bluuebunny/crossref_metadata_2025 huggingface dataset:
Extreme Learning Machine for Credit Risk Analysis
Authors: Qasem Mais Haj , Nemer Loai
Published: June 2018

Credit risk analysis is important for financial institutions that provide loans to businesses and individuals. Banks and other financial institutions generally face risks that are mostly of financial nature; hence, such institutions must balance risks and returns. Analyzing or determining risk levels involved in credits, finances, and loans can be performed through predictive analytic techniques, such as an extreme learning machine (ELM). In this work, we empirically evaluated the performance of an ELM for credit risk problems and compared it to naive Bayes, decision tree, and multi-layer perceptron (MLP). The comparison was conducted on the basis of a German credit risk dataset. The simulation results of statistical measures of performance corroborated that the ELM outperforms naive Bayes, decision tree, and MLP classifiers by 1.8248%, 16.6346%, and 5.8934%, respectively.
Energetics of Swimming With Hand Paddles of Different Surface Areas
Authors: Crocker George H. , Moon Joseph F. , Nessler Jeff A. , Newcomer Sean C.
Published: June 2018

Crocker, GH, Moon, JF, Nessler, JA, and Newcomer, SC. Energetics of swimming with hand paddles of different surface areas. J Strength Cond Res 35(1): 205–211, 2021—Hand paddles are one of the most common training aids used by the competitive swimmer, yet little is known regarding how hand paddle surface area affects the metabolic cost of transport (COT) while swimming. The purpose of this study was to determine how altering hand paddle size affects energy use during submaximal, front-crawl (i.e., freestyle) swimming. Twenty-six proficient, adult swimmers (13 men and 13 women) completed six 3-minute trials in a flume at a constant pace (102 cm·s−1; 1:38 per 100 m). Trials were performed in random order, using 1 of 5 pairs of hand paddles of different sizes or no paddles at all. Paddle surface areas were 201, 256, 310, 358, and 391 cm2 per hand. Without paddles, COT, arm cadence, and distance per stroke were 7.87 ± 1.32 J·kg−1·m−1, 29.4 ± 4.9 min−1, and 2.13 ± 0.34 m, which corresponded to a rate of oxygen consumption (V̇o
2) of 23.3 ± 3.7 ml·kg−1·min−1 and a heart rate (HR) of 118 ± 17 b·min–1. The use of larger hand paddles decreased COT, cadence, V̇o
2, and HR and increased distance traveled per stroke (all p < 0.001). However, the magnitude of the change of COT decreased as paddle size increased, indicating diminishing marginal return with increasing paddle surface area. The largest sized paddles increased COT per stroke compared with swimming without paddles (p = 0.001). Therefore, results from this study suggest that an optimal hand paddle size exists (210–358 cm2) for proficient, adult swimmers, which reduces COT without increasing COT per stroke.
Кадровая политика в здравоохранении: как преодолеть дефицит врачей
Authors: Шейман Игорь Михайлович , Сажина Светлана Владимировна
Published: June 2018

Игорь Михайлович Шейман – кандидат экономических наук, профессор, кафедра управления и экономики здравоохранения, Национальный исследовательский университет «Высшая школа экономики». Адрес: 101000, Москва, ул. Мясницкая, д. 20. E-mail: igor.sheim@g23.relcom.ru

Светлана Владимировна Cажина – ведущий аналитик, Центр политики в сфере здравоохранения, Национальный исследовательский университет «Высшая школа экономики». Адрес: 109074, Москва, Славянская площадь, д. 4, стр. 2. E-mail: ssazhina@hse.ru

Цитирование: Шейман И.М., Сажина С.В. (2018) Кадровая политика в здравоохранении: как преодолеть дефицит кадров // Мир России. Т. 27. № 3. С. 130–153. DOI: 10.17323/1811-038X-2018-27-3-130-153

 

В статье анализируется взаимосвязь кадровой и образовательной политики в здравоохранении в решении задачи преодоления структурных диспропорций в составе медицинских кадров. Анализ зарубежного опыта показывает растущую ориентацию кадровой политики на достижение структуры врачебных кадров, соответствующей потребности системы здравоохранения и общества в целом. Развиваются новые механизмы планирования и регулирования структуры приема студентов медицинских вузов, а также структуры мест в системе постдипломного образования, включая квотирование приема студентов в медицинские вузы и на последипломную подготовку, регулирование трудоустройства подготовленных врачей, меры по сокращению дефицита определенных категорий кадров и преодолению неравномерного географического размещения кадров.

