bluuebunny/crossref_metadata_2025 huggingface dataset:
A Large Pure Uterine Lipoma: Its Diagnosis by Pelvic MRI and Histopathology
Authors: Calongos Giannina , Ito Yoshihiro , Kubota Yoko , Handa Masafumi , Ida Akinori , Tsuji Yoshiyuki
Published: December 2019

The patient is a 74-year-old female previously diagnosed with an ovarian tumor at age 55. No changes were noted for one year; however, she was lost to follow-up. Eighteen years later, she presented to a local clinic complaining of diffuse abdominal and flank pain. Abdominal and pelvic ultrasound, CT, and gynecological examination showed a fatty pelvic tumor of approximately 12 cm in diameter. A left ovarian teratoma was suspected, and per the patient’s request, she was transferred to Kobe Adventist Hospital for further evaluation and treatment. Pelvic MRI revealed no ovarian enlargement; however, a mass in the uterine body was appreciated with a high signal on T1 and T2 images and signal dropout in the fat suppression images, a finding most consistent with a uterine lipoma. A total hysterectomy and bilateral salpingo-oophorectomy was performed, and histopathological examination confirmed the preliminary diagnosis. No complications were observed during the postoperative period. A pure uterine lipoma is an extremely rare tumor with only a few cases reported worldwide. It is a benign tumor; however, it can sometimes be misdiagnosed as a malignant neoplasm. Pelvic MRI appears to be a useful tool in order to make the correct diagnosis preoperatively.
Amniotic Fluid Embolism Treated with Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Gitman Robert , Bachar Bradlee , Mendenhall Byron
Published: December 2019

Amniotic fluid embolism (AFE) is an extremely rare yet fatal obstetric emergency. AFE presents as sudden cardiovascular collapse after a breach of maternal-fetal membranes and is often complicated by severe coagulopathy. We present a case where an AFE was treated with veno-arterial extracorporeal membrane oxygenation (ECMO) to help overcome the acute cardiopulmonary insult. The use of echocardiography proved to be an invaluable tool to help guide treatment and optimal duration of ECMO in the face of severe coagulopathy.
On the Coupling of the Homotopy Perturbation Method and New Integral Transform for Solving Systems of Partial Differential Equations
Authors: Eladdad E. E. , Tarif E. A.
Published: December 2019

In the current work, a combination between a new integral transform and the homotopy perturbation method is presented. This combination allows to obtain analytic and numerical solutions for linear and nonlinear systems of partial differential equations.
Constructing Digitized Chaotic Time Series with a Guaranteed Enhanced Period
Authors: Wang Chuanfu , Ding Qun
Published: December 2019

When chaotic systems are realized in digital circuits, their chaotic behavior will degenerate into short periodic behavior. Short periodic behavior brings hidden dangers to the application of digitized chaotic systems. In this paper, an approach based on the introduction of additional parameters to counteract the short periodic behavior of digitized chaotic time series is discussed. We analyze the ways that perturbation sources are introduced in parameters and variables and prove that the period of digitized chaotic time series generated by a digitized logistic map is improved efficiently. Furthermore, experimental implementation shows that the digitized chaotic time series has great complexity, approximate entropy, and randomness, and the perturbed digitized logistic map can be used as a secure pseudorandom sequence generator for information encryption.
A Massive Scalar Field under the Effects of the Lorentz Symmetry Violation by a CPT-Odd Nonminimal Coupling
Authors: Vitória R. L. L. , Belich H.
Published: December 2019

In this paper, based on the Standard Model Extended gauge sector, we made a nonminimal coupling in the Klein–Gordon equation which characterizes the Lorentz symmetry violation and, through this nonminimal CPT-odd coupling, we investigate the effects of possible scenarios of Lorentz symmetry violation by electrical and magnetic field configurations on a massive scalar field in this background, where, analytically, we determine solutions of bound states.
The Relationship between Military Combat and Cardiovascular Risk: A Systematic Review and Meta-Analysis
Authors: Boos Christopher J. , De Villiers Norman , Dyball Daniel , McConnell Alison , Bennett Alexander N.
Published: December 2019

Background and Objectives. Cardiovascular disease (CVD) is a leading cause of death among military veterans with several reports suggesting a link between combat and related traumatic injury (TI) to an increased CVD risk. The aim of this paper is to conduct a widespread systematic review and meta-analysis of the relationship between military combat ± TI to CVD and its associated risk factors.Methods. PubMed, EmbaseProQuest, Cinahl databases and Cochrane Reviews were examined for all published observational studies (any language) reporting on CVD risk and outcomes, following military combat exposure ± TI versus a comparative nonexposed control population. Two investigators independently extracted data. Data quality was rated and rated using the 20-item AXIS Critical Appraisal Tool. The risk of bias (ROB using the ROBANS 6 item tool) and strength of evidence (SOE) were also critically appraised.Results. From 4499 citations, 26 studies (14 cross sectional and 12 cohort; 78–100% male) met the inclusion criteria. The follow up period ranged from 1 to 43.6 years with a sample size ranging from 19 to 621901 participants in the combat group. Combat-related TI was associated with a significantly increased risk for CVD (RR 1.80: 95% CI 1.24–2.62;I2=59%,p=0.002) and coronary heart disease (CHD)-related death (risk ratio 1.57: 95% CI 1.35–1.83;I2=0%,p=0.77:p<0.0001), although the SOE was low. Military combat (without TI) was linked to a marginal, yet significantly lower pooled risk (low SOE) of cardiovascular death in the active combat versus control population (RR 0.90: CI 0.83–0.98;I2=47%,p=0.02). There was insufficient evidence linking combat ± TI to any other cardiovascular outcomes or risk factors.Conclusion. There is low SOE to support a link between combat-related TI and both cardiovascular and CHD-related mortality. There is insufficient evidence to support a positive association between military combat ± any other adverse cardiovascular outcomes or risk factors. Data from well conducted prospective cohort studies following combat are needed.
Discurso de Graduación Egresados 1974
Authors: Valdivieso D. Andrés
Published: December 2019

