bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between subcutaneous fat measurements in knee MRI and BMI: relationship to obesity and related co-morbidities
Authors: Hernandez Ricardo , Younan Yara , Mulligan Michael , Singer Adam D , Sharma Gulshan B , Umpierrez Monica , Gonzalez Felix M
Published: June 2019

Background

Obesity is a major public health disorder associated with multiple co-morbidities. Knee magnetic resonance imaging (MRI) permits visualization of the subcutaneous fat anatomy, which can be correlated to body mass index (BMI) and obesity-related co-morbidities.

Purpose

This study intends to validate a method of correlating measurements of subcutaneous fat around the distal femur on axial MR images to BMI and obesity-related co-morbidities.

Material and Methods

The most proximal axial slice of each knee MRI was divided into four quadrants. Measurements of the thickest portion of the subcutaneous fat in each quadrant were independently obtained, yielding a value which was assigned the name of the SubCut fat index. The relationship between the SubCut fat index of each quadrant and the patient’s BMI was then evaluated. Receiver operating characteristic curves utilizing both the subcutaneous fat in the medial and lateral quadrants as well as BMI were performed with respect to obesity-related co-morbidities.

Results

SubCut fat index measurements in all four quadrants and BMI show the strongest correlation (all four, ANOVA P < 0.0001, r = 0.6), with subcutaneous fat measurements of the anterior medial (p < 0.0001) and posterior medial quadrants ( P = 0.01). Additionally, BMI and medial quadrants SubCut indices showed strong association with obesity-related co-morbidities including sleep apnea, asthma, diabetes, hypertension, gastroesophageal reflux disease, and osteoporosis.

Conclusion

The SubCut fat index, a marker of distal femur subcutaneous fat on axial MRI, correlates with severity of obesity (BI) and associated obesity-related co-morbidities.
Comprehensive structured knowledge base system construction with natural language presentation
Authors: Khanam Shirin Akther , Liu Fei , Chen Yi-Ping Phoebe
Published: June 2019

Constructing an ontology-based machine-readable knowledge base system from different sources with minimum human intervention, also known as ontology-based machine-readable knowledge base construction (OMRKBC), has been a long-term outstanding problem. One of the issues is how to build a large-scale OMRKBC process with appropriate structural information. To address this issue, we propose Natural Language Independent Knowledge Representation (NLIKR), a method which regards each word as a concept which should be defined by its relations with other concepts. Using NLIKR, we propose a framework for the OMRKBC process to automatically develop a comprehensive ontology-based machine-readable knowledge base system (OMRKBS) using well-built structural information. Firstly, as part of this framework, we propose formulas to discover concepts and their relations in the OMRKBS. Secondly, the challenges in obtaining rich structured information are resolved through the development of algorithms and rules. Finally, rich structured information is built in the OMRKBS. OMRKBC allows the efficient search of words and supports word queries with a specific attribute. We conduct experiments and analyze the results of relational information extraction, with the results showing that OMRKBS had an accuracy of 84% which was higher than the other knowledge base systems, namely ConceptNet, DBpedia and WordNet.
Leak detection in water distribution networks: an introductory overview
Authors: El-Zahab Samer , Zayed Tarek
Published: June 2019

Leaks in resource transmission pipelines is a growing concern for the water transmission industry. This creates a need to prevent the threat of leaks and minimize their damages through extensive research in leak detection technology. This research work provides a thorough investigation into the history of leak detection in pipelines by surveying the web of knowledge database and visualizing the outputs using visualization software VOSviewer and CiteNetExplorer. The analysis of the web of knowledge output presents a set of the ten most used keywords in the field of leak detection in pipelines that are further described and analyzed. Additionally, in-depth analysis of a randomly selected sample of papers was conducted to draw a sense of the progress in the industry over the past four decades. This article also defines a novel approach to define the leak detection phases, i.e., the identify-localize-pinpoint approach. Furthermore, two classes of leak detection systems are identified, static leak detection systems and dynamic leak detection systems. The two systems are defined as well as their differentiative capabilities. Finally, this article provides a summary of popular leak detection technologies to provide a broad sense of understanding for the leak detection field of research.
The Need for Schools of Psychiatry
Authors: Bond C. Hubert
Published: June 2019

In their fourth Annual Report, published in 1918, the Board of Control drew attention—not for the first time, but in more extended form than hitherto—to deficiencies in the arrangements, as at present organised, for the treatment of persons suffering from mental disorder, especially in its incipient and early stages; to the insufficiency of attention paid at medical schools to this important branch of medical science with its consequent ill-effects both to patients and to the medical profession; and to the absence of any special qualification in psychiatry, as a requirement for the higher medical posts in public institutions for the insane, such as is demanded in public health of medical officers of health of areas of above a stated size.
The Identity of the Psychoses and the Neuroses
Authors: Macpherson John
Published: June 2019

Half a century ago Maudsley wrote “A pregnant but very difficult question of which little or no thought has ever been taken by writers on insanity is—What is the cause of the particular form which the disorder takes in a given case? Why does it assume one complexion rather than another? At the outset it is certain that what appears to be the same cause shall occasion different forms of insanity in different persons and even in the same person at different periods of life, and that the same form of disorder shall be produced by different causes; this being so it is plain that the special determining conditions lie hidden in that unknown region which we call by such names as ‘temperament’ and ‘idiosyncrasy.’”
Reform of the Penal System in Scotland
Authors: Shaw James E.
Published: June 2019

In presenting this paper I must erare indulgence. I feel rather in the position of an inexperienced player who, from a spirit of good nature, has been induced to “make up a ‘four’ at bridge.” He will be lucky if he does not find at the end of the game that his good nature is taken less into account than his presumption.
Hepatosplenic γ-δ T-Cell Lymphoma: Who Is on Your Speed Dial?
Authors: Krishnan Mridula , Lunning Matthew
Published: June 2019