В России структурная составляющая кадровой и образовательной политики явно ослаблена. Действующие методы планирования и регулирования подготовки медицинских кадров во многом воспроизводят накопленные структурные диспропорции; слабо выражены регулирующие меры повышения качества обучения врачей; отсутствует перспективное планирование. Последипломная подготовка врачей недостаточно ориентирована на дефицитные специальности, в результате чего при высоком числе врачей постоянно не хватает наиболее востребованных специалистов. В деятельности медицинских вузов прослеживается ориентация на подготовку врачей, обслуживающих платежеспособный спрос, при этом государство не обладает сильными рычагами влияния на структуру подготовки врачей. В последние годы предпринимаются попытки исправить положение путем установления новых требований к подготовке и переподготовке врачей, но пока результаты не ощущаются. Для снижения дефицита врачей первичного звена выпускники вузов получают право на работу в качестве участковых врачей без последипломной подготовки, что может привести к снижению качества медицинской помощи. Базируясь на изучении зарубежного опыта, в статье предложены новые механизмы государственного регулирования подготовки врачей, включая изменение порядка планирования потребности во врачебных кадрах, повышение роли перспективного планирования, усиление регулирования структуры мест постдипломного обучения, повышение требований к его качеству.
Clinical and Morpho-Molecular epidemiology of bovine theileriosis in Kashmir, India
Authors: Farooq U. , Tufani N. A. , Malik H. U. , Mir M. S.
Published: June 2018

Total 1683 cattle were screened for Theileria infections for one calendar year. The overall incidence was 4.34%. It was highest in summer (7.57%), followed by autumn (3.51%). Cattle above 2 years of age (6.19%) particularly Holstein Friesian Cross (5.81%), followed by Jersey Cross (2.77%) were highly infected. Female (4.49%) were mostly affected as compared to male (3.14%). Affected animals showed persistent high fever, tachycardia, tachypnea and reduced ruminal motility. Other important clinical signs were emaciation, swelling of pre-scapular lymph nodes, inappetence, pale mucous membranes or congested mucous membranes, occulo-nasal discharge, corneal opacity, presence of ticks, salivation, coughing and decreased milk production. The diagnostic efficacy of PCR was highest (100%, 73/73), followed by peripheral blood smears examination (93.15%, 68/73) and lymph node biopsy (49.31%, 36/73). There is a consistent increase in the incidence of bovine theileriosis which may be due climate change and import of carrier animals from the neighbouring states.
ÖĞRETMEN ADAYLARININ AKADEMİK HİZMETLERE İLİŞKİN GÖRÜŞLERİ VE MEMNUNİYET DÜZEYLERİ
Authors: Donat Bacıoğlu Seda , Vural Levent
Published: June 2018

Bu araştırmanın
amacı, öğretmen adaylarının bazı akademik hizmetlere ilişkin görüşlerini ve bu
görüşlerle ilgili olabilecek değişkenler (cinsiyet, sınıf düzeyi, bölüm ve
akademik not ortalaması ) ile öğrencilerin üniversiteye ve eğitim fakültesine
yönelik memnuniyet düzeylerini incelemektir. Araştırmada, betimsel tarama
modeli kullanılmıştır. Araştırmanın evrenini 2016-2017 öğretim yılında Trakya
Üniversitesi Eğitim Fakültesi’nde öğrenim gören yaklaşık 2700 öğretmen adayı,
örneklemini ise, üst sınıflarda öğrenim gören ve basit tesadüfî örnekleme
yoluyla seçilen 300 öğretmen adayı oluşturmaktadır. Veri toplama aracı olarak
“Eğitim Fakültesi Öğrencilerinin Bazı Akademik Hizmetlere İlişkin Beklentileri”
ölçeği kullanılmıştır. Elde edilen verilerin analizinde, aritmetik ortalama, standart sapma, faktör analizi ve
tek yönlü varyans analizi yapılmıştır. Araştırmanın bulgularına göre, akademik hizmetler alt boyutunda;
öğretim hizmeti alt faktörü, öğrencilerle iletişim alt faktörü, programın
etkililiği alt faktörü ve ders süreci alt faktörü olmak üzere toplam 4 alt
boyut ortaya çıkmıştır. Cinsiyet, sınıf düzeyi ve bölüm değişkenlerine göre
elde edilen bulgularda; eğitim fakültesi öğrencilerinin akademik hizmetlere
ilişkin görüşlerinin sınıf düzeyi ve bölüme göre farklılaştığı ancak cinsiyet
ve akademik not ortalamasına göre anlamlı düzeyde farklılaşmadığı görülmüştür.
Öğrencilerin üniversite ve fakülteye ilişkin memnuniyetine ilişkin bulgularda
ise; memnuniyet düzeyinin “orta” olduğu bulunmuştur. Araştırma sonuçları, Trakya
Üniversitesi Eğitim Fakültesinde öğrenim gören öğretmen adaylarının bazı
akademik hizmetlere ilişkin beklentilerinin karşılanmadığını,  memnuniyet düzeylerinin ise ortalama düzeyde
olduğunu ortaya koymuştur.
Fundamento central do direito à não autoincriminação
Authors: Carvalho Heloisa Rodrigues Lino de
Published: June 2018

