bluuebunny/crossref_metadata_2025 huggingface dataset:
Program Layanan Bimbingan Belajar untuk Anak Usia Dini
Authors: Hafidz Nur
Published: April 2021

Tutoring service program for individual assistance in order to overcome problems in children's learning activities so that there are different styles of children's learning in achieving maximum learning performance. Children's tutoring focuses on improving children's learning, children's independent attitudes, children's growth and development, and children's learning achievement. Improving children's learning requires the cooperation of teachers and parents as a source of communication. This program is the first pathway in the Wadas Kelir Play Group non-formal education unit as a child's learning excellence. The organizer of this tutoring service program is the Wadas Kelir Purwokerto Play Group which has programs, orientation services, information services, coaching and distribution, excellence, and learning assistance. The research objective is to find out the aspects of child development through active, educational, and communicative tutoring services programs. So, the achievement of the implementation of tutoring services is having learning resilience in learning habits, such as accustomed to reading or reading books, art school, appreciation of work, and motivation for children's independence. The research method is descriptive qualitative with the subject; classroom teachers, and children involved in learning activities. The research object of the tutoring service program is in the Wadas Kelir South Purwokerto Play Group. The method is by collecting data in the form of documentation, interviews, and observations. As a result, children are confident, skilled in learning, increased language vocabulary, are independent, can read, and have increased reasoning power. From here, the main key to maximum child development is to program children to learn in a fun learning model.
Filsafat Ilmu Pendidikan Islam dalam Perspektif Pendidikan Jasmani
Authors: Budiman Sri
Published: April 2021

Islamic education is a science that teaches people to be better. Humans also need a healthy body to survive. Therefore, it is necessary to study the material on the philosophy of Islamic education in the perspective of physical education. Human beings need knowledge to be able to solve every problem in life. Science that is very closely related to life is the science of Islamic education. Islamic education teaches life in accordance with Islamic values. Leaders in life must have strong physical and health mental to be able the overcome various problems. Efforts in improving physical health can be made by studying physical education. Muslims have long since applied physical education in learning and defending Islam. The religious foundation in physical education based on the Quran and hadith proves that Islamic religious education is interconnected with physical education and complements each other in supporting human life as caliphs on earth.
Recurrent follicular thyroid carcinoma presenting as a cutaneous lesion. An unusual case of pigmented skin lesion.
Authors: Roseman Gerald , Bola Sumrit , Ashman Alexander , Garvie S , Corbridge Rogan
Published: April 2021

Follicular thyroid carcinoma most commonly metastasises to the lungs, liver, and non-cranial bones. Where skin metastases have occurred, this has been in the context of diffuse metastatic disease, and most commonly occur in the scalp. Cutaneous deposits in the neck have been described in papillary thyroid carcinoma, but we believe this to be the first description of cancer recurrence presenting as cutaneous metastatic follicular thyroid carcinoma. A pigmented skin lesion in a patient with a history of thyroid cancer could represent a metastasis and should be treated with suspicion.
AngelChik Device Removal and Revisional Fundoplication
Authors: Chase Hannah , Mastoridis Sotiris , Maynard Nicholas
Published: April 2021

Gastro-oesophageal reflux disease (GORD) is a common condition in developed countries with an increasing incidence in the UK, currently estimated at 5 per 1000 person-years. Risk factors for GORD include Helicobacter pylori infection, obesity, alcohol consumption, smoking and genetic predisposition.  Surgical management is performed in chronic, severe cases of GORD, refractory to medical management.

There are a variety of interventional surgical techniques available and the patient in this case had placement of an AngelChik Device (AD) 30 years ago. This is now a historic device due to associated complications and this patient had it removed with revisional treatment of the patient’s GORD with Nissen Fundoplication. The patient experienced multiple post-surgical complications, namely biliary leak from the central port, pulmonary embolism and pneumonia. Following description of the case, this report will discuss the increasing incidence of late complications of AD and propose a proactive approach to these patients going forwards. It will also discuss the current uncertain evidence of a new surgical intervention called magnetic sphincter augmentation (MSA) of the lower oesophagus that has similar principles to the mechanism of an AD. From this it will emphasise that more stringent and worldwide collaboration is required when bringing a new medical device into clinical care.
A Donor Transmitted Melanoma in Pancreatic Islet Cell Transplantation
Authors: Foord Thomas , Gilbert James , Coupe Nick
Published: April 2021

Transmission of cancer through organ donation is a rare but notable complication of transplantation, affecting 0.05% of transplant recipients in the UK. In this case a metastatic melanoma was transmitted through transplantation of pancreatic islet cells. Current screening practices make cases such as this incredibly infrequent, but the occurrence of such an event can significantly impact the health of the recipient. As the organ donor population increases in age and risk factors for malignancy, decisions around transplantation of high-risk organs may become more common in surgical practice. This case study discusses the genuine risk of donor transmitted cancer to the average transplant recipient and investigates the potential use of additional screening tests to stratify this risk in the future.
Racism in Medicine: Education and Employment
Authors: Hotine Emily
Published: April 2021

There is an ethnicity attainment gap that appears in early education and persists into the senior levels of the NHS. Disadvantage and discrimination is certainly pervasive for Chinese, Pakistani, Bangladeshi and Indian students, but this editorial will focus on how Black students appear to be systematically disadvantaged compared to their white peers, as factors of social and cultural biases and class work to create layers of disadvantage that work against them from their education to their medical careers.

