bluuebunny/crossref_metadata_2025 huggingface dataset:
Mapping visuospatial and self-motion perception functions in the left parietal lobe
Authors: Velásquez Carlos , Goméz Elsa , Martino Juan
Published: October 2018

Parietal lobe functions include somesthesia, language, calculation, self-motion perception, and visuospatial awareness. In this video, the authors show the intraoperative mapping of a left parietal lobe for a low-grade glioma resection. Standard sensory and language mapping were performed. Interestingly, by using the “Line Bisection” task, subcortical stimulation of the gyrus angularis was repeatedly associated with ipsilateral spatial neglect, often described in the right parietal lobe. In a similar way, subcortical stimulation in a more posterior point elicited episodes of vertigo, probably due to stimulation of the superior longitudinal fasciculus. Both findings were useful to define the functional limit of the resection.

The video can be found here: https://youtu.be/qgGDRW_6u0A.
Contralateral interhemispheric, transfalcine approach with asleep motor mapping for parasagittal lesions near the medial precentral gyrus
Authors: Mooney Michael A. , Sanai Nader
Published: October 2018

The contralateral interhemispheric approach has several advantages for approaching parasagittal lesions, including lesions involving or approaching the medial precentral gyrus. Supplementing the interhemispheric approach with asleep motor mapping is useful for confirming the location of the corticospinal tracts from the contralateral transfalcine corridor and identifying subcortical motor fibers at the deep aspect of the resection cavity. The authors describe the contralateral interhemispheric, transfalcine approach with asleep motor mapping to resect a parasagittal metastatic lesion involving the medial precentral gyrus.

The video can be found here: https://youtu.be/L-fJ6m5kOWs.
nTMS guidance of awake surgery for highly eloquent gliomas
Authors: Ille Sebastian , Gempt Jens , Meyer Bernhard , Krieg Sandro M.
Published: October 2018

Navigated transcranial magnetic stimulation (nTMS) allows for preoperative mapping for eloquent gliomas. Besides surgical planning, it also guides intraoperative stimulation mapping. The authors’ routine includes preoperative nTMS plus nTMS-based tractography for motor and language to consult patients, plan surgery, craniotomy, and guide cortical and subcortical stimulation.

Here, the authors present this routine in a 48-year-old woman with a glioma of the left middle and superior frontal gyrus reaching the precentral gyrus and superior longitudinal fascicle. Gross-total resection via awake surgery was achieved without deficit.

The nTMS data and nTMS-based tractography augment eloquent glioma management far beyond its current application.

The video can be found here: https://youtu.be/h4ldgMXL1ys.
Reducing inequities in preventable neural tube defects: the critical and underutilized role of neurosurgical advocacy for folate fortification
Authors: Estevez-Ordonez Dagoberto , Davis Matthew C. , Hopson Betsy , MSHA  , Arynchyna Anastasia , Rocque Brandon G. , Fieggen Graham , Rosseau Gail , Oakley Godfrey , MSPM  , Blount Jeffrey P.
Published: October 2018

Neural tube defects (NTDs) are one of the greatest causes of childhood mortality and disability-adjusted life years worldwide. Global prevalence at birth is approximately 18.6 per 10,000 live births, with more than 300,000 infants with NTDs born every year. Substantial strides have been made in understanding the genetics, pathophysiology, and surgical treatment of NTDs, yet the natural history remains one of high morbidity and profound impairment of quality of life. Direct and indirect costs of care are enormous, which ensures profound inequities and disparities in the burden of disease in countries of low and moderate resources. All indices of disease burden are higher for NTDs in developing countries. The great tragedy is that the majority of NTDs can be prevented with folate fortification of commercially produced food. Unequivocal evidence of the effectiveness of folate to reduce the incidence of NTDs has existed for more than 25 years. Yet, the most comprehensive surveys of effectiveness of implementation strategies show that more than 100 countries fail to fortify, and consequently only 13% of folate-preventable spina bifida is actually prevented. Neurosurgeons harbor a disproportionate, central, and fundamental role in the management of NTDs and enjoy high standing in society. No organized group in medicine can speak as authoritatively or convincingly. As a result, neurosurgeons and organized neurosurgery harbor disproportionate potential to advocate for more comprehensive folate fortification, and thereby prevent the most common and severe birth defect to impact the human nervous system. Assertive, proactive, informed advocacy for folate fortification should be a central and integral part of the neurosurgical approach to NTDs. Only by making the prevention of dysraphism a priority can we best address the inequities often observed worldwide.
Overcoming barriers to neurosurgical training in Tanzania: international exchange, curriculum development, and novel methods of resource utilization and subspecialty development
Authors: Ormond D. Ryan , Kahamba Joseph , Lillehei Kevin O. , Rutabasibwa Nicephorus
Published: October 2018

