bluuebunny/crossref_metadata_2025 huggingface dataset:
FAKTOR RISIKO KEJADIAN STUNTING PADA BALITA DI WILAYAH KERJA PUSKESMAS GODEAN I YOGYAKARTA TAHUN 2019
Authors: Rahman Nurdiana
Published: December 2019

Latar Belakang: Stunting adalah malnutrisi kronis yang disebabkan oleh asupan nutrisi yang buruk untuk waktu yang lama karena pemberian makanan yang tidak sesuai kebutuhan gizi. Angka kejadian stunting dapat ditekan dengan pemberian nutrisi yang adekuat sejak masa kehamilan dan 1000 hari pertama kehidupan. Puskesmas Godean adalah Puskesmas dengan prevalensi stunting tertinggi di daerah Sleman pada tahun 2018 yaitu 26,60%.Tujuan: penelitian ini adalah untuk menganalisis hubungan berat lahir, pendidikan ibu, pengetahuan ibu, status gizi ibu, pola pemberian makan, penghasilan keluarga, dan jumlah anak dengan kejadian stunting di wilayah kerja puskesmas Godean I Tahun 2019.Metode: Jenis penelitian ini adalah penelitian survei analitik, dengan desain case control sampel dipilih dengan menggunakan simple random sampling dengan jumlah masing-masing kelompok adalah 37 balita. Populasi pada penelitian ini adalah semua balita usia 24-59 bulan berjumlah 1165 balita di wilayah kerja Puskesmas Godean Kec. Depok Kab. Sleman, Yogyakarta. Analisis data menggunakan uji  Chi Square.Hasil: penelitian menunjukkan bahwa ada hubungan antara berat badan lahir (BBL), (P=0,033, OR= 3,176), penetahuan ibu tentang gizi (P=0,018, OR=3,544), status gizi ibu (P=0,035, OR=3,102), dan pola pemberian makan (P=0,002, OR=5,625) dengan kejadian stunting dan keempatnya adalah faktor risiko stunting. Hasil analisi multivariat menunjukkan bahwa pola makan merupakan faktor yang paling dominan dalam hubungannya dengan Kejadian stunting (P= 0,002, OR=7,660).Kesimpulan: pola makan merupakan faktor yang paling dominan dalam hubungannya dengan Kejadian stunting. Pusat Kesehatan Masyarakat perlu untuk melakukan pendidikan gizi dan memantau status gizi secara teratur dan secara berkala, sehingga bisa dilakukan pencegahan sedini mungkin atau pencegahan stunting pada balita, dan ibu harus lebih aktif mengikuti posyandu untuk memantau proses
UJI KESESUAIAN ALAT DIGITALISASI TFU, PITA UKUR dan HPHT DALAM MENENTUKAN USIA KEHAMILAN PADA IBU HAMIL TRIMESTER DUA DAN TRIMESTER TIGA
Authors: Utami Febi Puji , Wirakusumah Firman F , Wijayanegara Hidayat , Rasyad Adjat Sedjati , Soepardan Suryani , Sutisna Ma’mun
Published: December 2019

Latar Belakang: Estimasi usia kehamilan yang akurat mempengaruhi asuhan kebidanan yang akan diberikan pada ibu dan bayi. Usia kehamilan dapat ditentukan berdasarkan HPHT, gerakan janin, pemeriksaan Leopold, pengukuran TFU, dan USG. Pada penelitian ini usia kehamilan di hitung berdasarkan tinggi fundus uteri menggunakan alat digitalisasi TFU dan pita ukur kemudian setelah didapatkan usia kehamilan di sesuaikan dengan usia kehamilan menurut HPHT.Tujuan: Untuk menganalisis kesesuaian alat digitalisasi TFU, Pita Ukur dan HPHT dalam menentukan usia kehamilan pada ibu hamil trimester dua dan trimester tiga. Metode Penelitian : Pada penelitian ini digunakan metode penelitian yang bersifat observasi analitik dengan pendekatan (potong lintang) dan dianalisis dengan analisis “Uji Kesesuaian” untuk mengetahui seberapa besar metode baru (alat digitalisasi TFU) memiliki kesesuaian dengan pita ukur menggunakan uji kesesuaian kappa. Hasil: Berdasarkan  hasil analisis statistik untuk menguji hipotesis, dapat diketahui bahwa kesesuaian (menggunakan uji kappa) alat digitalisasi TFU dan HPHT sebesar 0.83, uji kesesuaian alat digitalisasi TFU dan pita ukur 0.93, uji kesesuaian pita ukur dan HPHT sebesar 0.76.Kesimpulan: Alat digitalisasi TFU dapat digunakan untuk menentukan usia kehamilan pada ibu hamil trimester II dan trimester III  tanpa harus diketahui HPHT dan Penulis menyarakan agar dapat mengembangkan alat digitalisasi TFU sebagai alat tepat guna dengan melakukan penelitian lebih mendalam menggunakan uji diagnostik oleh peneliti selanjutnya.
财政税收工作存在的问题及改革研究
Authors: 钟 志君
Published: December 2019

财政税收是政府部门的重要财政收入，财政税收工作的顺利实施，有助于社会经济的稳定发展，缩小贫富差距。但是，在新时期的财政税收工作中仍存在一系列问题，文章主要研究了财政税收工作存在的问题及改革。
导航站外聘新员工培训工作总结
Authors: 周 江
Published: December 2019

铱随着社会的不断进步与发展，人才需求量在不断扩大的同时，人才质量也在不断提升，导航站工作作为中国通信事业发展过程中的一个重要环节，在人才培养方面也特别重视。论文根据培训实际情况及相关经验总结，探讨培训工作中的问题，并提出相应的解决措施，通过培训提高新员工业务水平。
大数据时代下企业管理模式创新探究
Authors: 陈 燕 , 韦 玮 , 韩 斌
Published: December 2019

