bluuebunny/crossref_metadata_2025 huggingface dataset:
Естезионевробластом с чернодробна метастатична болест
Authors: Райчева Габриела , Попов Веселин , Калинов Живко , Вълчева Мариана
Published: November 2019

Въведение: Естезионевробластома или олфакторен невробластом е много рядък злокачествен тумор на невроепитела. Среща се предимно във възрастта 11-20 години или 51-60 години, засяга по-често мъже. Характеризира се с бавен, но интензивен растеж, чести рецидиви, рядко дава далечни метастази. Поради раритета на патологията липсва консенсус за лечение и се налага интердисциплинарен подход.

Клиничен случай: Касае се за бяла жена на 30 години. През 2016 г. по повод на ринорея и главоболие е направен ЯМР на главен мозък – данни за туморна формация в носна кухина. След биопсия се верифицира хистологично нискодиференциран естезионевробластом. Проведено оперативно лечение (септември 2016 г.) с последващо лъчелечение в областта на засегнатите структури (носна кухина, ляв максиларен синус, етмоидални клетки, сфеноидален синус и фронтален синус) до ООД 60 Гр. На пореден контролен ЯМР от ноември 2017 г. се описва рецидивна формация в областта на носната преграда дорзално. След ексцизия е насочена за лъчелечение до толеранс на тъканите. За остатъчната формация на първичния тумор е реализирана стереотактична роботизирана радиохирургия с Кибернож. На КТ през май 2018 г. се доказват множествени чернодробни метастази. Извършена е ТАБ и лезиите се верифицират като свързани с основното заболяване. Преценена от ОКОК за започване на системно ПХТ лечение по протокол Cisplatin/ Etoposide (4-6 курса), предстоят рестадиращи изследвания с ПЕТ-КТ.

Заключение: Алгоритъмът на терапевтичното поведение при естезионевробластома се базира на ретроспективни проучвания като липсва съвременен терапевтичен стандарт. С доказана ефективност са радикалната оперативна интервенция с последваща дефинитивна лъчетерапия. Системната химиотерапия има роля в случаите, когато туморът се разпространява извън носна кухина и дава далечни метастази. Платина-базираните режими са средство на избор като първа линия на лечение, особено при високодиференцираните тумори.
Случай на синдром на Adams-Oliver, проследяван от раждането до 1-годишна възраст
Authors: Валериева Елица , Атанасова Виктория , Ковачева Катя , Коларова-Янева Надя , Георгиева Десислава , Асанова Айля , Василев Ивайло
Published: November 2019

Синдромът Adams-Oliver е изключително рядко наследствено заболяване, което се характеризира с дефекти, разделящи се в две групи. Първа група на големи клиничнибелези са aplasia cutis congenita и дефекти на терминалните части на крайниците, често придружаващи се от дефекти на скалпа и черепната осификация, които могат да се различават значително сред засегнатите индивиди. Малките клинични признаци включват cutis marmorata telangiectatica congenita, вродени сърдечни и съдови малформации. Особеност на синдрома е генетична хетерогенност – описани са 6 основни типа и различен тип на унаследяване, свързани с мутации в отделни гени. Предвид полиорганното засягане лечението е мултидисциплинарно: дерматологично, ортопедично и хирургично.

Представяме случай на синдром Adams-Oliver с характерен дефект на скалпа в областта на вертекса, включващ кожна аплазия и аплазия на структурите на черепа, включително костите в тази област, както и дефекти на крайниците терминално. В конкретния случай откриваме и някои малки клинични признаци, асоцииращи се със синдрома – вродена сърдечна малформация (междупредсърден дефект), множествени хемангиоми и кожна марморираност. Детето е проследявано до 1-годишна възраст.
Влияние на хроничното анемично състояние върху спиналната костна минерална плътност при пациенти с трансфузионно-зависима бета-таласемия на възраст над 18 години
Authors: Сапунарова Катя , Денева Таня , Цветкова Силвия , Горанова-Маринова Веселина , Грудева-Попова Жанет
Published: November 2019

Цел: Да се потърси количествена зависимост на връзката между тежестта на хроничното анемичното състояние и тежестта на синдрома на остеопения/остеопороза на спинално ниво при пациентите с ТЗБТ.

Материал и методи: В периода април 2017 – май 2018 г. са изследвани 62 лица с ТЗБТ на възраст над 18 години.

Резултати: Средната възраст на пациентите с ТЗБТ е 30.7±10.0 г. за жените и 32±12.9 г. за мъжете. Средният претрансфузионен Хб за жените е 80.4±10.6 g/l и 79.1±10.9 g/l за мъжете. Средните стойности на спиналната КМП на L1-L4 ниво, представена чрез Z-скор, за жени и мъже са съответно -2.5±1.07 и -2.7±1.1). Пациентите от двата пола със средна стойност на претрансфузионния Хб над 90 g/l показват сигнификантно повисоки стойности на Z-скора спрямо тези с нива на Хб под 90 g/l. За всяко увеличение на средния претрансфузионен Хб с 1 g/l, стойността на Z-скор на ниво L1-L4 се увеличава с 0.050 при мъжете и 0.048 при жените с ТЗБТ.