Sin resumen
Introducción
Authors: Prat A. Gabriel
Published: December 2019

Sin resumen.
Infección en la Enfermedades Hematológicas Malignas: El papel del Granulocito
Authors: Mezzano A. Diego
Published: December 2019

Sin resumen.
Epidemiología Clínica
Authors: Quesney L. Francisco
Published: December 2019

Sin resumen
Necrología
Authors: Soto O. Santiago
Published: December 2019

Sin resumen.
Nota del Editor Invitado
Authors: Monge E. Juan Ignacio
Published: December 2019

Sin resumen
Uso del Laboratorio de Diagnóstico Bacteriológico en Infecciones Quirúrgicas
Authors: Montiel A. Francisco
Published: December 2019

Sin resumen
Toma de Muestras para Exámen Bacteriológico
Authors: Lobos M. Teresa
Published: December 2019

Sin resumen.
Uso de Antibióticos en Infecciones por Cocaceas GRAM-Positivas
Authors: Montiel A. Francisco
Published: December 2019

Sin resumen.
Uso de Antibióticos en Infecciones por Bacilos GRAM-Negativos
Authors: Montiel A. Francisco
Published: December 2019

Sin resumen.
Shock Séptico
Authors: Soto O. Santiago
Published: December 2019

Sin resumen.
Prevención de Infecciones en el Pre y Postoperatorio
Authors: Cubillos O. Lorenzo
Published: December 2019

Sin resumen.
Generalidades y manejo inicial del shock
Authors: Sánchez Zobarzo Daniel Osvaldo , Lara Hernández Barbara , Clausdorff Fiedler Hans Jurgen , Guzmán Herrera Andrés Ignacio
Published: December 2019

El shock es un síndrome multifactorial que requiere un enfrentamiento sistematizado para su identificación, clasificación y tratamiento adecuado.A pesar de los avances en medicina, distintos estudios y series clínicas indican que la mortalidad puede llegar hasta un 50%. La única variable que ha mostrado ser consistente en disminuir la mortalidad, independiente de la causa del shock, es su reconocimiento y manejo precoz.Este manuscrito pretende dar un marco teórico acerca de la presentación del paciente en shock en el servicio de urgencia, describir sus principales características y orientar el estudio y tratamientos tiempo-dependientes desde su primera evaluación por el equipo médico.Inicia con la exposición de casos clínicos relevantes al tema. Luego revisa la fisiopatología del fenómeno del shock y sus subtipos. Finalmente ofrece herramientas para su evaluación y tratamiento en el servicio de Urgencia.
Responsabilidad médica frente a casos de violencia al interior de las familias. Una mirada desde distintas perspectivas.
Authors: Rojas Gonzalez Pamela Elisa , Pérez Hernández Iván , Valladares Perroni Carla , Rada Salazar Patricia , Rain Velásquez Carolina
Published: December 2019

La violencia al interior de las familias (VIF), en sus distintas formas y con distintas víctimas, es un problema que nos toca en forma transversal a las distintas disciplinas médicas.En Chile, una de cada tres mujeres reporta haber experimentado VIF, y cerca de 45 mueren cada año por esta causa. Como país hemos optado por hacernos cargo de esta situación y nos hemos trazado como meta reducir la morbilidad, discapacidad y mortalidad prematura asociada a violencia, y, específicamente, a reducir los femicidios en un 33%. La denuncia es un instrumento legal que puede ayudar a este propósito.Este artículo reflexiona sobre conceptos médicos, legales y éticos involucrados en el abordaje inicial de una víctima de VIF, con especial foco en la denuncia. Se discute sobre los alcances de la nueva legislación vigente en Chile en materia de VIF, sobre la responsabilidad legal y ética del médico en Chile frente a este problema de salud, y sobre la postura de la Organización Mundial de la Salud al respecto.
Cambios en el modelo de atención de personas con multimorbilidad crónica: una revisión narrativa
Authors: Barros Urzua Jorge , Zamorano Pichard Paula , Varela Yuraszeck Teresita , Irazoqui Soto Esteban , Téllez Téllez Alvaro
Published: December 2019

