bluuebunny/crossref_metadata_2025 huggingface dataset:
ESTIMATION AND UNIQUENESS OF THE GOMPERTZ FORCE OF MORTALITY IN TERMS OF THE MODAL AGE AT DEATH
Authors: George K.A. , Sumathi M.
Published: October 2021

The initial level of mortality and the rate at which mortality rises with age are generally expressed in terms of the Gompertz force of mortality (hazard function). In their paper, James W. Vaupel and others define the Gompertz force of mortality as the rate at which mortality rises with age and the modal age at death. In this paper we estimate the Gompertz force of mortality and prove uniqueness theorem.
Effect of Cavities in Suddenly Expanded Flow at Supersonic Mach Number
Authors: Atifatul Ismah Ismail
Published: October 2021

The contribution from the base drag due to the sub-atmospheric pressure is significant. It can be more than two-thirds of the net drag. There is a need to increase the base pressure and hence decrease the base drag. This research examines the effect of Mach Number on base pressure. To accomplish this objective, it controls the efficacy in an enlarged duct computed by the numerical approach using Computational Fluid Dynamics (CFD) Analysis. This experiment was carried out by considering the expansion level and the aspect cavity ratio. The computational fluid dynamics method is used to model supersonic motion with the sudden expansion, and a convergent-divergent nozzle is used. The Mach number is 1.74 for the present study, and the area ratio is 2.56. The L/D ratio varied from 2, 4, 6, 8, and 10, and the simulated nozzle pressure ratio ranged from 3 to 11. The two-dimensional planar design used commercial software from ANSYS. The airflow from a Mach 1.74 convergent-divergent axi-symmetric nozzle expanded suddenly into circular ducts of diameters 17 and 24.5 mm with and without annular rectangular cavities. The diameter of the duct is taken D=17mm and D=24.5mm. The C-D nozzle was developed and modeled in the present study: K-ε standard wall function turbulence model was used with the commercial computational fluid dynamics (CFD) and validated. The result indicates that the base pressure is impacted by the expansion level, the enlarged duct size, and the passage’s area ratio.
DEVELOPMENT OF THE DIGITAL ENTERPRISES ARCHITECTURES
Authors:   Plekhanov Russian University of Economics, TELNOV Yu.F. ­
Published: October 2021

The article examines the impact of the use of digital technologies, such as new production technologies, industrial Internet, artificial intelligence, big data and predictive analytics on the construction of dynamic and flexible architectures of modern digital enterprises. As a tool that implements a single information space of production and business processes of the enterprise, the concept of Industry 4.0 and the architectural approach based on RAMI are proposed, which consider the use of the network structure of the connected world as the technological basis of the enterprise. To model the production and business processes of a digital enterprise, the concept of building enterprises whose activities are based on the use of models (Model-Based Enterprise) and an approach to modeling and managing digital flow (Digital Thread) is considered. To increase the semantic interoperability of interacting models of digital enterprises, it is proposed to use methods of ontological modeling, and to accelerate the flexible configuration of digital enterprises – methods of microservice organization of software.
NEW TRENDS IN THE DEVELOPMENT OF AGRICULTURE AND PRIORITIES OF AGRICULTURAL POLICY IN RUSSIA
Authors:   All-Russian Institute of Agrarian Problems and Informatics named after A.A. Nikonova, PETRIKOV A.V.
Published: October 2021

The article analyzes the role of agriculture in the Russian economy, the main trends and problems of its development for 2014-2020. There is a decrease in the average annual indices of agricultural production for 2018-2020 compared to 2015-2017, an increase in anthropogenic pressure on the natural environment, an imbalance between the reduction of agricultural employment and the creation of alternative jobs in rural areas, uneven technological development of various categories of farms. The article substantiates the main measures of agrarian policy that ensure economic growth in agriculture, solving environmental and social problems in rural areas: improving state support for agriculture, priority development of small and medium-sized businesses, creating a modern innovation system in the agro-industrial complex.
DIGITAL AND INFORMATION TECHNOLOGIES AS A TOOL FOR CREATIVE SPATIAL DEVELOPMENT OF TERRITORIES
Authors:   Volgograd­ State Technical ­University, MOROZOVA I.А. , KUZMINA E.V. ,   Volgograd­ State Technical ­University, SHEVCHENKO S.A. ,   Volgograd­ State Technical ­University, SIMONOV A.B. ,   Volgograd­ State Technical ­University
Published: October 2021

The article examines the structure and state of the industry of the Volgograd region, analyzes the indicators by production sectors, and provides macroeconomic indicators of the region's activity. Based on the results obtained, the problems of the region are identified and directions for their solution are proposed. As an effective tool for the development of not only the industrial complex, but also the economic system of the subject, the authors propose the use of digital and information and communication technologies.
THE STATE AND PROSPECTS FOR THE DEVELOPMENT OF ORGANIC AGRICULTURE
Authors:   Academy­ of Sciences­ of the Republic ­of Tatarstan,, KHOMENKO V.V.
Published: October 2021

The article presents the author's analysis of the state, problematic positions and prospects for the development of organic agriculture and the production of ecologically clean products in Russia. The potential, technological and organizational conditions for the implementation of this direction are determined.
ECONOMIC POLARIZATION OF RUSSIA AT THE SUBNATIONAL LEVEL
Authors:   Saratov ­State­ University, FENIN K.V.
Published: October 2021

