bluuebunny/crossref_metadata_2025 huggingface dataset:
Computer System Architecture
Authors:   Ananda College, Devakottai Tamil Nadu, India, A Victor Benevent Raj , S Kevin Andrews ,   Dr. M. G. R Educational and Research Institute, Chennai, Indi
Published: March 2023

System Architecture is a comprehensive book that provides a detailed understanding of computer systems and their organization. The book is divided into five units, each of which deals with a specific topic related to computer architecture. In Unit I, the book covers Data Representation, which includes topics like data types, complements, register transfer language, register transfer bus, and memory transfers. Additionally, it explains Arithmetic, Logic, and Shift unit along with the introduction of basic computer organization and design, which covers instruction codes, computer registers, computer instructions, timing and control, and instruction cycle. Unit II focuses on Memory Reference Instructions, Input-Output, and Interrupt. Furthermore, the book introduces programming the basic computer, machine language, assembly language, the assembler, program loops, programming arithmetic, and logic operations and subroutines. Unit III covers Central Processing Unit, including General Register Organization, Stack Organization, Instruction Formats, addressing modes, data transfer, and manipulation, and Reduced Instruction Set Computer (RISC). In Unit IV, the book explains computer arithmetic, such as addition and subtraction, multiplication algorithms, division algorithms, input-output interface, priority interrupt-direct memory access, and input-output processor. Finally, Unit V concentrates on Memory Organization, including memory hierarchy, main memory, auxiliary memory, associative memory, cache memory, virtual memory, and the characteristics of multiprocessors. In conclusion, System Architecture is an excellent resource for computer science students and professionals interested in understanding the design, organization, and functioning of computer systems. Keywords: Data Representation, Central Processing Unit, Memory Organization, Instruction Formats, Arithmetic and Logic, Input-Output Interface. Keywords: Architecture, Data Representation, Data Types, Complements, Register Transfer Language, Register Transfer Bus, Memory Transfers, Arithmetic, Logic, Shift unit, Basic Computer Organization, Instruction Codes, Computer Registers, Computer Instructions, Timing and Control, Instruction Cycle, Memory Reference Instructions, Input-Output, Interrupt, Machine Language, Assembly Language, Assembler, Program Loops, Programming Arithmetic, Logic Operations, Subroutines, Central Processing Unit.
A formation of xingnu iron bits and its surroundings areas
Authors:   The Pusan Archaeological Society, Kang Nari
Published: March 2023

There are two similarities in the iron bits before Xiongnu Period, as known as Schyto-Siberian Culture period, which was existed around the eastern Eurasian steppe area in terms of using two pieces of iron rods made of bronze and having two holes on the bit to connect to the horse straps. During Xiongnu Period, people accepted the previous traditions which are having the two holes on a bit and making the two edges of a bit symmetrically. They began in earnest to use iron to make the iron bits to make their own shape of bits. The characteristic of Xiongnu iron bits can be seen in the iron bits of Han Dynasty which was existed at the same time with Xiongnu in the structure and shape including having the two holes on the bit to connect to the horse straps and making the two edges symmetrically. On the other hand, Han iron bits have their own characteristics such as using three pieces of iron rods and decoration on the two edges of the bit. The iron bits in Korean Peninsula can be divided into two regional bases, the western North Korea and Yeongnam areas. Among the iron bits from the western North Korea, there are S-shape bits that look similar to one in Xiongnu bits. There are gaps of time and distance in the iron bits from the western North Korea and Xiongnu so that it is hard to assumed that the S-shaped iron bits of the both regions are directly related. But it is reliable that there is technological connection between the two regions in terms of having the two holes on the bit. In Yeongnam area, S-shaped and I-shaped iron bits are found. It is assumed that the S-shaped bits were came to the area through the relationship with the western North Korea. On the other hand, I-shaped iron bits are only found in this area. The I-shaped iron bits look the same with Xiongnu iron bits (e.g. axe blade-shaped bits) so that it could be thought of Xiongnu's impact on Yeongnam except for and manufacturing technique of rods. In this study, I could examine the formation of Xiongnu iron bits and the relationship with the surrounding areas including Han dynasty and Korean Peninsula. Base on the Xiongnu iron bits, I wanted to scrutinize overall aspect of the eastern Eurasian iron bits.
Teachers' Knowledge, Attitudes, Beliefs, and Instructional Practices in Education 4.0
Authors: Arpilleda Yvonne J. , Oracion Regina Vera L. , Arpilleda Alcher J. , Chua Liza L. , Gortifacion Audi Kondessa N.
Published: March 2023

Education 4.0 is the desired learning strategy that coincides with the fourth industrial revolution. This study aimed to determine the extent of teachers' knowledge, attitudes, beliefs, and instructional practices in the context of Education 4.0. A quantitative descriptive research design using a survey technique was employed. The participants of this study were the basic education teachers of St. Paul University Surigao. The main instrument used to solicit information is a five-part questionnaire adapted from Arpilleda and Mallillin (2020). The statistical tools used in this study were Frequency Count and Percentage Distribution, Mean and Standard Deviation, ANOVA, and Pearson Product Moment Correlation Coefficient. Findings revealed that the Basic Education Teachers of St. Paul University Surigao are fully aware of the nature of the fourth industrial revolution in education who possess a positive attitude towards its demands and accept its principles that the learners are at the center of the future ecosystem focusing on an innovative-producing education. The teacher's age, sex, length of service, and highest educational attainment affects their knowledge, attitudes, beliefs, and instructional practices in the context of Education 4.0. It is recommended that the teachers strengthen their practice of teaching students to interpret data for them to apply their theoretical knowledge to numbers, as this was found to be the lowest indicator among the instructional practices.
Edukasi Dampak Penggunaan Cotton Buds untuk Membersihkan Telinga pada Siswa SMP YARI School Padang
Authors: Dewi Nadia Purnama , Vani Ade Teti , Triansyah Irwan , Abdullah Dessy , Hansah Rendri Bayu
Published: March 2023

