bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting factors and barriers in implementing kangaroo mother care in Indonesia
Authors: Pratomo Hadi , Uhudiyah Uut , Sidi Ieda Poernomo Sigit , Rustina Yeni , Suradi Rulina , Bergh Anne-Marie , Rogers-Bloch Quail , Gipson Reginald
Published: August 2016

Background Kangaroo mother care (KMC) was introduced toIndonesia in the 1990s. Since then, KMC has not been widelyimplemented and has not received national policy support.Objective The objectives of this case study were to implementKMC by an intervention that would ultimately benefit tenhospitals in Java, Indonesia, as well as identify supporting factorsand barriers to KMC implementation.Methods An intervention with four phases was conducted inten hospitals. Two teaching hospitals were supported to serve astraining centers, six hospitals were supported to implement KMCand two other hospitals were supported to strengthen existingKMC practices. The four phases were comprised of a baselineassessment, a five-day training workshop, two supervisory visitsto each hospital, and an end-line assessment.Results A total of 344 low birth weight infants received KMCduring the intervention period. Good progress with regards toimplementation was observed in most hospitals between the firstand second supervisory visits. Supporting factors for KMC were thefollowing: support received from hospital management, positiveattitudes ofhealthcare providers, patients, families and communities,as well as the availability of resources. The most common challengeswere record keeping and data collection, human resources and staffissues, infrastructure and budgets, discharge and follow-up, as wellas family issues. Challenges related to the family were the inabilityof the mother or family to visit the infant frequently to provideKMC, and the affordability of hospital user fees for the infant tostay in the hospital for a sufficient period of rime.Conclusion KM C appeared to be well accepted in most hospitals.For an intervention to have maximum impact, it is importantto integrate services and maintain a complex network ofcommunication systems. [Paediatr lndones. 2012;52:43-50).
Diagnostic accuracy of the 2004 Indonesian Pediatric Society medical standard of care for neonatal sepsis
Authors: Fitriani Oki , Suryantoro Purnomo , Wandita Setya , Wibowo Tunjung , Haksari Ekawaty L. , Julia Madarina
Published: August 2016

Background Neonatal sepsis is a leading cause of neonatal morbidityand mortality. There are no pathognomonic signs or symptomsto diagnose neonatal sepsis. Blood culture is the standard tool forsepsis diagnosis, but it is not available in most district hospitals. In2004, the Indonesian Pediatric Society (IPS) developed a medicalstandard of care to diagnose neonatal sepsis, but its accuracy hasnot been adequately verified.Objective To evaluate the diagnostic accuracy of the IPS medicalstandard of care 2004 to diagnose neonatal sepsis.Methods We conducted diagnostic testing at the PerinatalWard, Dr. Sardjito Hospital, Yogyakarta, from June to November2010. Inclusion criteria were neonates with signs and symptomsof infection. We excluded neonates with congenital anomalies,blood disorders, or whose mothers received peripartum antibiotictreatment. All neonates were assessed by the 2004 IPS medicalstandard of care for neonatal sepsis and by blood cultureexaminations.Results A total of 193 neonates with signs and symptoms ofinfection were evaluated. The IPS medical standard had asensitivity of 88% (95% CI 81 to 94), specificity of 17% (95%CI 2 to 25), positive predictive value of 53% (95% CI 45 to 60),negative predictive value of 57% (95% CI 39 to 75), positivelikelihood ratio of 1.06 (95% CI 0.94 to 1.19), and negativelikelihood ratio of0.71 (95% CI 0.36 to 1.42).Conclusion The 2004 IPS medical standard of care showedadequate sensitivity for diagnosing neonatal sepsis, but its lowspecificity limits its use as a diagnostic tool. [Paediatr lndones.2012;52:86-90].
Prognostic factors of epilepsy in patients with neonatal seizures history
Authors: Sidiq Banani , Herini Elisabeth S. , Wibowo Tunjung
Published: August 2016

Background Seizures in neonates are often associated withneurological disorders in early life, including epilepsy. Severalpossible prognostic factors may influence the development ofepilepsy in these patients.Objective To evaluate prognostic factors that may influence theoccurrence of epilepsy in the first two years of life in patients witha history of neonatal seizures.Methods We performed a cohort retrospective study on patientswith neonatal se izures in Sardjito Hospital during 2004-2009.Prognostic factors observed were gender, family history ofepilepsy, neonatal hypoglycemia, assisted labor, hypoxic ischemicencephalopathy, preterm infant delivery, and epileptic state.Results Hypoxic ischemic encephalopathy and epileptic stateincreased the risk of epilepsy (HR 5.8; 95%CI 1.63 to 20.43 andHR 6.3; 95%CI 2 .0 to 19. 70, respectively). Assisted labor, pretermdelivery, neonatal hypoglycemia, family history of epilepsy, andgender did not increase the risk of epilepsy in the first two yearsof life.Conclusion Hypoxic ischemic encephalopathy and epileptic statein neonates presenting with seizures are the prognostic factors tobe epileptic children during the first two years of life.
Relationship between migraine and sleep disorders in adolescents
Authors: Waty Lina , Supriatmo Supriatmo , Saing Bistok
Published: August 2016

