payne Jason Leslie , Morgan Anthony
Published: May 2020

At the time of writing, there was 3.4 million confirmed cases of COVID-19 and more than 300,000 deaths worldwide. Not since the Spanish Flu in 1918 has the world experienced such a widespread pandemic and this has motivated many countries across globe to take unprecedented actions in an effort to curb the spread and impact of the SARS-CoV-2 virus. Among these government and regulatory interventions includes stringent domestic and international travel restrictions as well as a raft of stay-at-home and social distancing regulations. The scale of these containment measures has left criminologists wondering what impact this will have on crime in both the short- and long-term. In this study, we examine officially recorded property crime rates for March, 2020, as reported for the state of Queensland, Australia. We use ARIMA modeling techniques to compute six-month-ahead forecasts of property damage, shop theft, other theft, burglary, fraud, and motor vehicle theft rates and then compare these forecasts (and their 95% confidence intervals) with the observed data for March 2020. We conclude that the observed rates of reported property offending across Queensland were significantly lower than expected for shop theft, other theft and credit-card fraud but statistically unchanged for property damage, burglary, and motor-vehicle theft.
Practice of “Defensive Medicine”
Authors: Mishra S.M.
Published: May 2020

No Abstract available.
Study of Correlation of Left Atrial Size and Atrial Fibrillation in Rheumatic Mitral Valve Disease
Authors: Shrestha Anil , Shrestha Richa
Published: May 2020

Aim: To study the correlation between Atrial Fibrillation (AF) and left atrial size in Rheumatic Mitral valve disease (RMVD).

Background: AF is the most common sustained cardiac arrhythmia which is associated with increased cardiovascular morbidity, mortality and preventable stroke. AF is common in rheumatic heart disease (RHD) particularly mitral stenosis (MS). LA dilatation is the predisposing factor for the development of AF in RMVD.

Methodology: This is a hospital based cross sectional descriptive study conducted in 52 patients who were diagnosed as RMVD clinically and echocardiographically in NGMCTH, Kohalpur between December 2018 to November 2019. Detailed history and complete clinical examination were performed. Standard 12 lead ECG and 2-D echocardiography were done. Left atrial size was measured and compared with patients in AF and with sinus rhythm.

Result: The age of patients ranged from 20-76 years with the mean age of 40.33 years. Out of 52 patients 30 were in AF and 23 in sinus rhythm. Among 30 patients in AF, 27 (90%) had LA size ≥ 4 cm with mean LA size of 4.6 cm whereas among 22 patients in sinus rhythm, 14 (63.64%) had LA Size <4 cm with a mean of 3.83 cm.

Conclusion: Left atrial size ≥ 4 cm is the predisposing factor for the development of AF in rheumatic mitral valve disease. Therefore, if patients in sinus rhythm who are at high risk of developing AF are identified, prophylactic anticoagulation and antiarrythmic drug might prevent AF induced embolism and exacerbation of symptoms in rheumatic mitral valve disease.
A Comparative Study of Interscalene Block Vs. Interscalene Block with Superficial Cervical Plexus Block for Clavicular Plating
Authors: Regmi Nabin Kumar , Pokhrel Kapil
Published: May 2020

Background: Regional anaesthesia for fixation of clavicle fracture is a new concept. Various techniques of regional anaesthesia are being tried to find the optimal type. Combined interscalene and superficial cervical plexus block is widely accepted.

Aim of Study: This study aims to compare the efficacy of interscalene block (ISB) with combined interscalene block and superficial cervical plexus block (ISB+ SCPB) for clavicular plating.

Material and Methods: This prospective, hospital based comparative study was conducted from March 2019 to October 2019, in the department of anaesthesiology, Nepalgunj Medical College. 60 ASA category I and II patients undergoing clavicular plating and belonging to age group 16-65 years were enrolled. Patients were divided into two groups: Group I: ISB (n=30), Group II: ISB+ SCPB (n=30). Blocks were given using landmark technique. Primary outcome measures were conversion to general anesthesia (GA), requirement of supplemental analgesia and patient satisfaction. Secondary outcome measures were sensory and motor block, duration of analgesia and complications. These outcome measures were compared between the groups.

Results: No patient required conversion to GA. The number of patient requiring supplemental analgesia was significantly higher in ISB group in comparison to ISB+ SCPB. Patient satisfaction was excellent in both groups. No statistically significant complications were seen in either group.