Ears are one of the most frequently cleaned parts of the body. There are many ways to clean the ears, for example by using cotton buds, using candles and so on. The act of cleaning the ear with cotton buds is not recommended, because it can cause earwax (cerumen prop) to be pushed into the ear so that over time it will cause hearing loss (deafness). Sometimes the use of cotton buds is too deep, causing damage to the eardrum. Education in the form of counseling given to junior high school students aims to reduce the risk of ear damage from an early age due to the use of cotton buds and how to clean the ears properly. Education is held at SMP Yari School Padang. The extension method uses power points and leaflets which are distributed to school students. At the time the counseling was carried out, pretest and posttest were given to see students' knowledge of the material presented. The results of the pretest and posttest showed an increase in students knowledge about the material that had been given with p value=0,000.
Dampak Sosmed Addiction Disorder Terhadap Kesehatan Remaja
Authors: Huvaid Sevilla Ukhtil , Yulianita Yulianita
Published: March 2023

SMAN 9 is one of the favorite schools that has grown rapidly in the city of Padang. Based on the situation analysis conducted, it is known that in this high school there has never been any outreach to students about the negative impact of social media on their health and learning achievement. The existence of this high school which is located in Cyber Pasar Baru and Andalas University campus is certainly a threat to the health aspect and student achievement, because with this strategic location students have additional high enough access to be able to use social media such as in internet cafes ( internet cafe) without having to spend a lot of money to buy packages and this of course provides an opportunity for students to become social media addicts. For that reason, in this service program the team made SMAN 9 Padang City as a partner. The methods of activities carried out include doing pre-tests, counseling, showing videos about social media addiction disorder, discussions, doing post-tests, sharing experiences, and competitions about materials. Based on the community service activities carried out, it was found that there was an increase in the knowledge and motivation of the participants after attending the counseling. In addition, it was found that there was still a lack of attention and support from the puskesmas, schools, and families in an effort to increase their knowledge about the impact of excessive use of social media.
Pijat Bayi Terapi Komplementer untuk Optimalkan Tumbuh Kembang Anak
Authors: Abdullah Dessy , Vani Ade Teti , Anissa Mutiara , Dewi Nadia Purnama , Darmayanti Anita
Published: March 2023

The development of a child is very important for parents. Every parent wants their child to grow up well and be a strong and good quality child. One of the efforts that parents can do from an early age is to stimulate with the baby massage method. Massage therapy is one of the complementary therapies that can stimulate tactile-kinesthetic stimulation. Massage therapy given since infancy can increase the stimulation of receptors on the skin, affect brain cells, increase interaction between mother and child, and increase body weight so that children's growth becomes optimal. This community service activity aims to increase community knowledge at the Sinar Gunung VI Posyandu, about baby massage and how to do it, so that babies can grow and develop properly. The method used is lecturing and practicing as well as distributing leaflets on how to do a baby massage that will optimize the growth and develop optimally of children. This activity was attended by 18 mothers who have babies. The results of this activity were increased knowledge and skills of mothers who came to Posyandu Sinar Gunung VI who had babies. The conclusion is that there is an increase in the knowledge and skills of mothers who have infants and higher confidence in practicing complementary therapy for infant massage therapy with mentoring and coaching to optimize the growth and develop optimally of infants.
Pembinaan Kesehatan Reproduksi Remaja Berencana
Authors: Febriani Gabriela Advitri
Published: March 2023

Population in Indonesia in 2020 is 270,203,917 people with the number of teenagers (aged 10-19 years) as many as 46 million (17%). This large number of adolescents requires special attention from all parties, considering that adolescents are an age group that is vulnerable to the Three Basic Risks of Adolescent Reproductive Health Threats. The purpose of this community service is to educate adolescents about the importance of awareness in maintaining their reproductive health. This community service activity is in collaboration with the Information and Counseling Center for Adolescent Reproductive Health Rafflesia Singkawang Timur Districts, which was held on March 27, 2022, took place at the Singkawang City Regional Mess Court with a total of 24 male and female adolescents from Singkawang City. The method of activity is in the form of counseling through demonstrations, games, questions and answers and discussions. The counseling activity begins with a question and answer (pre-test). After counseling and discussion, a post-test was carried out and the result was an increase in knowledge with an average value of 77.6. This proves the need for special attention for adolescents to understand the importance of maintaining reproductive health in order to avoid the Three Basic Risks of Adolescent Reproductive Health Threats.
Getting Science Back on Track: Voices of Scientists across Six Federal Agencies
Authors: Desikan Anita , Carter Jacob
Published: March 2023

