bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Extra Mammary Paget’s Disease of Vulva, With Apocrine Adenocarcinoma, Signet Ring Cell Differentiation and Distant Metastasis
Authors: Rathore Ruchi , Yadav Deepika , Agarwal Shipra , Dudani Pankhuri , K Verma Kaushal , R Mathur Sandeep
Published: January 2021

Objective: Extramammary Paget's disease (EMPD) with invasive carcinoma and distant metastasis is extremely rare. In vulva EMPD associated apocrine carcinoma with signet ring cell differentiation has not been described in the literature so far. Its slow evolution, varied clinical presentation and histological appearances, lead to difficulty in diagnosis of this disease.
Case report: We hereby report a case of primary EMPD with invasive carcinoma and distant metastasis in a 59-year-old female who presented with erythematous indurated plaque over vulva. Histopathology revealed Paget cell infiltration throughout the epidermis with invasive carcinoma in dermis and liver metastasis on CECT. The immunohistochemical expressions of CK7, CK20, GCDFP-15, CEA, p40, CDX 2, Her-2/ neu, AR, ER, were examined to explicate the cellular differentiation of this carcinoma. According to the histological assessment, this case was diagnosed as primary EMPD with apocrine adenocarcinoma, signet ring cell differentiation, vulva.
Conclusion: Owing to poor prognosis, a high index of clinical suspicion along with histological and immunohistochemical assessment is of utmost importance in arriving at final diagnosis.
Simulação de processos de transferência de calor aplicada à indústria alimentícia com enfoque em produtos cárneos
Authors: Torres Isadora Vitoria Coelho , Souza Tainara Camila de , Siqueira Antonio Marcos de Oliveira
Published: January 2021

O objetivo desse artigo é o estudo dos processos de transferência de calor em produtos cárneos. A metodologia adotada foi o fracionamento da carne do tipo “coxão mole”, a construção de uma malha igualmente espaçada nas coordenadas x e y e a aferição das temperaturas nas regiões nodais em diferentes intervalos de tempo. A partir da temperatura calculada no tempo zero, pode-se prever as temperaturas nos demais tempos, utilizando o método explícito das diferenças finitas e, assim, foi possível comparar os resultados obtidos com as temperaturas experimentais.  Os erros encontrados entre os dados experimentais e os calculados foi da faixa de oitenta por cento, distorção que pode ser justificada pelos erros associados ao experimento. Ademais, por meio da aferição das temperaturas centrais pode-se estudar a cocção da carne e classificá-las como mal passadas, ao ponto ou bem passadas. Conclui-se que o experimento obteve êxito no estudo do método das diferenças finitas bem como na análise da importância dos fenômenos de transferência de calor na indústria alimentícia.
El amor como modo primordial de la existencia
Authors: Molina Pérez Sergio
Published: January 2021

El hombre siempre está en relación, no puede no estarlo. Su mera existencia implica la relación con Dios, consigo mismo, con los demás y con el cosmos. Si bien la modernidad invita al individualismo, también existe la posibilidad de fomentar un ser más abierto a relacionarse conscientemente para reconocer todo lo que lo rodea y entenderlo como bueno para sí mismo. El presente artículo problematiza el concepto de amor como modo primordial de la existencia humana a partir de un diálogo con distintos autores de la tradición filosófica y teológica, mediante una metodología hermenéutica y en el marco del diálogo entre la filosofía clásica, la teología católica y el personalismo filosófico, integrados por una cosmovisión cristiana en la que el amor es uno de los conceptos fundamentales. Como punto de partida y, a manera de introducción, se ofrece al lector un marco del concepto de amor y la justificación de la noción de amor como modo primordial. Posteriormente, se dedica un apartado a distintas concepciones del amor en la historia del pensamiento y se explica la importancia de la razón como facultad humana en la experiencia del amor contra visiones irracionalistas muy propias de la posmodernidad. En lo sucesivo, se sustenta la existencia del modo amor en la relación del hombre consigo mismo y en el marco de la alteridad, con base, principalmente, en la propuesta personalista. Por último, se define el amor como modo de relación con el cosmos, considerando que amar y cuidar el mundo que se habita es una de las características del hombre que vive el amor como modo primordial de la existencia.
THE MAPPING OF MOVEMENT VERBS FOUND IN THE GOOD EARTH
Authors: Juliarta I Made
Published: January 2021

This study aimed at focussing the translation of movement verbs in The Good Earth written by Pearl S. Buck. The Natural Semantic Metalanguage (NSM) is applied in translation process. The novel The Good Earth was chosen as data source because it has two texts which have different language types. This study has the purpose to describe the application of translation procedures that is proposed by Vinay and Darlbener and it is applied to examine the mapping of Action Verbs by the NSM (Natural Semantic Metalanguage) theory. The analysis was shown as the mapping between Indonesian and English action verbs which was presented into the subtype of the verbs based on the classification. This study attempts to apply that theory in solving the problem of the different language.  Semantic mapping (SM) is a method in statistics for dimensionality reduction that can be used in a set of multidimensional vectors of features to extract a few new features that preserves the main data characteristics. Translation is very important in various areas which are used to translate from one language into another language. However, it is not all the references written in Indonesian as they are coming from different countries and use different languages.
EFL-Writing Activities Using WhatsApp Group: Students’ Perceptions during Study from Home
Authors: Muthmainnah Nur , Azmina Badi'atul
Published: January 2021

