bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurosurgeons’ opinions on the prenatal management of myelomeningocele
Authors: Gadjradj Pravesh S. , Spoor Jochem K. H. , Eggink Alex J. , Wijnen René , Miller Jena L. , Rosner Mara , Groves Mari L. , DeKoninck Philip L. J. , Harhangi Biswadjiet S. , Baschat Ahmet , van Veelen Marie-Lise , de Jong Tjeerd H. R.
Published: October 2019

OBJECTIVE

Improvements in imaging and surgical technological innovations have led to the increasing implementation of fetal surgical techniques. Open fetal surgery has demonstrated more favorable clinical outcomes in children born with open myelomeningocele (MMC) than those following postnatal repair. However, primarily because of maternal risks but also because of fetal risks, fetal surgery for MMC remains controversial. Here, the authors evaluated the contemporary management of MMC in the hope of identifying barriers and facilitators for neurosurgeons in providing fetal surgery for MMC.

METHODS

An online survey was emailed to members of the Congress of Neurological Surgeons (CNS) and the International Society for Pediatric Neurosurgery (ISPN) in March 2019. The survey focused on 1) characteristics of the respondents, 2) the practice of counseling on and managing prenatally diagnosed MMC, and 3) barriers, facilitators, and expectations of fetal surgery for MMC. Reminders were sent to improve the response rate.

RESULTS

A total of 446 respondents filled out the survey, most (59.2%) of whom specialized in pediatric neurosurgery. The respondents repaired an average of 9.6 MMC defects per year, regardless of technique. Regardless of the departments in which respondents were employed, 91.0% provided postnatal repair of MMC, 13.0% open fetal repair, and 4.9% fetoscopic repair. According to the surgeons, the most important objections to performing open fetal surgery were a lack of cases available to become proficient in the technique (33.8%), the risk of maternal complications (23.6%), and concern for fetal complications (15.2%). The most important facilitators according to advocates of prenatal closure are a decreased rate of shunt dependency (37.8%), a decreased rate of hindbrain herniation (27.0%), and an improved rate of motor function (18.9%). Of the respondents, only 16.9% agreed that open fetal surgery should be the standard of care.

CONCLUSIONS

The survey results showed diversity in the management of patients with MMC. In addition, significant diversity remains regarding fetal surgery for MMC closure. Despite the apparent benefits of open fetal surgery in selected pregnancies, only a minority of centers and providers offer this technique. As a more technically demanding technique that requires multidisciplinary effort with less well-established long-term outcomes, fetoscopic surgery may face similar limited implementation, although the surgery may pose fewer maternal risks than open fetal surgery. Centralization of prenatal treatment to tertiary care referral centers, as well as the use of sophisticated training models, may help to augment the most commonly cited objection to the implementation of prenatal closure, which is the overall limited caseload.
Using the keystone design perforator island flap in large myelomeningocele closure
Authors: Formentin Cleiton , de Andrade Erion Junior , Matias Leo Gordiano , Joaquim Andrei F. , Tedeschi Helder , Raposo-Amaral Cássio Eduardo , Ghizoni Enrico
Published: October 2019

OBJECTIVE

Many repair techniques have been proposed to treat large myelomeningocele (MMC), and although effective in many cases, some of these techniques can be complex and time consuming, with complications such as cerebrospinal fluid (CSF) leakage, flap loss, tip necrosis, and wound dehiscence. The purpose of this study was to analyze cases of large skin defects and the methods applied and to report the outcomes of the keystone design perforator island flap (KDPIF) technique for large MMC closure.

METHODS

The authors performed a retrospective review of all neonatal patients who had undergone KDPIF for MMC closure in the period from 2013 to 2018. All patients had a diagnosis of lumbosacral MMC based on obstetric ultrasound. The neurosurgeons and plastic surgeons had selected the cases after concluding that primary closure would be unlikely. The design of the flap is based on the randomly located vascular perforators, creating two identical opposing flaps to fashion a double keystone flap. During wound closure, V-Y advancement of each end of the double flap in the longitudinal axis creates redundancy in the central portion of the flap and reduces the horizontal tension. After discharge, both the neurosurgery and plastic surgery teams followed up all patients, tracking the results with photography.

RESULTS

No skin flap dehiscence or necrosis, infection, or CSF leakage was detected, proving the reliability of the flap. One of the patients required further surgery for the large skin defects after insufficient intrauterine closure of the MMC and successfully underwent KDPIF treatment. Another patient (14.3%) had severe neonatal sepsis, which ultimately led to death. A ventriculoperitoneal shunt was required after the skin defect repair in 5 (83.3%) of the 6 surviving patients. Exceptional aesthetic results were achieved for all patients during the follow-up.

CONCLUSIONS

The KDPIF technique is based on well-known vascular perforators of the intercostal, lumbar, and gluteal regions. Wound tension is widely distributed by the flap and, as a consequence, relevant tissue bulk, reliable vascularity, and important geometrical versatility are provided. In addition, most of the muscles and fascia are preserved, which is another advantage in terms of minimizing secondary morbidity to local tissue rearrangement. The use of KDPIF closure was successfully shown to be a viable alternative for more complex MMCs that present with large skin defects.
The role of sacral laminoplasty in the management of spina bifida and sacral cystic lesions: case series
Authors: Chen Yu-Ning , Yang Shih-Hung , Chou Sheng-Che , Kuo Meng-Fai
Published: October 2019

OBJECTIVE

Although laminae are not viewed as essential structures for spinal integrity, in the sacrum the anatomical weakness and gravity makes it a vulnerable area for CSF accumulation and expansion. The congenital or postoperative defects of sacral laminae, such as in patients with spina bifida, make this area more susceptible to forming progressive dural ectasia, pseudomeningocele, or expansile arachnoid cyst (Tarlov cyst). In addition, adhesions between the dura and surrounding soft tissue after laminectomy can cause some local symptoms, which are difficult to relieve. The authors propose that sacral laminoplasty with titanium mesh can provide a rigid support and barrier to resolve these sacral lesions and local symptoms.