Racism exists in both the UK education system and in healthcare, not only through biases and prejudices, conscious or unconscious, but also through the systemic lack of racial and cultural literacy that exists in those institutions and their practices. Here we consider the ways in which racism presents itself in the journey of a Black doctor, from childhood to employment, and how it may produce this attainment gap.

Because research often groups subjects into a collective BAME category, that term is used here, but care has been taken to disaggregate those groups where possible.
Papyon Modeli Risk Değerlendirme Metodu Kullanılarak Proaktif ve Reaktif Önlemlerin Belirlenmesi, Depo Örneği
Authors: ÇABUK Ahmet , ATALAY Hilal , ERDEM Esin , AKSÖZ Şeymanur
Published: April 2021

İşyeri ekosistemi içerisinde yer alan tüm canlı ve cansız varlıkların sağlık, emniyet ve güvenliğini sağlamak için gerçekleştirilen çalışmalar ve yerine getirilen hizmetler iş sağlığı ve güvenliği olarak tanımlanmaktadır. İş sağlığı ve güvenliğinin amacı çeşitli araçlar kullanılarak ramak kala olay, iş kazası ve meslek hastalığına neden olan tehlikelerin riske dönüşmesini engellemek ve tehlike ile tehlikeden kaynaklı risklerin kontrol altında tutulması, gözden geçirilmesiyle canlı ve cansız varlıkların bedenen, ruhen ve sosyal açıdan iyilik hallerinin korunması ve devamlılığının sağlanmasıdır. İşyerlerinde kullanılan çok farklı risk değerlendirme metotları bulunmakta olup bu çalışmada Bow Tie (Papyon) Modeli hakkında kapsamlı bilgi verilmiş ve papyon modeli kullanılarak yiyecek ve içecek malzemelerinin bulunduğu depoda örnek bir çalışma yapılmıştır. İşyerlerinde iş sağlığı ve güvenliği çalışmalarında kullanılan en temel araç risk değerlendirmesidir. Papyon modeli risk değerlendirme metodu tehlikelerin belirlenmesinden sonra tehlikelerin riske dönüşme-den önce alınması gereken önlem ve uygulanması gereken sınırlayıcı tedbirler ile tehlikenin riske dönüştükten sonra zararın azaltılması ve riskin tekrar etmemesine yönelik önlem ve sınırlayıcı tedbirlerin belirlenmesine yönelik bir çalışma olup depolara uygulanması kolaydır
« Faire société » : récit d’une expérience associative de personnes âgées d’origine chinoise à Paris
Authors: Lui Tamara
Published: April 2021

Partant des résultats d’une recherche-action, l’auteure s’intéresse au profil des personnes âgées immigrées d’origine chinoise à Paris, membres de l’association Chinois de France-Français de Chine , puis s’interroge sur les difficultés spécifiques auxquelles elles font face au quotidien, notamment dans le cadre de leurs démarches auprès des services administratifs. En s’appuyant sur une étude de cas autour de ce groupe social, l’article montre comment les personnes âgées d’origine chinoise cherchent à renforcer leurs pratiques de socialisation au quotidien en apprenant la langue française et en participant à des activités associatives afin d’enrichir leur expérience sociale et de faciliter leur insertion dans le pays d’accueil 1 .
La refonte du règlement sur l'obtention des preuves en matière civile
Authors: Richard Vincent
Published: April 2021

Le règlement (UE) n° 2020/1783 adopté le 25 novembre 2020 procède à la refonte du règlement (CE) n° 1206/2001 relatif à la coopération entre les juridictions des États membres dans le domaine de l'obtention des preuves en matière civile ou commerciale. Les demandes d'obtention de preuves entre les États membres devront désormais privilégier les communications électroniques en s'appuyant sur une solution informatique décentralisée telle que l'e-CODEX. La refonte vise également à renforcer l'attrait du règlement en élargissant la notion de juridiction et en encourageant l'exécution directe des mesures d'instruction par la juridiction requérante.
Compétence pour ordonner la mainlevée d'une saisie conservatoire transfrontière
Authors: Cuniberti Gilles
Published: April 2021

1) L'article 1 er , paragraphe 1, du règlement (UE) n° 1215/2012 du Parlement européen et du Conseil, du 12 décembre 2012, concernant la compétence judiciaire, la reconnaissance et l'exécution des décisions en matière civile et commerciale, doit être interprété en ce sens qu'une action en référé, introduite devant une juridiction d'un État membre, dans le cadre de laquelle une organisation internationale invoque son immunité d'exécution afin d'obtenir tant la mainlevée d'une saisie-arrêt conservatoire, exécutée dans un État membre autre que celui du for, que l'interdiction de pratiquer de nouveau une telle saisie sur le fondement de mêmes faits, et engagée parallèlement à une procédure au fond portant sur une créance résultant du non-paiement allégué de carburants fournis pour les besoins d'une opération de maintien de la paix assurée par cette organisation, relève de la notion de « matière civile ou commerciale », pour autant que cette action n'est pas exercée en vertu de prérogatives de puissance publique, au sens du droit de l'Union, ce qu'il appartient à la juridiction de renvoi d'apprécier. 2) L'article 24, point 5, du règlement n° 1215/2012 doit être interprété en ce sens qu'une action en référé, introduite devant une juridiction d'un État membre, dans le cadre de laquelle une organisation internationale invoque son immunité d'exécution afin d'obtenir tant la mainlevée d'une saisie-arrêt conservatoire, exécutée dans un État membre autre que celui du for, que l'interdiction de pratiquer de nouveau une telle saisie sur le fondement de mêmes faits ne relève pas de la compétence exclusive des juridictions de l'État membre dans lequel la saisie-arrêt conservatoire a été exécutée.
Ordre public international de procédure et étendue des pouvoirs du juge de l'exequatur pour statuer sur des demandes accessoires : nouvelles précisions de la Cour de cassation
Authors: Sindres David
Published: April 2021