This research aims to investigate writing activities using the WhatsApp group during the study from home amid the COVID-19 pandemic and students’ perceptions about it. It is a qualitative research, in which the data were analyzed descriptively. This research was carried out at the Sentence-Based Writing class at IAIN Salatiga, Indonesia, in April - June 2020. This research participant involved 30 students. The researchers utilized a questionnaire and documentation for data collection. After conducting the research, the results revealed various students’ perceptions. 63% of the total students possessed a positive perception toward the writing activities using the WhatsApp group, and the rest 37% of students’ preferred face-to-face meetings and perceived writing using WhatsApp group as boring, confusing, and distracting. After analyzing the WhatsApp group activities, at least five writing activities were conducted: sharing and explaining materials, discussing materials, composing sentences, editing sentences, and posting writing products. Thus, this research can definitely provide teachers with knowledge regarding students' perceptions and writing activities carried out in the WhatsApp group.
Some Regulatory Dilemmas of Artificial Termination of Pregnancy in Slovenian and Comparative Law
Authors: Žnidaršič Skubic Viktorija
Published: January 2021

The article deals with the issue of the artificial termination of pregnancy through the prism of, typically, conflicting relations between the subjects involved and their interests. It specifically addresses the most contentious and morally-ethically as well as legally complicated relationship between the pregnant woman (the future mother) and the embryo or pre-embryo. The article explains the positions of legal theory and jurisprudence in Slovenia and abroad regarding the status of an embryo as a legal person. The authoress moreover touches the question of legal status of the (potential future) father of such an embryo and presents regulations dealing with artificial termination of pregnancy in domestic and comparative law. Through a schematic summary of typical characteristics of such regulations around the world, which greatly differs in details, the author highlights their basic characteristics as well as individual trends in the field.
Relationship between a Doctor and a Patient with Mental Disorder
Authors: Plesničar Blanka Kores
Published: January 2021

Quality relationship between a doctor and a patient with mental disorder is pivotal to successful treatment. The doctor, the patient and the environment contribute numerous factors to this relationship. There are also ethical and legal aspects to consider, and above all, it is intrinsically linked with the patient's trust. However, the relationship between a doctor and a patient with mental disorder may lead to crossing professional boundaries and even to their violation. Crossing boundaries means deviating from normal standards of practice that does not exploit or harm the patient, and can be even beneficial to the later; violation of boundaries is harmful to the patient and serves primarily for satisfying the needs of the doctor. Education and learning ethical norms and communication techniques represent the foundation of all professional relationships.
E-documentation and Crossborder Healthcare
Authors: Sjeničić Marta
Published: January 2021

E-health is, in many European countries, one of the health care areas that are in the fastest development, due to the endeavor to apply modern information and communication technologies for the purpose of meeting the needs of citizens, patients, health professionals and the health policy creators. E-health potentials are virtually endless and can reach from the delivery of health information and health controle over the internet, through on-line consultations, issuing of drugs through electronic devices, till robotised surgeries or care of elderly population. European Union works actively in this field through different conventions and directives related to the patients’ rights in cross-border healthcare, but also protection of individuals with regard to the processing of personal data. One of the most recent and important documents in this field was Working Document 01/2012 on epSOS (Article 29 Data Protection Working Party), which was enacted January, 2012, and which was the basis for so-called epSOS project that has been impelemented from July 1, 2008 till June 31, 2014. The main objective of epSOS project is to shape, establish and evaluate the infrastructure of services which would enable the crossborder operability between the system of electronic health documentation in Europe. epSOS project aims to develop practical frame for e-health and information-communication infrastructure that would be basis for the safe access to the information on patients' health, in the diferent European health systems.
Comparative Analysis of ART in the EU: Cross-border Reproductive Medicine
Authors: Stanić Gordana Kovaček
Published: January 2021

The need for cross-border reproductive medicine exists for several reasons. Some are due to the fact that some states do not permit particular ART procedures; thus couples travel to the state where needed procedure is allowed (surrogate motherhood, embryo donation, posthumous fertilization). Other situations are due to the fact of who is entitled to ART procedures. In some states ART procedures are not allowed to same-sex couples or a single woman. The consequence of the cross-border reproductive medicine might be that the born child becomes parentless (“limping legal parentage”) and stateless. Since the best interest of the child is the paramount principle in contemporary family law, it is most important to find solutions for these situations. The most complicated issues are the consequences arising from international surrogacy arrangements. The Hague Conference on private international law is working on these issues trying to find the best solutions.
Patient Safety in Cross-border Care
Authors: Turk Eva , Leyshon Stephen , Pytte Morten
Published: January 2021

Patient safety is a right and it raises particular issues in the context of cross-border care. Patients should be able to have trust and confidence in the healthcare structure as a whole; they must be protected from the harm caused by poorly functioning health systems, medical errors and adverse events. This paper addresses the state of cross-border healthcare in the European Union, the state of patient safety, the question of quality assurance and the role of accreditation as a risk based approach.
Virtual autopsy in legal medicine: literature review and example of application on the mummified remains
Authors: Kružić Ivana , Jerković Ivan , Mihanović Frane , Marušić Ana , Anđelinović Šimun , Bašić Željana
Published: January 2021