To protect the public's safety and health, the US government should base policies on the best evidence—and that requires keeping the work of federal scientists free from political interference. Fortunately, the latest Union of Concerned Scientists survey of federal scientists shows the powerful, positive effects of strengthening scientific integrity policies under President Biden. While challenges remain, the survey found significant improvements in scientific integrity over previous administrations, and scientists say morale and working conditions are better. A majority of those surveyed feel that their agencies have protected scientific staff from COVID-19 in the workplace, and that the agencies frequently consider the impact of their work on historically marginalized communities. Scientists report feeling mostly positive about efforts to incorporate considerations of justice, equity, diversity, and inclusion into research and policy, although perceptions are mixed about the efforts’ long-lasting effectiveness.
Composite Model of Marketing Mix and Brand Equity for Purchasing Motorcycles
Authors: Jhantasana Chanta
Published: March 2023

The current study investigates the effect of a composite model of the marketing mix and brand equity on motorcycle purchase decisions. For second-order, the marketing mix and brand equity were constructed using a disjointed two-state approach and a formative-formative weighting scheme. The purchasing decision was measured as a latent variable using a consistent partial least square (PLSc) model. The data was collected from 148 people who have bought motorcycles in Thailand. The results show that the lower-order constructs demonstrate how well they are organized by the indicators, as determined by the model fit indexes. To begin, the hypothesis regarding the three model fitting indexes is rejected. Thus, all bias indicators with shallow values and a negative symbol were removed from the composite model. Furthermore, multicollinearities exist between PLACE indicators, and they are addressed by removing the indicator with the highest variance inflation factors (VIF). Concerning purchasing decisions, the PLSc model with an indicator loading of less than 0.708 was eliminated. As a result, all three total model fit hypotheses returned to be accepted. For the higher-order construct, the composite model created a marketing mix positively linked to brand equity and purchasing decisions, and brand equity positively correlates with purchasing decisions. The hybrid model can generate model fit indexes for both the first and second construct.
DIFERENÇAS E SEMELHANÇAS ENTRE A AGRICULTURA FAMILIAR E A AGRICULTURA CAMPONESA
Authors: Vilas Boas Lucas Guedes
Published: March 2023

Muitos estudos tratam a agricultura familiar e a agricultura camponesa como sinônimos. Embora toda agricultura camponesa seja familiar, nem toda agricultura familiar é camponesa, uma vez que abrange diversos tipos de agricultura. Assim, o objetivo do artigo é discutir as duas categorias, com ênfase na conjuntura agrária brasileira, evidenciando as diferenças teóricas e práticas entre ambas.Ademais, salienta as relações de trabalho e de produção estabelecidas por camponeses e agricultores familiares, assim como seu envolvimento com a conservação da terra e da natureza. A pesquisa bibliográfica e a análise documental foram os procedimentos metodológicos adotados. Destarte, podese afirmar que, com o desenvolvimento do capitalismo, houve nos últimos decênios diminuição da quantidade de camponeses no Brasil em virtude da migração campo-cidade e, principalmente, da integração e subordinação ao modo de produção capitalista.
IDENTIDADE CULTURAL SUL-RIO-GRANDENSE, NA CONTEMPORANEIDADE, E SUA MANIFESTAÇÃO NA PAISAGEM DE SANTA MARIA – RS
Authors: Lorensi Deise Caroline Trindade , Becker Elsbeth Léia Spode
Published: March 2023

O objetivo da presente pesquisa é evidenciar a identidade cultural sul-rio-grandense na contemporaneidade, e analisar sua manifestação na paisagem de Santa Maria – RS. A influência da cultura sobre o território, a exemplo da tradição gaúcha, fortalece os aspectos geográficos, pois diversifica a ação do homem sobre a superfície terrestre, diferenciando o espaço de acordo com suaherança cultural, ou seja, o modo de vida partilhada historicamente por grupos culturais. Os procedimentos metodológicos perpassaram por uma revisão bibliográfica, aplicação de questionário a jovens santa-marienses, entre 15 e 28 anos, bem como levantamento fotográfico e visitação as entidades tradicionalistas do município. Constatou-se a premissa de que o tradicionalismo gaúcho no município é um importante componente desencadeador para o convívio da população em suas múltiplas expressõessociais e culturais; e evidencia-se que são necessários o resgate e a valorização da tradição gaúcha na contemporaneidade.
Comprensión lectora: intervención para su desarrollo en estudiantes de primer ciclo de la escolaridad primaria
Authors: Musci María Cecilia , Picca Romina , Barreyro  Juan Pablo , Brenlla María Elena , Gottheil Bárbara
Published: March 2023

La comprensión lectora (CL) es un proceso cognitivo complejo que implica un conjunto de operaciones mentales que posibilitan la construcción de una representación integrada del texto. Se presentan resultados de un estudio en curso que apunta a evaluar la mejora en CL de niños de escolaridad primaria a partir de la implementación de un programa de intervención específico: Para Leerte Mejor (PLM) (Gottheil et al., 2017), que interviene sobre el conocimiento acerca del vocabulario, la autorregulación de la comprensión, el conocimiento de la estructura del texto y la generación de inferencias. Se trabajó con una muestra compuesta por 60 niños de 3° grado de escuelas de la zona del Alto Valle, de la Región Patagónica. Se optó por un diseño de tipo experimental, con grupo control en espera y otro de intervención, en modalidad longitudinal (pretest y postest). La intervención consistió en 20 sesiones de trabajo, con una frecuencia de dos veces por semana. Las evaluaciones pretest y postest se realizaron mediante pruebas que permiten identificar el desempeño en procesos cognitivos y metacognitivos vinculados con la CL, adaptadas para nuestro contexto. Los resultados permiten inferir que la intervención mediante el programa implicó una mejora significativa en la CL en general y en las habilidades centrales comprendidas en la misma, en comparación con los cambios que se producen mediante la enseñanza convencional. Se evidencia la importancia de la enseñanza explícita de estrategias y del trabajo sistemático sobre estas.
Entre lápices, papeles, teclados y pantallas: prácticas de escritura en entornos virtuales
Authors: Hirch Lucas , Medeot Celeste , Barcia Vanesa Ruth
Published: March 2023

