bluuebunny/crossref_metadata_2025 huggingface dataset:
Say, What Is on Your Mind? Surgeons’ Evaluations of Realism and Usability of a Virtual Reality Vertebroplasty Simulator
Authors: Koch Amelie , Pfandler Michael , Stefan Philipp , Wucherer Patrick , Lazarovici Marc , Navab Nassir , Stumpf Ulla , Schmidmaier Ralf , Glaser Jürgen , Weigl Matthias
Published: January 2019

Background. Virtual reality (VR)–based simulations offer rich opportunities for surgical skill training and assessment of surgical novices and experts. A structured evaluation and validation process of such training and assessment tools is necessary for effective surgical learning environments. Objective. To develop and apply a classification system of surgeon-reported experience during operation of a VR vertebroplasty simulator. Methods. A group of orthopedic, trauma surgeons and neurosurgeons (n = 13) with various levels of expertise performed on a VR vertebroplasty simulator. We established a mixed-methods design using think-aloud protocols, senior surgical expert evaluations, performance metrics, and a post-simulation questionnaire. Verbal content was systematically analyzed using structured qualitative content analysis. We established a category system for classification of surgeons’ verbal evaluations during the simulation. Furthermore, we evaluated intraoperative performance metrics and explored potential associations with surgeons’ characteristics and simulator evaluation. Results. Overall, 244 comments on realism and usability of the vertebroplasty simulator were collected. This included positive and negative remarks, questions, and specific suggestions for improvement. Further findings included surgeons’ approval of the realism and usability of the simulator and the observation that the haptic feedback of the VR patient’s anatomy requires further improvement. Surgeon-reported evaluations were not associated with performance decrements. Discussion. This study is the first to apply think-aloud protocols for evaluation of a surgical VR-based simulator. A novel classification approach is introduced that can be used to classify surgeons’ verbalized experiences during simulator use. Our lessons learned may be valuable for future research with similar methodological approach.
Shear behavior of concrete beams pre-stressed with carbon fiber reinforced polymer tendons
Authors: Wang Zuohu , Yao Yuan , Liu Du , Cui Yuqiang , Liao Weizhang
Published: January 2019

This article presents experimental and numerical studies on the shear behavior of reinforced concrete beams pre-stressed with carbon fiber reinforced polymer tendons. A total of 23 beams were tested to analyze the failure mode and shear performance of pre-stressed concrete beams. Experimental results revealed that there were two typical shear failure modes, that is, shear compression failure and inclined compression failure. Next, the experimental and numerical results were used to explore factors influencing the failure mode and the shear behavior of the concrete beams, including the type of pre-stressing tendons, stirrup ratio, shear span–depth ratio, number of pre-stressing tendons, and their initial pretension levels. It is demonstrated that shear span–depth ratio and stirrup ratio are the two main determinants of the failure mode and shear capacity of the concrete beams pre-stressed with carbon fiber reinforced polymer tendons. However, the bonding conditions of the pre-stressing carbon fiber reinforced polymer tendons have no significant effect on the shear capacity of the pre-stressed concrete beam.
Loudness calculation procedure to study electronic steering column lock noise measurement
Authors: Maffiodo Daniela , Sesana Raffaella
Published: January 2019

In the automotive field, the customer requirements for low interior noise and pleasant sound quality inside a vehicle are getting higher and higher. Various national and international regulatory authorities established and reviewed vehicle interior noise for the past years. Besides, lots of studies have shown that vehicle noise can influence the driver’s perceptions and also his or her driving capabilities. To succeed in this scenario, all manufacturers are investing in technology and research in order to improve their component performance. Working on the noise source so as to reduce the seriousness of these noise problems can be really effective. However, various engineering techniques are available to deal with noise and sound-measuring instruments, and systems can help to identify the nature of the problem and they can also be helpful in determining the right procedure to analyse the noise problem. This work proposes a procedure to evaluate the noise originated from an electronic steering column lock device which is used to lock and unlock the steering wheel according to European safety requirements. In particular, different standards and requirements for loudness evaluation have been discussed and the formulation of a straightforward procedure, which can be used to evaluate the loudness according to costumer’s requirements, is defined.
Remission of type 2 diabetes and pleiotropic effects of long-term testosterone treatment for “late-onset” hypogonadism: A case report
Authors: Haider Ahmad , Haider Karim , Saad Farid , Hanefeld Markolf
Published: January 2019

For obese type 2 diabetes patients, weight reduction is one of the most important measures but fails in most cases. Testosterone deficiency can be the reason for such failure. This case presents a 57-year-old man who was referred to a urologist due to benign prostatic hyperplasia and erectile dysfunction. He had type 2 diabetes, was overweight, and had hypertension and dyslipidemia. The blood test revealed testosterone deficiency. Under testosterone therapy, the patient lost 10 kg; cardiometabolic parameters returned to normal and lower urinary tract symptoms disappeared; complete remission of diabetes was recorded. Overweight and obese patients with type 2 diabetes should be tested for hypogonadism and testosterone therapy, if indicated, be considered. These patients can considerably benefit from testosterone therapy in terms of sustainable weight loss and a clinically significant reduction of cardiometabolic risk factors including complete remission of diabetes.
Reducing return of disease activity in patients with relapsing multiple sclerosis transitioned from natalizumab to teriflunomide: 12-month interim results of teriflunomide therapy
Authors: Cohan Stanley L , Edwards Keith , Lucas Lindsay , Gervasi-Follmar Tiffany , O’Connor Judy , Siuta Jessica , Kamath Vineetha , Garten Lore , Chen Chiayi , Thomas James , Smoot Kyle , Kresa-Reahl Kiren , Spinelli Kateri J
Published: January 2019

Background

Natalizumab is an effective treatment for relapsing multiple sclerosis. Return of disease activity upon natalizumab discontinuance creates the need for follow-up therapeutic strategies.

Objective

To assess the efficacy of teriflunomide following natalizumab discontinuance in relapsing multiple sclerosis patients.