The virtual autopsy and post-mortem imaging methods are relatively novel methods used in medicine to determine cause and manner of death. They can also be exceptionally useful in the process of identification. Although they have numerous advantages, they are still not implemented in practice to a sufficient extent because the methodology has not yet been validated, and studies that deal with legal and practical implications of those methods are relatively scarce. In this article we describe basic principles and advantages of the methodology, explore related legal and practical issues, and present a case of virtual autopsy in practice on the mummified remains of St. Ivan Olini from Church of St. Blaise in Vodnjan (Croatia).Virtualna obdukcija in postmortalna metoda slikanja sta relativno novi metodi v medicini za ugotovljanje vzroka in načina smrti. Izjemno koristni sta lahko tudi v procesu identifikacije. Kljub številnim prednostim pa se v praksi še vedno ne izvajata v zadovoljivem obsegu, ker metodologija še ni potrjena, študije, ki se ukvarjajo s pravnimi in praktičnimi posledicami teh metod, pa so redke. V tem članku so opisana temeljna načela in prednosti metodologije, preučevana so pravna in praktična vprašanja ter predstavljen primer virtualne obdukcije v praksi na mumificiranih ostankih sv. Ivana Olinija iz cerkve sv. Blaža v Vodnjanu (Hrvaška).
Blood pressure variability — regular and irregular waves
Authors: Tsyrlin V. A. , Kuzmenko N. V. , Pliss M. G.
Published: January 2021

The review presents data on regular and irregular waves of blood pressure (BP) recorded during its invasive (intra-arterial) and non-invasive registration. Regular pulse waves, Traube-Hering waves (second-order waves) and Mayer waves (third-order waves) are described. The characteristic of circadian and ultradian super slow waves is given. The role of the sympathetic nervous system in the origin of regular waves of BP and their relationship with the magnitude of the baroreceptor reflex are shown. Attention is drawn to the role of changes in the minute volume of blood circulation and peripheral resistance to blood flow in the occurrence of fluctuations in BP. We also review the methods and features of BP registration, which enable identification and analysis of irregular high-frequency fluctuations in BP, the relationship of these fluctuations with the magnitude of the baroreceptor reflex and the activity of the sympathetic nervous system. The data on the amplitude of high-frequency irregular fluctuations in BP in animals with simulated hypertension are presented. The review draws attention to the possibility of recording regular fluctuations in BP during its constant non-invasive registration.
Assessment of cardiovascular risk and prevention of complications in non-cardiac surgery in patients with coronary heart disease
Authors: Panov A. V. , Kuleshova E. V. , Lokhovinina N. L. , Alugishvili M. Z. , Abesadze I. T. , Titenkov I. V. , Kudaev Yu. A.
Published: January 2021

The incidence of cardiovascular complications in non-cardiac surgery is about 3 %. The review presents the data on the assessment of cardiovascular risk (CVR) in non-cardiac surgery. The algorithm of decisionmaking considers the functional state of the patient and the category of CVR of the upcoming surgery. Functional testing is not indicated for patients with low CVR. Stress tests should be considered in high-risk patients if the test results may change the perioperative drug therapy, the method of anesthesia, or the surgical approach. Routine coronary revascularization does not reduce perioperative risks and is used for special indications. Percutaneous coronary intervention and associated dual antiplatelet therapy may delay the timing of non-cardiac operations. Perioperative drug therapy (beta-blockers, aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins) should be prescribed taking into account the individual risk of the patient.
Change in the aortic pulse wave velocity in children with familial hypercholesterolemia
Authors: Galimova L. F. , Sadykova D. I. , Slastnikova E. S. , Marapov D. I.
Published: January 2021

Background.Familial hypercholesterolemia (FH) is the genetic disease characterized by an increase in the levels of total cholesterol and low density lipoproteins since childhood.The aim of the studywas to assess arterial stiffness in children with heterozygous FH by measuring pulse wave velocity (PWV) in the aorta.Designand methods.The study involved 118 children. Of these, 60 healthy children were in the control group and 58 children with the diagnosis of heterozygous FH were included in the main group. Both groups were divided into 3 age subgroups: from 5 to 7 years old, from 8 to 12 years old and from 13 to 17 years old. The diagnosis of FH was made according to the British criteria by Simon Broome. The lipid profile was determined for all children, blood pressure was monitored daily with the estimate of the minimum, average and maximum PWV (PWVmin, PWVav, PWVmax) in aorta using oscillometric method.Results.In the younger age subgroup (5–7 years), there were no significant differences in PWV between main and control groups. In children aged 8–12 years, the main group was characterized by significantly higher values of maximum PWV compared to healthy peers — 5,1 [4,7–5,8] and 4,6 [4,45–5,05] m/s, respectively (p = 0,041). In group of children with FH aged 13–17 years, compared to the control group, a significant increase in the minimum PWV was observed — 4,7 [4,1–5,1] and 3,9 [3,5–4,1] m/s, respectively (p = 0,009), average PWV — 5,5 [4,8–6,4] and 4,5 [4,2–4,9] m/s, respectively (p = 0,009), and maximum PWV — 6,2 [5,7–7,55] and 5,4 [5,05–5,6] m/s, respectively (p = 0,007). Correlation analysis in patients with FH showed direct correlation between PWVmin, PWVav and PWVmax with total cholesterol (r = 0,46, r = 0,46 and r = 0,464, respectively, p < 0,001).Conclusions.Our study demonstrates an increase in the PWV in the aorta in children with FH compared with healthy peers from 8–12 years of age. There is a further progression of arterial stiffness with an increase in the minimum, average and maximum PWV most significant in the group of 13–17 years.
The relationship of folate deficiency, hyperhomocysteinemia and glutathione metabolism in hypertensive patients
Authors: Aleksandrova L. A. , Subbotina T. F. , Zhloba A. A.
Published: January 2021