The article examines the causes of the interregional polarization of Russia. The statistics analysis allowed us to conclude the importance of public policy in the socio-economic convergence and the divergence of Russian regions.
DYNAMICS OF SPATIAL DEVELOPMENT INDICATORS FOR THE RUSSIAN ECONOMY (REGIONAL LABOR MARKETS EXAMPLE)
Authors:   Povolzhskiy Institute of Management – branch of the RANEPA, LATKOV Andrey V. , BARASHOV N.G. ,   Saratov State Technical University
Published: October 2021

The article examines the trends for the internal spatial migration dynamics of the Russian economically active population also the factors influencing this process. The main research instruments are the coefficient of range (spread), decile coefficient of differentiation, coefficient of variation, Herfindahl – Hirschman index. As a result, the Russian regions were grouped according to the criterion of the migration vector, their differentiation was assessed by the level of average wages and by the location of the largest companies’ headquarters. The relationship between migration activity and economic activity dynamics is illustrated.
FEATURES OF FORMATION OF INVESTMENT POLICY OF SMALL INDUSTRIAL ENTERPRISES IN MODERN CONDITIONS
Authors:   Ural State Economic University, ZAKIROVA E.R.
Published: October 2021

The article deals with the main problems of financing Russian enterprises at the present stage of development of the national economy. Among the main problems in this area, the lack of the ability to attract long-term financing in the form of debt securities, as well as the inability to attract long-term bank loans due to their high cost and insufficient development of the stock market, seem to be especially complicated for Russian enterprises. In the context of the sanctions confrontation, Russian enterprises are experiencing problems with attracting foreign capital, which also negatively affects the financing of the current activities of enterprises. Solving the problems of financing domestic enterprises remains an urgent problem for the national economy, the solution of which will increase the pace of economic development of the Russian Federation.
ON ECONOMIC STRATEGY AND ECONOMIC POLICY IN RUSSIA UNDER CURRENT CONDITIONS
Authors:   Moscow­ School­ of­ Economics,­ Lomonosov­ Moscow­ State ­University, NEKIPELOV A.D.
Published: October 2021

In the face of clear limitations of the current economic model, the formation of a long-term vision of its development is of particular importance in each country. It is essential to decide on two issues on a purely pragmatic basis: the relative importance of internal and external factors and the role that the state should play in the economy. The strategy developed on this basis should determine the specifics of economic policy. Russia has developed an original holistic model of macroeconomic policy aimed at countering the "Dutch disease." Within its framework, the financial component is used not only for classical functions, but also as a tool to influence the monetary sphere. The "division of labour" in this area between the monetary and financial authorities is aimed at targeting not one but two indicators - the level of inflation and exchange rate - to simultaneously maintain the high efficiency of fuel and raw materials exports and to protect from competition domestic production oriented to the national market. But the implementation of this model entails serious costs - the freezing of significant resources in international reserves, with the impossibility of using them as a “safety bag”, high interest rate and, ultimately, prolonged stagnation. To move towards a sustainable development and modernization strategy, a whole range of interconnected changes to fiscal and monetary policy, on the one hand, and industrial policy, on the other, are proposed. At the same time, the author advocates a return to the classical division of functions between monetary and financial power, and in the sphere of monetary policy - for the transition to the regime of "dirty float" of the ruble and the use of economic instruments limiting the cross-border movement of speculative capital. The importance of implementing structural reforms, primarily concerning the economic behavior of the state, is emphasized.
ANALYTICAL MODEL FOR THE PREDICTION OF THE ELASTIC RESPONSE OF CURVED T-STUBS
Authors: Mudrov Andrej , Jaspart Jean-Pierre , Corman Adrien , Šapalas Antanas
Published: October 2021

Composite steel-concrete columns utilise the advantages of both materials, by combining high strength and ductility of steel with the compressive strength of the concrete. But the wide adaptation of composite structures is limited, mainly because of the lack of cheap and easy to construct connections, as many of which require costly and timeconsuming on-site welding, when circular concrete filled steel tubes (CFST) are adopted. New connections, like those incorporating the use of blind bolts and curved end-plates, may represent a valuable alternative. Such joints can be adapted to circular CFST to eliminate on-site welding, but they require the creation of new curved T-stub components. This paper proposes an analytical model for the evaluation of bolt forces in the curved T-stubs within the elastic range. The model is then validated against experimental results of joints between circular CFST columns and steel beams, with both preloaded and snug tightened bolts. Analytical model shows good agreement with experimental data, but needs further development to take into account the prying forces.
DEVELOPMENT OF AN AGGREGATED SOCIAL INCLUSION INDICATOR. DISPARITIES IN THE EUROPEAN UNION ON INCLUSION/EXCLUSION SOCIAL DETERMINED WITH SOCIAL INCLUSION INDEX
Authors: Paraschiv Dorel-Mihai , Manea Daniela-Ioana , Țițan Emilia , Mihai Mihaela
Published: October 2021

When we mention social inclusion, most of us think of political participation, social rights, civil liberties, equal access to race, ethnicity and gender, access to social services and the labour market, basically to a broader concept than social development. Social inclusion is a concept that can actually be defined, which means it can probably be measured. On this basis, a continuous effort is being made to measure the social inclusion elements, so the results can be used to build new indicators that help measure the multiple dimensions of social inclusion: The Social Inclusion Index, the Human Opportunity Index. This paper presents the development, based on multivariate data analysis techniques and methods, of an aggregated indicator of social inclusion for the member countries of the European Union which, besides the traditional variables (GDP), also measures the factors related to civil and political rights, women’s rights or perception of the LGBT community.
The Attitudes of Nurses in the Hospital toward Vulnerable People
Authors: Mulyani Sri , Suti Lasmani Patricia , David Saifullah Azam , Fawadya Afifah , Iffah Aisyah , Pramestya Shania
Published: October 2021