En rejetant la demande d'exequatur, sans rechercher, comme il le lui était demandé, si la connaissance par la défenderesse de l'assignation et de l'instance devant la juridiction californienne ne démontrait pas que ses droits au procès équitable et au recours effectif, au sens des articles 6 et 13 de la Convention de sauvegarde des droits de l'homme et des libertés fondamentales, avaient été respectés, nonobstant l'absence de notification des décisions rendues, dès lors qu'elle disposait d'un délai d'un an à compter de la décision pour former un recours, ce dont il résultait qu'au regard des circonstances de l'espèce, les décisions américaines pouvaient ne pas révéler d'atteinte à l'ordre public international de procédure, la cour d'appel a privé sa décision de base légale au regard de l'article 509 du code de procédure civile et des articles 6 et 13 de la Convention de sauvegarde des droits de l'homme et des libertés fondamentales. Le juge de l'exequatur, dont les pouvoirs se limitent à la vérification des conditions de l'exequatur, ne peut connaître d'une demande reconventionnelle en responsabilité fondée sur une faute qui n'a pas été commise au cours de l'instance dont il est saisi .
Les enjeux RH de l’Armée de terre
Authors: Hingray Frédéric
Published: April 2021

L’Armée de terre a un besoin essentiel de ses soldats d’où l’importance de la dimension RH qui doit permettre de préparer les combats de demain. Ces exigences nombreuses s’appuient sur le recrutement, la formation en particulier morale et éthique, et les métiers émergents tout en accroissant la fidélisation.
Savoir, servir, combattre en mer : former les officiers de marine de demain
Authors: Dubs Julien
Published: April 2021

L’École navale doit former les officiers de marine qui agiront demain. Cela nécessite de développer les talents individuels dans un esprit d’équipage. Cela nécessite de durcir la formation en aiguisant les forces morales pour être capables d’affronter les tempêtes dont le combat de haute intensité.
Préparer la ressource humaine de la Gendarmerie aux enjeux d’avenir
Authors: de Oliveira Armando
Published: April 2021

La Gendarmerie a su préserver son identité militaire au service de sa mission quotidienne de sécurité. Cela passe par une préparation innovante de sa ressource humaine, avec en particulier l’émergence de la génération Z, pour répondre aux enjeux de demain dans le champ de la protection de nos concitoyens.
Le plan d’accompagnement des familles et d’amélioration des conditions de vie des militaires 2018-2022
Authors: Cottez Jean-Charles
Published: April 2021

Accompagner les familles – dans toutes leurs diversités – est essentiel pour accroître nos capacités opérationnelles. Cela passe par de nombreuses mesures concrètes au plus près du terrain, les garnisons, afin de répondre aux attentes sociétales du personnel du ministère. Ambition et proximité guident le Plan Famille.
Esprit guerrier et société : du Regimental Spirit à la nation en armes, la tentation d’ Eirene
Authors: Leuenberger Guillaume
Published: April 2021

Les évolutions sociétales contemporaines ont éloigné le spectre de la guerre. Or, la conflictualité reste une réalité de plus en plus polymorphe. Cela oblige à réfléchir au besoin de renforcer l’esprit guerrier et donc la résilience globale de la nation.
L'interdit de l'analogie en droit pénal de l'Union : entre principe de sauvegarde et exigences d'effectivité
Authors: Manzoni Giovanni
Published: April 2021

Résumé Le présent article analyse le statut et les implications de l'interdit de l'analogie en matière pénale au sein du droit de l'Union. Le but de la recherche est de vérifier dans quelle mesure le principe est reconnu en tant que corollaire de la légalité pénale européenne. En particulier, la réflexion se penche sur les tensions potentielles avec des principes majeurs de l'ordre juridique de l'Union, tels que la primauté et l'effet utile.   Abstract Le présent article analyse le statut et les implications de l'interdit de l'analogie en matière pénale au sein du droit de l'Union. Le but de la recherche est de vérifier dans quelle mesure le principe est reconnu en tant que corollaire de la légalité pénale européenne. En particulier, la réflexion se penche sur les tensions potentielles avec des principes majeurs de l'ordre juridique de l'Union, tels que la primauté et l'effet utile. La Cour de justice a reconnu le principe lex stricta comme faisant partie du principe de légalité inscrit à l'article 49 de la Charte, dans une série d'arrêts rendus à propos de directives. Les différentes conceptions de la légalité qui émergent de la culture juridique européenne, tout comme la nature éminemment téléologique du droit de l'Union, se reflètent dans les incertitudes de la jurisprudence de la Cour de justice. L'article s'emploie à approfondir l'analyse de cette jurisprudence au regard de concepts clés : l'obligation d'interprétation conforme par les juges nationaux, les obligations d'effectivité et d'équivalence qui découlent du droit primaire et les limites du pouvoir d'interprétation de la Cour de justice s'agissant des normes européennes appelées à intégrer une disposition d'incrimination nationale. Il est argué que le principe fait partie de la légalité pénale européenne qui reconnaît le rôle primordial et, en principe, exclusif joué par le législateur. Toutefois, en cas de conflit avec d'autres obligations découlant du droit primaire, la portée de la légalité est réduite à un seuil minimal. Ce seuil correspond à celui de la prévisibilité raisonnable élaboré par la Cour de Strasbourg et n'empêche pas une transgression significative de l'interdiction de l'analogie. Des conclusions similaires s'imposent par rapport au respect du principe lex stricta par la Cour elle-même s'agissant de l'exégèse du droit de l'Union.
La rétroactivité des lois pénales de mise en œuvre du Statut de Rome dans le contexte de la République démocratique du Congo : un bon vieux vin dans des outres neuves ?
Authors: B. Mbokani Jacques
Published: April 2021