Hypertension (HTN) is often accompanied by folic acid (FA) deficiency and hyperhomocysteinemia (HHcy). Reduced glutathione (GSH) and dependent enzymes determine the state of cellular antioxidant and redox systems in cardiovascular pathology. The aim of our work is to assess the relationship between the status of FA and the presence of HHcy with enzymes of glutathione metabolism and the redox state of erythrocyte glutathione in HTN. Design and methods. In blood plasma samples from 43 HTN patients admitted to the clinic of Pavlov University, the concentration of FA and total homocysteine (oHcy) was determined. We also evaluated the level of GSH, the activity of glutathione peroxidase and glutathione reductase (GR) in erythrocytes. Results. In the whole group, GR activity positively correlated with the concentration of FA (R = 0,415; p = 0,001). A significant decrease in GR activity (U/g Hb) was found in the subgroup with the low level of FA [0,8 (0,5–1,1)] compared with the subgroup without a FA deficiency [1,2 (0,9–2,0)]. The GSH level (μM/g Hb) was also lower (p < 0,018) in the subgroup with FA deficiency [1,3 (0,9–2,1)] compared with the subgroup with normal FA levels [1,8 (1,5–4,6)]. A significant decrease in the level of GSH and GR activity in the subgroup with HHcy was found compared with the corresponding parameters in the subgroup without HHcy. However, even in the absence of HHcy patients with FA deficiency demonstrated a significant decrease in GR activity compared to patients without FA deficiency. In this case, GR positively correlated with FA (R = 0,564; p = 0,03). Conclusions. The deficiency of FA can increase the deficiency of GR activity, regardless of the level of oHcy. The indicator of GR activity in erythrocytes can be considered as a possible marker of functional deficiency of FA in the absence of HHcy.
Personality type D, stress reactivity and autonomic balance in healthy young people: gender and ethnic characteristics
Authors: Sumin A. N. , Prokashko I. Yu. , Shcheglova A. V.
Published: January 2021

Objective. To assess the association of personality type D with stress reactivity and autonomic balance among medical students, depending on gender and nationality. Design and methods. The study included 188 healthy students aged 18 to 23 years (median 18,0 ± 1,0 years), Russian speakers and residents of India. To determine the type of personality D used questionnaire DS-14. All examined were divided into two groups: with the presence of personality type D (n = 67) and without personality type D (n = 121). Additionally, groups of male students with type D (n = 24) and without type D (n = 63) and female students with type D (n = 43) and without type D (n = 58) were identified. We evaluated the psychophysical stress test “Mathematical Account” and indicators of variational pulsometry at rest. Results. When examining medical students, personality type D was detected in 27,5 % girls and 42,6 % boys (p = 0,03). When analyzing ethnic differences among Indian students, type D was detected in 42,6 % cases, among Russian-speaking students in 32,8 % (p = 0,21). Among the examined, there was no effect of type D on the test with an oral count, in the whole cohort, as well as in boys and girls. Logistic regression analysis in young men showed a pronounced relationship between Indian nationality and the presence of personality type D (p < 0,001). Conclusions. The influence of multidirectional factors (gender, nationality) can offset the influence of personality type D on the studied psychophysiological mechanisms and determine the heterogeneity of the influence of personality type D on the course of the disease in the general cohort.
Antihypertensive therapy features in multimorbid outpatients
Authors: Izmozherova N. V. , Popov A. A. , Bakhtin V. M. , Shambatov M. A.
Published: January 2021

Objective. To assess the characteristics of antihypertensive therapy (AHT) in outpatient patients in relation to comorbidities and multimorbidity level. Design and methods. A cross-sectional study included 140 patients with diagnosed hypertension (HTN). We performed a standardized complaints and medical history registration, questionnaire survey, anthropometry, office blood pressure (BP) assessment. Based on Charlson index the patients were divided into 2 groups: group 1 with moderate multimorbidity (≤ 4 points), group 2 with high multimorbidity level (≥ 5 points). The data are presented as median and proportions with bi-directional 95 % confidence interval. Results. In the sampling of 100 (64,3 71,4 78,6 %) women and 40 (21,4 28,6 35,7 %) men median age was 65 68 70, median Charlson index was 4 5 5. Group with moderate multimorbidity included 63 patients. High multimorbidity group included 77 subjects. HTN degree did not differ between the groups. Subjects from group 2 had higher level of cardiovascular risk (χ2 = 17,2, df = 2, p = 0,00018) and were more likely to have a history of HTN-associated clinical conditions (χ2 = 27,1, df = 2, p = 0,00000). By the time of examination, AHT was started in 137 (95,097,9 100,0%) patients. Monotherapy was ongoing in 20 cases (8,814,3 20,4%), combined AHT was prescribed to 117 (79,6 85,4 91,2 %) persons: 50 (21,2 36,5 43,8 %) patients received 2 drugs, 67 (40,9 48,9 56,9 %) patients received ≥ drugs. Number of antihypertensive drugs was higher in patients of group 2 than in group 1 (χ2 = 6,7, df = 2, p = 0,036). Drug number was not associated with HTN degree (χ2 = 3,8, df = 4, p = 0,44). Patients from group 2 were more likely to take β1-blockers (p = 0,027) and moxonidine (p = 0,042). Non-steroid anti-inflammatory drugs (NSAIDs) reduced the frequency of achieving the target BP level in patients treated by angiotensin converting enzyme inhibitors (p = 0,002). The frequency of achieving target BP was 42,9 50,7 58,6 %, it was independent of the number of prescribed drugs (p = 0,07) and did not differ in the groups of moderate and high multimorbidity (p = 0,87). Conclusions. Multimorbid patients require combined antihypertensive drugs to control hypertension. Multimorbidity level, comorbidities and drug-to-drug interactions should be taken into account during individualized HTN management. NSAID significantly affect the effectiveness of antihypertensive therapy.
Calendar Effects in the Stock Markets of Central European Countries
Authors: Szymański Marek , Wojtalik Grzegorz
Published: January 2021