Methods

Clinically stable relapsing multiple sclerosis patients completing 12 or more consecutive months of natalizumab, testing positive for anti-John Cunningham virus antibody, started teriflunomide 14 mg/day, 28 ± 7 days after their final natalizumab infusion. Physical examination, Expanded Disability Status Scale, laboratory assessments, and brain magnetic resonance imaging were performed at screening and multiple follow-up visits.

Results

Fifty-five patients were enrolled in the study. The proportion of patients relapse-free was 0.94, restricted mean time to first gadolinium-enhancing lesion was 10.9 months and time to 3-month sustained disability worsening was 11.8 months. The mean number of new or enlarging T2 lesions per patient at 12 months was 0.42. Exploratory analyses revealed an annualized relapse rate of 0.08, and a proportion of patients with no evidence of disease activity of 0.68. Forty-seven patients (85.5%) reported adverse events, 95% of which were mild to moderate.

Conclusions

Teriflunomide therapy initiated without natalizumab washout resulted in a low rate of return of disease activity. Clinicians may consider this a worthwhile strategy when transitioning clinically stable patients off natalizumab to another therapy. ClinicalTrials.gov Identifier: NCT01970410
“Equiheptatonic” Tuning in Thai Classical Music: Strict Propriety and Step Sizes
Authors: Rahn Jay
Published: January 2019

Tunings of Thai classical music have been a source of disagreement during the past century. Focusing on 28 ensembles, the present study analyzes ways in which the intervals they produce can be formulated so that they are both falsifiable and verifiable. Of these, a model that corresponds to Rothenberg’s formulation of strict propriety excels among pairs of tones that span different numbers of scale degrees. According to Rothenberg’s model of strict propriety, intervals that span fewer scale degrees are smaller than intervals that span more scale degrees. Further, according to a formulation of clear patterning among intervals that span precisely two scale degrees (i.e., a single step), there is no clear pattern of one-step intervals unless all the instances of at least one interval that spans two particular consecutive scale degrees are smaller and/or larger than all the instances of all the other intervals that span two consecutive scale degrees. Among the 28 ensembles, single-step intervals tend to constitute chains that overlap in size rather than a clear pattern of small and large intervals.
Exploring probation officer styles and goals with individual, organizational, and social characteristics
Authors: DeMichele Matthew , Payne Brian
Published: January 2019

Probation offices are organizational units that provide the structure necessary to develop shared meaning systems that influence individual level attitudes, values, and beliefs. We analyze survey responses (n = 252) from county-level probation departments (n = 19) in a single state. The dependent variables are three-factor scales combining items to measure enforcement, reentry, and protection scales. Our central goal is to determine if the authoritarian (i.e. law enforcement) and assistance (i.e. social worker) typologies predict supervision goals. The robust regression analyses show that department (e.g. caseload size, number of officers) and county-level measures of poverty and percent black in the population are significant factors for enforcement and reentry. The article concludes with policy implications.
Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke
Authors: Sexton Eithne , McLoughlin Affraic , Williams David J , Merriman Niamh A , Donnelly Nora , Rohde Daniela , Hickey Anne , Wren Maev-Ann , Bennett Kathleen
Published: January 2019

Introduction

Increasing attention is being paid to interventions for cognitive impairment (CI) post-stroke, including for CI that does not meet dementia criteria. The aim of this paper was to conduct a systematic review and meta-analysis of the prevalence of cognitive impairment no dementia (CIND) within one year post-stroke.

Patients and methods

Pubmed, EMBASE and PsychInfo were searched for papers published in English in 1995–2017. Included studies were population or hospital-based cohort studies for first-ever/recurrent stroke, assessing CIND using standardised criteria at 1–12 months post-stroke. Abstracts were screened, followed by full text review of potentially relevant articles. Data were extracted using a standard form, and study quality was appraised using the Crowe Critical Appraisal Tool. A pooled prevalence of CIND with 95% confidence intervals (CI) was estimated using random-effects meta-analysis. Heterogeneity was measured using the I2 statistic.

Results

A total of 7000 abstracts were screened, followed by 1028 full text articles. Twenty-three articles were included in the systematic review, and 21 in the meta-analysis. The pooled CIND prevalence was 38% [95% CI = 32–43%] (I2=92.5%, p < 0.01). Study quality emerged as one source of heterogeneity. The five studies with the highest quality scores had no heterogeneity (I2=0%, p = 0.99), with a similar pooled prevalence (39%, 95%CI = 35–42%). Other sources of heterogeneity were stroke type, inclusion of pre-stroke CI, and age at assessment time. Discussion and conclusion: Meta-analysis of available studies indicates that in the first year post-stroke, 4 in 10 patients display a level of cognitive impairment that does not meet the criteria for dementia.
NCF1 (p47phox)–deficient chronic granulomatous disease: comprehensive genetic and flow cytometric analysis
Authors: Kuhns Douglas B. , Hsu Amy P. , Sun David , Lau Karen , Fink Danielle , Griffith Paul , Huang Da Wei , Priel Debra A. Long , Mendez Laura , Kreuzburg Samantha , Zerbe Christa S. , De Ravin Suk See , Malech Harry L. , Holland Steven M. , Wu Xiaolin , Gallin John I.
Published: January 2019