在科学技术水平不断提升的今天，智能终端和互联网实现快速的发展，在对数据监控及应用存储进行分析和研究时，不难发现所涉及的数据量呈现快速的增长态势，海量数据的出现使得数据时代应运而生。为了有效应对来自时代发展的挑战，企业必须要注重管理模式的创新及优化，挖掘其中的经济效益及商业价值，促进管理质量和水平的提升，只有这样才能实现自身的跨越式发展。
ИМПЛИКАЦИЯ СЕМАНТИЧЕСКИХ РОЛЕЙ КАУЗАТОРА И ЭКСПЕРИЕНТА В ВЫСКАЗЫВАНИЯХ С ЭМОТИВНЫМИ ГЛАГОЛАМИ РУССКОГО ЯЗЫКА
Authors: KUKATOVA Olga
Published: December 2019

Статья посвящена различным способам импликации обязательных семантических
ролей Каузатора и Экспериента в высказываниях, содержащих эмотивные глаголы
современного русского языка типа волноваться, тревожиться, беспокоиться,
раздражаться, пугаться, страшиться, ужасаться. Случаи импликации обусловлены как
коммуникативно-прагматическим устройством высказывания, типом и характером
имплицитной информации и фокусом внимания говорящего, так и процессами семантической
деривации.
Импликация семантической роли Каузатора в высказываниях с возвратными
эмотивными глаголами обусловлена 1) коммуникативно-прагматическим устройством вы-
сказывания, а именно: типом и характером имплицитной информации и фокусом внимания
говорящего; 2) процессами семантической деривации. Коммуникативно-прагматическое
устройство высказывания предопределяет тип и характер имплицитной информации, наличие
которой высвечивает роль говорящего / слушающего и невыраженность Каузатора в
высказываниях с исследуемыми глаголами. Семантическая деривация предполагает
употребление глагола в значении 'имитация эмоционального состояния'
Импликация семантической роли Экспериента имеет место реже, чем импликация
семантической роли Каузатора, и обусловлена фокусом внимания говорящего.
Pengaruh Pemberian Emras Terhadap Pertumbuhan dan Hasil Tanaman Buncis (Phaseolus vulgaris L.) pada Lahan Rawa Lebak
Authors: Zarmiyeni Zarmiyeni , Adriani Farida , Majedi Majedi
Published: December 2019

Beans are a kind of edible beans. Beans are rich in protein and vitamins that help lower blood pressure and monitor blood sugar metabolism and are equated with being eaten by those who suffer from diabetes or hypertension. High fiber and enzyme content can help you lose weight. In peanut cultivation it needs to be optimized considering the consumption needs are not comparable with production, One way to increase the productivity of peanut plants is proper fertilization, such as by using organic fertilizers. This study aims (i) to determine the effect of EMRAS on the growth and yield of beans (Phaseolus vulgaris L.) on swampy swamp land. (ii) Getting the best concentration between EMRAS and growth and yield of beans (Phaseolus vulgaris L.) on swamp swamp land. This research was carried out on swamp swamp land in Teluk Buluh Village, Banjang District, Hulu Sungai Utara Regency in May - July 2013, using a Randomized Block Design (RBD), with 6 treatments and 4 replications, resulting in 24 experimental units and each experiment. consists of 2 sample plants, so that the total sample is 48 plants. The factors tested were the provision of EMRAS, e0 = 0% (0 l/beds), e1 = 25% (0,25 l/beds), e2 = 50% (0,5 l/beds), e3 = 75% (0,75 l/beds), e4 = 100% (1 l/beds) and e5 = 125% (1,25 l/beds). The results showed that the observation variables of EMRAS administration affected plant height, number of productive branches, number of pods per plant, and pod wet weight per plant with the best administration at 100% concentration (1 l / bed)
Aplikasi Dosis Pupuk NPK Majemuk terhadap Pertumbuhan dan Hasil Tanaman Semangka pada Lahan Rawa Lebak
Authors: Hidayat Muhammad Rizqillah
Published: December 2019

Watermelon come from arid tropical and subtropical regions of Africa. Watermelon is an annual plant that grows and requires full sun. Lebak swamp soil is known to have the properties and properties of acid sulphate soils that affect the physical, chemical and biological properties of the soil. Fertilizers are the key to soil fertility. Compound fertilizer is a fertilizer that contains several nutrients, for example nutrients (nitrogen), potassium (K) and phosphorus (P). This study aims (i) to obtain influence and (ii) the best dosage of various applications of NPK Compound fertilizer dosage on the growth and yield of watermelon plants on lebak wetland. The study was conducted in Teluk Buluh Village, Banjang District, Hulu Sungai Utara Regency in July - September 2013, this study used a single randomized block design (RBD) with 5 treatments and 5 replications so that there were 25 experimental units. The factors tested were various doses of Compound NPK fertilizer, namely m1: 0.333 t.ha-1 (200 g / bed), m2: 0.666 t.ha-1 (400 g / bed), m3: 0.999 t.ha-1 ( 600 g / bed), m4: 1,332 t.ha-1 (800 g / bed) and m5: 1,665 t.ha-1 (1000 g / bed). The results of this study indicate that the dosage of Compound NPK fertilizer given to watermelon plants in swampland area had a significant effect on plant length and number of leaves aged 25 HST and 30 HST and had a very significant effect on the fruit weight and number of watermelon plants with the best treatment is  m3: 0.999 t.ha-1 (600 g / bed).
Perbandingan Pendapatan Peternak Ayam dan Industri Rumah Tangga (Industri Purun) terhadap Permodalan PUAP Di Desa Panyaungan Kecamatan Amuntai Utara Kabupaten Hulu Sungai Utara
Authors: Fitriannor Rachman , Muzalifah Muzalifah
Published: December 2019

