bluuebunny/crossref_metadata_2025 huggingface dataset:
Water resources governance: A study of the stakeholder perceptions in the state of Minas Gerais
Authors: Pardini Daniel Jardim , Gonçalves Carlos Alberto , Camargos Luiza de Marillac Moreira , Gonçalves Marcio Augusto
Published: January 2017

The world is preoccupied with the water quality, distribution and scarcity. The aim of this paper is to present the stakeholders perceptions and regulation involved in Water Management on the public governance mechanisms. The theoretical development of this work contemplated the public governance theory, specifically where it refers to the stakeholders participation in the Water Management. The research was performed as case studies on the state organization IGAM (Water Management Institute of Minas Gerais - Brazil) taking in consideration the public governance mechanisms defined by the Organization for Cooperation and Economical Development – OCDE (2005). By means of the use of a specialist panel and a focal group undertaken with representatives of stakeholders involved in the Water Management it was possible to evidence the necessities for adjustment of the legislation concerning the supplying of semi-arid areas and the integration of the hydrographical basins’ public policies. The conflicts appear more clearly in the interaction between some stakeholders. Those are discourses that question the utilitarian acting of the water, the technical ignorance of the members of Hydrographical Basin Committees and the defense of the democratic format of these decision organs.
Ownership structure and firm performance in emerging markets: evidence from Chinese listed firms
Authors: Ehikioya Benjamin , Qin Yuanjin , Xie Keifa , Yun Chen ru
Published: January 2017

This study investigates how ownership structure impacts on the corporate performance of listed firms in China. The study uses sample data of firms listed in the Shanghai and Shenzhen stock exchanges for the five year fiscal period that ended 2005. The results of the panel data regression analysis suggests firm performance to have positive and significant relation with the proportion of shares held by the institution, through the legal person holding companies. In addition, while state ownership indicates negative influence on performance, individual and foreign investors are found to have positive effect on performance, though at a minimal levels. Interestingly, the effect of ownership structure is stronger in firms experiencing the dominance of legal person share holdings over state shares. Further, firm size and ratio of debt to equity are also observed to have influence on the performance of Chinese listed firms. These findings are of great significant to policymakers, academics, shareholders and other stakeholders.
Management turnover and corporate performance in Taiwanese electronic industries
Authors: Wang Yi-Hsien , Lin Che-Yang
Published: January 2017

This paper analyzes the impacts of management turnover in Taiwanese electronic industries during 1996-2006 using the price and the trading volumes of underlying stock around the TSE announcement date. These results provide evidences that market participator would hold an active position following the appointment of a specialized, innovative, and self-motivated CEO. Hence, positive abnormal stock returns and trading volumes were expected. However, chairman turnover suggests that the corporate power structure of Board of Directors is unbalanced, thus, market participators would hold a conservative position.
Management compensation, restructuring, and value creation at union carbide corporation
Authors: Caton Gary L.
Published: January 2017

The paper is a case study of the Union Carbide Corporation during a very tumultuous period. In 1979, the demand for several of UCC’s chemical products either was in decline or soon would be which contributed to a severe decline in stock value. During this period, management compensation plans evolved to more closely align management with shareowners. The Bhopal tragedy and a subsequent unsolicited takeover attempt tested management, and the new compensation incentives, ultimately leading to a more focused and more highly valued company.
A propensity score analysis of public incentives: The Italian case
Authors: Affuso Antonio
Published: January 2017

Public support to firms has been a traditional and important industrial policy measure in many countries for several decades. One of the reasons for public intervention is the existence of market failures or imperfections. Informational asymmetries between borrowers and lenders of funds in particular are used to justify subsidies to firms, especially small and medium-sized enterprises. Within this framework, the main purpose of public subsidies is offsetting market imperfections. This paper makes a contribution to current empirical literature by examining the effects of public funding on credit rationing of small and medium-sized Italian firms. The results suggest that public subsidies reduce the probability of a firm being credit rationing.
Assessing the predictive power of the multifactorial models of the bankruptcy risk
Authors: Bărbuţă-Mişu Nicoleta , Mazilescu Vasile
Published: January 2017

The bankruptcy prediction of the enterprises is a great interest issue, which has continued such attention to researchers and specialists for several decades. This paper evaluates the risk of bankruptcy of a sample of 20 enterprises acting in the construction sector in Romania, in 2008. The bankruptcy risk is evaluated using 4 models: 2 models very well-known at the international level - Altman model (1968) with 5 variables and Conan & Holder model (1979) - and 2 models created taking into account the specificity of the Romanian business environment: the A model (2000) and the model of determining the financial performance developed especially for features of the enterprises acting in the construction sector (2008). The aim of this paper is to find a link or match between predictive power of the most used multi-factorial models of bankruptcy risk, taking into account the period in which they were created, the specific characteristics of the economy and industry.
Evaluating the investment decision-making process for business expansion into Africa: A case study
Authors: Kasozi Jason
Published: January 2017