Muchos países deben enfrentarse al rápido aumento de personas viviendo con alguna condición crónica de salud. En Chile, según datos entregados por la última encuesta nacional de salud, se ha estimado que la población con alguna condición crónica es de 11 millones de personas, de las cuales un 81% presenta multimorbilidad. Este grupo tiene una menor calidad de vida, una mayor mortalidad ajustada por edad, mayor utilización de recursos del sistema de salud, así como un mayor riesgo de hospitalización y una estadía hospitalaria más prolongada. Metodología: revisión narrativa de la literatura para lograr identificar como se ha organizado el cuidado de los pacientes con multimorbilidad a lo largo del tiempo y como se han ido desarrollando estrategias que buscan un abordaje distinto. Resultados: los sistemas de salud se han organizado con un enfoque centrado en la enfermedad, lo que genera que los pacientes reciban un cuidado fragmentado, ineficiente e inefectivo, sin lograr dimensionar la complejidad de la persona y su contexto biopsicosocial. Los sistemas de salud, principalmente en Europa han desarrollado diversas iniciativas que buscan cambiar la perspectiva desde el cuidado centrado en la enfermedad al cuidado centrado en la persona Conclusiones: se  puede concluir que la multimorbilidad es un problema que afecta a millones de personas en el mundo y que los servicios y sistemas de salud necesitan hacer un cambio hacia un modelo centrado en la persona de forma de dar respuestas a las necesidades de este grupo de pacientes.
Tumor neuroendocrino primario testicular: reporte de un caso y revisión de la literatura.
Authors: Ortega González Francisco , Urdaneta Nelson , Yañez Nicolas , Morales Erik , Monasterio Valeria , Pulgar Dahiana , Henríquez René
Published: December 2019

Los tumores neuroendocrinos primarios del testículo son una entidad muy infrecuente, dando cuenta del 1% de las neoplasias testiculares. Clínicamente se presentan indolentes, por una masa testicular. En tumores localizados, rara vez presentan síndrome carcinoide. La orquiectomía radical es el tratamiento de elección; el pronóstico es excelente en etapas precoces. Las terapias adyuvantes no han mostrado utilidad.Se presenta un caso de un hombre de 53 años con una masa testicular palpable de larga evolución. Se realiza orquiectomía radical. La biopsia muestra un tumor neuroendocrino bien diferenciado. Sin evidencia de metástasis en etapificación. Se define en comité oncológico, realizar seguimiento.
P300 characterization using empirical mode decomposition
Authors: Braz Victor S. , Souza Ana Claudia , Rodrigues Gustavo F.
Published: December 2019

As the communication between brain and computer becomes more accessible the extraction of important features of electrophysiological signals is an essential step in artificial communication systems. This paper proposes the usage of the Empirical Mode Decomposition to identify characteristics of the P300 signal and classify target and non-target signals using a feedforward neural network. The results show that through the usage of EMD method it is possible to identify the P300 signal using low volume of data.
ESTIMATION OF ONLINE PURCHASING INTENTION USING DECISION TREE
Authors: Topal İbrahim
Published: December 2019

It is very difficult to estimate consumer behavior
due to different variables. There are also differences between the online
consumer and the traditional ones. While there are studies for the prediction
of purchasing behavior of online consumers, there is need for further studies
with larger data including different features. Large data is difficult to
obtain due to restrictions on private information and causes the analysis
systems run for a long time. So, in this study, it is aimed to create a
meaningful rule by estimating the purchasing behavior of online consumers with
fewer data. After selecting the Fisher Score feature in a current and open
database, training and test data were determined with K fold and a rule was
created with Decision Tree. As a result, it can be suggested that it is
possible to determine the purchasing behavior of online consumers with high
accuracy by using a single feature.
TÜRK BEYAZ EŞYA SANAYİİ’NİN REKABET GÜCÜ
Authors: AKİŞ Elife
Published: December 2019

Bilgi ve teknolojiye dayalı yüksek katma
değerli sektörlerin dünya ticaretinden aldığı pay hızla artmaktadır. Orta üst
teknoloji düzeyine sahip Beyaz eşya sektörü ülkemizi uluslararası ölçekte
temsil eden önde gelen sektörlerden biridir. Çalışmada, 2008 – 2017 yılları
arasında Türk Beyaz Eşya Sanayii’nin rekabet gücünün ve sürdürebilirliğinin
belirlenmesi amaçlanmıştır. Bu amaç doğrultusunda ilk olarak Dünya beyaz eşya
sanayiinin genel yapısı ve Türk beyaz eşya sanayii incelenerek, rekabet gücü ve
Açıklanmış Karşılaştırmalı Üstünlükler Endeksi açıklanmıştır. Son olarak da Türk
beyaz eşya sanayiinin rekabet gücü analizi, Balassa’nın “Açıklanmış
Karşılaştırmalı Üstünlükler Endeksi”ne göre yapılmıştır. Yapılan hesaplamaların
sonucuna göre toplam beyaz eşya sektörü ve ürün gruplarının endeks değeri 1’den
büyük çıkmıştır ve dolayısıyla Türk beyaz eşya sanayii rekabet gücüne sahiptir.
Sektörlere Sanayi 4.0’ın yön verdiği günümüzde, dünya piyasasında daha etkin
yer almak için firmaların sektörün rekabet gücünü devam ettirirken, katma
değeri daha yüksek, yoğun bilgi ve Ar-Ge yatırımı gerektiren, ileri teknolojili
ürünlere ağırlık vermeleri ve Sanayi 4.0 dönüşümüne uyum sağlamaları
gerekmektedir.
TÜRKİYE SEKÜLERLEŞİYOR MU TARTIŞMASINA SOSYO-POLİTİK BİR KATKI: NİLÜFER GÖLE ÖRNEĞİ
Authors: KOÇ Yunus , TOPLUK Gökhan
Published: December 2019

