bluuebunny/crossref_metadata_2025 huggingface dataset:
Merits of Level III Axillary Dissection in Node-Positive Breast Cancer: A Prospective, Single-Institution Study From India
Authors: Joshi Shalaka , Noronha Jarin , Hawaldar Rohini , Kundgulwar Girish , Vanmali Vaibhav , Parmar Vani , Nair Nita , Shet Tanuja , Badwe Rajendra
Published: February 2019

PURPOSE

A complete axillary lymph node (ALN) dissection is therapeutic in node-positive breast cancer. Presently, there is no international consensus regarding anatomic levels to be addressed in complete axillary dissection. We assessed the burden of disease in level III axilla.

MATERIALS AND METHODS

A prospectively maintained database was assessed for 1,591 consecutive patients with nonmetastatic breast cancer registered at Tata Memorial Center, Mumbai, between January 2009 and December 2014.

RESULTS

A median of four (zero to 20) level III ALNs were dissected and a median of two (one to 17) nodes were positive. A total of 27.3% (434 of 1,591) patients had level III ALN metastasis, and 4.7% of patients had positive interpectoral nodes. Some 53.2% of patients had level III metastases in the presence of four or more positive level I and II ALNs. A total of 9.4% of patients had level III involvement when one to three ALNs were positive in level I and II ( P < .001). Some 53.2% of patients had level III metastases in the presence of four or more positive level I and II ALNs. On logistic regression analysis, four or more positive ALNs in level I or II ( P < .001), inner/central quadrant tumor location ( P = .013), and perinodal extension ( P < .001) were associated with level III ALN involvement. At a median follow-up of 36 months, the disease-free survival was significantly worse for level III ALN metastases on univariate analysis ( P < .001). On multivariate Cox regression analysis, histologic grade ( P = .006), four or more positive ALNs ( P < .001), hormone receptor status ( P < .001), and tumor size ( P = .037) were independent prognostic factors for disease-free survival.

CONCLUSION

The axillary nodal burden is high in patients with breast cancer in developing countries like India. One of two women with four or more positive level I and II ALNs may have residual disease in level III if it is not cleared during surgery. Intraoperative interpectoral space clearance should be considered in the presence of either palpable interpectoral lymph nodes or multiple positive ALNs.
The Making of a Foreign National Language: Language Politics and the Impasse between Assimilationists and Language Nationalists in Colonial Korea
Authors: Pieper Daniel
Published: February 2019

This article examines the process by which Japanese came to be solidified as the national language of instruction in public schools during the first decade of colonial rule (1911–22). First, I analyze Government-General of Korea language policy and the recollections in 1917 by the policy insider Oda Shogō, which reveal a confidence in the efficiency of administration but also a tension between the official discourse on Japanese language nationalization and the perceived proficiency of Korean instructors and students. The March First Movement less than two years later exploded the misconception of a complacent student body and brought to the fore simmering grievances, notably the language of instruction issue in public schools. Through an analysis of the language of instruction debate in the popular press, I demonstrate the rupture that had developed between Japanese officials and the Korean public, an unbridgeable divide due to the impasse between co-educationalists calling for integrated education in Japanese only and “language nationalists” demanding more instruction in Korean. The Second Rescript on Education proclaimed by the Government-General in 1922 thus affirmed the dominant position of Japanese in the curriculum and ensured the continuing vitality of private sŏdang well into the 1920s.
Automated morphometry toolbox for analysis of microscopic model organisms using simple bright-field imaging
Authors: Liu Guanghui , Dong Fenfen , Fu Chuanhai , Smith Zachary J.
Published: February 2019

Model organisms with compact genomes, such as yeast and C. elegans, are particularly useful for understanding organism growth and life/cell cycle. Organism morphology is a critical parameter to measure in monitoring growth and stage in the life cycle. However, manual measurements are both time consuming and potentially inaccurate, due to variations among users and user fatigue. In this paper we present an automated method to segment bright field images of fission yeast, budding yeast, and C. elegans roundworm, reporting a wide range of morphometric parameters, such as length, width, eccentricity, and others. Comparisons between automated and manual methods on fission yeast reveal good correlation in size values, with the 95% confidence interval lying between −0.8 and +0.6 microns in cell length, similar to the 95% confidence interval between two manual users. In a head-to-head comparison with other published algorithms on multiple datasets, our method achieves more accurate and robust results with substantially less computation time. We demonstrate the method's versatility on several model organisms, and demonstrate its utility through automated analysis of changes in fission yeast growth due to single kinase deletions. The algorithm has additionally been implemented as a stand-alone executable program to aid dissemination to other researchers.
Spatial regulation of the polarity kinase PAR-1 by parallel inhibitory mechanisms
Authors: Folkmann Andrew W. , Seydoux Geraldine
Published: February 2019