A não autoincriminação, imanente sobretudo à área do Direito Processual Penal Constitucional, é um direito individual humano e fundamental, de observância obrigatória na persecução penal, previsto em importantes documentos internacionais de direitos humanos, bem como na maioria das Constituições democráticas. Utilizando-se uma metodologia científica por meio de pesquisa bibliográfica e método teórico dedutivo, objetiva-se analisar seu fundamento central. O princípio motriz da razão de sua existência é a dignidade humana, cujo aspecto particular mais sólido apontado é a integridade mental e moral. Esta é violada ao ser o indivíduo colocado frente a possíveis disjuntivas desagradáveis, constituídas da possibilidade de dar origem a consequências negativas, seja por optar manter-se em silêncio ou declarar e, neste caso, por se autoincriminar (admitindo a imputação, sendo verdadeira ou não) ou por mentir. Isso transgride a natureza humana, que tem dificuldade de admitir as próprias falhas e assumir as consequências daí advindas. A vedação de se obrigar o acusado a emitir uma declaração e de se atribuir qualquer consequência negativa ao seu silêncio é uma decorrência incontestável desse direito. No entanto, sua aplicabilidade nos diferentes casos concretos enseja muitas controvérsias. A delimitação de seu real fundamento objetiva contribuir com subsídios para coerentes soluções.
Sacubitril/valsartan: from a large clinical trial to clinical practice
Authors: Sciatti Edoardo , Senni Michele , Lombardi Carlo M. , Gori Mauro , Metra Marco
Published: June 2018

The Prospective Comparison of Angiotensin Receptor Antagonist and Neprilysin Inhibitor with Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial (PARADIGM-HF) has shown a reduction in the risk of death and heart failure hospitalizations with sacubitril/valsartan, compared with enalapril, in patients with heart failure and reduced ejection fraction. Guidelines now recommend the substitution of angiotensin-converting enzyme inhibitors or AT1 blockers with sacubitril/valsartan in patients with heart failure and reduced ejection fraction. The aim of this review is to discuss factors that may have an impact on the implementation of these guidelines into clinical practice. The main limitation is that, based on the inclusion criteria of PARADIGM-HF, sacubitril/valsartan is not indicated in patients with heart failure and preserved ejection fraction, although they may be the majority of the patients with heart failure. The trial enrolled ambulatory patients and thus start of sacubitril/valsartan is not indicated in those hospitalized for heart failure. A drug's tolerability may be limited by hypotension with, however, a lower rate of renal dysfunction, compared with enalapril. The cost of the new treatment is also an issue. Similarly to what occurred when other neurohormonal antagonists have been introduced in clinical practice, increased awareness of poor heart failure outcomes and better patients’ management programs may be of utmost importance for the implementation of this new agent.
Morphological and GIS-based land use Analysis: A Critical Exploration of a Rural Neighborhood
Authors: Agboola Oluwagbemiga Paul , Rasidi Mohd Hisyam , Said Ismail , Abogan Samson Olutayo , Adejuwon Adebambo Stephen
Published: June 2018

The significance of neighbourhood in hosting a group of dwellings units and possessing adequate communal facilities could not be overemphasized in the study of people and place relationships. There are two main objectives of this study: (i) to study the neighbourhood’s associated challenges through the size, growth, and land use distribution, and (ii) to investigate the perceived inhabitants’ activities pattern within the neighbourhood. The objectives are explored through a morphological and GIS-based land use analysis of a rural neighbourhood in South-west, Nigeria. The town is studied in three transformation phases, dating back to five decades using ArcGIS version 10.3. The 1st phase spanned between the year 1910 to 1959, while the 2nd and 3rd phases ran through the year 1960 to 1999, and the year 2000 to 2015 respectively. The exploration in this study is to document the diverse neighbourhood challenges, features, and prospects, which remain uninvestigated in the case study area for the past years. In conclusion, human historical and social influences play a significant role in ameliorating the challenges associated with the spatial developments of the settlements. The implication of the study becomes vital to the major stakeholders and professionals in the built environment on the significance of enhancing the sustainable communities in Nigeria.
Urban Planning as an Extension of War Planning
Authors: WANG HUAQING , NEWMAN GALEN , WANG ZHIFANG
Published: June 2018

War-city relationships had long been studied by scholars regarding wars’ sudden impact on cities. Studies typically focused on one specific event’s impact on urban military, politics, economy, or society. This approach, however, treated war’s impact on cities as only temporary, hindered opportunities to reveal multiple political regimes’ spatial competition through war-oriented city planning and construction, which is crucial for city development, and their resultant urban form changes through time. In response, this study has examined city planning and construction activities during the short time gaps between multiple military conflicts, with various military objectives, and conducted by different political regimes in Shenyang, China. In accordance with archival research, a space syntax axis analysis has been used to quantify spatial dynamics throughout war-peace-war cycles to explore the impact of military-oriented planning on city-scaled development. We have found these planning strategies, initiated by specific military goals, acted as extensions of war planning, segregating the city and causing urban fragmentation. They also acted as a driving factor which promoted modernization of the city in the early 20th century. We conclude that wars oriented planning can alter a city’s development track and impact its structure and form through the creation of internally connected but isolated urban districts. Copyright © 2018 Journal Of Contemporary Urban Affairs.
A, Multicultural Multicultural Narrative of History Textbook
Authors: Afiyadi Akhmad Dwi
Published: June 2018