Mutations in NCF1 (p47phox) cause autosomal recessive chronic granulomatous disease (CGD) with abnormal dihydrorhodamine (DHR) assay and absent p47phox protein. Genetic identification of NCF1 mutations is complicated by adjacent highly conserved (>98%) pseudogenes (NCF1B and NCF1C). NCF1 has GTGT at the start of exon 2, whereas the pseudogenes each delete 1 GT (ΔGT). In p47phox CGD, the most common mutation is ΔGT in NCF1 (c.75_76delGT; p.Tyr26fsX26). Sequence homology between NCF1 and its pseudogenes precludes reliable use of standard Sanger sequencing for NCF1 mutations and for confirming carrier status. We first established by flow cytometry that neutrophils from p47phox CGD patients had negligible p47phox expression, whereas those from p47phox CGD carriers had ∼60% of normal p47phox expression, independent of the specific mutation in NCF1. We developed a droplet digital polymerase chain reaction (ddPCR) with 2 distinct probes, recognizing either the wild-type GTGT sequence or the ΔGT sequence. A second ddPCR established copy number by comparison with the single-copy telomerase reverse transcriptase gene, TERT. We showed that 84% of p47phox CGD patients were homozygous for ΔGT NCF1. The ddPCR assay also enabled determination of carrier status of relatives. Furthermore, only 79.2% of normal volunteers had 2 copies of GTGT per 6 total (NCF1/NCF1B/NCF1C) copies, designated 2/6; 14.7% had 3/6, and 1.6% had 4/6 GTGT copies. In summary, flow cytometry for p47phox expression quickly identifies patients and carriers of p47phox CGD, and genomic ddPCR identifies patients and carriers of ΔGT NCF1, the most common mutation in p47phox CGD.
Validation of the United Kingdom copy-number alteration classifier in 3239 children with B-cell precursor ALL
Authors: Hamadeh Lina , Enshaei Amir , Schwab Claire , Alonso Cristina N. , Attarbaschi Andishe , Barbany Gisela , den Boer Monique L. , Boer Judith M. , Braun Marcin , Dalla Pozza Luciano , Elitzur Sarah , Emerenciano Mariana , Fechina Larisa , Felice Maria Sara , Fronkova Eva , Haltrich Irén , Heyman Mats M. , Horibe Keizo , Imamura Toshihiko , Jeison Marta , Kovács Gábor , Kuiper Roland P. , Mlynarski Wojciech , Nebral Karin , Ivanov Öfverholm Ingegerd , Pastorczak Agata , Pieters Rob , Piko Henriett , Pombo-de-Oliveira Maria S. , Rubio Patricia , Strehl Sabine , Stary Jan , Sutton Rosemary , Trka Jan , Tsaur Grigory , Venn Nicola , Vora Ajay , Yano Mio , Harrison Christine J. , Moorman Anthony V.
Published: January 2019

Genetic abnormalities provide vital diagnostic and prognostic information in pediatric acute lymphoblastic leukemia (ALL) and are increasingly used to assign patients to risk groups. We recently proposed a novel classifier based on the copy-number alteration (CNA) profile of the 8 most commonly deleted genes in B-cell precursor ALL. This classifier defined 3 CNA subgroups in consecutive UK trials and was able to discriminate patients with intermediate-risk cytogenetics. In this study, we sought to validate the United Kingdom ALL (UKALL)–CNA classifier and reevaluate the interaction with cytogenetic risk groups using individual patient data from 3239 cases collected from 12 groups within the International BFM Study Group. The classifier was validated and defined 3 risk groups with distinct event-free survival (EFS) rates: good (88%), intermediate (76%), and poor (68%) (P < .001). There was no evidence of heterogeneity, even within trials that used minimal residual disease to guide therapy. By integrating CNA and cytogenetic data, we replicated our original key observation that patients with intermediate-risk cytogenetics can be stratified into 2 prognostic subgroups. Group A had an EFS rate of 86% (similar to patients with good-risk cytogenetics), while group B patients had a significantly inferior rate (73%, P < .001). Finally, we revised the overall genetic classification by defining 4 risk groups with distinct EFS rates: very good (91%), good (81%), intermediate (73%), and poor (54%), P < .001. In conclusion, the UKALL-CNA classifier is a robust prognostic tool that can be deployed in different trial settings and used to refine established cytogenetic risk groups.
Tumor-Infiltrating Lymphocytes and Prognosis: A Pooled Individual Patient Analysis of Early-Stage Triple-Negative Breast Cancers
Authors: Loi Sherene , Drubay Damien , Adams Sylvia , Pruneri Giancarlo , Francis Prudence A. , Lacroix-Triki Magali , Joensuu Heikki , Dieci Maria Vittoria , Badve Sunil , Demaria Sandra , Gray Robert , Munzone Elisabetta , Lemonnier Jerome , Sotiriou Christos , Piccart Martine J. , Kellokumpu-Lehtinen Pirkko-Liisa , Vingiani Andrea , Gray Kathryn , Andre Fabrice , Denkert Carsten , Salgado Roberto , Michiels Stefan
Published: January 2019

Purpose

The aim of the current study was to conduct a pooled analysis of studies that have investigated the prognostic value of tumor-infiltrating lymphocytes (TILs) in early-stage triple negative breast cancer (TNBC).

Methods

Participating studies had evaluated the percentage infiltration of stromally located TILs (sTILs) that were quantified in the same manner in patient diagnostic samples of early-stage TNBC treated with anthracycline-based chemotherapy with or without taxanes. Cox proportional hazards regression models stratified by trial were used for invasive disease-free survival (iDFS; primary end point), distant disease-free survival (D-DFS), and overall survival (OS), fitting sTILs as a continuous variable adjusted for clinicopathologic factors.

Results

We collected individual data from 2,148 patients from nine studies. Average age was 50 years (range, 22 to 85 years), and 33% of patients were node negative. The average value of sTILs was 23% (standard deviation, 20%), and 77% of patients had 1% or more sTILs. sTILs were significantly lower with older age ( P = .001), larger tumor size ( P = .01), more nodal involvement ( P = .02), and lower histologic grade ( P = .001). A total of 736 iDFS and 548 D-DFS events and 533 deaths were observed. In the multivariable model, sTILs added significant independent prognostic information for all end points (likelihood ratio χ2, 48.9 iDFS; P < .001; χ2, 55.8 D-DFS; P < .001; χ2, 48.5 OS; P < .001). Each 10% increment in sTILs corresponded to an iDFS hazard ratio of 0.87 (95% CI, 0.83 to 0.91) for iDFS, 0.83 (95% CI, 0.79 to 0.88) for D-DFS, and 0.84 (95% CI, 0.79 to 0.89) for OS. In node-negative patients with sTILs ≥ 30%, 3-year iDFS was 92% (95% CI, 89% to 98%), D-DFS was 97% (95% CI, 95% to 99%), and OS was 99% (95% CI, 97% to 100%).