The MARK/PAR-1 family of kinases are conserved regulators of cell polarity that share a conserved C-terminal kinase-associated domain (KA1). Localization of MARK/PAR-1 kinases to specific regions of the cell cortex is a hallmark of polarized cells. In Caenorhabditis elegans zygotes, PAR-1 localizes to the posterior cortex under the influence of another polarity kinase, aPKC/PKC-3. Here, we report that asymmetric localization of PAR-1 protein is not essential, and that PAR-1 kinase activity is regulated spatially. We find that, as in human MARK1, the PAR-1 KA1 domain is an auto-inhibitory domain that suppresses kinase activity. Auto-inhibition by the KA1 domain functions in parallel with phosphorylation by PKC-3 to suppress PAR-1 activity in the anterior cytoplasm. The KA1 domain also plays an additional role that is essential for germ plasm maintenance and fertility. Our findings suggest that modular regulation of kinase activity by redundant inhibitory inputs contributes to robust symmetry breaking by MARK/PAR-1 kinases in diverse cell types.
Dynamic BAF chromatin remodeling complex subunit inclusion promotes temporally distinct gene expression programs in cardiogenesis
Authors: Hota Swetansu K. , Johnson Jeffrey R. , Verschueren Erik , Thomas Reuben , Blotnick Aaron M. , Zhu Yiwen , Sun Xin , Pennacchio Len A. , Krogan Nevan J. , Bruneau Benoit G.
Published: February 2019

Chromatin remodeling complexes instruct cellular differentiation and lineage specific transcription. The BRG1/BRM-associated factor (BAF) complexes are important for several aspects of differentiation. We show that the catalytic subunit gene Brg1 has a specific role in cardiac precursors (CPs) to initiate cardiac gene expression programs and repress non-cardiac expression. Using immunopurification with mass spectrometry, we have determined the dynamic composition of BAF complexes during mammalian cardiac differentiation, identifying several cell-type specific subunits. We focused on the CP- and cardiomyocyte (CM)-enriched subunits BAF60c (SMARCD3) and BAF170 (SMARCC2). Baf60c and Baf170 co-regulate gene expression with Brg1 in CPs, and in CMs their loss results in broadly deregulated cardiac gene expression. BRG1, BAF60c and BAF170 modulate chromatin accessibility, to promote accessibility at activated genes while closing chromatin at repressed genes. BAF60c and BAF170 are required for proper BAF complex composition, and BAF170 loss leads to retention of BRG1 at CP-specific sites. Thus, dynamic interdependent BAF complex subunit assembly modulates chromatin states and thereby participates in directing temporal gene expression programs in cardiogenesis.
Imaging elemental events of store-operated Ca2+ entry in invading cancer cells with plasmalemmal targeted sensors
Authors: Lu Fujian , Sun Jianwei , Zheng Qiaoxia , Li Jinghang , Hu Yuanzhao , Yu Peng , He Huifang , Zhao Yan , Wang Xianhua , Yang Shengyu , Cheng Heping
Published: February 2019

STIM1- and Orai1-mediated store-operated Ca2+ entry (SOCE) constitutes the major Ca2+ influx in almost all electrically non-excitable cells. However, little is known about the spatiotemporal organization at the elementary level. Here, we developed Orai1-tethered or palmitoylated biosensor GCaMP6f to report subplasmalemmal Ca2+ signals. We visualized spontaneous discrete and long-lasting transients (‘Ca2+ glows’) arising from STIM1-Orai1 in invading melanoma cells. Ca2+ glows occurred preferentially in single invadopodia and at sites near the cell periphery under resting conditions. Re-addition of external Ca2+ after store depletion elicited spatially synchronous Ca2+ glows, followed by high-rate discharge of asynchronous local events. Knockout of STIM1 or expression of the dominant-negative Orai1-E106A mutant markedly decreased Ca2+ glow frequency, diminished global SOCE and attenuated invadopodial formation. Functionally, invadopodial Ca2+ glows provided high Ca2+ microdomains to locally activate Ca2+/calmodulin-dependent Pyk2 (also known as PTK2B), which initiates the SOCE–Pyk2–Src signaling cascade required for invasion. Overall, the discovery of elemental Ca2+ signals of SOCE not only unveils a previously unappreciated gating mode of STIM1-Orai1 channels in situ, but also underscores a critical role of the spatiotemporal dynamics of SOCE in orchestrating complex cell behaviors such as invasion.

This article has an associated First Person interview with the first author of the paper.
Early-life adversity programs long-term cytokine and microglia expression within the HPA axis in female Japanese quail.
Authors: Walker David J. , Zimmer Cédric , Larriva Maria , Healy Susan D. , Spencer Karen A.
Published: February 2019

Stress exposure during pre and post-natal development can have persistent and often dysfunctional effects on several physiological systems, including immune function, affecting the ability to combat infection. The neuro-immune response is inextricably linked to the action of the Hypothalamic Pituitary Adrenal (HPA) axis. Cytokines released from neuro-immune cells, including microglia, activate the HPA axis while glucocorticoids in turn regulate cytokine release from microglia. Because of the close links between these two physiological systems, coupled with potential for persistent changes to HPA axis activity following developmental stress, components of the neuro-immune system could be targets for developmental programming. However, little is known of any programming effects of developmental stress on neuro-immune function. We investigated whether developmental stress exposure via elevated pre-natal corticosterone (CORT) or post-natal unpredictable food availability, had long-term effects on pro (IL-1β) and anti-inflammatory (IL-10) cytokine and microglia-dependent gene (CSF1R) expression within HPA axis tissues in a precocial bird, the Japanese quail (Coturnix japonica). Following post-natal stress, we observed increased IL-1β expression in the pituitary gland, reduced IL-10 expression in the amygdala and hypothalamus and reduced CSF1R expression within the hypothalamus and pituitary gland. Post-natal stress disrupted the ratio of IL-1β:IL-10 expression within the hippocampus and hypothalamus. Pre-natal stress only increased IL-1β expression in the pituitary gland. We found no evidence for interactive or cumulative effects across life stages on basal cytokine and glia expression in adulthood. We show that post-natal stress may have a larger impact than elevated pre-natal CORT on basal immunity in HPA axis specific brain regions, with changes in cytokine homeostasis and microglia abundance. These results provide evidence for post-natal programming of a pro-inflammatory neuro-immune phenotype at the expense of reduced microglia, which could have implications for CNS health and subsequent neuro-immune responses.
Mechanical properties of the venomous spines of Pterois volitans and morphology among lionfish species
Authors: Galloway Katherine A. , Porter Marianne E.
Published: February 2019