Conclusion: Interscalene block combined with Superficial Cervical Plexus Block (ISB + SCPB) has better efficacy than Interscalene block (ISB) alone for clavicular plating. Nevertheless, both techniques avoid GA and provide excellent patient satisfaction level.
Risk Factors in Patients with Intrauterine Fetal Death at Tertiary Referral Centre
Authors: Sinha Kavita , Pandey Subhash
Published: May 2020

Background: Among various community health indicators available for measurement of quality and impact of health services in developing countries, perinatal mortality accounts one of the top most single indicators even today. Documentation and evaluation of the etiology and the associated risk factors for stillbirth is required in order to decrease the fetal mortality rate and to devise plan in maternal health sector.

Objective: To find out common risk factors in patient and its association with intrauterine fetal death.

Methods: A hospital based cross-sectional study carried out in the Department of OBSGYN, Nepalgunj Medical College, Kohalpur from Jan 2018 to September 2019.Cases of multiple pregnancies, intrapartum death and fetal death diagnosed before 28th weeks of gestation were excluded. After exclusion, 65 cases of intrauterine fetal death were studied.

Results: Majority (78.4%) of the patients with IUFD belonged to the reproductive age group(20-35yrs) and (15.4%) belong to <19yrs (p=0.008) associated with illiteracy (84.6%). More than half (58.5%) had at least one ANC visit and were primigravida (17%) with preterm (63.07%). Hypertensive disorder was the commonest obstetric complication in these mothers (36.92%) followed by unexplained (26.15%), anaemia (18.46%), PROM (15.4%), APH (13.8%). Most of the babies were low birth weight (63.69%) and majority were males (63.1%).

Conclusion: Majority of the risk factors found in the present study were preventable. Stillbirth rate can be reduced by proper management of these risk factors during antenatal care and intrapartum care.
Outcome of Lateral Condyle Fracture of Humerus in Children Treated with Open Reduction and Internal Fixation
Authors: K.C. Dipendra , Mishra S.M. , Yogi Sushil , Shrestha Dinesh , Karki Prateek , Shrestha Sabin
Published: May 2020

Introduction: Lateral condyle fracture is one of the commonest injuries encountered in pediatric age group. There is no unanimity regarding the method of treatment, however closed reduction is not applicable to all cases and have failure rates making open reduction and internal fixation (ORIF) as the treatment of choice at least in displaced fractures. There are a number of options during surgical management of these fractures; Kirschner-wire (K-wire) is the most commonly used implant for fixation. The purpose of our study was to evaluate the results of lateral condyle fractures of humerus in children treated by ORIF by K-wires based on Hardacre criteria.

Materials: This prospective study was conducted in the department of orthopedics in Nepalgunj Medical College Teaching Hospital, Kohalpur from May 2016 to October 2018. All of the fractures in this study were treated by ORIF with unburied K-wires. It included 37 children of age group upto 14 years. Children were evaluated for age, sex, side of arm involved, mechanism of injury, type of fracture, presence of additional injuries, implant removal time, outcome and accompanying complications. K-wires were removed after clinico-radiological union of the fractures. Patients were evaluated using the Hardacre criteria in follow up till 6 months.

Result: In this study of 37 children, 28 (75.7%) were males and 9 (24.3%) were females. All of them were 14 years of age or less with mean age of 6.7 ± 0.316. Majority of fractures (67.6%) were observed between six to ten years of age. Left side was predominantly involved (62.2%). Milch type I fracture was found in 5 (13.5%) children while Milch type II fracture were observed in 32 (86.5%) children. The final outcome and functions were evaluated using Hardacre criteria in which 27 (73%) cases had excellent result and all cases had good result as per Hardacre criteria. The complications were 10 (27%) cases of lateral spur; eight (21.6%) cases of hypertrophied scar and four (10.8%) cases of pin track infection and 2 (5.4%) of cubitus varus.

Conclusion: The treatment of displaced lateral condyle fracture of humerus by open reduction and unburied K-wire fixation is safe, easy and cost effective procedure with good results. This modality of treatment provides good results among pediatric population without the need for second admission for implant removal.
Assessment of Liver Function Tests in Children with Typhoid Fever: A Hospital Based Study
Authors: Ahmad Shakil
Published: May 2020

Background: Typhoid fever is among the most endemic diseases in the tropics and which causes significant morbidity and mortality. It can lead to liver damage if not properly treated. Therefore, the liver function test assessment was conducted in children with typhoid fever. Our study aimed to evaluate the liver function test abnormalities in typhoid fever.