Abstract: History textbook is a student’s handbook used in a process of learning history with 2013 Curriculum. That textbook used a popular regressive approach. Through the textbook, students were invited to observe historical events in everyday life and also events occurred. The researchers analyzed the textbook using Discourse-Historical Approach by Ruth Wodak. The approach included three layers of analysis namely; textual analysis, contextual analysis, and prospective criticism analysis. The multicultural narrative contextually can be found throughout the book, especially in the categorization of historical relics in spatial and historical events in the spatial. Textual and contextual meanings can be the basis or paradigm of education policy and praxis as a multicultural competence that is owned by the students themselves, both in solving problems in the classroom as well as in human life. Textbook is important for educational purposes in this area of multicultural competence. Tthe continuation of this book for further analysis in the field of education is quite open, for example in the learning model with other relevant material and so on. The researchers suggest for developing the book, both from the material field and exploring the potential possessed by students to transmit the multicultural values of books to students.

Keywords: History Textbook, Multicultural Narrative, Discourse-Historical Approach, Multicultural Competence, Multicultural Values.
Optimasi Sistem Penyembunyian Data pada Audio menggunakan Sub-band Stasioner dan Manipulasi Rata-rata Statistik
Authors: NOVAMIZANTI LEDYA , BUDIMAN GELAR , WIBOWO BHISMA ADI
Published: June 2018

ABSTRAKKasus pelanggaran hak cipta musik atau lagu menjadi masalah dan mendapat perhatian serius oleh industri musik di Indonesia. Teknik audio watermarking merupakan salah satu solusi untuk melindungi hak cipta audio digital dari tindakan ilegal dengan cara menyembunyikan watermark berupa identitas pemilik ke dalam audio tersebut. Pada penelitian ini, audio host diubah menjadi matriks 1-dimensi untuk proses framing. Selanjutnya Stationary Wavelet Transform (SWT) digunakan untuk mendapatkan sub- band stasioner terpilih yang akan disisipkan watermark. Metode Statistical Mean Manipulation (SMM) akan menghitung rata-rata host audio dalam satu frame, dan dilakukan proses penyisipan bit. Optimasi dilakukan dengan melakukan evaluasi parameter yang menghasilkan BER paling tinggi setelah sistem diberikan serangan. Hasil dari optimasi diperoleh suatu sistem audio watermarking yang kuat dan tahan terhadap gangguan signal, dengan rata-rata BER 0.113, SNR 31 dB, ODG -0.6, dan MOS 4.6.Kata kunci: audio watermarking, SWT, SMM, optimasiABSTRACTThe case of copyright infringement of music or song becomes a serious problem in Indonesia. Audio watermarking technique is one solution to protect the music copyright of digital audio from illegal acts by hidding the watermark in the form owner's identity into the audio. The workings of audio watermarking is to embed the watermark in the form owner's identity into the audio. In this study, the audio host is converted into a 1-dimensional matrix for the framing process. Furthermore Stationary Wavelet Transform (SWT) used to obtain stationary sub-bands selected to be inserted watermark. Statistical methods Mean Manipulation (SMM) will calculate the average host audio in one frame, and do bits insertion process. Optimization is done by evaluating the parameters that produce the highest BER after the system is given an attack. The results of the optimization obtained an audio watermarking system that is robust and resistant to signal interference, with the average BER 0.113, SNR 31 dB, ODG -0.6, and MOS 4.6. Keywords: audio watermarking, SWT, SMM, optimization
Pengendalian Kamera berdasarkan Deteksi Posisi Manusia Bergerak Jatuh berbasis Multi Sensor Accelerometer dan Gyroscope
Authors: MELITA RAHMI AGUS , BHASKORO SUSETYO BAGAS , SUBEKTI RUMINTO
Published: June 2018