Заключение: Поддържането на средни претрансфузионни нива на хемоглобина под 90 g/l влияе негативно върху КМП при пациенти с ТЗБТ във възрастта над 18 години. В този смисъл, придържането към хипертрансфузионен режим дори и при завършен соматичен растеж е ключово за превенция срещу повишената загуба на костно вещество при възрастните пациенти с ТЗБТ.
Оценка на разходната ефективност на здравните технологии в България – методологични проблеми и потенциални възможности
Authors: Искров Георги , Стефанов Румен
Published: November 2019

През последните години, месеците октомври – декември се утвърдиха като време за нови идеи за реформи в здравеопазването и в частност управлението на публичните разходи за лекарствени продукти на Националната здравноосигурителна каса (НЗОК). В края на 2017 г. водеща тема бе предложението за мораториум за заплащане на нови лекарствени терапии. Тази година приетите мерки са значително по-мащабни. Настоящата редакционна статия няма за цел да описва и анализира тези промени предвид факта, че предстои допълнително конкретизиране на механизмите за тяхното прилагане с евентуален преходен период, както и възможно произнасяне по тях от страна на Конституционния съд на Република България.

Сред условните нововъведения е въвеждането на т. нар. принцип за разходна ефективност в начина, по който НЗОК ще заплаща лекарствените продукти. Съгласно приетата законова дефиниция, разходна ефективност на лекарствен продукт/терапевтичен курс е съотношението между постигане на терапевтичен резултат от прилагане на лекарствен продукт/лекарствена терапия и разходване на средства от бюджета на НЗОК за същия продукт/терапия при съпоставянето му с друг/други лекарствен/лекарствени продукт/продукти или лекарствени терапии, представляващи терапевтични алтернативи и заплащани напълно или частично от НЗОК. Съответно, предписването на даден лекарствен продукт/терапевтичен курс ще се извършва съобразно неговата разходна ефективност, когато в конкретния случай са налице терапевтични алтернативи – лекарствени продукти с доказана сходна терапевтична ефикасност и безопасност.
Анализ на разходите за провеждане на интравенозна бифосфонатна терапия при пациенти с онкологични заболявания
Authors: Райчева Ралица , Христамян Мери
Published: November 2019

Цел: Ретроспективен анализ на преките разходи за провеждане на интравенозна бифосфонатна (БФ) терапия за периода 2012 – 2016 г.

Материали и методи: Данните за анализираните единици на наблюдение са извлечени от регистрите на аптечните бази на болничните заведения в област Пловдив, в които се прилага БФ терапия. В допълнение са анализирани и годишните разходи за золедронова киселина, достъпни от регистъра на НЗОК. Всички разходи са количествено определени на базата на национални ставки, определени от законодателя.

Резултати: Преките разходи за лекарствена терапия за страната спадат 32 пъти от 2018 г. до 2012 г. – от 8 983 283.42 лв. до 276 722.51 лв. Тази тенденция се наблюдава и при данните от болничните аптеки, при които спадът е 99 пъти от 2012 г. до 2016 г. – от 2 334 138.90 лв. до 23 542.65 лв, но тук влияние оказва не само спада в цената на терапията, но и близо 4 пъти по-малкия брой на заплатените опаковки – от 4004 бр. за 2012 до 1402 бр. за 2016 г. Средният брой на вливките за една година е сравнително малък: 2012 г. и 2013 г. – медиана 5 бр. (минимум 1 бр. – максимум 14 бр.); 2014 г. – медиана 5 бр. (минимум 1 бр. – максимум 16 бр.); 2015 г. и 2016 г. – 3 бр. (минимум 1 бр. – максимум 14 бр.).

Заключение: Важна последица от болестта е, че индивидите не могат да изпълняват обичайните си ежедневни дейности и така освен, че се разходва бюджета на НЗОК се търпят и производствени загуби.
Имат ли принудителните лицензии място в дебата за достъпа до иновативни терапии?
Authors: Искров Георги , Стефанов Румен
Published: November 2019

Достъпът до иновативни здравни технологии остава водещ дискусионен момент в съвременната здравна политика. Постигането на взаимноизгодно и справедливо за всички решение може да бъде изключително сложно, дори невъзможно в определени случаи. Напоследък, интерес за регулаторната практиката представлява възможността за прилагане на принудителни лицензии във фармацевтичната индустрия. Тази законова опция или по-скоро заплахата от използването й може да изиграе определена роля при договаряне на достъп до нови лекарствени терапии. В същото време обаче, това представлява крайна мярка с множество неизвестни дългосрочни последствия за здравния сектор и обществото.
Акромегалия – епидемиологични данни и въздействие върху качество на живот на пациентите
Authors: Левтерова Боряна
Published: November 2019

Акромегалията е придобито прогресиращо рядко заболяване, свързано с прекомерно производство на растежен хормон. Характеризира с прогресивно соматично обезобразяване (основно включващо лицето и крайниците) и предизвиква мултисистемни уреждания. Хората с това заболяване са изложени на риск от тежка инвалидизация и живото-застрашаващи здравни проблеми. Акромегалия е коварно хронично заболяване, което протича с повишена заболеваемост и смъртност от сърдечно-съдови, метаболитни и неопластични усложнения. Контролът на заболяването лесно може да се оцени със съвременните клинични и лабораторни методи, но за пациента от първостепенно значение е самооценката за благополучие и качество на живот. Въпреки че акромегалията е рядко заболяване, тежестта върху свързаното със здравето качество на живот е значително поради широкия спектър от съпътстващи усложения, както и необходимостта от управление през целия живот. Целта на настоящия преглед е да представи актуални данни за епидемиологията на акромегалията и въздействието на заболяването върху качеството на живот на пациентите.
Рядък случай на цепка на устната – хирургично-ортодонтско лечение
Authors: Пеев Илия , Тончев Цветан
Published: November 2019

Тъй като в България до скоро не съществуваше уеднаквен стандарт за лечение на деца с вродени лицеви аномалии (ВЛА), се наблюдават различни по своята тежест проблеми, свързани със семейството, обществото и специалистите: ранна пренатална диагностика; превенция на изоставянето на децата с ВЛА; клиничен протокол, който да координира работата на специалистите; единствено хирургичното лечение се заплаща от НЗОК; социална стигма на пациентите с ВЛА.