The red lionfish, Pterois volitans, an invasive species, has 18 venomous spines: 13 dorsal, 3 anal, and one on each pelvic fin. Fish spines can have several purposes such as defense, intimidation, and for anchoring into crevices. Instead of having hollow spines, lionfish have a tri-lobed cross-sectional shape with grooves that deliver the venom, tapering towards the tip. We aim to quantify the impacts of shape (Second moment of area) and tapering on the mechanical properties of the spine. We performed two-point bending at several positions along the spines of P. volitans to determine mechanical properties (Young's modulus, Elastic energy storage, and Flexural stiffness). The short and recurved anal and pelvic spines are stiffer and resist bending more effectively than the long, dorsal spines. In addition, mechanical properties differ along the length of the spines, most likely because they are tapered. We hypothesize that the highly bendable dorsal spines are used for intimidation, making the fish look larger. The stiffer and energy absorbing anal and pelvic spines are smaller and less numerous, but they may be used for protection since they are located near important internal structures such as the swim bladder. Lastly, spine second moment of area varies across the Pterois genus. These data suggest there may be morphological and mechanical trade-offs among defense, protection, and intimidation of lionfish spines. Overall, the red lionfish venomous spine shape and mechanics may offer protection and intimidate potential predators, significantly contributing to their invasion success.
Propulsive design principles in a multi-jet siphonophore
Authors: Sutherland Kelly R. , Gemmell Brad J. , Colin Sean P. , Costello John H.
Published: February 2019

Coordination of multiple propulsors can provide performance benefits in swimming organisms. Siphonophores are marine colonial organisms that orchestrate the motion of multiple swimming zooids for effective swimming. However, the kinematics at the level of individual swimming zooids (nectophores) have not been examined in detail. We used high speed, high resolution microvideography and particle image velocimetry (PIV) of the physonect siphonophore, Nanomia bijuga, to study the motion of the nectophores and the associated fluid motion during jetting and refilling. The integration of nectophore and velum kinematics allow for a high-speed (maximum ∼1 m s−1), narrow (1-2 mm) jet and rapid refill as well as a 1:1 ratio of jetting to refill time. Scaled to the 3 mm nectophore length, jet speeds reach >300 lengths s−1. Overall swimming performance is enhanced by velocity gradients produced in the nectophore during refill, which lead to a high pressure region that produces forward thrust. Generating thrust during both the jet and refill phases augments the distance travelled by 17% over theoretical animals, which generate thrust only during the jet phase. The details of velum kinematics and associated fluid mechanics elucidate how siphonophores effectively navigate three-dimensional space and could be applied to exit flow parameters in multijet underwater vehicles.
Inhibition of Silicic Acid Elution during the Regeneration of Strong Base Anion Exchange Resin Column
Authors: Chuuman Takaaki , Eguchi Kinnosuke , Akinaga Marina , Kawamoto Daisuke , Horii Shigeki , Yonezu Kotaro , Watanabe Koichiro , Yokoyama Takushi
Published: February 2019

To determine why silicic acid elution is often incomplete during regeneration of strong base anion exchange resin columns, an OH− type anion exchange resin (OH− type resin) adsorbing silicic acid was prepared and the desorption (elution) behavior of silicic acid adsorbed to the resin was examined by batch and column experiments. It was first found that silicic acid adsorbed to an OH− type resin polymerizes to form polysilicic acids (Q1, Q2 and Q3 structures) even when a smaller amount of silicic acid than the ion exchange capacity was adsorbed (unsaturated adsorption). Consequently, elution of silicic acid from the OH− type resin column is most likely caused by hydrolytic decomposition of polysilicic acid. Silicic acids with Q0, Q1 and Q2 structures can be easily desorbed from the OH− type resin by immersing them in a 1% NaOH solution for 5 min. On the other hand, silicic acid with the Q3 structure is barely desorbed. In this study, incomplete elution of silicic acid from OH− type resin columns has been found to be caused by polymerization of adsorbed silicic acid and the elution behavior may depend on the polymerization mode.
Effect of p- or n-Type Semiconductor on CO Sensing Performance of Catalytic Combustion-Type CO Gas Sensor with CeO2-ZrO2-ZnO Based Catalyst
Authors: Rodlamul Pattaraphon , Tamura Shinji , Imanaka Nobuhito
Published: February 2019