This study aims to find out (i) the total income obtained by respondents seeking broiler chicken livestock (ii) the total income obtained by respondents seeking purun woven industry, (iii) the amount of difference in total income obtained by respondents seeking broiler chickens, with those strive for purun plaited household industry. The results showed that: total costs for broiler chicken farming conducted by respondents in Panyaungan Village, North Amuntai Sub-District, Hulu Sungai Utara Regency, averaged Rp.21,004,932.10. With details of the average cost of fixed costs of Rp.577,744, 60 / period of maintenance and the average variable costs reached Rp.20,427,187.50 / maintenance period. Average revenue of Rp. 23,307,375.00 / peroide of maintenance, with an average profit reaching Rp.2,302,443.00 / maintenance period. While respondents who sought purun matting, the total cost incurred averaged Rp2,053,134.70. Average fixed costs incurred reached Rp.828,010.00 / month, and the average variable costs incurred reached Rp.1,225,125.00 / month. The average income reaches Rp.2,250,000.00 / month, and the average profit obtained reaches Rp.196,685.00 / month. Broiler chicken and purun matting are feasible, because the RCR value of the two types of business is> 1. The RCR value of broiler chicken farming reaches 1,107 and the RCR value of purun plait business reaches 1,096. Thus the farming that is held is feasible to be cultivated, because every sacrifice of Rp. 1.00 will produce Rp. 1,107 and Rp. 1,096.
THE IMPACT OF AUDITING AND INTERNAL CONTROLS ON THE MANAGEMENT OF A BUSINESS ORGANIZATION. A CASE STUDY OF PRUDENTIAL BANK LIMITED (WEIJA BRANCH)
Authors: Acquah Alex , Nsiah Takyi Kwabena , Ofosuhene Ebenezer Yaw , Antie Elizabeth Naa Akushia
Published: December 2019

For system-based auditing to work effectively the auditor will like to rely on internal controls to reduce the volume of substantive testing. It is therefore important for the auditor to examine the internal control practice and procedures that are in place in the client’s business. Where weaknesses are revealed, the auditor recommends ways of improving the systems. This research examines the relationship between some components (risk assessment, control environment and control activate) of internal control systems and the effectiveness of audit program in prudential bank Weija branch. The study exploited information by the help of both primary and secondary data from questionnaires and interview schedules. However, the purposive method of sampling was used in this research work. In all 10 respondents were sampled from the fifty (50) respondents under review. The data captured in this study, was analyzed and interpreted through descriptive method by the help of frequency tables, graphical presentation and tables. Based on the investigations carried, the internal control system was seen to be significant in detection of fraud in banks in Ghana; there is therefore the need for an effective and acceptable internal control structure in banking organizations. It was therefore recommended that Prudential Bank Limited set up internal audit units at their various branches all over the country, so that there shall always be internal audit personnel to ensure adherence to the internal controls that exist in the organization. In view of this, the internal audit personnel should also be revolved at regular intermissions to prevent any form of professional misconducts.
Percepción docente sobre la relación maestro-alumno en escuelas secundarias
Authors: Barrios Gaxiola Melanie Itsel
Published: December 2019

Debido a que el trabajo con adolescentes en escuelas secundarias es de suma importancia en educación básica, los maestros deben percatarse de las características y comportamientos que se presentan en la adolescencia para definir las estrategias a implementar durante su enseñanza. Por esta razón, el objetivo es conocer la percepción del docente de secundaria acerca de la rela- ción que existe entre el maestro y el alumno. Tanto el desempeño del maestro como la importancia que el alumno otorgue a la asignatura guiarán a este último hacia la obtención de un aprendizaje significativo. Por medio de estas expectativas, se concluyó que la mayoría de los profesores tratan de mejorar este tipo de relación, sin embargo, hoy en día éste todavía no es el adecuado ya que la etapa de la adolescencia, la gran cantidad de alumnos por grupo y el tiempo son factores negativos que influyen en dicho aspecto. Por lo tanto, se recomienda que el maestro ponga en práctica sus habilidades para mejorar la interacción y convivencia dentro del aula escolar con el propósito de generar en los alumnos motivación e interés por aprender.
La construcción del personaje femenino en La Regenta de Leopoldo Alas
Authors: Osuna Osuna Gabriel
Published: December 2019

En el presente artículo me propongo describir algunos elementos que considero de singular importancia para comprender por qué Leopoldo Alas construyó el  personaje de Ana Ozores en La Regenta (1884-1885) con características que aún hoy siguen llamando nuestra atención y que coinciden en buena medida con los postulados del naturalismo. Para llevar a cabo tal descripción, analizaré la idea de la sexualidad en la configuración del personaje y cómo el determinismo lleva a concebir a la protagonista de esta novela como paradigma del problemático binomio belleza/sino trágico, que se observa sobre todo en su imposibilidad para ser feliz y también en su destino final relacionado con la soledad y el aislamiento.
Der Gentrifizierungsbegriff in wohnungspolitischen Protesten
Authors: Vollmer Lisa
Published: December 2019

In diesem Beitrag wird die Rolle und Funktion des Begriffs Gentrifizierung in sozialen Bewegungen reflektiert. Das wissenschaftliche Konzept Gentrifizierung, und seine Popularisierung durch kritische Wissenschaftler*innen in Deutschland, hat ohne Zweifel der Mieter*innenbewegung wichtige Anhaltspunkte für die Interpretation ihrer Protestanlässe, die entwickelten Erzählungen und Strategien geliefert. Die Auswirkungen der unternehmerischen Stadt sind in Groß- und Mittelstädten, in boomenden oder peripherisierten Nachbarschaften ähnliche, ebenso die Verwertungsstrategien bestimmter Wohnungsmarkakteure. Taugt der Begriff Gentrifizierung also zur Vergemeinschaftung innerhalb der Mieter*innenbewegung? Oder zieht er nicht gerade Grenzen zwischen eigentlich ähnlichen Hintergründen?
„Es macht einfach Sinn!”
Authors: Holm Andrej
Published: December 2019

