bluuebunny/crossref_metadata_2025 huggingface dataset:
A formulação de políticas públicas e as concepções de espaço, território e região
Authors: Theis Ivo Marcos , Galvão Antônio Carlos F.
Published: January 2017

A preocupação que inspirou este artigo foi que políticas públicas podem lograr maior efetividade se sua dimensão espacial for trazida para o primeiro plano. E se noções como espaço, território e região, aqui examinadas, tiverem seus significados devidamente explicitados. Comparativamente, as estratégias de desenvolvimento informadas pela consideração geográfica dos problemas a serem enfrentados tendem a ser mais bem encaminhadas no contexto brasileiro atual. O artigo inicia com uma revisão das trilhas teóricas perseguidas pela Geografia e pela Economia na formulação de seus respectivos conceitos de espaço. Em seguida, avança-se sobre as noções de território e região, respectivamente, tomadas como elementos centrais para a formulação de políticas que enfatizam a dimensão espacial – buscando, tanto quanto possível, colocar a Geografia e a Economia em diálogo. Por fim, na última seção, procura-se relacionar as concepções examinadas com as estratégias de desenvolvimento que se descortinam para o país nessa desafiadora quadra de sua história. Palavras-chave: Brasil; desenvolvimento; espaço; políticas públicas; região; território. Abstract: This article is concerned with the fact that public policy can achieve greater effectiveness once its spatial dimension gets more attention and if such notions as space, territory and region, here examined, have their meanings adequately explained. Development strategies informed by geographical considerations of the problems to be faced tend to favour the use of more appropriate measures in the current Brazilian context. The article begins with a review of theoretical paths followed in Geography and Economics by elaborating their respective concepts of space. Then we move on to notions of territory and region, respectively, taken as central to the formulation of public policies that emphasize the spatial dimension – as much as possible, by trying to put Geography and Economics in dialogue. Finally, in the last section, we relate the examined concepts to the development strategies that can be adopted in this challenging time of the Brazilian history. Keywords: Brazil; development; public policies; region; space; territory.
An analysis of the performance of private equity: Agency cost approach
Authors: Krishnaswamy C.R.
Published: January 2017

In this paper, we explore the effects of agency costs on the performance of private equity. We discuss why private equity firms generally have much lower agency costs. We show using Capital Asset Pricing Model approach that private equity funds would be better off by investing in firms with low beta than high beta firms.
Ownership structure, internal governance and earnings management in Hong Kong
Authors: Ali Muhammad Jahangir , Ng Kwong San
Published: January 2017

This study examines whether ownership structure and internal governance mechanisms are associated with earnings management in Hong Kong. We hypothesize that the earnings management of a firm is associated with the ownership structure including ownership concentrations, different ownership concentration levels of family held companies and substantial institutional investors; and internal governance mechanisms including firms that are audited Big 4 auditors and proportion of outside directors. The non-discretionary accruals are measured using modified Jones model with crosssectional basis. We employ multivariate model to investigate the relationship between discretionary accruals and various independent variables. Our results show that discretionary accruals are positively associated with high/low level of family ownership and negatively related to firms that are audited by Big 4 auditor as hypothesized. Our results reveal that the controlling shareholders in family businesses can expropriate minority shareholders by accounting manipulations and that independent nonexecutive directors cannot effectively constrain opportunistic earnings management. This requires regulators and standard setters to improve the extent of investor protection and to increase the independence of outside directors on the board.
Governance and organisation design: A negotiation and network analytic approach
Authors: Grandori Anna , Soda Giuseppe
Published: January 2017

This paper proposes a negotiation analytic approach to the design of corporate governance mechanisms. The main research questions addressed in the paper are: Which packages of governance mechanisms maximize the utility of firm representatives – CEO – and human resource providers? On which matters do interests converge and on which do they diverge? Which packages are Paretorankable and which are not? Where are there areas of preferences balancing and effective negotiation? The answers to those questions structure the “governance game”, indicating what are the interesting and sensible values for each mechanism, and what are the most interesting (value adding) combinations among policies on each mechanism. The approach is applied to a database of preferences over a wide array of governance and organisational mechanisms, expressed by two samples of relevant actors (CEOs and high potential managers working in 315 firms – domestic or subsidiaries – located in Italy) and contributes both in method and in the substantive identification of solutions. Results indicate, that the governance game is less adversarial than suggested by ‘shareholder views’, but also less generically cooperative than suggested by ‘stakeholder views’; and develops policy implications by identifying on which matters preferences converge or diverge, among themselves and with respect to the solutions applied in practice. The framework and the findings offer new propositions about the design of CG structures, different from those based on the extant conventional approaches to CG.
Corporate governance and managerial opportunism: The case of us pension plans
Authors: Asthana Sharad
Published: January 2017