METHODS

From January 2016 to December 2017, patients with progressive CSF-containing lesions in the sacral area and defective sacral laminae were included in the study. After repair of the lesion, the authors performed sacral laminoplasty with titanium mesh in each patient. Subsequently, the soft tissue and skin were closed primarily.

RESULTS

A total of 6 patients were included. Four patients with repaired myelomeningocele had progressive dural ectasia. One patient with lipomyelomeningocele previously underwent detethering surgery and developed postoperative pseudomeningocele. One patient had a symptomatic Tarlov cyst. Four of these 6 cases presented with low-back pain and local tenderness. During follow-up, ranging from 13 to 37 months, all 6 patients experienced no recurrence of dural ectasia or pseudomeningocele and were free from local symptoms.

CONCLUSIONS

Sacral laminoplasty with titanium mesh is a safe and effective procedure for treating progressive sacral dural ectasia and refractory pseudomeningocele, preventing CSF leakage as well as relieving local symptoms that may occur years after previous surgery for spina bifida.
Cost of prenatal versus postnatal myelomeningocele closure for both mother and child at 1 year of life
Authors: Kessler Brice A. , Catalino Michael P. , Quinsey Carolyn , Goodnight William , Elton Scott
Published: October 2019

OBJECTIVE

Prenatal myelomeningocele (MMC) closure has been performed in the United States for 2 decades. While prior work has focused on clinical outcomes of prenatal MMC closure, the cost of this procedure in comparison with that of postnatal MMC closure is unclear. The authors’ aim was to compare the cost of prenatal versus postnatal MMC closure for both the child and mother at 1 year.

METHODS

A prospective database of patients undergoing prenatal and postnatal MMC closure between 2011 and 2018 with 1-year follow-up was retrospectively reviewed. Charge data for relevant admissions were converted to a cost estimate using the authors’ institution’s Medicare hospital-specific cost-to-charge ratio. Children, mothers, and mother/child pairs were considered separately. The primary outcome was cost. Secondary outcomes included the need for hydrocephalus treatment, length of stay (LOS), and readmissions. Other covariates included gestational age at birth, MMC lesion level, and obstetric complications.

RESULTS

The median cost of care for children in the prenatal group was greater, although not significantly so, at $58,406.71 (IQR $16,900.24–$88,951.01) compared with $49,889.95 (IQR $38,425.18–$115,163.86) for children in the postnatal group (p = 0.204). The median cost for mothers in the prenatal group was significantly greater at $24,548.29 (IQR $20,231.55–$36,862.31) compared with $5087.30 (IQR $4430.72–$5362.56) (p < 0.001). The median cost for mother/child pairs in the prenatal group was $102,377.75 (IQR $37,384.30–$118,527.74) compared with $55,667.82 (IQR $42,840.78–$120,058.06) (p = 0.45). Children in the prenatal group had a lower gestational age at birth (235.81 days vs 265.77 days, p < 0.001) and fewer readmissions (33.3% vs 72.7%, p < 0.001), and hydrocephalus treatment was less common (33.3% vs 90.9%, p < 0.001). Index LOS did not differ between children in the prenatal and postnatal groups (26.8 days vs 23.5 days, p = 0.63). Mothers in the prenatal group had longer LOS (15.92 days vs 4.68 days, p < 0.001) and more readmissions (18.5% vs 0.0%, p = 0.06).

CONCLUSIONS

The median cost of prenatal versus postnatal MMC closure did not significantly differ from a hospital perspective at 1 year, although variability in cost was high for both groups. When considering the mother alone, prenatal MMC closure was costlier. Future work is needed to assess cost from a patient and societal perspective both at 1 year and beyond.
Development of an evidence-based individualized transition plan for spina bifida
Authors: Hopson Betsy , MSHA  , Alford Elizabeth N. , Zimmerman Kathrin , Blount Jeffrey P. , Rocque Brandon G.
Published: October 2019

OBJECTIVE

In spina bifida (SB), transition of care from the pediatric to adult healthcare settings remains an opportunity for improvement. Transition of care is necessarily multidimensional and focuses on increasing independence, autonomy, and personal responsibility for health-related tasks. While prior research has demonstrated that effective transition can improve health outcomes and quality of life while reducing healthcare utilization, little is known about the most advantageous transition program components/design. The individualized transition plan (ITP) was developed to optimize the readiness of the adolescent with SB for adult healthcare. The ITP is a set of clearly articulated, mutually developed goals that arise from best available data on successful transition and are individualized to meet the individual challenges, needs, and attributes of each patient and family.

METHODS

Prospectively completed ITPs were retrospectively reviewed from June 2018 to May 2019. Demographic and disease characteristics were collected, and specific goals were reviewed and categorized.