Novel catalytic combustion-type CO gas sensors were successfully devised by applying precious metal-free catalysts composed of the p- or n-type semiconducting Ln2CuO4-loaded CeO2-ZrO2-ZnO (Ln2CuO4/CZZn; Ln = La, Nd, and Sm). Complete CO oxidation using the p-type semiconducting La2CuO4/CZZn catalyst occurred at 350 °C, while the n-type semiconducting Nd2CuO4/CZZn and Sm2CuO4/CZZn catalysts completely oxidized CO gas at 220 °C and 200 °C, respectively. All the fabricated sensors exhibited quantitative detection of CO gas over 250 °C. The La2CuO4/CZZn catalyst has the smallest heat capacity, which dramatically increases the Pt coil temperature compared with the other catalysts, resulting in the highest sensor signal. However, the sensor applying Nd2CuO4/CZZn and Sm2CuO4/CZZn catalysts exhibited faster response time to CO gas than the sensor employing La2CuO4/CZZn catalyst due to their superior CO oxidation activity.
Templated Synthesis of Gold Nanoparticles on Surface-Aminated 2D Cellulose Assemblies
Authors: Nohara Takatoshi , Sawada Toshiki , Tanaka Hiroshi , Serizawa Takeshi
Published: February 2019

2D nanomaterials with atomic-/molecular-level thickness are of great interest due to their unique physicochemical and functional properties derived from their planar morphologies. In vitro enzymatic synthesis of cellulose oligomers is an attractive approach for crafting 2D cellulose assemblies with tailored surface functionality. In this study, the templated synthesis of gold nanoparticles (AuNPs) was demonstrated on surface-aminated 2D cellulose assemblies prepared via enzymatic reaction. Gold precursor effectively adsorbed to the surface amino groups and was subsequently reduced for AuNP production via lateral diffusion-based nucleation and subsequent growth processes on the assemblies. The immobilized AuNPs on the assemblies showed high catalytic activities toward a model hydrogenation reaction. The cellulose-based 2D nanomaterials with molecularly designable surface functionality open a new avenue for controlled synthesis and immobilization of inorganic nanoparticles.
Cone beam CT imaging of the mandibular third molar: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology (EADMFR)
Authors: Matzen Louise Hauge , Berkhout Erwin
Published: February 2019

Objectives:

Lack of evidence on the use of CBCT for management of mandibular third molars in Radiation Protection guideline no. 172 of the European Commission made the European Academy of DentoMaxilloFacial Radiology (EADMFR) decide to update the recommendations of the guideline.

Methods and materials:

A literature search was performed addressing the following questions: (1) does CBCT change the treatment of the patient?; (2) does CBCT reduce the number of post-operative sensory disturbances of the inferior alveolar nerve?; and (3) can CBCT predict the risk for a post-operative sensory disturbance of the inferior alveolar nerve?

Results: 

Since the European Commission published the guideline in 2012 several high-evidence studies on the use of CBCT before removal of mandibular third molars have been conducted including five randomized controlled clinical trials and one meta-analysis. Present literature allows to propose recommendations with highest level of evidence.

Conclusion:

New and up-to-date evidence-based recommendations advocate that CBCT imaging of the mandibular third molar should not be applied as a routine method before removal of mandibular third molars and therefore, CBCT imaging should only be applied when the surgeon has a very specific clinical question in an individual patient case that cannot be answered by conventional (panoramic and/or intraoral) imaging.
Association of hearing loss with depression, anxiety and stress in patients suffering from Chronic Suppurative Otitis Media
Authors: Khan Shafaque Mehboob , Rafi Tariq , Ahmed Naveed , Mehjabeen Mehjabeen
Published: February 2019

Objective: To study the correlation of hearing loss with depression, anxiety and stress in patients suffering from chronic suppurative otitis media in local population of Pakistan.

Methods: This is a cross-sectional study conducted from May to September 2018 at tertiary care hospital of Karachi. One hundred and twenty patients of chronic suppurative otitis media were divided into three groups: Group-1 (maintained on ciprofloxacin), Group-2 (maintained on co-amoxicillin) and Group-3 (did not subject to the treatment).The measurement of hearing loss was carried out by pure tone audiometry (PTA) and the depression, anxiety and stress were scored taking depression, anxiety and stress scale (DASS) as tool. To observe the effect of hearing loss on different groups one way ANOVA was applied and Spearman correlation was used to find correlation of depression with hearing loss.

Results: There was no significant difference found for hearing loss and severity among the groups treated with ciprofloxacin, co-amoxicillin and not maintained on antibiotic therapy. Positive correlations found between hearing loss and depression, anxiety and stress in patients of the three groups.

Conclusion: Depression induced by hearing loss as a result of CSOM in patients need to be monitored during and after treatment and scored so that can be treated by counseling and antidepressant (if required). Information regarding this topic on population of Pakistan will be helpful for health care takers and policy makers to manage mental stress with hearing loss in CSOM.

How to cite this:Mehboob S, Rafi SMT, Ahmed N, Mehjabeen. Association of hearing loss with depression, anxiety and stress in patients suffering from Chronic Suppurative Otitis Media. Pak J Med Sci. 2019;35(2):510-514. doi: https://doi.org/10.12669/pjms.35.2.152

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Hypomagnesaemia and other electrolytes imbalances in open and closed pediatrics cardiac surgery
Authors: Shahidi Mohsen , Bakhshandeh Houman , Rahmani Khaled , Afkhamzadeh Abdorrahim
Published: February 2019

Objective and Background: During the past decade, many researchers have indicated that open cardiac surgery, using cardiopulmonary bypass, could be an essential factor to induce post-operative electrolyte imbalances which may be followed by life threatening complications such as arrhythmia. Nevertheless, by this time there may be a few researches about comparing of hypomagnesaemia and other electrolyte imbalances between open, on pump, and closed, off pump, heart operation.