Modernitenin siyaset, toplum, din üzerindeki etkilerine ve bu olguları nasıl dönüştürdüğüne dair pek çok farklı yaklaşım vardır. Bu yaklaşımların odak noktasını din ile seküler kavramları oluşturmuştur. Klasik yaklaşım, Batı modernitesinin sekülerleştirdiğini, dinin siyasal ve toplumsal etkilerini tamamen ortadan kaldırdığını ya da azalttığını iddia etmiştir. Klasik teze karşı yeni paradigma, sekülerin yerine dini olanın yükselişine dikkat çekmiştir. Ancak bu iki paradigmadan farklı olarak Nilüfer Göle, seküler ile din arasındaki ilişkiyi Batı merkezli bir idealite yerine Batı-dışı toplumların kendine mahsus modernleşme tecrübeleri üzerinden yeniden okumuştur. Bu çalışmada Göle’nin Türk modernleşmesine yönelik analizleri üzerinden kamusal alanların ve mekânların kurgulanan ve sahnelenen yüzleri değerlendirilecek; kamusal alanlardan dışlanan merkez-kaç unsurların meydan okumaları ve bu alanlara talip olmaları sonucu kamusal mekânları nasıl dönüştürdükleri ve kendilerinin de neye dönüştükleri yazarın perspektifinden sekülerleşme tartışmaları bağlamında ele alınacaktır. Çalışma konusu bağlamında yazarın değindiği temel kavram ve yaklaşımlar içerik analizi yöntemine uygun olarak kritik edilmeye çalışılmıştır.
European Dreams and European Nightmares in Prewar Donetsk
Authors: Risch William Jay
Published: December 2019

This article is based on interviews with and questionnaires completed by Donetsk area residents when the author visited the city January 7–17, 2014. They demonstrate that, at least among Donbas area residents with higher education, there were possibilities for building a “European dream” that Euromaidan protesters in Kyiv championed. Fighting for the rule of law, human rights, and an end to corruption—values identified with the Euromaidan—could have transcended Ukraine’s regional divisions. Even those skeptical of “European values” still agreed that they belonged to one nation with differing political objectives. Yet the manipulation of the Kyiv protests by politicians, outbursts of violence in Kyiv, continued stereotypes of Ukraine’s regions, and complex economic ties with Russia and Europe made this European dream elusive. Escalating violence in January 2014 and the sudden implosion of the regime of Viktor Yanukovych the next month polarized public opinion in Donetsk. Due to manipulations by local politicians, pro-Russian activists, and pro-Russian propaganda in local media, Donetsk residents and others in the Donbas protested the Kyiv “Junta” and demanded greater rights for their region. The ensuing geopolitical battle brought about greater Russian intervention, both politically and militarily, making it impossible for civil society to resist the sudden emergence of separatist republics. As pro-Russian activists and armed militants, some from across the Russian border, terrorized pro-Ukrainian citizens and Euromaidan activists, the European dream in Donetsk came to an end for the foreseeable future.
Fighting Fire with Fire? “Muslim” Political Parties in the Netherlands Countering Right-Wing Populism in the City of Rotterdam
Authors: Loukili Sakina
Published: December 2019

This article explores the emergence of Muslim-majority political party DENK in Dutch politics by focusing on two encounters before the 2018 local elections in Rotterdam. It explains the circumstances of DENK’s rise and success and argues that social media plays a central role. By analysing social media data, the author demonstrates that the party counters right-wing populist discourse by making use of the local context and particular on- and offline strategies. In addition, the article shows that a novel development is taking place concerning Muslim political participation in the Netherlands, which is part of a broader trend in Western Europe.
From Dionysius to al-Ġazālī
Authors: Treiger Alexander
Published: December 2019

The present article reports the discovery of a previously unknown ninth-century Arabic paraphrase of Dionysius the Areopagite and demonstrates that this paraphrase was accessible to al-Ġazālī (and, probably, to other authors, notably the Brethren of Purity). It also proves that this paraphrase was produced by the same translator as the Doxography of Pseudo-Ammonius. The doctrinal content of the Arabic Dionysian paraphrase is then analyzed in relation to Arabic Neoplatonic texts as well as al-Ġazālī’s writings. The influence of Gregory of Nyssa and John of Damascus on some Arabic philosophical texts (notably al-Kindī’s Book of Definitions) is also considered. The origin of “Interpositional Neoplatonism” (i.e., the kind of Neoplatonism that interposes an intermediate hypostasis between the First Principle and the Intellect) is examined. The Appendix discusses the relationship between the Doxography of Pseudo-Ammonius and Hippolytus of Rome’s Refutatio omnium haeresium.
Visual Semiotics and Real Events
Authors: Semetsky Inna
Published: December 2019

This article adopts a semiotic (and edusemiotic) perspective that abolishes all binary divisions in favour of the process of semiosis that ensures a continuous translation of signs into other signs via the dynamic relations formed by the human mind, cultural artefacts, and events in real life. The mind, in edusemiotics, partakes of unconscious ideas in the form of mental images. As for culture, the field of communication phenomena calls for, according to Yuri Lotman, the identification of specific semiotic systems representing their ‘languages’, including non-verbal signs such as images, pictures, and other art forms that function as cultural texts. The methodology of bricolage (conceptualized in educational research by Joe Kincheloe) combines hermeneutics with narratology, and ‘reading’ images becomes imperative for advancing critical pedagogy. The article examines and interprets selected images, including those belonging to the low end of popular culture, and connects them with the exemplarily significant event at the level of socio-cultural reality.The paradoxical self-referential ‘logic’ is the prerogative of semiotic reason that constantly reflects on – thus bringing to cognition and transforming – our often unconscious assumptions, beliefs and habits thus contributing to the construction of subjectivity that uses critical reason informed by signs, which include the bricolage of images.
Predictions of NOx and CO emissions from a low-emission concentric staged combustor for civil aeroengines
Authors: Zhang Qun , Hai Han , Li Chengyu , Wang Yuming , Zhang Peng , Wang Xin
Published: December 2019