Material and methods: This was a prospective observational study conducted at the department of paediatrics, Nepalgunj Medical College and Teaching hospital, Nepalgunj for a period of one year August 2018-July 2019.In the present study total 60 children of Typhoid fever were included on the basis of inclusion and exclusion criteria. On admission a detailed history and complete physical examination was carried out. Routine investigations were also carried out. The diagnosis was confirmed by serum Widal test. Liver function tests were performed i.e. Serum glutamic oxaloacetic transaminase [SGOT] and serum glutamic pyruvic transaminase [SGPT] estimation.

Result: In the present study total children were 60 in which 43.33% were boys and 56.66% were girls. Fever was present in all the cases loss of appetite, cough, vomiting was present in majority of cases. On admission, SGOT and SGPT levels were found > 35 IU/L in 26 cases (43.33%) and 34 cases (56.66%) respectively. On discharge after 7 days of antibiotic, majority of patients had SGOT and SGPT levels < 35 IU/L.

Conclusion: Our study concluded that on admission of children SGOT and SGPT levels were found > 35 IU/L in 43.33% and 56.66% respectively. On discharge after 7 days of antibiotic, majority of patients had SGOT and SGPT levels < 35 IU/L.
Practice of “Defensive Medicine” Among Doctors at a Tertiary Care Hospital
Authors: Bhandari Binus , Khadka Dipendra , Saxena Prem , Mishra S.M.
Published: May 2020

Introduction: Defensive medicine is the short term coined for a defensive medical decision making.It means advising diagnostic tests, prescribing more drugs than required or avoids treating and operating high risk patients. These may not be the best options for the patient but the practice among doctors is currently adopted to avoid litigation. A situation aggravated by the promulgation of tough consumer laws and other criminal laws applicable to health care providers. This study was conducted to assess the frequency of defensive medicine practice among doctors at the teaching medical college hospital of NGMC.

Methods: A cross sectional study was conducted at Nepalgunj Medical College, Teaching Hospital, Kohalpur, a tertiary care center in between January to December 2018. A questionnaire was developed to assess the various aspects of defensive medicine practice. In this study, a total of 75 doctors participated.

Results: Practice of defensive medicine was common in age between 30-40 years. Fear of caring high risk patients (76%)), ordering un-necessary tests (56%)) followed by avoiding high risk procedures (46%) were common forms of defensive medicine practices observed in sampled doctors. Senior faculties were found practicing more defensive medicine than juniors (69.4% versus 30.6%) and more in surgical field as compared to non-surgical 61% vs. 39%.

Conclusion: Defensive medical practice in various ways is common among the doctors. This has produced a positive impact in the form of greater communications with the patients and awareness to have a good medical record keeping. However, the negative impacts on the doctors have been more in the form of prescribing more investigations, drugs, more referral and reluctance to accept high risk patients if there is choice.
Correlation of Serum Prolactin and Thyroid Hormone in Female Infertility
Authors: Banu Fahat
Published: May 2020

Background: Infertility is a growing problem with adverse medical, social and psychological consequences globally. Apart from several causes of infertility, hormonal imbalance especially thyroid dysfunction and hyperprolactinemia can lead to female infertility. Both these conditions are treatable so Proper management of hormonal imbalance can result in restoration of normal fertility.

Aims and objectives: Correlation of serum Prolactin and Thyroid hormone in female infertility.

Materials and methods: Descriptive hospital based study was conducted at Nepalgunj medical college and teaching hospital, Nepalgunj, Banke, Nepal. The data was collected from September 2018 to August 2019. Total 30 cases of females of primary and secondary infertility attending outpatient department of gynecology department of Nepalgunj medical college were included in the study. A detailed history and clinical evaluation was done along with estimation of serum Prolactin and Thyroid hormone profile.

Result: Hormonal status of subjects showed 15 i.e. 50% participants were thyroid whereas 11 (36.33%) were hypothyroid and 4 (13.33%) were hyperthyroid. Serum Prolactin was raised in 17 (57%) and normal in 13 (43%). Serum TSH and prolactin were found to be significantly positively correlated in female infertility (r=0.507, p =0.004).

Conclusion: There is a high incidence of hyperprolactinaemia and thyroid dysfunction in female infertility.
Perinatal Outcomes of Hypertensive Pregnancy: A Case Control Study
Authors: Acharya Niraj , Dhungana Diwas , Gupta Veena
Published: May 2020

Background: Hypertensive disorders of pregnancy (HDP) are one of the maternal diseases that cause the most detrimental effects to the mother and the fetus.