Tanzania sits on the Indian Ocean in East Africa and has a population of over 53 million people. While the gross domestic product has been increasing in recent years, distribution of wealth remains a problem, and challenges in the distribution of health services abound. Neurosurgery is a unique case study of this problem. The challenges facing the development of neurosurgery in Tanzania are many and varied, built largely out of the special needs of modern neurosurgery. Task shifting (training nonphysician surgical providers) and 2-tiered systems (fast-track certification of general surgeons to perform basic neurosurgical procedures) may serve some of the immediate need, but these options will not sustain the development of a comprehensive neurosurgical footprint. Ultimately, long-term solutions to the need for neurosurgical care in Tanzania can only be fulfilled by local government investment in capacity building (infrastructure and neurosurgical training), and the commitment of Tanzanians trained in neurosurgery. With this task in mind, Tanzania developed an independent neurosurgery training program in Dar es Salaam. While significant progress has been made, a number of training deficiencies remain. To address these deficiencies, the Muhimbili Orthopedic Institute (MOI) Division of Neurosurgery and the University of Colorado School of Medicine Department of Neurosurgery set up a Memorandum of Understanding in 2016. This relationship was developed with the perspective of a “collaboration of equals.” Through this collaboration, faculty members and trainees from both institutions have the opportunity to participate in international exchange, join in collaborative research, experience the culture and friendship of a new country, and share scholarship through presentations and teaching. Ultimately, through this international partnership, mutual improvement in the care of the neurosurgical patient will develop, bringing programs like MOI out of isolation and obscurity. From Dar es Salaam, a center of excellence is developing to train neurosurgeons who can go well equipped throughout Tanzania to improve the care of the neurosurgical patient everywhere. The authors encourage further such exchanges to be developed between partnership training programs throughout the world, improving the scholarship, subspecialization, and teaching expertise of partner programs throughout the world.
Causes, clinical presentation, management, and outcomes of chronic subdural hematoma at Mbarara Regional Referral Hospital
Authors: Kitya David , Punchak Maria , Abdelgadir Jihad , Obiga Oscar , Harborne Derek , Haglund Michael M.
Published: October 2018

OBJECTIVE

Causes, clinical presentation, management, and outcomes of chronic subdural hematoma (CSDH) in low- and middle-income countries are not well characterized in the literature. Knowledge regarding these factors would be beneficial in the development and implementation of effective preventive and management measures for affected patients. The authors conducted a study to gain a better understanding of these factors in a low-income setting.

METHODS

This prospective study was performed at Mbarara Regional Referral Hospital (MRRH) in Uganda between January 2014 and June 2017. Patients of any age who presented and were diagnosed with CSDH during the aforementioned time period were included in the study. Variables were collected from patients’ files at discharge and follow-up clinic visits. The primary outcome of interest was death. Secondary outcomes of interest included discharge Glasgow Coma Scale (GCS) score, ICU admission, wound infection, and CSDH recurrence.

RESULTS

Two hundred five patients, the majority of whom were male (147 [72.8%]), were enrolled in the study. The mean patient age was 60.2 years (SD 17.7). Most CSDHs occurred as a result of motor vehicle collisions (MVCs) and falls, 35.6% (73/205) and 24.9% (51/205), respectively. The sex ratio and mean age varied depending on the mechanism of injury. Headache was the most common presenting symptom (89.6%, 173/193), whereas seizures were uncommon (11.5%, 23/200). Presenting symptoms differed by age. A total of 202 patients underwent surgical intervention with burr holes and drainage, and 22.8% (46) were admitted to the ICU. Two patients suffered a recurrence, 5 developed a postoperative wound infection, and 18 died. Admission GCS score was a significant predictor of the discharge GCS score (p = 0.004), ICU admission (p < 0.001), and death (p < 0.001).

CONCLUSIONS

Trauma from an MVC is the commonest cause of CSDH among the young. For the elderly, falling is common, but the majority have CSDH with no known cause. Although the clinical presentation is broad, there are several pronounced differences based on age. Burr hole surgery plus drainage is a safe and reliable intervention. A low preoperative GCS score is a risk factor for ICU admission and death.
A review of Big Data analytics and potential for implementation in the delivery of global neurosurgery
Authors: West James L. , Fargen Kyle M. , Hsu Wesley , Branch Charles L. , Couture Daniel E.
Published: October 2018

Global access to neurosurgical care is still a work in progress, with many patients in low-income countries not able to access potentially lifesaving neurosurgical procedures. “Big Data” is an increasingly popular data collection and analytical technique predicated on collecting large amounts of data across multiple data sources and types for future analysis. The potential applications of Big Data to global outreach neurosurgery are myriad: from assessing the overall burden of neurosurgical disease to planning cost-effective improvements in access to neurosurgical care, and collecting data on conditions which are rare in developed countries. Although some global neurosurgical outreach programs have intelligently implemented Big Data principles in their global neurosurgery initiatives already, there is still significant progress that remains to be made. Big Data has the potential to drive the efficient improvement of access to neurosurgical care across low- and medium-income countries.
Neural tube defects in Uganda: follow-up outcomes from a national referral hospital
Authors: Xu Linda W. , Vaca Silvia D. , He Joy Q. , Nalwanga Juliet , Muhumuza Christine , Kiryabwire Joel , Ssenyonjo Hussein , Mukasa John , Muhumuza Michael , Grant Gerald
Published: October 2018

OBJECTIVE

Children with neural tube defects (NTDs) require timely surgical intervention coupled with long-term management by multiple highly trained specialty healthcare teams. In resource-limited settings, outcomes are greatly affected by the lack of coordinated care. The purpose of this study was to characterize outcomes of spina bifida patients treated at Mulago National Referral Hospital (MNRH) through follow-up phone surveys.

METHODS

All children presenting to MNRH with NTDs between January 1, 2014, and August 31, 2015, were eligible for this study. For those with a documented telephone number, follow-up phone surveys were conducted with the children’s caregivers to assess mortality, morbidity, follow-up healthcare, and access to medical resources.