Africa is a potential domain for international business. However, numerous uncertainties characterize this environment and the challenge for multinationals remains the ability to assess the true value of an Africa-bound investment project. A telecommunications’ survey was conducted on Siemens Southern Africa (Siemens) and Mobile Telecommunications’ Network (MTN) and the following observations were made: (1) Approaches used by the businesses to value Africa-bound investments were not comprehensive and inclusive. (2) Neutrality existed to the suggestion that Africa is unique and that investment decisions should be customized to suit it. (3) Certain approaches used by the businesses
were modified to suit pertaining investment circumstances thereby differing from literature, and (4), participants desired to learn new ways of improving this process suggesting dissatisfaction with the current norm. This paper presents the conflicting ideologies about the decision-making process for business expansion into Africa and suggests ways of improving the process.
The effect of bank monitoring as an alternative of corporate governance mechanisms on the borrowers’ firm value: Evidence from Indonesian listed firms
Authors: Dina Alexandra Ryan Ahmad , Hermawan Ancella Anitawati
Published: January 2017

The objective of this research is to examine the effect of bank monitoring as an alternative of corporate governance mechanisms on the borrowers’ firm value. The strengths of bank monitoring on the borrowers are measured based on the magnitude of the bank loan, the size of the loan from banks with high monitoring quality, the length of a bank loan outstanding period, and the number of lenders. The research hypotheses were tested using multiple regression model with a sample of 230 companies listed in Indonesia Stock Exchange during 2009. The empirical results show that only the size of the loan from banks with high monitoring quality and the number of lenders significantly influences the borrowers’ firm value. These findings imply that only banks with high monitoring quality could play an important role in the corporate governance and therefore increasing the firm value by their monitoring function. Furthermore, bank monitoring is less effective if a company borrows from many banks, and therefore decreasing the firm value.
The possibility of increasing the antioxidant activity of celery root during osmotic treatment
Authors: Nicetin Milica , Pezo Lato , Loncar Biljana , Filipovic Vladimir , Suput Danijela , Knezevic Violeta , Filipovic Jelena
Published: January 2017

Osmotic treatment of celery root was studied in two osmotic solutions (sugar beet molasses and a ternary solution of water, sucrose and salt), at three temperatures (20, 35 and 50?C), and three different immersion periods (1, 3 and 5 h), at atmospheric pressure. The aim was to examine the influence of the type of the used hypertonic agent, the temperature and the immersion time on the water loss, solid gain, water activity, dry matter content, antioxidant activity (expressed by DPPH) and colour attributes (described by CIELAB coordinates L*, a* and b*). During the experiments, the antioxidant activity of celery root was increased in sugar beet molasses, while the DPPH value tended to decrease in the ternary solution. The experimental data of osmotic dehydration was used for PCA modelling. The standard scores analysis revealed that the optimum process parameters were gained with an immersion time of 5 h and a temperature of 35?C.
Functional Magnetic Resonance Imaging: From Acquisition to Application
Authors: Yarmish Gail , Lipton Michael L.
Published: January 2017

Functional magnetic resonance imaging (fMRI) is a technique that exploits magnetic resonance imaging (MRI) to detect regional brain activity through measurement of the hemodynamic response that is coupled to electrical neuronal activity. The most common fMRI method detects blood oxygen level dependent (BOLD) contrast. The BOLD effect represents alteration in the ratio of deoxygenated to oxygenated hemoglobin within brain tissue following neuronal activity. Alterations in this hemoglobin ratio result from changes in cerebral oxygen extraction, cerebral blood flow, and cerebral blood volume that occur in response to neuronal activity. The small, but detectable, change in magnetics resonance signal intensity is due to the sensitivity of magnetic resonance (MR) images to the paramagnetic deoxygenated state of hemoglobin that is the basis of contrast in fMRI applications. This review describes the physical and physiological bases of the MR signal, the principle of the BOLD effect, technical issues related to fMRI implementation, and fMRI experimental design. Research and clinical applications of fMRI are presented, including the use of fMRI in neurosurgical planning. Since it provides an individualized map of brain function, fMRI enables accurate localization of eloquent brain regions prior to surgery, allowing assessment of surgical risk and prognosis, as well as planning surgical approach.
Can Outstanding Research Be Done Under Less Than Ideal Conditions?
Authors: Igic Rajko
Published: January 2017

Great scientific discoveries rarely originate from small and poor countries. However, the lives and achievements of three Yugoslav scientists who were active in the biomedical sciences, Laza K. Lazarevic ́ (1851-1891), Ivan Djaja (1884-1957), and Pavao Stern (1913-1976), serve as an example of success in this environment. These scientists, as well as the majority of other successful investigators in small and poor countries, weretrained in foreign and developed countries and, upon return, were given the freedom to start a self-dependent research program. They overcame many obstacles, including wars and civil unrests, to contribute significantly to certain medical fields. It is interesting that although a Jew, Stern was allowed to work during the World War II in Zagreb, which became capital of the so-called Independent State of Croatia, a puppet state under German control. Perhaps his good name among pharmacologists helped him to keep position during this tough period. Nowadays, new technologies needed for biomedical research are rather expensive, and poor countries cannot afford to finance many scientists. Thus, selection of the most productive researchers is the challenge for those who finance scientific work.
Trends in the Financing of United States Medical Schools: 1970-1999
Authors: Ozuah Philip O , Stick Sheldon L
Published: January 2017