Neil Smith (1954-2012) hat eine ganze Generation von Stadtforscher*innen geprägt, die sich selbst in städtische Konflikte begeben und in den letzten 40 Jahren versucht haben, soziale Mobilisierungen gegen Aufwertung und Verdrängung zu unterstützen. Sein eigenes Schreiben war über viele Jahre mit seinen politischen Aktivitäten verbunden und hat vielen stadtpolitisch Aktiven geholfen, die Analyse städtischer Konflikte vom Kopf auf die Füße zu stellen. Der Text hebt die Bedeutung der Rent-Gap-Theorie für die Gentrification-Forschung hervor und zeigt, dass Gentrification nicht nur im Stadtraum, sondern auch in den wissenschaftlichen und politischen Debatten umkämpft ist.
Ghettos am Rande der Stadt?
Authors: Fleischer Friederike , Hurtado Tarazona Adriana , Alvarez Rivadulla Maria Jose
Published: December 2019

Konfrontiert mit kontinuierlich wachsender Nachfrage nach preiswertem Wohnraum, begann die Regierung Kolumbiens in den 1980er Jahren mit einer neuen privatisierten Wohnungsbaupolitik, die Hauseigentümerschaft ermöglichen und fördern soll. Dazu wurden staatliche Subventionen und spezielle Hypotheken für die unteren Einkommensklassen geschaffen, sowie Preislimits und Steuerfreiabkommen für die privaten Baufirmen eingeführt. Besonders seit der Baukrise zu Beginn des Jahrtausends setzen private Konstruktionsfirmen auf den sozialen Wohnungsbau. Seitdem entstehen massenweise großflächige, standardisierte Wohnsiedlungen an den Rändern Bogotás. Bewohner_innen sind Niedrigverdiener_innen, die zuvor in informellen Siedlungen lebten. Für die staatlich subventionierten Hypotheken, mit denen sie sich einkaufen, müssen Käufer_innen ein festes Arbeitsverhältnis nachweisen, was die Hälfte der kolumbianischen Bevölkerung ausschließt. Basierend auf mit diversen Forschungsmethoden in neun verschiedenen Sozialwohnungsbaugebieten erhobenen Daten, analysieren wir in diesem Artikel die gegenwärtige Wohnungsbaupolitik Kolumbiens und ihre Folgen. Wir argumentieren, dass die neue Politik tatsächlich mehr Menschen Zugang zu Eigentumswohnungen verschafft. Gleichzeitig zeigen wir, dass ohne weiterreichende soziale Reformen die Gefahr besteht, dass sich die isoliert liegenden Wohnsiedlungen in urbane Ghettos verwandeln, die ihre Bewohner_innen weiterhin stigmatisieren. Zugang zu Bildung, Jobs, Kultur und anderen urbanen Ressourcen ist notwendig, um langfristige soziale Mobilität zu ermöglichen bzw. zu garantieren.
Campus Bockenheim Revisited
Authors: Noeske Jannik
Published: December 2019

Jürgen Schardt legt eine umfassende Studie zur Architektur der Stadt- und Universitätsbauten in Frankfurt am Main von 1906 bis 1956 vor. Besonderer Schwerpunkt liegt dabei auf den gesellschaftlichen und politischen Rahmenbedingungen der Architekturproduktion und einer kritischen Revision der etablierten Historiografie der Goethe-Universität. Der Autor widmet sich in drei Teilen jeweils dem Kaiserreich und der Gründung der Hochschule im Jahr 1914, der Zeit der Weimarer Republik sowie der Jahre des Aufbaus nach dem Zweiten Weltkrieg. Schardt untersucht die entstandenen Gebäude hinsichtlich schlüssiger Kriterien bürgerlicher Architektur, beleuchtet aber auch andere für die Hochschulgeschichte relevante Rahmenbedingungen. Die lesenswerte Studie verbindet dabei Aspekte der Sozial-, Wissenschafts- und Architekturgeschichte.
RISK FACTORS FOR THE DEVELOPMENT OF INITIAL MANIFESTATIONS OF ATHEROGENIC CARDIOVASCULAR DISEASES IN PERSONNEL OF CHEMICALLY HAZARDOUS FACILITIES
Authors: Gorichny V. A. , Serdukov D. Yu. , Yazenok A. V. , Nosov A. V. , Zagorodnikov G. G. , Lazarenko D. Yu. , Vetoshkin S. L.
Published: December 2019

An outpatient examination of 530 employees engaged in work with chemical weapons related to organophosphorus compounds at chemically hazardous facilities was carried out. Risk factors for the development of cardiovascular diseases of atherogenic etiology among personnel of the facilities were studied in relation to the type of work performed using statistical analysis methods. When assessing the lipidogram, a high incidence of atherogenic dyslipidemia in a group of personnel involved in the storage of chemical weapons was found out in comparison with a group of people engaged in the destruction and control of chemical weapons (73.1 vs 61.2 vs 59.6%, p
MODERN METHODOLOGICAL APPROACHES TO THE EXPERIMENTAL SUBSTANTIATION OF THE PERMISSIBLE CONTENT OF ODOROUS SUBSTANCES IN THE AMBIENT AIR
Authors: Budarina O. V. , Pinigin M. A. , Fedotova L. A. , Sabirova Z. F. , Potapchenko T. D.
Published: December 2019

The paper presents an overview of the main methodological approaches in experimental standardization of odorants (or mixtures of odorants) in the ambient air according to «obsessive» odor inadmissibility as a limiting criterion for justification of Maximum allowable concentration (MAC maximum one time dose) . It is shown that the developed procedure of establishing a permissible content of those substances is based on estimating the relationship «concentration – odor sensation probability of different intensity» (olfactory-odorimetry), using a common scoring of smell intensity and modern olfactometry equipment. Justified normative values are harmonized with international criteria for air quality including epidemiological studies-based levels established for odors with various qualitative characteristics. Their implementation will ensure the protection of the population from «obsessive» odor.
Penerapan Perawatan Payudara pada Pasien Post Natal Care (PNC) terhadap Keberhasilan Menyusui
Authors: Lestari Ani , Atoy Lena , Taamu Taamu
Published: December 2019