Conclusion

This pooled data analysis confirms the strong prognostic role of sTILs in early-stage TNBC and excellent survival of patients with high sTILs after adjuvant chemotherapy and supports the integration of sTILs in a clinicopathologic prognostic model for patients with TNBC. This model can be found at www.tilsinbreastcancer.org .
Continuous Noninvasive Arterial Pressure Monitoring in Obese Patients During Bariatric Surgery: An Evaluation of the Vascular Unloading Technique (Clearsight system)
Authors: Rogge Dorothea E. , Nicklas Julia Y. , Schön Gerhard , Grothe Oliver , Haas Sebastian A. , Reuter Daniel A. , Saugel Bernd
Published: January 2019

BACKGROUND:

Continuous monitoring of arterial pressure is important in severely obese patients who are at particular risk for cardiovascular complications. Innovative technologies for continuous noninvasive arterial pressure monitoring are now available. In this study, we compared noninvasive arterial pressure measurements using the vascular unloading technique (Clearsight system; Edwards Lifesciences Corp, Irvine, CA) with invasive arterial pressure measurements (radial arterial catheter) in severely obese patients during laparoscopic bariatric surgery.

METHODS:

In 35 severely obese patients (median body mass index, 47 kg/m2), we simultaneously recorded noninvasive and invasive arterial pressure measurements over a period of 45 minutes. We compared noninvasive (test method) and invasive (reference method) arterial pressure measurements (sampling rate 1 Hz = 1/s) using Bland-Altman analysis (accounting for multiple measurements per subject), 4-quadrant plot/concordance analysis (2-minute interval, 5 mm Hg exclusion zone), and error grid analysis (calculating the proportions of measurements in risk zones A–E with A indicating no risk, B low risk, C moderate risk, D significant risk, and E dangerous risk for the patient due to the risk of wrong clinical interventions because of measurement errors).

RESULTS:

We observed a mean of the differences (±SD, 95% limits of agreement) between the noninvasively and invasively assessed arterial pressure values of 1.1 mm Hg (±7.4 mm Hg, −13.5 to 15.6 mm Hg) for mean arterial pressure (MAP), 6.8 mm Hg (±10.3 mm Hg, −14.4 to 27.9 mm Hg) for systolic arterial pressure, and 0.8 mm Hg (±6.9 mm Hg, −12.9 to 14.4 mm Hg) for diastolic arterial pressure. The 4-quadrant plot concordance rate (ie, the proportion of arterial pressure measurement pairs showing concordant changes to all changes) was 93% (CI, 89%–96%) for MAP, 93% (CI, 89%–97%) for systolic arterial pressure, and 88% (CI, 84%–92%) for diastolic arterial pressure. Error grid analysis showed that the proportions of measurements in risk zones A–E were 89.5%, 10.0%, 0.5%, 0%, and 0% for MAP and 93.7%, 6.0%, 0.3%, 0%, and 0% for systolic arterial pressure, respectively.

CONCLUSIONS:

During laparoscopic bariatric surgery, the accuracy and precision of the vascular unloading technique (Clearsight system) was good for MAP and diastolic arterial pressure, but only moderate for systolic arterial pressure according to Bland-Altman analysis. The system showed good trending capabilities. In the error grid analysis, >99% of vascular unloading technique–derived arterial pressure measurements were categorized in no- or low-risk zones.
Music Interventions in Pediatric Surgery (The Music Under Surgery In Children Study): A Randomized Clinical Trial
Authors: Kühlmann A. Y. Rosalie , van Rosmalen Joost , Staals Lonneke M. , Keyzer-Dekker Claudia M. G. , Dogger Jaap , de Leeuw Tom G. , van der Toorn Fred , Jeekel Johannes , Wijnen Rene M. H. , van Dijk Monique
Published: January 2019

BACKGROUND:

Perioperative music interventions have been shown to reduce anxiety and pain in adults. This inexpensive, easily applicable intervention could be of benefit to children as well. Our objective was to determine the effects of music interventions on distress, anxiety, and postoperative pain in infants undergoing surgery.

METHODS:

The Music Under Surgery In Children study was designed as a parallel, single-blind, randomized controlled trial with an a priori formulated hypothesis. Data were collected between August 2015 and October 2016 in a single tertiary care children’s hospital. There was a 24-hour follow-up with blind primary outcome assessment. A random sample of 432 eligible 0–3 years of age infants admitted for orchidopexy, hypospadias, or inguinal hernia repair receiving general anesthesia and caudal block were asked for participation. Subjects were assigned to a preoperative music intervention, pre- and intraoperative music intervention, or no music intervention (control) via random allocation using a computer-generated list with the use of opaque envelopes. The main outcome measure was the postoperative level of distress assessed with the COMFORT-Behavior scale, which is an observational scale; furthermore, preoperative level of distress, preoperative anxiety, and physiological measurements such as heart rate (HR) and blood pressure were measured. The trial was registered at the Dutch Trial Register, number NTR5402 (www.trialregister.nl).

RESULTS:

One hundred ninety-five infants with median age 6.9 months (interquartile range, 3.3–11.1) were randomized, 178 of whom were included in the primary analysis. A nonsignificant difference in COMFORT-Behavior scale scores between the pre- and intraoperative music intervention group and control group at 4 hours after surgery was found (mean difference, −1.22; 95% CI, 2.60–0.17; P = .085). Additional analysis showed weak nonsignificant evidence for an interaction effect between music exposure and COMFORT-Behavior score at baseline (P = .027 with a Bonferroni-adjusted significance level of .025). General linear modeling showed a statistically significantly reduced HR after the preoperative music intervention in the holding area in the combined preoperative music intervention and intraoperative music intervention group compared to the control group (P = .003). The differences in HR among the 3 study arms at all time points were not statistically significant (P = .069).