Insuring post-retirement benefits to retirees is a joint responsibility of the employees, employers, and the US government. Managers have been shown to manipulate pension plan reports with the intention of maximizing their own gains to the detriment of current and future retirees. External monitoring by regulators and auditors is effective in curbing this opportunistic behavior. This paper extends these findings to examine if effective internal monitoring in the form of strong corporate governance is instrumental in controlling manipulations of pension reports by managers. Empirical tests support the finding that effective corporate governance is inversely associated with the extent of managerial manipulations in pension plan reporting. This result should be of interest to employees, retirees, and the US Government that are trying to insure the future income of senior citizens.
Executive compensation: NYSE and NASDAQ listed firms
Authors: Vieito João Paulo , Khan Walayet , Cerqueira António , Brandão Elísio
Published: January 2017

In this paper, we examine whether the determinants and forms of executive compensation for NYSE versus NASDAQ listed firms are the same during the period from 1992 to 2004. We also investigate whether the determinants and forms of executive compensation changed after the NASDAQ crash in 2000 and the Sarbanes-Oxley Act in 2002. Our results reveal that the factors that explain executive compensation for NYSE and NASDAQ listed firms are generally different. We also find that executives are paid different forms of compensation for NYSE and NASDAQ listed firms and that the forms of compensation change after the NASDAQ crash but essentially after the Sarbanes-Oxley act in 2002.
An empirical investigation on determinants of executive directors’ remuneration in bursa Malaysia
Authors: Ooi Chye-Khoon , Lai Ming-Ming
Published: January 2017

Executive directors’ remuneration may link to company performance. This paper investigates the determinants of executive directors’ remuneration of all public listed companies in Bursa Malaysia from 2004 to 2006. Multiple regression results indicated that tenure of an executive director has held the director’ position appeared to be the most significant determinant for executive directors’ remuneration. Duality emerged as second significant determinant except for Kuala Lumpur Composite Index (KLCI) component companies. Company performance and size were found as determinants except for KLCI component companies. The results also suggest that age and qualification are the weakest determinants for human capital variables. Overall, net profit was significant positive correlated with company size and particularly is evident for KLCI companies
Cost of capital adjusted for governance risk through a multiplicative model of expected returns
Authors: Apreda Rodolfo
Published: January 2017

This paper sets forth another contribution to the long standing debate over cost of capital, firstly by introducing a multiplicative model that translates the inner structure of the weighted average cost of capital rate and, secondly, adjusting such rate for governance risk. The conventional wisdom states that the cost of capital may be figured out by means of a weighted average of debt and capital. But this is a linear approximation only, which may bring about miscalculations, whereas the multiplicative model not only takes account of that linear approximation but also the joint outcome of expected costs of debt and stock, and their proportions in the capital structure. And finally, we factor into the cost of capital expression a rate of governance risk.
Corporate governance in Macedonia – micro and macro analysis
Authors: Apostolov Mico
Published: January 2017

The corporate governance issue in Macedonian companies has been brought forward during the recent few years. The main reason is the fact that the privatization process completion of socially-owned and partly state-owned enterprises has put emphasis to the challenge to reasonably regulate relationships established within companies on one hand, and relationships between companies and larger society on the other. All market economies, including those with longest tradition, have faced this kind of challenge so far.
Corporate governance becomes an increasingly important issue for the Macedonian economy. It is being taken with greater consideration by the companies, regulators and government. The strong wave of privatization programs from mid-90’ have resulted in an altered business environment, and new legal and institutional frameworks have been established. Indeed, corporate governance contributes to sustainable economic development by enhancing the performance of companies and increasing their access to external sources of capital. In this paper we will make attempt to analyze the predominant factors that Create a prolific corporate governance environment in two terms; a) micro level and macro level.
Lending behavior of multinational bank affiliates
Authors: Derviz Alexis , Podpiera Jiří
Published: January 2017

We study the parent influence on lending by affiliates of a multinational bank. In the proposed theoretical model, local lending is influenced by shareholder-affiliate manager delegation and precautionary motives. The outcome is either contagion (the loan volume in the affiliate follows the direction of the parent bank country shock) or performance-based reallocation of funds (substitution), depending on the degree of manager delegation in the affiliate and the liquidity-sensitivity in the parent bank. Empirical investigation, deliberately conducted on a sample not covering the latest financial crisis, shows that also in “normal” times, multinational banks that are likely to delegate lending decisions or be more liquidity-sensitive are more inclined towards contagionist behavior.
Interaction effects between internal governance mechanisms on the components of initial returns during the IPO
Authors: Mezhoud Mediha , Boubaker Adel
Published: January 2017

Our work provides an analysis of the interaction effects between internal governance mechanisms on the components of initial returns during the listing period. The application of multivariate regressions on a sample of 110 IPO French companies during 2005-2010, has allowed us to conclude that the different interactions between these mechanisms significantly influence the level of under / overpricing. Indeed, the positive relationship between internal governance mechanisms and overpricing reflects a substitutability relationship. In contrast, the complementarity effect comes from the negative relationship characterizing the combination of governance mechanisms and the underpricing. Thus, the interactions effects between institutional ownership, board structure and under / overpricing are not conforming to the existence of a complementarity or substitutability
relationship between these variables given the absence of a significant combination between these variables.
Reforming Medicaid and Vulnerable People
Authors: Birenbaum Arnold
Published: January 2017