This study is aimed to establish a detailed chemical reactor network model based on the analysis of complex reaction flowfield structures in aeroengine combustors, so that the emissions of nitrogen oxides and carbon monoxide from advanced civil aeroengines can be predicted quickly and accurately. In this study, a low-emission concentric staged combustor with three axial swirlers is designed for civil aeroengines, and numerical simulations of the three-dimensional reaction flowfields of the combustor during four load phases of takeoff, climb, approach, and idle, are conducted. Based on the numerical results, a simple chemical reactor network model with seven perfectly stirred reactors and a detailed chemical reactor network model using up to 15 perfectly stirred reactors are established. Using the developed chemical reactor network models and the detailed JP10 chemical reaction mechanism—composed of 374 step elementary reactions and 82 species, the emission variations of nitrogen oxides and carbon monoxide are predicted and compared with those estimated using an empirical formula and with the numerical results as a function of the combustion load. Using a combined chemical reactor network–computational fluid dynamics analysis method, the variations of the formation path, the mechanism, and the amounts of nitrogen oxides in the combustor and in the perfectly stirred reactors, are analyzed as a function of the combustion load. In addition, the effects of fuel and air pilot-to-total ratio on nitrogen oxides emissions for the 100% load condition are also analyzed. It is found that at high loads, the production rate of the thermal NO is the highest, while at low loads, the production rate of the prompt NO is the highest. The nitrogen oxide is mainly produced in the pilot zone and the recirculation zone, while its production in the outer main stage zone is low. The results show that the NOx emissions predicted by the complex chemical reactor network model are most consistent with those elicited using the empirical formula.
Optimisation methodology for integrated equipment installation in new engine architecture nacelles
Authors: Vankan Wilhelmus J , Maas Robert , Peyron Vincent
Published: December 2019

The development of new higher efficiency turbofan aero engines requires several design enhancements that typically result in shorter and slimmer nacelles. Consequently these engines provide less space for the engine systems installation and for maintenance accessibility. In the Novel Integration of Powerplant System Equipment project, optimisation methodologies are being investigated and developed for the integrated installation of equipment into the restricted volume of new architecture engines’ nacelles. The underlying optimisation methodology is built on a graph based approach involving efficient routing algorithms. Besides the methodology, also the software implementation and its application to engine equipment installation design cases are presented in this paper.
Transient Ischaemic Attack Care Pathway
Authors: Clare S , Kausar S
Published: December 2019

A transient ischaemic attack (TIA) is a common medical encounter, which is often managed suboptimally in the acute phase. A TIA should be treated as a medical emergency as studies have shown that high-risk patients can go on to have a stroke within seven days of a TIA. An audit was completed looking at referrals to the TIA clinic. Results prompted the production of a TIA care pathway, which prompted health-care teams on the appropriate management of these patients.
An All–Wales Audit of the Integrated Care Pathway for the Last Days of Life: Establishing the Audit Cycle
Authors: Closs Susan , Johnstone Ros , Fowell Andrew
Published: December 2019

Since 2000, the Integrated Care Pathway (ICP) for the last days of life has been implemented mainly in secondary care and to some extent in primary care throughout Wales. The use of the document was monitored centrally. Analysis and feedback of the variance sheets demonstrated that looking at the ICP variances in isolation had limitations. In response to suggestions made by colleagues working with the ICP for the last days of life throughout Wales, an all-Wales audit of the pathway was initiated. At the close of the baseline audit (31 August 2006), data were analysed from 24 sites, which included four (of 5) hospices, three (of 5) specialist inpatient units, eight (of 28) community sites, eight (of 9) district general hospitals and one nursing home. These sites submitted data on 201 deaths managed using the ICP for the last days of life and represent a 77% response rate. Data arriving up to one week after the deadline were subsequently entered onto the database resulting in a response rate of 80%. The response rate from a concomitant staff survey sent out to district nursing teams, community hospitals, wards in district general hospitals and hospices was 48%. The findings of the audit indicate that standards were met in 62% of cases. Variance recording and reporting are misunderstood resulting in 34% underreporting of variances or changes to the expected course of care as detailed in the ICP. Ongoing training and ‘refresher’ sessions are indicated for new and existing staff. The outcomes of the staff survey endorse the findings of the audit and call for more training, although the pathway is recognized as a contributory factor in improving the care of the dying patient. Re-audit six months later showed an overall outcome of the ICP standards being met in 81% of cases. This second audit establishes the annual audit cycle for the pathway that will continue to monitor quality of care and contribute to the annual review of the pathway.
The Care Process Organization Triangle: A Framework to Better Understand how Clinical Pathways Work
Authors: Vanhaecht Kris , de Witte Karel , Sermeus Walter
Published: December 2019

Clinical pathways, also known as care pathways or integrated care pathways, are used worldwide to make care processes transparent and organize care around patient needs. Although this is in international use, it is still unclear why pathways sometimes work and sometimes do not. To better understand how pathways work, there is a growing need for paradigms or organizing concepts. Different quality and health-care management gurus have developed frameworks to better understand how certain processes or methods work. This paper will provide an overview of several frameworks and integrate them into Donabedian's Structure–Process–Outcome configuration. In view of this configuration, the care process organization triangle was developed. In this paper, we will describe the three cornerstones of this triangle by integrating the literature on clinical pathways. The care process organization triangle is only one model, but as Deming described it: ‘Some models can be quite useful’.
Idiopathic Intracranial Hypertension: Towards an Integrated Care Pathway
Authors: Larner A J
Published: December 2019