We examined 30-year trends in the financing of allopathic medical schools in the United States using data from the Annual Medical School Questionnaire administered to United States medical schools. We calculated relative proportions for total revenues derived from different sources. Federal support for teaching/training/public service represented 18.8% of total revenues in 1970-1971, but only 0.3% of total revenues in 1998-1999. The proportion of revenues derived from state/localgovernment appropriations also declined across this period. In contrast, the proportion of revenues derived from medical services increased substantially. The proportion of revenues derived from tuition/fees, gifts, and endowments remained constant.
Jews of the Sahara
Authors: Nagel Ronald L
Published: January 2017

Many years ago, my French colleague and collaborator, Dominique Labie, had arranged a scientific trip to Algeria to study hemoglobinopathies in Algiers (Mears et al., 1981; Pagnier et al., 1984). After several days of intense work, Cherif Beldjord, the younger of our hosts, proposed that we take the weekend off and go to Ghardaia. To entice us, he said, “It will be a fun trip to the Sahara desert, and you cannot imagine how beautiful the place is.” Dominique and I rapidly signed up for this great opportunity. Finally, I would see the Sahara desert, the magical and mysterious Sahara desert.
It is a Small World: Global Medical Education for the Twenty-first Century
Authors: Atwood Stephen J
Published: January 2017

Last year’s epidemic of the Severe Acute Respiratory Syndrome (SARS) virus in Asia and the present world-wide concern about the spread of the H5N1 avian flu virus has brought international health concerns to the front pages of national and international newspapers, newsmagazines, and health journals around the world. Add to this the global Human Immunodeficiency Virus (HIV) epidemic, the global resurgence of tuberculosis (TB), and the disturbing increases in antibiotic-resistant bacteria, and it becomes difficult to imagine the compartmentalized world of even 30 years ago when diseases of different continents stayed in their place. Today, more than one million people cross international borders each day (not including refugees and displaced persons). Air transport guarantees a rapid transit of both person and pathogen well within the incubation period of many diseases. Body-heat detectors used recently at immigration points (e.g., Singapore and Hanoi) to detect febrile passengers are symbolic of the coarse screening attempts being used to control the movement of contagious diseases.
First, There Was Pedagogy And Then Came Andragogy
Authors: Ozuah Philip O
Published: January 2017

The assertion that first, there was pedagogy and then came andragogy, is simultaneously true and misleading. What is pedagogy? What is andragogy? Which preceded the other? And what, if anything, does any of this have to do with medical education? In this article, we will explore the answers to these questions, review the historical bases for the pedagogical and andragogical paradigms, and discuss learning theories and their relevancy to teaching and learning in medicine.
Global Antiretroviral Therapy: The Hope Within Pandora’s Box?
Authors: Harris Carol , Getaneh Asqual , Zuniga José M.
Published: January 2017

The vast numbers of individuals now infected with the HIV-1 virus and its spread to all corners of the globe have been well chronicled. It is difficult to convey, however, the desperation and hopelessness of the majority of those HIV-1-infected individuals that live in regions where resources are sparse. Pursuit of the unique and complex medical and societal issues relating to the HIV pandemic is globally creating a discrete area within the field of infectious disease. The consequences of the severe immunologic compromise resulting from HIV-1 infection vary from those seen in the West, both in terms of entities and their frequency. While a number of antiretroviral distribution programs are in place, the development of guidelines that simplify antiretroviral regimens, enrollment in treatment programs, and monitoring remain difficult. Furthermore, the epidemiology, response to antiretroviral therapy, and resistance patterns of non-B sybtypes await further elucidation. The goals that have been set may be compromised by concomitant endemic diseases (such as tuberculosis and malaria), unpreventable mother-to-child transmission, malnutrition, poor sanitation, inadequate public health systems, and, especially, the lack of an adequate healthcare workforce. However, awareness of these impediments is growing. The understanding of the complex and diverse economic, political and cultural forces entwined with and driving the epidemic is evolving. Finally, the need for a long-term, multifaceted response to the broad crisis in underdeveloped nations where AIDS is but one of a number of critical elements is becoming appreciated.
Genomic Medicine
Authors: Star Kremema , Birshtein Barbara
Published: January 2017

The human genome project created the field of genomics – understanding genetic material on a large scale. Scientists are deciphering the information held within the sequence of our genome. By building upon this knowledge, physicians and scientists will create fundamental new technologies to understand the contribution of genetics to diagnosis, prognosis, monitoring, and treatment of human disease. The science of genomic medicine has only begun to affect our understanding of health.
Harm Reduction Outreach Services and Engagement of Chemically Dependent Homeless People Living with HIV/AIDS: An Analysis of Service Utilization Data to Evaluate Program Theory
Authors: Shepard Benjamin
Published: January 2017