Впоследствие, специалисти от различни страни на Европа, сред които и България, ратифицират Техническия доклад CEN/TR 16824:2015 „Ранни грижи при бебета, родени с цепнатина на устната и/или небцето“ на Европейския комитет по стандартизация (CEN) през 2015 г. На основата на този документ е издаден български аналог, с цел подпомагане на семействата в нужда, уеднаквяване на критериите за оценка на клиницистите и възможности за международно сътрудничество за подпомагане и постигане на устойчиви резултати.
Орално здраве при пациенти с хронични бъбречни заболявания
Authors: Мусурлиева Нина
Published: November 2019

Хроничнoтo бъбречнo заболяване (ХБЗ) е социално значим здравен проблем, оказвайки негативни последици върху качеството на живот на пациентите. Според научни изследвания, при тези болни много по-често се наблюдават патологични състояния в устната кухина в сравнение със здравите лица. Целта на настоящото проучване е да се очертаят типичните промени в оралното здраве на пациентите с хронични бъбречни заболявания, да се представи алгоритъм за тяхното диагностициране и оценка, както да се отправят препоръки за правилното лечение.
За Aлфред Нобел, Нобеловите награди и наградите за медицина
Authors: Комитова Радка , Кеворкян Ани
Published: November 2019

Нобеловите награди са поредица от международни отличия, които всяка година се присъждат от Шведскa и Норвежка институция за отбелязване на високи академични, културни и научни постижения. Според наследство на Alfred Nobel през 1895 г. се учредяват 5 награди. Призовете в областта на химия, физика, литература, мир и медицина или физиология се връчват за първи през 1901 г. Нобеловите награди се приемат за най-престижните постижения в съответната област. Te все повече се утвърждават като научни открития, отстояли изпитанието на времето. В настоящия ръкопис авторите правя кратък преглед на историята на Нобеловите награди, най-вече на тези в областта медицина или физиология, като представят някои по-малко известни и противоречиви данни.
Slowing of the Solar Wind in the Outer Heliosphere
Authors: Elliott Heather A. , McComas David J. , Zirnstein Eric J. , Randol Brent M. , Delamere Peter A. , Livadiotis George , Bagenal Fran , Barnes Nathan P. , Stern S. Alan , Young Leslie A. , Olkin Catherine B. , Spencer John , Weaver Harold A. , Ennico Kimberly , Gladstone G. Randall , Smith Charles W. ,   New Horizons Plasma and Particle Team
Published: November 2019

This study provides a deeper understanding of how the solar wind evolves with increasing distance from the Sun as it encounters an increasing amount of interstellar material. This work extends our prior work by (1) extending the solar wind proton data radial profiles for New Horizons (NH) out to nearly 43 au, (2) quantifying the observed amount of slowing in the solar wind in the outer heliosphere by performing a detailed comparison between the speeds at NH (21–43 au) with speeds at 1 au, and (3) resolving discrepancies between the measured amount of slowing and estimates of the amount of slowing determined from the measured amount of interstellar pickup present in the solar wind. We find that the solar wind density radial profile may decrease at nearly or slightly less than a spherical expansion density profile. However, the temperature profile is well above what would be expected for an adiabatic profile. By comparing outer and inner heliospheric solar wind observations, we find the solar wind speed is reduced by 5%–7% between 30 and 43 au. We find the solar wind polytropic index (γ
sw) steeply decreases toward zero in the outer heliosphere (21–43 au) with a slope of ∼0.031 au−1. Using both this radial variation in γ
sw and the measured amount of interstellar pickup ions, we estimate the slowing in the solar wind and obtain excellent agreement with the observed slowing.
Orbital Evolution of Eccentric Low-mass Companions Embedded in Gaseous Disks: Testing the Local Approximation
Authors: Sánchez-Salcedo F. J.
Published: November 2019

We study the tidal interaction between a low-mass companion (e.g., a protoplanet or a black hole) in orbit about a central mass, and the accretion disk within which it is submerged. We present results for a companion on a coplanar orbit with eccentricity, e, between 0.1 and 0.6. For these eccentricities, dynamical friction arguments in its local approximation, that is, ignoring differential rotation and the curvature of the orbit, provide simple analytical expressions for the rates of energy and angular momentum exchange between the disk and the companion. We examine the range of validity of the dynamical friction approach by conducting a series of hydrodynamical simulations of a perturber with softening radius R
soft embedded in a two-dimensional disk. We find close agreement between predictions and the values in simulations provided that R
soft is chosen sufficiently small, below a threshold value

, which depends on the disk parameters and on e. We give

for both razor-thin disks and disks with a finite scale height. For point-like perturbers, the local approximation is valid if the accretion radius is smaller than

. This condition imposes an upper value on the mass of the perturber.
A Black Hole at the Center of Earth Plays the Role of the Biggest System of Telecommunication for Connecting DNAs, Dark DNAs and Molecules of Water on 4+N- Dimensional Manifold
Authors: Fioranelli Massimo , Sepehri Alireza , Roccia Maria Grazia , Linda Cota , Rossi Chiara , Vojvodic Petar , Lotti Jacopo , Barygina Victoria , Vojvodic Aleksandra , Wollina Uwe , Tirant Michael , Nguyen Thuong Van , Lotti Torello
Published: November 2019

