bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiencia religiosa e incertidumbre en las sociedades postseculares
Authors: Prades Lopez Javier María , Cantos Aparicio Marcos
Published: March 2018

El artículo analiza algunos estudios sobre la sociedad occidental. La describen como «secular»/«postsecular» y la caracterizan por la «incertidumbre». Situados en este horizonte, y desde una perspectiva de teología católica, se argumentará la necesidad de fomentar «espacios de acción» que posibiliten una personalización de la experiencia religiosa y favorezcan así la promoción humana y social. Se ofrecerán claves antropológicas y epistemológicas para mostrar que, entre estos «espacios de acción», se encuentra el testimonio cristiano personal y comunitario. La conclusión tendrá carácter propositivo, señalando algunas categorías idóneas para la traducción de dichas claves a la vida social.
Dose adjustment of immunosuppressants during co-administration of posaconazole: a systematic review
Authors: Fu Chengcheng , Chen Jia , Xu Yang , Wu Depei
Published: March 2018

Purpose: The purpose of this retrospective study was to analyze the dose adjustment of immunosuppressants (cyclosporine, tacrolimus and sirolimus) for the patients with allogeneic hematopoietic stem cell and solid-organ (heart/lung) transplantation during co-administration of posaconazole.

Methods: MEDLINE, EMBASE and Cochrane Library were searched from January 1, 2000 to June 30, 2017 for clinical reports of patients who received allogeneic hematopoietic stem cell and organ transplantation and were co-administered posaconazole and immunosuppressants (cyclosporine, tacrolimus or sirolimus).

Results: Seven studies were included in the systematic review with a total of 215 patients. Five studies involved hematopoietic stem cell transplant, one heart transplant and one lung transplant. In general, the co-administration of posaconazole with sirolimus, tacrolimus or cyclosporine necessitated immunosuppressant dose reductions to maintain the levels of the drug in the optimal therapeutic range. Reported dose reductions were
50%–68% for sirolimus, 75% for tacrolimus and 14%–49% for cyclosporine. The findings were similar for hematopoietic stem cell, heart or lung transplantation studies.

Conclusion: Our findings indicate that, when posaconazole is co-administered, the dosage of sirolimus and tacrolimus should be reduced by 60%–70% and for cyclosporine and by 30%–40% following allogeneic hematopoietic stem cell and solid-organ transplantation.
MiR-7, miR-9 and miR-375 contribute to effect of Exendin-4 on pancreatic β-cells in high-fat-diet-fed mice
Authors: Guo Chang , Sun Yi-Qiong , Li Qiang , Zhang Jin-Chao
Published: March 2018

Purpose: The purpose of this study was to test whether glucagon-like peptide-1 (GLP-1) receptor activation preserved pancreatic β-cells via the regulation of microRNAs and target genes in high-fat-diet-fed mice.

Methods: C57BL/6 male mice were simultaneously treated with high-fat-diet (HFD) and GLP-1 analogue, Exendin-4 (Ex-4) (3 μg/kg/day or 30 μg/kg/day), i.p. or vehicle, for consecutive 13 weeks. Fasting blood glucose, postprandial blood glucose, ΔI30/ΔG30, HOMA-IR and HOMA-% β were measured in each group. Pancreatic β-cell mass was assessed by immunohistochemistry. The expression of miRNAs and related downstream genes were investigated using quantitative real-time PCR.

Results: Thirteen weeks of Ex-4 treatment significantly reduced body weight and food intake in HFD-fed mice (P
The 2nd Annual Clinical Scientist Trainee Symposium, August 22, 2017, London, Canada
Authors: Yin Charles , Blom Jessica N , Lewis James F
Published: March 2018

Clinician scientists play a critical role in bridging research and clinical practice. Unfortunately, the neglect of research training in medical schools has created clinicians who are unable to translate evidence from literature to practice. Furthermore, the erosion of research training in medical education has resulted in clinicians who lack the skills required for successful scientific investigation. To counteract this, the Schulich School of Medicine & Dentistry has made an effort to engage trainees, at all levels, in the research process.

The 2nd Annual Clinician Scientist Trainee Symposium was held in London, Ontario, Canada on August 22, 2017. Organized each year since 2016 by the Schulich Research Office, the symposium features research being conducted by trainees in Schulich’s Clinical Research Training Program. The focus this year was on the current state of clinician-scientist training in Canada and visions for the path ahead.
PHYTOCHEMICAL SCREENING AND ANTIBACTERIAL ACTIVITY OF LANTANA CAMARA LEAVES AGAINST BACTERIA ISOLATED FROM EPICARP OF SOLANUM MELONGENA (GARDEN EGG)
Authors: K.M. Ibrahim M. M. Shah, U. Abdulmutalib,
Published: March 2018