RESULTS

Of the 201 patients, the vast majority (n = 185, 92%) were diagnosed with myelomeningocele. The median age at presentation was 6 days, the median length of stay was 20 days, and the median time to surgery was 10 days. Half of the patients had documented surgeries, with 5% receiving multiple procedures (n = 102, 51%): 80 defect closures (40%), 32 ventriculoperitoneal shunts (15%), and 1 endoscopic third ventriculostomy (0.5%). Phone surveys were completed for 53 patients with a median time to follow-up of 1.5 years. There were no statistically significant differences in demographics between the surveyed and nonrespondent groups. The 1-year mortality rate was 34% (n = 18). At the time of survey, 91% of the survivors (n = 30) have received healthcare since their initial discharge from MNRH, with 67% (n = 22) returning to MNRH. Hydrocephalus was diagnosed in 29 patients (88%). Caregivers reported physical deficits in 39% of patients (n = 13), clubfoot in 18% (n = 6), and bowel or bladder incontinence in 12% (n = 4). The surgical complication rate was 2.5%. Glasgow Outcome Scale–Extended pediatric revision scores were correlated with upper good recovery in 58% (n = 19) of patients, lower good recovery in 30% (n = 10), and moderate disability in 12% of patients (n = 4). Only 5 patients (15%) reported access to home health resources postdischarge.

CONCLUSIONS

This study is the first to characterize the outcomes of children with NTDs that were treated at Uganda’s national referral hospital. There is a great need for improved access to and coordination of care in antenatal, perioperative, and long-term settings to improve morbidity and mortality.
Global neurosurgery: current and potential impact of neurosurgeons at the World Health Organization and the World Health Assembly. Executive summary of the World Federation of Neurosurgical Societies–World Health Organization Liaison Committee at the 71st World Health Assembly
Authors: Rosseau Gail , Johnson Walter D. , Park Kee B. , Arráez Sánchez Miguel , Servadei Franco , Vaughan Kerry A.
Published: October 2018

Since the creation of the World Health Organization (WHO) in 1948, the annual World Health Assembly (WHA) has been the major forum for discussion, debate, and approval of the global health agenda. As such, it informs the framework for the policies and budgets of many of its Member States. For most of its history, a significant portion of the attention of health ministers and Member States has been given to issues of clean water, vaccination, and communicable diseases. For neurosurgeons, the adoption of WHA Resolution 68.15 changed the global health landscape because the importance of surgical care for universal health coverage was highlighted in the document. This resolution was adopted in 2015, shortly after the publication of The Lancet Commission on Global Surgery Report titled “Global Surgery 2030: evidence and solutions for achieving health, welfare and economic development.” Mandating global strengthening of emergency and essential surgical care and anesthesia, this resolution has led to the formation of surgical and anesthesia collaborations that center on WHO and can be facilitated via the WHA. Participation by neurosurgeons has grown dramatically, in part due to the official relations between WHO and the World Federation of Neurosurgical Societies, with the result that global neurosurgery is gaining momentum.
The shifting burden of neurosurgical disease: Vietnam and the middle-income nations
Authors: Carr Christopher , Kahn Lora , Mathkour Mansour , Biro Erin , Bui Cuong J. , Dumont Aaron S.
Published: October 2018

OBJECTIVE

The Global Burden of Disease (GBD) is an international collaboration and the largest comprehensive investigation of global health disease burden ever conducted. It has been particularly insightful for understanding disease demographics in middle-income nations undergoing rapid development, such as Vietnam, where 6 of the top 10 causes of death are relevant to the neurosurgeon. The burden of stroke—the number one cause of death in Vietnam—is particularly impressive. Likewise, road injuries, with a disproportionate rate of traumatic brain injury, continue to increase in Vietnam following economic development. Low-back and neck pain is the number one cause of disability. Simultaneously, more patients have access to care, and healthcare spending is increased.

METHODS

It is imperative that neurosurgical capital and infrastructure keep pace with Vietnam’s growth. The authors searched the existing literature for assessments of neurosurgical infrastructure or initiatives to address neurosurgical disease burden. Using GBD data, the authors also abstracted data for death by cause and prevalence of years of life lost due to disability (YLD) for common neurosurgical pathologies for Vietnam and comparison nations.

RESULTS

Interventions aimed at primary prevention of risk factors for neurosurgical disease and focused on the transference of self-sustainable technical skills were found to be analogous to those that have been successful in other regions. Efforts toward stroke prevention have been focused on causal risk factors. Multiple investigators have found that interventions aimed at increasing helmet use were successful in preventing traumatic brain injury. Government-led reforms and equipment donation programs have improved technical capacity. Nevertheless, Vietnam lags behind other nations in neurosurgeons per capita; cause-attributable death and YLD attributable to neurosurgical disease are considerably higher in Vietnam and middle-income nations compared to both lower-income nations and upper-income nations.

CONCLUSIONS

More than two-thirds of deaths attributable to neurosurgical pathologies in Vietnam and other middle-income nations were due to stroke, and one-fifth of both cause-attributable death and YLD was associated with neurosurgical pathologies. Vietnam and other middle-income nations continue to assume a global burden of disease profile that ever more closely resembles that of developed nations, with particular cerebrovascular, neurotrauma, and spinal disease burdens, leading to exponentially increased demand for neurosurgeons that threatens to outpace the training of neurosurgeons.
Karadeniz barbunya balığının (Mullus barbatus ponticus) ilk üreme boyunun tahmini
Authors: ERDEM Yakup
Published: October 2018

Bu çalışmanın konusu Karadeniz’in ticari
olarak önemli balık türlerinden barbunya balığının ilk üreme boyunun tahminidir.
Eylül 2016- Mart 2017 tarihleri arasında toplam 229 örnek toplanmış ve örneklenen
balıklarda total boy, vücut ağırlığı, cinsiyet ve eşeysel olgunluk durumu
belirlenmiştir. Dişi/erkek birey oranı 1:0.85 olarak hesaplanmıştır. Dişi ve
erkek bireylerde ortalama total boy sırasıyla 11.62 ± 0.114 cm ve 11.07 ± 0.116
cm olarak, ortalama vücut ağırlığı 16.30 ± 0.475 g ve 13.96 ± 0.457 g olarak belirlenmiştir.
Boy ağırlık ilişkisi denklemi dişiler için W=0.0112 L2.954, erkekler
için W = 0.0098 L3.0045ve
her iki cins için W = 0.0102 L2.9903 olarak tahmin edilmiştir.