Recently, some scientists from NASA have claimed that there may be a black hole like structure at the centre of the earth. We show that the existence of life on the earth may be a reason that this black hole like object is a black brane that has been formed from biological materials like DNA. Size of this DNA black brane is 109 times longer than the size of the earth's core and compacted interior it. By compacting this long object, a curved space-time emerges, and some properties of black holes emerge. This structure is the main cause of the emergence of the large temperature of the core, magnetic field around the earth and gravitational field for moving around the sun. Also, this structure produces some waves which act like topoisomerase in biology and read the information on DNAs. However, on the four-dimensional manifold, DNAs are contracted at least four times around various axis's and waves of earth couldn't read their information. While, by adding extra dimensions on 4 +n-dimensional manifold, the separation distance between particles increases and all of the information could be recovered by waves. For this reason, each DNA has two parts which one can be seen on the four-dimensional universe, and another one has existed in extra dimensions, and only it's e_ects is observed. This dark part of DNA called as a dark DNA in an extra dimension. These dark DNAs not only exchange information with DNAs but also are connected with some of the molecules of water and helps them to store information and have memory. Thus, the earth is the biggest system of telecommunication which connects DNAs, dark DNAs and molecules of water.
Who are you, Griselda? A replacement name for a new genus of the Asiatic short-tailed shrews (Mammalia, Eulipotyphla, Soricidae): molecular and morphological analyses with the discussion of tribal affinities
Authors: Bannikova Anna A. , Jenkins Paulina D. , Solovyeva Evgeniya N. , Pavlova Svetlana V. , Demidova Tatiana B. , Simanovsky Sergey A. , Sheftel Boris I. , Lebedev Vladimir S. , Fang Yun , Dalen Love , Abramov Alexei V.
Published: November 2019

The first genetic study of the holotype of the Gansu short-tailed shrew, Blarinella griselda Thomas, 1912, is presented. The mitochondrial analysis demonstrated that the type specimen of B. griselda is close to several recently collected specimens from southern Gansu, northern Sichuan and Shaanxi, which are highly distinct from the two species of Asiatic short-tailed shrews of southern Sichuan, Yunnan, and Vietnam, B. quadraticauda and B. wardi. Our analysis of four nuclear genes supported the placement of B. griselda as sister to B. quadraticauda / B. wardi, with the level of divergence between these two clades corresponding to that among genera of Soricinae. A new generic name, Parablarinella, is proposed for the Gansu short-tailed shrew. Karyotypes of Parablarinella griselda (2n = 49, NFa = 50) and B. quadraticauda (2n = 49, NFa = 62) from southern Gansu are described. The tribal affinities of Blarinellini and Blarinini are discussed.
Depth-Dependent Reduction of Biomechanical Efficacy of Contact Lens–Assisted Corneal Cross-linking Analyzed by Brillouin Microscopy
Authors: Zhang Hongyuan , Roozbahani Mehdi , Piccinini Andre L. , Golan Oren , Hafezi Farhad , Scarcelli Giuliano , Randleman J. Bradley
Published: November 2019

PURPOSE:

To determine the relative impact of contact lens– assisted corneal cross-linking (CACXL) and standard protocol CXL (CXL) on regional corneal stiffness using Brillouin microscopy.

METHODS:

CXL and CACXL were performed on 30 intact fresh porcine eyes (15 per group). Depth profile of stiffness variation and averaged elastic modulus of anterior, middle, and posterior stroma were determined by Brillouin maps. Corneas were cut into strips to conduct mechanical stress-strain tests after Brillouin microscopy to evaluate stiffness difference between CXL and CACXL. Each eye served as its own control.

RESULTS:

CXL had a greater impact on corneal stiffness, with a maximum increase of 5.74% compared to 3.99% for CACXL (
P
< .001). CXL increased longitudinal modulus by 7.8% in the anterior, 1.7% in the middle, and −0.7% in the posterior regions compared to CACXL, which increased longitudinal modulus by 5.5% in the anterior (
P
< .001), 1.2% in the middle (
P
= .15), and −0.4% in the posterior regions (
P
= .60). Mechanical stress-strain tests showed that at 10% strain averaged Young's modulus was 5 MPa for CXL and 2.97 MPa for CACXL (
P
< .001).

CONCLUSIONS:

Both CACXL and standard protocol CXL induced significant corneal stiffening primarily concentrated in the anterior cornea. CACXL leads to less stiffening compared with CXL. An attenuated but continuous stiffening effect can be observed through the whole cornea for both CACXL and CXL, although CACXL has a smaller stiffness gradient.

[
J Refract Surg
. 2019;35(11):721–728.]
Retrieving the specialised substance from a corpus of professional discourse in the field of Records and Information Management
Authors: Millot Philippe
Published: November 2019

Cet article vise à approfondir notre connaissance des discours professionnels dans le domaine de la gestion de l’information et de la documentation, à partir d’un corpus spécialisé. Après un bref résumé de la longue tradition des travaux en analyse des discours professionnels, nous présentons une méthode de compilation et d’analyse d’un corpus dans le domaine de la gestion de l’information, notamment dans le but d’identifier sa « matière spécialisée ». Cette matière est mise en évidence par trois micro-analyses : celle du processus de spécialisation des catégories sémantiques générales de l’anglais, celle de la cohérence sémantique, et celle de dimensions sémantiques spécifiques. Nos résultats montrent tout d’abord que la gestion de l’information peut être considérée comme un registre spécialisé de l’anglais. Ils montrent ensuite que la comparaison d’une variété professionnelle avec l’usage général fournit une vue partielle du spécialisé-professionnel et qu’il convient d’envisager la création de dimensions sémantiques ad hoc.
Emerging Contaminants in Trans-American Waters
Authors: Vélez Verónica Patricia Pinos , Esquivel-Hernández Germain , Cipriani-Avila Isabel , Mora-Abril Enma , Cisneros Juan Fernando , Alvarado Andrés , Abril-Ulloa Victoria
Published: November 2019