Résumé Le principe de la non-rétroactivité des lois pénales s'applique-t-il aux lois de mise en œuvre du Statut de Rome lorsque de telles lois incorporent, en droit interne, les crimes visés dans ce texte international ? La question ainsi énoncée se pose de façon particulière dans le contexte de la RDC où, d'un côté, des atrocités graves ont été perpétrées depuis les années 1990 ; et, de l'autre côté, la ratification du Statut de Rome est intervenue en avril 2002 et les lois de mise en œuvre de ce texte international ne sont intervenues qu'en 2015, soit 13 ans après l'entrée en vigueur du Statut de Rome à l'égard de la RDC. Le cadre juridique de la répression des crimes antérieurs tant aux lois de 2015 qu'à la date d'entrée en vigueur du Statut de Rome le 1 er juillet 2002 n'étant pas clairement perceptible dans ce contexte, la présente étude se propose de démontrer que la possibilité de faire rétroagir les lois de 2015 repose (I) sur le caractère purement déclaratif desdites lois et (II) sur le fait que ces lois portent sur des crimes de droit international coutumier dont il existe, à charge de la RDC, une obligation d'en poursuivre les responsables, à défaut de les extrader, même en l'absence d'une législation nationale incriminant de tels comportements.
Synthesis and Piloted Evaluation of Advanced Rotorcraft Response Types Using Robust Sliding Mode Control
Authors: Halbe Omkar , Mehling Tim , Hajek Manfred , Vrdoljak Milan
Published: April 2021

Sliding mode control (SMC) is a promising technique for robust control synthesis with desirable properties. This paper describes the synthesis and piloted evaluation of advanced helicopter response types using the SMC technique. The required closed-loop response characteristics are
specified as ideal, lower order, axial transfer functions that conform to predicted level 1 handling qualities. Two-loop, full-authority, output-tracking SMC laws are then synthesized to enforce the closed-loop performance and accurately track pilot commands. Analytical proofs for SMC gain
tuning are given for the closed-loop performance to remain robust to unknown but bounded uncertainties in the input channels and the effects of rotor modes on closed-loop stability. The closed-loop eigenstructure is nearly identical to the specified closed-loop performance and has good modal
decoupling. Furthermore, a frequency domain analysis with a nonlinear helicopter model shows good stability margins and disturbance rejection characteristics. Finally, the paper reports on simulation testing conducted with four experimental test pilots in a rotorcraft simulation environment.
The simulation results indicate improved mission task performance and handling qualities ratings and a substantial reduction in pilot workload for the SMC-based advanced response types compared to the bare-airframe responses.
Impact of Die Attach Sample Preparation on Its Measured Mechanical Properties for MEMS Sensor Applications
Authors: Misrak Abel , Chauhan Tushar , Bhandari Rabin , Chowdhury A S M Raufur , Lakshminarayana Akshay , Mirza Fahad , Bazehhour B. Gholami , Vujosevic Milena , Agonafer Dereje
Published: April 2021

Computational modeling is often leveraged to design and optimize electronic packages for both performance and reliability purposes. One of the factors that affect the accuracy of computational models is the accuracy of the material properties. Microelectromechanical system sensors, in particular, are usually extremely sensitive to slightest material property changes in the package. Therefore, even small measurement variations in material characterization due to different sample preparation methods or different testing techniques can impact accuracy of computational models that are leveraged for designing or analyzing sensor performance. The challenge in material characterization is even greater for materials that require curing. Die attach polymers, for example, have strict curing profile requirements that are used during the manufacturing process. Such curing conditions are usually hard to duplicate in laboratories, and the samples used for material characterization may not necessarily be representative of the actual component in the final product. In this study, the effect of parameters such as temperature curing profile, application of pressure during curing, and sample preparation technique on temperature-dependent thermomechanical properties of two types of die attach elastomers is investigated. The mechanical properties, including the elastic modulus (E), coefficient of thermal expansion, and glass transition temperature of the die attach material, are measured using a suite of techniques such as dynamic mechanical analysis and thermomechanical analysis. The analysis is performed for a wide temperature range corresponding to typical sensor applications. It is shown that sample preparation and characterization techniques have a considerable impact on the measurements, which results in different MEMS sensor performance predictions through computational modeling.
Effect of Menopause on Arterial Stiffness and Central Hemodynamics
Authors: Solanki Jayesh Dalpatbhai , Bhatt Devanshi Nishantbhai , Patel Ravi Kanubhai , Mehta Hemant B. , Shah Chinmay J.
Published: April 2021

Background:

Menopause, a cardiovascular risk in mid-life women, is studied in terms of blood pressure mostly. Arterial stiffness (AS) and central hemodynamics (CH) are direct surrogates measured by pulse wave analysis (PWA) with no study from our region.