Post Natal Care dimulai sejak 2 jam pertama setelah lahirnya plasenta sampai dengan 6 minggu/42 hari setelah itu. Selama masa nifas, ibu akan mengalami perubahan fisiologis. Perubahan terjadi pada sistem reproduksinya. Perubahan pada sistem reproduksi tersebut diantaranya adalah payudara (mamae), involutio uterus, pengeluaran lokia, perubahan pada endometrium, serviks, vulva dan vagina, dan pada perineum. Data menunjukkan jumlah persalinan normal pada tahun 2015 jumlah ibu nifas sebanyak 589 orang (64%), tahun 2016 jumlah ibu nifas sebanyak 931 orang (65%), tahun 2017 sebanyak 1.230 orang (67%), tahun 2018 sebanyak 804 orang. Studi kasus ini bertujuan untuk mengetahui keberhasilan penerapan perawatan payudara terhadap keberhasilan menyusui maternal pada pasien Post Natal Care (PNC). Desain studi kasus ini adalah menggunakan desain penelitian deskriptif dengan bentuk penerapan studi kasus dengan subjek studi kasus menggunakan satu orang pasien sesuai dengan kriteria inklusi dan eksklusi yang telah ditetapkan. Data diperoleh dengan pengkajian dan wawancara secara langsung kepada pasien serta dokumen-dokumen yang ada Di Rumah Sakit. Hasil studi kasus ditemukan bahwa penerapan perawatan payudara efektif dalam meningkatkan volume produksi ASI yang keluar. Bagi Rumah Sakit diharapkan dapat menambah dan mengembangkan ilmu yang sudah ada serta meningkatkan mutu pelayanan kesehatan khususnya untuk penerapan perawatan payudara pada Ibu Post Partum dengan masalah payudara dan ASI.
ROLE OF INTEGRATED PET/CT IN DETECTING RECURRENT OVARIAN CANCER IN PATIENTS WITH RISING CA-125 LEVELS
Authors: Naz Fozia , Murtaza Ahmed , Mufti Khurram A , Faruqui Zia S. , Bashir Humayun
Published: December 2019

Purpose: The purpose of this study was to assess the sensitivity and diagnostic accuracy of integrated positron emission tomography/computed tomography (PET/CT) in detecting recurrent ovarian cancer in treated patients presenting with rising CA-125 levels during clinical follow-up and compare it with those of CT alone. Materials and Methods: This was a retrospective study. We evaluated 45 patients with pathologically proven ovarian carcinoma who underwent PET/CT during October 2010–November 2013 at our institution for suspected relapse; IRB deemed that approval for this retrospective study was not required. Of these, 35 patients who presented with rising CA-125 levels during clinical follow-up were included in this study. Remaining 10 patients were excluded as they had normal CA-125 levels. At least three previous consecutive CA-125 readings and initial conventional imaging before uorodeoxyglucose-PET/CT were noted. Sensitivity and diagnostic accuracy for tumour detection with PET/CT and CT alone were calculated; histological analysis after biopsy/second look surgery or clinical- radiologic follow-up/response to chemotherapy was taken as reference standard. K statistics (Cohen K) was used for statistical analysis. Results: Of 35 patients with suspected relapse, one patient was lost to follow up. 30 patients were documented to have relapsed, while in four patients, recurrence was not identi ed either on CT or PET-CT and they were proved to be disease free on 2-year follow-up. Amongst these relapsed patients, 10/30 cases were proven histologically, 3 with imaging-guided biopsy and 7 with second-look surgery, whereas 20/30 were con rmed on clinical/radiological follow-up (ranging from 3 to 6 months) or by response to chemotherapy on subsequent imaging. Of 30 patients with relapse, PET-CT highlighted recurrence in 27. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of integrated PET/CT were calculated to be 90%, 75%, 96%, 50%, and 88%, respectively. CT alone detected recurrence in 20 patients. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of CT were calculated to be 73.3%, 100%, 100%, 33%, and 76%, respectively. Conclusion: PET/CT is a highly sensitive and accurate post-therapy surveillance modality for the detection of recurrent ovarian cancer in patients with rising tumour markers as compared to CT alone. Key words: CA125, uorodeoxyglucose, ovarian cancer, positron emission tomography/computed tomography, recurrence
USE OF PEG SITE FOR SPECIMEN RETRIEVAL AND EXTRACORPOREAL GASTRIC CONDUIT FORMATION, IN MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Khan Misbah , Urooj Namra , Syed Aamir A , Khattak Shahid , Muzzafar Anam , Ashraf Ijaz
Published: December 2019

Purpose: Purpose of the present study is to report our technique of the use of percutaneous endoscopic gastrostomy (PEG) site excision biopsy wound, for specimen retrieval and gastric conduit formation, in minimally invasive oesophagectomy for oesophageal cancer.Methods: It is a retrospective comparative study where we present data of our 100 resectable oesophageal cancer patients who underwent postneoadjuvant minimally invasive oesophagectomy from January 2012 to September 2015. All of the patients had an initial staging endoscopic ultrasound with PEG placement. The prestudy (conventional) approach, i.e., laparoscopic gastric conduit formation along with specimen pull up from the cervical/thoracic wound is compared to the present (Study) group.Results: The two groups were similar for basic demographic variables, tumour stage, morphology and nutritional status. The primary endpoints were an operative time in minutes and any additional procedure-speci c complications. The rate of procedure speci c complications (Abdominal excision wound complications or conduit failure) was low 11%. PEG site excision biopsy was positive in two cases; one adenocarcinoma and one squamous carcinoma, both were mid to lower oesophageal tumours not involving gastroesophageal junction.Conclusions: Bene ts of the approach are ease of gastric conduit formation along with an additional second layer with less operative time through the small wound, avoidance of tumour specimen removal all the way through mediastinum from the cervical incision, and excision of a potential site of oesophageal cancer metastasis, without any added morbidity.Key words: Extracorporeal gastric conduit, minimally invasive oesophagectomy, percutaneous endoscopic gastrostomy
USE OF SIMULTANEOUS INTEGRATED BOOST INTENSITY-MODULATED RADIATION THERAPY TECHNOLOGY IN LARYNGEAL CARCINOMA
Authors: Rafaye Muhammad Abdur , Usman Sadaf , Jamshed Arif
Published: December 2019