Objective: This study was conducted to compare the perinatal outcomes of neonates delivered by hypertensive mothers and normal mothers.

Methods: This comparative hospital based study was conducted in Nepalgunj Medical College Teaching Hospital, Kohalpur from December 2014 to December 2015. Fifty mothers fulfilling the inclusion criteria and their fetal outcome in form of still birth and newborn babies were taken for the study and 50 healthy mothers with normotensive pregnancies and their newborn babies or fetal outcome were taken as control. They were followed up till their hospital stay in NICU or postnatal ward and final outcomes were noted.

Results: The prevalence of HDP in our hospital was 2.16%. Among neonates, 27(54%) in case group and 9(18%) in control group were low birth weight which is statistically significant. It was found that 18(36%) neonates in case group and 7(14%) neonates in control group were IUGR(Intrauterine growth retardation). Seventeen (34%) neonates in case group were preterm as compared to 2(4%) neonates in control group (p value < 0.001).

Conclusion: Pregnancies complicated by hypertension were characterized by an increase in the rate of preterm delivery and low birth weight infants compared with normal pregnancies.
COVID-19: Cardiovascular perspective
Authors: Acharya Kiran Prasad , Poudel Pratima , Sherpa Kunjang , Adhikari Chandra Mani
Published: May 2020

Introduction: Recently the outbreak of COVID-19 has created a nuisance in the health care system throughout the world. There are multiple early reports covering the cardiovascular perspective of COVID-19. However, there are limited guidelines/protocols addressing the issue. With the emerging pandemic, data is ever-changing and so is our understanding of the cardiovascular implication of COVID-19.
Shahid Gangalal National Heart Centre-ST-elevation Myocardial infarction Registry (SGNHC-STEMI-Registry), Nepal
Authors: Adhikari Chandra Mani , Acharya Kiran Prasad , Manandhar Reeju , Sherpa Kunjang , Tamrakar Rikesh , Bogati Amrit , Singh Satish Kumar , Kansakar Subodh , Yadav Dharma Nath , Dhungana Murari , Dhungel Sachin , Baniya Bibek , Joshi Surakshya , Rajbhandari Sujeeb , Pandey Rabindra , Raut Roshan , Prajapati Dipanker , KC Sanjay Singh , Adhikari Jagat , Adhikari Ajay , Gautam Binayak , Najmy Shaneez , Poudel Rajan , Timalsina Birat Krishna , Karki Parag , Poudel Samir , Thakur Kartikesh Kumar , Limbu Deepak , Nepal Himanshu Prasad , Sharma Mukunda , Rauniyar Binay Kumar , Rajbhandari Rajib , Limbu Yuba Raj , Maskey Arun , Malla Rabi , Sharma Deewakar , KC Man Bahadur
Published: May 2020

Background and Aims: Incidence of ST-elevation myocardial infarction (STEMI) is increasing in Nepal. We aim to describe the presentation, management, complications, and outcomes of patients admitted with a diagnosis of STEMI in Shahid Gangalal National Heart Centre (SGNHC), Nepal.

Methods: Shahid Gangalal National Heart Centre-ST-elevation registry (SGNHC-STEMI) registry was a cross sectional, observational, registry. All the patients who were admitted with the diagnosis of STEMI from January 2018 to December 2018 were included.

Results: In this registry, 1460 patients out of 1486 patients who attended emergency were included. The mean age of patients was 60.8±13.4 years (range: 20 years to 98 years) with 70.3% male patients. Most of the patients (83.2%) were referred from other hospitals and 16.8% of patients directly attended the SGNHC emergency. During the presentation, smoking (54%) was the most common risk factor, followed by hypertension (36.6%), diabetes mellitus (25.3%), and dyslipidemia (7.8%). After admission, new cases of dyslipidemia, HTN, Impaired Fasting Glucose (IFG), and Type 2 DM were diagnosed in 682 (51.3%), 182 (20.1%), 148 (10.3%) and 95 (8.9%) respectively. At the time of presentation, 73.3% were in Killip class I and 26.3% were above Killip class II with 5.1% in cardiogenic shock. Thirty-one percent of the cases received reperfusion therapy (Primary percutaneous intervention in 25.2% and fibrinolysis in 5.8%). Inferior wall MI was the most common type of STEMI. Among the patients who underwent invasive therapy, the multi-vessel disease was noted in 46.2% cases and left main coronary artery involvement in 0.7% cases. In-hospital mortality was 6.2% with cardiogenic shock being the most common cause. Aspirin (97.8%), clopidogrel (96.2%), statin (96.4%), ACEI/ARB (76.8%) and beta-blocker (76.8%) were prescribed during discharge.