This research was aimed at testing the antibacterial properties of Lantana camara plant leaves extracts against the bacteria isolated from the epicarp of an unwashed garden egg Solanum melongena fruit. Qualitative phytochemical screening of the plant leaves shows that the plant possesses Tannin, Saponin, Glycosides and Reducing sugar, while Anthraquinones, Alkaloid were absent in all the various extracts used. Three different types of bacteria were isolated from the epicarp of the unwashed fruit sample; they include Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus spp. The minimum inhibitory concentration of the leaf extracts on Pseudomonas aeruginosa were 12mg/mL for the methanolic extract and 48mg/mL for the ethanolic extract. The minimum inhibitory concentration on Streptococcus spp. was 8mg/mL for the methanolic extract and 4 mg/mL for ethanolic extract, while the minimum inhibitory concentration on Staphylococcus aureus was 25 mg/mL for the methanolic extract and 7 mg/mL for the ethanolic extract. Methanolic extracts have the highest activity on Staphylococcus aureus at 8 mg/mL, followed by Pseudomonas aeruginosa at12 mg/mL and the least was on Streptococcus spp. at 25 mg/mL. While with ethanolic extracts, the highest activity was on Streptococcus spp. at 4 mg/mL followed by Staphylococcus aureus at 7 mg/mL and the least was on Pseudomonas aeruginosa at 48 mg/mL. Therefore, Lantana camara leaves contain bioactive compounds believe to have a bactericidal effect at various concentrations species wise.
Effects of green algae, Chlorella Vulgaris, extracts and its bioactive substances on the biofilm-producing microorganism
Authors: Al- Abboodi Ahmed Khayoon Abed , Al- Rubiaee Ghaidaa Husain , Zaki Neihaya Heikmet
Published: March 2018

The current study aims at the in-vitro use of 2 types of extracts of Chlorella Vulgaris, one of the most widely known green algae species in the world, to evaluate their effects on biofilm-producing bacteria. In this study, 7 species of algae were isolated from different environments and then diagnosed according to the sources of green algae and greenish algae. Some of these isolates were proliferated under constant laboratory conditions at 25±2 ̊C, 200μm/m2/sec, and 8:16 hours of light: dark using fixed farms. Then, these species were subjected to 2 types of polycarbonate-based solvents (hexane and chloroform). These extracts were tested on E.Coli, Klebsiella, Acinetobacter, Serratia mesccens, St epidermis, S. aureus, Candida albicans, and Aspergills niger. Using different methods of measuring turbidity of the red agar, micrometer plate, spreading Balacar, the effects of these extracts were examined on these microorganisms. Then, the algae were subjected to vertical chromatography to separate active substances. The hexane-based extract was more effective against E. coli, Acinetobacter, St. aureus. On the other hand, the chloroform-based extract showed slight effects on Acinetobacter and C. albicans. The best inhibitory activities were 30mm for Staphylococcus aureus and Serratia and 25mm for E. coli. The lowest inhibition activity was 15mm for Klebsiella and C. albicans. For the chloroform-based extract, the highest rate of inhibition was 20mm for Klebsiella and S. aureus. The lowest inhibition was 10mm for Acinetobacter and C. albicans. Separation method targeted the hexane-based extraction yielded hxan, gasoline group III ethyl estate, gasoline, group IV ethyl ester, methanol group, and methanol. The hexane + 25 ml of benzene and the fourth group of ethyl ester 25 + methanol showed higher inhibition activities against microbes than that using the other three groups. The hexane-based extracts and the related hexane + 25 ml of benzene and the fourth group of ethyl ester 25 + methanol of C. vulgaris were better than the chloroform-based extracts in their effectiveness against the studied microbes using the turbidity measurement method.

Keywords: Biofilm; Chlorella Vulgaris; Extract effects; Microorganisms
Evaluation of aqueous and hydro alcoholic extracts of Clerodendrum viscosum V. leaves & Macrotyloma uniflorum L. seeds against DMH-induced colon cancer
Authors: Eluru Jagadeesh Reddy , Koumaravelou Kailasam
Published: March 2018

Evaluation of anti-neoplastic activity of aqueous and hydro alcoholic extracts of Clerodendron viscosum V. leaves & Macrotyloma uniflorum L. seeds against DMH-induced colon cancer is the objective of this study. Extracts were obtained using cold maceration process. Six groups of animals, each containing ten male albino wistar rats (80 – 100 g) were administered with respective treatment to evaluate the anti-neoplastic activity. On the last day of experimental period, fecal matter was collected and colons were removed. Fecal matter was homogenized, and subjected to the measurement of fecal pH and bacterial enzymes. Colons of five animals were subjected for the presence of MPLs, ACFs in each colon, and histopathology by using standard methodology. Colons of remaining five animals were subjected to homogenization to measure the bacterial enzymes such as β-Glucosidase, β-Glucuronidase, and mucinase. The extracts showed significant protective effect by showing significant decrease in the levels of fecal and colon β-glucosidase, β-glucuronidase, mucinase; reduction in total number of ACFs in each colon and crypt multiplicity. Although, all the plant extracts has shown protective effect against colon carcinogenesis, treatment with hydro alcoholic extracts has produced more pronounced effect as compared with aqueous extracts.
Multiculturalism in Javanese Humor (A Case in 'Sing Lucu' Rubric of Panjebar Semangat Magazine)
Authors: Suryaningtyas Valentina Widya , Setyaningsih Nina
Published: March 2018

Crystal (1998) points out everyone plays with language or responds to language. We play with language when we manipulate it as a source of enjoyment, either for ourselves or for the benefit of others. We take some words, phrases, sentences, and other linguistic features and make them do things that they do not normally do. This language manipulation can result in humor. Humor has formed a substantial part of Javanese culture. Some jokes in Javanese contain local wisdom and this, according to Bascom (in Wijana, 2003) plays an important role to maintain the social and cultural norms. This paper examines the humor used in Sing Lucu rubric which contains jokes in Panjebar Semangat magazine. In Indonesia, there are only a few printed media that specialize in Javanese language and culture. One of them is Panjebar Semangat. It is a magazine that maintains Javanese culture, especially by the use of Javanese language and Javanese related contents. This paper aims to identify the types of humor and to explore the multiculturalism through the Javanese language expression. This study is framed by drawing on theories on humor, language play, and ambiguity. The result shows that there are three types of humor used in Sing Lucu: positive, negative, and neutral. Positive and neutral jokes have entertaining contents, while negatives jokes contain stereotyping of certain races. Some jokes are not based on facts and therefore they do not always represent certain races stereotyped in such jokes.
Teacher’s Directive Expressions Analysis in English Teaching Classes
Authors: Haryanto Haryanto , Mubarok Husni
Published: March 2018