En este artículo, nos ocupamos del análisis de algunas dimensiones que favorecieron o condicionaron la práctica de escritura en el contexto de educación remota, en un Instituto Superior de Formación Docente, de una localidad de Córdoba, Argentina. Específicamente, nos interesó saber qué modificaciones o continuidades se produjeron en las significaciones que los actores escolares otorgaron a dicha práctica, a partir del 2020. Para ello recurrimos a un diseño exploratorio-interpretativo y cotejamos los resultados obtenidos con indagaciones que realizamos en investigaciones anteriores, en contexto de educación presencial. Abordamos el análisis desde una perspectiva transdisciplinaria, es decir, consideramos tanto las dimensiones pedagógicas, lingüístico-discursivas como las intersubjetivas implicadas en el acto de escribir. Nos ayudan a comprender este fenómeno autores del campo de la Lingüística como Cassany, Navarro y Revel Chion, Carlino, Ramos, quienes estudian la escritura desde una perspectiva procesual; y, del campo de la Filosofía y la Sociología, autores como Bourdieu, Berardi y Han. Como una primera aproximación analítica, en relación con la escritura, consideramos que los avances pedagógicos-didácticos que se venían sucediendo en los últimos años fueron interrumpidos a partir de la digitalización de las prácticas educativas. Esto es, se puso en suspenso la apertura sociocultural que venía cobrando fuerza en cuanto a su enseñanza y aprendizaje. Si bien se reconocen los beneficios y posibilidades de los medios y recursos virtuales, estos mismos entornos también pueden operar como barreras para que la experiencia académica pueda acontecer.
Efficacy of aquatic exercise on pulmonary function and aquatic skills performance in older children with cerebral palsy. Randomised controlled study
Authors: Abdelaal Mohamed Abdelaal Ashraf , Atia Doaa Tammam
Published: March 2023

Introduction

To evaluate the effectiveness of the aquatic aerobic exercise training (AqET) on the pulmonary function (PF) and aquatic skills performance in the older children with spastic cerebral palsy (CP). Randomized controlled study.

Methods

Twenty-eight children, 13–15 years old, with spastic CP were randomly allocated into AqET group (n = 13; received AqET plus traditional Physiotherapy “TPT” program) and control group (n = 15; received TPT only). The PF [including (the forced vital capacity; FVC), (forced expiratory volume in one second; FEV1)] and the aquatic skills performance (including the WOTA mental adaptation score “WMA”, the WOTA skills balance control movement score “WSBM”, the WOTA total score “WTOT”) were evaluated at the beginning and after 12-weeks.

Results

Post-study results revealed significant increases in the PF, WMA, WSBM, WTOT mean values in both groups. The FEV1% and FVC% mean values and percentages of changes were [84.00% (21.5%), 78.23% (24.56%)] and [(71.13% (6.9%), 62% (7.12%)] for the AqET, and control groups respectively. The WMA, WSBM, WTOT mean scores and percentages of changes were [33.15 (77.01%), 15.46 (643.27%), 48.62, (133.19%)] and [(20.2 (7.59%), 2.27 (23.89%), 22.47 (7.36%) for the AqET, and control groups respectively (p < 0.05). There were significant differences between-groups in the PF and the aquatic skills performance post-study, but in favor of AqET group.

Conclusions

Children with spastic CP benefit favorably from AqET or TPT programs. The AqET is more beneficial than the TPT in increasing the PF and the aquatic skills performance in older children with spastic CP.
ANALISIS FAKTOR YANG MEMPENGARUHI KEPUASAN KERJA SDM
Authors: Wardah ramadaniatul millah Neng , Fariha Amalia Putri Nisa , Damayanti Sri , Hapiddin Saleh Riswandy , Kholik Abdul
Published: March 2023

Penelitian ini bertujuan untuk menggambarkan kepuasan kerjapada faktor internal dan eksternal yang mempengaruhi kepuasan kerja guru. Setiap jenis menjadi faktor pendukung dan penghambat yang mempengaruhi kinerja guru. Instrumen penelitian adalah wawancara, dalam pembelajaran deskiptif kualitatif.  Dari hasil yang dapat diperoleh dalam penelitian ini adalah bahwa kepuasan kerja guru-guru di pondok pesantren al-bunyan secara garis besar telah terpenuhi, untuk lebih jelasnya maka peneliti memaparkan hasil penelitian tersebut secara khusus sebagai berikut: Faktor yang mempengaruhi kepuasan kerja SDM di Pondok pesantren Al-bunyan yaitu: (1) faktor psikologis, (2) faktor sosial, (3) faktor fisik, (4) faktor financial. Faktor psikologis terdiri dari faktor yang berhubungan dengan interaksi social antara (Kepuasan Kerja SDM Pendidikan) sesama anggota organisasi, hubungan dengan direktur, atasan langsung, karyawan yang berbeda fungsi tugasnya, relawan. Faktor pendukung dan penghambat yang mempengaruhi kepuasan kerja SDM yaitu: Faktor pendukung terdiri dari: keterlibatan semua stakeholders, tersedianya tenaga, sarana prasarana, fasilitas dan pembiayaan yang cukup, adanya dukungan semua stakeholders, masyarakat, dan instansi aktif terkait, melakukan monitoring dan evaluasi secara teratur dan terjadwual. Dengan demikian hasil penelitian ini diharapkan dapat memberikan kontribusi bagi dunia ilmu pengetahuan dan teknologi. Dari hasil penelitian, dapat disimpulkan bahwa kepuasan aktivitas belajar di Pondok pesantren Al-bunyan dapat dipengaruhi oleh layanan di sekolah, kesejahteraan guru, dan faktor positif dapat meningkatkan hasil belajar siswa
HUBUNGAN ANTARA EFEKTIVITAS PENGGUNAAN APLIKASI EDUCATION MANAGEMENT INFORMATION SYSTEM (EMIS) DENGAN PENDATAAN PENDIDIKAN DI RAUDHATUL ATHFAL (RA) KABUPATEN SUMEDANG
Authors: Khairah Hisan Fabian , Ibrahim Tatang , Hidayat Wahyu
Published: March 2023