The efficient market hypothesis suggests that there are no opportunities to gain above‑normal profits using available information, because it is all reflected in the prices. However, calendar anomalies are found to contradict the efficient market hypothesis and enable investors to predict prices during specific days. Based on a review of papers on market efficiency and market anomalies, this paper examines and compares calendar effects known as ‘the month‑of‑the year effect’ and ‘the day‑of‑the‑week effect’ between the stock markets of three Central European countries: Poland, Hungary and the Czech Republic. The study has revealed the presence of calendar anomalies in the indexes representing small‑cap stocks listed on the Polish stock market and, to some extent, in the indexes used in the Hungarian and Czech stock markets.
Comparative Assessment of Troponin T, Atrial Natriuretic Peptide, B-type Natriuretic Peptide and Echocardiography in the Diagnosis of Cardiac and Renal Disorders in Canine
Authors: Mahendran K. , Thakur Neeraj , Chethan G.E. , . Priyanka , Choudhary Shyam Sundar , Dey S. , Saxena A.C. , Mahajan Sumit , Kavitha K.
Published: January 2021

Background: Canine cardiovascular problems are commonly seen in veterinary medicine. Cardiac abnormalities in canine can be diagnosed by various means like electrochardiography, radiography, blood pressure measurement, echocardiography and biomarkers like troponins and peptides specific for heart. Methods: The present study was conducted to evaluate different biomarkers such as cardiac troponin T (cTnT), atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) for the diagnosis of cardiac diseases in comparison to echocardiography in canine. A total of 40 cases were included in the study, out of which 26 cases found to be positive for cardiac affections as confirmed by echocardiographic examination. Result: The serum concentration of cTnT and BNP were found significantly (P less than 0.05) elevated in dogs having cardiac as well as cardiac along with renal affections. ANP values were significantly (P less than 0.05) increased in dogs having both cardiac and renal diseases as compared to dogs with cardiac diseases only. Biomarkers like cTnT, ANP and BNP were compared with echocardiography (gold standard). The BNP was having the highest sensitivity (88.46%) and specificity (78.57%) as compared to cTnT and ANP. From the study, it is concluded that BNP can be used as suitable biomarker than cTnT and ANP for the diagnosis of cardiac diseases in canine. It can be used as a biomarker for cardiac diseases under field conditions where facilities for echocardiography are not available.
Assessment of Adverse Effects of Lead, Nickel and Cadmium on Biochemical Parameters, Antioxidants Status and Metallothionein Expression in Buffaloes Slaughtered at Local Abattoir
Authors: Bhardwaj Himalaya , Singh Chanchal , Nayyar Shashi
Published: January 2021

Background: With the pace of industrialization, heavy metal level has been increasing in animals thereby causing deleterious effects, which emanate as public health concern, associated with their accumulation in food chain. The present study was undertaken to assess the systemic damage caused by heavy metals in buffaloes. Methods: The assessment of adverse effects of the lead (Pb), nickel (Ni) and cadmium (Cd), in blood was determined by monitoring the levels of biochemical parameters, antioxidants and expression of metallothionein in buffaloes. Blood and tissue (liver, kidney, pancreas and ovary) samples (n=50) were collected from local abattoir to estimate the levels of lead, nickel and cadmium using atomic absorption spectrophotometry. Antioxidants and biochemical parameters were estimated using standard procedures and while the expression of metallothionein-2 was analyzed using real-time PCR. Result: After determining the concentration of heavy metals in samples the buffaloes were classified as heavy metal exposed and non-exposed groups. The plasma level of heavy metals were found to be significantly (p less than 0.05) higher than the permissible limit in exposed buffaloes. In tissues, heavy metals levels were within the permissible limits. Malondialdehyde level in each of lead, nickel and cadmium exposed groups was significantly (p less than 0.05) higher than the non-exposed, control group. The antioxidant activity of superoxide dismutase, catalase and glutathione was found to be increased significantly (p less than 0.05) in exposed groups. Also, plasma glucose, cholesterol, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), lactic dehydrogenase (LDH), creatine kinase (CK), urea and creatinine levels were found to be significantly higher (p less than 0.05) in the blood of the animal model used for the study. The fold change expression of MT-2 in blood was found to be at maximum level in cadmium and minimum in nickel exposed buffaloes. It can be concluded from the results of the experiment that heavy metals affect major organs (liver, kidney and muscle etc.) as evident by altered intracellular expression of MT-2, antioxidants and biochemical parameters.
Educational Intervention for Bupropion Abuse Prevention
Authors: Debeltz Brittany
Published: January 2021

Background

Bupropion is being abused due to effects that are comparable with methamphetamine and cocaine. Current research indicates several interventions that can prevent prescription medication abuse.