Objective:

We studied AS, CH in relation to menopause using PWA.

Materials and Methods:

A cross-sectional study was performed in 134 middle-aged females divided into groups with or without menopause. Oscillometric PWA done by Mobil-o-Graph (IEM, Germany) gave – AS like augmentation pressure, augmentation index at heart rate (HR) 75, aortic pulse wave velocity (aPWV), and total AS pulse pressure amplification; CH like aortic blood pressure, cardiac output and related parameters, peripheral resistance, stroke work, prevalent brachial/central hypertension, and raised central pulse pressure. They were further compared between groups, in relation to body mass index (BMI) and by multiple regressions with P < 0.05 as statistical significance.

Results:

Postmenopausal women were significantly elder, physically inactive with comparable BMI and showed higher AS (only aPWV was significantly different) and CH. BMI was unrelated to AS or CH in postmenopausal group. Age (except for aPWV), BMI, and HR (except for AIx@75) were insignificant predictors, while systolic blood pressure (SBP) in premenopausal and diastolic blood pressure (DBP) in postmenopausal group was major AS predictors. Age, HR, and BMI were insignificant predictors, while SBP more than DBP was significant predictors of CH.

Conclusions:

In obese, predominantly sedentary midlife Gujarati women, menopause negatively affects AS and hemodynamics, central more than peripheral. Menopause accelerates cardiovascular aging, independent of BMI, and age that calls for further studies.
Perceived Stress and Its Determinants among Postmenopausal Women in Urban Puducherry
Authors: Sarveswaran Gokul , Jayaseelan Venkatachalam , Krishnamoorthy Yuvaraj , Sakthivel Manikandanesan , Arivarasan Yashodha , Vijayakumar Karthiga , Marimuthu Yamini
Published: April 2021

Background:

Menopause characterized by a gradual decline in ovarian hormones takes its toll on the women both physically and mentally. These health problems can negatively impact the mental status. Hence, the current study was done to determine the level of stress and its associated factors among postmenopausal women in urban Puducherry, India.

Materials and Methods:

A facility-based cross-sectional study was done among 219 postmenopausal women attending the outpatient department in urban primary health center during May 2017–June 2017. Information regarding sociodemographic profile was collected using pretested semi-structured questionnaire and Cohen's Perceived Stress Scale was used to assess the stress level. We calculated adjusted prevalence ratios (aPRs) to identify the determinants of stress.

Results:

Among 219 participants, 46.6% were in the age group of 60–74 years; 32.9% had primary to secondary level of education; 56.2% were unemployed; 42.5% belonged to lower socioeconomic class; and 32.9% had both diabetes mellitus and hypertension. The prevalence of stress among the postmenopausal women was 26.0% (95% confidence interval: 20.7–32.2). Postmenopausal woman with higher education (aPR – 2.18), belonging to nuclear family (aPR – 1.93), lesser parity (aPR – 1.18), and current alcohol/tobacco users (aPR-2.32) were found to have a significant association with stress among the study participants.

Conclusion:

The current study showed that more than one-fourth of the postmenopausal women had high to very high level of stress. Education, religion, parity, and substance abuse were the significant determinants of stress. However, further longitudinal research needs to be done to determine whether the factors informed in the current study are truly associated with stress and develop interventions accordingly.
A Mini-Review of Office Hysteroscopic Techniques for Endometrial Tissue Sampling in Postmenopausal Bleeding
Authors: Haimovich Sergio , Tanvir Tanvir
Published: April 2021

Postmenopausal bleeding (PMB) is a common cause for a gynecological visit. Endometrial cancer risk varies from 3% to 25% in women with PMB. There is a significant concern of malignancy of the endometrium and the endocervical canal by a physician in postmenopausal women, and hence, most prefer operating room hysteroscopies with dilation and curettage (D & C) compared to in-office procedures. With increased availablility of miniaturized instruments such as mini- resectoscope and tissue removal systems, there is high likelihood of blind D & C being replaced by hysteroscopic- guided targetted biopsy or visual D & C. The cost-effectiveness of office hysteroscopy is also well demonstrated. In December 2020, an electronic search was performed of PubMed, MEDLINE, and Cochrane Library to look for articles on office hysteroscopic biopsy techniques in postmenopausal women from 2010 to 2020. Relevant studies were included where various office hysteroscopic techniques are used for endometrial sampling in PMB. Studies with 5 Fr scissors, biopsy forceps, crocodile forceps, cup forceps, bipolar electrode, in-office tissue removal system (morcellator), flexible hysteroscope, and mini-resectoscope were included. Standard reference was used as an adequate endometrial sample for histology. The objective of this review is to explore the current evidence on different office hysteroscopic techniques available for endometrial tissue sampling in PMB.

Research Question:

What are the different available in - office hysteroscopy techniques for obtaining endometrial biopsy?