This paper aimed at finding out the types of teacher‟s directive expressions at two schools and describing the realizations of directive expressions in English teaching. This research was designed as a qualitative and comparative study. The subjects of the research were English teachers at one Senior High School (first School) at Semarang city and one (second school) at Jepara city. The data of this research were gained through recording, observation and interview. The result showed that there were 11 illocutionary kinds found in the teacher‟s directive expressions at the first school, and 8 illocutionary types in teacher‟s directive expressions at the second school. The most illocutionary kind found in the conversation of teaching activity in both schools was question. The directive‟s expression in both schools used direct and indirect utterances. The teachers of first school more often used language instruction in the classroom because they applied varieties of directive expression. Meanwhile, the teachers at the first school used little directive expressions in English teaching because they did not apply varieties of directive‟s expressions. The implication in teaching learning English process is that teacher-centered and student-centered type of learning depends on the frequency of production of directive expressions. More directives the teacher expresses, more center the learning by the teacher. On the other hand, less directives the teacher expresses, less center the learning by the teacher.
EĞİTİM DÜZEYİNİN İŞSİZLİK ÜZERİNDEKİ ETKİSİ GELİŞMİŞ VE GELİŞMEKTE OLAN ÜLKELERİN KARŞILAŞTIRILMASI
Authors: BAĞCI Erdem
Published: March 2018

Bütün toplumlarda,
işsizlik önemli bir makroekonomik sorundur.
Çünkü işsizliğin
sadece ekonomik sonuçları yoktur, aynı zamanda sosyal boyutları vardır. Bu
nedenle işsizlikle mücadele için otoriteler ekonomik ve sosyal politikalar
oluşturmak zorundadırlar. Bu bağlamda, eğitim düzeyini yükseltmek işsizliği
azaltmaya yönelik önemli bir politikadır. Bu durumda, önemli bir soru karşımıza
çıkmaktadır; "aynı eğitim politikaları farklı ülkelerde aynı sonuçları
verir mi ?" Bu sorunun cevabını bulmak için, bu çalışma yapılmıştır.

 

Bu çalışmada,
literatür incelenerek, işsizlik ile eğitim düzeyi arasındaki ilişkiyi inceleyen
yirmi adet çalışma incelenmiştir. Gelişmiş ülkelerde yapılan çalışmalar, eğitim
düzeyi artışının işsizliği azalttığı tespit edilirken, gelişmekte olan
ülkelerde yapılan çalışmalarda ise eğitim düzeyi artışının işsizliği
azaltmadığı tespit edilmiştir. Nitekim gelişmiş ülkelerde eğitim durumuna göre
işsizlik trendleri incelenmiştir ve eğitim düzeyi ile işsizlik arasında negatif
bir ilişkinin olduğu tespit edilmiştir. Aynı şekilde, gelişmekte olan ülkelerde
eğitim durumuna göre işsizlik trendleri de incelenmiştir. Eğitim düzeyi daha
yüksek olan bireylerde işsizlik oranının daha yüksek olduğu tespit edilmiştir.
SOSYAL BİLİŞ TEORİSİ ve PAZARLAMA DİSİPLİNİNDE KULLANIMINA DAİR ÖRNEKLER
Authors: GÖKTAŞ Bora
Published: March 2018

Sosyal biliş
yaklaşımı, insanın çevresinden aldığı verileri zihninde gruplandırdığı, bunları
belli bir şemaya oturttuğu ve böylece işleyip bir bilgi haline getirdiği,
sonrasında da bu bilgiyi yorumlayıp bir davranış göstermesini ifade etmektedir.
Pazarlama ise; müşteriler, alıcılar, paydaşlar ve toplumun tümü için değer
ifade eden önerilerin oluşturulması, iletişimi, ulaşımı ve değişimi için bir
faaliyet, bir dizi kurum ve bir süreçtir. Bu çalışmanın amacı “sosyal biliş
kuramının” pazarlama kavramı içerisinde kullanım alanına ilişkin örnekler
vermektir. Böylece bu yaklaşımın pazarlamada da kullanıldığı gözler önüne
serilerek ülkemizdeki akademik çalışmalarda da faydalanılması için öneri
niteliği taşımaktadır. Çalışma “sosyal biliş teorisi” ve “pazarlama” ilişkisine
yönelik güncel araştırmalardan oluşan bir derlemedir. Derleme olması sebebiyle
de iki kavram arasındaki ilişkiyi sınayacak bir uygulama mevcut değildir. Fakat
araştırmanın son kısmında araştırmacı bu iki kavramı ilişkilendirme gayreti
içine girerek önerilerde bulunmaktadır.  Bu kapsamda incelenen onlarca araştırma
içerisinden 7 adet çalışma araştırma incelemesi olarak belirlenmiştir. Ancak
araştırmacı tarafından önümüzdeki süreçti bu konuyla ilgili olarak uygulamalı
bir çalışma yapılması hedeflenmektedir.
The eristic of newsworthiness in the representation of Barnevernet controversy: A case study of the Norwegian Child Welfare Service
Authors: Szyma Klaudia
Published: March 2018