Background: Vulnerable people are at higher risk for ill health and often experience discrimination in health services. Persons with disabilities, People with Dementia (PWD), and People with HIV/AIDS (PLWHA) are some groups of people with vulnerabilities who often need hospital care. Nurses are the largest group of health personnel and frequently meet with these patients so that the attitude of nurses can have a consequence on the quality of health care. Research Objectives: To identify nurses' attitudes towards vulnerable people and factors related to their attitudes. Methods: This quantitative research used a cross-sectional design. The research subjects were 386 nurses in the main public Dr. Sardjito hospital selected using a convenience sampling technique. Data were collected in January-February 2021 with a Google Form. Researchers used a demographic data questionnaire, an attitude questionnaire (Attitude Toward Disabled Person Scale Form O, Dementia Attitude Scale, and AIDS Attitude Scale), and a knowledge questionnaire (Self-Administered Questionnaire about Knowledge), Dementia Knowledge Assessment Scale, and HIV-Knowledge Questionnaire-18). Data were analyzed using non-parametric statistical tests, specifically the Spearman rank, Mann-Whitney, and Kruskal-Wallis tests. Results: The score of nurses' attitudes towards persons with disabilities was 54.00 out of 120; the score of nurses' attitudes to PWD was 102.00 out of 140; and the score of nurses' attitudes toward PLWHA was -0.65 out of +5. Knowledge, history of interaction, and experience in caring have a significant effect on nurses' attitudes towards vulnerable people (p value <0.05). The education level only affects the attitudes of nurses towards persons with disabilities (p value = 0.042). Family history only affects nurses' attitudes to PWD (p value = 0.013). Age and special education/training only affect the attitudes of nurses on PWD and PLWHA (p value <0.05). Conclusion: Nurses tend to present positive attitudes toward PWD, but nurses are inclined to show negative attitudes against people with disabilities and PLWHA. Knowledge, caring experience, and interaction are confirmed to have an effect on nurses' attitudes with the result that programs to increase knowledge and experience of nurses towards vulnerable groups are recommended for this group. Keywords: Attitude, Dementia, Disability, HIV/AIDS, Knowledge, Nurse.
Epidemiology of Neuromelioidosis in Asia-Pacific: A Systematic Review
Authors: Zamzuri Mohd ’Ammar Ihsan Ahmad , Jamhari Mohd Nazrin , Nawi Haniff Mohd , Hassan Mohd Rohaizat , Pang Nicholas Tze Ping , Kassim Mohd Amiruddin Mohd , Rahim Syed Sharizman Syed Abdul , Jeffree Mohammad Saffree , Lee Shi Yun
Published: October 2021

Introduction: Neuromelioidosis is a rare complication of melioidosis caused by Burkholderia pseudomallei, a Gram-negative bacterium commonly found in soil and surface water. Although cerebral involvement of melioidosis comprises only 4% of total complications, it significantly impacts mortality and morbidity. This study aims to perform a systematic review on various neurological complications of melioidosis in the Asia-Pacific region within the previous 5 years.
Method: Systematic search was performed in PubMed, Web of Science databases and Google Scholar on neuromelioidosis complications published from 2015-2019.
Results: Central nervous system (CNS) complications comprise 5% of all cases of melioidosis. 16 selected articles were analysed based on its risk factors like diabetes mellitus, chronic renal and lung disease, alcohol abuse, and immunosuppression. Neuromelioidosis is detected 6-14 days after the first presentation and confirmed by detailed investigations. Radioimaging helps to differentiate neuromelioidosis from other diagnoses such as meningitis or brain abscess. The majority of literature recommended 2-week intensive Ceftazidime or Meropenem therapy, followed by 3–6 months Trimethoprim and Sulfamethoxazole oral eradication therapy.
Conclusion: Neuromelioidosis is rare, with relatively nonspecific CNS clinical features. Patients or travelers from endemic areas with risk factors should be treated cautiously. Radioimaging modalities aid early microbiological sampling and appropriate antibiotic therapy.
A Simple Way to Reduce the Risk of Being Exposed to COVID-19 Using Instruments for Children
Authors: Sumasto Hery , Subagyo Subagyo , Sugito Bambang Hadi , Purwanto Hadi , Wisnu Nurwening Tyas
Published: October 2021

Background. Children need to get protection during the Covid-19 pandemic, in accordance with Presidential Regulation 12/2020 on The Determination of Non-Natural Disasters. The purpose of the research is to develop non-natural disaster risk instruments for children. Research methods. This type of research is Research and Development. The participant population is divided into 3 roles, Focussed group discussion participants (20 people), instrument testing (267 respondents) and experts (methodology experts and disaster experts). Instrument development is carried out in 5 (five) stages, namely: 1) instrument evaluation; 2) development; 3) experiment; 4) socialization; 5) recommendations. The results showed that from 32 valid items, 25 items were all reliable because the Cronbach alpha value was above 0.7. Not valid for 7 items. The results of the instrument trial of 267 children, who had the potential to be exposed to Covid-19 were 69% who were not exposed to 31%. Of the 69%, strong exposure is 2%, high exposure is 15% and medium exposure is 83%. Conclusion: The developed non-natural disaster risk instrument can be used to assess disaster risk for children. The instrument works well, has efficiency, functionality and usability. Outputs: 1) disaster risk instruments for children; 2) intellectual property rights; 3) publication of international journals 4) monograph books.
A novel biome concept and classification system based on bioclimate and vegetation – a Neotropical assay
Authors: Navarro Gonzalo , Molina José Antonio
Published: October 2021