İlk üreme boyu dişi bireyler için 10.73
cm, erkek bireyler için 10.95 cm olarak hesaplanırken her iki cins için ortak
değer 10.88 cm olarak tahmin edilmiştir. Örneklenen balıkların içerisinde 10.9
cm’den küçük balıkların oranı %37.6 (86 adet) olarak belirlenmiştir. Karadeniz’deki
barbunya balığı stoklarının korunması için balıkçılık düzenlemelerinde
belirlenen bu boydan daha büyük bir asgari avlama boyu kısıtlaması bulunmasının
yararlı olacağı söylenebilir.
Early Complications and Mortality following Radical Cystectomy: Associations with Malnutrition and Obesity
Authors: Arora Karan , Hanson Kristine T. , Habermann Elizabeth B. , Tollefson Matthew K. , Psutka Sarah P.
Published: September 2018

Background:

There are conflicting data regarding the impact of obesity on postoperative outcomes following radical cystectomy (RC) and how obesity and malnutrition interact in patients undergoing RC.

Objective:

To evaluate associations of body mass index (BMI), significant preoperative weight loss, and hypoalbuminemia with 30-day complications and mortality after RC.

Methods:

Review of the American College of Surgeons National Surgical Quality Improvement Program database identified 2,055 patients who underwent RC (2006-12). Univariate and multivariable logistic regression models were developed to assess associations between hypoalbuminemia (<3.5 g/dL), >10% preoperative weight loss, obesity as characterized by BMI (class I: 30–34.9, II: 35–39.9, III: ≥40 kg/m2), and 30-day complications and mortality.

Results:

The median BMI of the study cohort was 27.82 kg/m2 with 22.4% classified as having class I, 7.5% class II, and 4.2% class III obesity, respectively. Hypoalbuminemia and >10% weight loss were present in 16.7% and 3.5%, respectively. Among obese patients, 13.4% had hypoalbuminemia. On multivariable analysis, class I (OR 1.43, p = 0.01), class II (OR 1.92, p < 0.001), and class III (OR 2.32, p < 0.001) obesity and hypoalbuminemia (OR 1.47, p = 0.02) were independently associated with 30-day complications, and class III obesity (OR 2.96, p = 0.02) and hypoalbuminemia (OR 2.33, p = 0.03) were independently associated with 30-day mortality.

Conclusion:

Increasing class of obesity and hypoalbuminemia were independently associated with increased complications following RC. Hypoalbuminemia and class III obesity were associated with early mortality. This study highlights the fact that malnutrition may coexist in obese patients and underscores the need to identify patients with malnutrition who may be candidates for preoperative nutritional optimization.
Evaluation of Intraoperative Versus Postoperative Adjuvant Mitomycin C with Nephroureterectomy for Urothelial Carcinoma of the Upper Urinary Tract
Authors: Noennig Blake , Bozorgmehri Shahab , Terry Russell , Otto Brandon , Su Li-Ming , Crispen Paul L.
Published: September 2018

Background:

Results of randomized trials support a single dose of intravesical chemotherapy following radical nephroureterectomy (RNU) for urothelial carcinoma.

Objective:

To evaluate the impact of the timing of intravesical mitomycin C (MMC) administration on the rate of bladder tumor recurrence (BTR) following RNU.

Methods:

We performed a retrospective review of patients who underwent RNU for upper tract urothelial carcinoma (UTUC) and received intravesical MMC between 2008 and 2016. Patients were categorized into two separate groups based on the timing of MMC administration: patients who received MMC intraoperatively (IO) and patients who received MMC on post-operative day 1 or later (PO). Our primary endpoint was BTR rate within the first year after surgery.

Results:

Fifty-one patients met our inclusion criteria: (IO: n = 30; PO: n = 21). There were no statistically significant differences in baseline characteristics of age, gender, race, surgical approach, tumor grade, tumor stage, surgical margins, nodal status, concomitant CIS, or history of bladder cancer. The median length of follow-up for each group was 22 months for IO and 12 months for PO ( P = 0.10). The estimated probability of 1-year BTR rates for the IO and PO groups were 16% and 33%, respectively ( p = 0.09). Cox analysis noted that the IO patients had a significantly lower rate of BTR in the first year postoperatively (HR = 0.113, 95% CI = 0.28–0.63, p = 0.01).

Conclusions:

The use of intraoperative MMC at the time of RNU was associated with a decrease in the risk of 1-year recurrence within the bladder.
Urinary Biomarkers in the Evaluation of Primary Hematuria: A Systematic Review and Meta-Analysis
Authors: Sathianathen Niranjan J. , Butaney Mohit , Weight Christopher J. , Kumar Raj , Konety Badrinath R.
Published: September 2018

Introduction:

Urinary biomarkers are entering the clinical landscape as a non-invasive method to evaluate patients for bladder cancer, however it is currently predominantly used in the surveillance setting. The use of biomarkers in the setting of primary hematuria is not widespread despite initial promising results. This study comprehensively reviews the literature on the diagnostic performance of FDA-approved biomarkers in the evaluation of primary hematuria.

Methods:

According to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement, MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries, HTA database, Google Scholar and Web of Science were searched up to June 2017 for studies assessing the diagnostic accuracy of FDA-approved urinary biomarkers amongst patients presenting with primary hematuria. The quality of included studies was assessed using the QUADAS-2 tool.