Hepatosplenic γ-δ T-cell lymphoma, an exceptionally uncommon subtype of peripheral T-cell lymphomas, commonly presents with advanced-stage disease manifesting with hepatosplenomegaly, cytopenias, and constitutional symptoms. Management of this subset is challenging as a result of the unique presentation and refractory nature to conventional treatment approaches. There is a lack of consensus guidelines for up-front induction strategies, and the role of consolidative autologous or allogeneic stem-cell transplantation is controversial. Prospective studies are lacking, and treatment is often guided by literature on the basis of case series or single-institution studies, lending to expert opinions influencing treatment paradigms.
New Dialect Formation Through Language Contact
Authors: Carter Phillip M. , Valdez Lydda López , Sims Nandi
Published: June 2019

The situation of sustained contact between Spanish and English in Miami during the past half century provides a rare opportunity to study contact-induced language change in an ecological context in which speakers of the immigrant language (i.e., Spanish) have become the numerical majority. The study reported here is designed to track the phonetic and prosodic influences of Spanish on the variety of English emerging among second-generation Miami-born Latinx speakers of various national origin backgrounds by examining a suite of variables shown in prior studies to exhibit Spanish substrate influence in other regional contexts. We examine two kinds of phonetic variables in the English spoken by 20 second-generation Latinx and 5 Anglo white speakers: (1) prosodic rhythm and (2) vowel quality. Prosodic rhythm was quantified using Low and Grabe’s Pairwise Variability Index (nPVI); results show that Miami-born Latinx speakers are significantly more syllable-timed in casual speech than Miami-born Anglo white speakers. Significant vocalic differences were also observed, with Latinx speakers producing lower and more backed tokens of [æ] in prenasal and nonprenasal positions and more backed tokens of [u].
Źródła do dziejów Łemkowyny w latach 1917‑1921: stan poznania, kierunki poszukiwań, aneks dokumentacyjny
Authors: Zięba Andrzej A.
Published: June 2019

Source Materials for the History of the Lemko Region in the Years 1917‑1921: Current State of Knowing, Directions of Research, Documentation AnnexAt the beginning of the 20th century, the Lemko region was culturally active and documented its existence in writing, but the spoken word still played a major role in the social life. The course of history – even in such turbulent years as those between 1918 and 1921 – remained mainly in human memory. The generation of Lemkos who then co‑ created history and experienced, remembered and were to pass it on, suffered a traumatic fate – uprooting (Ukrainization), dispersion (economic migration, war and post‑war displacement to Ukraine), and finally exile (the “Wisła” action). Under these circumstances, not only did memory fail, but also documents were destroyed – these few literal traces of those times. None of the institutions created or managed by the Lemkos in the period analyzed survived for a long time. Although we know that they produced documents, these were not collected nor archived in the right way by these very institutions. Searching for the remnants of this documentation in private home archives in Poland, Ukraine and in the Lemko diaspora countries is an action necessary to recover the original documents, appeals and correspondence of the Lemko councils. It would be advisable to locate and catalogue ephemeral prints regarding the Lemko case – Rusyn, Polish, Czech, Slovak, Russian, Ukrainian. Some of the events and probably all the persons involved in them were photographed, but access to iconographic sources is very fragmentary, as these photographs often remain unrecoginsed. Apart from one archive (the collection of Zygmunt Lasocki in the National Archives in Krakow), own archives of non‑Lemko participants of events have not been found nor investigated – individual persons and institutions such as state organs, churches or political parties. Polish and Czech press, especially local press, has not been well‑ researched, apart from the Carpatho-Rusyn diaspora newspapers in the United States. It is of great importance to prepare a printed selection of basic sources for the history of the Lemko region in such an important period. It should contain basic declarations of Lemko councils, memorials addressed to state and international bodies, documentation of court proceedings against its activists, basic documents prepared by other forces active at the time in the Lemko region, and major press publications. The documentation annexed here (20 source texts) is just a sample of such a collection.
School-stakeholder-partnership enhancement strategies in the implementation of arts in Botswana basic education
Authors: Mannathoko Magdeline Chilalu
Published: June 2019

School-stakeholder partnership is an effective approach in curriculum development and implementation as it promotes children’s academic success. Thus, this study examined the extent to which stakeholders participated in the promotion of the arts in two phases of Basic Education. The study investigated school-stakeholder partnership schemes that schools could adopt to nurture the arts status. Qualitative case study was embraced whereby eight teachers, two education officers (EOs), six arts experts and six entrepreneurs were interviewed. The study further examined the education policies to diagnose its status in promoting school-stakeholder partnership programmes. The study revealed that school-stakeholder partnership scheme is essential to effective schooling. The findings also indicated limited practice in school-stakeholder partnerships. As a result, the status of the subjects remains low as it is not effectively implemented due to teachers’ limited skills in the arts. The study recommends intensifying the levels of stakeholders’ participation in children’s academic work to facilitate improvements in arts education.
Drawing out the soul: Contemporary arts integration
Authors: Oliver Kristi , Hall Maureen P. , Dalton Jane , Jones Libby Falk , Watson Vajra , Hoyser Catherine , Santavicca Nicholas
Published: June 2019

Arts integration, viewed holistically, values the arts as a conduit for the development of K-16 students into whole selves – bodies, minds and souls. Building on arguments for the importance of the arts in education made by Maxine Greene, John Dewey and others, this article puts the arts at the centre of learning, as a means of drawing out and restoring the soul to humanize education. We provide examples for ways arts integration is modelled and applied across English and education, art education, and English as a second language (ESL); our work is interdisciplinary and intersectional. This transformational work reveals possibilities for educating active members of a democratic society through the development of imagination, creativity and expression. Integrating a variety of arts, including visual art, photography, storytelling and poetry-writing, among others, can make these developments visible. We see this arts integration work as drawing out the soul.
Youth on the edge of society and their participation in community art projects
Authors: Nielsen Anne Mette W. , Sørensen Niels Ulrik
Published: June 2019