Clinical Importance:

Understanding the adequacy of an endometrial tissue sample obtained by different in - office hysteroscopy techniques and their accuracy by histology.
Robot-Assisted Laparoscopic Approach in a Patient of Zinner Syndrome with Hematuria
Authors: Talwar Harkirat Singh , Mittal Ankur , Kumar Sunil , Panwar Vikas Kumar , Narain Tushar Aditya , Ranjan Rohit , Ranjan Satish Kumar
Published: April 2021

Congenital malformations of the seminal vesicles (SVs) are rare and are often associated with abnormalities of the ipsilateral upper tracts as embryologically both the ureteral buds and SVs arise from the mesonephric ducts. The triad of SV cysts, ipsilateral renal agenesis, and ejaculatory duct obstruction is known as the Zinner syndrome. We herein present the case of Zinner syndrome with hematuria as the mode of presentation. A 52-year-old gentleman presented with complaints of gross and painless hematuria for 3 months. An initial ultrasound revealed absent right kidney with a cystic structure abutting the urinary bladder. Cystoscopic examination revealed a high bladder neck. Magnetic resonance imaging of the abdomen revealed an absent right kidney and a large tubular structure in the region of the right ureter extending up to right SV with blood content and stones within. It was distally seen communicating with one of the cysts of the right SV. The cystic structure was removed with a robot-assisted laparoscopic approach. The console time was 110 min with minimal blood loss. Postoperative course was uneventful. Histopathology of the cyst wall revealed chronic inflammation. The patient is doing well on 6 months follow-up. This case was unique in terms of it presenting with a large intra-abdominal cyst with sharp stones within, probably first of its kind to be ever reported. Surgery is mandated for such symptomatic cysts and the daVinci robot with its minimally invasive approach offers the perfect platform for treating such challenging cases.
Mifepristone in Fibroids
Authors: Shaikh Neelofar , Mehra Reeti , Goel Poonam , Kaur Ravinder
Published: April 2021

Background:

Leiomyomas are the most prevalent benign tumors of the uterus and are seen more with increasing age. 50 mg biweekly dose was compared with 25 mg daily dose in terms of efficacy and safety in symptomatic women as the biweekly dose maybe an economically better alternative. Two different dosages of mifepristone for medical management of fibroids were compared in terms of efficacy and safety in symptomatic women.

Materials and Methods:

Ninety-two women were recruited who fulfilled the criteria after informed consent and were randomized in two groups. Sample size was calculated on the basis of earlier literature, for response in terms of reduction in fibroid volume, assuming 1% level of significance and 95 % power of study, the optimum sample size came out to be minimum 27 in each group. Assuming loss to follow up of few patients, we took 45 patients in group 1 and 47 patients in group 2. Group 1 was given mifepristone in a dose of 25 mg once a day and Group 2 was given mifepristone 50 mg biweekly for 3 months. Fibroid volume, uterine volume, endometrial thickness, pictorial blood loss assessment chart score, hemoglobin levels, and liver transaminases were recorded at the beginning and at the end of treatment. Side effects were noted at the end of the treatment.

Results:

Both the dosages lead to improvement in symptoms of the patients. Mifepristone significantly reduced fibroid volume in both the groups, but the difference between the groups was not significant (P = 0.99). Mifepristone treatment significantly reduced bleeding and increased hemoglobin levels in both the groups. The side effects were mild and tolerable.

Conclusion:

Mifepristone in both dosages is highly efficacious in causing amenorrhea, improving anemia, and enhancing the quality of life, and hence 50 mg biweekly dosage shows potential for being cost efficient.
Trends in dental-related visits to a tertiary hospital emergency department in Saudi Arabia
Authors: Alammar Raghad A. , Alsulaiman Nada A. , Alabdullatif Moath A. , Alwhaibi Abdullah M. , Alkadi Lubna T.
Published: April 2021

Introduction:

Emergency medicine department visits for odontalgia, related to traumatic and non traumatic dental events has seen a shift towards increase in cases. Emergency departments provide palliative care especially for the non traumatic dental injuries Aims: To explore the trends of emergency department (ED) visits for dental-related conditions in Saudi Arabia. The study also aimed to analyze visit management patterns, including procedures, prescriptions, and recall visits.

Materials and Methods:

A cross-sectional retrospective observational study was done using simple random sampling on dental emergency visit data to the ED at hospitals under renowned university of health sciences in Riyadh and Al-Ahsa between January 2016 and May 2019.

Results and Discussion:

A total of 5050 charts were included. An increase in dental emergency visits was observed between 2016 and 2017. Pulpal and periapical lesions were the most frequently diagnosed conditions every year (53.83% of all dental-related ED visits), and traumatic injuries were the least frequently (6.37%) diagnosed condition.

Conclusion:

Dental-related visits to EDs in Saudi Arabia increased remarkably from 2016 to 2019. Pulpal and periapical conditions were the most frequent cause of dental-related ED visits. To ensure better use of ED time and resources, it is imperative to raise public awareness of what types of urgent dental conditions require an ED visit, as well as to increase the number of public health unit dental clinics and their ease of access.
A narrative review of Diabetes mellitus
Authors: AL-Haddad Alaa , Hassona Yazan , Silawi Alia , Al Kayed Awni
Published: April 2021

Introduction:

Diabetes mellitus (DM) is a common metabolic disorder and a leading cause of mortality and morbidity worldwide. Dentists are increasingly encountered with patients affected by this chronic condition.

Aim:

To a review on updates in DM, dental management and emergencies.

Methods:

Database search was carried out in PubMed and Google scholar limited to articles of English language from 1998 to 2021 and pertaining to the keywords diabetes, orofacial manifestations, dental management diabetic emergency. A narrative review of this search is presented in this article.