Results:

Fourteen studies met the pre-specified eligibility criteria and were included for analysis. The biomarkers assessed in these studies were AssureMDx, Bladder tumor antigen, CxBladder, NMP22, UroVysion and uCyt+. Across these four biomarkers, the sensitivity ranged from 0.67 to 0.95, and specificity from 0.68 to 0.93, respectively. There was significant heterogeneity between the included studies. Limited head-to-head comparison with urine cytology demonstrated that in general, the biomarkers have superior sensitivity but inferior specificity. Overall, the quality of evidence was graded as moderate primarily because of inadequate blinding.

Conclusion:

The current diagnostic performance of biomarkers are inadequate to replace cystoscopy in the primary hematuria setting. However, AssureMDx in particular may have a role as a triage test for cystoscopy but further prospective data is required to validate these findings. Given the current evidence, the use of these markers as an adjunct to cystoscopy for the evaluation of hematuria should be considered investigational.
Class-Specific Incidence of All-Cause Dementia and Alzheimer’s Disease: A Latent Class Approach
Authors: Zammit Andrea R. , Hall Charles B. , Katz Mindy J. , Muniz-Terrera Graciela , Ezzati Ali , Bennett David A. , Lipton Richard B.
Published: September 2018

Identifying preclinical Alzheimer’s disease (AD) is an important step toward developing approaches to early treatment and dementia prevention. We applied latent class analysis (LCA) to 10 baseline neuropsychological assessments for 1,345 participants from Einstein Aging Study. Time-to-event models for all-cause dementia and AD were run examining events in 4-year intervals. Five classes were identified: Mixed-Domain Impairment ( n = 107), Memory-Specific Impairment ( n = 457), Average ( n = 539), Frontal Impairment ( n = 118), and Superior Cognition ( n = 124). Compared to the Average class, the Mixed-Domain Impairment and Memory-Specific Impairment classes were at higher risk of incident all-cause dementia and AD in the first 4 years from baseline, while the Frontal Impairment class was associated with higher risk between 4 and 8 years of follow-up. LCA identified classes which differ in cross-sectional cognitive patterns and in risk of dementia over specific follow-up intervals.
Why MICAS?
Authors: Menzies David , Murphy Anna Marie
Published: October 2018

Introduction

The Mobile Intensive Care Ambulance Service (MICAS) was initiated in 1996 to assess, stabilise and transfer critically ill patients from a referring hospital to a receiving hospital to meet their clinical needs. 

Critically ill patients are transferred throughout Ireland to an increased level of care, repatriation for continuity of care following specialist treatment, specialist critical care services or in some instances, are considered too unstable to be transported by local staff.  In 2015, it was estimated that approximately 1000 ICU patients are transported per annum (Murphy, Dwyer). These numbers are likely to increase as a result of the reorganisation of health services, the development of hospital groups, the establishment of the hub and spoke critical care services and introduction of trauma centres. This increases the requirement of inter hospital transfers throughout the country.

Aims

The aim of this audit was to establish the rationale for a critical care retrieval service and to evaluate the adverse events for inter hospital transport of critically ill patients in Ireland over a 3 year period

Methods

A retrospective chart review of all patients transported by MICAS between January 2015 and December 2017 was undertaken. Clinical records were reviewed for acuity and for adverse events.  

Results

339 patients were transported in this timeframe with 7% experiencing an adverse event overall.

Conclusion

The MICAS data shows an increasing number of critically ill patients transferred by MICAS within the timeframe. 

The rationale for MICAS includes the provision by a specialist team with transport specific equipment with reduced adverse events. 

 

 

 

 

 

 
Leopoldo Marmora ist tot
Authors: Messner Dirk
Published: October 2018

Nachruf
Joan Robinson
Authors: Hickel Rudolf
Published: October 2018

Joan Robinson ist eine der ganz wenigen Ökonominnen, die in die internationale Diskussion vorgedrungen ist. Ihre gleichwohl mangelnde Beachtung in der von Männern beherrschten Zunft ist jedoch nicht allein auf ihre Eigenschaft als Frau zurückzuführen, sondern nicht zuletzt auf ihre unerbittliche Kritik an den männlichen Autoritäten des Fachs. Selbst Keynes, in dessen »Cambridge-Circus« sie eine bedeutende Rolle spielte, wurde von ihr wegen seiner Kompromißbereitschaft gegenüber der Marktorthodoxie kritisiert; der revolutionäre Impuls seiner Lehre wurde maßgeblich von Joan Robinson in Richtung eines »Linkskeynesianismus « und einer gebrauchswertorientierten BetrachtunJoan Robinson ist eine der ganz wenigen Ökonominnen, die in die internationale Diskussion vorgedrungen ist. Ihre gleichwohl mangelnde Beachtung in der von Männern beherrschten Zunft ist jedoch nicht allein auf ihre Eigenschaft als Frau zurückzuführen, sondern nicht zuletzt auf ihre unerbittliche Kritik an den männlichen Autoritäten des Fachs. Selbst Keynes, in dessen »Cambridge-Circus« sie eine bedeutende Rolle spielte, wurde von ihr wegen seiner Kompromißbereitschaft gegenüber der Marktorthodoxie kritisiert; der revolutionäre Impuls seiner Lehre wurde maßgeblich von Joan Robinson in Richtung eines »Linkskeynesianismus « und einer gebrauchswertorientierten Betrachtung weiterentwickelt.g weiterentwickelt.
Politik in Deutschland
Authors: Redaktion Prokla
Published: October 2018

Editorial
Zur Politischen Ökonomie des doppelten Deutschland
Authors: Hübner Kurt
Published: October 2018