This study offers a critical evaluation of news values by four selected contemporary media outlets: BBC News, The Federalist, OneEurope and Dagbladet. The material covers the controversy around the Norwegian Child Welfare Service with cases of children being taken away from their families, thus it involves cultural and legal aspects of the issue. The analytic categories are based on news value research guidelines that were introduced in the study by Johan Galtung and Mari H. Ruge (1965). In parallel, the philosophical reference is construed through the works by Artur Schopenhauer and Anton Powell. This, in turn, allows evaluating the language that construes newsworthiness from an eristic perspective. The study demonstrates how the eristic application of news values may influence the fair presentation of an issue, at least when a case is presented as involving a controversy. The focus is on the eristic tools of news value enhancement which lead to channeling consumers’ attention in a desirable manner.
Commitment to the Truth: Parrhesiastic and Prophetic Elements of Paul’s Letter to the Galatians
Authors: Harvey Lexie
Published: March 2018

Paul writes to the Galatians in the New Testament to bridge the two realms of cultural Judaism and Roman Imperialism. In this analysis of the letter written to the church of Galatia, we see both Hebraic prophecy and Greek, or Gentile, parrhesia. As the context shows, Paul attempts to persuade a hybrid audience on the edge between the two ancient cultures. Paul diagnoses the church’s problems through a prognostic teaching that fulfills a larger Pauline gospel agenda. Future scholars will need to attend to the work of both parrhesia and prophetic rhetoric in Christian texts over the two millennia since Paul’s initial fusion.
Ravel’sValses nobles et sentimentalesand its Models
Authors: Puri Michael J.
Published: March 2018

Most commentators have been content to accept Ravel’s claim that the reference to both theValses nobles(D. 969) and theValses sentimentales(D. 779) in the title of hisValses nobles et sentimentales(1911) “sufficiently indicates my intention of composing a series of waltzes in imitation of Schubert,” but this claim does not hold up under scrutiny. Instead, this article seeks to show that theValses nobles et sentimentalesis better understood as a Schumannian piano cycle. As such, the piece is a fascinating attempt at a rapprochement between French Modernism and German Romanticism shortly before the onset of the First World War.
Tonal Ambiguity in Popular Music’s Axis Progressions
Authors: Richards Mark
Published: March 2018

The harmonic progression of aFCG (Am–F–C–G) and its transpositions constitute one rotation of what I callAxis progressions, namely progressions that begin with one of these four chords and cycle through the others in order, hence the Axis-a, -F, -C, and -G, respectively. Of these four progressions, the a-form and C-form, and to a lesser extent, the F-form, have become staples of mainstream popular songs from the last decades of the twentieth century and the first decades of the twenty-first. The a-form is especially noteworthy for being both extremely widespread and tonally ambiguous, in that the perception of its tonality may waver between the major and Aeolian modes. Not only does the progression conflate aspects of the two modes, but it may also vary the degree to which those modes are expressed and their proportion within the progression, resulting in a vast array of possible tonal settings. This article posits that tonality in these settings depends primarily on the melodic content of the progression. A methodology for melodic analysis is then presented and applied to a number of examples of Axis-a (as well as some Axis-F) progressions, to demonstrate how diverse its settings can be.
The Impacts of Reading Recovery at Scale: Results From the 4-Year i3 External Evaluation
Authors: Sirinides Philip , Gray Abigail , May Henry
Published: March 2018

Reading Recovery is an example of a widely used early literacy intervention for struggling first-grade readers, with a research base demonstrating evidence of impact. With funding from the U.S. Department of Education’s i3 program, researchers conducted a 4-year evaluation of the national scale-up of Reading Recovery. The evaluation included an implementation study and a multisite randomized controlled trial with 6,888 participating students in 1,222 schools. The goal of this study was to understand whether the impacts identified in prior rigorous studies of Reading Recovery could be replicated in the context of a national scale-up. The findings of this study reaffirm prior evidence of Reading Recovery’s immediate impacts on student literacy and support the feasibility of successfully scaling up an effective intervention.
Hubungan antara paritas dengan persalinan letak sungsang
Authors: Widia Lidia
Published: March 2018

Abstract: The purpose of this study was to determine the relationshipbetween parity with the layout of Breech Birth on RSUD dr. H. AndiAbdurrahman Noor Kabupaten Tanah Bumbu. This research methodis analytic survey with cross sectional design. The population in thisstudy were all women who registered in the Delivery Room on RSUDdr. H. Andi Abdurrahman Noor Kabupaten Tanah Bumbu with asample of 510 respondents. The sampling technique used is totalsampling and testing data using chi-square test.The results showedrespondents who have breech deliveries of 210 respondents (41.2%)and normal delivery 300 respondents (58.8%). Of Chi-square testobtained There is a significant relationship between parity with breechdeliveries by value Ã± = 0.000. The conclusion of this study therelationship between parity chest with breech deliveries in the DeliveryRoom RSUD dr. H. Andi Abdurrahman Noor Kabupaten TanahBumbu. Suggestions are expected for health workers to providecounseling to pregnant mothers and young checkups on a regularbasis in order to avoid breech.
Hubungan antara perawatan payudara dengan pengeluaran colostrum pada kehamilan trimester III
Authors: Widia Lidia
Published: March 2018