Medicaid, the federal-state financed program that assists people to gain access to health services when they cannot afford them, has been inthe news of late. Unfortunately the news is disquieting for people who count on this program for health care and rehabilitation services. Change is not always the friend of vulnerable people, and in this instance, it can be downright disruptive when it comes to accessing services. Because they are not well organized, people with Medicaid coverage do not have political clout, even though more people are covered by Medicaid than Medicare (e.g., the public insurance program for almost all people over the age of 65 and some people with disabilities). New Bush administration proposals and ongoing practices could be particularly harsh for people with disabilities.
Molecular and Cellular Foundations of Medicine
Authors: Steinman Howard M.
Published: January 2017

After six years and six medical school classes, the course leader of Molecular and Cellular Foundations of Medicine reflects on how the course began and where it is going.
The Department of Medicine at the Albert Einstein College of Medicine, 1955-1980
Authors: Fulop Milford
Published: January 2017

After several years of planning, the new Albert Einstein College of Medicine (AECOM) recruited its first class, of just 56 students, and began their instruction in the fall of 1955. This event took place in a not-yet-fully-outfitted Forchheimer building, which was then the only one of what later became a cluster of AECOM buildings. Across the street was the Bronx Municipal Hospital Center (BMHC, now Jacobi Medical Center, JMC), which was the original (and, for years, only) teaching hospital of the College. The evolution of the Department of Medicine at this new College, from its early stages – with 56 medical students, a small outstanding young faculty, one science building and one teaching hospital – to a world-renowned medical research and educational institution, with over 800 medical and doctoral students, numerous post-doctoral fellows and trainees, a large outstanding faculty, four major science buildings, and six major teaching hospital affiliates, is described.
What's Ahead for Med Ed?
Authors: Kuperman Albert S
Published: January 2017

In response to biomedical advances and changes in the practice environment, medical education is always in the process of change. This paper deals primarily with educational changes involving the integration of the disciplines of genomics, prevention and population health, global health and integrative medicine into the curriculum. External and internal forces that tend to impede development of professional and humanistic values are also discussed along with the call to action for developing strategies that mitigate these forces.
The Price of Professional Integrity—Ethics of the Physician-Patient Relationship
Authors: Kiprilov Enko
Published: January 2017

Historically, the science of medicine has met a great deal of social rejection, if not outright hostility. Through the years physicians have had to maintain a delicate balance between the norms and values established by societies and the dictates of their own conscience of what constitutes the best interest of their patients. Confronted by the dilemma of facing social ostracism or defying their duties as stated in the Hippocratic oath to be “bound by a stipulation and oath according to the law of medicine, but to none others (Information for Research on Euthanasia, 2003)”, physicians have often faced difficult ethic quandaries. It is a hotly debated issue whether the duty of physicians is to assess every individual case and act solely according to their own best judgment or act in line with the rigid norms and social structures imposed by the community. Issues such as euthanasia, abortion and organ transplantation present the very essence of this controversial bioethical debate.
Social Support: A Role for Social Work in the Treatment and Prevention of Hypertension
Authors: Schnall Eliezer
Published: January 2017

Researchers have long noticed an association between social relationships and health. More recently, a vast and growing literature has developed, linking various forms of social support to hypertension, often even suggestive of a causal relationship. A detailed survey of this literature is presented, followed by a review of possible psychosocial and physiological explanations for the phenomena. Implications for social workers in various settings are emphasized.
The Neurosurgical Treatment of Movement Disorders
Authors: Schwartz Gary
Published: January 2017

The management of movement disorders has been his- torically treated with both surgical and medical modalities. While L-Dopa has been the medical mainstay for Parkinson’s Disease, surgical techniques have evolved over the past century to the current state of stereotactic procedures in focal parts of the central nervous system. Presented here is a review of the history of this evolution.
Role of Auxilin and Heat Shock Protein 70kDa in Clathrin Uncoating
Authors: Wu Lily
Published: January 2017

An interaction between auxilin and heat shock protein 70kDa (Hsc70) was initially discovered in 1995. There exists a large amount of data supporting the basis for their interaction in vitro and their function in clathrin uncoating in vivo. This review examines the key experiments in elucidating this interaction and introduces a third protein that may connect constriction or fission with hsc70/auxilin mediated clathrin uncoating.
HIV-1 Dynamics in the Host Cell: A Review of Viral- and Host- Protein Interactions and Potential Therapeutic Targets for HIV-1 Infection
Authors: Sorin Masha , Kalpana Ganjam V.
Published: January 2017