CONCLUSIONS:

Music interventions do not seem to benefit all young infants undergoing surgery. The potential benefits of music interventions in the preoperative period and in more distressed children warrant further exploration.
Daily Caffeine Consumption Does Not Influence Acupuncture Analgesia in Healthy Individuals: A Preliminary Study
Authors: Cao Jin , Tu Yiheng , Lang Courtney , Vangel Mark , Park Joel , Liu Jiao , Wilson Georgia , Gollub Randy , Orr Scott , Kong Jian
Published: January 2019

Animal studies suggest that caffeine may interfere with acupuncture analgesia. This study investigated the modulation effect of daily caffeine intake on acupuncture analgesia in 27 healthy subjects using a crossover design. We found that real acupuncture increased pain thresholds compared to sham acupuncture. Further, there was no association between caffeine intake measurements of daily caffeine use, duration of caffeine consumption, or their interaction and preacupuncture and postacupuncture pain threshold changes. Our findings suggest that daily caffeine intake may not influence acupuncture analgesia in the cohort of healthy subjects who participated in study.
Acute Adrenal Insufficiency After an Antiemetic Dose of Dexamethasone: A Case Report
Authors: Bacigalupo Landa Andres , Viswanath Omar , D’Mello Jayanand
Published: January 2019

Dexamethasone is widely used in current practice for the prevention of postoperative nausea and vomiting. Although its use in the perioperative setting has been associated with several side effects (eg, hyperglycemia and suppression of adrenal cortisol production), their clinical significance remains questionable. We present the case of a healthy 27-year-old woman who developed acute adrenal insufficiency after receiving intraoperative dexamethasone for postoperative nausea and vomiting prophylaxis during a laparoscopic left oophorectomy.
“The Hodegon. Considerations on the location of the Hodegetria sanctuary in Constantinople”
Authors: GROTOWSKI Piotr
Published: January 2019

Αν και ήταν ένα από τα πιο γνωστά ιερά της Κωνσταντινούπολης, η Μονή των Οδηγών παραμένει καλυμμένη από την αχλύ της ιστορίας. Η ίδια δεν διασώζεται μεν, είναι γνωστή όμως χάρη σε πολυάριθμες περιγραφές, τόσο σε βυζαντινές γραπτές πηγές, όσο και σε μαρτυρίες ξένων ταξιδιωτών και προσκυνητών. Αρχαιολογικά κατάλοιπα που κατά καιρούς συσχετίστηκαν με την μονή είναι: α) η εξαγωνική κατασκευή που εντόπισαν ο R. Demangel και ο Ε. Mamboury, και β) το αγίασμα κάτω από το κτίριο στην διασταύρωση των οδών Mimar Mehmet Ağa και Admiral Tafdil, το οποίο ανακάλυψε πριν από δύο δεκαετίες ο F. Düzgüner στο κέντρο της περιοχής Cankurtaran. Οι προτάσεις αυτές όμως δεν είναι ικανοποιητικές, αφού εν συμβιβάζονται με τα στοιχεία που προκύπτουν από τις γραπτές πηγές. Σύμφωνα με τις περιγραφές των προσκυνητών, η Μονή των Οδηγών βρισκόταν πολύ κοντά στην Αγία Σοφία, προς τα ανατολικά.Το συγκρότημα τοποθετείται κοντά στο παλάτι των Μαρίνης (που αναδιαμορφώθηκε από τον Λέοντα Ϛ´ σε λουτρά, και είναι δυνατόν να ταυτιστεί με το εξαγωνικό κτίσμα των Demangel και Mamboury), έξω από τα τείχη των ανακτόρων (όπως υποδεικνύεται από την περιγραφή στο Χρονικό του Συμεών Λογοθέτη). Επιπλέον, στο κείμενο το γνωστό ως Λόγος περί του πανσέπτου ναού της Υπεραγίας Θεοτόκου των Οδηγών, αναφέρεται ότι η εκκλησία ήταν ένα υψηλό κτίριο, το οποίο υπερέβαινε το ύψος των τειχών της Πόλης και ήταν ορατό για τους ναυτικούς που έπλεαν στον Βόσπορο. Το ίδιο κείμενο μας πληροφορεί επίσης ότι το ιερό είχε τρία τμήματα. Ένα κλίτος που καλυπτόταν από θόλο και στηριζόταν σε μια δομή, ορατή μόνο εν μέρει πάνω από το επίπεδο του εδάφους. Η τελευταία μπορεί να χαρακτηριστεί ως εξώστης με δεξαμενή (όπως αναφέρεται στα επιγράμματα του Θεοδώρου Βαλσαμώνος). Η προσεκτική ανάλυση των γραπτών ενδείξεων μας υποχρεώνει να επιστρέψουμε στην παλαιά υπόθεση που είχε διατυπωθεί πριν από εκατό χρόνια από τον K. Wulzinger, ο οποίος ταύτισε την Μονή Οδηγών με τον εξώστη κάτω από το σημερινό στρατιωτικό νοσοκομείο του Gülhane. Ενώ το κτίριο παραμένει απρόσιτο λόγω του ότι ανήκει στον στρατό, ο εξώστης (και η δεξαμενή που στεγάζεται σε αυτό) είναι αρκετά καλά τεκμηριωμένα χάρη στις ιατρικές εκθέσεις που δημοσιεύθηκαν στις αρχές του 20ου αιώνα από το προσωπικό της κλινικής. Η κατασκευή, μικτής τοιχοδομίας με πλίνθους και λίθους, αρχικά στηριζόταν σε έξι κίονες με σύνθετα κιονόκρανα, και σε παραστάδες. Με βάση τις αρχιτεκτονικές αναλογίες μπορεί να χρονολογηθεί γενικά μεταξύ του ενάτου και του ενδεκάτου αιώνα, όταν οι εξώστες κάτω από εκκλησίες συνηθίζονταν στην Κωνσταντινούπολη. Αυτό υποδεικνύει ότι η δεξαμενή-εξώστης κάτω από το μοναστήρι κτίστηκε κατά τη διάρκεια της βασιλείας του Μιχαήλ Γ΄. Η οριστική επιβεβαίωση των παραπάνω υποθέσεων θα καταστεί δυνατή μόνο όταν οι ερευνητές αποκτήσουν πρόσβαση στο συγκρότημα Gülhane και στην τεκμηρίωση που σχετίζεται με την αποκατάστασή του, κάτι που αναμένεται με ανυπομονησία στο εγγύς μέλλον.
Online Vehicle Routing: The Edge of Optimization in Large-Scale Applications
Authors: Bertsimas Dimitris , Jaillet Patrick , Martin Sébastien
Published: January 2019