Industrial development has made new products available to people to make their lives easier. Items such as food, cleaning, personal care and health products, among others, are processed, sold and consumed daily by all age groups. These products include in their formulation inorganic and organic chemicals with the purpose of improving or increasing some of their properties, making them more attractive to the consumer. These substances are strictly controlled during production so that the final product may be safely consumed. In most cases, the constituents of commercial products end up in wastewater, where they are not controlled. These uncontrolled pollutants of differing chemical natures are known as “Emerging Contaminants” (ECs). Research worldwide has found ECs in various environmental matrices, especially water. To understand this problem, four fundamental aspects must be addressed: 1) the analytical methods for its determination; 2) the occurrence in environmental matrices; 3) the treatments for the removal of ECs in wastewater and drinking water plants; and 4) the risks to health and the environment. This document reviews these four aspects with regard to 14 ECs commonly found in the studies around the world and addresses the state of these ECs in trans-American waters.
Deporte y comunicación: las primeras huellas del fútbol femenino en Canarias
Authors: Castro Hernández Laura Esther , Rodríguez Wangüemert Carmen María , Aránzazu Calzadilla Medina María
Published: November 2019

Introducción: El fútbol femenino estuvo vetado durante muchos años hasta que comenzaron a crearselos primeros equipos en Canarias. Metodología: La investigación ha partido de la revisiónbibliográfica y hemerográfica de la prensa especializada y de las noticias deportivas de la época.Asimismo, se han tenido en cuenta otros estudios actuales para centrar una posición desde la historiasocial del deporte. Esta comunicación recoge los artículos publicados en los periódicos canarios entrelos años 1915 y 1950. Resultados y conclusiones: La investigación muestra la escasa representacióndel fútbol femenino en Canarias en el periodo estudiado y un tratamiento desigual fruto del contextohistórico, social y jurídico de la época estudiada.
Desinformación y comunicación organizacional: estudio sobre el impacto de las fake news
Authors: Rodríguez Fernández Leticia
Published: November 2019

Introducción: La desinformación es un fenómeno de actualidad. La viralidad e impacto de las fake news muestran nuevos riesgos para la reputación de las organizaciones. Metodología: Se pretende conocer cuáles son las organizaciones (instituciones, partidos políticos y empresas) más afectadas por información falsa en España y abordar los tipos de bulos más frecuentes para cada una. Se realiza una investigación descriptiva para aproximarnos al objeto de estudio y un análisis de contenido sobre las verificaciones recogidas por Maldito bulo durante 3 meses. Resultados y conclusiones: Los resultados confirman que más de la mitad de las verificaciones analizadas en la muestra están relacionadas con alguna organización y trataban de afectar mayormente a la reputación de instituciones públicas, seguida de las empresas y los partidos políticos. El 31% de las verificaciones sobre organizaciones se referían a alguna persona física relacionada con la misma.
Improved simulation of clouds over the Southern Ocean in a General Circulation Model
Authors: Varma Vidya , Morgenstern Olaf , Field Paul , Furtado Kalli , Williams Jonny , Hyder Patrick
Published: November 2019

Abstract. The present generation of global climate models is characterized by insufficient reflection of short-wave radiation over the Southern Ocean due to a misrepresentation of clouds. This is a significant concern as it leads to excessive heating of the ocean surface, sea surface temperature biases, and subsequent problems with atmospheric dynamics. In this study we modify cloud micro-physics in a recent version of the Met Office's Unified Model and show that choosing a more realistic value for the shape parameter of atmospheric ice-crystals, in better agreement with theory and observations, benefits the simulation of short-wave radiation. In the model, for calculating the growth rate of ice crystals through deposition, the default assumption is that all ice particles are spherical in shape. We modify this assumption to effectively allow for oblique shapes or aggregates of ice crystals. Along with modified ice nucleation temperatures, we achieve a reduction in the annual-mean short-wave cloud radiative effect over the Southern Ocean by up to 4 W/m2, and seasonally much larger reductions. By slowing the growth of the ice phase, the model simulates substantially more supercooled liquid cloud. We hypothesize that such abundant supercooled liquid cloud is the result of a paucity of ice nucleating particles in this part of the atmosphere.
Urban organic aerosol composition in Eastern China differs from North to South: Molecular insight from a liquid chromatography-Orbitrap mass spectrometry study
Authors: Wang Kai , Huang Ru-Jin , Brüggemann Martin , Zhang Yun , Yang Lu , Ni Haiyan , Guo Jie , Wang Meng , Han Jiajun , Bilde Merete , Glasius Marianne , Hoffmann Thorsten
Published: November 2019