HIV-1, the causative agent of AIDS, is a sophisticated retrovirus that has both evolved to invade the complex human immune system and adapted to utilize the host machinery for its own propagation. A dynamic interaction between the virus and host systems can be observed at every step of the HIV-1 lifecycle. Host factors are involved not only in mounting antiviral responses, but are also hijacked by the virus to enhance viral replication. Host factors are necessary for viral replication during entry, reverse transcription, nuclear import, integration, transcription, nuclear export, translation, assembly, and budding. Recently, a new class of host factors, called “host restriction factors,” has been identified that prevent retroviral replication in a specific host cell environment and constitute an important part of intracellular innate immunity against the virus. These restriction factors act as barriers to retroviral replication at various stages within the infected cell. Nevertheless, the HIV-1 virus has learned to subvert these antiviral responses and successfully propagate within the permissive host environment. This review article describes the identification and mechanism of action of several pro- and anti-HIV-1 host factors. It is likely that we are only beginning to get a glimpse of an ongoing complex battle between HIV-1 and the host, the understanding of which should provide valuable information for the development of novel therapeutic strategies against HIV-1.
The Pathogenesis of HIV-Associated Dementia: Recent Advances Using a SCID Mouse Model of HIV-Encephalitis
Authors: Cook Jennifer , Tyor William
Published: January 2017

In the era of highly active antiretroviral therapy (HAART) there has been a decrease in AIDS death rates and a reduction in HIV-related neurological complications. However, Human Immunodeficiency Virus-1 (HIV)-associated dementia (HAD) still affects at least 7% of HIV-positive individuals. Despite significant advances in HIV research there are still questions surrounding the pathogenesis of HAD. Clinical information and pathological studies suggest that the frontal cortex, basal ganglia, and hippocampus are important neuroanatomical areas involved in HAD. Recent studies utilizing a severe combined immunodeficiency (SCID) mouse model of HIV-encephalitis (HIVE) indicate that central nervous system (CNS) viral load determines the severity of astrogliosis, an important feature of HIVE. Human and animal studies suggest that viral strains may also be important in the pathogenesis of HAD. A recent study suggests that HAART does not eradicate virus in the brain, and therefore, the CNS is a reservoir for HIV. Future research efforts need to focus on the role of viral strain and mutations in the pathogenesis of HAD.
Large Maf Transcription Factors: Cousins of AP-1 Proteins and Important Regulators of Cellular Differentiation
Authors: Yang Ying , Cvekl Ales
Published: January 2017

A large number of mammalian transcription factors possess the evolutionary conserved basic and leucine zipper domain (bZIP). The basic domain interacts with DNA while the leucine zipper facilitates homo- and hetero- dimerization. These factors can be grouped into at least seven families: AP-1, ATF/CREB, CNC, C/EBP, Maf, PAR, and virus-encoded bZIPs. Here, we focus on a group of four large Maf proteins: MafA, MafB, c-Maf, and NRL. They act as key regulators of terminal differentiation in many tissues such as bone, brain, kidney, lens, pancreas, and retina, as well as in blood. The DNA-binding mechanism of large Mafs involves cooperation between the basic domain and an adjacent ancillary DNA-binding domain. Many genes regulated by Mafs during cellular differentiation use functional interactions between the Pax/Maf, Sox/Maf, and Ets/Maf promoter and enhancer modules. The prime examples are crystallin genes in lens and glucagon and insulin in pancreas. Novel roles for large Mafs emerged from studying generations of MafA and MafB knockouts and analysis of combined phenotypes in double or triple null mice. In addition, studies of this group of factors in invertebrates revealed the evolutionarily conserved function of these genes in the development of multicellular organisms.
Primary Care in Cuba
Authors: Hauge Stephanie
Published: January 2017

The Cuban health system surprises the international health community with strong health indicators despite economic hardship and international political tensions. This paper provides an analysis of the Cuban health system with a special focus on the role of primary care and primary care practitioners in Cuban culture. The paper also includes a discussion of Cuban health indicators, current epidemiological issues, national health initiatives, and the effects of Cuba’s political situation on its health care system.
A Mini Analysis: Depression and Omega-3 Essential Fatty Acids
Authors: Blakaj Dukagjin M
Published: January 2017

Omega-3 polyunsaturated fatty acids have received a considerable amount of attention in a number of human pathologies, including inflammation, cardiovascular disease, behavioral or mental disease, and especially depression. They make up one component of mammalian brain tissue that includes the different saturated, monounsaturated, and polyunsaturated fatty acids (McNamara and Carlson, 2006).
Factors Influencing Primary Care Residency Selection among Students at an Urban Private Medical School
Authors: Shapiro Miriam , Fornari Alice
Published: January 2017