Background Headaches and sleep disorders may influenceacademic performances, personality, memory, and interpersonalrelationships. Migraine is the most common headache type seen inadolescents. Although headaches and sleep disorders are believedto be related, there has been little study in this area.Objectives To assess the relationship between migraine andsleep disorders in adolescents and compare different types ofsleep disorders found in adolescents with migraine vs. healthyadolescents.Methods We conducted a cross sectional study in December 2009on students of three junior high schools in the Secanggang District,Langkat Regency, North Sumatera. We included adolescents aged12 to 17 years who suffered from migraines, as defined by theInternational Cftissificaticm of Headache Disorders, 2nd edition criteria(ICHD-II), and h ealthy adolescents who did not experien cemigraines as the control group. Parents filled questionnaires ontheir child's sleep patterns for one week.Results A total of 100 adolescents were enrolled in the study,consisted of 50 adolescents in the migraine group and the others50 in the control group. There was a significant difference in theincidence of sleep disorders between the two groups (76% and30%, in the case and control groups, respectively; P= 0.0001).Moreover, significant differences were also found in the prevalenceof different sleeping disorder types between the case and controlgroups, i.e. insomnia (62% and 30%, respectively; P= 0.003), sleepapnea (56% and 16%, respectively; P= 0.0001), restlessness (56%and 18%, respectively; P= 0.0001) , parasomnia (76% and 10%,respectively; P= 0.0001), narcolepsy (42% and 16%, respectively;P= 0.008), and excessive daytime sleepiness (50% and 26%,respectively; P= 0.023).Conclusions Migraine in adolescents is significantly associatedwith sleep disorders. Parasomnia is the most common type ofsleeping disorder observed in adolescents with migraines in ourstudy.
Plasma homocysteine and blood pressure in small for gestational age children
Authors: Louis Irene Melinda , Umboh Adrian
Published: August 2016

Background Homocysteine is associated with endothelial damage and hypertension. Increased plasma homocysteine levels are often accompanied by cardiovascular impairment, including hypertension. Small for gestational age children have been found to have morbidity and mortality in cardiovascular diseases.Objective To assess for a possible association between homocysteine level and blood pressure in small for gestational age children.Methods This observational study was undertaken from December 2011 to April 2012 in Prof. Dr. R. D. Kandou Hospital, Manado, North Sulawesi, on children who were born small for gestational age in year 2004-2005. Data was analyzed by T-test to compare homocysteine levels in small for gestational age and normal birth weight children. Regression analysis and simple coefficient test were used to assess for an association between homocysteine levels and blood pressure in children who were small for gestational age at birth.Results The mean homocysteine level in small for gestational age children was significantly higher than that of normal birth weight children (P<0.001). We observed no correlation between homocysteine level and systolic blood pressure in the small for gestational age group (r=0.151, P=0.189). However, there was a weak correlation between homocysteine level and diastolic blood pressure in the small for gestational age group (r=0.237, P=0.049).Conclusion Children who were small for gestational age at birth have significantly higher mean homocysteine level than that of normal birth weight children. Higher homocysteine levels are associated with higher diastolic blood pressure in children who were small for gestational age at birth.
McIsaac criteria for diagnosis of acute group-A β-hemolytic streptococcal pharyngitis
Authors: Malino Imanuel Y. , Utama Dwi Lingga , Soenarto Yati
Published: August 2016

Background The early use of antibiotics for acute upper respiratory infections is controversial because most of these infections are caused by viruses. A strategy is needed to correctly identify the causitive agents of acute pharyngitis, so that antibiotics can be prescribed appropriately.Objective To assess McIsaac criteria for diagnosing acute group-A β-hemolytic streptococcal (GABHS) pharyngitis in children.Methods This diagnostic study was conducted from August 2011 to February 2012, to compare clinical criteria of McIsaac to throat swab culture results as the gold standard for diagnosis. Subjects were children aged 3-14 years who visited the pediatric outpatient clinic or emergency ward at Sanglah Hospital and the pediatric outpatient clinic at Wangaya Hospital.Results There were 550 cases of acute pharyngitis during the study period, with 313 patients aged 3-14 years and 199 patients excluded due to a history of taking antibiotics in the two weeks prior to the hospital visit. Hence, 114 subjects were eligible for the study. GABHS prevalence in this study was 7.9%. McIsaac’s area under the curve (AUC) from receiver operating characteristic (ROC) curve was 78.1%(95%CI 60.3 to 96%, P= 0.005). A McIsaac score ≥4 had a 66.7% (95%CI 49 to 97%) sensitivity, 87.6% (95% CI 81 to 94%) specificity, 31.6% (95 %CI 11 to 52%) positive predictive value (PPV), 96.8% (95%CI 93 to 100%) negative predictive value (NPV), 86.0% accuracy, 5.4 (95% CI 2.7 to 10.7) positive likelihood ratio (LR+) and 0.4 (95% CI 0.2 to 0.9) negative likelihood ratio (LR-).Conclusion A McIsaac criteria total score of <4 is favorable for excluding a diagnosis of GABHS pharyngitis. A McIsaac total criteria score of ≥4 requires further examination to confirm a diagnosis of GABHS pharyngitis.
Cotinine and interferon-gamma levels in pre-school children exposed to household tobacco smoke
Authors: Kalalo Lina , Takumansang-Sondakh Diana , Wahani Audrey
Published: August 2016