The knowledge of biomes as large-scale ecosystem units has benefited from advances in the ecological and evolutionary sciences. Despite this, a universal biome classification system that also allows a standardized nomenclature has not yet been achieved. We propose a comprehensive and hierarchical classification method and nomenclature to define biomes based on a set of bioclimatic variables and their corresponding vegetation structure and ecological functionality. This method uses three hierarchical biome levels: Zonal biome (Macrobiome), Biome and Regional biome. Biome nomenclature incorporates both bioclimatic and vegetation characterization (i.e. formation). Bioclimate characterization basically includes precipitation rate and thermicity. The description of plant formations encompasses vegetation structure, physiognomy and foliage phenology. Since the available systems tend to underestimate the complexity and diversity of tropical ecosystems, we have tested our approach in the biogeographical area of the Neotropics. Our proposal includes a bioclimatic characterization of the main 16 Neotropical plant formations identified. This method provides a framework that (1) enables biome distribution and changes to be projected from bioclimatic data; (2) allows all biomes to be named according to a globally standardized scheme; and (3) integrates various ecological biome approaches with the contributions of the European and North American vegetation classification systems.

Taxonomic reference: Jørgensen et al. (2014).

Dedication: This work is dedicated to the memory of and in homage to Prof. Dr. Salvador Rivas-Martínez.
La guerre du Golfe vue de Moscou : la haute précision en ligne de mire
Authors: Marangé Céline
Published: October 2021

La défaite irakienne a été cruelle pour Moscou, révélant le retard militaire accumulé par la Russie. Celle-ci s’est efforcée d’en tirer les leçons pour moderniser son appareil de défense. Les opérations alliées au Kosovo – huit ans plus tard – ont accéléré la prise de conscience par les Russes de leurs lacunes.
La mère de toutes les réformes : la guerre du Golfe et la politique de défense française
Authors: Gautier Louis
Published: October 2021

Après la construction de la dissuasion nucléaire par le général de Gaulle, un des fondamentaux de la V e  République, la guerre du Golfe marque une mutation de la politique de défense de la France. Trente ans après, le cycle de réformes s’achève, obligeant à envisager une nouvelle phase pour le projet stratégique national.
Le financement des armées au sortir de la guerre du Golfe et de la guerre froide
Authors: Malizard Julien
Published: October 2021

La fin de la guerre froide et la guerre du Golfe sont concomitantes. Les budgets consacrés à la défense ont alors entamé une décroissance surnommée « les dividendes de la paix ». Les conséquences pour la France ont été le non-respect des lois de programmation militaire, la baisse et le vieillissement des équipements.
Conclusion : la guerre du Golfe, un événement historique ?
Authors: Bruyère-Ostells Walter
Published: October 2021

La guerre du Golfe est un événement historique, mais qui s’inscrit dans des temporalités différentes en fonction de l’approche retenue. Il y a à la fois des continuités et des ruptures ayant profondément modifié les organisations militaires comme en France. Cela oblige à s’interroger sur les conflictualités d’aujourd’hui.
Quelles formes pour les conflits de demain ?
Authors: Rameau Hervé
Published: October 2021

Les conflits resteront une réalité de demain. Si les formes évolueront en raison des progrès technologiques dont l’intelligence artificielle, la robotisation et le soldat augmenté, les principes de la guerre demeureront tant l’objectif restera la soumission de l’adversaire à la volonté du vainqueur.
Vision stratégique de l’armée belge : l’adaptation (1/2)
Authors: Dumoulin André
Published: October 2021

La Belgique, après avoir largement baissé son effort de défense, a décidé de mettre à jour sa vision stratégique 2030 et de réfléchir aux moyens nécessaires. La principale difficulté sera d’ordre politique avec les choix budgétaires à faire pour redresser une situation très fragilisée dans un pays peu intéressé par sa défense.
Postoperative Use of Blood Flow Restriction in Orthopedics
Authors: Curley Andrew J. , Conroy Christine M. , West Robin V. , Chang Edward S.
Published: October 2021

Blood flow restriction (BFR) therapy is being used more frequently for rehabilitation from orthopedic injuries. Several physiologic mechanisms of action, at local and systemic levels, have been proposed. Numerous studies have investigated the effects of BFR training in healthy athletes; however, limited clinical data exist supporting the use of BFR after surgery. Given that BFR training may facilitate muscle development using low-load resistance exercises, it offers a unique advantage for the post-surgical patient who cannot tolerate traditional high resistance training. [
Orthopedics
. 2021;44(6):e694–e698.]
Platelet-Rich Plasma and Stem Cell Injections in the Treatment of Arthritis of the Knee
Authors: Wei Xuelei , Riehl John T.
Published: October 2021