This study examines service utilization patterns among a socially vulnerable population of homeless people living with HIV/AIDS and who have a history of chemical dependence, as they are engaged through outreach services. CitiWide Harm Reduction collaborates with Montefiore Medical Center to connect homeless people with health care through harm reduction outreach and low threshold medical services. Analysis of two cohorts – individuals engaged through harm reduction outreach and individuals who “walk-in” to engage in services at CitiWide Harm Reduction’s drop-in center – assesses the program’s theory that outreach engagement is a mediating variable increasing service utilization. These results demonstrate that low-threshold harm reduction outreach, a brand of outreach designed to reduce barriers to services, does increase access to health care and related services for a socially vulnerable, traditionally “hard-to-reach,” population. Harm reduction outreach is a valuable intervention for increasing service utilization among this highly marginalized group.
The Physician-Patient Relationship in Light of Fetal Homicide Laws
Authors: Coeller Nathalie
Published: January 2017

After several cases in which pregnant women were forced to undergo cesarean sections under court order or where court orders were sought for cesarean sections, the medical community reaffirmed the principle of autonomy for pregnant women. Women are allowed to refuse care during pregnancy, even if that means harm to the fetus. In addition, it is inappropriate for medical personnel to seek legal assistance in forcing a woman to accept treatment. This article presents a case in which the medical community upheld the woman’s right to refuse care; however, the legal community then charged her with criminal homicide under the state’s fetal homicide law because the baby was stillborn after the patient delayed in obtaining a cesarean section. The differences between medical guidelines and state law must be addressed so that the patient’s autonomy is upheld and so that patients may be informed of all consequences, medical and otherwise, of refusing treatment.
A History of the Children’s Evaluation and Rehabilitation Center (CERC) at the Albert Einstein College of Medicine, 1956-2008
Authors: Cohen Herbert J
Published: January 2017

The Children’s Evaluation and Rehabilitation Center (CERC) is the oldest continuously Einstein-operated clinical program. Its history has paralleled that of other achievements at Einstein, as well as changes in the service system, legislative mandates, and creation of programs for the developmentally disabled in both the Bronx and the United States. This article describes the growth and development of CERC, identifies several key faculty members and staff who have been major contributors to CERC’s operations and to related Einstein activities, describes its numerous accomplishments over the past 50 years, and indicates some of the future directions for its programs.
Making HIV Testing a Routine: Facing the Truth ￼
Authors: Kon Maria
Published: January 2017

Wrath of God syndrome, Gay-related Immuno- deficiency Syndrome, Gay Cancer, Gay Plague—these are the names AIDS had in the 1980s. False myths made uninfected people afraid to interact with affected individuals. A political cartoon of these times bitterly made fun of the prevailing attitude towards the disease, “It affects homosexual men, drug users, Haitians and hemophiliacs...Thank goodness it hasn’t spread to human beings yet (Black, 1985)."
What Is the Evidence that Riboflavin Can Be Used for Migraine Prophylaxis?
Authors: Liebman Tracey N. , Crystal Sara C.
Published: January 2017

Individuals with migraine often have recurrent, painful symptoms, and symptomatic treatments have detrimentalside effects and do not prevent further attacks. Studies indicate that riboflavin can be used to decrease headachefrequency and lessen the need for symptomatic treatment. Mitochondrial dysfunction may play a role in migrainepathogenesis by interfering with oxygen metabolism. Daily doses of riboflavin, vitamin B2, may improve mitochondrialfunction by increasing the reserve of brain mitochondrial energy, and there are minimal side effects with dailytreatment. However, there is a need for further randomized, double-blind controlled studies to determine the effectivedose. Although riboflavin may not fully eliminate migraine nor take effect for several months, riboflavin is apromising prophylactic agent with minimal adverse effects that may significantly reduce the frequency of migraine.
The Risk of Fracture in Patients Undergoing Androgen Deprivation May Be Overstated: Analysis of an Unselected Cohort of Patients
Authors: Clerkin Kevin J. , Cohen Seth M. , Ennis Ronald D.
Published: January 2017

Objective: In this study we examined the prevalence of fracture among men undergoing ADT for prostate cancer to determine if the fracture risk was increased among this population.Background: Androgen deprivation therapy (ADT) is a therapeutic approach for men with various prostate cancer disease states. Treatment-related side effects of ADT include rapid bone loss. Previous studies have found that the bone loss related to ADT leads to the development of fractures. Methods: This is a retrospective cohort study of patients treated with ADT in a radiation oncology and medical oncology practice at an urban academic medical center from 2005 to 2010. Patients with evidence of bone metastases responsive to ADT were included. Those with androgen-independent prostate cancer were excluded. Results: One hundred thirty patients met the inclusion criteria and among them only three fractures occurred during 373 person-years of follow-up. The fracture-free survival (FFS) rate at three years for all was 97.7%. Excluding fractures occurring within six months of ADT initiation, the FFS rate was 100% at three years. No significant difference was demonstrated in those screened with a pretreatment dual-emission X-ray absorptiometry (DEXA) scan; there was no relationship between the number of ADT cycles, recovery of testosterone to normal, or total time on ADT. Older patients, surprisingly, had a lower risk (p = 0.054). Patients with normal bone mineral density (BMD) had an FFS rate of 93.8% at three years, osteopenic patients had 94.7%, and patients with osteoporosis and hormone-responsive metastases had 100%. Conclusion: The prevalence of fracture among this group is significantly less than what has previously been reported for men receiving ADT, potentially suggesting an overstatement of risk in the literature to date. Further prospective study with a larger sample size is needed.
From Bio 101 to Pillars of Biology: A Pedagogical Experiment
Authors: Maxson Michelle E. , Volpi Sabrina A. , Wontakal Sandeep N.
Published: January 2017