The high number of pregnant women who do not breast care during pregnancy, after childbirth will then encountered problems that harm the mother and the baby. The aim of research to find out if there is a relationship between breast care expenditure colostrum in the third trimester of pregnancy. The research method using the analytic survey with cross sectional approach. The primary data obtained with tools questionnaire answered by all respondents amounted to 29 people. Sampling technique using total sampling, data analysis techniques using Chi-Square. The results of the analysis we found the majority of respondents do breast care, and the majority of respondents spending colostrum. P values obtained value 0,002 <0,05 so Ho rejected, so that there is a very close relationship between breast care expenditure colostrum in the third trimester of pregnancy. The conclusion of this study there is a very close relationship between breast care expenditure colostrum in the third trimester of pregnancy on Poskesdes Kampung Baru. Expected health workers provide counseling to pregnant women about breast care so that colostrum can get out.
Knowledge Regarding Prevention of Mother to Child Transmission of HIV/AIDS among Antenatal Mothers in Nepal
Authors: Acharya Radha , Acharya Trishna , Devkota Ramesh
Published: March 2018

Background & Objectives:Prevention of Mother to child Transmission (PMTCT) is a global intervention which aims at preventing mother to child transmission of Human Immunodeficiency Virus (HIV). The study aims to find out knowledge of pregnant women on Mother to child Transmission (MTCT) of HIV/AIDS (Acquired Immune Deficiency Syndrome).Materials & Methods:A cross-sectional study was carried out at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal among the pregnant women who came to visit Antenatal Clinic. Data was collected using non-probability purposive sampling technique. Face to face interview was done and a structured questionnaire was developed for data collection. Data analysis and interpretation were done in SPSS and MS Excel.Results:The total number of respondents was 80 with a mean age of 27.4 years. 90% (n=72) respondents were found to be literate. 86.3% (n=69) were well aware of the knowledge on PMTCT. Majority of the respondents (40%) mentioned that radio, TV/Media were the main sources of information about HIV/AIDS. Out of 32.5% (26) who had heard about the window period, only 26.9% (n=7) gave the correct answer. 93.8% (n=75) were well known about the routes of transmission of HIV but only 10.1% (n=7) gave the correct answer about it. Further, 54% (n=43) respondents knew about the availability of drugs to reduce MTCT of HIV/AIDS.Conclusion:The level of awareness about PMTCT among antenatal mothers was satisfactory. However, knowledge was inadequate which imparts for the need of health education about MTCT of HIV/AIDS in every health facilities of Nepal.
Effect of Dexmedetomidine on Intraoperative Haemodynamics and Postoperative Analgesia in Laparoscopic Cholecystectomy
Authors: Trikhatri Yojan , Singh Satyendra Narayan , Koirala Siddhartha , Prasad Jagat Narayan , Adhikari Sailesh
Published: March 2018

Background and objectives:Dexmedetomidine is an α2 agonist with sympatholytic, anxiolytic, sedative and analgesic effect used as adjunct during surgeries for its haemodynamic stabilizing effect and analgesic effect. Primary aims of the study were to evaluate the haemodynamic effect of intravenous dexmedetomidine and the duration and quality of analgesia in laparoscopic cholecystectomy. Secondary aims were sedation levels and occurrence of side effects.Materials and methods:Eighty four patients, American society of Anaesthesiologists physical status I and II, aged 18-60 years of either gender undergoing laparoscopic cholecystectomy in general anaesthesia were randomly allocated into two equal groups. Group C patient received Normal Saline and Group S patient received dexmedetomidine loading dose infusion of 1µg/kg over 10 minutes before induction and maintained with 0.4µg/kg/hr till the removal of gall bladder. Induction with propofol and fentanyl was done. Standard monitoring including Heart Rate, Mean arterial pressure, oxygen saturation were monitored perioperatively. Postoperative analgesia requirement and sedation score were assessed.Results: In Group S, the haemodynamic responses were significantly attenuated. During postoperative period, 24 hours analgesic requirement of diclofenac sodium was 141.43mg in group S as compared to 217.50mg in group C(p<0.001). Side effects were treatable. Sedation was better in Group S.Conclusion:Dexmedetomidine effectively attenuates haemodynamic stress response during laparoscopic surgery with reduction in postoperative analgesic requirements.
Demographic Profile of Liver Injury Managed at a Tertiary Care Hospital in Central Nepal -A Retrospective Study
Authors: Belbase Narayan Prasad , Jalan Aditya Kumar , Upadhyay Hari , Mishra Rohit , Karki Mukesh , Kumar Sujit
Published: March 2018

Background & Objectives:The liver is one of the commonly injured solid organ following abdominal trauma. The aim of this study was to determine the outcome of liver injuries managed operatively or non-operatively and predict factors affecting morbidity and mortality.Materials & Methods:This was a retrospective study of 40 liver injuries managed in the department of Surgical Gastroenterology at College of Medical Sciences over a period of 2 years. The liver injury was classified in accordance with the American Association for the Surgery of Trauma liver injury scoring scale. Patients were divided into two groups those managed operatively or non-operatively and were compared in terms of demographic profile and outcome.Results:Forty patients were analyzed. The mean age of the patients was 29.95years. Male predominance was seen with 72.5% of the cases. Road traffic accidents were the commonest mode of injury seen in 72.5% cases. The mean Revised Trauma Score (RTS) and Injury severity score (ISS)  were 7.11and 22.58. The mean systolic BP, hospital stay and ICU stay were 93.80 mm of mercury, 11.55 days and 3.55 days respectively. Twenty six patients (65%) were initially managed non-operatively and 14 patients were managed operatively. Five patients had to be converted to operative management for hemodynamic instability. Mortality was 7.6% in patient undergoing non-operative management and 21.43% in patients managed operatively. Low systolic BP at presentation, low RTS score, high ISS score, high AST, ALT and prothrombin time were significantly associated with operative management and mortality.Conclusion:Patients with hemodynamic instability, low RTS score, high ISS score, high liver enzymes have high likelihood of operative management.
C shaped canal: Variation and Recommendations
Authors: Shrestha Sushmita , Agrawal Navin , Vikram Mannu , Singh Vimmi , Ayer Ashok , Rai Arbind
Published: March 2018