ABSTRAKPenelitian ini menyajikan pengembangan sistem surveillans berbasis multisensor secara portable dengan memberikan peringatan terkait aktifitas yang tidak biasa. Sistem menginformasikan pengguna atau pengasuh melalui email ketika mendeteksi aktifitas yang abnormal, seperti gerakan jatuh (lansia atau anakanak). Penelitian ini menggunakan multisensor antara lain accelerometer, gyroscope, dan menambahkan sensor kamera untuk membuat informasi lebih akurat. Evaluasi dibagi menjadi dua kategori. kategori pertama adalah deteksi jatuh manusia, dan kategori kedua adalah menangkap gambar. Hasil evaluasi mendeteksi gerakan jatuh adalah accuracy sebesar 88%, recall 88%, specificity 88%, dan precision 93%. Selain itu, hasil evaluasi pengambilan gambar adalah accuracy 86% dengan ketepatan pergerakan kamera ke arah objek sebesar 51%.Kata kunci: bergerak jatuh, kamera, internet of things, accelerometer, gyroscope, fuzzy logic. ABSTRACTThis research presents the development of multi-sensor based portable surveilance system with intrusion alert notification. The system will notify theuser or caregiver by email immediately when an abnormal activity is detected, such as falling motion (elderly or children). This research using multisensor there are accelerometer, gyroscope, and adding camera sensor to make information more accurate. The evaluation divided into two categories. first category is human falling detection, and second category is capturing image. The result of falling detection are 88% for accuracy, 88% for recall, 88% for specificity, and precision is 93%. The result of capturing image are 86% for accuracy 86%, with camera motor movement precision is 51%.Keywords: falling motion, camera, internet of things, accelerometer, gyroscope, fuzzy logic.
Are we practising defensive medicine: a cure that is costlier than the disease?
Authors: Joshi Arbin
Published: June 2018

Introductions: In the current scenario where intimidation and manhandling to health personnel and vandalism in the hospital is high, sense of insecurity among the newer lot of surgeons and methods they incorporate to combat the possible threat from the patients or their peers has not been validated properly yet. Methods: A preformed questionnaire with ten yes or no answers was circulated manually or via emails among the surgical residents and surgeons of less than 5 year experience. More number of 'yes' answers was considered as high level of sense of insecurity. Results: Majority (n= 45, 90%) of respondents had 5 or more than 5 'yes' answers in the questionnaire and median 'yes' answer in the questionnaire was 8, indicating high level of insecurity among the respondents. All respondents (100%) expect themselves to be intimidated or sued in their career and 60 percent of respondents admit themselves ordering more tests than required to be on the 'safe' side. Conclusions: This study has showed both sense of insecurity and subjective prevalence of defensive medicine among the newer lot of surgeons are high.Journal of Patan Academy of Health Sciences, Vol. 2, No. 2, 2015, page: 3-6
Travels of the 'Authentic Craftswoman'
Authors: Russo Alexa
Published: June 2018

This article assesses representations of the ‘authentic craftswoman’ as she travels from an all-women’s cooperative, Haath Ka Honar (HKH), in Rajasthan, India through the transnational craft market. It suggests that the representations at HKH exceed the hegemonic discourses of both the neoliberal (female) ‘entrepreneur’ within international development and ‘authentic’ third-world cultures. In contrast, HKH seeks to produce a market subject, who works within a collective that both reclaims dynamic traditions and guarantees the artisans’ livelihoods. However, this subject and her gendered labour remains governed by market structures, and require 'translation' into these hegemonic discourses in order to become legible and deemed valuable within the market. This study exposes limits to alternative economic structures – particularly regarding their ability, on their own, to change larger capitalist systems that are sustained through gendered and racialised discourses and value systems.
Numerical simulation of bubble growth on and departure from the heated surface by an improved lattice Boltzmann model
Authors: He H. , Liu Y. , Liu L. , Guo C. , Yang C.
Published: June 2018

Based on the phase change model developed by lattice Boltzmann method (LBM), an improved source term which is responsible for phase change is proposed. The computation of the latent heat is taken into consideration to avoid the error and instability caused by the equation of state (EOS). Periodic bubble growth and departure from a heated surface during the boiling process is investigated based on the newly developed lattice Boltzmann model. Effects of gravity, contact angel and superheat on bubble departure diameter and release period under constant wall temperature conditions are illustrated. The three-phase contact line movements of the vapor bubble and the wall heat flux are also described. The results reflect the dynamic features and the influencing mechanism of bubble in boiling period, and this research lays the foundation of further studies on thermal-hydraulics and safety analysis by LBM.
Experimental investigation on the distribution of spray water in a spent fuel-assembly simulator
Authors: Gao Sh. , Lu D. G. , Wang H. , Cao Q. , Han Y. D.
Published: June 2018

The spent fuel pool cooling system in a nuclear power plant, which is comprised mainly by the cooling pumps and heat exchangers, ensures the safety of the spent fuel assemblies and the integrity of the fuel rods during the period of storage. With the development of the passive cooling technique, a spray cooling system for the spent fuels based on the gravity was designed to further enhance the safety of the spent fuel pool in case of accident conditions. This paper presents an experimental investigation of the validity of the spray-cooling system using two types of tight rod bundles, namely a 5 × 5 heated rod bundle and a 17 × 17 isothermal rod bundle. Results shows that the rod bundle heated with a lower power can be effectively cooled only by air without any spray water. With the increase of the heated power, the rod surface temperature increases gradually and the spray cooling has to be implemented to maintain the wall temperature at a certain level. The effect of flow rate on wall temperature was investigated. For the isothermal rod bundle, main interests were focused on the distribution of the spray water after it flowed along the rods.
Soft Tissue Reconstruction around the Ankle with Sural Artery Flap
Authors: Chowdhury Maruf Alam , Khundkar Shafquat Hussain , Ali Md Ayub , Islam Md Obaidul
Published: June 2018