Penelitian ini bertujuan untuk mengetahui seberapa besar efektivitas penggunaan aplikasi EMIS sebagai sistem pendataan pendidikan Raudhatul Athfal (RA) di Kabupaten Sumedang. Penerapan Aplikasi Education Manajemen Information System (EMIS) memiliki urgensi yang begitu besar bagi lembaga, karena data yang  dimasukkan  menentukan suatu kebijakan terkait dana-dana pendidikan seperti Bantuan Operasional Sekolah (BOS) dan Program Indonesia Pintar (PIP). Data-data yang tertera pada aplikasi EMIS juga sangat diperlukan dalam pengambilan kebijakan dan keputusan manajerial untuk mempertahankan mutu pendidikan.Penelitian ini menggunakan metode deskriptif dengan pendekatan kuantitatif. Teknik pengambilan sampel menggabungkan antara 2 teknik sampling, yaitu purposive sampling dan simple random sampling sebanyak 52 responden. Analisis data menggunakan analisis statistik deskriptif dan uji hipotesis dengan uji satu sampel t-test (one sample t-test) dan dibantu dengan SPSS Versi 24. Hasil penelitian diketahui persentase efektivitas aplikasi EMIS sebagai sistem pendataan RA di Kabupaten Sumedang  yang didapat dari tanggapan responden adalah sebesar 75,25% yang didasarkan pada kriteria uji hipotesis jika nilai thitung  ≥  ttabel (6.04 ≥ 1.675), maka Ho ditolak dan Ha diterima.
Mit dem digitalen Zwilling in der Pharmazie unterwegs
Authors: Laux Matthias
Published: March 2023

Gerresheimer und Merck arbeiten zusammen. Ziel des Projektes ist es, die pharmazeutische Lieferkette von Grund auf zu verändern.
Management of the adverse effects of cancer immunotherapy with a focus on the gastrointestinal and hepatic systems
Authors: Cheon Jaekyung
Published: March 2023

Background: Immunotherapy has become established as a new cancer treatment that enhances patients’ immune systems’ ability to fight cancer. Immune checkpoint inhibitors (ICI) have demonstrated remarkable benefits in the treatment of a range of cancer types. The increasing use of immune-based therapies has exposed a discrete group of immune-related adverse effects. Effective recognition and treatment of ICI-induced toxicities have emerged as essential goals of ICI management.Current Concepts: Gastrointestinal (GI) and hepatic adverse effects of ICI treatment are relatively common. Immune-related GI or hepatic toxicities occur in approximately 30% of patients. The incidence of grade 3 or 4 adverse effects ranges from 0.5% to 2%. The management strategy for immune-related adverse effects depends on their severity. In general, ICI treatment can be continued with close monitoring for mild (grade 1) GI/hepatic toxicities. ICI treatment should be interrupted for most grade 2 to 4 toxicities, and systemic steroid administration is recommended. If steroids are ineffective, immunosuppressive agents such as infliximab may be used. When symptoms and laboratory values revert to grade 1 or less, ICI treatment may be resumed with caution. Grade 4 toxicities warrant permanent discontinuation of ICI treatment.Discussion and Conclusion: Most immune-related GI and hepatic adverse effects are mild to moderate in severity and can be managed with supportive care, steroid therapy, and other immunomodulatory agents. Management of ICI-related toxicities in the GI and hepatic systems requires close collaboration between the patient, the treating oncologist, and other specialists.
Proposal to establish a hospital dedicated for surgical essential medicines: a pilot project to strengthen the essential medical service in Korea
Authors: Kim Phils
Published: March 2023

Background: In December 2022, the Ministry of Health and Welfare of the Korean government announced the “action plan for essential medicine (EM),” featuring that the regional emergency centers in tertiary general hospitals would be responsible for emergency medical care. There have been several limitations in regional emergency centers because of lacking operating rooms, intensive care units, and wards during weekdays and surgery staff during the nighttime and holidays. Thus, this plan may be insufficient to achieve the goal.Current Concepts: This paper proposes special hospitals for EM, especially essential surgery in which there are no scheduled surgeries and outpatient clinics during weekdays. At least half of wards should be reserved for EM patients because of lacking wards, and these empty wards should be financially rewarded. During weekends, a team of five surgical specialists works 16 h per day to prevent the so-called weekend or Friday effect because of lacking surgeons. The special hospital would operate 365 days and 24 hours with an EM surgeon pool in the digital twin system—virtual and real hospitals (so-called smart essential surgery metaverse hospital).Discussion and Conclusion: This paper proposes a pilot project to establish a smart essential surgery metaverse hospital to compare the efficiency of EM with the regional emergency centers in tertiary general hospitals.
Tumor markers: when, whom?
Authors: Varlıbaş Artuner , Çifci Aydın
Published: March 2023