Background Environmental tobacco smoke has been consistently linked to negative health outcomes, especially in children, including an increased susceptibility to infections. Cigarette smoking has a depressive effect on interferon-γ (IFN-γ). Serum cotinine is a marker of exposure to smoke.Objective To determine the association between serum cotinine and interferon-γ (IFN-γ) levels in children with household tobacco smoke exposure.Methods We conducted a cross-sectional study at the Tumumpa and Singkil Districts of Manado, Indonesia, from February to May 2012. Subjects were collected by consecutively sampling of healthy children aged 1-3 years who came to the integrated health posts. Seventy-four children were recruited and consisted of two groups of 37 subjects each, the tobacco smoke exposure group and the non-tobacco smoke exposure group. Blood specimens were collected from all subjects for laboratory blood tests of cotinine and IFN-γ levels. Results were analyzed by T-test and Pearson’s correlation analysis with a P<0.05 is considered as statistically significant.Results There was no significant correlation between serum cotinine and interferon-γ levels in the tobacco smoke exposure group. However, the interferon-γ level in the tobacco smoke exposure group was significantly lower than that of the non-tobacco smoke exposure group (P<0.0001).Conclusion Cotinine is not related to the interferon-γ level in children exposed to tobacco smoke, however, the interferon-γ level in children with tobacco smoke exposure is lower than in the non-tobacco smoke exposure group.
Modelagem hidrogeológica de fluxo e transporte advectivo na Bacia do Engenho Nogueira, Campus Pampulha da UFMG, Belo Horizonte, MG
Authors: Gonçalves Laila Garcia Maia , Velásquez Leila Nunes Menegasse
Published: August 2016

O estudo teve como objetivos a construção e calibração de um modelo numérico permanente de fluxo de água subterrânea a partir de dados secundários e a sua aplicação teórica na avaliação de transporte advectivo de partículas para identificar zonas de transporte de poços tubulares pertencentes à UFMG, no campus Pampulha. A área está situada no Complexo Belo Horizonte, que constitui o aquífero fissural gnáissico, sobreposto pelo aquífero granular, formado por solos residuais e coluvionares areno-argilosos a argilo-arenosos e por depósitos aluvionares argilo-arenosos com lentes de argila orgânica plástica. Ambos os aquíferos possuem forte conexão hidráulica entre si. Foram divididas cinco unidades hidrogeológicas e definidas cinco zonas de recarga na área de estudo variando de 100 a 400 mm/ano de acordo com a ocupação do solo, com a sua textura e com as cotas altimétricas. A modelagem numérica de fluxo se mostrou bastante satisfatória e compatível com o modelo conceitual concebido para área, e, na modelagem de transporte advectivo de partículas, foram identificadas zonas de transporte cuja contaminação pode afetar a qualidade da água bombeada a dezenas de metros de distância ao longo do tempo. O bombeamento dos poços considerados equivale a aproximadamente 50% da recarga feita por chuva. Os resultados devem contribuir para a gestão quantitativa e qualitativa da água subterrânea no campus Pampulha da UFMG. Foi utilizado o software Visual MODFLOW 2011.1, e o aplicativo MODPATH.
Groundwater recharge influencing the arsenic enrichment in the aquifer of west Bengal
Authors: Singh Neha , Sen Ratan , Vishwakarma Chandrashekhar Azad , Asthana Harshita , Mukherjee Saumitra
Published: August 2016

Arsenic contamination, a very serious issue, has a detrimental effect on the living being. Arsenic contamination is found in the Gangetic plains, with West Bengal as the most affected state. In the present study, an attempt has been made to use weighted overlay analysis for arsenic hazard zonation based on the factors that influence the groundwater in a terrain. Weighted overlay analysis was done for mapping the arsenic contamination zone by assigning weightage and rating to geomorphology, land use/land cover, soil type, cropping intensity, slope and drainage density in North 24 Parganas. The whole region has been formed by the sedimentation from the river, and soil at the surface contains higher concentration of arsenic. Arsenic may get released from the sediment by various mechanism and transport downward along with the infiltration of rainwater. Thus, arsenic contamination in groundwater is influenced by the arsenic rich sediments, slope, and drainage pattern of the area. The arsenic concentration in collected groundwater samples shows the same result as obtained from the weighted overlay analysis except in the area with deeper water level. Thus, weighted overlay analysis along with water level data can be an effective method for determining the risk of arsenic in an area.
Stability of n-Dimensional Additive Functional Equation in Generalized 2-Normed Space
Authors: Arunkumar M.
Published: August 2016

In this paper, the author established the general solution and generalized Ulam-Hyers-Rassias stability of n-dimensional additive functional equation

in generalized 2-normed space.
Semi-Slant Submersions from Almost Product Riemannian Manifolds
Authors: Gündüzalp Yılmaz
Published: August 2016

In this paper, we introduce semi-slant submersions from almost product Riemannian manifolds onto Riemannian manifolds. We give some examples, investigate the geometry of foliations which are arisen from the definition of a Riemannian submersion. We also find necessary and sufficient conditions for a semi-slant submersion to be totally geodesic.
Anti-synchronization of fractional order chaotic and hyperchaotic systems with fully unknown parameters using modified adaptive control
Authors: Al-Sawalha M. Mossa , Al-Sawalha Ayman
Published: August 2016

The objective of this article is to implement and extend applications of adaptive control to anti-synchronize different fractional order chaotic and hyperchaotic dynamical systems. The sufficient conditions for achieving anti–synchronization are derived by using the Lyapunov stability theory and an analytic expression of the controller with its adaptive laws of parameters is shown. Theoretical analysis and numerical simulations are shown to verify the results.
Experimental Evaluation of Mechanical Properties of Friction Welded Dissimilar Steels under Varying Axial Pressures
Authors: Handa Amit , Chawla Vikas
Published: August 2016