Reconstruction for injuries around the ankle becomes a challenge due to limitation of available similar or near similar tissue. Tendons, bones and joints are frequently exposed after trauma because of the thinness of the subcutaneous tissue around the ankle. A durable flap with good texture, reliable vascularity, good arc of rotation and minimum donor site morbidity is always desired for coverage of such defect. Traditionally local flaps are used for resurfacing but their use is limited by their size and arc of rotation. This study was done in the dept. of Plastic Surgery, NITOR from Dec, 2012 to Feb, 2016. Total number of patients was 50 and their age varied from 7 years to 55 years. Among the 50 patients, 41 patients recovered uneventfully, 8 patients showed partial flap necrosis and complete flap necrosis in 1 patient. The distally based sural flap is a versatile and reliable flap for coverage of soft tissue defects around the ankle. Most of the cases were single stage procedure except extended reverse sural flap. The dissection is easy with short operative time and minimum morbidity. Thus the superficial sural artery flap can be used as a good alternative to microsurgical reconstruction.J Bangladesh Coll Phys Surg 2018; 36(3): 101-106
The Effect of Alimentary Hyperlipemia on Thrombolysis in vivo
Authors: Bang Nils U. , Cliffton Eugene E.
Published: June 2018

1. The effect of a standard, potent fibrinolytic enzyme therapy has been compared in fasting and lipemic dogs.

2. The standard fibrinolytic regimen resulted in the complete dissolution of all clots produced experimentally in the fasting state in 10 dogs.

3. Clots formed during alimentary lipemia exhibited a markedly increased resistance to the standard fibrinolytic regimen in 6 dogs.

4. An increase in anti plasmin fibrinolytic titer with concomitant decrease in spontaneous fibrinolytic activity was observed in 15 dogs following the administration of a fatty meal. No difference in fibrinolytic activity and APF titer was demonstrable in fasting and lipemic blood samples obtained during fibrinolytic enzyme treatment.

5. The possibility of the presence of specific inhibitors against the fibrinolytic enzyme in clots formed during lipemia has been investigated and the evidence to support this theory is discussed.
Separation of Coagulation Factors by Means of Starch Gel Electrophoresis
Authors: Straub Werner
Published: June 2018

The starch gel electrophoresis method of Smithies was applied to the separation of a concentrate of serum clotting factors. The original hydrolysed potato starch, though forming a suitable gel, was not able to separate clotting factors. They are well separated by using a self hydrolysed maize starch. Different batches of this starch show different separation properties according to the degree of hydrolysis. The factor with the highest mobility, i.e. factor X, is highly purified, while the other factors are purified to a certain extent. The protein content does not exceed 2—3 mg% in a solution containing 100 U/ml of one factor and factor X is 2300 times purer than in plasma. The recovery is much better than in paper electrophoresis and 5—10 times more material can be separated in one experiment.

The possibilities of this separation method are limited by the fact that the separated clotting factors are distributed along a distance of only 5—10 cm.
Old English ead in Anglo-Saxon given names
Authors: Boiché Olga Khallieva
Published: June 2018

The Anglo-Saxon name-element ead- was the one of the most common themes used to form dithematic personal names. The overall goal of this paper is to examine the reason for this abundance in anthroponyms such as Eadbald, Eadberht, Eadred. First, the paper addresses the questions of which meaning of Old English ead (wealth, prosperity, happiness, bliss) is present in personal names, and whether there is a hidden message in these names. I look for the ancestral meaning of ead by examining the Old English poetic corpus and then establish lexical and anthroponomical parallels within continental Germanic and other Indo-European traditions: namely Old Greek and Old Slavic. The paper suggests that names formed with Germanic *aud- (etymon of OE ead-), Greek plouto-, and Slavic žir- referred to riches and abundance and were originally used within the inferior stratum of society. Originally, they would have been monothematic and reflected the parents’ desire that their progeny would have a prosperous life. Dithematic anthroponyms, then, containing the ead- element (Eadric, Eadwald, Edmund) emerged during the Heroic Age; they were a later interpretation of ancient poetic epithets describing the lord as a guardian of his people and his land.
“A riddle to myself I am”
Authors: Gather Kirsten
Published: June 2018