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PRIMARY GASTROINTESTINAL STROMAL TUMOUR OF THE PROSTATE: A CASE REPORT OF A RARE TUMOUR
Authors: Khalil Muhammad Arshad Irshad , Khan Nouman , Ali Azfar , Mir Khurram
Published: December 2019

A 70-year-old gentleman underwent prostatectomy for bladder outlet obstruction due to enlarged prostate and was found to have primary extragastrointestinal stromal tumour (EGIST). He has been started on imatinib therapy and is presently on follow-up. Prostatic EGIST should be one of the differential diagnoses in patients with enlarged prostate with normal prostate-specific antigen levels.Key words: Prostate, gastrointestinal stromal tumour, PSA
PNEUMATOSIS INTESTINALIS - A RARE CLINICAL FINDING REQUIRING MULTIMODALITY TREATMENT
Authors: Urooj Namra , Janjua Mahin , Malik Awais Amjad , Khattak Shahid , Syed Aamir Ali
Published: December 2019

This is a case report of Pneumatosis intestinalis (PI), which has traditionally been associated with immediate operative intervention and a high mortality rate. We present a case of ulcerative colitis that developed Pneumatosis intestinalis and was managed at our hospital. A 29 year old male with known history of ulcerative colitis presented with an acute exacerbation. A week into his treatment, PI developed. Emergency total colectomy with end ileostomy was performed. Postoperatively, he remained critically ill and expired during same hospitalization after 45 days.Key words: Pneumatosis intestinalis, Ulcerative Colitis, Adalumimab
EXPRESSION OF ANTI-APOPTOTIC PROTEIN BCL-2 IN CUTANEOUS BASAL CELL CARCINOMA
Authors: Bartoš Vladimír , Kullová Millada
Published: December 2019

Purpose: Overexpression of antiapoptotic B-cell lymphoma-2 (Bcl-2) protein is one of the major contributors to oncogenesis and high levels have been identified in a variety of tumour types. We investigated an immunohistochemicalexpression of Bcl-2 protein in cutaneous basal cell carcinomas (BCCs) to elucidate whether there are differences in the expression pattern related to tumour growth phenotype.Materials and Methods: The study group consisted of 45 cutaneous BCCs, which were categorised into the nonaggressive (NA-BCCs; 31 cases) and aggressive histologic variants (A-BCCs; 14 cases).Results: There were 3 tumours (6.6%) with negative staining and 42 tumours (93.4%) with positive staining for Bcl-2 protein, 10 of which (23.8%) displayed low and remaining 32 cases (76.2%) exhibited high expression. All three “Bcl-2 negative” BCCs showed aggressive-growth features (infiltrative subtypes). When Bcl-2 values were evaluated as negative/low versus high expression, there was significantly lower Bcl-2 protein expression in the A-BCCs comparedto the NA-BCCs. Even an intensity of immunostaining showed a tendency of being weaker in the A-BCCs. In spite of that, three infiltrative BCCs showed a diffuse strong immunoreactivity.Conclusion: An immunohistochemical positivity of Bcl-2 protein in the neoplastic cells of cutaneous BCC was nearly constant feature, and its decreased staining was associated with an infiltrative growth pattern. It suggests that a lowBcl-2 protein expression in tumor tissue might be considered an unfavorable prognostic indicator.Key words: Basal cell carcinoma, B-cell lymphoma-2 protein, biological behavior
UNMET SUPPORTIVE CARE NEEDS AMONG BONE SARCOMA PATIENT IN SARAWAK
Authors: Whye Lian Cheah , Dollah Nurul Bahariah , Thon Chang Ching
Published: December 2019

Purpose: This study aimed to determine the prevalence of unmet supportive care needs among bone sarcoma patients in Kuching, Sarawak and explored the relationship between these needs with various associated factors.  Methods: It was a descriptive cross-sectional study conducted among all bone sarcoma patients recruited from Sarawak General Hospital in Kuching, Sarawak. Data collection was done using an adopted questionnaire via interview assisted survey. Unmet needs were assessed using the 59-item Supportive Care Needs Survey (SCNS-SF59). Data was entered and analyzed using SPSS version 20.    Results: A total of 75 respondents participated in the study. The patients were mainly above 36 years (56%), Sarawak natives (33.3%) and married (54.7%). Majority of patients were not undergoing any active treatment (52%). Nine out of 10 items with highest ‘moderate’ to ‘high’ level unmet needs were from the domain of Health system and information.  Needs from Physical and daily living, and sexuality domains were found to have statistically significant associations with ethnicity, age and marital status.  Conclusion: Patients who were diagnosed with bone sarcoma had substantive unmet supportive care needs in relation with their illness trajectory. It is important that such needs to be acknowledged in order to provide quality healthcare services to them.   Key words : bone sarcoma, unmet needs, Malaysia, SCNS-SF59,supportive care needs
THE PREVALENCE OF DYSPLASIA IN COLORECTAL SERRATED/HYPERPLASTIC POLYPS IN OMANI POPULATION
Authors: Qureshi Asim , Al hadi Nawras Suleiman , Shalaby Asem
Published: December 2019