A growing number of research studies emphasize that art projects make a difference for youth on the edge of society in relation to social inclusion, increased well-being and stronger relations to formal education/employability. However, while these studies present inspiring cases and convincingly point to the significance of involving young people in art practices, they often seem less focused on analysing the conditions constituting a positive difference. Based on a recent study, this article introduces six core elements present in young people’s accounts about how art can work across art forms and projects. The approach thus proposes a shift from a focus on validating the positive effects of art projects to a discussion of the defining practices, when youth on the edge of society engage in community art projects.
Understanding art as experience through painting
Authors: Smith-Wyatt Paige
Published: June 2019

John Dewey’s ([1934] 2005) Art as Experience, and Maxine Greene’s (2001), Variations on a Blue Guitar, are seminal texts of art education. I experienced my own comprehension of these classics through reading as well as my own art-making process. Working through tension and resistance, and arriving at a synthesis with my own ideas, I gained a depth of understanding at which I could not have arrived without also experiencing and learning through the process of painting. This visual essay provides a glimpse into the act of art-making as an emergent and integral part of the learning process to inform how art education students may reach a fulfilling conclusion to integrating foundational texts with their work as art educators in order to open a world of possibilities for their students.
Book Reviews
Authors: Lampela Laurel , Wasilewski Marek , Houghton Nicholas
Published: June 2019

Feminism and Queer in Art Education, Anniina Suominen and Tiina Pusa (eds) (2018) Helsinki: Alto University School of Arts, Design & Architecture, 176 pp., 12 colour illustrations, 3 black and white illustrations, ISBN 978-9-52607-998-1, p/bk, available for free download: https://shop.aalto.fi/media/filer_public/20/d6/20d67326-b89c-4d16-b13c-6f0d70c31656/feminism_and_queer_in_art_education.pdf

Across the Art/Life Divide: Performance, Subjectivity, and Social Practice in Contemporary Art, Martin Patrick (2018) Bristol: Intellect, 256 pp., ISBN 978-1-78320-854-8, p/bk, £20, US$26.50

Art and Design Pedagogy in Higher Education: Knowledge, Values and Ambiguity in the Creative Curriculum, Susan Orr and Alison Shreeve (2019) London and New York: Routledge, 168 pp., ISBN 978-0-36719-250-1, p/bk, £36.99
The representation of the New Guinea tree house in the historical popular medium of the trade card
Authors: Mückler Hermann
Published: June 2019

This article focuses on the depiction of the iconographically significant subject of the Melanesian tree house in the popular medium of the trade or collectors card. Since the middle of the nineteenth century, the new and innovative medium of the trade card had gained great importance in Europe and the United States as a colourful form of advertising through the use of the new printing technique of chromolithography. The resulting striking designs were not only used to advertise consumer products but also to convey information on overseas countries to an increasingly interested domestic population. In particular, countries engaged in overseas colonialism used the medium to provide information about exotic countries and the civilizing goals of the colonial powers. Using the example of the unique and spectacular tree houses that existed in Oceania, predominantly in New Guinea, this article explores the variations of this motif on trade and collectors cards. The conclusion is that these cards, while serving exoticism, contain only limited ethnologically useful information. Nevertheless, the trade cards are valuable testimonies to the European-overseas relationship, in which clichés such as the romantic idea of the ‘South Seas’ found their expression. Ultimately, the trade cards say more about the colonizing European countries and their prejudiced perception of Oceanic cultures than about the peoples and cultures of the Pacific islands depicted.
Waving the flag, anchoring the shot: The National Film Unit’s colonizing optic in Showing the Flag... H.M.N.Z.S. “Arbutus” in Pacific (1947)
Authors: Sigley Simon
Published: June 2019

In the aftermath of World War II the government of New Zealand looked anew at its Pacific ‘realm’ – those island territories that were either a part of New Zealand, such as Niue, or those that it administered as a United Nations-mandated trust territory, such as Samoa. It is the cinematic expression of a part of Greater New Zealand – an oceanic vastness much greater than the principal islands of mainland New Zealand – that this article examines. I analyse how one of the first post-World War II films made by the National Film Unit (NFU) depicted nascent public policy changes regarding the state’s administration of its island territories in the light of both calls for decolonization and an awareness that administering these islands was an economic burden. The Unit’s 1947 documentary Weekly Review (#319), Showing the Flag... H.M.N.Z.S. “Arbutus” in Pacific, sought to reassure, among other things, New Zealand audiences that their tax revenue was being well-spent in the islands on what was already known as ‘welfare colonialism’. The film also constructs racialized Polynesian bodies as scopic objects of sensual delight for virtual consumption.
Superfauna and superheroes: Re-imagining New Zealand and the Pacific in the impossible worlds of comic books
Authors: Conrich Ian
Published: June 2019

Visual culture has repeatedly been associated with exercises in mythmaking, with consumers fed images that prioritize an appeal to their aesthetic sensibilities and their demands for the sensational, sublime, unfamiliar and the fantastic. Film, computer games and comic books are especially fertile grounds for mythmaking with the primary sources of production – the United States, Japan and Europe – re-imagining and re-presenting foreign cultures to the point that many are transformed into impossible worlds. Key characteristics of a foreign culture can become representative of a national identity, and these are often heightened and exaggerated. Within the Pacific, South Seas myths have been effective in helping to convey an abundance of stories of adventure and romance, yet there have been only sporadic attempts to understand the microcosmic ways in which mythmaking functions regionally. Moving beyond studies of popular culture depictions of Hawai‘i and Rapanui, this article considers the representations in American comic books of animals of the Pacific and, in particular, New Zealand. The focus here is on lands of unfamiliar creatures where the animals have acquired special powers and become superfauna.
Deterritorialization and the landscape of New Zealand video games
Authors: Callahan David
Published: June 2019