Methods: In this cohort study conducted at Rajaie Heart Center in Tehran from December 2014 to August 2015, we evaluated hypomagnesaemia, hypocalcemia, hypokalemia and hyponatremia in 205 children aged under 15 years who underwent open (101 children) and closed (104 children) cardiac surgery. Repeated measures ANOVA, paired t test and Chi-square/Fisher exact test were used for analysis the data in SPSS version 21.

Results: According to our study the frequency of electrolyte imbalances including hypomagnesaemia after pediatric heart surgery is relatively high (28.7% hypomagnesaemia at the second day) with more occurrence in closed cardiac operations. There was no significant relationship between hypomagnesaemia and pump time duration (P>0.05). On the other hand, this research indicated that there is significant relationship between post-operative hypomagnesaemia and some other variables including cyanotic heart disease (P=0.01) and concurrent electrolyte imbalance such as hypocalcaemia and hypokalemia (P<0.05).

Conclusion: Early evaluation and correction of hypomagnesaemia should be considered after both closed and open heart operation.

How to cite this:Shahidi M, Bakhshandeh H, Rahmani K, Afkhamzadeh A. Hypomagnesaemia and other electrolytes imbalances in open and closed pediatrics cardiac surgery. Pak J Med Sci. 2019;35(2):353-359. doi: https://doi.org/10.12669/pjms.35.2.367

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Assessment of topical corticosteroid ointment on postcesarean scars prevention: A prospective clinical trial
Authors: Meseci Elif
Published: February 2019

Objective: To evaluate the effectiveness of corticosteroid ointment in hypertrophic scars prevention following Cesarean section.

Methods: This study was conducted between June 2017-May 2018 in Acıbadem Kozyatagı Hospital. Sixty-one patients (31 treatment and 30 control patients) took part in the current study which evaluated wound outcomes and patient satisfaction. All patients’ wound characteristics were assessed via the modified Vancouver Scar Scale (MVSS) score (height, pigmentation, vascularity, and pliability) at baseline (post-op 10th day), three months and six months. The treatment group received corticosteroid cream every other day for three months. Comparative evaluations and time-bound changes were evaluated in both groups.

Results: The mean age of the subjects was 31.28 ± 3.95 years. While the height and vascularity subsection scores of corticosteroid recipients were significantly reduced compared to those without treatment at three months, the scores were similar at six months. Furthermore, pliability and pigmentation decreased equally in both groups. There was high satisfaction with scar healing in the experimental group (20%, n=6), while 12.9% (n=4) of the patients were satisfied in the control group. Two patients reported itching after treatment.

Conclusions: The clinical outcomes in both groups were similar. Although vascularity and height parameters improved in three months, similar results were also observed in the group that did not receive treatment after the end of six months. This may have been due to the fact that treatment was stopped after three months. We recommend that the hypothesis be tested in larger series in future studies.

How to cite this:Meseci E. Assessment of topical corticosteroid ointment on postcesarean scars prevention: A prospective clinical trial. Pak J Med Sci. 2019;35(2):309-314. doi: https://doi.org/10.12669/pjms.35.2.553

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The relationship between levels of Alexithymia and communication skills of nursing students
Authors: Sancar Behire , Aktas Demet
Published: February 2019

Background & Objective: Effective communication in the nursing profession is not just a personal skill but is accepted as a learned and gained technique in the instructional process. It is possible for nurses to professionally provide effective and quality service with the establishment, development, and transfer to emotion of effective communication with people. The purpose of this study was to investigate the relationship between levels of alexithymia and communication skills of nursing students.

Methods: This cross-sectional study was conducted among students attending the School of Nursing in a university in Turkey in the 2017-2018 Spring semester. A total of 634 nursing students participated in the study. The data in the study were collected with the “Student Introduction Form”, the “Toronto Alexithymia Scale (TAS)” and the “Communication Skills Scale (CSS)”. Means, standard deviations, t-test, ANOVA and Pearson correlation analysis were used for the analysis.

Results: The mean TAS scores of the nursing students were found to be 56.31±8.82, and the students had “moderate alexithymia” based on the average scores of the scale. The mean CSS scores of the nursing students in the study was found to be 91.16±12.99, and the students had “Good level of communication” based on the average scores of the scale. In our study, a negative and moderate correlation between the levels of alexithymia of nursing students and their communication skills was detected (p: 0.001).

Conclusion: It was found that as the levels of alexithymia of nursing student increased, their communication skills decreased.