Objectives

A research study was performed at two healthcare organizations to evaluate whether education on prevention-based interventions increased self-efficacy of healthcare staff in addressing potential and ongoing bupropion abuse and whether the education reduced the rate of bupropion prescribing.

Methods

The study sample consisted of 43 staff members who completed a paper-based preeducation survey, attended a 1-hour educational session, and completed a paper-based posteducation survey.

Results

There was a 42% increase in total staff self-efficacy scores along with significant differences between pre-/postsurvey scores (p ≤ .001). After education prescribers answered they plan to change prescribing practices and the number of bupropion prescriptions filled decreased.

Conclusions

The research findings suggested that education on interventions for bupropion abuse prevention improved healthcare staff self-efficacy in the management of potential and ongoing bupropion abuse, influenced prescribing practices of prescribers, and decreased the number of bupropion prescriptions. This research can be used to continue providing education to help prevent further cases of bupropion abuse.

Implications for Nursing

Future practice recommendations should include education on bupropion abuse and implementation of prevention interventions to reduce the occurrence of the abuse of bupropion.
The Impact of Nurse Education on Heart Failure Readmissions and Patient Education
Authors: Mattina Kimberly , Dabney Beverly W. , Linton Mary
Published: January 2021

Background

Heart failure (HF) has become a national concern, with approximately 5.7 million adults in the United States suffering from this life-altering disease. Improved education of these patients prior to discharge helps patients manage their disease adequately and reduce symptom exacerbations.

Objective

This quality improvement initiative aimed to determine the effectiveness of an educational intervention in improving nurses’ knowledge of HF discharge teaching and documentation of this education in patient charts.

Methods

This project was conducted at a Magnet-recognized acute care hospital with 39 critical care step-down beds. Twenty-nine nurses employed on the step-down unit participated in the educational intervention. Pre/post nurse knowledge and chart review data were analyzed.

Results

There was a statistically significant increase in the percentage of patients receiving HF education from unit nurses from preintervention 77.0% (n = 81) to postintervention 96.4% (n = 138) (p < .001). There was also a statistically significant increase in the mean number of days patients were educated from 1.64 to 2.58 days (p < .001). Nurse knowledge also increased from pretest (69.7%) to posttest scores (100%) (p < .001).

Conclusions

Providing HF educational opportunities enhanced nurse knowledge and increased their documentation of HF education in patient charts.

Implications for Nursing

Nurse educators may use the study results to improve nurse education and practices aimed at reducing HF readmissions.
The Impact of Telephonic Follow-Up Within 2 Business Days Postdischarge on 30-Day Readmissions for Patients With Heart Failure
Authors: Chestnut Victoria M. , Vadyak Karen , McCambridge Matthew M. , Weiss Michael J.
Published: January 2021

Background

Heart failure (HF) is a chronic condition associated with high rates of hospital readmissions. The prevalence and costs of HF are expected to rise dramatically by 2030 (Heidenreich,et al., 2013).

Objective

A 24-month, retrospective study was conducted using electronic medical record (EMR) chart review, seeking to identify if postdischarge follow-up phone calls decreased 30-day readmissions in individuals with HF.

Methods

The study included 705 adult participants who were admitted to the hospital for HF. Some received a postdischarge call within 2 business days of discharge, and some did not.

Results

Participants who received the postdischarge call were less likely to be readmitted (20.1%) than participants who did not receive a postdischarge call (28.8%; p = .007). Participants who received the postdischarge call were more likely to have a follow-up visit within 14 days (70.1%) than participants who did not receive a postdischarge call (30.2%; p < .001).

Conclusions

The findings from this study may help to drive future transitional care strategies for individuals diagnosed with HF.

Implications for Nursing

Nurse-led transitional care interventions offer potential solutions to ensure safe, effective hospital discharges.
Flipping the Classroom to Optimize Clinical Decision-Making in the Didactic Setting
Authors: Arca-Contreras Karen Marie
Published: January 2021

Background

Deliberate inclusion of clinical decision-making nursing skills in the didactic setting will assist students in potentially making better patient care decisions. This can be optimized through use of the flipped learning andragogy. Flipped learning promotes an interactive classroom environment. It fosters teamwork and collaboration. Direct content instruction is the responsibility of students.

Objective

This cohort pilot study investigated how the flipped and nonflipped approach to teaching impacted clinical decision-making and student participation.

Methods

The Clinical Decision-Making in Nursing Scale (CDMNS) was administered to the students in the flipped classroom and the nonflipped classroom on week 1 and week 6. A student participation checklist was used to observe class activities at three separate intervals (baseline, mid-semester, and end-semester). A repeated measures analysis of covariance was conducted with Instruction Group as the between subjects factor (Flipped and Nonflipped) and Time (preinstruction and postinstruction) as the within subjects factor, and covarying age. The Time by the Instruction group was significant. The Flipped group showed an increase in Clinical decision-making scores (p < .001) after instruction while the Nonflipped group did not (p = .40).