An integrated care pathway is proposed for idiopathic intracranial hypertension, a condition which may result in permanent visual impairment or loss in young people. This proposal is prompted by the ‘boundary’ nature of the condition, which transcends traditional professional categories and hence involves a wide array of professional groups in patient management from both primary and secondary care, and also by the absence of sufficient information from clinical trials to permit an evidence-based management strategy. An integrated care pathway may not only optimize current best practice but also facilitate patient recruitment for randomized controlled trials.
Prospective Trial of Functional Thyrotropin Receptor Antibodies in Graves Disease
Authors: Kahaly George J , Diana Tanja , Kanitz Michael , Frommer Lara , Olivo Paul D
Published: December 2019

Context

Scarce data exist regarding the relevance of stimulatory (TSAb) and blocking (TBAb) thyrotropin receptor antibodies in the management of Graves disease (GD).

Objective

To evaluate the clinical utility and predictive value of TSAb/TBAb.

Design

Prospective 2-year trial.

Setting

Academic tertiary referral center.

Patients

One hundred consecutive, untreated, hyperthyroid GD patients.

Methods

TSAb was reported as percentage of specimen-to-reference ratio (SRR) (cutoff SRR < 140%). Blocking activity was defined as percent inhibition of luciferase expression relative to induction with bovine thyrotropin (TSH, thyroid stimulating hormone) alone (cutoff > 40% inhibition).

Main Outcome Measures

Response versus nonresponse to a 24-week methimazole (MMI) treatment defined as biochemical euthyroidism versus persistent hyperthyroidism at week 24 and/or relapse at weeks 36, 48, and 96.

Results

Forty-four patients responded to MMI, of whom 43% had Graves orbitopathy (GO), while 56 were nonresponders (66% with GO; P < 0.01). At baseline, undiluted serum TSAb but not thyroid binding inhibitory immunoglobulins (TBII) differentiated between thyroidal GD-only versus GD + GO (P < 0.001). Furthermore, at baseline, responders demonstrated marked differences in diluted TSAb titers compared with nonresponders (P < 0.001). During treatment, serum TSAb levels decreased markedly in responders (P < 0.001) but increased in nonresponders (P < 0.01). In contrast, TBII strongly decreased in nonresponders (P = 0.002). All nonresponders and/or those who relapsed during 72-week follow-up period were TSAb-positive at week 24. A shift from TSAb to TBAb was noted in 8 patients during treatment and/or follow-up and led to remission.

Conclusions

Serum TSAb levels mirror severity of GD. Their increase during MMI treatment is a marker for ongoing disease activity. TSAb dilution analysis had additional predictive value.
A Contemporary View of the Definition and Diagnosis of Osteoporosis in Children and Adolescents
Authors: Ward Leanne M , Weber David R , Munns Craig F , Högler Wolfgang , Zemel Babette S
Published: December 2019

The last 2 decades have seen growing recognition of the need to appropriately identify and treat children with osteoporotic fractures. This focus stems from important advances in our understanding of the genetic basis of bone fragility, the natural history and predictors of fractures in chronic conditions, the use of bone-active medications in children, and the inclusion of bone health screening into clinical guidelines for high-risk populations. Given the historic focus on bone densitometry in this setting, the International Society for Clinical Densitometry published revised criteria in 2013 to define osteoporosis in the young, oriented towards prevention of overdiagnosis given the high frequency of extremity fractures during the growing years. This definition has been successful in avoiding an inappropriate diagnosis of osteoporosis in healthy children who sustain long bone fractures during play. However, its emphasis on the number of long bone fractures plus a concomitant bone mineral density (BMD) threshold ≤ −2.0, without consideration for long bone fracture characteristics (eg, skeletal site, radiographic features) or the clinical context (eg, known fracture risk in serious illnesses or physical-radiographic stigmata of osteoporosis), inappropriately misses clinically relevant bone fragility in some children. In this perspective, we propose a new approach to the definition and diagnosis of osteoporosis in children, one that balances the role of BMD in the pediatric fracture assessment with other important clinical features, including fracture characteristics, the clinical context and, where appropriate, the need to define the underlying genetic etiology as far as possible.
Valorization of snail shell (Helixaspersa) from Tangier-Tetouan region (north of Morocco): an application to eliminate methylene blue
Authors: Erradi Ghizlane , El yousfi Farida , Stitou Mostafa
Published: December 2019

Removal of industrial waste becomes increasingly critical for environmental protection. This study aims to search for effective and less expensive adsorbents in order to remove methylene blue (MB) commonly used in many industrial sectors. To this end, we experiment Helix aspersa snail shell as a biosorbent for the removal of MB. The raw snail shells were cleaned, smashed, and characterized afterwards using a scanning electron microscopy (SEM) coupled with an energy dispersive X-Ray analysis (EDX) and by X-ray diffraction. Different parameters were tested in order to identify the optimal conditions for the effective removal of MB. Our experimental results showed that, within the first ten minutes, a remarkable elimination of methylene blue dye reaching a percentage of 82%, with the following optimal conditions; 3.5 g of the adsorbent, initial MB concentration of 20 mg/L, the temperature of 15 Â°C, and agitation of 250 rpm. This study showed that the use of snail shell waste has inevitably a positive impact on the protection of the environment, in particular, the purification of industrial effluents.
Design of a large aperture, tunable, Pancharatnam phase beam steering device
Authors: Yousefzadeh Comrun , Van Rynbach Andre , Bos Philip J.
Published: December 2019