With the emergence of ride-sharing companies that offer transportation on demand at a large scale and the increasing availability of corresponding demand data sets, new challenges arise to develop routing optimization algorithms that can solve massive problems in real time. In “Online Vehicle Routing: The Edge of Optimization in Large-Scale Applications,” D. Bertsimas, P. Jaillet, and S. Martin present a novel and generalizable backbone algorithm that uses integer optimization to find high-quality solutions to large routing optimization problems. The algorithm, together with the real-time routing optimization software framework developed and shared by the authors, can dispatch thousands of taxis serving more than 25,000 customers per hour. An extensive study with historical simulations of Yellow Cabs in New York City is used to both show that the algorithm improves on the performance of existing heuristics and to provide insights on the optimization opportunities of a large ride-sharing fleet.
OS (DES)CAMINHOS DA SEGURANÇA PÚBLICA E DA JUSTIÇA CRIMINAL NO RIO GRANDE DO SUL: UM OLHAR A PARTIR DO SISTEMA PENITENCIÁRIO COM BASE NO PRESÍDIO CENTRAL DE PORTO ALEGRE
Authors: Sohngen Clarice Beatriz da Costa , Spaniol Marlene Inês
Published: January 2019

O artigo trata dos (des)caminhos da segurança pública e da justiça criminal no Estado do Rio Grande do Sul fazendo uma análise a partir do sistema penitenciário e da Cadeia Pública de Porto Alegre, antigo Presídio Central de POA (PCPA), nome pelo qual é mais conhecida, uma vez que esta casa prisional, além de lidar com superlotação contínua, ter como missão abrigar presos provisórios e de estar sendo gerenciada pela Política Militar há mais de vinte anos para evitar motins e rebeliões. Esta casa prisional também já foi denunciada junto à Comissão Interamericana por violação de direitos humanos, sendo sempre citada como referência negativa quando se analisa o sistema penitenciário brasileiro chegando a ser considerado o pior presídio do país ao ser investigado pela Comissão Parlamentar de Inquérito (CPI) do sistema carcerário. A metodologia do estudo consiste na análise documental, situacional e dos registros do número de encarcerados, entradas e saídas nos últimos dez anos.
A PARTICIPAÇÃO POPULAR NA GESTÃO PÚBLICA MUNICIPAL A PARTIR DOS CONSELHOS MUNICIPAIS DE ASSISTÊNCIA SOCIAL
Authors: Diehl Rodrigo Cristiano , Lehnhart Eliete Dos Reis
Published: January 2019

Este artigo tem por objetivo verificar a importância da participação popular na gestão pública, por meio dos Conselhos Municipais de Assistência Social, na promoção da democracia participativa no espaço público local. Para tanto, a partir de levantamento bibliográfico e pesquisa de campo, buscou-se estudar o poder local na (re)construção dos espaços públicos; delinear os desafios e as perspectivas da participação popular na gestão pública municipal e; verificar a percepção da sociedade civil sobre a importância da participação nos Conselhos Municipais de Assistência Social. Para alcançar os objetivos do estudo, por meio de uma pesquisa de campo (modalidade levantamento) de natureza qualitativa e descritiva foi aplicado um questionário online de livre acesso que contou com a participação de sessenta e cinco pessoas. Os principais resultados perpassam pela necessidade de ampliar a divulgação da organização, funcionamento e objetivos dos Conselhos Municipais de Assistência Social como forma de possibilitar a ampliação da participação popular nesses centros decisórios de políticas públicas.
EFEITOS JURÍDICOS DA POLÍTICA FISCAL MINERÁRIA NO ESTADO DO PARÁ: A ILEGALIDADE DO DIFERIMENTO COM EFEITOS DE ISENÇÃO
Authors: Nascimento Thiago Lima do , Silva Maria Stela Campos da
Published: January 2019

O presente trabalho visa realizar uma análise sobre a política fiscal minerária, aplicada pelo Estado do Pará, buscando compreender os instrumentos normativos autorizativos, bem como as normas de estrutura que delimitam a responsabilidade dos Estados-membros e do Distrito Federal, quando da concessão de renúncia de receita tributária, na espécie de diferimento de ICMS, analisando-o comparativamente, em seus efeitos, ao instituto da isenção tributária. Para tanto, utilizou-se o método analítico dedutivo, através da legislação Constitucional, Complementar e Estadual. Concluiu-se, ao fim, que a utilização de diferimento de ICMS, onde o fato interruptivo da concessão do benefício não chega a se realizar, modifica a natureza do benefício, transformando-o em uma concessão irregular de isenção do tributo, devendo, portanto, ser combatido, sempre que identificado pelos órgãos de controle.
This is a land of confusion…
Authors: Allingham Sue
Published: January 2019

With so many conflicting ideas bombarded at us through a multiplicity of media channels, it is important that we try to focus on a reliable body of knowledge and use our own professional judgement.
In perfect harmony
Authors: Bull Louise
Published: January 2019