Platelet-rich plasma (PRP) and stem cell (SC) injections have become increasingly common in the treatment of knee arthritis. This systematic review was performed to answer the following questions: (1) What effects does intraarticular PRP injection have in the setting of knee arthritis? (2) What effects does intra-articular SC injection have in the setting of knee arthritis? (3) What adverse events have been reported in the literature from PRP injections for knee arthritis? (4) What adverse events have been reported in the literature from SC injections for knee arthritis? [
Orthopedics
. 2021;44(6):376–383.]
Septic Arthritis Among Users of Injection Drugs: Clinical Course and Microbial Characteristics
Authors: Mawn J. Gregory , Rao Sandesh S. , Chaudhry Yash P. , Gottlich Caleb , Lobaton Gilberto O. , Sabharwal Samir , Sterling Robert S. , Humbyrd Casey J.
Published: October 2021

Injection drug use (IDU) is a risk factor for septic arthritis (SA) of native joints. Amid the opioid crisis, IDU rates have increased. This study assessed differences in pre-operative characteristics, microbial characteristics, and postoperative outcomes of 177 cases of SA treated operatively from 2015 to 2019 at 3 US hospitals, by self-reported IDU status. Forty cases (23%) involved patients who reported IDU. Patient characteristics, comorbidities, microbial characteristics, duration of hospital stay, discharge destination, follow-up rates, and rates of persistent/secondary infection were compared by self-reported IDU status. Compared with non–IDU-associated SA (non–IDU-SA), IDU-associated SA (IDU-SA) was associated with female sex (
P
=.001), younger age (
P
<.001), lower body mass index (
P
<.001), tobacco use (
P
<.001), and psychiatric diagnosis (
P
=.04) and was more likely to involve methicillin-resistant
Staphylococcus aureus
(
P
<.001). The IDU-SA was associated with discharge to a skilled nursing facility or against medical advice (
P
<.001) and with loss to follow-up (
P
=.01). The 2 groups did not differ in terms of American Society of Anesthesiologists classification, joint involved, Gram stain positivity, presence of bacteremia, peripherally inserted central catheter placement, return to hospital within 3 months, or persistent/secondary positive results on culture within 3 months. Patients with IDU-SA were younger, were more likely to be female, had lower body mass index, and had fewer medical comorbidities but were more likely to use tobacco and to have a psychiatric diagnosis compared with patients with non–IDU-SA. Methicillin-resistant
S aureus
was more common in the IDU-SA group, as was discharge to a skilled nursing facility or against medical advice. Patients with IDU-SA were less likely to return for follow-up than patients with non–IDU-SA. [
Orthopedics
. 2021;44(6):e747–e752.]
Health Literacy and Intercultural Competence Training
Authors: Mavreles Ogrodnick Michelle , O'Connor Mary Helen , Feinberg Iris
Published: October 2021

Intercultural competence (ICC) and health literacy (HL) are vital components of patient education. The purpose of this study was to determine if an educational intervention that combined ICC and HL was effective at changing second-year nursing students' self-efficacy, beliefs, and knowledge. A total of 157 second-year nursing students in two different programs participated in pre- and post-surveys consisting of the Transcultural Self-Efficacy Tool and Health Literacy Beliefs and Knowledge survey. Students attended a two-part lecture with a moderated panel on ICC and health literacy and began clinical fieldwork. Results were analyzed using Wilcoxon signed-rank test and Pearson correlation. There was a statistically significant difference in all ICC subscales after an educational intervention and clinical fieldwork (cognitive
z
= 7.681,
p
< .001; practical
z
= 7.319,
p
< .001; affective
z
= 6.533,
p
< .001). HL knowledge and belief measures showed statistically significant difference after the intervention (
z
= 3.037,
p
< .001). There was a statistically significant correlation between intercultural self-efficacy and HL beliefs (Pearson's
r
= .486,
p
< .001). Self-efficacy in ICC and beliefs and knowledge in HL increased over time for nursing students, indicating that it may be beneficial to train students about these two constructs simultaneously.

[
HLRP: Health Literacy Research and Practice
. 2021;5(4):e283–e286.]
L’ambassadeur de famille, diplomate et courtisan au service des Bourbons
Authors: Lemaigre-Gaffier Pauline
Published: October 2021

Cette contribution étudie le statut d’étranger à la cour de France à travers l’analyse des prérogatives de l’ambassadeur de famille au xviiie siècle. Au titre de ses fonctions de représentant d’un autre souverain de la maison de Bourbon, l’ambassadeur d’Espagne en France pouvait prétendre à un rang qui le distinguait notamment des autres ambassadeurs en atténuant sa qualité d’étranger. En poste entre 1773 et 1787, le comte d’Aranda fit du respect de ces prérogatives dynastiques l’un des objectifs politiques de sa mission. Il s’employa aussi à prolonger son intégration cérémonielle à Versailles par son active participation à la vie mondaine parisienne. C’est ainsi qu’il entendait paradoxalement transcender son statut d’étranger, en s’intégrant le mieux possible à la société de cour française, pour incarner dignement la nation espagnole et en défendre les intérêts.
Robotic enucleation of oesophageal leiomyoma technique and surgical outcomes
Authors: Asaf Belal Bin , Bishnoi Sukhram , Puri Harsh Vardhan , Pulle Mohan Venkatesh , Cerfolio Robert James , Kumar Arvind
Published: October 2021

Introduction:

Complete enucleation of oesophageal leiomyoma is the treatment of choice, traditionally performed by open surgery. Minimally invasive thoracoscopic approaches have been proposed as an alternative to thoracotomy. Robotic surgical systems with improved dexterity, tremor filtration and stereoscopic vision are advancement over conventional thoracoscopy and may make the preservation of mucosal integrity relatively easier. We present herein our technique of robotic-assisted thoracoscopic (RATS) enucleation of oesophageal leiomyoma along with surgical outcomes and intermediate follow-up of 11 cases.