How to cite this:Sancar B, Aktas D. The relationship between levels of Alexithymia and communication skills of nursing students. Pak J Med Sci. 2019;35(2):489-494. doi: https://doi.org/10.12669/pjms.35.2.604

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Non-biological methods for phosphorus and nitrogen removal from wastewater: A gap analysis of reinvented-toilet technologies with respect to ISO 30500
Authors: Trotochaud Lena , Hawkins Brian T. , Stoner Brian R.
Published: February 2019

The aims of the Reinvent the Toilet Challenge (RTTC) include creation of an off-the-grid sanitation system with operating costs of less than US$0.05 per user per day. Because of the small scale at which many reinvented toilets (RT) are intended to operate, non-biological treatment has been generally favored. The RTTC has already instigated notable technological advances in non-sewered sanitation systems (NSSS). However, increasingly stringent effluent standards for N and P could limit the deployment of current RT in real-world scenarios, despite the urgent need for these systems. The newly adopted ISO 30500 standards for water reuse in NSSS dictate minimal use of chemical/biological additives, while at the same time requiring a 70% and 80% reduction in total nitrogen and phosphorus, respectively. This document provides a brief overview of the mature and emerging technologies for N and P removal from wastewater. At present, the dearth of nutrient removal methods proven to be effective at small scales is a significant barrier to meeting ISO 30500 standards. Closing the gap between RTs and ISO 30500 will require significant investments in basic R&D of emerging technologies for non-biological N and P remediation and/or increased reliance on biological processes. Adaptation of existing nutrient-removal technologies to small-scale NSSS is a viable option that merits additional investigation.
Predicting the Future: Using Simulation Modeling to Forecast Patient Flow on General Medicine Units
Authors: Mishra Vimal , Tu Shin‐Ping , Heim Joseph , Masters Heather , Hall Lindsey , Clark Ralph R , Dow Alan W
Published: February 2019

BACKGROUND

Hospitals are complex adaptive systems within which multiple components such as patients, practitioners, facilities, and technology interact. A careful approach to optimization of this complex system is needed because any change can result in unexpected deleterious effects. One such approach is discrete event simulation, in which what‐if scenarios allow researchers to predict the impact of a proposed change on the system. However, studies illustrating the application of simulation in optimization of general internal medicine (GIM) team inpatient operations are lacking.

METHODS

Administrative data about admissions and discharges, data from a time‐motion study, and expert opinion on workflow were used to construct the simulation model. Then, the impact of four changes – aligning medical teams with nursing units, adding a hospitalist team, adding a nursing unit, and adding both a nursing unit and hospitalist team with higher admission volume – were modeled on key hospital operational metrics.

RESULTS

Aligning medical teams with nursing units improved team metrics for aligned teams but shifted patients to unaligned teams. Adding a hospitalist team had little benefit, but adding a nursing unit improved system metrics. Both adding a hospitalist team and a nursing unit would be required to maintain operational metrics with increased patient volume.

CONCLUSION

Using simulation modeling, we provided data on the implications of four possible strategic changes on GIM inpatient units, providers, and patient throughput. Such analyses may be a worthwhile investment to study strategic decisions and make better choices with fewer unintended consequences. Journal of Hospital Medicine 2018;14:9‐15. Published online first November 28, 2018. © 2019 Society of Hospital Medicine
Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults
Authors: Fakheri Robert J , Volpicelli Frank M
Published: February 2019

The “Things We Do for No Reason” (TWDFNR) series reviews practices that have become common parts of hospital care but which may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent “black and white” conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.
Statistical Modeling and Aggregate‐Weighted Scoring Systems in Prediction of Mortality and ICU Transfer: A Systematic Review
Authors: Linnen Daniel T , Escobar Gabriel J , Hu Xiao , Scruth Elizabeth , Liu Vincent , Stephens Caroline
Published: February 2019

BACKGROUND

The clinical deterioration of patients in general hospital wards is an important safety issue. Aggregate‐weighted early warning systems (EWSs) may not detect risk until patients present with acute decline.

PURPOSE

We aimed to compare the prognostic test accuracy and clinical workloads generated by EWSs using statistical modeling (multivariable regression or machine learning) versus aggregate‐weighted tools.

DATA SOURCES

We searched PubMed and CINAHL using terms that described clinical deterioration and use of an advanced EWS.

STUDY SELECTION

The outcome was clinical deterioration (intensive care unit transfer or death) of adult patients on general hospital wards. We included studies published from January 1, 2012 to September 15, 2018.

DATA EXTRACTION

Following 2015 PRIMSA systematic review protocol guidelines; 2015 TRIPOD criteria for predictive model evaluation; and the Cochrane Collaboration guidelines, we reported model performance, adjusted positive predictive value (PPV), and conducted simulations of workup‐to‐detection ratios.

DATA SYNTHESIS

Of 285 articles, six studies reported the model performance of advanced EWSs, and five were of high quality. All EWSs using statistical modeling identified at‐risk patients with greater precision than aggregate‐weighted EWSs (mean AUC 0.80 vs 0.73). EWSs using statistical modeling generated 4.9 alerts to find one true positive case versus 7.1 alerts in aggregate‐weighted EWSs; a nearly 50% relative workload increase for aggregate‐weighted EWSs.