Within the Department of Cell Biology at Albert Einstein College of Medicine, each student is required to present a research article of his or her choosing for the department journal club. As new students entering the Department, it was unclear to us (Sabrina Volpi and Sandeep Wontakal) whether there were any rules for choosing the papers we would pres- ent. Should the paper relate to work performed within the Department? Did the paper have to be published within the last year, or five years, or could we select a “classic” paper from the early 1900s? While pondering these questions, we realized we shared a great interest in reading the original “landmark” papers we had once learned about in our introductory biology courses, the papers that laid the foundation of what we know as biology today.
The Role of Hormones in Women’s Stroke Risk
Authors: Bier Dara M.
Published: January 2017

Although often overshadowed by breast cancer and other women’s health issues, stroke is a primary cause of mortality and morbidity among women in the United States today. This article explores three major populations of women: postmenopausal women who are taking hormone-replacement therapy, women ingesting estrogen-containing oralcontraceptive pills, and women who are currently pregnant. It compiles recent research and physiologic information that can aid in assessing these women’s risk for stroke. This review can help healthcare providers evaluate and manage these populations, and assess the health risks and benefits of certain estrogen-containing therapies.
Engaging Healthcare Providers to Help Mothers with Eating Disorders Create Healthy Eating Environments for Their Children
Authors: Campol Meagan
Published: January 2017

Eating disorders (EDs), such as anorexia, bulimia, and bingeeating disorder, involve extreme emotions, attitudes, and behaviors surrounding weight, food, and body image, all of which can lead to destructive health consequences. While EDs have innumerable effects on affected individuals, less is known about the consequences for the offspring of childbearing women with past or current EDs. Children of mothers with EDs are at increased risk of various problems during gestation and childhood, including higher rates of miscarriage, cesarean-section deliveries, and stillbirth; greater likelihood of preterm delivery, small- or large-for-gestational-age, low or high birth weight, and growth disturbances; and lower likelihood of being breastfed. These children are also more likely to develop dysfunctional eating habits, behaviors, and attitudes throughout adolescence. Possible effects of maternal EDs on parenting include withholding food from children, using food to reward or punish, a preoccupation with weight interfering with the mother’s responsiveness to her child, failure to express positive attitudes toward eating, and higher tension during mealtimes. These risks are influenced by a variety of factors and the consequences for children are difficult to predict. Complicating matters, the foundations of an ED are established long before diagnosis. The familial setting provides a unique opportunity for integrated and concurrent primary and tertiary ED-prevention strategies for both child and mother. It is imperative for healthcare providers to consider the potential value of educational programs and support for mothers with EDs, as early intervention could interrupt the cycle of risk associated with eating disorders and their effects on the developing child.
Inside This Issue
Authors: EJBM EJBM
Published: January 2017

EJBM volume 28 Preview
Science at the Heart of Psychotherapy: A Review of Three Evidence-Based Treatments
Authors: Brady Victoria , Taylor Victoria , Rego Simon
Published: January 2017

Changes in the U.S. healthcare system over the past fewdecades have led to a transformation of the mental healthfield. The demand for accountability and the need for effective,cost-efficient treatments have spurred the movementtoward evidence-based practices. Today, a number of empiricallybased psychotherapies exist that have proven efficaciousin the treatment of a wide range of physical and psychologicaldisorders. Despite the strong evidence base for these treatments,their dissemination and implementation have beenslow. The intention of the present article is to summarize themajor characteristics of three types of psychotherapy (cognitivebehavioral therapy, acceptance and commitment therapy,and dialectical behavior therapy) that have received muchempirical support and have demonstrated applicability to awide range of both mental and medical problems. For eachtreatment, some background information is provided, alongwith the theoretical underpinnings of the treatment, a summaryof the current state of the evidence, and limitations andcriticisms in the literature.
The Discovery of Insulin: Is There Glory Enough for All?
Authors: Whitford Ian , Quereshi Sana , Szulc Alessandra L.
Published: January 2017