Cancer is a leading health problem with its prevalence, clinical course and deaths all over the world. It is known that cancer is the second leading cause of death in Turkey after cardiovascular diseases. Therefore, intensive research is carried out on the early diagnosis and treatment of cancer. The most important of these are tumor markers that are still used in clinical practice. Based on this definition, it is theoretically possible to obtain information about the presence of the tumor and the character of the tumor by investigating tumor markers in body fluids. A tumor marker is a molecule that is present in the structure of the tumor cell, secreted by the tumor cell or produced in response to the tumor and can be measured or demonstrated in body fluids. However, its use is limited due to its low sensitivity and specificity to cancer type in the early period. Therefore, it is important to select the appropriate test at the appropriate time for the appropriate patient. In this review, general principles regarding the use of tumor markers were tried to be explained.
A case of malignant melanoma presented with lombar vertebra fracture
Authors: Sarıcı Ahmet , Kuku İrfan , Berber İlhami , Erkurt Mehmet Ali , Ulubaba Hilal Er , Biçim Soykan , Durmuş Mefkure , Kaya Emin
Published: March 2023

Aims: Malignant melanoma is a type of skin cancer with a very poor prognosis. It is the most common skin cancer. Metastases are frequently observed in malignant melanoma, which can have a very aggressive course, even without skin findings. Here, we aimed to report a malignant melanoma case presenting with lumbar vertebra fracture, which is a unique form of presentation.
Case description: A 31-year-old male patient was admitted to the internal medicine outpatient clinic with complaints of low back pain and inability to walk 15 days ago. After the first hour sedimentation value was found to be 101 in the examinations of the patient who came with the complaint of low back pain, he was referred to the hematology department with the preliminary diagnosis of multiple myeloma. Bone marrow aspiration and biopsy was performed. Non-hematopoietic cells were observed in bone marrow aspiration. L2 vertebra fracture was detected in lumbar MRI of the patient with bilateral limitation of movement in the lower extremities. The patient with L2 vertebral fracture was transferred to the neurosurgery service for operation. The patient was diagnosed with malignant melanoma after the frozen biopsy sent after the operation and the previous bone marrow biopsy.
Conclusions: Bone marrow infiltration can be seen in malignant melanoma patients. However, a malignant melanoma patient presented with lombar vertebra fracture has not been reported before in the literature.
A case of dapsone-induced hemolytic anemia related to G6PD enzyme deficiency
Authors: Doğan Ali , Yıldırım Doğan Narin , Ekinci Ömer , Demircioğlu Sinan , Demir Cengiz , Ural Cihan , Esen Ramazan
Published: March 2023

Hemolytic anemia is characterized by a decrease in the number of circulating erythrocytes due to an increase in their hemolysis. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common erythrocyte enzyme defects related to hemolysis. The G6PD enzyme abrogates the hemolysis of erythrocytes by protecting them against oxidative stress due to its involvement in the glutathione metabolism. G6PD enzyme deficiency-related hemolytic anemia may present as neonatal jaundice or become manifest due to exposure to infections, favism and medications later in life. Dapsone is a medication that is preferred by doctors in the treatment of many dermatological disorders such as pemphigus vulgaris, and leads to hemolysis in the presence of G6PD enzyme deficiency. In this type of non-immune hemolysis, haptoglobulin is low and Coombs' tests are negative. Hemolytic anemia, a serious complication that may appear subsequent to dapsone use, can be prevented by testing G6PD enzyme levels prior to dapsone therapy. In this case, we emphasized that the hemolytic anemia in the patient using dapsone may be due to G6PD enzyme deficiency.
Evaluation of the systemic inflammatory response in patients with a spinal synovial cyst or lumbar disc herniation
Authors: Öğden Mustafa , Karagedik Mustafa İlker , Bulut İbrahim Umud , Zengin Mehmet , Yüksel Ulaş , Bakar Bülent
Published: March 2023

Aims: This study aimed to determine whether a systemic inflammatory response occurs in patients with spinal synovial cysts (SSC) and patients with lumbar disc herniation.
Methods: Patients who underwent surgery for SSC or lumbar disc herniation between 2016-2022 were included in the study. To compare the results of these patients, patients who applied to the outpatient clinic due to headaches but did not find any abnormal findings in the radiological examinations were also included. Age, gender, duration of stay in the hospital, comorbidity, and histopathological evaluation results were recorded for all patients. The lumbar T2 weighted MR sagittal and axial images obtained on admission to the hospital were examined. The venous blood samples taken from the patients on first admission to the hospital were analyzed biochemically.
Results: There was no statistical difference between the three groups regarding age, gender, and blood biochemistry parameters. Furthermore, no statistical difference was found between SSC patients and patients with lumbar disc herniation in age, gender, cyst or herniated disc localization levels, comorbidity, and blood biochemistry analysis results. Correlation analysis for the findings of all patients revealed that no parameters were correlated with the study groups. ROC-Curve test and Logistic Regression tests showed that no parameter could be a predictive marker in differentiating SSC from disc herniation.
Conclusion: Study results demonstrated that neither SSC nor disc herniation caused a systemic inflammatory or allergic reaction in the patients. In addition, it was determined that no biochemical parameter could distinguish disc herniation from SSC.
¿El (in)cumplimiento laboral se pone serio?: entre disuasión y criminalización
Authors: Molina Navarrete Cristóbal
Published: March 2023