This study investigated factors influencing primary care–focused students’ selection of a family medicine residency at a private urban medical school. Reasons for why or why not students chose family medicine as opposed to other primary care–focused residencies is discussed. A questionnaire was sent to all fourth-year students (N=157) selected for residency with a primary care focus (medicine and pediatrics (medicine/pediatrics), emergency medicine (EM), obstetrics/gynecology (OB/GYN), internal medicine, pediatrics, and family medicine) from 2006 to 2008. Sixty-three surveys were completed. Respondents reported the most influential factor in primary care selection was patient-care model, followed by patient population and mentor/role model. The factor reported as having the strongest positive and negative influence on residency choice was clerkship experience. Half of respondents (53%) reported being told or directly overhearing negative comments about their career interest in primary care frequently (5+ times) during clinical clerkships. The most frequently cited reasons for not pursuing family medicine as a residency choice were broad focus, lack of prestige, and stereotype of family medicine as a nonacademic field. The Department of Family Medicine is focusing on strategies to combat these perceptions and expose students to positive primary care experiences early in their medical education. Action must be taken to monitor and address family medicine’s negative stereotype, as it has a clear presence in medical education and may have a negative influence on residency selection.
Medical Student Views of Healthcare Reform in the United States, 2009
Authors: Benson Ariel A. , Mendelsohn Nathaniel , Gervits Maria , Adeshuko Folashade , Garcia Carlo S. , Smoller Sylvia
Published: January 2017

PurposeTo assess the opinions of Albert Einstein College of Medicine (Einstein) medical students about U.S. healthcare reformin the context of the 2008 U.S. presidential election through the use of an online survey. The study additionallyevaluates the influences on students’ healthcare opinions and whether there is sufficient instruction given to medicalstudents about healthcare systems.MethodDuring January and February 2009, first-year and second-year (classes of 2011 and 2012) Einstein medical students(n=362) were surveyed about U.S. healthcare using a web-based electronic survey. The survey included questionsabout students’ healthcare views and influences, political views, and education related to healthcare systems.ResultsWith a response rate of 56%, the survey showed that, among Einstein students, the most popular reform to the U.S.healthcare system would be a multipayer system (41%) in which all U.S. citizens would have access to healthcare paidfor by the U.S. government, but could also choose to obtain private insurance. More than 86% of the respondentsfelt that they had not received adequate education in medical school about the U.S. healthcare system. Seventy-fourpercent of respondents supported Barack Obama in the 2008 U.S. presidential election.ConclusionsEinstein students overwhelmingly recognize the need for reform in the U.S. healthcare system, and students are confidentthat, under Barack Obama’s leadership, the number of uninsured American citizens will decrease in the nextfour years. Survey findings also reveal the need for improved medical student education about the U.S. healthcaresystem.
Cognition without a Neural Code: How a Folded Cortex Might Think by Harmonizing Its Own Electromagnetic Fields
Authors: Erlich Victor M.
Published: January 2017

Extensive investigation of the brain’s synaptic connectivity, the presumed material basis of cognition, has failed toexplain how the brain thinks. Further, the neural code that purportedly allows the brain to coordinate synapticmodulation over wide areas of cortex has yet to be found and may not exist. An alternative approach, focusing onthe possibility that the brain’s internally generated electromagnetic fields might be biologically effective, leads to amodel that solves this “binding problem.” The model of cognition proposed here permits mind and consciousness toarise naturally from the brain as trains of signifying states, or stationarities. Neuronal circuits in suitably constructedhierarchies produce thought by reconciling themselves with each other through the forward- and back-broadcast ofspecific electromagnetic fields, executing a natural algorithm as a harmonized set is selected. Beyond the postulationthat information is encoded in specifically organized electromagnetic fields, the only other “code” necessary is topographic,one that is already known. That the brain might use its own fields to think is supported by the literature onthe widespread sensitivity of biological organisms to small, windowed fields. This model may help explain the coherenceof the brain’s fields, the conservation of the folded cortex, and, in its emphasis on a self-harmonizing process,the universality of the esthetic impulse as a projection of the brain’s basic mechanism of thought.
From Visual Plasticity to the Bionic Eye
Authors: Buss Stephanie
Published: January 2017

While visual plasticity is strongest in early infancy, new studies show that plasticity is maintained well into adult life.This possibility is compellingly demonstrated by one patient, SK, who gained vision for the first time in adult life andsignificantly improved his ability to see the world around him. The persistence of visual plasticity in adults is promisingnews for the developing field of visual prosthesis.In recent years, there has been an explosion of research on prosthetic devices for the brain. While memory-enhancingbrain chips are still science fiction, cochlear implants, which stimulate the inner ear with tiny electrodes, now allowpeople who were once deaf to hear with increasing accuracy. Although there is not yet any visual equivalent to thecochlear implant, in recent years vision researchers have started to experiment with similar prosthetic techniques totreat blindness.The goal of visual prosthesis is to allow functional restoration of vision and to improve quality of life for blindpatients. In order to achieve these goals, the prosthetic devices must tap into the brain’s plasticity. Plasticity is howthe brain adapts to new environmental stimuli. It enables all forms of learning, including memorizing facts, playingthe piano, and learning to see. Specifically, plasticity is how neural networks in the brain reorganize in response tonew experiences. Understanding plasticity furthers insight into the brain mechanisms active in visual prostheses, andmay help scientists develop new approaches for future devices.
Development of Preclinical Biomarkers Predictive of Safety of Vaginal Microbicides for the Prevention of HIV
Authors: Mhatre Mohak
Published: January 2017