Results and Discussion:

This article gives a concise update on DM and discuss the management of diabetic patients in a dental setting.

Conclusion:

Discussion of the possible orofacial manifestations of DM and management of diabetic emergencies is emphasized for efficicient dental practice.
Evaluation of practices of self-medication among undergraduate dental students in Riyadh
Authors: Muhammad Umbreen Noor
Published: April 2021

Introduction:

Self-medication (SM) and purchase of over-the-counter medication have been in practice in medical fields. Dental students have the knowledge of pharmacological drugs and they have a higher chance than the population to indulge in SM.

Aim:

The aim of the study was to evaluate the practice, awareness, and attitude of undergraduate dental students toward SM and its relation with gender and to assess whether this practice differs among students of different years of study.

Methods:

A cross-sectional survey was conducted using simple random sampling among undergraduate dental students in a private dental college in Riyadh. A self-designed online questionnaire was used to collect data, which was validated and used for the research

Results and Discussion:

A total of 465 students (31% males and 69% females) responded to the survey. 60% of the students agreed to practice SM and it was significantly (P < 0.05) higher in females than males. With each successive year of study, there was significant decrease (P < 0.05) in the practice of SM and significant increase (P = 0.000) in the level of awareness toward SM. Body aches (57%) and mouth ulcers (35%) were the most common indications to practice SM regarding general and oral health, respectively. Most commonly used medicines were analgesics. Previous experience to treat the same illness was the most common reason for practicing SM, and the primary source of medicine was the medicine present at home.

Conclusion:

More than half of the respondents practiced SM for minor illnesses, and it was higher among females and students of preparatory years. There was less awareness among dental students relating to survey items such as importance of completing the course of medicine and adverse drug reactions. This study highlights the need to develop awareness and interventions to assess this health problem among dental undergraduates.
Diagnosis and treatment for normal pressure hydrocephalus
Authors: Tseng Pao-Hui , Wu Li-Kung , Wang Yi-Cheng , Ho Tsung-Jung , Lin Shinn-Zong , Tsai Sheng-Tzung
Published: April 2021

Idiopathic normal pressure hydrocephalus (iNPH), albeit characterized by gait impairment, cognitive decline, and urinary incontinence, in clinical diagnosis is poorly defined and is usually coexistent with other neurodegenerative diseases. Surgical operation with shunt implantation is the primary treatment but leads to variable outcomes. Recent studies demonstrated that the pathophysiology of iNPH may include both preceding cerebrovascular events and concomitant Alzheimer's dementia or dopaminergic degenerative neuropathology in patients’ brain. These factors not only help differentiate iNPH from its mimics but also associated with the extent of symptomatic improvement after surgery. In this review, we examined these mechanisms underlying the development of iNPH and the beneficial effects of shunt surgery. Furthermore, the increasing identification and importance of biomarkers from cerebrospinal fluid and neural imaging could also predict the responsiveness of treatment. Finally, these progresses suggest that combination therapy would be necessary for iNPH treatment in the future.
Comparing the Effects of Design Thinking and A3 Problem-Solving on Resident Attitudes Toward Systems Change
Authors: Buckley Ryan , Spadaro Anthony , Rosin Roy , Shea Judy A. , Myers Jennifer S.
Published: April 2021

Background

Quality improvement (QI) is a required component of graduate medical education. Many medical educators struggle to foster an improvement mindset within residents.

Objective

We conducted a mixed-methods study to compare a Design Thinking (DT) approach to QI education with a Lean, A3 problem-solving approach. We hypothesized that a DT approach would better promote a mentality of continuous improvement, measured by residents' resistance to change.

Methods

Thirty-eight postgraduate year 2 internal medicine residents were divided into 4 cohorts during the 2017–2018 academic year. One cohort participated in an experimental QI curriculum utilizing DT while 3 control cohorts participated in the existing curriculum based on Lean principles. Participants voluntarily completed a quantitative Resistance to Change (RTC) scale pre- and post-curriculum. To inform our understanding of these results, we also conducted semistructured interviews for qualitative thematic analysis.

Results

The effect size on the overall RTC score (response rate 92%) was trivial in both groups. Three major themes emerged from the qualitative data: factors influencing the QI learning experience, factors influencing creativity, and general attitudes toward QI. Each contained several subthemes with minimal qualitative differences between groups.

Conclusions

This study found similar results in terms of their effect on attitudes toward systems change, ability to promote creative change agency, and educational experience. Despite positive educational experiences, many residents still did not view systems-based problem-solving as part of their professional identity.
Hermeneutic of law and philosophy of jurisprudence
Authors:   International Science Group
Published: April 2021

Collection of scientific articles published is the scientific and practical publication, which contains scientific articles of students, graduate students, Candidates and Doctors of Sciences, research workers and practitioners from Europe and Ukraine. The articles contain the study, reflecting the processes and changes in the structure of modern science.
Modern education, training and upbringing
Authors:   International Science Group
Published: April 2021

Collection of scientific articles published is the scientific and practical publication, which contains scientific articles of students, graduate students, Candidates and Doctors of Sciences, research workers and practitioners from Europe and Ukraine. The articles contain the study, reflecting the processes and changes in the structure of modern science.
Kalsit Mineral Katkılı Orta Yoğunlukta Liflevha (MDF)’nin Yanma Performansının Araştırılması
Authors: ÇAMLIBEL Osman , AKGÜL Mehmet
Published: April 2021