Abstract. Particulate air pollution in China is influencing human health, ecosystem and climate. However, the chemical composition of particulate aerosol, especially of the organic fraction, is still not well understood. In this study, particulate aerosol samples with a diameter ≤ 2.5 μm (PM2.5) were collected in January 2014 in three cities located in Northeast, East and Southeast China, i.e., Changchun, Shanghai and Guangzhou, respectively. Organic aerosol (OA) in the PM2.5 samples was analyzed by ultrahigh performance liquid chromatography (UHPLC) coupled to high-resolution Orbitrap mass spectrometry in both negative mode (ESI−) and positive mode electrospray ionization (ESI+). After a non-target screening including molecular formula assignments, compounds were classified into five groups based on their elemental composition, i.e., CHO, CHON, CHN, CHOS and CHONS. The CHO, CHON and CHN compounds present the dominant signal abundances of 81–99.7 % in the mass spectra and the majority of these compounds were assigned to mono- and polyaromatics, suggesting that anthropogenic emissions are a large source of urban OA in all three cities. However, the chemical characteristics of these compounds varied among different cities. The degree of aromaticity and the number of polyaromatic compounds were significantly higher in samples from Changchun, which could be attributed to the large emissions from residential heating (i.e., coal combustion) during winter time in Northeast China. Moreover, the ESI− analysis showed higher H / C and O / C ratios for organic compounds in Shanghai and Guangzhou compared to samples from Changchun, indicating that OA in lower latitude regions of China experiences more intense photochemical oxidation processes. The majority of sulfur-containing compounds (CHOS and CHONS) in all cities were assigned to aliphatic compounds with low degrees of unsaturation and aromaticity. Again, samples from Shanghai and Guangzhou exhibit a larger chemical similarity but largely differ from those from Changchun.
Analysis of functional groups in atmospheric aerosols by infrared spectroscopy: method development for probabilistic modeling of organic carbon and organic matter concentrations
Authors: Bürki Charlotte , Reggente Matteo , Dillner Ann M. , Hand Jenny L. , Shaw Stephanie L. , Takahama Satoshi
Published: November 2019

Abstract. The Fourier transform infrared (FTIR) spectra of fine particulate matter (PM2.5) contain many important absorption bands relevant for characterizing organic matter (OM) and obtaining organic matter to organic carbon (OM/OC) ratios. However, extracting this information quantitatively – accounting for overlapping absorption bands and relating absorption to molar abundance – poses several challenges. For instance, a subset of model parameters lead to calibrations that test almost indistinguishably well against laboratory standards generate substantially different predictions in ambient samples. Furthermore, additional parameters related to molecular structure are required to estimate carbon content from functional group (FG) abundance. However, since many carbon atoms can be branched (not fully functionalized) or polyfunctional, these parameters are not well constrained for ambient sample mixtures. In this work, we present a probabilistic framework to characterize combinations of these parameters that are consistent with field measurements of organic carbon (OC), for which estimates from thermal optical reflectance (TOR) measurements are used. Uncertainties in this probabilistic framework characterize the plausibility of many different parameter values that yield acceptable predictions (to the extent that they can be evaluated) neglected in conventional estimates of statistical uncertainties. Based on calibrations of aliphatic CH, alcohol COH, carboxylic acid COO, carboxylate COO, and amine NH2, we find model parameters for approximately homogeneous groups of samples determined from cluster analysis of FTIR spectra available for 17 sites in the Interagency Monitoring of Protected Visual Environments (IMPROVE) monitoring network (7 sites in 2011 and 10 additional sites in 2013). These groups are interpreted as being predominantly influenced by dust, residential wood burning, wildfire, urban sources, and biogenic aerosols. The resulting calibrations reproduce TOR OC concentrations (R2 = 0.96) and provide OM/OC values consistent with our current best estimate of ambient OC. The mean OM/OC ratios corresponding to sample types determined from cluster analysis range between 1.4 and 2.0, though ratios for individual samples exhibit a larger range. Trends in OM/OC for sites aggregated by region or year are compared with another regression approach for estimating OM/OC ratios from a mass balance of the major chemical species contributing to PM fine mass. Differences in OM/OC estimates are observed according to estimation method and are explained through the sample types determined from spectral profiles of the PM.
A high-quality hourly, daily and monthly solar irradiance
dataset in China during 1981–2014 based on MERRA-2
Reanalysis products
Authors: Qin Wenmin , Wang Lunche , Zhang Ming , Feng Lan , Fang Hejin , Cai Hong , Zhong Yulong , Zhu Qiqi , Yang Chao
Published: November 2019

Abstract. Solar irradiance (SI) is the main driving factor contributing to climate change and energy balance between the land and atmosphere. High-quality records of global solar irradiance (GHI), direct normal irradiance (DNI) and diffuse solar irradiance (DIF) are of vital importance for solar applications, but the solar radiation observations are sparse around the world. As an alternative, numerous SI reanalysis data in grid format have been developed in regional and global scales. Among them, the MERRA-2 (Modern-Era Retrospective Analysis for Research and Applications, version 2) products could provide high quality SI records with acceptable accuracy and long temporal ranges. This study attempted to improve the accuracy of GHI records derived from MERRA-2 products, and to generate grid DNI and DIF datasets for all-sky conditions over mainland China during 1981–2014, based on the REST2 model and cloud transmittance estimates combining sunshine observations. The results indicate that the estimated GHI values (GHInew) show higher agreements with GHI measurement at 17 CMA (China meteorological administrations) stations than that for the GHI records derived from MERRA-2 products (MERRA-2 GHI). Then, grid GHI, DNI and DIF datasets (0.50° (lat) *0.625° (lon)) throughout China were constructed. The results indicated that the MERRA-2 GHI records may overestimate the GHI values over mainland China. Generally, the GHI and DNI values gradually decreased during 1981-2014, however, DIF values gradually increased from 1981 to 2014, especially in 1992 (DIF = 90.914 W m−2, anomaly DIF value = 15.544 W m−2). The Qinghai Tibetan Plateau has always been an area with the highest GHI, the highest DNI and the lowest DIF values, whereas the Sichuan Basin has always been an area with the lowest GHI, the lowest DNI and the highest DIF values. The grid GHI, DNI and DIF dataset generated in this study can assist in numerous solar studies and applications. We provide these solar irradiance data in publicly available repository: https://doi.org/10.6084/m9.figshare.10026563 (Qin, W. et al., 2019).
Improving boundary layer flow simulations over complex terrain by applying a forest parameterization in WRF
Authors: Wagner Johannes , Wildmann Norman , Gerz Thomas
Published: November 2019