Human immunodeficiency virus (HIV) is transmitted predominantly through sexual intercourse. Research suggeststhat the vaginal epithelium acts as a barrier to HIV transmission, but this epithelium can be disrupted, leading toHIV infection and other sexually transmitted infections. Topical microbicides are considered an effective strategy forHIV prevention, and several candidate drugs are currently in clinical trials. However, significant concerns about drugadherence, efficacy, and safety must be addressed in order to develop a safe and effective microbicide. This paper willprovide an overview of the field and strategies to overcome some of the obstacles facing microbicide development,and briefly discuss a research project that focused on one aspect of preclinical microbicide safety testing.
From Sacrilege to Privilege: The Tale of Body Procurement for Anatomical Dissection in the United States
Authors: Hulkower Raphael
Published: January 2017

Anatomical dissection remains an integral part of most medical schools’ curricula, and in order to meet their educationalneeds, schools turn to a mixture of donated and unclaimed bodies. However, the procurement of bodies foranatomical dissection has not always been a simple task. The history of the cadaver supply in the United States, asin many other countries, is a story of crime, punishment, and legal dilemmas. The method by which medical schoolsobtain cadavers has affected not only anatomists and medical students, but all members of society. Methods of procurementthrough the centuries have been able to change only along with concurrent changes in societal perceptionsof death and dissection. An appreciation of this history and these societal changes may benefit students in theirstruggles to come to terms with how their cadavers were obtained and how society has granted them the privilegeto dissect a fellow human’s body.
Congenital Melanocytic Nevi and the Risk of Malignant Melanoma: Establishing a Guideline for Primary-Care Physicians
Authors: Nikfarjam Jeremy , Chambers Earle
Published: January 2017

Objective: The objective of this review is to determine what size congenital melanocytic nevi (CMN) increases the risk of malignant melanoma in affected patients.Background: Congenital melanocytic nevi are benign proliferations of cutaneous melanocytes apparent at birth or in the first postnatal weeks. The Kopf system classifies nevi based on size: small, <1.5 cm in diameter; medium, 1.5–19.9 cm in diameter, and large, ≥20 cm in diameter. Great variability exists in quantifying the risk of malignant transformation from congenital nevi of different sizes. Evidence-based standard guidelines for clinical investigation need to be established.  Methods: Literature search included studies on medium, large, and giant congenital nevi in association with melanoma.Results: Three studies pertaining to small, medium, and large congenital nevi are defined. The odds ratio of malignant transformation from small CMN was determined to be 20.9 by history and 10.5 by histology in 238 patients in the case-control study selected. No malignant transformation was found in a prospective study of 230 individuals with medium-sized melanocytic nevi. Finally, a 5% risk of malignant transformation was reported in a prospective study of patients with large congenital nevi.Conclusion: All patients should receive total body skin and mucosal surface exams. Patients with small CMN (<1.5 cm in diameter) and medium CMN (≥1.5 cm–19.9 cm in diameter) should be closely observed over their lifetimes and given the option of specialist referral. Finally, patients with large CMN (≥20 cm in diameter) should be referred to specialists upon initial presentation. More original data and follow-up are needed for maturation of evidence-based clinical recommendations.
Optogenetic Technology and Its In Vivo Applications
Authors: Gelman Simon
Published: January 2017

Optogenetics is a novel technology with the widely acknowledged potential to revolutionize cell biology and neuroscience. Essentially, optogenetic methods integrate optical and genetic tools to control the activity of whole cells or subcellular events. In recent years, optogenetics has been used to activate and to inhibit genetically defined neuronal populations within neural circuits. As such, it has been used to show the sufficiency or the necessity of specific neuronal cell types in generating behaviors across a number of animal species. When employed in rodent models of human neurological and psychiatric disorders, optogenetics has provided clinically relevant insights into the function of pathologic neural circuits. Recent progress in the in vivo applications of this methodology is reviewed in this article, with particular focus on behavioral applications in nematodes, fish, rodents, and nonhuman primates.
Your Practical Survival Guide to Surgical Internship
Authors: Amanatullah Derek F.
Published: January 2017

There is a lot of anxiety in medical school regarding internship, especially surgical internship. Internship is your introduction to medical responsibility. After four years of developing your interview and examination skills, as well as increasing your fund of medical knowledge, you are ready for real patients. Internship is easy if you are diligent and reliable. The anxiety over internship results from translating theoretical knowledge into practical skill, while “doing no harm.” Do not fear. It is not as hard as you think. Some sage words from my general surgery chief the day before internship sum it up: “Do what you are told; anticipate what you will be told; and, if you find yourself thinking ‘independently,’ call someone.” You know a lot as an intern! Use the team and the hospital to your advantage and your transition to responsibility will be easy. Maybe with these ten tips and tricks I found useful during my internship in your pocket, you can get some sleep as well.
A Rare Case of Cystic Schwannoma of the Portal Triad
Authors: Avgerinos Dimitrios , Heenatigala Meshach , Lo Andrew
Published: January 2017