Conclusion: The SGNHC-STEMI registry provides valuable information on the overall aspect of STEMI in Nepal. In general, the SGNHC-STEMI registry findings are consistent with other international data.
Precipitating factors leading to decompensation of heart failure in patients attending a tertiary care centre of Nepal
Authors: Adhikari Suman , Gajurel Ratna Mani , Poudel Chandra Mani , Shrestha Hemanta , Thapa Sanjeev , Devkota Surya , Yadav Vijay , Sharma Manju
Published: May 2020

Background and Aims: Heart failure is one of the debilitating conditions in patients with various forms of heart disease. It can have impacts on various aspects of the life of a patient. There have been few studies on the etiological aspects and precipitants of heart failure in the Nepalese population. The aim of our study is to find out the major factors that lead to decompensation of heart failure in patients who already have established heart failure.

Methods: This study was a single-centre, prospective, observational study conducted in the emergency department of Manmohan Cardiothoracic Vascular and Transplant Centre (MCVTC) from 1st June 2019 to 30th November 2019. Hundred and one patients with established heart failure in the past, who presented again with decompensated heart failure were enrolled.

Results: The mean age of the patients was 62.81 years (SD=15.92). Factors responsible for acute decompensation of heart failure were identified in 95.0 % of patients included in the study. The most common factor identified was poor compliance with medications and diet and fluid intake (38.6%). Next to it was arrhythmia identified in about 35.6% of cases.Other important factors responsible for decompensation in our study were infection (12.8%), anemia (4.9%) and ischemia (2.9%).

Conclusion: Preventable and identifiable factors are responsible for the decompensation of heart failure. Most of these factors can be modified with the use of proper patient counseling/patient education, thereby reducing recurrent hospital admissions and economic burden to the patient and the government as well.
Adherence to guideline-directed medical therapy among left ventricular systolic dysfunction patients in Shahid Gangalal National Heart Centre, Kathmandu, Nepal
Authors: Manandhar Reeju , Bogati Amrit , Prajapati Dipanker , Aslam Sheikh , Choudhary Taanya , Mahat Sanjeev , Tamrakar Binita , Neupane Pushpa , Adhikari Chandra Mani
Published: May 2020

Background and Aims: Heart Failure (HF) with reduced Ejection Fraction (HFrEF) is defined as the clinical diagnosis of HF and left ventricular ejection fraction (LVEF) ≤ 40%, also referred to as systolic HF. Guideline-directed medical therapy (GDMT) has shown to reduce mortality for HFrEF. We aim to evaluate adherence to GDMT treatment in our outpatients.

Methods: It was a cross-sectional observational study. All patients who attended the Department of preventive medicine and cardiac rehabilitation for medical counseling from October 2016 to May 2018 and have already completed 3 months of follow up for HF were included in this study. Performa was designed to collect patient information which included; age, gender, NYHA functional class, LVEF, systolic and diastolic blood pressure, pulse rate, creatinine, potassium and drugs with doses were recorded.

Results: Among the 451 patients, ninety-nine (65.6%) were male and 52 (34.4%) were female. The mean age was 56.2±4.2 years. Most of the patients were in NYHA class II 114 (75.5%) and in Sinus rhythm 119 (79.4%). Mean LVEF was 26.6±6.1%. Dilated Cardiomyopathy was the most common clinical diagnosis in 76 (50.3%). Diuretic, Angiotensin-converting enzyme inhibitor (ACEI)/Angitensin receptor blocker (AB), Aldosterone Antagonist, β-blocker and digoxin were prescribed in 151 (100%), 140 (93.3%), 127 (84.1%), 114 (75.4%) and 46 (30.4%) patients respectively. The mean dose of furosemide, Enalapril, Losartan, carvedilol, bisoprolol and metoprolol succinate was 45.3mg, 4.0mg, 33.2mg, 33.6mg, 18.8mg, 3.0mg, and 27.5mg was respectively.

Conclusion: Our center's adherence to GDMT in HFrEF patients is comparable to international studies. We still need more effort to re-emphasize the importance of GDMT by focusing on the optimization of drug doses during out-patient visits.