The strategy of catching-up shows some non-intended effects which produced a vicious circle in the sense of Myrdal. First, the economic measures for building up a high-wage/high-tech economy in Eastem Germany induced a severe process of de-industrialization. Second, the market-oriented policy of the liberal-conservatuce govemment runs into a strong interventionist attitude towards stabilizing the eastem
Die Bedeutung der Allgemeinen Gleichgewichtstheorie für die Transformation zentral geplanter Ökonomien
Authors: Hahn Frank
Published: October 2018

In this paper the relevance of General Equilibrium Theory for the understanding of the Eastern European transformations is discussed. Using several examples and problems it is demonstrated that GET illuminates the classical problem of Adam Smith: how market coordination is possible without central controll. However, because of its formal mode of construction and the non-empirical character of its basic assumptions the theory cannot have any descriptive relevance. Contrary to the claims of most main-stream economists, it is argued that the transformation should aim for a mixed economy in which the state has to take an important task, which either could not be solved by markets or for which markets do not exist.
Weltordnung und Vereinte Nationen
Authors: Albrecht Ulrich
Published: October 2018

Der Artikel geht der Frage nach, welches denn die Ordnungsprobleme der Weltordnung sind und welche Akteure sich als Problemlöser anbieten. Es wird die These vertreten, daß zukünftig insbesondere die Vereinten Nationen eine wichtige Rolle spielen werden. Abschließend wird auch die Rolle der Bundesrepublik in dem neuen Szenario untersucht.
Fundamentalismus und neue Religiosität
Authors: Redaktion Prokla
Published: October 2018

Editorial
Die Rückkehr zum Islam
Authors: Avineri Shlomo
Published: October 2018

Der Artikel geht den historischen Ursachen der islamischen Renaissance in den arabischen Ländern nach: nicht nur das Scheitern westlicher Modelle kapitalistischer Modernisierung haben zu dieser Renaissance beigetragen, sondern auch das Scheitern der westlich inspirierten Kritik an diesen Modellen wie sie vom Marxismus übernommen wurden. Und nicht zuletzt wurden radikale islamische Gruppen, wie z. B. in Afghanistan von westlichen Ländern und ihren Geheimdiensten gefördert, wenn dies zum geostrategischen Kalkül paßte.
Geschlechterforschung, Postmoderne und die Wissenschaft von der Politik
Authors: Lang Sabine
Published: October 2018

Gender Studies have only just started to establish themselves in Political Science. Nevertheless, a paradigm debatecan already be anticipated between anti-essentialist and deconstructive/post-modern approaches and theory formation. The category »Gendern is a central point of conflict as an analytical unit of reference. Which explanatory power can the category claim for the production, reproduction and legitimization of gender dominance in the political process?
Rückblick auf 25 Jahre PROKLA
Authors: Lorek Volker
Published: October 2018

The article focuses on the developmentof the PROKLA from 1970 to 1995. lt highlights some of the most impmtant articles and debates in view of the historic and academic circumstances in which they took place.
Vom Werdegang eines Soziologen zum Staatspräsidenten: Fernando Henrique Cardoso
Authors: Müller-Plantenberg Urs
Published: October 2018

F. H. Cardoso was one of the leading Latin American sociologists in the 60s and 70s and was a founder of the "Theory of Dependency" (as it was later called byothers). In the 80s he went into politics, became a Senator and Minister. 1994 he was elected the Brazilian President of the State as the socialdemocratic candidate with help from the right.
Zwischen Kelch und Lippe
Authors: Gordon David M
Published: October 2018

Many of the typical economic policy recommendations, especially those of neo-classical economists, are often hardly covered by their own theoretical findings. Despite this, such recommendations are made and followed. The article not only lists a number of examples for this disproportion, but also analyzes the social causes of this phenomenon using the example of the USA.
PERAN KBIH MERESTORASI MENTAL JAMAAH HAJI MANDIRI: STUDI DI KOTA TANGERANG BANTEN
Authors: Ishom Muhammad
Published: October 2018

The role of the Hajj Guidance Group (KBIH) has not been effective as the implementation of the independent Hajj mentalty’s program, such as self-sustaining travel, Manasik-al-hajj, and health. That’s factor are; (1) there is trade orientation of trade orientation, (2) distinction between independent pilgrimage and group hajj (3) pilgrimage following the culture of patriarchi (3) prestice group.
FENOMENA MEME HADIS CELANA CINGKRANG DALAM MEDIA SOSIAL
Authors: Miski Miski
Published: October 2018

This written is aimed to study more about popular culture, espesially in relation to meme phenomenon of shorten-long pants hadith (meme hadis celana cingkrang) spread around social media. From paradigm that this phenomenon is not only about creativity and wasn’t born at an empty space in social world, so the question is what behind this phenomenon is? To answer this question, this study is using constructivism paradigm with discourse analysis framework, all of the data are documentation and analyzed by using content analysis method, that is by means of exploration process, selection and classification so interpretation. This study shows that as religious phenomenon, at least there are two main problems behind meme phenomenon of shorten-long pants hadith. The first, it is an efforts to strengthen the religiousness identity of textual group among ideological contestation. The second, it is a form of their retaliation for the various shapes of resistance the common society does. This finding also strengthen the existence and textual group power relation along with political condition which they may be more free and having a notion and expressing the religious practice which is fully supported by the easiness of literature accessing, both directly or by relevant website.
IMPLEMENTASI KEBIJAKAN SERTIFIKASI TANAH WAKAF DI KABUPATEN SERANG PROVINSI BANTEN TAHUN ANGGARAN 2017
Authors: Wahab Abdul Jamil
Published: October 2018