Materials and Methods:

The present study retrospectively reviews patients undergoing robotic portal oesophageal leiomyomectomy from March 2012 to October 2019. The collected data were analysed for demographic details, clinical presentation, size, shape, tumour location, operating time, post-operative complications, length of hospital stay and recurrence on follow-up.

Results:

Twelve patients underwent robotic portal oesophageal leiomyomectomy with a clinical diagnosis of oesophageal leiomyoma. Of these, 11 patients were included in the study. The average operative time was 110 min, with a mean blood loss of 26 ml. There was no conversion in this series. At a median follow-up of 44 months (range 6–78 months), all patients were symptom-free with no recurrence or diverticula.

Conclusion:

Our series demonstrates the safety and feasibility of RATS oesophageal enucleation with good short and intermediate outcomes. In our opinion, the robotic system's technical advantages are particularly beneficial for oesophageal leiomyoma enucleation.
Age-specific serum anti-Mullerian hormone reference values for infertile Filipino women in a tertiary in vitro fertilization center in the Philippines
Authors: Novero. Virgilo M. , Yu Mary Liezl N. , Gamilde Arnel D. , Beramende Rowena B. , Sy Alvin Duke R.
Published: October 2021

BACKGROUND:

Anti-Mullerian hormone (AMH) levels have been used as an invaluable tool in reproductive medicine for over a decade, especially in predicting ovarian reserve and follicular response during in vitro fertilization (IVF) cycles. Age-specific reference values of AMH levels have been derived from mostly Western and few Asian population groups but none from the Philippines. In this study, we attempted to determine the first age-specific AMH reference values from infertile Filipino women to be able to provide local infertility centers a guide in treating Filipinos and those with similar racial and lifestyle characteristics.

MATERIALS AND METHODS:

This was a retrospective cross-sectional study that was conducted at the Center for Advanced Reproductive Medicine and Infertility at St. Luke's Medical Center Global City. Age, serum AMH levels, body mass index (BMI), and cause of infertility of Filipino women who underwent IVF from August 2015 to March 2020 were taken. AMH was assayed using the automated Access AMH Immunoassay (Beckman Coulter).

RESULTS:

A total of 1463 women who underwent IVF and with valid AMH results were initially found but only 1233 were included in the study. Mean age was 36.67 + 4.35 years and mean BMI was 24.43 + 4.14 kg/m2. There was minimal effect of BMI on AMH levels and increasing age (R
2 = 0.0068), but there were significant differences of mean AMH levels among the general causes of infertility. The mean and median AMH values decreased with advancing age (R
2 = 0.1391) although the mean values were consistently higher than the median values. The mean level of the AMH was 2.32 ± 1.90 ng/mL with a 0.16 ng/ml (confidence interval: 0.14–0.19 ng/ml) level decrease per year of increase in age. By age category, the following were the derived AMH values (ng/ml) at the 25th to 75th percentiles: 25–29 = 1.52–4.92; 30–34 = 1.60–4.10; 35–39 = 0.95–3.13; 40–44 = 0.44–1.99; 45 = 0.47–1.08. The mean AMH in this study appears to be similar to several but lower than most other reported AMH nomograms from other population groups.

CONCLUSION:

The first age-specific AMH reference values for infertile Filipino women are presented and may serve as a useful diagnostic marker in local infertility centers, especially those treating Filipino patients or others with similar characteristics.
A deadly twist detorted
Authors: Superable Aries Glenn B. , Lampitoc Meliza M. , Umipig-Guevara Zoraida R.
Published: October 2021

Intestinal obstruction secondary to sigmoid colon volvulus in pregnancy is a rare but serious complication of pregnancy with significant maternal and fetal mortality. We report the first case in this institution of volvulus of the sigmoid colon in a pregnant patient on her 30th week age of gestation that was successfully managed conservatively with flexible colonoscopic decompression and detorsion. The presenting signs and symptoms seen in this patient are the same as with a nonpregnant patient and are often nonspecific. Hence, a high level of suspicion is essential for early diagnosis. Fetal and maternal mortality rates are higher during pregnancy if the diagnosis is delayed.
Tumor recurrence in a previous abdominal incision site in a patient with endometrial adenocarcinoma
Authors: Fernandez Patricia Marie T. , Luna Jericho Thaddeus P.
Published: October 2021