RESULTS

Thirty-two patients with an ITP were included. The cohort was 50% male and had a mean age of 16.4 years. For goal 1 (maximize education), the most common goal was to complete a career interest survey (44%), followed by researching application/admission requirements for programs of interest (25%), shadowing in and/or visiting a workplace (16%), and improving high school performance (16%). For goal 2 (bowel management), most patients (59%) had a working bowel program with few or no bowel accidents. Eight patients (25%) were having more than the desired number of bowel accidents and received formal consultation with a gastroenterologist. Five patients (16%) needed only minor adjustments to their bowel management regimen. Goal 3 (SB program coordinator goal) focused on documenting medical and/or surgical history for the majority of patients (66%). Other goals aimed to increase patient communication in healthcare settings or utilize available community resources.

CONCLUSIONS

The authors developed an evidence-based ITP that focuses around 5 goals: maximizing education, bowel continence, and goals set by the SB clinic coordinator, parent/caregiver, and patient. Although developed for the authors’ SB clinic, the ITP concept is applicable to transition of care in any chronic childhood illness.
Progressive hydrocephalus despite early complete reversal of hindbrain herniation after prenatal open myelomeningocele repair
Authors: Lu Victor M. , Snyder Kendall A. , Ibirogba Eniola R. , Ruano Rodrigo , Daniels David J. , Ahn Edward S.
Published: October 2019

OBJECTIVE

Open prenatal myelomeningocele (MMC) repair is typically associated with reversal of in utero hindbrain herniation (HBH) and has been posited to be associated with a reduction in both postoperative prenatal and immediate postnatal hydrocephalus (HCP) risks. However, the long-term postnatal risk of HCP following HBH reversal in these cases has not been well defined. The authors describe the results of a long-term HCP surveillance in a cohort of patients who underwent prenatal MMC repair at their institution.

METHODS

A retrospective review of all prenatal MMC repair operations performed at the Mayo Clinic between 2012 and 2017 was conducted. Pertinent data regarding the clinical courses of these patients before and after MMC repair were summarized. Outcomes of interest were occurrences of HBH and HCP and the need for intervention.

RESULTS

A total of 9 prenatal MMC repair cases were identified. There were 7 cases in which MRI clearly demonstrated prenatal HBH, and of these 86% (6/7) had evidence of HBH reversal after repair and prior to delivery. After a mean postnatal follow-up of 20 months, there were 3 cases of postnatal HCP requiring intervention. One case that failed to show complete HBH reversal after MMC repair required early ventriculoperitoneal shunting. The other 2 cases were of progressive, gradual-onset HCP despite complete prenatal HBH reversal, requiring endoscopic third ventriculostomy with choroid plexus cauterization at ages 5 and 7 months.

CONCLUSIONS

Although prenatal MMC repair can achieve HBH reversal in a majority of well-selected cases, the prevention of postnatal HCP requiring intervention appears not to be predicated on this outcome alone. In fact, it appears that in a subset of cases in which HBH reversal is achieved, patients can experience a progressive, gradual-onset HCP within the 1st year of life. These findings support continued rigorous postnatal surveillance of all prenatal MMC repair patients, irrespective of postoperative HBH outcome.
Growing up with spina bifida: bridging the gaps in the transition of care from childhood to adulthood
Authors: Patel Smruti K. , Staarmann Brittany , Heilman Alexander , Mains Allie , Woodward Jason , Bierbrauer Karin S.
Published: October 2019

Spina bifida is the most common nonchromosomal birth defect, resulting in permanent disability of multiple organ systems, yet compatible with long-term survival. Important advances across various disciplines have now improved survival among the spina bifida population. Although the majority of individuals living with spina bifida are now adults, there are few publications in the neurosurgical literature regarding the care of adults with spina bifida, associated medical conditions, surgical interventions, and long-term complications. The major goals for transitioning adult patients with spina bifida are preservation of function and promotion of independence as well as general overall health. Nevertheless, many gaps exist in our knowledge and understanding of the complex needs of this aging patient population. The goal of this paper was to provide a comprehensive updated review of the literature regarding the challenges and considerations involved in the transitional care to adulthood for patients with spina bifida. Unique to this review, the authors provide a first-hand personal communication and interview with an adult patient with spina bifida that discusses many of these challenges with transition.
Reviewing the prognostic factors in myelomeningocele
Authors: Protzenko Tatiana , Bellas Antônio , Pousa Marcelo Sampaio , Protzenko Michelle , Fontes Juliana Marin , de Lima Silveira Anne Margareth , Sá Cynthia Amaral , Pereira José Paulo , Salomão Renato Manganelli , Salomão José Francisco M. , dos Santos Gomes Saint Clair
Published: October 2019

OBJECTIVE

The goal of this study was to analyze the factors that have an impact on morbidity and mortality in patients with myelomeningocele (MMC).

METHODS

A retrospective cohort study was conducted to analyze factors associated with MMC that influence the morbidity and mortality of the disease. Data were collected from medical records of children who underwent the primary repair of MMC at the Fernandes Figueira Institute–Oswaldo Cruz Foundation (IFF-Fiocruz) between January 1995 and January 2015, with a minimum follow-up of 1 year. The following variables were analyzed: demographic characteristics (gestational age, sex, and birth weight); clinical features (head circumference at birth, anatomical and functional levels of MMC, hydrocephalus, symptomatic Chiari malformation type II, neurogenic bladder, and urinary tract infection [UTI]); and surgical details such as timing of repair of MMC, age at first shunt placement, shunt surgery modality (elective or emergency), concurrent surgery (correction of MMC and shunt insertion in the same surgical procedure), incidence and cause of shunt dysfunction, use of external ventricular drain, transfontanelle puncture, surgical wound complications prior to shunting, and endoscopic treatment of hydrocephalus.