It is undeniable that video games are among the most important visual, narrative and affective forms of cultural production of the present. Although games are produced in different cultural locations, however, they are often not perceived as cultural productions which tell us something of the countries in which they are produced and consumed. The deterritorialization of such a significant cultural phenomenon has a bearing on video game production in any country that wishes to enter the global market: to succeed it is presumed that a referencing of the local is either absent or muted, at best. Opposed to this is the understanding that creative material emanating from New Zealand will or even should say something about New Zealand specificities. This article will examine the extent to which recent video games produced in New Zealand satisfy such an expectation, albeit focusing only on one key aspect of the local imaginary: the representation of landscape, given that the land constitutes a well-known marker through which New Zealand perceives and constructs identity discourses about itself. This examination will be accompanied by the question as to whether it is a legitimate expectation of video games that they articulate culturally identitarian inventories.
A portrait that asks questions: John Dempsey’s 1828 painting John Rutherford, the Tattooed Englishman
Authors: Bell Leonard
Published: June 2019

Painted in England, John Dempsey’s portrait (until recently attributed to George Scharf) represents John Rutherford, who lived in pre-colonial New Zealand from 1816 to 1826, with a full-face moko (tattoo), in European clothing and hat, smoking a pipe, with a basket of nuts slung over his left arm, and, curiously, holding a fortune wheel in his right hand. He is posed three-quarter length, facing the viewer. Rutherford was a Pākehā-Māori, a European who lived among Māori and was absorbed into the life of a tribe (Ngāpuhi). The circumstances of his time in New Zealand remain unclear. After leaving New Zealand, Rutherford claimed that he was a prisoner of Ngāpuhi and forcibly tattooed. Back in Britain, he enjoyed considerable mileage from this story, which was recounted in several publications. However, local accounts in New Zealand present a different story, of a man who willingly immersed himself in Māori culture and may well have played a primary role as a military strategist for Ngāpuhi in the widespread inter-tribal warfare of the period. He could be seen as a mediating figure, who crossed various boundaries between Māori and European, at a crucial time when the country was riven with internecine warfare among Māori, and proposals to colonize New Zealand were mooted. What role did Dempsey’s portrait, an embodiment of transformation and multiple identifications, play in these dynamics? In what ways does the portrait convey the sense of a life? Or does it rather say something, inadvertently, about the Māori–European contact zone in a time of uncertainty, ambivalence and unknowability in their relationships? This article will explore these questions around this fascinating portrait.
jane says, an exhibition of works by Ann Shelton
Authors: White Amanda
Published: June 2019

jane says is an exhibition of works by Ann Shelton, that opened at the Denny Dimin Gallery in New York City, in Spring 2019. Ann’s sumptuous photographic portraits of botanic arrangements – arranged by the artist with an ikebana-like approach – present these contrivances in larger-than-life detail. Divorced from the domestic interior and titled both for the medicinal plants they feature and female archetypes, each botanic composition reveals an unexpected history of women’s plant knowledge and its suppression. An accompanying performance – assembled and choreographed by the artist – is constructed from a tapestry of quotes, and stories about the properties of plants, their historic use as contraceptives, for fertility and abortion. These arrangements show the plants contorted into obedience, just as colonization sought to control and claim our natural world and fellow species, and suppress indigenous and women’s botanic expertise. Now, we find ourselves at the brink of irreversible biodiversity loss and climate change, living in the era of the Anthropocene. Shelton’s work provokes us to consider not only humanity’s relentless depletion of the natural world, but the role women will play in a regenerative future.
Review Article
Authors: Conrich Ian
Published: June 2019

Selling the Dream: The Art of Early New Zealand Tourism, Peter Alsop, Gary Stewart and Dave Bamford (2013) Nelson: Craig Potton Publishing, 408pp., ISBN 978 1 87751 777 8 (hbk), NZ$79.99

Promoting Prosperity: The Art of Early New Zealand Advertising, Peter Alsop and Gary Stewart (2013) Nelson: Craig Potton Publishing, 440pp., ISBN 978 1 87751 796 9 (hbk), NZ$79.99
A formação de professores e as novas competências gerais propostas pela BNCC
Authors: Cericato Itale Luciane , Cericato Lauri
Published: June 2019

Este artigo busca promover um debate sobre as competências gerais propostas pela Base Nacional Comum Curricular, aprovada pelo Ministério da Educação, e sobre possíveis caminhos para a formação de professores. Aponta-se para a necessidade da criação de políticas educacionais que subsidiem um modelo formativo ancorado em experiências que mobilizem leituras de mundo interdisciplinares, condizentes com o que se espera do professor no exercício de sua prática pedagógica para a formação das novas gerações. Sugere-se a exploração de recursos artísticos e culturais que ampliem o capital cultural dos professores, que, articulado aos demais saberes necessários para a atuação docente, favorece uma formação ativa, aberta, plural e conectada aos desafios contemporâneos.
Educação, pobreza e programas de transferência de renda: A implementação do Programa Oportunidades no México
Authors: Oliveira Breynner Ricardo , Peixoto Maria do Carmo de Lacerda
Published: June 2019