Endometrial cancer is frequently diagnosed at an early stage and exhibits a good prognosis. However, 10%–15% of tumors recur usually within 3 years. Common sites of recurrence are the vaginal vault and pelvis. Only a number of case reports exist for tumor recurrence in a previous incision site. We present a case of a 71-year-old Filipino woman, a diagnosed case of Endometrial Adenocarcinoma Stage III A, FIGO Grade 1, who underwent surgical management, chemotherapy, and radiation therapy 9 years prior, presenting with an abdominal mass at the inferior aspect of the previous surgical scar with the foul-smelling discharge of 1-year duration. Physical examination revealed a 6 cm × 4 cm, friable, movable, nontender abdominal mass, with associated edema of the mons pubis. Surgical resection showed that the mass was confined to the abdominal wall, with no extension beneath the fascia and no evidence of tumor in the pelvic and abdominal cavity. Histological examination revealed a moderately differentiated adenocarcinoma in the abdominal wall, confirming tumor recurrence in an atypical location, probably arising from the previous incision site.
An evaluation of the awareness, perceptions, and practice of ultrasound and the use of telesonography among obstetrics and gynecologic sonologists in the Philippines during COVID-19 pandemic
Authors: Amosco Melissa D. , David-Bustamante Lara Marie G. , Ramos Maria Febi B. De , Cacas-David Ireene G.
Published: October 2021

BACKGROUND:

Major changes in the practice of medicine have been adopted due to the COVID-19 pandemic and have not spared the practice of ultrasound among obstetrician–gynecologists, considered to have higher risk due to unique attributes of an ultrasound examination.

OBJECTIVES:

This study evaluated the awareness, attitudes, perceptions, and practices of the obstetric–gynecologic sonologists in the country during the pandemic, including the use of telesonography.

METHODOLOGY:Adescriptive, cross-sectional survey was conducted through a self-administered, structured questionnaire using an online survey software.

RESULTS:

There were 120 respondents with postresidency training in ultrasound (54.2%) or in maternal and fetal medicine (43.3%), practicing in different regions, and mostly with teaching affiliations (56.7%). Most are aware of the guidelines on the practice of ultrasound this pandemic and they perceived themselves to be especially vulnerable to the infection. They admitted having feelings of stress, sadness, and depression, and their concerns centered on being infected and potentially transmitting it to their family. These perceptions translated to specific practices that include use of level 3 personal protective equipment, patient screening, triaging, and use of physical barriers to minimize environmental and contamination. While most are consistent with guidelines, some practices are neither based on sound scientific evidence nor correctly adhered to, including noncompliance with appropriate ultrasound transducer cleaning and disinfection. Regarding telesonography, only half of the respondents had good knowledge, with most having informal sources of information on the technology. Although the respondents have a good attitude toward it, only a few (15.8%) admitted to using it, mainly to confer with an expert or colleague (38.3%), and for teaching purposes (11.7%).

CONCLUSIONS:

Obstetric–gynecologic sonologists in the Philippines are aware of the risks and have the same attitudes and perspective on COVID-19 infection as other health-care providers. Specific practices have been modified; however, the use of telesonography is not among the changes adopted.
Practice of minimally invasive gynecologic surgery in the Philippines during the COVID-19 Pandemic
Authors: Habana Maria Antonia E. , Aquino-Aquino Prudence V. , Aranzamendez Jennifer A. , Abat Marinella Agnes G. , Alensuela Anna Belen I. , Go-Du Jean S. , Fernandez Ma. Asuncion A. , Tan-Garcia Joan , Tanangonan Gladys G. , Trinidad Anne Marie C. , Sua-Lao Chiaoling
Published: October 2021

OBJECTIVE:

This study aims to establish baseline information on the practice of minimally invasive gynecologic surgery (MIGS) among Filipino gynecologic endoscopists amid the COVID-19 pandemic.

MATERIALS AND METHODS:

An online survey was conducted among Fellows of the Philippine Society for Gynecologic Endoscopy (PSGE) practicing in private and government hospitals in the Philippines after informed consent. The survey had five subsections: (1) demographic data, (2) impact of COVID-19 pandemic on MIGS practice, (3) changes of practice during the COVID-19 pandemic, and (4) changes in the conduct of surgery and postoperative care.

RESULTS:Atotal of 119 out of 144 PSGE Fellows based in the Philippines participated in the survey, 83% were Fellows in both laparoscopy and hysteroscopy. The majority had more than 15 years of practice and were practicing in the National Capital Region. Surgeries were canceled initially but have since resumed. The majority were hysteroscopy cases, the most common being polypectomy. Majority of the respondents reduced their clinic hours and appointments. Most have used telemedicine for consultations. Use of face masks, face shields, and personal protective equipment (PPE) were the top precautions taken in the clinics. Screening and precautions per guidelines inside the operating room setting were observed. Modifications during surgery include the use of smoke evacuators, minimizing energy device use, and wearing enhanced PPE.

CONCLUSION:

The volume of laparoscopy and hysteroscopy cases was greatly reduced during the pandemic. The pandemic has disrupted the practice of MIGS both in the outpatient clinics and the operating rooms. Most of the changes made are congruent to local and international automotive task force guidelines. Precautionary measures and screening procedures must remain in place to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to patients and health-care workers.
Depression, anxiety, and stress levels in pregnant women who do not have access to regular antenatal services due to existing COVID-19 community quarantine measures and their perception on telemedicine
Authors: Acriche Nicole Marie M. , Uyheng Geraldine Isabelle B.
Published: October 2021

BACKGROUND:

The COVID-19 pandemic has brought about mental anguish to the general population. This pandemic has changed the way we deliver healthcare. The enhanced community quarantine measures have caused the institution to close the outpatient department, leading to apprehensions among patients. Shifting to telemedicine to reach out to the patients as an alternative to face-to-face prenatal services is the current practice.

OBJECTIVES:

This study was conducted to assess the level of depression, anxiety, and stress in pregnant women enrolled under obstetric (OB) service who now have no access to regular antenatal services, as well as to determine the acceptance of telemedicine as a satisfactory alternative to regular prenatal visits.