Results

The Flipped group (n = 24) showed an increase in Clinical decision-making scores (p < .001) after instruction while the Nonflipped group (n = 23) did not (p = .40). The Flipped classroom showed 100% participation at baseline, mid-semester, and end of semester. The Nonflipped classroom showed overall lower levels of participation, with 42%, 33%, and 39% at each point respectively.

Conclusion/Implications for Nursing

Students who were taught using the flipped instruction were able to apply what they learned in relevant case studies, virtual simulations, and practice National Council Licensure Examination RN (NCLEX-RN) type questions. Through teamwork and collaboration, students had time to practice clinical decision-making skills. This was evident in the increased CDMNS scores and increased levels of participation over time in the flipped group when compared to the nonflipped group.
Remisyonda olan romatoid artritli hastada tedavi kararı
Authors: YAZICI Ayten
Published: January 2021

Romatoid artrit (RA) erişkinde en sık görülen inflamatuar artrit olup, tedavisinde remisyon veya düşük
hastalık aktivitesi hedeflenmektedir. Bu nedenle öncelikle RA’da kalıcı remisyon tanımının ve süresinin
kesin olarak belirlenmesi gerekmektedir. Mevcut önerilere göre en az altı aydır remisyonda olan ve
sabit dozda hastalık modifiye edici ilaç (DMARD) kullanan hastalarda doz azaltılması önerilmektedir.
Özellikle anti-siklik sitrüline peptid sonucu negatif, inflamatuar belirteçleri normal olan ve
ultrasonografide aktif inflamasyonu olmayan hastalarda steroid kesildikten sonra biyolojik DMARD
dozu veya sıklığının azaltılması, sonrasında konvansiyonel DMARD ile kombine kullanan ve halen
remisyonda olanlarda biyolojik DMARD’ın kesilmesi relaps açısından daha güvenli görünmektedir. Tek
başına konvansiyonel DMARD kullananlarda ise sadece doz azaltılması önerilmektedir.
Diffüz alveoler hemoraji
Authors: TAŞBAKAN Mehmet Sezai
Published: January 2021

Diffüz alveoler hemoraj (DAH) pulmoner mikro-sirkülasyondan kaynaklanan, sıklıkla sistemik bir
vaskülitin neden olduğu, alveol içine eritrosit birikmesidir. DAH etiyolojisinde immün ve non-immün
nedenler sorumludur. Hemoptizi ve nefes darlığı en sık karşılaşılan klinik semptomlardır. Akciğer
grafisinde bilateral buzlu cam dansiteleri izlenir. Hemogram, böbrek fonksiyon testleri ve immünolojik
belirteçler tanıya yardımcı laboratuvar testleridir. Bronko-alveoler lavaj sıvısının makroskopik ve
mikroskobik bulguları ile tanı konulur. Tedavisinde altta yatan hastalığın tedavisi yanı sıra, yüksek doz
kortikosteroid başta olmak üzere immünsupresif tedavi önem taşır.
Biyobenzer ilaçların preklinik ve klinik performanslarının değerlendirilmesi
Authors: BOZKURT Turgut Emrah
Published: January 2021

Biyoteknolojik ilaçlar doku veya hücre kültürleri gibi canlı organizmalar aracılığıyla genellikle rekombinant DNA teknolojisi kullanılarak üretilen kompleks, büyük moleküllerdir. Biyobenzerler daha önce onaylanmış olan referans biyolojik ilaçlara yüksek oranda benzeyen biyolojik ilaçlardır. Biyobenzer ilaçların referans ilaca kalite, etkililik ve güvenlilik açısından benzerliğinin gösterilmesi küçük moleküllerle karşılaştırıldıklarında çok daha karmaşık bir süreçtir. Ulusal ve uluslararası kılavuzlar biyobenzerlerin performanslarının değerlendirilebilmesi için genel bir çerçeve oluşturmuşlardır. Ancak, biyoteknolojik ilaçların sayılarının fazlalığı ve etki mekanizmalarının çeşitliliği bu ürünlerin performanslarının değerlendirilmelerini karmaşık bir hale getirmektedir. Bu makalede biyobenzerlerin eşdeğerliğini değerlendirmek için önemli noktalar son gelişmeler ve ilgili kılavuzlar doğrultusunda sunulmuş ve tartışılmıştır.
Kırmızı göz ayırıcı tanısı - oküler yüzey nedenleri
Authors: PALAMAR Melis
Published: January 2021

Bu makalede kırmızı gözün oküler yüzey ilişkili sık görülen nedenleri tartışılacaktır.
Romatoid artrit - tedavi prensipleri: Ne zaman geçiş yapalım?
Authors: ARSLAN Didem
Published: January 2021

Romatoid artrit, esas olarak sinoviyal eklemleri tutan kronik, sistemik, inflamatuvar eklem hastalığıdır. Erken tanı konması, yüksek hastalık aktivitesi, otoantikor pozitifliği ve erken eklem hasarı gibi kötü prognostik faktörlere sahip hastalarda optimal terapötik başarı için anahtardır. Tedavi algoritmalarında, kompozit indeksler ile hastalık aktivitesi ölçümleri, treat-to-target tedavi stratejileri ve tedavilerin etki ve yan etkiler açısından uygun şekilde izlemleri yer alır. Remisyon veya en azından düşük hastalık aktivitesi olarak belirlenen tedavi hedefi sağlanana kadar tedavi modifikasyonları yapılmalıdır. Hedef sağlandığında ve sürdürülebildiğinde, doz azaltımına gidilebilir. Çoğu hastada tedavi yanıtları kabul edilebilir düzeylerde olsa da, mevcut tedavilere yanıt her zaman mümkün olamamaktadır. Gelecekte yapılacak daha kapsamlı çalışmalar ile bireyselleştirilmiş tedavilerin geliştirilmesi mümkün olabilecektir.
Economic Policy of Japan in the Time of Pandemic
Authors: Belov A.
Published: January 2021