Este artigo analisa a implementação do Programa Oportunidades no México a partir da perpectiva dos agentes de base vinculados a condicionalidade educacional. Ao adotar a abordagem bottom up para analisar a implementação, a formulação de Lipsky (1980) é o referencial que estrutura o estudo. Os profissionais da educação, os promotores comunitários e as representantes das titulares são os que correspondem à caracterização do autor nesse caso. Foram realizadas 47 entrevistas: nove com o corpo estratégico e gerencial nos níveis nacional e estadual; 38 com agentes locais (duas com profissionais da saúde; 14 com atores da escola, 10 com agentes vinculados ao acompanhamento das famílias e 12 com vocales. Os roteiros para as entrevistas foram adaptados conforme sua posição na hierarquia do programa, contemplando as categorias: desenho institucional e sua operação; percepções sobre o programa e o público-alvo; impressões sobre a condicionalidade educacional e as exigências impostas aos agentes locais. Os dados revelam que a condicionalidade educacional mobilizou os agentes locais, apesar das dificuldades de cooperação institucional, das disputas políticas, das limitações orçamentárias, das oscilações na hierarquização das prioridades sociais e da tutela e dependência, evidenciando aspectos que estão diretamente ligados ao processo de formação do Estado e da sociedade mexicanos.
Condições de infraestrutura das escolas brasileiras: Uma escola pobre para os pobres?
Authors: Duarte Marisa Ribeiro Teixeira , Gomes Carlos André Teixeira , Gotelib Luciana Gonçalves de Oliveira
Published: June 2019

As condições de infraestrutura das escolas brasileiras foram analisadas com o objetivo de expor suas desigualdades e distribuição territorial. Revisão de literatura apontou a influência da regulação por resultados na coordenação sistema educacional sobre os estudos precedentes de infraestrutura escolar e os limites das atuais políticas redistributivas na promoção de maior equidade interfederativa. A hipótese de uma escola pobre para os pobres foi testada mediante análise de clusters (uso do K-médias após aplicação de método hierárquico, para determinação do número de clusterse os centroides). Os três agrupamentos elaborados (adequado, intermediário e precário) permitiram traçar perfis das desigualdades de infraestrutura das escolas, mediante a construção de variáveis de referência que expressam qualidade do bem ou serviço. Entre os resultados obtidos evidenciou-se a presença de um maior número de alunos de famílias participantes do Programa Bolsa-Família em escolas públicas (estaduais e municipais) localizadas em áreas urbanas no agrupamento denominado “adequado”, para os padrões brasileiros. Verificou-se também maior concentração desses alunos nas escolas municipais de áreas rurais do agrupamento “precário”, apesar do número reduzido de matriculas para os padrões brasileiros. Concluiu-se o estudo relacionando as razões da invisibilidade dessas escolas às agendas das políticas públicas nacionais de educação a sua distribuição na federação.
Perbandingan Efektifitas Larutan Antiseptik Kombinasi Chlorexidine Gluconate Cetrimide - Alkohol 70% Dengan Povidone Iodine 10 % Terhadap Kepadatan Kuman Pada Tindakan Anestesi Spinal
Authors: Indrawan Khadafi , Jaya Wiwi , Noorhamdani Noorhamdani
Published: June 2019

Latar belakang : Infeksi bakteri dapat disebabkan oleh tehnik neuraxial. Salah satu faktor penyebab  infeksi bakteri adalah  peralatan yang digunakan, tehnik aseptik yang salah, atau larutan anti septik yang dipakai. Larutan antiseptik yang biasa digunakan pada anestesi spinal adalah chlorhexidine dan povidone iodine. Chlorhexidine gluconate adalah larutan antiseptik yang kuat dan  berspektrum luas,  efektif melawan hampir semua bakteri (gram positif dan gram negatif) dan jamur nosokomial . Povidone iodine memiliki aktivitas melawan mikroorganisme b gram negatif maupun gram postif dan dapat menembus dinding sel serta menghambat sintesis protein bakteriTujuan : Mengetahui Efektifitas  larutan antiseptik kombinasi Chlorhexdine gluconate cetrimide – alkohol 70% dengan pemakaian Povidone iodine 10%  terhadap kepadatan kuman pada tindakan  anestesi spinalMetode : Penelitian eksperimental dengan rancangan “single blind true experimental design” pada 32 pasien dengan usia 18 – 40 tahun, status fisik ASA I-II yang menjalani tindakan anestesi spinal. Terdiri dari 2 kelompok: kelompok Chlorexidine gluconate cetrimide-alkohol 70% (clor) dan kelompok Povidone Iodine 10% (pov). Dilakukan pengambilan swab I pada punggung pasien sebelum perlakuan. Dan pengambilan swab II setelah mendapat perlakuan dan mengambil cairan serebrospinal untuk dikultur. Analisa hasil dengan uji statistik dilakukan uji beda t berpasangan (sebelum dan sesudah perlakuan) dan uji t dua sampel bebas (sesudah perlakuan), dengan derajat kemaknaan yaitu nilai p< 0,05.Hasil : Insidensi kepadatan kuman pada kelompok clor sebesar 1,4% sedangkan pada kelompok pov 4,1%. Insidensi kepadatan kuman lebih banyak pada kelompok povidone iodine. Dari rata-rata penurunan kepadatan kuman sesudah perlakuan kelompok chlorexidine mean = 0,0625, sedangkan pada kelompok povidone mean = 1,0625. Rata-rata penurunan kepadatan kuman pada kelompok chlorexidine lebih kecil.Simpulan : Efektifitas antiseptik kombinasi Chlorexidine gluconate cetrimide-alkohol 70 % lebih baik bila dibandingkan antiseptik Povidone iodine 10%  terhadap kepadatan kuman pada tindakan anestesi spinal.
Perbandingan Waktu Pemberian Atrakurium Besylate Intravena 0,5 mg/kgbb 5 Detik dan 90 Detik Terhadap Peningkatan Nadi Saat Induksi Anestesi Umum di Rumah Sakit Saiful Anwar Malang
Authors: Santika Suparno Adi , Basuki Djujuk Rahmat , Karmini Karmini
Published: June 2019