RESULTS

A total of 231 patients with MMC were included in the analysis. Patients were followed for periods ranging from 1 to 20 years, with a mean of 6.9 years. The frequency of shunt placement was observed mainly among patients with MMC at the highest spinal levels (p < 0.01). The main causes of morbidity and mortality in patients with MMC were shunt failures, diagnosed in 91 of 193 cases (47.2%) of hydrocephalus, and repeated UTIs, in 129 of 231 cases (55.8%) of MMC; these were the main causes of hospitalization and death. Head circumference ≥ 38 cm at birth was found to be a significant risk factor for shunt revision (p < 0.001; 95% CI 1.092–1.354). Also, the lumbar functional level of MMC was associated with less revision than upper levels (p < 0.014; 95% CI 0.143–0.805). There was a significant association between recurrent UTI and thoracic functional level.

CONCLUSIONS

Macrocephaly at birth and higher levels of the defect have an impact on worse outcome and, therefore, are a challenge to the daily practice of pediatric neurosurgery.
Neurological dysfunction of the bladder from myelomeningocele
Authors: Weiss Dana A. , Lee Albert S. , Flanders Tracy M. , Long Christopher J. , van Batavia Jason P. , Zderic Stephen A. , Heuer Gregory G.
Published: October 2019

Myelomeningocele (MMC) affects approximately 2000 infants in the US yearly and causes long-term damage to the genitourinary system. There is a wide spectrum of effects on the bladder and urethral sphincter that do not correlate with the level of the spinal cord defect. The bladder changes can provide a safe storage pressure, often at the expense of continence, or can create a hostile environment leading to increased pressure on the kidneys and eventually to chronic kidney disease. The ultimate goals in management are to maintain a safe system that prevents renal deterioration, while providing social continence and independence in the long term. This review intends to provide an overview of the effects of MMC on the genitourinary system, regardless of intervention, in order to understand the pathophysiology of the disease.
Maternal and obstetric complications in fetal surgery for prenatal myelomeningocele repair: a systematic review
Authors: Licci Maria , Guzman Raphael , Soleman Jehuda
Published: October 2019

OBJECTIVE

Comparing prenatal and postnatal surgical repair techniques for myelomeningocele (MMC), in utero fetal surgery has increasingly gained acceptance and is considered by many specialized centers the first choice of treatment. Despite its benefits, as demonstrated in the Management of Myelomeningocele Study (MOMS), including reduced need for CSF shunting in neonates and improved motor outcomes at 30 months, there is still an ongoing debate on fetal and maternal risks associated with the procedure. Prenatal open hysterotomy, fetoscopic MMC repair techniques, and subsequent delivery by cesarean section are associated with maternal complications. The aim of this systematic review is to assess the available literature on maternal and obstetric complication rates and perinatal maternal outcomes related to fetal MMC repair.

METHODS

The authors identified references for inclusion in this review by searching PubMed and MEDLINE, with restrictions to English language, case series, case reports, clinical trials, controlled clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews. The rate of maternal and obstetric complications was analyzed based on studies focusing on this issue and presenting clear results on the matter.

RESULTS

Of 1264 articles screened, 36 were included in this systemic review, whereof 11 were eligible for data analysis and comparison. The average overall rate of maternal and obstetric complications corresponds to 78.6%. The majority of the described events are obstetric complications, varying from chorioamniotic membrane separation in 65.6% of cases, oligohydramnios in 13.0% of cases, placental abruption in 5.0% of cases, spontaneous or preterm premature membrane rupture in 42.0% of cases, and early preterm delivery in 11.3% of cases due to uterine dehiscence, occurring in 0.9% of cases. The most common medical complications are development of pulmonary edema occurring in 2.8%, gestational diabetes in 3.7%, gestational hypertension/preeclampsia in 3.7%, and need for blood transfusions in 3.2% of cases. Limitations of the review arise from the lack of data in the current literature, with maternal and obstetric complications being underreported.

CONCLUSIONS

Although the efforts of further advancement of intrauterine prenatal MMC repair aim to increase neonatal outcomes, maternal health hazard will continue to be an issue of crucial importance and further studies are required.
Long-term results for total lumbar facet joint replacement in the management of lumbar degenerative spondylolisthesis
Authors: Smorgick Yossi , Mirovsky Yigal , Floman Yizhar , Rand Nahshon , Millgram Michael , Anekstein Yoram
Published: October 2019

OBJECTIVE

The authors evaluated the long-term clinical outcome of a total posterior arthroplasty system in the surgical treatment of lumbar spinal stenosis with degenerative spondylolisthesis.

METHODS

Between June 2006 and July 2007, 10 patients with neurogenic claudication due to spinal stenosis and single-level degenerative spondylolisthesis were enrolled in a nonrandomized prospective clinical study. The patients were evaluated with radiographs and MRI scans, the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the SF-36 health survey preoperatively and at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years, 7 years, and 11 years postoperatively.

RESULTS

The mean VAS score for leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 17 at 11 years after surgery. The mean VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 14 at 11 years after surgery. The mean ODI score decreased from 49.1 preoperatively to 13.5 at 6 weeks and 16 at 11 years after surgery. MRI at 11 years demonstrated stenosis adjacent to the stabilized segment in one patient. This patient was not symptomatic. The authors did not find evidence of progression of the spondylolisthesis in any of the cases. In one patient, conversion to posterolateral fusion was performed due to an early device malfunction.