Root canal morphology is not uniform, variations of root canals are routinely encountered by endodontists making the root canal treatment more challenging. C shaped canal is a variation commonly encountered in mandibular second molars. The main identifying feature of such canals is presence of fins or webs interconnecting with the main canals. Such canal systems require meticulous mechanical and rigorous chemical preparation to ensure desired outcome of the treatment. Proper assessment of tooth morphology, preoperative radiograph along with consideration towards racial predilection will greatly help in accurate identification of such canals pre-operatively. This paper reports a case of C shaped canal in mandibular second molar diagnosed and treated taking all the precautions and adapting necessary modifications in the steps of conventional root canal treatment steps where required thus increasing the likelihood of success.
Diabetes and Pancreatic Anastomosis: Friend or Foe?
Authors: Kafle Awaj , Gupta Vikas
Published: March 2018

Background & Objectives:Pancreaticoduodenectomy (PD) has become a standard operative procedure for both benign and malignant lesions of pancreatic head and periampullary region. Pancreatic Fistula (PF) is the most troublesome complication and heralds the development of other complications. The procedure was associated with high morbidity and mortality in the past but with the identification of various risk factors associated with the development of PF, the management has changed dramatically. Similarly, Diabetes mellitus (DM) and poor glycemic control is associated with various adverse postoperative events. So, the objective of this study was to identify the association between DM and postoperative occurrence of PF.Materials & Methods:This was a prospective cross-sectional study enrolling a total of 72 patients. Patients were screened for the presence or absence of DM based on guidelines by American Diabetes Association in January 2009. After surgery, patients were observed for the development of PF. The association between these two was assessed using Chi-Square test.Results:Out of 72 patients, 12 had DM. All the patients who had DM did not develop PF; in contrast 15 patients who developed PF were non-diabetic.Conclusion:Diabetes Mellitus was found to be protective in preventing the occurrence of PF postoperatively.
Outlook of Pharmacoeconomics and its status in Nepal
Authors: Paudel Sabita
Published: March 2018

Pharmacoeconomics is a branch of health economics which is derived from latin word “Pharmacon”- and “Economia”- It deals with the economic aspect of health that is the costs of health services. There are different types of costs which is affecting the health services. There is not only the direct medical cost, but also direct nonmedical cost, indirect nonmedical costs and intangible cost. The consequences of therapy are evaluated from economic, clinical and humanistic perspective, also known as the ECHO model. There are partial and full pharmacoeconomic analyses. The partial analyses are cost of illness and cost of consequence. The full analyses are cost effective, cost benefit, cost utility and cost minimization analyses. The cost effective analysis is the most commonly used analysis.
Predictors of cerebral aneurysm persistence and occlusion after flow diversion: a single-institution series of 445 cases with angiographic follow-up
Authors: Bender Matthew T. , Colby Geoffrey P. , Lin Li-Mei , Jiang Bowen , Westbroek Erick M. , Xu Risheng , Campos Jessica K. , Huang Judy , Tamargo Rafael J. , Coon Alexander L.
Published: March 2018

OBJECTIVE

Flow diversion requires neointimal stent overgrowth to deliver aneurysm occlusion. The existing literature on aneurysm occlusion is limited by heterogeneous follow-up, variable antiplatelet regimens, noninvasive imaging modalities, and nonstandard occlusion assessment. Using a large, single-center cohort with low attrition and standardized antiplatelet tapering, the authors evaluated outcomes after flow diversion of anterior circulation aneurysms to identify predictors of occlusion and aneurysm persistence.

METHODS

Data from a prospective, IRB-approved database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion with the Pipeline embolization device (PED) at the authors’ institution. Follow-up consisted of catheter cerebral angiography at 6 and 12 months postembolization. Clopidogrel was discontinued at 6 months and aspirin was reduced to 81 mg daily at 12 months. Occlusion was graded as complete, trace filling, entry remnant, or aneurysm filling. Multivariate logistic regression was performed to identify predictors of aneurysm persistence.

RESULTS

Follow-up catheter angiography studies were available for 445 (91%) of 491 PED procedures performed for anterior circulation aneurysms between August 2011 and August 2016. Three hundred eighty-seven patients accounted for these 445 lesions with follow-up angiography. The population was 84% female; mean age was 56 years and mean aneurysm size was 6.6 mm. Aneurysms arose from the internal carotid artery (83%), anterior cerebral artery (13%), and middle cerebral artery (4%). Morphology was saccular in 90% of the lesions, and 18% of the aneurysms has been previously treated. Overall, complete occlusion was achieved in 82% of cases at a mean follow-up of 14 months. Complete occlusion was achieved in 72%, 78%, and 87% at 6, 12, and 24 months, respectively. At 12 months, adjunctive coiling predicted occlusion (OR 0.260, p = 0.036), while male sex (OR 2.923, p = 0.032), aneurysm size (OR 3.584, p = 0.011), and incorporation of a branch vessel (OR 2.206, p = 0.035) predicted persistence. Notable variables that did not predict aneurysm occlusion were prior treatments, vessel of origin, fusiform morphology, and number of devices used.