Latar Belakang : Atracurium besylate, merupakan obat pelumpuh otot nondepolarisasi kelas bisquaternary benzylisoquinolinium yang menghasilkan beberapa efek samping selama uji klinis luas di berbagai penelitian, berupa pelepasan histamin yang dikaitkan dengan refleks takikardia, hipotensi berat dan ruam pada pengamatan klinis. Beberapa kasus reaksi anafilaksis parah dilaporkan setelah injeksi atrakurium, menyebabkan komplikasi yang mengancam jiwa. Pemberian lambat injeksi Atrakurium besylate, menurunkan manifestasi refleks peningkatan nadi. Tujuan penelitian ini adalah untuk mengetahui, perbandingan waktu pemberian Atrakurium besylate intravena dapat menurunkan tingkat kejadian peningkatan nadi saat induksi anestesi umum di RSSA Malang.Metode : Penelitian ini merupakan uji klinis tersamar tunggal, bersifat eksperimental. Pasien dengan kriteria klinis ASA I-II sejumlah 32 orang dilakukan randomisasi sederhana menjadi 2 kelompok P dan mendapatkan perlakuan pemberian Atrakurium besylate 0,5 mg/kgBB iv dalam waktu 5 detik. Kelompok lainya dilakukan pemberian Atrakurium besylate 0,5 mg/kgBB iv dalam waktu 90 detikHasil : Penelitian ini didapatkan, perbedaan peningkatan nadi yang bermakna secara statistik (p < 0,05), pada saat kelompok O dan P dibandingkan pada menit ke 3 (0,005) dan ke 4 (0,004), sedangkan pada menit ke 5 (0,210) tidak didapatkan perbedaan peningkatan nadi pasienKesimpulan :  Disimpulkan bahwa, pemberian Atrakurium besylate intravena 0,5 mg/kgBB dalam waktu 90 detik menurunkan tingkat terjadinya peningkatan nadi daripada pemberian dalam waktu 5 detik.
Perbandingan Efek Kecepatan Injeksi 0,4 ml/dtk Dan 0,2 ml/dtk Prosedur Anestesi Spinal Terhadap Kejadian Hipotensi Pada Seksio Sesaria
Authors: Arif Syafri Kamsul , Setiawan Iwan
Published: June 2019

Latar belakang : Anestesi spinal merupakan teknik anestesi regional yang paling sering digunakan pada prosedur seksio sesaria, selain karena teknik yang sederhana juga memiliki kualitas blok yang kuat walaupun dengan volume dan dosis yang kecil, efek samping yang minimal bila dibandingkan dengan anestesi umum. Efek yang biasanya muncul pasca anestesi spinal antara lain hipotensi. Insiden hipotensi pasca anestesi spinal mencapai 30-80% pada persalinan seksio sesaria.Tujuan : Untuk mengetahui apakah injeksi anestesi spinal yang lebih lambat dapat mengurangi insiden hipotensi pada seksio sesaria tanpa memengaruhi onset blok anestesi.Metode : Penelitian ini menggunakan metode acak tersamar tunggal, sampel penelitian sebanyak 48 orang yang memenuhi criteria inklusi. Sampel dipilih secara acak dan dibagi ke dalam dua kelompok. Anestesi spinal menggunakan bupivakain 0,5% 10mg dan fentanyl 25mcg, kelompok IC dilakukan injeksi anestesi spinal dengan kecepatan 0,4 mL/dtk, sedangkan kelompok IL dilakukan injeksi anestesi spinal dengan kecepatan 0,2 mL/dtk. Insiden hipotensi, onset blok dan insiden efek samping pasca anestesi spinal dicatat dan dilakukan analisis statistik.Hasil : Penelitian ini mendapatkan Injeksi anestesi dengan kecepatan 0,2 mL/dtk dapat mengurangi insiden hipotensi pasca anestesi spinal tanpa memengaruhi onset dan tinggi blok.Kesimpulan : Anestesi spinal dengan kecepatan 0,2 mL/dtk dapat mengurangi insiden hipotensi pasca anestesi spinal tanpa memengaruhi onset dan tinggi blok.
Meperidin, Ketamin dan Klonidin Efektif Untuk Terapi Menggigil pada Sectio Secaria dengan Anestesi Spinal
Authors: Budiono Uripno
Published: June 2019

Latar Belakang : Anestesi spinal banyak dilakukan pada sectio cesarea, tetapi anestesi spinal dapat menimbulkan menggigil pada periode perioperatif. Menggigil menyebabkan pasien tidak nyaman, membahayakan pasien dan mengacaukan pemantauan peri dan postoperatif. Ondansetron, meperidin, klonidin, dan ketamin adalah obat-obatan yang dapat mengatasi menggigil.Tujuan :  mengetahui angka kejadian menggigil pada section secaria pada pasien yang mendapat ondansetron, dan menilai efektivitas terapi menggigil dari meperidin, klonidin, dan ketamin pada sectio secaria dengan anestesi spinalMetode : pasien pasien sectio secaria dengan anestesi spinal yang memenuhi kriteria inklusi dan ekslusi, diberikan premedikasi 0,25 mg sulfas atropin dan 4 mg ondansetron setengah jam sebelum tindakan . Dilakukan anestesi spinal dengan bupivakain hiperbarik. Bila terjadi hipotensi diterapi dengan efedrin, bila terjadi bradikardi diberikan sulfas atropin. Dilakukan pengamatan pada onset dan beratnya menggigil. Pasien yang menggigil kemudian dikelompokkan kedalam 3 kelompok. Kelompok M diterapi dengan 25 mg meperidin. Kelompok K mendapat terapi 25 mg ketamin dan kelompok L mendapat terapi 75 mcg klonidin. Respon terapi diukur sejak penyuntikan terapi sampai hilangnya menggigil. Terapi dianggap berhasil bila dalam waktu 15 menit tanda menggigil hilang. Dilakukan pengamatan tentang skor sedasi dan efek samping mengenai nausea, vomitus, bradikardi, hipotensi,tanda alergi, mengigau, depresi respirasi dan efek samping yang lain. Bila terjadi efek samping diterapi dengan cara yang sesuai.Hasil : Menggigil terjadi pada 46% pasien. Ketiga kelompok menunjukkan perbedaan yang tidak bermakna, baik dalam hal respon terapi maupun keberhasilan terapi.Simpulan : Menggigil terjadi pada 46% pasien sectio secaria dengan anestesi spinal yang mendapat ondansetron sebelumnya. Meperidin, ketamin dan klonidin efektif dan mempunyai efektivitas yang sama untuk terapi menggigil pada sectio secaria dengan anestesi spinal.
Jumlah Koloni Bakteri Pada Sediaan Propofol Diluar Kemasan Pada Jam Ke 0, 6, Dan 24 Di Kamar Operasi Sentral Rumah Sakit Saiful Anwar Malang
Authors: Zulfakhri Zulfakhri , Basuki Djudjuk Rahmad , Isngadi Isngadi
Published: June 2019