There are lots of ways settings can use music to create community cohesion – from organising intergenerational sessions, parent workshops and building a vibrant global music community.
In a winter wonderland
Authors: Chapman Ailsa
Published: January 2019

Make the most of chilly weather to offer children open-ended resources and provocations that can develop and enhance their learning in more meaningful ways than set pieces bound by strict themes.
Malnutrition: The forgotten factor in COPD management?
Authors: Rimington Gail
Published: January 2019

Gail Rimington details the nurse's role in promoting good nutrition amongst respiratory patients
Metformin use and B12 deficiency: What nurses need to know
Authors: Perry Margaret
Published: January 2019

Margaret Perry explains how to negate the side effects of this commonly used treatment
The use of dual-mobility bearings in patients at high risk of dislocation
Authors: Jones C. W. , De Martino I. , D’Apolito R. , Nocon A. A. , Sculco P. K. , Sculco T. P.
Published: January 2019

Aims

Instability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years.

Materials and Methods

We performed a retrospective review of a consecutive series of DM THA performed between 2010 and 2014 at our institution (Hospital for Special Surgery, New York, New York) by a single, high-volume orthopaedic surgeon employing a single prosthesis design (Anatomic Dual Mobility (ADM) Stryker, Mahwah, New Jersey). Patient medical records and radiographs were reviewed to confirm the type of implant used, to identify any preoperative risk factors for dislocation, and any complications. Radiographic analysis was performed to assess for signs of osteolysis or remodelling of the acetabulum.

Results

There were 151 patients who met the classification of high-risk according to the inclusion criteria and received DM THA during the study period. Mean age was 82 years old (73 to 95) and 114 patients (77.5%) were female. Mean follow-up was 3.6 years (1.9 to 6.1), with five patients lost to follow-up and one patient who died (for a reason unrelated to the index procedure). One patient (0.66%) sustained an intraprosthetic dislocation; there were no other dislocations.

Conclusion

At mid-term follow-up, the use of a DM bearing for primary THA in patients at high risk of dislocation provided a stable reconstruction option with excellent radiographic results. Longer follow-up is needed to confirm the durability of these reconstructions.
Should postoperative haemoglobin and potassium levels be checked routinely following blood-conserving primary total joint arthroplasty?
Authors: Greco N. J. , Manocchio A. G. , Lombardi A. V. , Gao S. L. , Adams J. , Berend K. R.
Published: January 2019

Aims

Despite declining frequency of blood transfusion and electrolyte supplementation following total joint arthroplasty, postoperative blood analyses are still routinely ordered for these patients. This study aimed to determine the rate of blood transfusion and electrolyte restoration in arthroplasty patients treated with a perioperative blood conservation protocol and to identify risk factors that would predict the need for transfusion and electrolyte supplementation.

Patients and Methods

Patients undergoing primary total joint arthroplasty of the hip or knee between July 2016 and February 2017 at a single institution were included in the study. Standard preoperative and postoperative laboratory data were collected and reviewed retrospectively. A uniform blood conservation programme was implemented for all patients. Need for blood transfusion or potassium supplementation was determined through a coordinated decision by the care team. Rates of transfusion and supplementation were observed, and patient risk factors were noted.

Results

The overall rate of blood transfusion was 1.06% in the study population of 1132 total joint arthroplasties performed in 1023 patients. Of the 12 patients requiring transfusion, 11 were female, ten occurred in patients undergoing total hip arthroplasty, and all 12 patients had a preoperative haemoglobin level less than 130 g/l. Operative duration and surgical blood loss were significantly greater in those patients requiring blood transfusion. Nearly all patients requiring transfusion had a history of, or risk factors for, cardiovascular disease. Potassium supplementation was required in 15.5% of the study cohort; 72% of these patients receiving potassium presented with a potassium level less than 4 mmol/l during preoperative testing, while the remaining 28% had a past medical history of either significant anaemia, cardiopulmonary, cardiovascular, or renal diseases that had required substantial medical management.

Conclusion

A consistent blood-conserving perioperative strategy effectively minimized need for blood transfusion in total joint arthroplasty patients below previously reported rates in the literature. We suggest that postoperative full blood counts and basic metabolic panels should not routinely be ordered in these patients unless their preoperative haemoglobin and potassium is below 130 g/dl or 4 mmol/l respectively, and they have medical comorbidities.
A vizuális nevelés és a médiapedagógia szinergiája – problémák és lehetőségek
Authors: Klima Gábor , Kárpáti Andrea
Published: January 2019

Ebben az írásban áttekintjük a vizuális nevelés és médiapedagógia metszéspontjait, párhuzamait és esetenként ellentéteit. Nemzetközi források szemlézésével jó gyakorlatokra kerestünk példákat, a területet érintő elméleti írásokat sem mellőzve. A hazai és nemzetközi oktatás egyik legfontosabb és egyben legaktuálisabb kérdése az új- és digitális médiák jelentette kihívás, valamint a technológiai környezet gyors változása. Olyan példákat kerestünk, ahol a tanítási gyakorlat és a tanmenet érzékenyen, értő módon és aktívan reagál ezekre a jelenségekre, a vizuális kultúra és vizuális média eszköztárát segítségül hívva. A források alapján úgy tűnik, hogy a technika és technológia iskolai jelenléte gyakran jelent kihívást vagy problémát a tanítási gyakorlatok szempontjából. A rajz- vagy média tanár „digitális érzékenysége” szintén döntő fontosságú az új technológiák iskolai integrációja szempontjából. A vizuális média mint tantárgy a források alapján meglehetősen változatos képet mutat. Különböző értelmezési lehetőségei időnként mintha ellentmondásba keverednének a tantárgy szerepét és helyét illetően. A média tantárgy hazai „mostoha sora” tehát nemzetközi jelenségnek tűnik, azonban a vizuális kultúra tantárgy tanmenetébe integrálva olyan új dimenziókkal gazdagítja a hagyományos rajzoktatást, ami jó gyakorlatok számtalan lehetősége felé nyithat utat. Írásunk tehát a nemzetközi források bemutatásával arra tesz kísérletet, hogy átfogó képet nyújtson a vizuális kultúra és média tantárgyak előtt álló kihívásokról és kérdésekről.
A szociálisprobléma-megoldás és a perfekcionizmus kapcsolata 12, 15 és 18 évesek körében
Authors: Fehér Orsolya , Kasik László
Published: January 2019