The present study emphasizes on joints two industrially important materials AISI 304 with AISI 1021steels, produced by friction welding have been investigated. Samples were welded under different axial pressures ranging from 75MPa to 135MPa, at constant speed of 920rpm. The tensile strength, torsional strength, impact strength and micro hardness values of the weldments were determined and evaluated. Simultaneously the fractrography of the tensile tested specimens were carried out, so as to understand the failure analysis. It was observed that improved mechanical properties were noticed at higher axial pressures. Ductile failures of weldments were also observed at 120MPa and 135MPa axial pressures during fractography analysis.
Serum C-reactive protein, fibrinogen and D-dimer in patients with progressive cerebral infarction
Authors: Zang Ruo-shi , Zhang Hong , Xu Yan , Zhang Sheng-ming , Liu Xi , Wang Jing , Gao Yong-zhe , Shu Min , Mei Bin , Li Hua-gang
Published: August 2016

Objective

Progressive cerebral infarctions increase mortality and functional disability through mechanisms which have yet to be completely understood. The goal of this study was to explore the dynamic changes of serum C-reactive protein (CRP), fibrinogen (FIB) and D-dimer (D-D) in order to better characterize progressive cerebral infarction.

Methods

The amount of serum CRP, FIB and D-D was measured in 82 patients with progressive cerebral infarction by taking samples from the internal carotid artery (progressive group), and in 186 patients with non-progressive cerebral infarction (non-progressive group) by using an automatic biochemical analyzer during the next day (day 1), day 3, day 7, and day 14 after being admitted to hospital. Carotid vascular ultrasound and neurological deficit score (National Institutes of Health Stroke Scale, NIHSS) were also recorded.

Results

Carotid stenosis ratio was significantly higher in the progressive group than in the non-progressive group (P < 0.01) on admission. In the progressive group, CRP increased significantly on day 3, followed by a decline on day 7 and day 14, but was significantly higher than those in the non-progressive group (P < 0.01). The levels of FIB and D-D increased in the progressive group more than those in the non-progressive group on day 3, day 7, and day 14 (P < 0.01). The progressive group patients’ NIHSS score gradually increased after admission, which was opposite to the non-progressive group patients whom followed a downward trend. The difference between these two groups was significant (P < 0.01).

Conclusion

Observing changes of CRP, FIB and D-D may contribute to early identification and timely treatment of progressing ischemic strokes.
Effect of Caffeine on Perceived Soreness and Functionality Following an Endurance Cycling Event
Authors: Caldwell Aaron R. , Tucker Matthew A. , Butts Cory L. , McDermott Brendon P. , Vingren Jakob L. , Kunces Laura J. , Lee Elaine C. , Munoz Colleen X. , Williamson Keith H. , Armstrong Lawrence E. , Ganio Matthew S.
Published: August 2016

Caldwell, AR, Tucker, MA, Butts, CL, McDermott, BP, Vingren, JL, Kunces, LJ, Lee, EC, Munoz, CX, Williamson, KH, Armstrong, LE, and Ganio, MS. Effect of caffeine on perceived soreness and functionality following an endurance cycling event. J Strength Cond Res 31(3): 638–643, 2017—Caffeine can reduce muscle pain during exercise; however, the efficacy of caffeine in improving muscle soreness and recovery from a demanding long-duration exercise bout has not been established. The purpose of this study was to investigate the effects of caffeine intake on ratings of perceived muscle soreness (RPMS) and perceived lower extremity functionality (LEF) following the completion of a 164-km endurance cycling event. Before and after cycling RPMS (1-to-6; 6 = severe soreness) and LEF (0-to-80; 80 = full functionality) were assessed by questionnaires. Subjects ingested 3 mg/kg body mass of caffeine or placebo pills in a randomized, double-blind fashion immediately after the ride and for the next 4 mornings (i.e., ∼800 hours) and 3 afternoons (i.e., ∼1200 hours). Before each ingestion, RPMS and LEF were assessed. Afternoon ratings of LEF were greater with caffeine ingestion the first day postride (65.0 ± 6.1 vs. 72.3 ± 6.7; for placebo and caffeine, respectively; p = 0.04), but at no other time points (p > 0.05). The caffeine group tended to have lower overall RPMS in the afternoon versus placebo (i.e., main effect of group; 1.1 ± 0.2 vs. 0.5 ± 0.2; p = 0.09). Afternoon RPMS for the legs was significantly lower in the caffeine group (main effect of caffeine; 1.3 ± 0.2 vs. 0.5 ± 0.3; p = 0.05). In conclusion, ingesting caffeine improved RPMS for the legs, but not LEF in the days following an endurance cycling event. Athletes may benefit from ingesting caffeine in the days following an arduous exercise bout to relieve feelings of soreness and reduced functionality.
KONUT PAZARLAMASINDA MÜŞTERİ MEMNUNİYETİNİN ÖLÇÜLMESİ: SAFRANBOLU ÖRNEĞİ
Authors: Özgüner Kılıç Hicran , Özer Hüseyin Alper
Published: August 2016