Replacing mechanical optical beam steering devices with non-mechanical electro-optic devices has been a long-standing desire for applications such as space-based communication, LiDAR and autonomous vehicles. While promising progress has been achieved to non-mechanically deflect light with high efficiency over a wide angular range, significant limitations remain towards achieving large aperture beam steering with a tunable steering direction. In this paper, we propose a unique liquid crystal based Pancharatnam Phase Device for beam steering which can provide both tunability and a fast response times in a format scalable to large apertures. This architecture employs a linear array of phase control elements to locally control the orientation of the liquid crystal director into a cycloidal pattern to deflect transmitted light. The PCEs are comprised of a fringe field switching electrode structure that can provide a variable in-plane electric field. Detailed modeling of the proposed design is presented which demonstrates that such a device can achieve a high degree of uniformity as it rotates the LC molecules over the 180 ° angular range required to create a Pancharatnam phase device.
Exceptional cones in 4D parameter space
Authors: Wang Qiang , Ding Kun , Liu Hui , Zhu Shining , Chan Che Ting
Published: December 2019

The notion of synthetic dimensions has expanded the realm of topological physics to four dimensional (4D) space lately. In this work, non-Hermiticity is used as a synthetic parameter in PT-symmetric photonic crystals to study the topological physics in 4D non-Hermitian synthetic parameter space. We realize a 3D exceptional hypersurface (EHS) in such 4D parameter space, and the degeneracy points emerge due to the symmetry of synthetic parameters. We further demonstrate the existence of exceptional degenerate points (EDPs) on the EHS that originates from the chirality of exceptional points (EPs), and the exceptional surface near EDPs behaves like a Dirac cone. We further show that a very narrow reflection plateau can be found near these EDPs, and their sensitivity towards the PT-symmetry breaking environmental perturbation can make these degeneracy points useful in optical sensing and many other nonlinear and quantum optical applications.
Detuning effects in Brillouin ring microresonator laser
Authors: Korobko D. A. , Zolotovskii I. O. , Svetukhin V. V. , Zhukov A. V. , Fomin A. N. , Borisova C. V. , Fotiadi A. A.
Published: December 2019

Brillouin lasers, with their unique properties, offer an intriguing solution for many applications, yet bringing their performance to integrated platforms has remained questionable. We present a theoretical framework to describe Brillouin lasing in integrated ring microcavities. Specifically, a general case of a mismatch between the Brillouin shift and the microresonator inter-mode spacing is considered. We show that although the lasing threshold is increased with the frequency detuning, a significant enhancement of the laser power in comparison with the pure resonant interaction could be achieved. Moreover, there is an optimal pump frequency detuning from the resonant mode frequency, when the effect is most pronounced. An increase of the Brillouin threshold with the pump frequency detuning is accompanied by narrowing the pump frequency range available for lasing. Importantly, at the optimal value of the pump frequency detuning when the Brillouin signal is maximal, Brillouin signal noise level is minimal. Analytical results obtained in the steady-state approach are in quantitative agreement with the results of numerical simulations.
Alternative formulation of the macroscopic field equations in a linear magneto-dielectric medium: field equations
Authors: Crenshaw Michael E.
Published: December 2019

We derive an alternative formulation of the field equations for macroscopic electromagnetic fields in a linear magneto-dielectric medium as an identity of the Maxwell–Minkowski equations, complementing a variety of other representations including the Ampère, Chu, Lorentz, and Minkowski formulations of continuum electrodynamics. In the new formulation of the macroscopic field equations, the material properties are carried as a renormalization of the temporal and spatial coordinates instead of as independent material constants. The new representation of the field equations raises some interesting physical issues with relativity and boundary conditions.
Sociolinguística no Brasil
Authors: Freitag Raquel Meister Ko. , Oushiro Livia
Published: December 2019

A mobilidade tem sido uma característica da população brasileira, com diferentes deslocamentos (pendulares, sazonais, movimentos de retorno, migração e imigração) atuando na dinâmica das relações sociais, e por conseguinte, repercutindo na língua.
O empreendimento da Sociolinguística no Brasil concentra suas pesquisas majoritariamente em capitais ou em grandes centros urbanos. Mas, mesmo em capitais, a metodologia de constituição de amostras, que guarda resquícios da dialetologia e do falante "puro", fica cada vez mais difícil de ser replicada: falante que tenha nascido no local, filho de pais igualmente nascidos no local.
Neste dossiê, reunimos trabalhos sociolinguísticos que ampliam o escopo da descrição de uma variável em uma comunidade para os efeitos da mobilidade, envolvendo questões relacionadas ao contato entre línguas e variedades de línguas, mas também ao contato de valores, culturas e modos de vida que podem (ou não) ser captados sob a forma de entrevistas sociolinguísticas. Os trabalhos versam sobre estudos de produção e percepção, assim como propostas de abordagem teórica e metodológica para lidar com fenômenos variáveis em situação de contatos linguísticos, mobilidade populacional e fronteiras dialetais.
A A parent participation proposal: Benefiting from the field expert teacher parents on teaching of course subjects
Authors: Karabacak Kerim
Published: December 2019

This research has been realized to determine whether students’ academic success increases when teacher parents as expert in their fields teach courses instead of classroom teachers with the aim of giving a parent participation proposal. In the research, the study group includes 4th grade elementary school students which has been realized experimentally in controlled pre-test and final test model. Success test developed by the researcher has been used as data collection instrument which is determined with sampling method with aimed study group in the research. Paired groups t-test has been user in the data analysis. According to the research findings, when field expert teacher parents enter the course and when these are compared with the courses which classroom teachers enter, it has been determined that academic success of the students increase at the same level. However, the result of permanence of the knowledge being higher has been reached when compared with the courses which classroom teachers enter.  According to the results, it is proposed that field expert teacher parents should enter the courses of classroom teachers in teaching of some subjects. This also can be accepted as a new parent participation proposal. 
​Extended English summary is in the end of Full Text PDF (TURKISH) file.
 