1. ¿Un derecho subjetivo sociolaboral vale solo lo que sus garantías jurídicas de efectividad?: hacia un rearme extramuros de la reforma laboral. Conforme a un tópico muy asentado en la cultura jurídica, de origen kelseniano, el reconocimiento normativo de un «derecho subjetivo» vale tanto como las «garantías» jurídicas de cumplimiento de las que venga revestido, desplazando, e incluso reduciendo, su existencia real (como un poder jurídico real individual) a la efectividad de su garantía. Aunque en fechas recientes se han introducido (Ferrajoli, 2004) matices a esa visión fáctica, defendiendo claramente que el derecho existe como tal desde que se reconoce, generando la obligación (jurídica y de coherencia) para las leyes de establecer, mediante nuevos actos normativos (deber ser normativo), las técnicas (garantías) adecuadas para asegurar el cumplimiento de los fines y la satisfacción de las expectativas generadas por las leyes.
Sistemas integrados de produção
Authors: Pereira Daniel Pena , Torres José Luiz Rodrigues
Published: March 2023

Os sistemas integrados de produção, de acordo com a Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA), se referem a estratégias de produção que integram diferentes sistemas produtivos (agrícolas, pecuários e florestais) em uma mesma área. Este livro “Sistemas Integrados de Produção” foi escrito e editado por profissionais de elevada experiência e dedicação, abordando temas ligados à área ambiental, planejamento, manejo dos sistemas e finaliza com exemplos de cases de sucesso na área.
Historical dynamics of terrestrial carbon during 1901–2016 as simulated by the CLM-Microbe model
Authors: He Liyuan , Rodrigues Jorge L. Mazza , Mayes Melanie A. , Lai Chun-Ta , Lipson David A. , Xu Xiaofeng
Published: March 2023

Abstract. The CLM-Microbe model was able to reproduce the variations of gross (GPP) and net (NPP) primary productivity, heterotrophic (HR), and soil (SR) respiration, microbial (MBC) biomass C in fungi (FBC) and bacteria (BBC) in the top 30 cm and 1 m, dissolved (DOC) and soil organic C (SOC) in the top 30 cm and 1 m during 2901–2016. During the study period, simulated C variables increased by approximately 30 PgC yr−1 for GPP, 13 PgC yr−1 for NPP, 12 PgC yr−1 for HR, 25 PgC yr−1 for SR, 1.0 PgC for FBC and 0.4 PgC for BBC in 0–30 cm, 1.2 PgC for FBC, 0.7 PgC for BBC, 2.4 PgC for DOC, 34 PgC for SOC, and 4 PgC for litter C in 0–1 m, and 37 PgC for vegetation C. Increases in C fluxes and pools were larger at northern high latitudes and in equatorial regions than at other latitudes; the largest absolute increases of C fluxes and pools were in Asia and South America, particularly in eastern Asia and central and northern South America. However, the largest relative increases of GPP, NPP, HR, and SR in Asia and Europe, FBC (0–30 cm and 0–1 m) in South America, BBC (0–30 cm and 0–1 m) in Europe, DOC (0–1 m) in South America and Europe, SOC (0–1 m) in Africa, and vegetation C and litter C (0–1 m) in Europe. Vegetation productivity was primarily controlled by warming and precipitation, while microbial and soil C was jointly governed by vegetation C input and soil temperature and moisture. This study enhances our understanding of soil microbial roles in the global terrestrial C cycle.
Long-term fertilization increases soil but not plant or microbial N in a Chihuahuan Desert Grassland
Authors: Mendoza-Martinez Violeta , Collins Scott L. , McLaren Jennie R.
Published: March 2023

Abstract. Although the negative consequences of increased nitrogen (N) supply on plant communities and soil chemistry are well known, most studies have focused on mesic grasslands, and the fate of added N in arid and semi-arid ecosystems remains unclear. To study the impacts of long-term increased N deposition on ecosystem N-pools, we sampled a 26-year-long fertilization (10 g N m-2 yr-1) experiment in the northern Chihuahuan Desert at the Sevilleta National Wildlife Refuge (SNWR) in New Mexico. To determine the fate of the added N, we measured multiple soil, microbial, and plant N pools in shallow soils at three time points across the 2020 growing season. We found small but significant increases with fertilization in soil available (NO3--N and NH4+-N), yet the soil microbial and plant communities do not appear to be taking advantage of the increased N-availability, with no changes in biomass or N-content in either community. However, there were increases in total soil N with fertilization, suggesting increases in microbial or plant N earlier in the experiment. Ultimately, the majority of the N added in this multi-decadal experiment was not found in the shallow soil, nor the microbial or plant community, and is likely to have been lost from the ecosystem entirely.
Indicator-to-impact links to help improve agricultural drought preparedness in Thailand
Authors: Tanguy Maliko , Eastman Michael , Magee Eugene , Barker Lucy J. , Chitson Thomas , Ekkawatpanit Chaiwat , Goodwin Daniel , Hannaford Jamie , Holman Ian , Pardthaisong Liwa , Parry Simon , Rey Vicario Dolores , Visessri Supattra
Published: March 2023