This article presents and refines the main results of a larger study on left-shifted arguments in congregational song (see Gather 2014) and discusses its implications for genre studies in general. Argument shifting1 is defined as the deviation from any unmarked order of obligatory arguments, as in the title of the famous carol We three kings of Orient are. Very often, requirements of meter and rhyme are evident causes of shifting. In this article, I provide the results obtained for congregational song, which lead to two major patterns of argument shifting with distinct syntactic and poetic criteria. The comparison to secular poetry shows the uniqueness of the phenomenon in congregational song and the conservatism of the genre.
Attention to Metaphor
Authors: Cuccio Valentina
Published: June 2018

The last decades of the twentieth century have witnessed a fundamental scientific discovery: the identification of mirror neurons and, consequently, the development of the Embodied Simulation theory. Neuroscientific data on the mechanism of Embodied Simulation and its role in conceptual and linguistic processing, figurative language included, have stimulated a great deal of research on the embodied nature of conceptual metaphors. However, the very definition of the notions of body and embodiment are today still controversial in the Embodied Cognition debate. This book addresses the issue of the specific contribution of the body to conceptual and linguistic processing and provides a new definition for the mechanism of Embodied Simulation. In this light, and in consideration of a revision of the contemporary theory of metaphor recently introduced by Gerard Steen, who distinguished between deliberate and non-deliberate metaphor processing, the book also proposes a new model of metaphor processing that brings together the mechanism of Embodied Simulation, on the one hand, and the notion of deliberateness on the other. Modulation of attention during linguistic processing is a key component in explaining how they interact.
Potential readers of the book include linguists, psychologists, philosophers and any other cognitive scientists and communication scientists piqued by the topic of metaphor and embodiment.
A gene therapeutic approach to inhibit calcium and integrin binding protein 1 ameliorates maladaptive remodelling in pressure overload
Authors: Grund Andrea , Szaroszyk Malgorzata , Döppner Janina K , Malek Mohammadi Mona , Kattih Badder , Korf-Klingebiel Mortimer , Gigina Anna , Scherr Michaela , Kensah George , Jara-Avaca Monica , Gruh Ina , Martin Ulrich , Wollert Kai C , Gohla Antje , Katus Hugo A , Müller Oliver J , Bauersachs Johann , Heineke Joerg
Published: June 2018

Aims

Chronic heart failure is becoming increasingly prevalent and is still associated with a high mortality rate. Myocardial hypertrophy and fibrosis drive cardiac remodelling and heart failure, but they are not sufficiently inhibited by current treatment strategies. Furthermore, despite increasing knowledge on cardiomyocyte intracellular signalling proteins inducing pathological hypertrophy, therapeutic approaches to target these molecules are currently unavailable. In this study, we aimed to establish and test a therapeutic tool to counteract the 22 kDa calcium and integrin binding protein (CIB) 1, which we have previously identified as nodal regulator of pathological cardiac hypertrophy and as activator of the maladaptive calcineurin/NFAT axis.

Methods and results

Among three different sequences, we selected a shRNA construct (shCIB1) to specifically down-regulate CIB1 by 50% upon adenoviral overexpression in neonatal rat cardiomyocytes (NRCM), and upon overexpression by an adeno-associated-virus (AAV) 9 vector in mouse hearts. Overexpression of shCIB1 in NRCM markedly reduced cellular growth, improved contractility of bioartificial cardiac tissue and reduced calcineurin/NFAT activation in response to hypertrophic stimulation. In mice, administration of AAV-shCIB1 strongly ameliorated eccentric cardiac hypertrophy and cardiac dysfunction during 2 weeks of pressure overload by transverse aortic constriction (TAC). Ultrastructural and molecular analyses revealed markedly reduced myocardial fibrosis, inhibition of hypertrophy associated gene expression and calcineurin/NFAT as well as ERK MAP kinase activation after TAC in AAV-shCIB1 vs. AAV-shControl treated mice. During long-term exposure to pressure overload for 10 weeks, AAV-shCIB1 treatment maintained its anti-hypertrophic and anti-fibrotic effects, but cardiac function was no longer improved vs. AAV-shControl treatment, most likely resulting from a reduction in myocardial angiogenesis upon downregulation of CIB1.

Conclusions

Inhibition of CIB1 by a shRNA-mediated gene therapy potently inhibits pathological cardiac hypertrophy and fibrosis during pressure overload. While cardiac function is initially improved by shCIB1, this cannot be kept up during persisting overload.
Selection of Patients’ Recumbent Position Laterality According to Physician Handedness Bias Increases the Success Rate of Lumbar Puncture: A Multicenter Study
Authors: Zhao Jian-Lan , Sun Yi-Rui , Shan Qiao , Xiao Zhi-Peng , Hou Ben-Chao , Hu Jin
Published: June 2018

Background:

Lumbar puncture (LP) is a medical procedure required during spinal anesthesia and for obtaining cerebrospinal fluid samples in the diagnosis of neurological disorders. The aim of this study was to assess the effects of physicians’ handedness bias and the laterality of patients’ recumbent position on the success rate of LPs.