Küreselleşme süreci ile birlikte bütün sektörlerde rekabetin yoğun yaşandığı bu dönemde işletmeler için mevcut müşterilerin elde tutulması yeni müşterinin elde edilmesinden daha önemli hale gelmiştir. Bu nedenle müşteri memnuniyetinin belirlenmesi işletmelerin öncelik verdiği konuların başında gelmektedir.  Müşteri memnuniyeti, mal ve hizmet üreten işletmelerin yanı sıra konut üreten kişi ya da işletmelerin de üzerinde durdukları önemli konulardan biridir. İlgili yazında önemli bir yer tutan müşteri memnuniyeti konusunda çok sayıda çalışma yapılmasına rağmen konut pazarlaması alanında yapılan çalışmaların yok denecek kadar az olması çalışmanın hazırlanmasında en büyük etken olmuştur. Bu bağlamda çalışma; Safranbolu’da gün geçtikçe artan konut ve konut üreticilerinin hangi düzeyde müşteri memnuniyeti oluşturduklarını tespit etmek amacıyla gerçekleştirilmiştir. Araştırma, konut müşterilerinin memnuniyet düzeylerini belirlemek amacıyla Safranbolu’da konut satın alan kişilere yüz yüze anket yöntemi kullanılarak yapılmış olup 247 kullanılabilir anket elde edilmiştir. Elde edilen sonuçlar değerlendirildiğinde; katılımcıların, genel olarak satın aldıkları konuttan elde ettikleri memnuniyetin orta düzeyde olduğu görülmektedir.
YÖNETİCİLERİN LİDERLİK DAVRANIŞLARININ ÇALIŞANLARIN ÖRGÜTSEL BAĞLILIĞI İLE İLİŞKİSİNİN İSTATİSTİKSEL YÖNTEMLERLE ARAŞTIRILMASI
Authors: Durmuş Aydoğan
Published: August 2016

Yöneticilerin liderlik davranışlarının çalışanların örgütsel bağlılıklarıyla ilişkisini araştırmak amacıyla gerçekleştirilen bu çalışmada İstanbul İlindeki 3 şirkette çalışan 155 personele anket uygulanmıştır. Çalışanların örgütsel bağlılıklarını ölçmek için Meyer, Allen ve Smith tarafından geliştirilen örgütsel bağlılık ölçeği, liderlik davranışlarını ölçmek için Kent’in “Liderlik Davranışları Envanteri”; ile Avolio, Bass ve Jung’un “Çokboyutlu Liderlik Soruları”, isimli anket formları incelenerek ve Goleman’ın “Liderlerin Davranış Repertuarı”nı temel alan liderlik davranışı soruları geliştirilerek oluşturulan ve araştırmalarda sık kullanılan liderlik davranışı ölçeğinden faydalanılmıştır. Anket uygulaması ile toplanan veriler SPSS 22 programına girilerek değerlendirilmiştir. Uygulama sonucunda yöneticilerin otokratik, vizyoner, katılımcı ve liderlik davranışları güçlendikçe çalışanların örgüte olan devam ve normatif bağlılıklarının arttığı; yöneticilerin eğitici ve ilişki odaklı liderlik davranışları güçlendikçe çalışanların örgüte olan duygusal, normatif ve devam bağlılıklarının da güçlendiği tespit edilmiştir. Çalışanların yöneticilerin liderlik davranışlarından genel memnuniyet düzeyleri yükseldikçe örgüte olan devam ve normatif bağlılıklarının da arttığı tespit edilmiştir.
KURUMSAL YÖNETİM ENDEKSİ KAPSAMINDAKİ İŞLETMELERİN FİNANSAL PERFORMANS ANALİZİ
Authors: Temizel Fatih , Doğan Hamza , Bayçelebi Berfu Ece
Published: August 2016

Payları Borsa İstanbul’da işlem gören işletmelere Sermaye Piyasası Kurulu (SPK)’nun ilgili tebliğine göre bağımsız derecelendirme kurumlarınca verilen Kurumsal Yönetim İlkelerine Uyum Notu kurumsal yönetim konusunda en başarılı 50 işletmenin belirlenmesini sağlamaktadır. Bu açıdan en başarılı 50 işletme ise fiyat ve getiri analizlerinde yardımcı göstergeler edinmek amacı ile Borsa İstanbul Kurumsal Yönetim Endeksi’ne dâhil edilmektedir. Bu çalışmada Kurumsal Yönetim Endeksi’nde bulunan 50 işletme arasından finans sektörü dışında kalan 34 işletmenin finansal performans sıralaması TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) yöntemi ile elde edilmiştir. TOPSIS yöntemi işletmelere ait 10 adet finansal orana dayalı olarak kullanılmıştır. 2011-2015 yıllarını kapsayan 5 yıl için performans sıralamaları elde edilip yıllar arası sıralama değişimleri incelenmiştir. Son olarak 5 yıllık ortalama performans sıralaması hesaplanarak endeksteki işletmelerin son 5 yıl içerisindeki finansal performans dereceleri ortaya konulmuştur.
Defects in homologous recombination repair behind the human diseases: FA and HBOC
Authors: Katsuki Yoko , Takata Minoru
Published: August 2016

Hereditary breast and ovarian cancer (HBOC) syndrome and a rare childhood disorder Fanconi anemia (FA) are caused by homologous recombination (HR) defects, and some of the causative genes overlap. Recent studies in this field have led to the exciting development of PARP inhibitors as novel cancer therapeutics and have clarified important mechanisms underlying genome instability and tumor suppression in HR-defective disorders. In this review, we provide an overview of the basic molecular mechanisms governing HR and DNA crosslink repair, highlightingBRCA2, and the intriguing relationship between HBOC and FA.
Preventing Obesity and Eating Disorders in Adolescents
Authors: Golden Neville H. , Schneider Marcie , Wood Christine ,   COMMITTEE ON NUTRITION,   COMMITTEE ON ADOLESCENCE,   SECTION ON OBESITY, Daniels Stephen , Abrams Steven , Corkins Mark , de Ferranti Sarah , Magge Sheela N. , Schwarzenberg Sarah , Braverman Paula K. , Adelman William , Alderman Elizabeth M. , Breuner Cora C. , Levine David A. , Marcell Arik V. , O’Brien Rebecca , Pont Stephen , Bolling Christopher , Cook Stephen , Liu Lenna , Schwartz Robert , Slusser Wendelin
Published: August 2016

This Clinical Report was reaffirmed June 2022.