Latar belakang :  Propofol (2,6-diisopropylphenol) merupakan obat anestesi intravena yang efektif , onset cepat, durasi kerja pendek. Propofol dengan pelarut yang mengandung emulsi yang terdiri dari 10 % minyak kedelai, 2,25% gliserol dan 1,2 Fosfatid telur yang dapat menjadi media yang baik untuk pertumbuhan bakteri. Pada praktek sehari-hari di Rumah Sakit syaiful Anwar (RSSA) dijumpai adanya emulsi propofol yang sudah dibuka dari kemasan (ampul) kemudian disimpan dalam spuit 10 cc dan dilakukan penyimpanan dalam lemari es dengan suhu yang diatur pada 4°C. Propofol tersebut kemudian digunakan kembali pada keesokan harinya atau lebih 24 jam dengan mengabaikan kemungkinan adanya pertumbuhan bakteri dengan alasan bahwa dengan dilakukan penyimpanan di lemari pendingin akan memperlambat pertumbuhan bakteri. Oleh karena itu penting diketahui apakah ada pertumbuhan kuman pada sediaan propofol sisa diluar kemasan pada jam ke 0, jam ke 6 dan jam ke 24.Tujuan : Untuk mengetahui apakah ada pertumbuhan bakteri pada propofol yang sudah dibuka dari ampul pada jam ke 0, jam ke 6 dan jam ke 24 di kamar operasi bedah sentral RSSA  setelah dilakukan pemeriksaan kultur mikrobiologiMetode :  Jenis penelitian yang digunakan adalah penelitian kohort prospektif dengan jumlah sampel 90. Sampel terpilih diberi label no sampel, dicatat warnanya. Pada jam ke- 0 propofol dibuka dari kemasan diambil 2 cc propofol dimasukkan dalam spuit 3 cc dan dilakukan pemeriksaan mikrobiologi. Pada Jam ke 6 diambil 2 cc propofol dimasukan dalam spuit 3cc diberi label dan nomor sampel, tanggal dan jam. Kemudian dilakukan pemeriksaan mikrobiologi. Pada Jam ke 24 propofol sisa yang disimpan dilemari pendingin Depo Farmasi Kamar Operasi diambil 2 cc propofol dimasukan dalam spuit 3cc yang telah diberi label dan nomor sampel, tanggal dan jam. Kemudian dilakukan pemeriksaan mikrobiologiHasil :  Dari penelitian ini didapatkan jumlah rerata koloni bakteri pada sampel  jam ke 0 adalah 0,1667 cfu/ml,  pada sampel jam ke 6 adalah 3,6667 cfu/ml, dan pada sampel jam ke 24 adalah 321,8573 cfu/ml. Jumlah rerata total koloni bakteri adalah 108.5636 cfu/ml. Dari analisa statistik didapatkan jumlah koloni bakteri pada jam ke 0 berbeda bermakna jika dibandingkan pada jam ke 6 dengan nilai p < 0,05, sedangkan jumlah koloni bakteri pada jam ke 0 dibandingkan dengan jam ke 24 didapatkan perbedaan yang bermakna dengan nilai P < 0,05. Jumlah koloni bakteri pada jam ke 6 berbeda bermakna jika dibandingkan pada jam ke 24 dengan P < 0,05Simpulan : Pertambahan jumlah koloni bakteri berkaitan erat dengan lamanya paparan propofol dengan udara luar. Semakin lama terbuka semakin banyak jumlah koloni bakteri.
Perbandingan Efek Swab Chlorhexidine 2% - Isopropyl Alcohol 70% dengan Povidone Iodine 10%- Isopropyl Alcohol 70% terhadap Jumlah Kolonisasi Bakteri di Kulit pada Preparasi Kulit untuk Pemeriksaan Kultur Darah
Authors: Sartika Listiana Dewi , Pujo Jati Listijanto , Puspitasari Iva
Published: June 2019

Latar belakang : Jenis antiseptik yang digunakan dalam teknik preparasi pengambilan kultur darah sangat penting untuk menghindari positif palsu yang disebabkan oleh bakteri komensal di permukaan kulit. Positif palsu ini menyebabkan pemborosan pada antibiotik yang tidak perlu sehingga mempengaruhi outcome pasien dan biaya Rumah Sakit. Penelitian akhir-akhir ini menyatakan bahwa telah ditemukan resistensi bakteri terhadap antiseptik.Tujuan : Mengetahui Swab Chlorhexidine 2%-isopropyl alcohol 70% lebih efektif sebagai antiseptik kulit dibanding Povidone iodine 10%-isopropyl alcohol 70% ditinjau dari jumlah kolonisasi bakteri di kulit.Metode : Desain eksperimental, 20 subyek mendapat perlakuan yang sama pada area berbeda pada volar lengan yang sama; kelompok Chlorhexidine 2%-isopropyl alcohol 70% dan kelompok Povidone iodine 10%-isopropyl alcohol 70%. Kedua kelompok sebelum perlakuan diambil swab. Uji  Wilcoxon untuk uji sebelum dan setelah perlakuan pada masing-masing kelompok dan Mann Whitney test untuk uji setelah perlakuan antara kedua kelompok.Hasil : Jumlah kolonisasi kuman sebelum dan sesudah perlakuan pada masing-masing kelompok berbeda bermakna (p<0,05) sedangkan jumlah kolonisasi kuman setelah perlakuan antara kedua kelompok pun berbeda bermakna. Kelompok Chlorhexidine 2%-isopropyl alcohol 70% menunjukkan hasil kolonisasi bakteri lebih sedikit dibanding kelompok Povidone iodine 10%-isopropyl alcohol 70%.Kesimpulan : Chlorhexidine 2%-isopropyl alcohol 70% merupakan antiseptik permukaan kulit yang lebih efektif menurunkan jumlah kolonisasi bakteri dibandingkan Povidone iodine 10%-isopropyl alcohol 70%.
Pengaruh Pemberian Pre Emptive Ketamin 0,15 mg/kgbb iv Terhadap Intensitas Nyeri Pasca Operasi Bedah Onkologi Mayor Dengan Anestesi Umum Di RSUD Dr Saiful Anwar Malang
Authors: Satiyah Umi , Basuki Djudjuk Rahmad , Laksono Ristiawan Muji
Published: June 2019