CONCLUSIONS

Compared with aggregate‐weighted tools, EWSs using statistical modeling consistently demonstrated superior prognostic performance and generated less workload to identify and treat one true positive case. A standardized approach to reporting EWS model performance is needed, including outcome definitions, pretest probability, observed and adjusted PPV, and workup‐to‐detection ratio.
Clinical Guideline Highlights for the Hospitalist: Maintenance Intravenous Fluids in Infants and Children
Authors: Girdwood Sonya Tang , Parker Michelle W , Shaughnessy Erin E
Published: February 2019

GUIDELINE TITLE

2018 American Academy of Pediatrics (AAP) Clinical Practice Guideline: Maintenance Intravenous Fluids in Children

RELEASE DATE

November 26, 2018

PRIOR VERSION

Not Applicable

DEVELOPER

Multidisciplinary subcommittee of experts assembled by the AAP

FUNDING SOURCE

AAP

TARGET POPULATION

Patients 28 days to 18 years of age requiring maintenance intravenous fluids (IVFs).
Leadership & Professional Development: Know Your TLR
Authors: Saint Sanjay , Chopra Vineet
Published: February 2019

The socio‐adaptive (or “nontechnical”) aspects of healthcare including leadership, followership, mentorship, culture, teamwork, and communication are not formally taught in medical training. Yet, they are critical to our daily lives as hospitalists. The LPD series features brief “pearls of wisdom” that highlight these important lessons.
A Concentration Bound for Stochastic Approximation via Alekseev’s Formula
Authors: Thoppe Gugan , Borkar Vivek
Published: February 2019

Given an ordinary differential equation (ODE) and its perturbation, the Alekseev formula expresses the solutions of the latter in terms related to the former. By exploiting this formula and a new concentration inequality for martingale-differences, we develop a novel approach for analyzing nonlinear stochastic approximation (SA). This approach is useful for studying a SA’s behavior close to a locally asymptotically stable equilibrium (LASE) of its limiting ODE; this LASE need not be the limiting ODE’s only attractor. As an application, we obtain a new concentration bound for nonlinear SA. That is, given ϵ > and that the current iterate is in a neighborhood of a LASE, we provide an estimate for (i) the time required to hit the ϵ-ball of this LASE, and (ii) the probability that after this time the iterates are indeed within this ϵ-ball and stay there thereafter. The latter estimate can also be viewed as the “lock-in” probability. Compared with related results, our concentration bound is tighter and holds under significantly weaker assumptions. In particular, our bound applies even when the stepsizes are not square-summable. Despite the weaker hypothesis, we show that the celebrated Kushner-Clark lemma continues to hold.
Working within a spiritual framework
Authors: Barber Chris
Published: February 2019

Chris Barber, Visiting Lecturer (Learning Disabilities), Birmingham City University ( chris.barber@bcu.ac.uk ), offers tips for nurses on supporting patients in the spiritual aspects of their lives
Fear and excitement mark the transition to autonomous, registered nurse
Authors: Gilbert Gabriella
Published: February 2019

Gabriella Gilbert, who recently completed her studies to become a fully fledged staff nurse, shares her final reflections on her journey to registration
Development and Validation of Stability-Indicating RP-HPLC Method for the Estimation of Lenalidomide and its Impurities in Oral Solid Dosage Form
Authors: Siva Prasad Somana , Krishna Mohan G. V. , Naga Babu A.
Published: February 2019

In this study, a novel, simple and precise RP-HPLC method has been developed for the quantitative analysis of Lenalidomide (LLM) in pharmaceutical formulations using analytical quality by design approach. An X-bridge-C18 column (150 mm × 4.6 mm × 3.5 µ) with mobile phases containing a Potassium dihydrogen orthophosphate anhydrous buffer and methanol in the ratio of (90:10 v/v) and (35:65 v/v) are used for the estimation of LLM and its degradation products. The flow rate of 0.8 mL/min is maintained and all degradation studies are performed at 210 nm using photodiode array (PDA) detector. Method Validation is carried out according to International Council for Harmonisation (ICH) guidelines and the parameters namely; precision, accuracy, specificity, stability, robustness, linearity, limit of quantitation (LOQ) and limit of detection (LOD) are evaluated. The present developed RP-HPLC method shows the purity angle of peaks is less than their threshold angle, signifying that it to be suitable for stability studies. Hence, the developed method can be used for the successful separation of LLM and its impurities in the pharmaceutical dosage formulations.
Phenolic Analysis and Characterization of Palm Sugar (Arenga pinnata) Produced by The Spray dryer
Authors: Jayanudin Jayanudin , Kurniawan Teguh , Kustiningsih Indar
Published: February 2019

The effect of spray dryer inlet temperature on characterization and total phenolic content of palm sugar has been studied. The spray dryer operating conditions used were 160 ̶ 220°C inlet temperature with a feed flow rate of 2 L/hour, while for outlet temperature was 85°C. The high inlet temperature produced a higher crystallinity of sucrose and did not agglomerate and not sticky. However, the high temperature of the spray dryer inlet produced palm sugar that was browner than the low temperature one. The effect of increasing temperature of spray dryer produced irregular total phenolic. The total phenolic at 220°C was higher than 200°C. Likewise, the temperature of 180°C generated total phenolic was higher than the temperature of 160°C. The total phenolic of palm sugar analyzed in this study was quite large within the range of 49 ± 0.01 to 63.6 ± 0.01 mg of GAE/100 g samples.
Benzyl and Sulfonyl Derivatives of N-(2,6-dimethylphenyl)-2-(piperazin-1-yl)acetamide (T2288): Biological Screening and Fingerprint applications
Authors: Khan Ghouse , Sreenivasa Swamy , Govindaiah Shivaraja , Chandramohan Vivek
Published: February 2019