Obesity and eating disorders (EDs) are both prevalent in adolescents. There are concerns that obesity prevention efforts may lead to the development of an ED. Most adolescents who develop an ED did not have obesity previously, but some teenagers, in an attempt to lose weight, may develop an ED. This clinical report addresses the interaction between obesity prevention and EDs in teenagers, provides the pediatrician with evidence-informed tools to identify behaviors that predispose to both obesity and EDs, and provides guidance about obesity and ED prevention messages. The focus should be on a healthy lifestyle rather than on weight. Evidence suggests that obesity prevention and treatment, if conducted correctly, do not predispose to EDs.
Parental Presence During Treatment of Ebola or Other Highly Consequential Infection
Authors: Davies H. Dele , Byington Carrie L. ,   COMMITTEE ON INFECTIOUS DISEASES
Published: August 2016

This clinical report offers guidance to health care providers and hospitals on options to consider regarding parental presence at the bedside while caring for a child with suspected or proven Ebola virus disease (Ebola) or other highly consequential infection. Options are presented to help meet the needs of the patient and the family while also posing the least risk to providers and health care organizations. The optimal way to minimize risk is to limit contact between the person under investigation or treatment and family members/caregivers whenever possible while working to meet the emotional support needs of both patient and family. At times, caregiver presence may be deemed to be in the best interest of the patient, and in such situations, a strong effort should be made to limit potential risks of exposure to the caregiver, health care providers, and the community. The decision to allow parental/caregiver presence should be made in consultation with a team including an infectious diseases expert and state and/or local public health authorities and should involve consideration of many factors, depending on the stage of investigation and management, including (1) a careful history, physical examination, and investigations to elucidate the likelihood of the diagnosis of Ebola or other highly consequential infection; (2) ability of the facility to offer appropriate isolation for the person under investigation and family members and to manage Ebola; (3) ability to recognize and exclude people at increased risk of worse outcomes (eg, pregnant women); and (4) ability of parent/caregiver to follow instructions, including appropriate donning and doffing of personal protective equipment.
Medication-Assisted Treatment of Adolescents With Opioid Use Disorders
Authors:   COMMITTEE ON SUBSTANCE USE AND PREVENTION, Ryan Sheryl A. , Gonzalez Pamela K. , Patrick Stephen W. , Quigley Joanna , Siqueira Lorena , Walker Leslie R.
Published: August 2016

Opioid use disorder is a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction.
Signs and Symptoms in the Temporomandibular Joint of Geriatric Patients with Arthritis, Before and After Physiotherapy
Authors: Mendiburu DDS, MSc, PhD Celia , Peñalosa DDS, MSc, PhD Ricardo , Mendiburu MD Josué , Cárdenas DDS, MSc Rubén , Cortés DDS, MSc David , Cervera DDS José
Published: August 2016

The temporomandibular joint (TMJ) may be affected in patients with rheumatoid arthritis and osteoarthritis, especially in elderly and senile adult patients. The objective of this study was to evaluate the signs and / or symptoms of TMJ in elderly subjects retired from a medical institution in Merida, Yucatan, Mexico, previously diagnosed with arthritis, the onset of physical therapy and one month after applying it. July-August 2015. A longitudinal, comparative and analytical study was conducted in 25 subjects ages 60 and older,   both sex: men and women. The subjects who agreed to participated signed voluntary consent letter. Also, a medical research card was made, which consisted of: 1) demographic and medical data; 2) a directed interview based on Rodriguez-Osores and modified by Mendiburu-Zavala in 2015 that included 33 dichotomous questions related to signs and / or symptoms of TMJ disorders; 3) the clinical examination was carried out carefully; 4) Finally, a manual prepared by Mendiburu-Zavala exercise based on Rocabado-Seaton and  Lawson´s manual.  The exercises for relaxation of the jaw and face, posture and managing TMJ noises were taught and explained individually, offering to teach them the times they needed to exercise at home. The questionnaire and clinical examination was applied a month later. The McNemar test was used. It was considered significant if P <0.05.  A 28 % of the studied subject were men and 72 % women, with an average age of 65.4 ± 4.8, with a 44 % with osteoarthritis and a 56 % with rheumatoid arthritis.  The effect of physiotherapy per month being applied, had a significantly favorable responses of " NO" for variables : blocked, jammed or dislocated jaw (P = 0.0156); Crackles ( P = 0.0195 ) and Snap ( P = 0.0001 ). The application of physiotherapy in this age group with arthritis was favorable.
Why we have no serious alternatives but cooperative taxonomy
Authors: Pupulin Franco
Published: August 2016