In October 2011, the University of Toronto and the TorontoheadquarteredGairdner Foundation partnered to celebrate theninetieth anniversary of the discovery of insulin. In 1921, fourscientists worked to discover, isolate, and purify insulin at theUniversity of Toronto: Frederick Banting, John J. R. Macleod,James B. Collip, and Charles H. Best. The credit for this achievementhas been assigned in varying ways. Popular opinion, inToronto and worldwide, has bestowed the recognition for discoveryupon Banting and Best. Indeed, many noted diabetologistshave credited the achievement to this pair. However, theNobel Committee awarded the Prize in Physiology or Medicineto Banting and Macleod in 1923. Michael Bliss, in his 1982history of the discovery of insulin, revisited the question ofwho really is responsible for this wonder drug. Our essay willexplore the pathway toward the discovery of insulin and seekto understand why the credit for this monumental achievementwas apportioned in such different ways.
Perceptions of an Implantable Cardioverter-Defibrillator: A Qualitative Study of Families with a History of Sudden, Life-Threatening Cardiac Events, and Recommendations to Improve Care
Authors: Linder Jarrett , Hidayatallah Nadia , Stolerman Marina , McDonald Thomas V. , Marion Robert , Walsh Christine , Dolan Siobhan
Published: January 2017

Objective: To identify major concerns associated with implantable cardioverter-defibrillators (ICDs) and to pro- vide recommendations to adult and pediatric physicians involved in the care of patients with ICDs. Background: Cardiac ion channelopathies are a well-recognized cause of sudden cardiac death in infants, children, adolescents, and young adults. ICDs are effective in preventing sudden death from fatal arrhythmias in patients with known cardiac channelopathies. There is a paucity of research on the effect of ICDs on quality of life in patients with cardiac channelopathy diagnoses, especially young patients. Methods: A qualitative study interviewing patients and families affected by inherited arrhythmias was conducted. Fifty participants with personal or family histories of cardiac events or sudden death were interviewed individually or in focus groups by clinical psychologists. All interviews were transcribed verbatim and then analyzed and coded based on current qualitative research theory to identify themes related to the research question. Twenty-four participants discussed ICDs in their interviews. Results: Participants reported concerns about ICDs, and these concerns were categorized into six themes: (1) comprehension and physician-patient communication; (2) anxiety; (3) restrictions and fallacies; (4) complications; (5) utility; and (6) alternative therapy. Participants noted communication breakdowns between providers and their colleagues, and between providers and their patients. Participants and their families experienced many different forms of anxiety, including worry about the aesthetics of the ICDs and fears of being shocked. Multiple restrictions, fallacies, and complications were also cited. Conclusion: Interview themes were used to formulate recommendations for counseling and educating patients with ICDs.
Impact of an Intensive Cardiology Orientation Program on Confidence of New Fellows
Authors: Kaur Priti
Published: January 2017

Objective: We implemented a four-day intensive clinical orientation program in 2004 for cardiology fellows to compare the change in self-assessed confidence of fellows before versus after the orientation. Background: The transition from an internal medicine residency to a cardiology fellowship can be challenging. There has been limited research on the use of orientation programs to ease this transition. Methods: New fellows in 2006 and 2007 (N = 13) were prospectively queried immediately before, immediately after, and six months after orientation about their confidence and their support for the orientation program. We retrospectively queried fellows who began their fellowships in 2004 and 2005 (N = 12) by asking them to complete the same questionnaire based on what they recalled feeling immediately before, immediately after, and six months after orientation. Responses to each question were based on a Likert scale from 1 to 7, and a total confidence score was calculated. Retrospective and prospective data were pooled, and nonparametric paired analyses were performed.Results: Twenty-five fellows were enrolled. Fellows’ confidence scores increased after the orientation from 20 to 36 (p<0.01). A significant increase was sustained after six months. In addition, at all time points, the fellows supported the orientation program. Conclusion: An intensive clinical orientation program improved new cardiology fellows’ confidence. Support for this program was high, and the findings support con- tinuation and further development of the program.
The Metamorphosis of a Horse into a Zebra: A Case of Primary Eosinophilic Gastroenteritis
Authors: Salamon Jason N. , Sherman Deborah
Published: January 2017

Chronic diarrhea is a common diagnostic entity faced by many primary care physicians. Primary eosinophilic gastroenteritis (PEG), a relatively rare but not uncommon cause of chronic nonbloody diarrhea, presents with nonspecific symptoms, making clinical consideration and diagnosis extremely challenging. In PEG, eosinophils selectively target the gastrointestinal tract, where they degranulate, causing inflammation and irritation. We report the case of a 46-year-old female with recurrent hospitalizations for nausea, vomiting, and diarrhea over a nine-month period. After an extensive workup ruling out secondary causes of eosinophilia, she was diagnosed with PEG.
Mineral and Bone Metabolism Disorders in Minority Incident ESRD Patients in an Inner-City Hemodialysis Unit
Authors: Goel Narender , Pokharna Hiren , Abramowitz Matthew K. , Gnanasekaran Isaiarasi
Published: January 2017