MATERIALS AND METHODS:

This is a descriptive study among patients currently enrolled under OB service in a tertiary hospital in Cebu City and Mandaue City. Respondents have been provided the social media page and given prenatal checks by phone calls from the OB resident doctors since March 2020. A data collection form was filled up online consisting of three parts: (1) the mother's sociodemographic and obstetrical information, (2) a validated tool, the depression, anxiety, and stress-21 scale to assess depression, anxiety, and stress, and (3) query on whether telemedicine has helped alleviate depression, anxiety, and stress.

RESULTS:

Among the 196 patients surveyed, 21.94% were found to be moderately to severely depressed, 35.2% were moderately to severely anxious, and 8.61% were moderately to severely stressed. About 96.43% of the patients felt that telemedicine alleviated depression, anxiety, and stress during this crucial time.

CONCLUSION:

The level of depression, anxiety, and stress among the patients was generally normal or low. However, 21.93%, 35.2%, and 8.61% were found to be moderately to severely depressed, anxious, and stressed, respectively. Telemedicine was found to be a satisfactory alternative to regular prenatal visits. Respondents accepted telemedicine for the following reasons: unwilling to go to the hospital for fear of contracting the virus, fear of certain lockdown measures such as no available public transportation and no crossing of borders were allowed.
Maternal and fetal outcomes of patients referred from primary health-care facilities to a tertiary hospital
Authors: Magno Rhacielle Cristina C. , Octavio Ma. Bernadette R.
Published: October 2021

INTRODUCTION:

There is insufficient local data on the maternal and fetal morbidity and mortality of cases seen initially at the primary health-care facility (PHCF) and subsequently referred to a tertiary hospital for acute management. This study aimed to determine the maternal and fetal outcomes of such patients using the World Health Organization maternal near miss, mortality, and neonatal mortality rates.

MATERIALS AND METHODS:

A cross-sectional study was done that involved obstetric patients beyond 20-week gestation and in the immediate postpartum who were initially managed at the PHCF then referred to a tertiary hospital for management.

RESULTS:

There were 485 deliveries (85.5%) with a primary cesarean section rate of 16.6%. One patient underwent exploratory laparotomy for uterine rupture with extraction of a stillborn baby and hysterectomy. Eighteen cases (3.2%) necessitated other forms of surgical interventions including hysterectomy (6), transverse compression suture (3) with bilateral uterine or hypogastric artery ligation, uterine repositioning (1), evacuation of vaginal hematoma (4), balloon pack insertion (2), postpartum curettage (1), and removal of retained suture needle (1). The maternal near-miss rate is 46.7/1000 live births (46.7%). There were three intensive care unit admissions and 5 cases required ventilatory support. The maternal mortality rate is 10.6 maternal deaths per 1000 live births (1.06%). Majority of the babies had good APGAR scores at birth. Twenty-two babies (4.5%) required intensive neonatal management. The neonatal mortality rate is 0.42% or 4.2/1000 live births.

CONCLUSIONS:

Almost 40% of referred cases were primigravidas and have preexisting medical problems that should not have been seen at the primary care level but directed to secondary or tertiary center at the outset. It cannot be understated that education of the populace, more training, and monitoring the performance of base health facility workers should be done to prevent maternal and fetal catastrophes.
The Effects of the Opioid Epidemic on Prescribing Practices in Long-Term Care Residents
Authors: Yamagishi Lisa , Erickson Olivia , Mazzei Kelly , O'Neil Christine , Kamal Khalid M.
Published: October 2021

OBJECTIVE: Evaluate opioid prescribing practices for older adults since the opioid crisis in the United States.
 DESIGN: Interrupted time-series analysis on retrospective observational cohort study.
 SETTING: 176-bed skilled-nursing facility
(SNF).
 PARTICIPANTS: Patients admitted to a long-term care facility with pain-related diagnoses between October 1, 2015, and March 31, 2017, were included. Residents discharged prior to 14 days were excluded. Of 392 residents, 258 met inclusion criteria with 313 admissions.

MAIN OUTCOME MEASURE: Changes in opioid prescribing frequency between two periods: Q1 to Q3 (Spring 2016) and Q4 to Q6 for pre- and postgovernment countermeasure, respectively.
 RESULTS: Opioid prescriptions for patients with pain-related diagnoses decreased during
period one at -0.10% per quarter (95% confidence interval [CI] -0.85-0.85; P = 0.99), with the rate of decline increasing at -3.8% per quarter from period 1 and 2 (95% CI -0.23-0.15; P = 0.64). Opioid prescribing from top International Classification of Diseases, Ninth Revision
category, "Injury and Poisoning" decreased in prescribing frequency by -3.0% per quarter from Q1 to Q6 (95% CI -0.16-0.10; P = 0.54). Appropriateness of pain-control was obtained from the Minimum Data Set version 3.0 "Percent of Residents Who Self-Report Moderate to Severe Pain (Short
Stay)" measure; these results showed a significant increase in inadequacy of pain relief by 0.28% per quarter (95% CI 0.12-0.44; P = 0.009).
 CONCLUSION: Residents who self-report moderate- to severe pain have significantly increased since October 2015. Opioid prescriptions
may have decreased for elderly patients in SNFs since Spring 2016. Further investigation with a larger population and wider time frame is warranted to further evaluate significance.