El trabajo taxonómico ha sido históricamente considerado como una disciplina doble. Por un lado, su objetivo fundamental es responder a la pregunta sobre la diversidad de cualquier grupo bajo estudio, y esto incluye la mayoría de las preguntas “biológicas” de la investigación. Para entender las relaciones y parentescos entre los taxones de un determinado grupo, y finalmente describir su diversidad, se requiere de la comprensión de la variación genética y morfológica, de la estructura de las poblaciones y sus ciclos de vida, de la bio- y filo-geografía, de los modelos ecológicos, así como de la polinización y otros componentes bióticos que interactúan con los taxones en estudio. La segunda parte del trabajo consiste en la aplicación de un nombre correcto a cada uno de los organismos así como resultan identificados a través de al etapa biológica del estudio. Esta segunda etapa se interpreta usualmente como la componente documentaria de la investigación, y de hecho tienen mayormente que ver con las fuentes documentales y las reglas de la nomenclatura biológica (tales como protólogos, tipos y otros materiales históricos asociados con las recolectas-tipo, etc.). Sin embargo, el uso de fuentes de nomenclatura asociados a poca o ninguna consideración de los aspectos biológicos de los organismos en estudio puede ser engañoso y el mismo concepto de “tipo” puede difícilmente entenderse si no está enmarcado en un contexto biológico complejo. Los especímenes tipo no son sino ejemplos individuales escogidos al azar, los cuales deben ser interpretados a la luz de la integridad biológica y geográfica de una especie determinada, y esto requiere de por lo menos de algún tipo de conocimiento directo de los organismos y su biología. Cuando el origen geográfico de los especímenes tipo se encuentra afuera de los límites políticos de una determinada área de estudio, la investigación taxonómica se encuentra seriamente impedida por la imposibilidad de visualizar y entender los tipos en un marco biológico. Un ejemplo del trabajo finalizado a completar el tratamiento de Orchidaceae para la flora de Costa Rica puede enseñar como solamente un acercamiento cooperativo, basado en una metodología común, puede resolver la taxonomía de especies complejas.
Main fungal partners and different levels of specificity of orchid mycorrhizae in the tropical mountain forests of Ecuador
Authors: Suárez Juan Pablo , Kottke Ingrid
Published: August 2016

Orchids are a main component of the diversity of vascular plants in Ecuador with approximately 4000 species representing about 5.3% of the orchid species described worldwide. More than a third of these species are endemics. As orchids, in contrast to other plants, depend on mycorrhizal fungi already for seed germination and early seedling establishment, availability of appropriate fungi may strongly influence distribution of orchid populations. It is currently debated if green orchids depend on specific mycobionts or may be equally promoted by a broad spectrum of mycorrhizal fungi, discussion mostly based on data from temperate regions. Here we summarize results obtained from broad scale investigations in the tropical mountain rain forest of Ecuador revealing associations with members of Serendipitaceae (Sebacinales), Tulasnellaceae, Ceratobasidiaceae (Cantharellales), and Atractiellales. Recent molecular data show that these worldwide spread fungal groups have broad ecological implications and are specifically suited as mycorrhizal fungi of green orchids. We found that main fungal partners and different levels of specificity among orchids and their mycobionts in the tropical mountain forests correspond to findings in other biomes despite the large ecological differences.
Active tectonic and volcanic mountain building as agents of rapid environmental changes and increased orchid diversity and long-distance orchid dispersal in the tropical Americas: opportunities and challenges
Authors: Kirby Stephen H.
Published: August 2016

Tropical Latin America is a nexus of tectonic plates whose relative motions have led to rapid tectonic and volcanic mountain building in late Neogene time. Tropical mountain building, in turn, leads to highland “cloud forest” microclimates with increased rainfall, lower diurnal temperatures, and diverse microclimates. I have previously emphasized how the geologically recent growth of mountains has been localized in Central America and that this is likely a factor in the high diversity and endemism in those highlands. This paper will show that Andean uplift accelerated at ~15 Ma ago and ~ 5 Ma BP and continues to this day. This process evolved geographically among the cordilleras of the region. Givnish and others recently presented phylogenomic evidence that the diversity of many epiphytic orchids, including tribes found in the neotropics, also accelerated during this time interval.. Phylogenetic investigations of tropical orchid pollinators have shown that acceleration in speciation in such pollinators as hummingbirds, orchid bees, and flies occurred over this same time frame, suggesting that geologically driven environmental changes may have acted in concert with changes in orchid biology to speed up orchid diversity in these highlands. I also review some of the long-distance dispersal processes of orchids in the tropical Americas. River systems draining the Colombian Andes discharge into the Caribbean Sea and current-driven log-raft drifts and air suspension during cyclonic storms transport plants and animals from east to the west. Lastly I emphasize the need for the more information on orchid floras and species distribution in this hotspot.
Risk reduction of needle stick injuries due to continuous shift from unsafe to safe instruments at a German University Hospital
Authors: Frickmann Hagen , Schmeja Wibke , Reisinger Emil , Mittlmeier Thomas , Mitzner Karen , Schwarz Norbert Georg , Warnke Philipp , Podbielski Andreas
Published: August 2016

This study assessed protective effects of a continuous introduction of safe instruments in terms of reduction of needle stick injuries. The retrospective study analyzed correlations between the increasing proportion of safe instruments and a reduction of the incidence of needle stick injuries linked to such instruments in a German university hospital over 5 years. Incidents declined about 17.6% from 80.3 incidents per 1000 employees to 66.2, associated with an increase in the proportions of injuries due to instruments without protective mechanisms such as scalpels or hypodermic needles by 12.2%. For injuries due to venipuncture cannulae in various surgical and internal medicine departments, there was a negative association between the proportion of safe instruments and the incidence of injuries. For injection needles, portacath needles, and lancets in selected internal medicine departments, the number of injuries also dropped during this study interval. However, there was no clear-cut association with the percentage of safe instruments. This observational study suggests a correlation between the implementation of use of safe instruments and the reduction of needle stick injuries in a case of a graduated implementation. However, the effects are much less pronounced than in previous interventional studies.
Global Health Learning - Are Students Demonstrating Insights Through Short Essays?
Authors: Wylie Ann , Elsabagh Sarah
Published: August 2016