CONCLUSIONS

The results of this 11-year follow-up study demonstrate that, in patients with spinal stenosis and degenerative spondylolisthesis, decompression and posterior arthroplasty maintain clinical improvement and radiological stability.
Minimally invasive fetal surgery for myelomeningocele: preliminary report from a single center
Authors: Carrabba Giorgio , Macchini Francesco , Fabietti Isabella , Schisano Luigi , Meccariello Giulia , Campanella Rolando , Bertani Giulio , Locatelli Marco , Boito Simona , Porro Giuliana A. , Gabetta Lorenzo , Picciolini Odoardo , Cinnante Claudia , Triulzi Fabio , Ciralli Fabrizio , Mosca Fabio , Lapa Denise A. , Leva Ernesto , Rampini Paolo , Persico Nicola
Published: October 2019

OBJECTIVE

Recent trials have shown the safety and benefits of fetoscopic treatment of myelomeningocele (MMC). The authors’ aim was to report their preliminary results of prenatal fetoscopic treatment of MMC using a biocellulose patch, focusing on neurological outcomes, fetal and maternal complications, neonatal CSF leakage, postnatal hydrocephalus, and radiological outcomes.

METHODS

Preoperative assessment included clinical examination, ultrasound imaging, and MRI of the fetus. Patients underwent purely fetoscopic in utero MMC repair, followed by postoperative in utero and postnatal MRI. All participants received multidisciplinary follow-up.

RESULTS

Five pregnant women carrying fetuses affected by MMC signed informed consent for the fetoscopic treatment of the defect. The mean MMC size was 30.4 mm (range 19–49 mm). Defect locations were L1 (2 cases), L5 (2 cases), and L4 (1 case). Hindbrain herniation and ventriculomegaly were documented in all cases. The mean gestational age at surgery was 28.2 weeks (range 27.8–28.8 weeks). Fetoscopic repair was performed in all cases. The mean gestational age at delivery was 33.9 weeks (range 29.3–37.4 weeks). After surgery, reversal of hindbrain herniation was documented in all cases. Three newborns developed signs of hydrocephalus requiring CSF diversion. Neurological outcomes in terms of motor level were favorable in all cases, but a premature newborn died due to CSF infection and sepsis.

CONCLUSIONS

The authors’ preliminary results suggest that fetoscopic treatment of MMC is feasible, reproducible, and safe for mothers and their babies. Neurological outcomes were favorable and similar to those in the available literature. As known, prematurity was the greatest complication.
Digital Watermark System with an Ability of its Extraction from Hard Copies of Data
Authors: Korzhik V. , Flaksman D.
Published: October 2019

In this paper it is presented Digital Watermark System for color images. The main feature of this system is an ability to extract digital watermarks even after printing and following scanning of watermarked images. There is a description of algorithms for embedding and extracting of additional information. These methods are based on the usage of spread-spectrum signals in the frequency domain. Furthermore, there is described algorithms of distortion correction after printing out and following scanning the paper copies of digital data. The results of the experimental research on evaluation of a possible embedding volume and the reliability after extraction of the embedded data are also presented.
KOMBINASI TEPUNG TERIGU DAN TEPUNG TAPIOKA TERHADAP DAYA KEMBANG DAN SIFAT ORGANOLEPTIK KERUPUK TERUBUK (Saccharum edule Hasskarl)
Authors: Chaniago Ramadhani , Lamusu Darni , Samaduri Lutfi
Published: October 2019

Terubuk processing techniques are still simple, such as processed into vegetables. Therefore, it is necessary to diversify food, namely making crackers in powder. Crackers are a type of small food that undergoes volume development forming a product that is porous and has a low density during the frying process. This study aims to determine the growth and organoleptic properties of crackers made from powder (Saccharum edule Hasskarl). this study was designed using a Completely Randomized Design (CRD) arranged with 1 factor, namely: A1 = 100 gram wheat flour + 200 gram tapioca flour + 100 gram flour; A2 = 150 gram wheat flour + 100 gram tapioca flour + 150 gram powder; A3 = 100 gram flour + 150 gram tapioca flour + 100 gram powder. Based on the organoleptic test results showed that: The best flower power is shown in treatment A1 (100 gram wheat flour + 200 gram tapioca flour + 100 gram flour) which is 75.58%. The panelist's assessment or organoleptic test of the combination of wheat flour, tapioca tapung and terubuk gave no significant effect on color, taste and texture and gave a real influence on the aroma of crackers made in powder. The best treatment based on the panelist's assessment is treatment (A2) Wheat flour 150 grams + Tapioca flour 100 grams + Powdered 150 grams. Where these crackers have a color value of 3.75 rounded to 4 (likes); the aroma value of 3.93 is rounded to 4 (likes); the flavor value of 3.57 is rounded to 4 (likes) and the texture value is 3.75 (likes).
Improvement of the Russian National Secondary Standard of the Unit of Length Using Latest Ultra-Stable Laser Equipment
Authors: Mosckalev Andrew A. , Rahman Ardi
Published: October 2019

Introduction. Increasing demands of precise geometry measurements by science and industry cause the necessity of improvement in an associated branch of legal and practical metrology. One of the most significant fields is the measurement of internal dimensions and so the issues with the unit of meter transfer. Now we face the situation when the current accuracies of National standards of different levels in corresponding traceability chain (reference rings measurements) get close to each other. This means that we have to make the standard of upper level more precise. One of the obvious ways is to apply the latest ultra-stable laser locked to a frequency comb.

Objective. The objective is to propose possibilities for improvement of the National secondary standard of the unit of length by researching its measuring capabilities to minimize measurement uncertainty.

Materials and methods. The calculation of expanded uncertainty of internal diameter measurements by the National secondary standard of the unit of length is performed according to the international document «Guide to the Expression of Uncertainty in Measurement» JCGM 100:2008 approved by BIPM. The secondary standard research results represented in previous reports and publications are also taken into consideration.