A series of five N-(2,6-dimethylphenyl)-2-(piperazin-1-yl)acetamide (T2288) sulfonamides 6a-e and its five alkylated piperazine derivatives 8a-e have been synthesized, characterized and screened for antibacterial, antifungal and anthelmintic activity. Some of the compounds showed significant biological activities. Molecular docking to crystal structures of target proteins revealed that, active compounds show similar binding poses as that of standards, indicating good correlation of the binding energy with observed invitro data for the active compounds. Finally, the study of latent fingerprint analysis showed that the compound 6c exhibits good stickiness and finger rhythm without dense dust. The resulting compound can be used to detect fingerprints on all types of flat surfaces and hence easily accepted for detecting hidden fingerprints. This research can offer an excellent setting that can lead to the discovery of potential antibacterial, antifungal, anthelmintic and fingerprint agents.
Theoretical Investigation of Application of Combining Pristine C60 and doped C60 with Silicon and Germanium atoms for Solar cells ; A DFT Study
Authors: Hojatkashani Leila
Published: February 2019

Solar energy and its conversion to electricity is an important research in the last decade. Solar cells are consist of a p-type semiconductor as donor and an n-type semiconductor as acceptor. Organic polymers as organic semiconductors are used in an organic solar cell. This research is a theoretical investigation of fullerene C60 as donor and C60 doped derivatives with Silicon and Germanium atoms as acceptors for basic structure of a solar cell. This research is done not only with using related equations but also with investigating theoretical UV-VIS spectrum of the chosen donors-acceptors and their absorption wavelengths, oscillator strength and maximum coefficient absorptions of these solar cells.
The negative effect of the chicken feather meal in the diet on growth performance of the shortfin eel Anguilla bicolor larvae
Authors: Thamren Muhammad Y. , Batubara Agung Setia , Nurfadillah Nurfadillah , Dewiyanti Irma , Muchlisin Zainal A.
Published: February 2019

The aim of these study was to examine the effect of the replacement fish meal with chicken feather meal (CFM) for eel Anguilla bicolor larvae. The study was conducted at the Laboratory of Ichthyology, Faculty of Marine and Fisheries of Syiah Kuala University on September to October 2017. The Complete Randomized Design (CRD) with 7 treatments and 4 replications were used in this study. The  tested dosage of CFM were of 0% CFM (control), 10% CFM, 20% CFM, 30% CFM, 40% CFM, 50% CFM and 60% CFM, where each treatment were contained of protein 32.26% (0% CFM), 33.09% (10% CFM), 36.20% (20% CFM), 39.10% (30% CFM), 41.22% (40% CFM), 45.43 ( 50% CFM) and 40.02% (60% CFM). The experimental fish were stocked in the plastic container at the stocking density of 15 fish container-1 and fed the experimental diets at the feeding level of 10% body weight a day for 60 days. The results showed that the application of CFM in the diet was not given a significant effect on the weight gain, daily weight gain, specific growth rate (P>0.05). In addition, the fish fed on CFM did not show growth rate even reduces the body weight of the experimental fish. It is concluded that the application of the CFM in diet gave the negative effect on the growth performance of the eel larvae.
Check list of the marine commercial and reef fishes of Belitung Timur, Bangka Belitung Islands, Indonesia
Authors: Akbar Helmy , Jailani Jailani , Suyatna Iwan , Destilawaty Destilawaty , Putra Singgih Afifa , Ambalika Indra
Published: February 2019

Marine fish community is very sensitive to environmental changes. So the number of species, abundance, and biodiversity index can be used as a reference to assess the quality of the aquatic environment. The aim of this study was to describe fish biodiversity in Belitung Timur, Bangka Belitung Islands, Indonesia. Three islands were visited i.e. Pekandis Island, and Keran Island, Gosong Semut (Gosong refers to sandbar) for reef fish survey and for the economical fish study we also visited fisheries landing sites (i.e. Teluk Pering, Tanjung Batu Pulas, and Pantai Burung Mandi). The underwater visual census was used for in situ surveys of reef fish, and the fish species landed in fisheries landing site also been checked. Forty-two families of economical fish that had been landed by local fishermen were identified, and ten families of reef fish were found in reef systems of research location. A total of 10 families were recorded from three islands in Belitung Timur Regency. In addition, 42 families of commercial fish were also observed in fish landing sites from the coastline of Belitung Timur Regency, Bangka Belitung Islands.
Openings and closures: Mental health in Joachim Trier’s cinematic universe
Authors: Gjelsvik Anne
Published: February 2019

This article argues that mental health and mental illness are important topics in Joachim Trier’s oeuvre. In Reprise (2006), two aspiring writers face multiple challenges when one of them suffers a mental breakdown and is hospitalized. Oslo, August 31st (2011) chronicles the final day of a depressed drug addict before he commits suicide. In Louder Than Bombs (2015), three family members try to process trauma and loss after the mother’s sudden death; the main character in Thelma (2017) struggles with emancipation while at the same time suffering from strange seizures, seemingly caused by some unidentified psychological issue. Focusing on close readings of central scenes in Oslo, August 31st and Thelma, the article investigates how the relationship between the protagonists and their environment is used to portray mental illness and create insight into the experience of depression and anxiety.