Background: Chronic kidney disease (CKD) predisposes patients to mineral and bone metabolism disorder (CKD- MBD), which is a well-known risk factor for increased mortality. Because Medical Evidence Form 2728 from the Centers for Medicare and Medicaid Services for incident end-stage renal disease (ESRD) patients does not require documentation of CKD-MBD markers, MBD status on incident patients remains unknown. Objective: Retrospective observational study to determine the prevalence of mineral and bone metabolism disorder in minority incident ESRD patients. Methods: We studied all incident ESRD patients in our hemodialysis unit between January 2000 and September 2008. Patients followed for less than three months were excluded. Target values for CKD stage 5 were defined as per 2003 Kidney Disease Outcome Quality Initiative guidelines. Results: One hundred seventy-four patients were stud- ied, with a mean age of 53.7±16.1 years, mean body mass index of 26.67±5.98 kg/m2, and mean estimated glomerular filtration rate of 6.7±4.03 mL/min/1.73m2. Mean lab values with one standard deviation were as follows: corrected calcium 8.5±1.3 mg/dL, serum albumin 3.05±0.77 g/dL, phosphorus 5.5±2.2 mg/dL, calcium-phosphorus product 46.7±18.5 mg2/dL2, and intact parathyroid hormone (iPTH) 440.9±397.8 pg/mL. Target values for cal- cium, phosphorus, calcium-phosphorus product, and iPTH were met in 34%, 42%, 72%, and 31% of the patients, respectively, while only 6% of the patients met all four target values. Conclusions: CKD-MBD is widely prevalent in minority incident dialysis patients at initiation of therapy. Its management continues to be a challenge and warrants early recognition and therapy in CKD patients.
Psychiatric Underpinnings of Chronic Diabetic Neuropathic Pain
Authors: Shabbir Syed H.
Published: January 2017

There is increasing evidence that psychosocial factors may be involved in the pathophysiology of chronic diabetic neuropathic pain. Individuals with diabetic polyneuropathy exhibit significantly higher rates of axis I psychiatric disorders, and worsening neuropathic symptoms correlate with worsened psychiatric illness. This association exists even when social-support and quality-of-life measures are controlled. Aberrant supraspinal structures and neuronal networks in diabetic neuropathy mimic those found in other psychiatric illnesses. Response to standard medications and therapeutic approaches remains unsatisfactory, and antidepressants continue to serve as first-line treatment for diabetic neuropathy. The exact interplay between neuropathic pain and psychiatric illness remains unclear and may have a common pathophysiological focus. This area of study needs to be revisited and psychological interventions must be explored as possible treatment options for diabetic neuropathy.
More Than Skin Deep: Genetics, Clinical Manifestations, and Diagnosis of Albinism
Authors: Gittler Julia Klein , Marion Robert
Published: January 2017

Although albinism may be considered a simple diagnosis, its clinical manifestations, which include hypopigmenta- tion of the skin, hair, and eyes and ocular abnormalities such as nystagmus and reduced visual acuity, are often subtle and initially missed. In oculocutaneous albinism, there is wide phenotypic variability, which correlates with specific mutations in genes with roles in melanin biosynthesis. Additionally, syndromic forms of albinism such as Hermansky-Pudlak syndrome, Chediak-Higashi syndrome, and Griscelli syndrome are associated with serious complications such as bleeding abnormalities, lysosomal storage defects, immunodeficient states, and progressive neurologic defects, which all can result in mortality. It is critical to confirm a suspicion of albinism and perform an appropriate workup involving molecular testing in order to establish a diagnosis. Given the various subtypes of oculocutaneous albinism and the life-threatening complications in syndromic forms of albinism, a diagnosis permits proper genetic counseling and timely implementation of necessary screenings and treatments. Recommendations regarding sun exposure and treatment of ocular abnormalities are imperative in oculocutaneous albinism, and preventive therapies should be implemented in syndromic forms. With knowledge of the differential in conjunction with the execution of simple diagnostic tests, many of these complications can be predicted and consequently ameliorated or prevented.
Yellow Fever and the Emotional Consequences of Untreatable Epidemic Disease
Authors: Runge John S.
Published: January 2017

Yellow fever terrorized communities in tropical and urban settings during its height in the nineteenth-century American south. Carried by Aedes aegypti mosquitoes, which breed in stagnant water, the virus infects humans fervently and is most known for its symptoms of jaundice and vomito negro, a dark vomit of coagulated blood. During the near-annual outbreaks of yellow fever, caregivers struggled to cope with the emotional consequences of failing medicine, sometimes leaving behind clues to their confusion in treating the disease and offering salient reflections on their inadequacies. The disease ravaged the Gulf region for decades. Records of the health workers’ feelings of futility reflect their questions of what to do for others and what to do for themselves, offering a new perspective on yellow-fever scholarship and insight into contemporary clinical practice and research.
An Uncommon Cause of Acute Abdominal Pain: Primary Epiploic Appendagitis in the Emergency Setting
Authors: Casey Scott D. , DiVito Jr. Joseph , Lupow Jason B. , Gulani Reshma
Published: January 2017

In the emergency setting, the diagnosis of benign causes of acute abdominal pain can prevent unnecessary medical interventions. To illustrate this point, we report the case of a 28-year-old man who presented to the emer- gency department with symptoms suggestive of acute diverticulitis. Abdominal computed tomography (CT) established, instead, a diagnosis of primary epiploic appendagitis (PEA), which was managed expectantly. The patient’s symptoms resolved within one week of hospital discharge and he remained free of pain at a five-month phone follow-up. Increased awareness of PEA and its self-limited course can help the emergency physician avoid unnecessary imaging studies and expectantly manage this cause of acute abdominal pain.
Origins and Applications of CRISPR-Mediated Genome Editing
Authors: Christin John R. , Beckert Michael V.
Published: January 2017