Bu çalışmada, MDF levhaların yangına dayanıklılık özelliklerini arttırmak için kalsit mineralinin MDF üretiminde kullanılma imkanları araştırılmıştır. Yongalar Asplund defibratörde 4 dakika 7.5 bar ve 180ºC sıcaklıkta pişirilmiştir. liflemeden önce % 1,5 sıvı parafin mantarlaşmış yongalara verilmiştir. 1 m³ MDF üretimi için kullanılan lignoselülozik liflerin yerine; %3, %6, %9 oranlarında kalsit minerali üre formaldehite tutkalı ile karıştırılarak blowlinedan liflere verilmiştir. Lifler % 12 rutubete kadar kurutulmuştur. Levhalar 185 °C sıcaklık, 32 kg/cm² basınç ve 270 saniyede sekiz katlı sıcak preste preslenmiştir. Üretilen levhalar 50, 80 ve 120 tane büyüklüğünde zımpara bantları ile zımparalanmıştır. Kalsit katkılı üretilen levhaların yanma testleri; AKY, KKY, KHY, AKY lüks, KKY lüks, KHY lüks, İYB, KHYS, Ağırlık kaybı deneyleri yapılmıştır. Sonuç olarak kalsit mineralleri; levhaların yangına karşı direnç testinde iyi bir performans göstermiştir.
Sonlu Elemanlar Yöntemi ile Dağıtım Transformatörlerinin Harmonik Yük Kayıplarının Analizi
Authors: ÖZÜPAK Yıldırım
Published: April 2021

Transformatörlerde meydana gelen kayıpları tahmin etmek, hem üreticiler hem de kullanıcılar için önemlidir. Teknolojinin gelişmesiyle birlikte güç sistemlerinde harmonikler artmaktadır. Güç sisteminin önemli bir bileşeni olan transformatörler de harmonikli yük akımları taşımaktadır. Çalışma sırasında sıcak nokta sıcaklıklarını ve toplam kayıpları tahmin edebilmek için yük kayıplarını doğru bir şekilde hesaplayabilmek önemlidir. Bu konuda farklı yöntemler geliştirilmiştir. Bu yöntemlerden Sonlu Elemanlar Yöntemi iyi bilinmekte ve doğruluğu mühendislik çalışmalarında kanıtlanmıştır. Transformatör tasarımcıları, tasarım ve analiz için geliştirilen ve kullanılan özel programlara sahiptirler. Bu çalışmada, ANSYS@Maxwell yazılım ve simülasyon programı bir güç transformatörünün parametrik bir modelini tasarlamak için kullanılmıştır. Bu sayede transformatörün hem normal çalışma koşullarındaki hem de harmonikli çalışma koşullarındaki yük kayıpları elde edilmiştir. Ayrıca harmonikli yüklerin manyetik akı dağılımına etkisi incelenmiştir.
Çelik Levhalı Perde-Çerçeve Binaların Dinamik Analizi İçin Bir Yaklaşım
Authors: GÜNGÖR Yasin , BOZDOĞAN Kanat Burak
Published: April 2021

Çelik binalarda depreme karşı kullanılan taşıyıcı sistemlerden birisi de çelik levhalı perde-çerçeve sistemlerdir. 1970’li yıllardan itibaren Amerika, Kanada ve Japonya gibi ülkelerdeki çelik binalarda, çelik levhalı perde duvarlar kullanılmaya başlanmış olup son yıllarda ise kullanımı tüm dünyada yaygınlaşmıştır. Bu bildiride, malzeme ve geometrik özellikleri bina yüksekliği boyunca üniform olan çelik levhalı perde-çerçeve sistemlerden oluşan binaların dinamik analizi için bir yaklaşım önerilmiştir. Çalışmada sürekli sistem hesap modeli, çelik levhalı perde-çerçeve sistemlerin dinamik analizine uyarlanmıştır. Sunulan yöntemle binanın periyot, etkin kütle gibi dinamik karakteristikleri belirlenebildiği gibi, spektral analiz ile tepe noktası deplasmanı ve taban kesme kuvveti de kolay bir şekilde elde edilmektedir. Makalenin sonunda, literatürden alınmış olan bir örnek hem sunulan yöntem ile hem de SAP2000 programı ile çözülmüş ve elde edilen sonuçlar literatürdeki sonuçlarla karşılaştırılmıştır. Sonuç olarak sunulan yöntemin, sonlu elemanlar yöntemine yeter derecede yakın sonuçlar verdiği gözlenmiştir.
Application of Intelligent Optimization Techniques to Spectral and Energy Efficiencies in Massive MIMO Systems at Different Circuit Power Levels
Authors: GÜL Burak Kürşat , TAŞPINAR Necmi
Published: April 2021

In cellular communications, whose usage continues to increase day by day, it is seen as a necessity to increase the area throughput in order to avoid data traffic density problems. For this, it is aimed to increase spectral efficiency by using massive multi-input multi-output systems and also to keep energy efficiency high. It is known that spectral and energy efficiencies can increase with different number of user equipments served in the cell, number of active antennas and values of the transmission power. By using intelligent optimization techniques, optimum combinations of these three variables can be determined and samples with both high spectral and energy efficiencies at the same time can be obtained. In this paper, multi-objective genetic algorithm, multi-objective particle swarm optimization and multi-objective differential evolution algorithm are applied on three different circuit power sets and then results obtained are evaluated.