Makalah hasil penelitian ini mendeskripsikan tentang implementasi kebijakan sertifikasi tanah wakaf di Kabupaten Serang Provinsi Banten. Dengan pendekatan kualitatif, penelitian ini berhasil mengungkapkan adanya beberapa fakta yaitu, data wakaf yang ada di selama ini tidak valid, masih adanya tanah wakaf yang belum didaftarkan, adanya ruslah yang tidak sesuai prosedur, dan minimnya pemahaman masyarakat tentang proses sertifikasi wakaf. Empat hal tersebut menjadi indikator dan kemudian disimpulkan bahwa implementasi kebijakan terkait sertifikasi wakaf di Kabupaten Serang kurang efektif. Simpulan tersebut, didasarkan pada analisis bahwa unsur pelaksana sebagai implementor kebijakan memiliki kelemahan baik karena minimnya SDM, sikap pelaksana, fasilitas, dan anggaran. Di sisi lain, kelompok sasaran juga memiliki karakteristik yang kurang memadai terhadap kebijakan yang telah ditetapkan.
PENGARUH BRAND PERSONALITY DAN BRAND TRUST TERHADAP KEPUTUSAN PEMBELIAN (Studi Kasus Butik Meccanism)
Authors: Mahuda Fauziah Dewi
Published: October 2018

This research aims to figure out the influence of brand personality and brand trust on purchasing decisions of Meccanism Boutique. The indicators that used to measure the brand personality are sincerity,excitement,competence,and sophistication. The data processing is done through Structural Equation Modeling (SEM) approach with a sample of one hundred respondents. The results showed that there is a positive influence of brand personality on the brand trust, and there is an influence of brand trust on purchasing decisions, and indirect influence of brand personality on purchasing decisions through the brand trust. While directly, the brand personality is not proven to have an effect on purchasing decisions.
Role of plant growth regulators on shoot formation from bulb sacles of Lily Sorbonne
Authors: Tran Thang Thanh , Tran Huong Thanh
Published: October 2018

In this study, plant growth regulators included 2,4-dichlorophenoxyacetic acid (2,4-D), picloram, 6-benzylaminopurine (BA) and thidiazuron (TDZ), at different concentrations were used individually or in combination to induce adventitious shoots from bulb scales of Lily Sorbonne. Morphological and physiological changes in shoot formation from bulb scales were analysed. The maximum number of shoots per explant were obtained on Murashige and Skoog medium (MS) supplemented with 2,4-D 1 mg/L, BA 1,5 mg/L, zeatin 0,2 mg/L and indole-3-acetic acid (IAA) 0,5 mg/L. The adventitious shoots were derived from parenchymal cells, which placed under epidermis cells. This process included the following stages: activation of cell division with large nucleus, thin-walled and without starch granules; initiating of meristematic region; formation of shoot primordium and shoot with leaves. Use of 1-naphthylphthalamic acid (1-NOA) and N-1-naphthoxyacetic acid (NPA), auxin transport inhibitors, showed the role of polar auxin transport in shoot formation. The correlation of plant hormone, respiration rate and shoot formation from bulb scales was discussed.
Perbandingan efektivitas flutikason furoat intranasal dengan dan tanpa loratadin oral pada penderita rinitis alergi
Authors: Talango Rita , Aminuddin Aminuddin , Punagi Abdul Qadar , Djufri Nani Iriani
Published: September 2018

Background: Allergic rhinitis (RA) is a symptomatic disorder of the nose induced by IgE mediatedinflamation. Corticosteroid alone or in combination with antihistamine have been recommended bythe ARIA-WHO and is often used in the management of RA. Purpose: To compare the effectiveness ofa combination therapy of intranasal fluticasone furoate (IFF) and oral loratadine (LO) with a singletherapy of IFF, based on the levels of eosinophils and clinical symptoms patients with RA. Method: Openclinical trial with 40 of patients divided into two groups 20 patients was given a combination therapyand 20 patients was given only IFF. The level of eosinophils and clinical symptoms were examinedbefore and after therapy. Data were analyzed using the Wilcoxon, Friedman and Mann Whitney tests.Results: Showed decrease in eosinophils level and clinical symptoms were significant (p<0.05) in bothtreatment groups, but there was no significant difference (p>0.05) in the effectiveness between bothtreatments. Conclusion: Therapy with IFF, alone or combined with LO were effective to decrease thelevel of eosinophils and clinical symptoms and there was no difference in efficacy, but still combinationtherapy is better than single therapy. Keywords: allergic rhinitis, intranasal fluticasone furoate, oral loratadine Abstrak :  Latar belakang: Rinitis alergi (RA) merupakan gangguan fungsi hidung, terjadi setelah pajananalergen melalui inflamasi mukosa hidung yang diperantarai IgE0. Penggunaan kortikosteroid baik tunggalmaupun kombinasi dengan antihistamin telah direkomendasikan oleh ARIA-WHO dan sering digunakandalam penatalaksanaan RA. Tujuan: Untuk membandingkan efektivitas terapi kombinasi flutikason furoatintranasal (FFI) dan loratadin oral (LO) dengan terapi tunggal FFI berdasarkan kadar eosinofil dan gejalaklinis penderita RA. Metode: Uji klinik terbuka pada 40 penderita RA, dibagi menjadi 20 penderita padakelompok pertama diberikan terapi kombinasi FFI dengan LO dan 20 penderita kelompok kedua diberikanterapi tunggal FFI. Pemeriksaan eosinofil dan gejala klinis dilakukan sebelum dan sesudah terapi. Datadianalisis menggunakan uji Wilcoxon, Friedman dan Mann Whitney. Hasil: Terjadi penurunan kadareosinofil dan gejala klinis secara signifikan (p<0,05) pada kedua kelompok terapi, namun tidak adaperbedaan efektivitas secara signifikan (p>0,05) antara kedua kelompok terapi. Kesimpulan: Terapi FFItunggal maupun dikombinasikan dengan LO efektif menurunkan kadar eosinofil dan gejala klinis sertatidak ada perbedaan efektivitas, namun terapi kombinasi masih lebih baik dibanding terapi tunggal. Kata kunci: rinitis alergi, flutikason furoat intranasal, loratadin oral
Penyakit kelenjar saliva dan peran sialoendoskopi untuk diagnostik dan terapi
Authors: Tamin Susyana , Yassi Duhita
Published: September 2018