Purpose: Serrated/hyperplastic polyps (SPs) are characterised histologically by sawtooth architecture. Historically, these polyps were considered benign, without malignant potential and thus clinically unimportant. At present, the WHO defines serrated/hyperplastic lesions as heterogeneous group, which include hyperplastic polyps (HP), sessile serrated adenoma (SSA)/polyp and traditional serrated adenoma (TSA). These can have malignant potential. The aim of this study was to evaluate the prevalence of dysplastic changes in SP of colon and rectum of Omani population reported at a tertiary care centre.Methods: The study was conducted in the pathology department of a tertiary care centre including endoscopic polypectomies from colon and rectum of Omani patients presenting to gastroenterology clinic reported between 2014 and 2016, and these were analysed retrospectively for dysplastic changes and their association with different clinical parameters.Results: Dysplasia was seen in 32 of 146 cases (21.9%) and 114 (78.1%) were without dysplasia. Of these dysplastic, biopsies’ only two cases (1.4%) showed high-grade dysplasia and rest 30 (20.5%) low-grade dysplasia. According to the type of polyp, dysplasia was found in TSA 8/21 cases (46.7%) and SSA 9/17 cases (53.3%). Association of dysplasia was more common in the age group of > 50 (15.07%) and male patients (62.5%).Conclusion: SPs are now common findings that a gastroenterologist faces in their daily practice. In our study of Omani population, the prevalence of dysplasia is associated with older age group, male gender, SSA/polyp and traditional serrated adenoma.Key words: Dysplasia. colorectal, polyps
PROGNOSTIC POWER OF INFLAMMATORY RESPONSE SCORING SYSTEMS IN PERIAMPULLARY PANCREATIC CANCER: A SYSTEMATIC REVIEW
Authors: Ali Majid , Farrugia Alexia , Bhogal Ricky , Khan Saboor , Marangoni Gabriele , Ahmad Jawad
Published: December 2019

Introduction: Assessment of systemic inflammatory response forms the basis of several scoring systems that attempt to prognosticate patients with periampullary pancreatic carcinoma (PPC). We assessed the validity of three of these scoring systems for patients’ prognosis following intervention for PPC: Glasgow prognostic score (GPS) and its modified version (mGPS), platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR).Methods: EMBASE and MEDLINE databases were searched for all published studies until September 2018 using comprehensive text word and MeSH terms. Meta-analysis of observational studies in epidemiology guidelines was followed. All identified studies were analysed and relevant studies were included in the review.Results: Three studies which assessed the role of GPS, four studies that evaluated the use of NLR and three that assessed the role of PLR in patients with PPC were identified. None of these studies demonstrated any value in the pre-operative assessment of patients with PPC. The limited number of studies available precluded further statistical analysis.Conclusions: Based on available evidence, GPS, NLR and PLR do not appear to be useful scoring systems to predict prognosis of patients with PPC. Larger studies are warranted before the application of inflammatory scoring systems could be recommended in patients with PPC.Key words: Periampullary cancer, Glasgow prognostic score, modified Glasgow prognostic score, platelet-lymphocyte ratio, neutrophil-lymphocyte ratio
THE ROLE OF INTRAOPERATIVE FROZEN SECTION OF SENTINEL LYMPH NODES IN UPFRONT BREAST CONSERVATION CANCER SURGERY
Authors: Khan Ruqayya Naheed , Malik Awais Amjad , Mohtasham Sameen , Khan Amina Iqbal , Parvaiz Muhammad Asad , Loya Asif
Published: December 2019

Objective: Sentinel lymph node biopsy is the standard of care in clinically negative axilla in breast cancer patients for which frozen section (FS) is routinely performed intraoperatively. The objective of this study was to justify the use of FS in terms of number of tests performed and their impact on decision-making and cost saving. Materials and Methods: We retrospectively reviewed our prospectively maintained data from January 2014 to January 2018 for intraoperative FS in upfront breast conservation surgery patients. Results: A total of 357 patients were studied. All were female. Median age was 50 years (24–84). Mean tumour size was 29.11 mm. Numbers of sentinel lymph nodes identified were 1 in 50 (14.2%) patients, 2 in 121 (33.89%) patients and ≥3 in 186 (52%) patients. Number of positive sentinel lymph nodes was 0 in 264 (73.9%) patients, 1 in 62 (17.4%) patients, 2 in 20 (5.6%) patients and ≥3 in 11 (3.08%) patients. Axillary lymph node dissection (ALND) was offered to 30 (8.4%) patients as per the American College of Surgeons Oncology Group Z0011. The results for ALND showed that only 8 (2.3%) out of 30 patients had positive nodes identified in the additional axillary nodes dissected. Sensitivity of FS was 97% and specificity was 98.86%. False-negative rate was 3.22%. Conclusion: Intraoperative FS can be safely omitted in early breast cancer patients undergoing upfront breast conservation cancer surgery due to high sensitivity and specificity leading to low false-negative rates. ALND can be performed as a second operation as warranted only in a minority of patients. Key words: American College of Surgeons Oncology Group Z0011 trial, axillary lymph node dissection, intraoperative frozen section, sentinel lymph node biopsy
Deterministic placement of ultra-bright near-infrared color centers in arrays of silicon carbide micropillars
Authors: Castelletto Stefania , Al Atem Abdul Salam , Inam Faraz Ahmed , Bardeleben Hans Jürgen von , Hameau Sophie , Almutairi Ahmed Fahad , Guillot Gérard , Sato Shin-ichiro , Boretti Alberto , Bluet Jean Marie
Published: December 2019

We report the enhancement of the optical emission between 850 and 1400 nm of an ensemble of silicon mono-vacancies (VSi), silicon and carbon divacancies (VCVSi), and nitrogen vacancies (NCVSi) in an n-type 4H-SiC array of micropillars. The micropillars have a length of ca. 4.5 μm and a diameter of ca. 740 nm, and were implanted with H+ ions to produce an ensemble of color centers at a depth of approximately 2 μm. The samples were in part annealed at different temperatures (750 and 900 °C) to selectively produce distinct color centers. For all these color centers we saw an enhancement of the photostable fluorescence emission of at least a factor of 6 using micro-photoluminescence systems. Using custom confocal microscopy setups, we characterized the emission of VSi measuring an enhancement by up to a factor of 20, and of NCVSi with an enhancement up to a factor of 7. The experimental results are supported by finite element method simulations. Our study provides the pathway for device design and fabrication with an integrated ultra-bright ensemble of VSi and NCVSi for in vivo imaging and sensing in the infrared.
A Mirage of the Cosmic Shoreline: Venus-like Clouds as a Statistical False Positive for Exoplanet Atmospheric Erosion
Authors: Lustig-Yaeger Jacob , Meadows Victoria S. , Lincowski Andrew P.
Published: December 2019