In the initial period of the COVID 19 pandemic (February–September 2020), Japan succeeded in minimizing the mortality rate and reducing the damage to the economy. The Japanese experience has both positive and negative aspects. Among the G7 countries, Japan recorded the best иге among the states of East Asia the worst indicators of overall and excessive mortality. From an economic perspective, the pandemic strongly affected inbound and outbound tourism, which will take years to recover. Employment opportunities in the tourism and other contact-intensive industries will be reduced by approximately one million jobs, primarily affecting part time and temporary workers. At the same time, the overall unemployment rate will hardly exceed one-third of the OECD average generally because of the ample financial support, long-term commitments among core employees in Japan, and job retention practices of domestic companies. In the macroeconomic realm, the Japanese government embarked on an extension of quantitatively easing measures of monetary expansionary steps in fiscal sphere and universal stimulus in growth-enhancing structural policies. This approach actually follows the logic of a long-standing reflationary Abenomics, which is expected to continue despite the abrupt resignation of S. Abe. At least, Japan’s newly elected Prime Minister Yo. Suga has indicated his support for current monetary and fiscal policies. He also hinted at a need to reduce the administrative red tape and to accelerate the digitalization in the economy. The package of anti-crisis measures in Japan turned out to be one of the largest in the world, and its implementation could increase the budget deficit and public debt, that is, cause the emergence of problems relevant to most other countries.
Globalization and Nation-State: Yesterday, Today, Tomorrow
Authors: Kuvaldin V.
Published: January 2021

The fairly common pandemic of the coronavirus has paralyzed the global world. The material damage it inflicted amounts to trillions of dollars. It is unclear how long it will take for humanity to overcome the consequences of the most serious socio-economic crisis after the World War II. The contours of the “new normal” after the pandemic are even vaguer. The “perfect storm” of the pandemic was created by a combination of three destructive forces: the coronavirus, the cyclical crisis of the economic conjuncture, and the nefarious trends of neoliberal globalization. The political practice of neoliberalism in recent decades, which has brought the world a number of significant achievements, has created a tangle of intractable contradictions in all areas of modern life. Both of its main drivers – capital accumulation on the basis of expanded reproduction and the global hegemony of the Anglo-Saxon elite – were called into question. Issues such as a more equitable distribution of the created wealth and expanding the membership of the elite club of global regulation are going to the forefront. At the same time, protecting the environment and preventing other cataclysms that threaten the well-being and even the very existence of mankind have become urgent imperatives of the political agenda. However, it seems that the world elite is not ready for a profound correction of the existing world order yet. The most likely scenario for the foreseeable future seems to be attempts, in one form or another, to return to the unconditional hegemony of the collective West under the aegis of the United States in world affairs. This portends a turbulent decade filled with conflicts of varying severity and duration. Although there is a fundamental possibility of another, much more positive scenario for the development of globalization processes. In it, the coordinated actions of national and global elites would focus on finding solutions to the most pressing problems of the world community, namely environmental protection, human rights upholding, the unhindered development of world trade, the prevention of pandemics, and the fight against terrorism.
Security Modus Operandi of the Northern Europe
Authors: Voronov K.
Published: January 2021

The article analyses the complex influence of dangerous changes, which took place after 2014 in the international political environment in Europe, on the ongoing transformations, suggests essential revision of national policies of the five Nordic countries (Denmark, Norway, Iceland, Sweden and Finland) in the field of their security and defenсe. The degree of military and political tension in the North of Europe has increased significantly after 2014. The conflict is escalating due to additional deployment within the so-called reinforcement of the “eastern flank” of the Alliance with three allied battalions, and NATO weapons in the Baltic States and Poland. However, great strategic stability in the zone of direct contact between NATO and Russia is still possible to maintain. The international political situation in the subregion has also deteriorated markedly as a result of the U.S., NATO and EU sanctions policy against Russia, strengthening of transatlantic relations of the Nordic countries, and reinforcement of allied ties within the framework of the Western bloc policy as a whole. It noted signified not only a revision in favor of further strengthening of transatlantic ties in the policy of bloc allegiance of the Nordic countries – members of NATO (Denmark, Norway, Iceland), but also an obvious intensification of practical cooperation between formally non-aligned states (Sweden and Finland) with the Alliance structures. The Nordic Defenсe Cooperation (NORDEFCO) has also started to acquire a risky pro-Atlantic style, losing its previous autonomous subregional nature. Apparently, in the present complex situation, the Nordic Five is disposed to solve security and defence problems by: 1) having a greater many-sided cooperation with NATO; 2) giving a real, limited meaning to the European Union in the military-political sphere; 3) continuing to bear pressure upon Russia for the purpose of limiting Russian influence in the subregion, especially in the Baltic region. In the near future, the problem of NATO accession for Sweden and Finland may remain in the same precarious condition unless some dangerous force majeure circumstances occur in the Baltic region.