In this graphical review we highlight key milestones in the discovery and development of CRISPR and cas9 technology, as well as illustrate mechanisms of cas9:sgRNA target binding and DNA repair.
Concordancia histopatológica entre la citología y la biopsia anal en hombres que tienen sexo con hombres portadores de VIH y neoplasia intraepitelial anal asociada a VPH
Authors: Bajo Ríos Christian , Ramírez Cabezas Francisco , García Sobarzo Ricardo
Published: January 2017

Objetivo: determinar la concordancia de los resultados de la citología y la biopsia anal en hombres que tienen sexo con hombres (HSH) portadores de VIH y neoplasia intraepitelial anal (NIA) asociada a virus del papiloma humano (VPH). Materiales y métodos: estudio observacional transversal, de diciembre de 2011 a diciembre de 2013 para determinar la concordancia de los resultados de la citología y la biopsia anal en hombres que tienen sexo con hombres (HSH) portadores de VIH y NIA asociada a VPH en pacientes del hospital de Infectología del Centro Médico Nacional la Raza. Se realizó análisis estadísticos descriptivos. Resultados: se estudiaron 92 sujetos VIH positivos y VPH positivo, el reporte histopatológico definitivo de las biopsias anales fueron: neoplasia intraepitelial de bajo grado en 39 %, neoplasia intraepitelial de alto grado 4 %, células atípicas de significado incierto 3 %, normales en 27 %, con cambios inflamatorios reactivos en 23 % y muestras inadecuadas para el diagnóstico el 9 %. La concordancia observada entre los dos métodos diagnósticos fue de 0.90 según alfa de Crobanch. Conclusión: el grado de concordancia del 90 % de las biopsias y citologías anales, indica que son buenos métodos de seguimiento de los pacientes infectados con VIH y VPH, y permite detectar en forma oportuna lesiones precancerígenas, brindando diagnóstico y tratamiento oportuno.
Uso de membrana amniótica como cobertura temporal en pacientes con quemaduras del hospital Luis Vernaza.
Authors: Quintana Jedermann Fernando , De loor Zambrano Stalin
Published: January 2017

El paciente con quemaduras demanda de un manejo complejo, y el uso de membrana amniótica como cobertura temporal conforma un método muy valioso para favorecer su evolución. Este método forma parte de las alternativas terapéuticas en la Unidad de Quemados del hospital Luis Vernaza (HLV). Objetivos: demostrar la eficiencia del amnios humano como cobertura temporal en pacientes con quemaduras. Metodología: se presenta una serie de 14 casos de pacientes con quemaduras de menos del 25 % de superficie corporal total, tratados en la Unidad de Quemados del HLV, donde se aplicó membrana amniótica humana. Resultados: el 100 % de los pacientes requirió solo de una aplicación, 9 pacientes fueron del sexo masculino (64 %) y 5 del femenino (36 %), con un rango de edades entre 25 y 86 años. La media de edad fue 45 años y mediana de 47 años, la causa de lesión más frecuente fue a causa de flama con 9 casos (64 %). El promedio de estancia hospitalaria postoperatoria fue de 9 días, con un límite inferior de 6 y superior de 13. En ningún paciente se observó signos de infección o rechazo inmunológico y en todos se observó re-epitelización de las lesiones. En la escala de valoración numérica del dolor (del 1 al 10), se confirmó que todos los pacientes referían menos dolor y posteriormente al día 7 desapareció en todos. Discusión: el uso de membrana amniótica humana en pacientes quemados evita la pérdida de líquidos, electrolitos y proteínas en las áreas cruentas, a modo de barrera artificial ayuda a prevenir las infecciones especialmente, como una membrana basal sustituta, sin desmerecer la importancia del efecto analgésico sobre las lesiones.
Role of Computed Tomography Scan in Non-Localized Headache in Tertiary Hospital of Mid Western Region of Nepal
Authors: Ghimire Prasanna , Singh B. P. , Chaturvedi S. K.
Published: January 2017

Objective: To investigate the implication of a computed tomography scan for headache with non-localizing sign.Materials and methods: One hundred and thirty six patients with headache having non-localizing signs were included in this prospective study. Patients with age > 11 years, incomplete radiological or clinical data, recent/new onset headache, any immunosuppressive state, neurological deficits at the time of presentation, history of fever, trauma, any previous surgical intervention and any malignancy were excluded from the study.Results: Among the 136 patients, 73% were females and 27% were males with age range of 11- 76 years. Negative computed tomography scan was present in 91 (66.9 %) cases. Positive findings that significantly influenced the management were present in only 6 (4.4%) cases. Conclusion: Computed tomography in headache with non-localizing signs has a poor yield for a significant intracranial pathology. A careful and detailed assessment curtails the need for inadvertent imaging thus reducing the economic burden and health related hazards.Journal of Nepalgunj Medical College Vol.13(1) 2015: 2-4