Background: Human salivary glands could be prone to diseases. Special tools have been createdto diagnose the disease of the glands and with the advancement of technology, better instruments weredeveloped. Purpose: We present this literature review to share the knowledge of diagnostic and therapyin today’s management of salivary gland disease. Literature Review: Human salivary glands consistedof major and minor salivary glands which produce saliva. Salivary gland secretion is a process that involves cell synthesis and active transport. Salivary gland diseases are also associated with secretion process. Sialoendosopy can be use as diagnostic and therapeutics tool in salivary glands disease. As atherapeutic tool, sialoendoscopy has a role in stone fragmentation and extraction and also dilatation ofstenosis and stricture. Conclusion: Sialoendscopy has many advantages in diagnosis and treatment ofsalivary gland disease, but its employment is still limited because of the high price and required skilledand experienced operator. Key words: salivary gland, salivary gland disease, sialoendoscopy Abstrak :  Latar belakang: Kelenjar saliva manusia tidak lepas dari gangguan penyakit. Beberapa alat telahditemukan untuk diagnosis penyakit ini dan dengan semakin berkembangnya teknologi, sangat diharapkanberkembang pula alat diagnosis yang lebih baik. Tujuan: dengan tulisan ini diharapkan dapat memperluaswawasan terhadap perangkat diagnostik dan terapi pada penyakit kelenjar saliva. Tinjauan Pustaka:Kelenjar saliva manusia terdiri dari kelenjar saliva mayor dan minor yang berperan untuk memroduksisaliva. Sekresi kelenjar saliva merupakan suatu proses yang melibatkan sintesis sel dan transpor aktif.Penyakit kelenjar saliva juga berhubungan dengan proses sekresi. Sialoendoskopi dapat digunakansebagai alat diagnostik maupun terapi pada penyakit kelenjar saliva. Sebagai alat terapi, sialoendoskopidapat berperan pada fragmentasi dan ekstraksi batu serta dilatasi stenosis dan striktur. Kesimpulan:Sialoendoskopi memiliki keunggulan dalam diagnosis dan terapi penyakit kelenjar saliva, namunpenggunaannya masih terbatas karena harganya yang mahal dan diperlukan operator yang trampil danberpengalaman. Kata kunci: kelenjar saliva, penyakit kelenjar saliva, sialoendoskopi
Ekspresi Interleukin-35 pada penderita karsinoma nasofaring undifferentiated stadium lanjut
Authors: Prabowo Imam , Nurhikmah Siti , Setiamika Made , Budiani Dyah
Published: September 2018

Latar belakang: Karsinoma nasofaring (KNF) merupakan keganasan pada kepala leher yang berasal dari epitel nasofaring. Sel pada tumor ini dapat memproduksi interleukin-35 (IL-35) yang mendukung pertumbuhan tumor, angiogenesis, dan stimulus radikal bebas melalui jalur mieloid dendritic supressor cells (MDSC) serta menghambat respons imun. Tujuan: Penelitian bertujuan untuk menganalisis ekspresi IL-35 pada penderita karsinoma nasofaring undifferentiated pada stadium lanjut tanpa metastasis. Metode: Penelitian ini merupakan penelitian observasional analitik dengan consecutive sampling pada 30 sampel jaringan biopsi penderita KNF undifferentiated yang dilakukan pemeriksaan imunohistokimia dengan menggunakan antibodi monoclonal rabbit anti IL-35 (RabMAbs) untuk mengetahui ekspresi IL- 35 kemudian dilakukan penghitungan dengan Intensity Distribution Score (IDS). Hasil: Pengukuran IDS ekspresi IL-35 dari 30 sampel penderita didapatkan sebagian besar kelompok menunjukan hasil positif kuat dan sangat kuat sebanyak 27 penderita, 2 penderita positif lemah, dan 1 penderita negatif dengan rerata (mean) serta simpang baku (SD) 224,67±78,00. Kesimpulan: Terdapat peningkatan (overexpression) ekspresi IL-35 pada KNF undifferentiated stadium lanjut.Kata kunci: KNF undifferentiated stadium lanjut, interleukin-35, faktor prediktifABSTRACT Background: Nasopharyngeal carcinoma (NPC) is a head and neck malignancy originated from nasopharyngeal epithelium. The tumor cells produced interleukin-35 (IL-35), which support the growth of tumors, angiogenesis, and stimulation of free radical pathways through mieloid dendritic supressor cells (MDSC), and also inhibition of the immune response. Purpose: This study aimed to analyze the expression of IL-35 in the end state of undifferentiated nasopharyngeal carcinoma. Methods: Analytic observational study with consecutive sampling from 30 samples of biopsy tissue of undifferentiated NPC which underwent immunohistochemical detection with rabbit monoclonal antibody anti IL-35 (RabMAbs) to determine the expression of IL-35, and scoring by Intensity Distribution Score (IDS). Results: The expression IL-35 by IDS measurement from 30 samples resulted mostly as strong to very strong in 27 samples, weak positive in 2 samples and negative in 1 sample with mean and standard deviation 224.67±78.00. Conclusion: There was an overexpression of IL-35 in the end state of undifferentiated nasopharyngeal carcinoma.Keywords: Nasopharyngeal carcinoma undifferentiated, Interleukin-35, predictive factor