Results. Detailed uncertainty budget for the proposed measuring system is given as well as graphical data representing the accuracy improvement.

Conclusion. Actions for minimization of measurement uncertainty components of the National secondary standard of the unit of length in the field of reference ring internal diameter measurements in combination with state-of-the-art laser interferometer system improve it to the next frontiers of accuracy and precision.
Microfluidic Acoustic Metamaterial SAW Based Sensor
Authors: Mukhin Nikolay V.
Published: October 2019

Introduction. Microacoustic sensors based on surface acoustic wave (SAW) devices allow the sensor integration into a wafer based microfluidic analytical platforms such as lab-on-a-chip. Currently exist various approaches of application of SAW devices for liquid properties analysis. But this sensors probe only a thin interfacial liquid layer. The motivation to develop the new SAW-based sensor is to overcome this limitation. The new sensor introduced here uses acoustic measurements, including surface acoustic waves (SAW) and acoustic methamaterial sensor approaches. The new sensor can become the starting point of a new class of microsensor. It measures volumetric properties of liquid analytes in a cavity, not interfacial properties to some artificial sensor surface as the majority of classical chemical and biochemical sensors.

Objective. The purpose of the work is to find solutions to overcome SAW-based liquid sensors limitations and the developing of a new sensor that uses acoustic measurements and includes a SAW device and acoustic metamaterial.

Materials and methods. A theoretical analysis of sensor structure was carried out on the basis of numerical simulation using COMSOL Multiphysics software. Lithium niobate (LiNbO3) 127.86° Y-cut with wave propagation in the X direction was chosen as a substrate material. Microfluidic structure was designed as a set of rectangular shape channels. A method for measuring volumetric properties of liquids, based on SAW based fluid sensor concept, comprising the steps of: (a) providing sensor structure with the key elements: a SAW resonator, a high-Q set of liquid-filled cavities and intermediate layer with artificial elastic properties between them; (b) measuring of resonance frequency shift, associated with the resonance in liquid-filled cavity, in the response of weakly coupled resonators of SAW resonator loaded by periodic microfluidic structure; (c) determination of volumetric properties of the fluid on the basis of a certain relationship between the speed of sound in liquid, the resonant frequency of the set of liquid-filled cavities, and the geometry design of the cavity.

Results. The new sensor approach is introduced. The eigenmodes of the sensor structure with a liquid analyte are carried out. The characteristic of sensor structure is determined. The key elements of introduced microfluidic sensor are a SAW structure, an acoustic metamaterial with a periodic set of microfluidic channels. The SAW device acts as electromechanical transducer. It excites surface waves propagating in the X direction lengthwise the periodic structure and detects the acoustic load generated by the microfluidic structure resonator. The origin of the sensor signal is a small frequency change caused by small variations of acoustic properties of the analyte within the set of microfluidic channels.

Conclusion. The principle of the new microacoustic sensor, which can become the basis for creating a new class of microfluidic sensors, is shown.
Optical Control System for Displacement Monitoring of the High Precision Measurement Setup Elements
Authors: Kholkin Victor V. , Kholkin Vladimir Yu.
Published: October 2019

Introduction. It is necessary to ensure the reliability of measurements when operating high-precision measurement setups. The elements displacement of the measurement path introduces measurement results distortions, especially in measurement setups operating in the microwave range. It is necessary to monitor the elements positions of the measurement setup to ensure the measurements reliability. The monitoring should be performed during the measurement, and the control device should be connected to the automatic control system of the measurement setup, and it should neither mechanically affect the setup elements nor introduce the electrical and electromagnetic interferences.

Objective. The objective of the present work is a design of the control system, which allows monitoring of elements displacements of the high precision measuring setup with an accuracy of 1.0·10–4 mm. And the designed control system should neither mechanically affect the controlled elements nor introduce the electrical and electromagnetic interferences, thus allowing the digital signal processing.

Materials and methods. The designed system utilizes optical methods of the displacements monitoring, which are based on the geometric optics principles. The charge-coupled devices (CCD) to record the system response to optical path changes are used.

Results. Two designs of the control system for the displacement monitoring of the high precision measurement setup elements are presented. The first system design allows detecting the elements displacement occurrence, and the second system design allows to identify the displaced element. The system is capable to register the elements displacements with accuracy of 1.0·10–4 mm and monitor the elements positions while vibration exposures. The system does not mechanically or electromagnetically affect the controlled elements. All system elements are resistant to the microwave radiation and increased background radiation, excluding CCD that should be placed outside the active zone. The mathematical simulation allows assessing the sensitivity of the designed optical control system. The system sensitivity increasing method by the optical path increasing and corrective reflector using is proposed.

Conclusion. The designed control system for the displacements monitoring of the high precision measurement setup elements meets the requirements imposed on it. The system allows the digital signal processing and can withstand the increased microwave, X-ray and background radiation. The designed system is much simpler to implement in comparison with systems based on other physical principles. The novelty of the control system technical solution is confirmed by the patent.
Peningkatan Kapasitas Kelompok PKK Desa Sumbersekar Kecamatan Dau Kabupaten Malang untuk Mengatasi Problematika Hukum Waris Islam
Authors: Hidayah Nur Putri , Komariah Komariah
Published: October 2019