CONCLUSIONS

This is the largest single-institution study showing high rates of anterior circulation aneurysm occlusion after Pipeline embolization. Predictors of persistence after flow diversion included increasing aneurysm size and incorporated branch vessel, whereas adjunctive coiling predicted occlusion.
Natural history of cavernous sinus meningiomas
Authors: Amelot Aymeric , van Effenterre Remy , Kalamarides Michel , Cornu Philippe , Boch Anne-Laure
Published: March 2018

OBJECTIVE

Meningiomas confined to the cavernous sinus (MCSs) are benign tumors. Due to the high risk of severe complications, the intracavernous surgical procedure was abandoned in favor of radiotherapy. However, the choice of treatment remains complicated due to the fact that the natural history of this lesion has not yet been described.

METHODS

The authors studied the natural history of this lesion using a prospective series of 53 consecutive patients suffering from MCSs. The median follow-up duration was 10.2 years (range 2–25 years), from 1990 to 2016.

RESULTS

Patients ranged in age from 30 to 72 years (mean 53 years). The meningiomas were diagnosed by major symptoms (mainly oculomotor palsy and neuralgia experienced in 28 patients), minor symptoms (headache, intermittent diplopia in 15 patients), or incidental findings (10 patients). Simple symptomatic treatment (short courses of corticosteroids and carbamazepine) allowed patients to become asymptomatic in 19 (67.9%) of 28 cases experiencing major symptoms, and for 12 (80%) of 15 patients with initial minor symptoms (p < 0.0001). All patients with incidental findings remained asymptomatic. Forty four (83%) of 53 MCSs did not show any significant growth and 42 (80%) of 53 patients were not symptomatic at the end of follow-up (p < 0.001). The radiographic progression-free survival rates (± SD) at 5, 10, and 20 years were 90% ± 4.2%, 82% ± 5.7%, and 70% ± 10.2%, respectively. Five patients (9.4%) with no evidence of any effect of the initial medical treatment desired additional conventional radiation therapy.

CONCLUSIONS

Because of the capricious, unpredictable, and slow growth of MCSs, together with high growth variability from one patient to the next, the symptomatic medical treatment of these tumors is a highly effective method. This series shows that these lesions are naturally, clinically, and radiologically indolent.
Cardiorespiratory Fitness and Cognitive Function are Positively Related Among Participants with Mild and Subjective Cognitive Impairment
Authors: Stuckenschneider Tim , Askew Christopher David , Rüdiger Stefanie , Polidori Maria Cristina , Abeln Vera , Vogt Tobias , Krome Andreas , Olde Rikkert Marcel , Lawlor Brian , Schneider Stefan ,   on behalf of the NeuroExercise Study Group
Published: March 2018

Background:

By 2030, about 74 million people will be diagnosed with dementia, and many more will experience subjective (SCI) or mild cognitive impairment (MCI). As physical inactivity has been identified to be a strong modifiable risk factor for dementia, exercise and physical activity (PA) may be important parameters to predict the progression from MCI to dementia, but might also represent disease trajectory modifying strategies for SCI and MCI.

Objective:

A better understanding of the relationship between activity, fitness, and cognitive function across the spectrum of MCI and SCI would provide an insight into the potential utility of PA and fitness as early markers, and treatment targets to prevent cognitive decline.

Methods:

121 participants were stratified into three groups, late MCI (LMCI), early MCI (EMCI), and SCI based on the Montreal Cognitive Assessment (MoCA). Cognitive function assessments also included the Trail Making Test A+B, and a verbal fluency test. PA levels were evaluated with an interviewer-administered questionnaire (LAPAQ) and an activity monitor. An incremental exercise test was performed to estimate cardiorespiratory fitness and to determine exercise capacity relative to population normative data.

Results:

ANCOVA revealed that LMCI subjects had the lowest PA levels (LAPAQ, p = 0.018; activity monitor, p = 0.041), and the lowest exercise capacity in relation to normative values ( p = 0.041). Moreover, a modest correlation between MoCA and cardiorespiratory fitness ( r = 0.25; p < 0.05) was found.

Conclusion:

These findings suggest that during the earliest stages of cognitive impairment PA and exercise capacity might present a marker for the risk of further cognitive decline. This finding warrants further investigation using longitudinal cohort studies.
Accessing mobile user’s privacy based on IME personalization: Understanding and practical attacks
Authors: Diao Wenrui , Liu Rui , Liu Xiangyu , Zhou Zhe , Li Zhou , Zhang Kehuan
Published: March 2018

Input Method Editor (IME) is an indispensable component on current smartphones. With its assistance, the number of key presses is reduced, and non-Latin characters could be inputted. Furthermore, modern IMEs integrate several personalized features like reordering suggestion lists and predicting the next words based on user’s input history. Such optimization improves the user experience but turns the IME dictionary into a pool of user privacy. Previous works have discussed the privacy risks coming from malicious IMEs. Indeed, they could cause security and privacy issues if installed by common users, but their impact is limited as the majority of IMEs are well-behaved. However, whether legitimate IMEs are bullet-proof is not answered before.