Abstract. Droughts in Thailand are becoming more severe due to climate change. Developing a reliable Drought Monitoring and Early Warning System (DMEWS) is essential to strengthen a country’s resilience to droughts. However, for a DMEWS to be valuable, the drought indicators it provides stakeholders must have relevance to tangible impacts on the ground. Here, we analyse drought indicator-to-impact relationships in Thailand, using a combination of correlation analysis and machine learning techniques (random forest). In the correlation analysis, we study the link between meteorological drought indicators and high-resolution remote sensing vegetation indices used as proxies for crop-yield and forest-growth impacts. Our analysis shows that this link varies depending on land use, season, and region. The random forest models built to estimate regional crop productivity allow a more in-depth analysis of the crop-/region-specific importance of different drought indicators. The results highlight seasonal patterns of drought vulnerability for individual crops, usually linked to their growing season, although the effects are somewhat attenuated in irrigated regions. Integration of the approaches provides new detailed knowledge of crop-/region-specific indicator-to-impact links, which can form the basis of targeted mitigation actions in an improved DMEWS in Thailand, and could be applied in other parts of Southeast Asia and beyond.
Continental-scale bias-corrected climate and hydrological projections for Australia
Authors: Peter Justin , Vogel Elisabeth , Sharples Wendy , Bende-Michl Ulrike , Wilson Louise , Hope Pandora , Dowdy Andrew , Kociuba Greg , Srikanthan Sri , Duong Vi Co , Roussis Jake , Matic Vjekoslav , Khan Zaved , Oke Alison , Turner Margot , Baron-Hay Stuart , Johnson Fiona , Mehrotra Raj , Sharma Ashish , Thatcher Marcus , Azarvinand Ali , Thomas Steven , Boschat Ghyslaine , Donnelly Chantal , Argent Robert
Published: March 2023

Abstract. The Australian Bureau of Meteorology has developed a national hydrological projections (NHP) service for Australia. With the focus on hydrological change assessment, the NHP service aims at being complementary to climate projections work carried out by many federal and state governments, universities, and other organisations across Australia. The projections comprise an ensemble of application-ready bias-corrected climate model data and derived hydrological projections at daily temporal and 0.05° × 0.05° spatial resolution for the period 1960–2099 and two emission scenarios (RCP 4.5 and RCP 8.5). The spatial resolution of the projections matches that of gridded historical reference data used to perform the bias correction and the Bureau's operational gridded hydrological model. Three bias correction techniques were applied to four CMIP5 global climate models (GCMs) and one to output from a regional climate model forced by the same four GCMs, resulting in a 16-member ensemble of bias-corrected GCM data for each emission scenario. The bias correction was applied to fields of precipitation, minimum and maximum temperature, downwelling shortwave radiation and surface winds. These variables are required inputs to the Bureau's landscape water balance hydrological model (AWRA-L) which was forced using the bias-corrected GCM and RCM data to produce a 16-member ensemble of hydrological output. The hydrological output variables include root-zone soil moisture (moisture in the top 1 m soil layer), potential evapotranspiration and runoff. Here we present an overview of the production of the hydrological projections, including GCM selection, bias correction methods and their evaluation, technical aspects of their implementation and examples of analysis performed to construct the NHP service. The data are publicly available on the National Computing Infrastructure (https://dx.doi.org/10.25914/6130680dc5a51) and a user interface is accessible at https://awo.bom.gov.au/products/projection/.
Spatio-temporal reconstruction of winter glacier mass balance in the Alps, Scandinavia, Central Asia and western Canada (1981–2019) using climate reanalyses and machine learning
Authors: Guidicelli Matteo , Huss Matthias , Gabella Marco , Salzmann Nadine
Published: March 2023

Abstract. Spatio-temporal reconstruction of winter glacier mass balance is important for assessing long-term impacts of climate change. However, high-altitude regions significantly lack reliable observations, which is limiting the calibration of glaciological and hydrological models. Reanalysis products provide estimates of snow precipitation also for remote high-mountain regions, but this data come with inherent uncertainty, and assessing their biases is difficult given the low quantity and quality of available (long-term) in situ observations.
In this study, we aim at improving knowledge on the spatio-temporal variations in winter glacier mass balance by exploring the combination of data from reanalyses and direct snow accumulation observations on glaciers using machine learning. We use the winter mass balance data of 95 glaciers distributed over the European Alps, western Canada, Central Asia and Scandinavia and compare them with the total precipitation from the ERA5 and the MERRA-2 reanalysis products during the snow accumulation seasons from 1981 until 2019. We develop and apply a machine learning model to adjust the precipitation from the reanalysis products along the elevation profile of the glaciers and consequently to reconstruct the winter mass balance in both space (for glaciers without observational data) and time (filling observational data gaps). The employed machine learning model is a gradient boosting regressor (GBR), which combines several meteorological variables from the reanalyses (e.g. air temperature, relative humidity) with topographical parameters. These GBR-derived estimates are evaluated against the winter mass balance data using (i) independent glaciers (site-independent GBR) and (ii) independent accumulation seasons (season-independent GBR). Both approaches resulted in reduced biases and increased correlation between the precipitation of the original reanalyses and the winter mass balance data of the glaciers. Generally, the GBR models have also shown a good representation of the spatial (vertical elevation intervals) and temporal (years) variability of the winter mass balance on individual glaciers.