Az utóbbi években egyre gyakrabban vizsgálják a szociálisprobléma-megoldás és a perfekcionizmus serdülőkori kapcsolatát, hiszen a korábbi kutatási eredmények nem egyértelműek, számos kérdést felvetnek. A perfekcionista személyt leginkább a hibátlanságra való törekvés és a teljesítményre vonatkozó túlzottan magas – elsősorban önmagával szembeni, illetve több területre kiterjedő – elvárás jellemez. Ez lehet adaptív és maladaptív is, és leginkább e két forma mentén azonosíthatók igen különböző mintázatok a szociálisproblémamegoldás mint folyamat motivációs bázisával és a megoldási stílusokkal (Chang et al., 2004; Frost et al., 1990). Kutatásunk célja e két terület életkori jellemzőinek és kapcsolatrendszerének feltárása volt 12, 15 és 18 évesek (N=155) körében. A mérés során az SPSI–R (D’Zurilla et al., 2002; magyar változat: Kasik et al., 2009) általunk adaptált változatát és a Frost-féle (Frost et al., 1990; magyar változat: Dobos & Pikó, 2017) perfekcionizmus kérdőívet használtuk. Az SPSI–R mindegyik életkori mintán jó megbízhatósággal működött. A perfekcionizmust mérő skála megbízhatósága elfogadható, ami felveti a kérdőív faktorszerkezetének jövőbeni felülvizsgálatát is. Az eredmények alapján más-más mintázatok rajzolódnak ki a három életkori csoportban, ugyanakkor a perfekcionizmus faktorainak negatív problémaorientációval való pozitív kapcsolata mindegyik csoportban markáns. A 15 éveseknél a racionalitás és a hibák feletti aggodalom, valamint a racionalitás és a szülői elvárások közötti pozitív összefüggés a legerősebb, míg a legidősebbek körében a pozitív orientáció és a hibák feletti aggodalom, a személyes elvárások, a cselekedetekkel kapcsolatos kételyek és a szervezettség közötti pozitív kapcsolat a legerősebb. Azok a 12 évesek, akikre magas perfekcionizmus jellemző, igen negatívan viszonyulnak társas problémáik megoldásához, holott korábbi vizsgálatainkban ebben a korosztályban magas pozitív orientáltságot azonosítottunk. A korábbi elemzéseknél tapasztalt racionalitás és elkerülés igen ritka erős kapcsolatának értelmezését segítette az az eredmény, miszerint a 15 és a 18 évesek körében azok, akik nagyon magas mércét állítanak fel önmagukkal szemben, illetve félnek a hibázástól, kivétel nélkül magas értékkel bírnak a racionalitás faktoron.
Cidadania e contestação social: a liberdade de crítica e a formação do Estado repressor
Authors: Bittencourt Rodrigo Do Prado
Published: January 2019

Este artigo se propõe a analisar a associação da Violência Estatal ao Sagrado e a desconstrução dessa ideologia na obra El ingenioso hidalgo Don Quijote de La Mancha, de Miguel de Cervantes. Tal desconstrução opera a partir do riso e revela o poder subversivo e contestador do “estranhamento” frente à vida social que ele causa. A Justiça deve estar a serviço do povo. A cidadania se faz em meio à liberdade. Contra os Estados Autoritários, o riso é arma subversiva de afirmação da democracia.
Clinical evaluation of the effectiveness of treatment of the hand-foot syndrome – skin toxicity of antitumor target therapy with multi-kinase inhibitors
Authors: Shatokhina Evgeniya A. , Kruglova Larisa S. , Shukhov Oleg A.
Published: January 2019

Background. The effective treatment of the hand-foot syndrome is a necessary component of the complex treatment of patients receiving antitumor therapy with multikinase inhibitors.
Aims. The assessment of a new effective method for the treatment of palm-plantar syndrome in patients receiving multi-kinase inhibitors.
Materials and methods. There are 27 patients received antitumor treatment with multi-kinase inhibitors and had clinical manifestations of the hand-foot syndrome (HFS) for observation. The main group (14 patients) used a combination of an alpha-lipoic acid at a dose of 600 mg per day per os and an ointment containing 0.005% calcipotriol and 0.05% betamethasone dipropionate 2 times a day. The control group, included 13 patients, used a combination with a cream containing 10% urea and ointment containing 0.05% betamethasone dipropionate.
Results. After a week of treatment, the regression of the skin process was observed in both groups, but it was more evident in the main group: significant differences in severity of erythema, paresthesia, pain and burning sensation, the Dermatological Life Quality Index (DLQI) were observed at this stage of therapy (p < 0.05). After 2 weeks of therapy: a more positive trend in the main group in terms of erythema, paresthesia and burning, but the most significant difference is DLQI – 17.4 in the main group and 22.8 in the control group (p < 0.0001). At the end of the 3rd week of therapy: differences with the main characteristics of erythema, desquamation, paresthesia (p < 0.0008), pain (p < 0.0001), DLQI (p < 0.0001). At the end point of the study (after 4 weeks of therapy), significant differences were found in reducing the symptoms and the main parameters for evaluating the effectiveness of DLQI in patients of the main group with a reliability of p < 0.0001. The high correlation of DLQI was found with erythema, pain, burning, paresthesia and desquamation.
Conclusions. The treatment of the hand-foot plantar syndrome combined using alpha-lipoic acid inside and topical therapy in the form of an ointment containing calcipotriol and betamethasone dipropionate, can be recommended for patients receiving targeted therapy with multi-kinaseinhibitors.