Sengketa waris adalah sengketa kedua terbesar di Pengadilan Agama Kota Malang dan Pengadilan Agama Kabupaten Malang. Sengketa waris juga merupakan salah satu sengketa keperdataan yang kerap terjadi di Desa Sumbersekar. PKK Desa Sumbersekar melalui kegiatan konsultasi pada Program Masyarakat Peduli Perempuan, Ibu dan Anak (MADU PRIA), berupaya memberikan jasa konsultasi penyelesaian sengketa waris terutama waris Islam, mengingat mayoritas penduduk Desa Sumbersekar bergama Islam dan melakukan pembagian harta warisan berdasarkan Hukum Waris Islam adalah bentuk ketaatan kepada Allah SWT. Sayangnya, pengetahuan mengenai Hukum Waris Islam yang dimiliki kader PKK Desa Sumbersekar masih minim. Oleh karena itu, dibutuhkan penyuluhan hukum mengenai hukum waris Islam kepada para kader PKK Desa Sumbersekar.
Ketrampilan Desain Ornamen Menuju Siswa yang Unggul dan Terampil pada MA Miftahul Huda Bulungan Jepara
Authors: Setiawan Agus , Yanuarsari Dzuha Hening , Haryadi Toto
Published: October 2019

Sebagai salah satu sekolah menengah atas di Jepara, Madrasah Aliyah Miftahul Huda Bulungan membekali siswa kelas XII dengan seni rupa, seni tari, serta seni musik yang ada dalam mata pelajaran Seni Budaya. Namun, ketrampilan tersebut belum mengeksplorasi identitas khas Jepara sebagai kota ukir. Hal ini melatarbelakangi kegiatan pengabdian untuk memperkenalkan desain ornamen kepada para siswa yang dilaksanakan tanggal 20 – 22 Juli 2019 di lab komputer MA Miftahul Huda. Siswa belajar tentang pembuatan desain ornamen secara manual, yang kemudian dikembangkan menjadi desain ornamen digital, desain label kemasan, serta poster kegiatan. Kegiatan ini diawali dengan presentasi materi, dilanjutkan dengan praktik menggambar ornamen secara manual dan digital menggunakan komputer dan perangkat lunak pengolah grafis. Hasil dari kegiatan ini yaitu gambar ornamen, label kemasan, serta poster kegiatan yang menggunakan elemen ornamen khas Jepara sebagai identitas visualnya. Para siswa menjadi mengerti tentang ornamen beserta potensi pemanfaatannya dalam karya desain.
Analisis Pendapatan dan Aktivitas Terhadap Kenyamanan Termal di Daerah Dataran Tinggi
Authors: Prawoto Eko , Effendi Bahtiar
Published: October 2019

Kenyamanan termal merupakan suatu bidang ilmu yang akan mengarahkan pada penghematan energi. Variabel pengaruh dari kenyaman termal yang paling kuat adalah variabel personal. Hal ini telah dikembangkan oleh Fergus Nicol dengan teori kenyamanan termal adaptif. Variabel personal yang dimaksud adalah variabel aktivitas dan pakaian. Selain kedua variabel tersebut manusia juga dipengaruhi oleh faktor psikologis. Beberapa penelitian menyebutkan bahwa faktor psikologis juga dipengaruhi oleh faktor ekonomi manusia. Penelitian ini akan melihat pengaruh tingkat pendapatan dan aktivitas terhadap kenyaman termal. Metode yang digunakan adalah metode kuantitatif dengan menggunakan analisis regresi. Hasil yang didapat menunjukkan bahwa terdapat pengaruh antara variabel aktivitas dan tingkat pendapatan terhadap kenyamanan termal. Penelitian juga menjelaskan tentang variabel iklim yang mempunyai pengaruh terhadap kenyamanan termal.
Pengaruh Supervisi Klinis Terhadap Implementasi Kompetensi Sesuai Clinical Appointment pada Perawat Klinis II di RSUD KRT Setjonegoro Wonosobo
Authors: Marwiati Marwiati , Khoiriyah Siti
Published: October 2019

Implementasi praktik keperawatan sesuai clinical appointment dilaksanakan agar tidak membahayakan keselamatan pasien, tidak terlalu lama dalam perawatan klien dan mendukung program pelaksanaan perawatan ada suatu metode yang dilakukan yaitu supervisi klinis.
Penelitian ini adalah untuk mengetahui adanya pengaruh supervisi klinis terhadap implementasi kompetensi perawat sesuai clinical appointment.
Penelitian ini menggunakan desain quasy eksperimen dengan one group pre post test design dengan  sampel  sejumlah 57  Perawat Klinis II sebagai responden penelitian.
Dari penelitian ini didapatkan jumlah perawat yang tidak melakukan implementasi kompetensi sesuai clinical appointment ada 50 perawat yang belum sesuai dan hasil post test didapatkan adanya perbedaan yang signifikan dengan pre test.
Supervisi klinis efektif untuk mengontrol implementasi kompetensi perawat sesuai clinical appointment.
AGIR COMUNICATIVO E INTERSECCIONALIDADE: INTERPRETAÇÕES INTRODUTÓRIAS DO PENSAMENTO DE HABERMAS A PARTIR DE FRANTZ FANON E PATRÍCIA HILL COLLINS PARA A CONSTRUÇÃO DE SERVIÇOS PÚBLICOS ADEQUADO
Authors: Rodrigues Reck Janriê , De Campos Bueno Winnie
Published: October 2019