In this paper, we make the first attempt to study the security implications of IME personalization and the back-end infrastructure on Android devices. In the end, we identify a critical vulnerability lying under the Android KeyEvent processing framework, which can be exploited to launch cross-app KeyEvent injection (CAKI) attack and bypass the app-isolation mechanism. By abusing such design flaw, an adversary can harvest entries from the personalized user dictionary of IME through an ostensibly innocuous app only asking for common permissions. Our evaluation over a broad spectrum of Android OSes, devices, and IMEs suggests such issue should be fixed immediately. All Android versions we examined (from very old 2.3.4 to the latest 6.0.1) and most IME apps we surveyed (11 out of 18) are vulnerable. User’s private information, like contact names, location, etc., can be easily exfiltrated. Up to hundreds of millions of mobile users are under this threat. To mitigate this security issue, we propose a practical defense mechanism which augments the existing KeyEvent processing framework without forcing any change to IME apps.
Risk-aware multi-objective optimized virtual machine placement in the cloud
Authors: Han Jin , Zang Wangyu , Liu Li , Chen Songqing , Yu Meng
Published: March 2018

Cloud computing, while becoming more and more popular as a dominant computing platform, introduces new security challenges. When virtual machines are deployed in a cloud environment, virtual machine placement strategies can significantly affect the overall security risks of the entire cloud. In recent years, the attacks are specifically designed to co-locate with target virtual machines in the cloud. The virtual machine placement without considering the security risks may put the users, or even the entire cloud, in danger. In this paper, we present a comprehensive approach to quantify the security risk of cloud environments from network, host and VM. Accordingly, we propose a Security-aware Multi-Objective Optimization based virtual machine Placement scheme (SMOOP) to seek a Pareto-optimal solution that reduces the overall security risks of a cloud, while considering workload balance, resource utilization on CPU, memory, disk, and network traffic. New placement strategies are designed and our evaluation results demonstrate their effectiveness. The security of clouds could be improved with affordable overheads. The latest VM allocation policies are further studied and integrated into our designs to defeat the co-residence attacks.
Non-Surgical Ablative Treatment of Distant Extracranial Metastases for Renal Cell Carcinoma: A Systematic Review
Authors: Verbiest Annelies , De Meerleer Gert , Albersen Maarten , Beuselinck Benoit
Published: March 2018

Background:

Local ablative treatments of extracranial metastases are increasingly used in renal cell carcinoma (RCC), but their impact on outcome and toxicity remains unclear.

Objectives:

To perform a systematic review on the efficacy and toxicity of stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for the treatment of distant extracranial RCC-metastases.

Methods:

Search strategy: Pubmed, Embase and the national trial register were searched for the combination of metastatic RCC and SBRT or RFA. Eligible studies were original comparative studies with at least 10 patients per treatment arm, published since 2000 and reporting on at least one of: local control, overall or cancer specific survival, symptom control, toxicity. When possible, hazard ratios were calculated from survival curves.

Results and limitations:

No eligible studies on RFA were found. Eight studies on SBRT were included, all were non-randomized and seven were observational. Six included only bone metastases. Radiation regime, treatment site and measured outcomes were heterogeneous and intrinsic risks of bias were high. SBRT, especially single dose 24Gy in the spine, seemed more effective than lower dose SBRT or conventional radiotherapy in achieving local control and pain control. Local control rates were 80–90%. The risk of vertebral compression fracture after SBRT for spinal metastases might be as high as 10–25% or more, especially at higher doses. Other toxicities were mild.

Conclusion:

Due to the poor quality of the existing evidence, no definite recommendations on the use of SBRT in metastatic RCC can be made. SBRT, especially a single high dose, seems well tolerated and efficacious in achieving local control and pain relief, but the risk of vertebral compression fractures in spinal metastases is high. Randomized trials are needed to assess impact on local control, symptom control, survival and toxicity, to determine optimal dosing and assess potential synergistic efficacy or toxicity upon combination with systemic treatment.
Impact of Aspirin and Non-Aspirin Nonsteroidal Anti-Inflammatory Drugs on Outcomes in Patients with Metastatic Renal Cell Carcinoma
Authors: Hamieh Lana , Moreira Raphael B. , Lin Xun , Simantov Ronit , Choueiri Toni K. , McKay Rana R.
Published: March 2018

Background:

Non-steroidal anti-inflammatory drugs (NSAIDs) have demonstrated an anti-tumorigenic effect in several cancers. However, their use is associated with an increased risk in renal cell carcinoma (RCC) and their effect has not been assessed in patients with metastatic disease.

Objective:

We investigated the impact of NSAIDs on survival outcomes in patients with metastatic RCC (mRCC).

Methods:

We conducted a pooled retrospective analysis of 4,736 mRCC patients treated on phase II and III clinical trials. Patients were categorized as: aspirin (ASA) only users, non-ASA NSAIDs only users, ASA and non-ASA NSAIDs users, and NSAIDs non-users. The primary endpoint was overall survival (OS). Progression free survival (PFS), overall response rate (ORR) and adverse events (AEs) were secondary endpoints. OS and PFS were estimated using the Kaplan–Meier method and were assessed using multivariate Cox regression analysis.

Results:

We identified 457 (10%) ASA only users, 639 (13%) non-ASA NSAIDs only users, 61 (1%) ASA and non-ASA NSAIDS users, and 3579 (76%) NSAIDs non-users. OS and PFS were significantly worse in non-ASA NSAIDs users compared to the NSAIDs non-users (OS hazard ratio (HR): 1.47, p < 0.0001, median 11.6 versus 21.1 months; PFS HR: 1.29, p < 0.0001, median 4.6 versus 7.4 months). There was no difference in survival in ASA users or ASA and non-ASA NSAIDs users compared to NSAIDs non-users.

Conclusions:

Our analysis demonstrates that NSAIDs do not confer a survival advantage in mRCC patients. Further studies are warranted to elucidate the interaction of NSAIDS with targeted therapy in mRCC.