Abstract. The impact of a forest parameterization on the simulation of boundary layer flows over complex terrain is investigated. Short- and long-term simulations are run for 12 hours and 1.5 months, respectively, with and without forest parameterization and the results are compared to lidar and meteorological tower observations. The test cases are based on the Perdigao 2017 campaign. Short-term simulations focus on low-level jet events over the double-ridge, while long-term simulations cover the whole intensive observation period of the campaign. Simulations without forest parameterization do not reproduce the interaction of the boundary layer flow with the double ridge satisfactorily. Surface winds are overestimated and flow separation and recirculation zones are not or only partly simulated. The additional drag of the forest parameterization considerably improves the agreement of simulated and observed wind speed and potential temperature by reducing the positive wind speed bias and increasing the correlation. The positive effect of the forest parameterization on the boundary layer flow is visible both in the short- and long-term simulations.
International Journal of Medical Students - Year 2013 - Volume 1 - Supplement 1
Authors: IJMS Executive Committee of
Published: November 2019

International Journal of Medical Students - Year 2013 - Volume 1 - Supplement 1

The Sixth Young European Scientist Meeting Special Supplement
Training Future Scientists – Enhancing Research Capabilities in Developing Nations
Authors: Coronel Emmanuel , Anez-Bustillos Lorenzo , Fregni Felipe
Published: November 2019

N/A
The Procedure
Authors: Mathew David
Published: November 2019

NA
A Nobel Day in Lisbon, Portugal – A Unique Experience for Someone who Loves Science
Authors: Alves-Vale Catarina
Published: November 2019

NA
A World Leader in Medicine
Authors: Mousa Omar
Published: November 2019

NA
Exposure and Knowledge of Sharps Injuries among Medical Students in Seven States of Mexico
Authors: Camacho-Ortiz Adrián , Díaz-Rodríguez Xiomara , Martínez-Palomares Mayra , Hernández-García, Raúl , Chávez-Moreno Susana , Garza-González Elvira , Valdez-Vázquez Rafael , Díaz-Pino Irlanda
Published: November 2019

Background: Medical students are vulnerable to accidental exposure to blood-borne pathogens when performing clinical activities. Knowledge of both the prevalence of exposure and necessary reporting procedures is important to minimize the risk of harm to medical students. Methods: A cross-sectional online survey of medical students from 19 universities from seven states in Mexico was utilized to determinethe prevalence of needle stick injuries amongst medical students and the associated reporting procedures. Results: We included 312 respondents; of these, 52.24% were men and 47.76% were women, and the mean age was 23.19 years (SD ± 2.11 years). Nearly all of them (94.23%) were medical students doing clerkships in public hospitals. Mean knowledge score of blood-borne pathogens was 3.6 (SD ± 1.16) on a scale of 0-10 designed specifically for this study. Thirty-five per cent of the respondents had sustained a needle stick injury at some point during their medical school training, and 33.97% reported some type of mucocutaneous exposure. Overall, the non-reporting rate of needle stick injury was 48.34%. Approximately 25% of the respondents were not familiar with reporting procedures in the event of a needle stick injury or mucocutaneous exposure; 61.50% had received information from their hospital about the standard protocol to follow after a blood or body fluid exposure. Conclusion: In this Mexican population of medical students, there is a high risk of suffering needle stick injuries  during medical training. Furthermore, knowledge regarding prevention, evaluation, and reporting of needle stick injuries is suboptimal.
Health Literacy Levels among Outpatients at a Tertiary Hospital in Delhi, India
Authors: Sahoo Monika , Kohli Charu , Kishore Jugal
Published: November 2019

Background: Health literacy is defined as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health. This study was conducted to determine health literacy levels and the associated factors among patients attending the outpatient departments of a tertiary care hospital in Delhi. Methods: A hospital-based cross-sectional study was carried out in a tertiary care teaching hospital in Delhi over a period of four months. A total of 150 patients were included in the study. Fifty patients from the Diabetes Clinics, 50 patients from Hypertension Clinics, and 50 patients with anemia from the Antenatal Outpatient Department (OPD) were selected using a convenience sampling method. Data was analyzed using Epi Info software. Statistical analysis was conducted with the chi-square test and the Fisher’s exact test. P values less than 0.05 were considered significant. Results: Out of 50 diabetic subjects, 37 (74%) understood the information about their blood sugar levels as explained to them by the doctor. Similar results were found among hypertensive subjects as well. Furthermore, education status was significantly associated with health literacy. In terms of understanding the regimen of medications, significant association was seen with age, sex, and education. Conclusion: Education status, age, and gender are important determinants of health literacy. Our results support that innovative strategies of communication should be used to improve health literacy among patients.
Advanced Small Cell Lung Cancer with Cerebellar Metastases – A Case Report
Authors: Xiong Chong Zhi , Noori Nazmi M.
Published: November 2019