Este trabalho visa estabelecer relações e observações críticas entre as noções principais de Jürgen Habermas, Frantz Fannon e Patrícia Hill Collins, notadamente no que toca aos conceitos de racionalidade, onde esta racionalidade se insere e opera, assim como procedimento democrático. O problema orientador é: quais insuficiências podem ser apontadas na teoria da racionalidade e na teoria da Democracia de Habermas a partir dos referidos autores? Como hipótese principal, o de que a situação de opressão do negro efetivamente não só é apenas social, mas gera assimetrias que remetem até à forma de expressão da racionalidade, as quais devem ser levadas em conta na formatação do processo democrático. Através do método bibliográfico, objetiva-se explorar as relações entre os autores, incluindo o apontamento das referidas insuficiências, com as diretrizes para sua superação.
A PREVIDÊNCIA SOCIAL E O PRINCÍPIO DO NÃO RETROCESSO SOCIAL: A DESNECESSIDADE DA REFORMA PREVIDENCIÁRIA
Authors: Da SILVA Daisy Rafaela , Caldas Mariana Reis
Published: October 2019

Este artigo visa discutir a aplicação do princípio do não retrocesso social base sólida para que direitos básicos conquistados ao longo dos anos pelas lutas sociais não se tornem efêmeros por mudanças políticas e econômicas, cujas decisões são apartadas da efetiva vontade e necessidade dos cidadãos, principalmente pela ótica da previdência social e suas reformas. Se por um lado os direitos sociais encontram-se previstos com destaque na Constituição Federal, em seus artigos 6º e 7º, sendo também garantidos pela própria democracia, o princípio do não retrocesso social é uma importante ferramenta para que estes não sejam suprimidos ou alterados, se mantendo protegidos pelo Estado que os tutela, ainda mais quando trata-se de uma possível reforma previdenciária que irá mitigar as bases de diversos benefícios, sendo que a crítica é que se há de fato necessidade desta reforma, tendo em vista as contas da previdência social.
O O ENVELHECIMENTO DAS CIDADES E A POLÍTICA HABITACIONAL PARA A PESSOA IDOSA: CASO DO CONDOMÍNIO CIDADE MADURA EM JOÃO PESSOA
Authors: Saleme Edson Ricardo , DANTAS AGAMENILDES DIAS ARRUDA VIEIRA
Published: October 2019

O objetivo do artigo é pesquisar sobre os avanços da legislação nacional no que tange ao direito social a moradia. Aqui serão relatadas as políticas públicas e normas que levaram à concretização do Condomínio Cidade Madura. Para isso se utilizou o método indutivo e a pesquisa bibliográfica, como fórmula metodológica. Também se empregou a documentação por meio indireto. O Condomínio Cidade Madura não só ocorre como uma forma de se dar dignidade a pessoa idosa, a partir de sua colocação em um abrigo que comporta condições para uma vida saudável, mas também viabiliza um projeto com novas vertentes que não ignoraram necessidades sociais e psicológicas do idoso diante de sua condição e limitações. O projeto partiu de experiências de outros estados e geralmente dispõe de consulta a conselhos para a final efetivação do projeto.
LA AGRICULTURA DE PRECISIÓN EN LA EMPRESA AGRARIA DE CUBA
Authors: Sánchez Alcides Francisco Antúnez
Published: October 2019

En el ensayo se realiza un esbozo de los referentes teóricos sobre la Agricultura de Precisión en el Derecho Agrario desde un enfoque histórico-jurídico, se fundamenta con ello la necesidad e importancia de su fomento en el desarrollo de la empresa pública agraria en la nación cubana. Es realizada una revisión desde su génesis, características, elementos, y el desarrollo que ha tenido la AP en los países desarrollados, que permita potenciar su inserción para dotar de una serie de competencias y habilidades para el ejercicio de su profesión a los profesionales agrícolas. Se realiza un análisis dentro del ordenamiento jurídico agrario de la AP. El ensayo propone como objetivo caracterizar los elementos de la Agricultura de Precisión en el escenario agrícola cubano a partir de su reconocimiento en el ordenamiento jurídico en la materia agraria para la empresa pública y la privada que permitan ponderar los principios de eficiencia y eficacia dentro del desarrollo sostenible en el siglo XXI incidentes en la seguridad y la soberanía alimentaria. Para ello fueron utilizados los métodos de inducción deducción, análisis síntesis, y el histórico lógico.
LA CONTAMINACIÓN AMBIENTAL EN LOS ACUÍFEROS DE ECUADOR. NECESIDAD DE SU REVERSIÓN DESDE LAS POLÍTICAS PÚBLICAS CON ENFOQUE BIOÉTICO
Authors: Tello Lucas Guanoquiza
Published: October 2019

El Ecuador es un país rico en recursos hídricos. La interacción del hombre con la biosfera suscita problemas: contaminación del suelo, aire y agua; y cuestiones: hambre y perdidas de flora y fauna. Estas interrogantes pertenecen a la ecología y a la bioética. En América Latina, el reconocimiento del agua como un derecho humano fundamental y como sujeto de derechos dentro del marco de los derechos de la naturaleza en la nación ecuatoriana, constituye un paso indispensable para precautelar la seguridad hídrica en los territorios, que garantice el efectivo goce y ejercicio de los derechos a una vida digna, salud, alimentación, vivienda, cultura, ambiente sano y la permanencia de los ciclos naturales del agua como unbien desde los pueblos originarios. El análisis del agua tiene múltiples análisis en cantidad, calidad y distribución de los recursos hídricos, en la interpretación de lo que sucede con el agua en el Ecuador. Uno de los aspectos considerados aún con debilidad es el referido a la calidad, afectada por actividades y procesos contaminantes que plantean una ausencia de políticas y acciones estatales claras y efectivas como un complejo fenómeno social, económico y ambiental, que constituye uno de los más serios obstáculos para el “buen vivir”. Necesitado de procesos de formación ambiental desde la bioética.