Özet
Bu araştırma bir veli katılım önerisinde bulunmak amacı ile konu alanında uzman olan öğretmen velilerin sınıf öğretmeninin yerine ders vermesinin öğrencilerin akademik başarılarını arttırıp arttırmadığını belirlemek için gerçekleştirilmiştir. Kontrollü ön test ve son test modelinde deneysel olarak gerçekleştirilen araştırmada, çalışma grubu ilkokul 4. sınıf öğrencilerinden oluşmaktadır. Çalışma grubu amaçlı örnekleme yöntemine göre belirlenmiş olan araştırmada veri toplama aracı olarak araştırmacı tarafından geliştirilen başarı testi kullanılmıştır. Verilerin analizinde eşleştirilmiş gruplar t-testi kullanılmıştır. Araştırma bulgularına göre alan uzmanı öğretmen velilerin sınıf öğretmenlerinin yerine derslere girmesinin öğrencilerin akademik başarılarının, sınıf öğretmenlerinin girmiş oldukları dersler ile karşılaştırıldığında aynı düzeyde arttığı belirlenmiştir. Ancak öğrenilen bilgilerin kalıcılığı ise sınıf öğretmenlerinin girmiş oldukları derslere göre daha yüksek olduğu sonucuna ulaşılmıştır. Sonuçlara göre bazı konuların öğretiminde o alanda uzman öğretmen velilerin sınıf öğretmenlerinin derslerine girmesi önerilmektedir. Bu da yeni bir veli katılım önerisi olarak kabul edilebilir.
Effects of gamma irradiation on the alkaloid content in seeds of Datura stramonium and the radiosensitivity of derived seedlings
Authors: Benslimani Nabila , Khelifi-Slaoui Madjda , Morsli Abdelkader , Djerrad Amar , Al-Ramamneh Ezz Al-Dein , Makhzoum Abdullah , Khelifi Lakhdar
Published: December 2019

Tropane alkaloids are a group of secondary metabolites occurring naturally in Solanaceae family as Atropa belladona, Datura stramonium, Mandragora officinalis, and Hyoscyamus niger. These molecules have valuable therapeutic applications, for example, atropine and hyoscyamine are utilized as antimuscarinic besides being stomach and intestinal diseases drugs. Plants of the Solanaceae family can provide a natural yet less expensive source of these compounds. Hitherto, in order to emphasize these metabolites biosynthesis, D. stramonium seeds were irradiated using a cobalt-60 source of gamma rays of 5 to 80 Gy and germinated in vitro on MS medium in growth controlled chamber. Mutagenesis of D. stramonium seeds was attempted aiming at obtaining plants from in vitro source that are genetically variable for enhancing the biosynthesis of secondary metabolites, namely alkaloids. Results indicated that D. stramonium seeds exhibited a good radiosensitivity and the mutagen damage index GR (30-50) for D. stramonium was determined at 80 Gy. The Characterization of alkaloids (Atropine and hyoscyamine) was done by infrared spectroscopy which showed that alkaloids content of the irradiated seeds is altered by irradiation as the reference bands were not found with all doses used. In addition, seedlings grown from irradiated in vitro seeds exhibited remarkable morphological variations that varied based on the employed dose of gamma rays. These findings permitted the selection of the optimal irradiation dose (80 Gy) to induce mutations that are likely to prompt changes at genetic and metabolic level of the targeted alkaloids.
Freedom of Expression in Ukraine: (Non)sustainable Constitutional Tradition
Authors: Slinko Tatiana , Uvarova Olena
Published: December 2019

Freedom of expression is one of the prerequisites for the formation and existence of a democratic society; it belongs among the universal values of paramount importance, because it allows not only to freely express own views, but also reveal the potential of the individual. In addition, it is considered (and it is justified) as one of the main and unconditional achievements of the political reform that is being carried out in Ukraine. The guarantee of freedom of expression, which has the highest political normative content, is, on the one hand, the most important asset of an organic constitution, and on the other hand, serves as the main function of the constitution as a legal source that reflects and responds to the interests of civil society.

However, the real challenge for the unsustainable constitutional tradition that still retains some signs of the post-Soviet model of regulation is the need to balance freedom of expression under the conditions of threats to national security. What should be the proper mechanism for guaranteeing freedom of expression at the constitutional level? How strong is the danger that the state violates the requirement of constitutionality in the case of restrictions on freedom of expression for the sake of national security? How does the post-Soviet tradition of legal regulation manifest itself in deciding which model of guaranteeing freedom of expression is chosen by the state? What is the role of the tradition of respect for personal autonomy and the value of tolerance of a society in guaranteeing freedom of expression? The article is devoted to finding answers to these questions.