This article was migrated. The article was marked as recommended. Background Aim: Learning outcomes (LO) for Global Health (GH) in medical curricula were developed by consensus. This discipline however is challenging to deliver. In one medical school we explored evidence of learning following symposia, by qualitatively analysing essays and data from student feedback. Methods: A purposive sample of 14% (N=58) GH essays, from senior medical students, were analysed for content, as they related to these LOs, the critical insights and arguments around GH. Free text student feedback data was analysed for student acceptability of the assignment, given that this contributes to students' final ranking. Results: A synthesis of themes were identified suggesting good awareness of the interconnectivity of health issues, such as health care systems and social determinants of health. A minority of students restricted themselves to descriptive essays. A quarter of students explicitly linked their essays to their forthcoming elective placement enabling them to feel well informed about local health issues regardless of whether they were going to a resource poor setting or not. Many students valued this assignment, but a minority disliked the lack of prescriptive directive. Conclusions: These approaches to GH teaching and assessment demonstrated learning for most students, and good scholarship in many essays, for this essential but emerging discipline.
Metastatic Breast Cancer With ESR1 Mutation: Clinical Management Considerations From the Molecular and Precision Medicine (MAP) Tumor Board at Massachusetts General Hospital
Authors: Bardia Aditya , Iafrate John A. , Sundaresan Tilak , Younger Jerry , Nardi Valentina
Published: August 2016

The last decade in oncology has witnessed impressive response rates with targeted therapies, largely because of collaborative efforts at understanding tumor biology and careful patient selection based on molecular fingerprinting of the tumor. Consequently, there has been a push toward routine molecular genotyping of tumors, and large precision medicine-based clinical trials have been launched to match therapy to the molecular alteration seen in a tumor. However, selecting the “right drug” for an individual patient in clinic is a complex decision-making process, including analytical interpretation of the report, consideration of the importance of the molecular alteration in driving growth of the tumor, tumor heterogeneity, the availability of a matched targeted therapy, efficacy and toxicity considerations of the targeted therapy (compared with standard therapy), and reimbursement issues. In this article, we review the key considerations involved in clinical decision making while reviewing a molecular genotyping report. We present the case of a 67-year-old postmenopausal female with metastatic estrogen receptor-positive (ER+) breast cancer, whose tumor progressed on multiple endocrine therapies. Molecular genotyping of the metastatic lesion revealed the presence of an ESR1 mutation (encoding p.Tyr537Asn), which was absent in the primary tumor. The same ESR1 mutation was also detected in circulating tumor DNA (ctDNA) extracted from her blood. The general approach for interpretation of genotyping results, the clinical significance of the specific mutation in the particular cancer, potential strategies to target the pathway, and implications for clinical practice are reviewed in this article.
Testing of open section drilled C-pile and CT-pile wall
Authors: Larkela Liisa , Lehtonen Jouko , Korkiala-Tanttu Leena
Published: August 2016

Micropile developments have greatly advanced over the last two decades and new kinds of piles have been created to meet different challenges in foundation works. This paper describes an open section steel C-pile. A C-pile can be used for lightly loaded foundations to reduce cost and improve environmental efficiency. This C-pile has been developed further for use as a vertical drilled ‘sheet pile wall’. In this application, a T-profile is welded to a single C-pile. This combined profile allows the piles to be connected to each other and to form a wall – a CT-pile wall. When cement grouting is used to infill the hollow sections, a moderately watertight structure with higher stiffness is created. This paper presents the results of an installation test conducted on a CT-pile wall. The results from the test showed that the CT-pile wall performed well, and the deformations in the wall and behind the wall were at an acceptable level. The CT-pile wall is similar to a moderately light sheet pile wall and is expected to provide relatively good watertightness.
A Study on the Perception of Elderly Leisure of the Reality Program “Grandpa over Flowers” Older Generation Viewers: Focusing on the Middle Class
Authors:   The Tourism Sciences Society Of Korea, Kim Jinok , Kim Nam Jo
Published: August 2016

Due to the increase of leisure time caused by the five-day work week and the introduction of comprehensive programming channels, reality programs related to tourism have greatly increased. Therefore, modern tourists are indirectly experiencing tourism on TV. The purpose of this study is to examine how older generation viewers form their viewpoints on leisure via reality programs. Specifically, using a reality program entitled “Grandpa over Flowers” in which the elderly go backpacking that is considered to be the exclusive property of the young generation. This study tried to analyze how the negative image of elderly individuals is restructured and reinterpreted. This study was conducted using an interview with six older generation viewers from a middle economic class who were over 60 years of age. As a result of the analysis, older generation middle economic class viewers claimed that the age criterion of the elderly was over 75 and the negative recognition of the elderly people resulted from the improper education of children. Men and women preferred distinctively different leisure types, and they had a negative viewpoint concerning free leisure facilities. Regarding the leisure policies of Korea, they had strong complaints concerning Korean welfare policies. They also claimed that the middle class and higher classes cannot benefit from welfare policies for the elderly. For “Grandpa over Flowers”, they contended that it is a commercial program that aggravated the values of elderly people through backpacking. However, they responded that they would prepare for language study by backpacking in the future and would not feel any economic burden from this plan. In conclusion, older generation viewers from the middle class in Korea showed both Bourdieu’s distinction phenomenon and Peterson & Simkus’ omnivore phenomenon simultaneously.