Schwannomas can occur anywhere throughout the body andhave often been mistaken for more-sinister lesions, especiallywhen found in relation to the pancreas. Clinical symptomsrange from none to vague abdominal pain, back pain,anorexia, weight loss, vomiting, jaundice, and episodes ofcholangitis and gastrointestinal bleeding. Preoperative diagnosisis difficult, and endoscopic ultrasound with fine-needleaspiration is often limited in specificity. Given the low statisticallikelihood of schwannomas, therapy is usually targeted at thepossibility of pancreatic cystadenoma/cystadenocarcinoma.Simple enucleation is usually the preferred treatment, anddiagnosis can be established at the time of operation by frozensection. Schwannomas can be malignant, but preoperativeimaging and pathology can help establish the benign natureof most specimens. Patients typically do well with resolution ofsymptoms. Here we present the case of a patient with abdominalpain and a peripancreatic mass observed with computedtomography, who was found to have a cystic schwannomaextending from the portal triad. The mass was removed andthe patient was discharged without complications.
From Form to Function: A History of the Department of Biochemistry of the Albert Einstein College of Medicine
Authors: Englard Sasha , Hopkin Karen
Published: January 2017

The department of biochemistry is the oldest basic sciencedepartment at the Albert Einstein College of Medicine. Its firstchair, who was also the first faculty member to be appointed tothe medical school itself, was hired in 1952, three years beforethe fledgling institution opened its doors to the first enteringclass. Since those early days, the department has helpedshape the academic environment of the college, influencingthe selection of departmental chairs, guiding medical schooladmissions, and teaching courses that laid the foundation forthe medical school curriculum. In this article, we summarizebriefly the history of the department from its inception to thepresent. We review the accomplishments of each of its threechairs and discuss how the department has helped define thecharacter of the institution as a whole.
Prevailing Theories in Cardiovascular Physiology during Ancient and Classical Times
Authors: Nguyen Michael
Published: January 2017

Currently accepted theories of human physiology have been proposed only in the last two centuries, with understanding of many molecular processes proposed within the last 50 years. However, theories of human physiology have been debated for thousands of years. This paper focuses on the theories of physiology discussed in ancient and classical times, with a focus on the structure and function of the heart and its vessels. The experiments and subsequent conclusions of physicians and philosophers of antiquity have led to some interesting interpretations. Notably, anatomical studies remain remarkably similar to today’s understanding, whereas ideas of function and physiology are drastically different.
Left-Sided Gallbladder: Uncommon Presentation and Laparoscopic Approach
Authors: Nguyen Quoc-Hung , Jhu Amalanshu
Published: January 2017

Sinistroposition, or left-sided placement of the gallbladder, is a rare congenital anomaly with a prevalence of about 0.3%. These gallbladders, through multiple proposed developmental aberrations, are situated beneath segment III or IV (or both, as in this case) of the liver, and can lead to diagnostic difficulty. We present a case of atypical presentation of acute cholecystitis from a left-sided gallbladder and the modified laparoscopic technique used for its safe removal.
Coffee Consumption and Cardiovascular Disease Risk: What Should We Tell Our Patients?
Authors: Engstrom Krysthel
Published: January 2017

The association between coffee and the risk of cardiovascular disease has been studied over the past 20 years. Given the complexity of conducting large, randomized, controlled trials to prove causality, conclusions are based on case reports, retrospective studies, and small physiologic trials. Surveys determine that most physicians advise discontinuing or reducing consumption of caffeine in patients with known heart disease, yet this recommendation lacks strong supporting evidence. The following is a short review of the effects of coffee and caffeine on the cardiovascular system that aims to provide objective advice to physicians and patients based on the published literature.
Stemming the Medical Brain Drain: A Personal Perspective on a Global Problem
Authors: Shakil Saate
Published: January 2017

The term “medical brain drain” refers to the international migration of physicians from the developing world to developed countries. This loss of health professionals contributes significantly to global health inequities. The issue has been framed in terms of ethical, financial, and infrastructural issues, and many attempts have been made to pose solutions that address the respective arms of this multifaceted phenomenon. This article seeks to explore the medical brain drain from a migrant physician’s personal perspective, contextualized with data and analysis from relevant literature. I conclude that adopting the mindset of “brain circulation” rather than “brain drain” will be a component in paving the way for multidisciplinary solutions to the problems that promote the migration of physicians from resource-limited settings.
Acute Obstructive Suppuration of the Pancreatic Duct Causing Sepsis
Authors: Yakubov Stanley , Braha Jack , Albert Joel , Rahmani Rabin , Mayer Ira , Tsirlin Yuriy
Published: January 2017