Near-term studies of Venus-like atmospheres with James Webb Space Telescope (JWST) promise to advance our knowledge of terrestrial planet evolution. However, the remote study of Venus in the solar system and the ongoing efforts to characterize gaseous exoplanets both suggest that high altitude aerosols can limit observational studies of lower atmospheres, and potentially make it challenging to recognize exoplanets as “Venus-like.” To support practical approaches for exo-Venus characterization with JWST, we use Venus-like atmospheric models with self-consistent cloud formation of the seven TRAPPIST-1 exoplanets to investigate the atmospheric depth that can be probed using both transmission and emission spectroscopy. We find that JWST/Mid-IR Instrument Low Resolution Spectrometer secondary eclipse emission spectroscopy in the 6 μm opacity window could probe at least an order of magnitude deeper pressures than transmission spectroscopy, potentially allowing access to the subcloud atmosphere for the two hot innermost TRAPPIST-1 planets. In addition, we identify two confounding effects of sulfuric acid aerosols that may carry strong implications for the characterization of terrestrial exoplanets with transmission spectroscopy: (1) there exists an ambiguity between cloud-top and solid surface in producing the observed spectral continuum; and (2) the cloud-forming region drops in altitude with semimajor axis, causing an increase in the observable cloud-top pressure with decreasing stellar insolation. Taken together, these effects could produce a trend of thicker atmospheres observed at lower stellar insolation—a convincing false positive for atmospheric escape and an empirical “cosmic shoreline.” However, developing observational and theoretical techniques to identify Venus-like exoplanets and discriminate them from stellar windswept worlds will enable advances in the emerging field of terrestrial comparative planetology.
La légalisation de la désobéissance à la loi. Le cas du droit de grève et de l’état de nécessité
Authors: Colson Renaud
Published: December 2019

En dépit de divergences importantes, le droit de grève et l’état de nécessité présentent une structure juridique commune. Produits d’une antinomie résolue, tous deux témoignent de la légalisation par le système juridique d’actes constitutifs d’une désobéissance à certaines normes légales. Cette légalisation se concrétise par la mise en place d’un véritable droit subjectif de désobéir à la loi. Celui-ci est soumis au contrôle rigoureux de l’ordre juridique qui s’assure que l’exercice de cette prérogative n’excède pas certaines limites largement déterminées par l’idéologie juridique du moment. Dans les deux cas, on peut analyser l’apparition de ce droit de désobéir en termes d’accession d’une norme particulière, caractérisée par une forte légitimité, à une validité juridique parfaite au dépend d’une autre, plus générale, qui voit son domaine d’application réduit. De ce processus résulte l’application d’un régime dérogatoire au droit commun permettant une meilleure appréhension du réel par le droit positif.
Les pionnières françaises du sport international des femmes : Alice Milliat et Marie-Thérèse Eyquem, entre tutelle médicale et non-mixité militante ?
Authors: Castan-Vicente Florys , Bohuon Anaïs , Henaff-Pineau Pia , Chanavat Nicolas
Published: December 2019

Dans l’entre-deux-guerres, Alice Milliat (1884-1957), présidente de la FSFSF (Fédération des Sociétés féminines sportives de France) et de la FSFI (Fédération sportive féminine internationale), accepte une adaptation partielle des épreuves sportives, tout en continuant à prôner un sport de compétition qui s’oppose aux volontés du CIO (Comité international olympique), de l’IAAF (International Association of Athletics Federations) et de nombreux médecins. Marie-Thérèse Eyquem (1913-1978), qui dirige le sport des femmes sous Vichy, place d’abord volontairement ses écrits sous l’autorité du discours médical. Son ouvrage phare, La Femme et le sport , est préfacé par le Dr Boigey, qui suit l’adage aristotélicien «  tota mulier in utero  ». Après la guerre, elle participe à l’IAPESGW (International Association of Physical Education and Sport for Girls and Women), héritière de la FSFI dans un cadre onusien. Tout au long de leurs carrières, les deux pionnières vont être confrontées au pouvoir médical, et notamment aux discours qui oscillent entre prescriptions et proscriptions au sujet de la mise en mouvement des corps des femmes. Les pratiquantes et organisatrices s’adaptent tant dans le choix et les modalités des activités pratiquées que dans les pratiques de (non-)mixité dans le choix de la direction, entre transgression et compromis, entre intégration, reproduction ou rejet des normes et injonction à la féminité dans les activités physiques.
Du local à l’international. Jalons pour une sociographie des dirigeants sportifs. Polignac, Kriegk, Daugé : trois trajectoires rémoises (années 1900-1960)
Authors: Moreau Sébastien
Published: December 2019

Cette contribution vise à éclairer comment des mandats associatifs locaux permettent à quelques dirigeants d’accéder à l’élite du sport international. Le cas de trois dirigeants internationaux (Louis Daugé, Teddy Kriegk et Melchior de Polignac) est observé à partir d’une sociographie des présidents de clubs sportifs de la ville de Reims, capitale sportive régionale de Champagne-Ardenne dont ils sont des figures notables et des élites locales. D’abord prosopographique, nourrie de travaux d’histoire sociale et institutionnelle, la démarche permet d’évaluer comment les dynamiques de démocratisation, d’institutionnalisation et de hiérarchisation du monde sportif ont des effets sur la vie sportive locale et la composition du groupe des présidents de clubs. La nomination de dirigeants fédéraux régionaux est à ce titre un processus-clé pour comprendre qui incarne l’imposition de l’autorité fédérale sur les pratiques sportives et comment s’intègre un tissu sportif local (et ses présidents de clubs) à l’édifice institutionnel international (et ses plus hauts dirigeants). Les trajectoires comparées de Daugé, Kriegk et Polignac sont ensuite étudiées dans une perspective davantage biographique. Elles tracent trois voies d’accès différentes au sommet des institutions sportives internationales et incarnent trois moments de l’histoire des sports qui coexistent pourtant dans le grand bouillonnement sportif du Reims de l’entre-deux-guerres.