Background: Small cell lung cancer is an aggressive subtype of lung cancer whereby about one-third of cases are complicated with brain metastases. However, cerebellar metastases are uncommon and contribute to less than 10% of brain metastases. Case: We report a 76-year-old Malay male, an active smoker who presented with dyspnea and occasional cough with hemoptysis for one week. He also presented with headache and constitutional symptoms of malignancy. Clinical examination suggested the presence of right upper chest pathology and positive left cerebellar signs. His condition deteriorated two days later and he passed away after failed attempts at resuscitation. Chest radiograph showed right upper lobe collapse, and brain magnetic resonance imaging showed metastatic lesion in the left cerebellum extending to the right cerebellum. Post-mortem findings revealed small cell lung cancer with cerebellar metastases. Conclusion: Small cell lung cancer patients with brain metastases deteriorate very rapidly, and the management is mainly supportive. Primary prevention through education is the best way to reduce the incidence of lung cancer. In addition, secondary prevention and screening should be undertaken at earlier stages of the disease, as some studies have shown that combined chemotherapy and radiotherapy improve prognosis of malignancies detected at early stage
International Journal of Medical Students - Year 2015 - Volume 3 - Supplement 1
Authors: IJMS Executive Committee of
Published: November 2019

International Journal of Medical Students - Year 2015 - Volume 3 - Supplement 1
Writing Case Reports: Teaching and Tuition Techniques, and the Improvement of Clinical Diagnostic Reasoning
Authors: Kakisaka Yosuke , Kakisaka Yosuke , Fujikawa Mayu , Gaillard Schuyler
Published: November 2019

NA
Multiculturalism in Healthcare: A Review of Current Research into Diversity Found in the Healthcare Professional Population and the Patient Population
Authors: Tan Nicole , Li Shuangyu
Published: November 2019

Culture plays a key role in the way health is perceived and the way healthcare is used. It has been seen that there are many barriers to accessing healthcare, particularly for those who come to the UK with a different background language, religion and healthcare structure. A literature review and content analysis has been performed using 60 articles, selected from the databases PubMed, Scopus and Web of Science, in order to expose how diverse the patient and healthcare professional population truly are, the number of barriers to healthcare and how one can improve access to become culturally competent. Although this is only a small sample of the material present, it is evident that at the present time physical amenities such as having a translator present, as well the training of the healthcare professionals to be able to make the most of the situation and see the patients in a holistic and biopsychosocial approach, reveal an important area to focus more on in practice as well as in research. Thus an increased availability of resources and training needs to be made available for both patients and healthcare professionals in order to ensure competence in accessing healthcare services
Abstracts of the Malaysian Medical Students Summit, 2015
Authors: IJMS Executive Board of
Published: November 2019

N/A
Prevalence of Impostor Phenomenon among Medical Students in a Malaysian Private Medical School
Authors: Ikbaal Muhammad Yassin , Salim Musa Nurhazirah 'Aqilah
Published: November 2019

Background: Impostor phenomenon is described as an "internal experience of intellectual fraudulence" among high achievers, which include medical students who often doubt their ability to become good doctors in the future. This study sought to determine the prevalence of impostor phenomenon among medical students and how impostorism is correlated with other psychological distresses namely anxiety, depression and low self-esteem.

Methods: To conduct this cross-sectional study, various scales were distributed to all 4th-year medical students in Melaka-Manipal Medical College (MMMC), Muar campus to measure impostorism, depression, anxiety and self-esteem. Clance Impostor Phenomenon Scale (CIPS) was used to measure impostorism and a score of 62 was set as the cut off value to classify a participant as an "imposter".

Results: Out of 300, 256 (85.3%) students completed the questionnaires. 48% and 44% of male and female students respectively scored as ‘impostors’ with no significant difference between the two genders. Positive correlations were noted between impostor phenomenon with low self-esteem (rho=0.56), depression (rho=0.42) and anxiety (rho=0.41). Impostors significantly have stronger intentions of quitting medical school (p < 0.001) and felt that they were not ready to cope with challenges during housemanship (p < 0.05).

Conclusion: Impostors suffer greatly from psychological distress. They are not confident to face the future challenges of housemanship and have stronger intentions of quitting the course. It is necessary for medical colleges to acknowledge this feeling and help the students to cope with it to ensure a smooth transition from medical school to housemanship period.
Self-medication among Undergraduate Medical Students of Alexandria Faculty of Medicine: Where do We Stand?
Authors: Ramadan Marwa , Eltaweel Asmaa , El Nakhal Tamwe , Hemead Hanan , Maraqa Abdelrahman , Abish Doha , Essam Rana , Baraka Azza
Published: November 2019

Background: The aim of the present study was to assess the prevalence of self-medication among undergraduate medical students in Alexandria Faculty of Medicine and recognize the patterns and the attitude of students towards intake.

Methods: A cross-sectional study was conducted among undergraduate medical students attending Alexandria Faculty of Medicine from both national and international programs during the period of June 2013 until October 2013. A self-administrated, semi-constructed questionnaire was used to assess the practice of self-medication among 408 students who were randomly selected using a stratified random sample technique.

Results: Self-medication was reported by 208 (52.7%) students, with no significant difference between males and females. The highest percentage of self-medication was reported among those who have completed six years of academic study and the lowest was reported among those who have completed two years of academic study. There was a statistically significant association between educational stage (preclinical and clinical) practice of self-medication. Most common medications involved were analgesic and anti-inflammatory followed by decongestants, antimicrobials and antihistaminic drugs. 309 (78.8%) students believed that self-medication is acceptable.

Conclusion: The present study demonstrated that self-medication is practiced by more than half of undergraduate medical students in the Faculty of Medicine - Alexandria University. Acquiring medical knowledge seems to be associated with the practice of self-medication. Therefore, more attention should be paid to medical curricula to raise awareness and limit the hazardous effects of this phenomenon