Objective: We report a rare case of acute obstructive suppuration of the pancreatic duct causing sepsis, which was successfully treated with emergent endoscopic retrograde cholangiopancreatography (ERCP). Methods: We describe the patient’s clinical presentation, laboratory test results, and imaging used for diagnosis and treatment. Results: A 33-year-old female with a history of recurrent acute pancreatitis was admitted during an episode of acute pancreatitis. Computed tomography (CT) scan of the abdomen revealed acute pancreatitis, diffuse pancreatic atrophy and pancreatic ductal dilatation with obstruction due to a soft tissue lesion within the distal duct. Shortly after admission she developed symptoms and signs of sepsis. Urgent ERCP was performed to further assess the suspected cholangitis. “Clean” bile emanated from the common bile duct, while copious purulent fluid was detected at the dilated pancreatic duct orifice, confirming suppuration of the pancreatic duct. A plastic single pigtail stent was placed traversing the ampulla and pancreatic duct stones that were causing the obstruction, which were later removed. After endoscopic decompression, the patient rapidly improved over the following 24 hours and had no subsequent admissions for pancreatitis.Conclusion: Acute suppuration of the pancreatic duct (ASPD) is a rare and potentially fatal infectious complication of pancreatic ductal obstruction with few cases reported in the English literature. It would be of interest to further investigate the exact pathophysiology leading to development of ASPD. The endoscopic methods of urgent ERCP and pancreatic duct decompression utilized in our case proved effective in successfully treating ASPD. This unusual condition should be considered in patients with acute pancreatitis who develop early clinical decompensation.
Pregunta de investigación y estrategia PICOT
Authors: Peñaherrera Oviedo Carlos , Soria Viteri Jaime
Published: January 2017

Cuando se observa un problema en la atención de la salud, y se desea encontrar la forma de solucionarlo, se origina una pregunta de investigación. Es esta interrogante la que dicta posteriormente cómo se llevará a cabo la investigación, qué diseño de estudio es el más adecuado para responderla y qué resultados se espera obtener. Por este motivo, es fundamental que todo investigador esté familiarizado con las estrategias para elaborar una pregunta de investigación, pues cada uno de sus componentes debe definirse. En la presente revisión se realizará una descripción sobre las características de una buena pregunta de investigación y su construcción mediante la estrategia conocida como PICOT. Además, se brinda una descripción de los posibles diseños epidemiológicos que pueden derivarse de esta pregunta, sus ventajas y desventajas. Esta información será importante para la correcta aplicación de la medicina basada en evidencia.
Registro retrospectivo de factores asociados al desarrollo de eventos cerebrovasculares en Guayaquil
Authors: Guzmán Adum Ivette , Mora Alarcón Carolina , Tettamanti Miranda Daniel
Published: January 2017

Antecedente: en el 2010 el INEC reportó que en Ecuador los eventos cerebrovasculares (ECV) constituyen la quinta causa de defunción (5.3 %). Se desconocen las formas más comunes de presentación clínica, evolución, y grado de discapacidad residual. Por consiguiente, la práctica médica se basa principalmente en estadísticas internacionales. Objetivos: diseñar un registro de Guayaquil-Ecuador sobre las características clínicas, sociales y factores asociados a pacientes que desarrollan un primer ECV, valorar el nivel de discapacidad funcional a causa del ECV. Métodos: el presente estudio de casos y controles denominado REPLACE es parte del estudio INTERSTROKE (2009-2011); se incluyeron 417 pacientes que acuden con su primer ECV, en un máximo de 120 horas desde el inicio de los síntomas hasta 72 horas luego de la admisión hospitalaria. Un número igual de sujetos de atención ambulatoria con características epidemiológicas similares a los casos se consideraron como controles (n=417). Los resultados se expresan como medias, porcentajes y odds ratios. Resultados: la edad promedio de los casos fue de 62.6 años. La tasa de mortalidad al mes de seguimiento fue del 33.5 % y 22.7 % para los ECV hemorrágicos e isquémicos respectivamente (p=0.014) y el grado de discapacidad residual promedio fue 3.8 y 3.4 respectivamente (p=0.3). El análisis de regresión logística determinó que el género femenino (OR 2.5; IC 95 %, 1.7-3.5), la diabetes mellitus (OR 1.9; IC 95 %, 1.3-3.0) y consumo de alcohol (OR 4.4; IC 95 %, 2.9-6-4), fueron factores vinculados a un mayor riesgo de desarrollar un ECV. Las dislipidemias en tratamiento (OR 0.5; IC 95 %, 0.3-0.7) y perímetro abdominal aumentado según el género (OR 0.4; IC 95 %, 0.3-0.6), disminuyen la probabilidad de tener un ECV. Conclusión: en esta muestra los factores que se asociaron para desarrollar ECV fueron similares a los descritos en la literatura médica; sin embargo, la ponderación de los mismos fue distinta.