Latar Belakang : Preemptive analgesia dan multimodal analgesia mempunyai peranan penting dalam penanganan nyeri selama dan pasca operasi dengan memblok jalur nyeri yang terdiri dari tranduksi, transmisi, modulasi dan persepsi. Ketamin sebagai Anti NMDA (N metil D Aspartat) reseptor bekerja memblok  jalur transmisi dan modulasi serta sinergis dengan opioid. Ketamin dosis kecil 0,15 mg/kgbb mempunyai efek preemptive analgesia dan tidak memiliki efek samping yang berat.Tujuan : mengetahui pengaruh pemberian preemptive ketamin 0,15 mg/kgbb iv terhadap intensitas nyeri  pasca bedah onkologi mayor dengan anestesi umum pada  1,2 dan 3 jam pasca operasiMetode : Penelitian ini merupakan uji klinis acak tersamar ganda, bersifat eksperimental. Sampel penelitian adalah pasien usia 17-40 tahun, kriteria klinis ASA I-II, pendidikan minimal SMP, dan BMI antara 20-30 kg/M2 yang menjalani pembedahan elektif bedah onkologi mayor kategori nyeri sedang yang meliputi operasi struma dan mammae selain radikal mastektomi (MRM). Jumlah sampel  adalah 44 pasien yang  dibagi secara random menjadi 2 kelompok, yaitu kelompok 1 (perlakuan) yang menerima ketamin 0,15 mg/kgbb dan kelompok 2 (kontrol) tanpa menerima ketamin 0,15mg/kgbb. Semua pasien menerima  (multimodal analgesia) yaitu fentanyl (opioid), ketorolac (NSID) dan juga obat2an lain untuk  anestesi umum. Intensitas nyeri  pada semua sampel diamati pada  1, 2 dan  3 jam pasca operasi dengan menggunakan Verbal numerical rating scale (VNRS) yang setara dengan VAS (visual Analogue scale). Uji statistik normalitas menggunakan uji saphiro wilk diperoleh hasil bahwa data yang ada tidak terdistribusi normal sehingga dilakukan uji beda non parametrik mann whitney testHasil : Penelitian ini menunjukkan bahwa pemberian ketamin 0,15 mg/kgbb mengurangi nyeri akut lebih baik pada  1, 2 dan 3 jam pasca operasi.  Pada  1 jam pasca operasi  kelompok perlakuan memiliki nilai rerata VAS 0 atau lebih rendah 0,77 cm dbandingkan kelompok kontrol dengan nilai p<0,001. Pada  2 jam pasca operasi kelompok perlakuan memiliki rerata VAS 0,3 cm atau lebih rendah 1,4 cm bila dibandingkan dengan kelompok kontrol dengan nilai p<0,001. Pada  3 jam pasca operasi kelompok perlakuan memiliki rerata 0,9 cm atau lebih rendah 1,6 cm dengan nilai p<0,001.Kesimpulan : Pada penelitian ini preepmtive ketamin 0,15 mg/kgbb iv memberikan pengaruh menurunkan intensitas nyeri  pada  1 jam, 2 jam dan 3 jam pasca pembedahan onkologi mayor kategori nyeri sedang.
Calcemia and Inflammatory Markers in Early-Onset Neonatal Infection
Authors: Kutílek Štěpán , Vracovská Martina , Pečenková Kamila , Brožíková Hana , Pikner Richard , Fejfarková Zlatka
Published: June 2019

Introduction: Ionised hypocalcemia (S-Ca2+) has been repeatedly observed in neonates with sepsis. Our aim was to evaluate total calcemia (S-Ca) and its relationship to laboratory markers of infection. Methods: We retrospectively evaluated total calcemia (S-Ca) and its relationship to laboratory markers of sepsis/infection (serum levels of C-reactive protein – S-CRP and procalcitonin – S-PCT) in 29 full-term neonates with early-onset neonatal infection hospitalized at our neonatology ward between 2012 and 2016. The control group consisted of 705 neonates without infection. Results: In neonates with early-onset infection , the S-Ca on day 1, 2 and 3 was significantly lower (p < 0.0001; p < 0.0001; p = 0.05 versus controls) same as the pooled S-Ca (p < 0.0001 versus controls). There was a weak negative correlation between pooled S-Ca and S-PCT, or pooled S-Ca and S-CRP (r = −0.22, p = 0.06; r = −0.19, p = 0.09). Conclusion: S-Ca was decreased in neonates with early-onset infection and did show a slight tendency to inverse correlation with S-CRP and S-PCT. Pediatricians must be aware of the fact that a drop in total S-Ca should alert their attention to the risk of neonatal infection, and, likewise, that the children with neonatal infection are at a higher risk of hypocalcemia with all its consequences.