Methods and Patients:

A prospective multicenter study including 36 physicians (18 left-handed and 18 right-handed) and 7200 patients was conducted in 6 medical centers. In each center, 1200 patients were randomized into group L (LPs performed by left-handed physicians) or group R (LPs performed by right-handed physicians). Each physician performed 200 cases of LPs, of which the laterality of the recumbent position (either on the left or right side) was decided after a second randomization. A successful LP was considered when the free flow of cerebrospinal fluid was observed upon the first attempt.

Results:

There was no significant difference in patient characteristics between groups L and R. Right-handed physicians had a significantly higher LP success rate with patients in the left lateral recumbent position (LRP) (1595/1800 vs. 1408/1800; odds ratio, 0.539; 95% confidence interval, 0.348-0.836;P=0.006). For left-handed physicians, the LP success rate was higher when patients were in the right LRP (1424/1800 vs. 1593/1800, odds ratio, 0.449; 95% confidence interval, 0.283-0.711;P=0.001). Patients’ age, sex, height, and weight were not statistically related to LP success during multivariate analyses.

Conclusions:

Physicians handedness bias and patient laterality of recumbent position affects the success of LPs. Right-handed physicians have a greater chance of performing successful LPs when patients are in the left LRP, and vice versa.
Closed Incision Negative Pressure Therapy in Oncological Breast Surgery: Comparison with Standard Care Dressings
Authors: Ferrando Pietro M. , Ala Ada , Bussone Riccardo , Bergamasco Laura , Actis Perinetti Federica , Malan Fabrizio
Published: June 2018

Background:

Negative pressure wound therapy was developed for treating wounds associated with unfavorable healing factors. The principles of the negative pressure wound therapy applied on clean and closed surgical incision originate the closed incision negative pressure therapy (ciNPT). We evaluated the use of ciNPT in the setting of oncological breast surgery.

Methods:

From January 1, 2015, to June 31, 2015, we prospectively selected 37 patients undergoing oncological breast surgery with a minimum of 4 risk factors. Seventeen patients (25 surgeries) voluntary tested ciNPT (ciNPT sample), whereas the remaining 20 (22 surgeries) chose conventional postsurgery dressing (Standard Care sample). Follow-up controls to evaluate postsurgical complications were performed on days 7, 14, 30, and 90. At 12 months, the quality of life, scar, and overall aesthetic outcomes were evaluated with specific questionnaires filled in by surgeon and patient. The Standard Care sample was investigated on risk factors associated with poor healing.

Results:

The ciNPT sample showed a significant prevalence of high risk factors, especially extensive undermining and bilateral surgeries, and a predominance of women under 65 years; only 1/25 (4%) surgical procedures was followed by complications. In the Standard Care sample, 10 of 22 surgeries (45%) were followed by complications. The difference in complication rate between the 2 samples was significant. The BIS (Body Image Scale) scores suggested that most patients were satisfied with their body image regardless of the type of dressing. All other questionnaire scores clearly vouched for a significant superiority of the ciNPT. Previous surgery ≤ 30 days emerged as the surgery-related high risk factor most frequently associated with postsurgery complications.

Conclusion:

The results of our study support the use of ciNPT in oncological breast surgery: it showed to be a well-tolerated, adaptable, and reliable dressing capable of reducing postsurgical complications and improving scar outcomes in patients presenting with high risk factors.
Predictors of Persistent Tricuspid Regurgitation after Transcatheter Aortic Valve Replacement in Patients with Baseline Tricuspid Regurgitation
Authors: Worku Berhane , Valovska Marie-Therese , Elmously Adham , Kampaktsis Polydoros , Castillo Catherine , Wong Shing-Chiu , Salemi Arash
Published: June 2018

Objective

This study sought to analyze outcomes in patients with moderate-severe tricuspid regurgitation (TR) undergoing transcatheter aortic valve replacement (TAVR). The consequences of uncorrected significant TR in patients undergoing TAVR remain undefined.

Methods

Between 2009 and 2014, 369 patients underwent TAVR at our institution, and 58 of these had baseline moderate-severe TR. Preoperative, 30-day, and 1-year transthoracic echocardiograms were analyzed. Predictors of persistent TR at 30 days and survival were assessed.

Results

Fifty-eight patients with baseline moderate-severe TR underwent TAVR. Transcatheter aortic valve replacement resulted in significant reductions in pulmonary artery pressures and TR severity (100% vs 64%; P < 0.001) at 30 days. This was sustained at 1 year and was associated with significant improvements in stroke volume index and New York Heart Association functional class. No changes in right ventricular function or size were noted. The only independent predictor of persistent moderate-severe TR at 30 days was preoperative atrial fibrillation [AF; odds ratio (OR), 4.56; 95% confidence interval, 1.1–18.3; P = 0.033]. Independent predictors of overall long-term survival included AF (OR, 0.41; P = 0.001) and chronic lung disease (OR, 0.47; P = 0.011), but not baseline moderate-severe TR. In patients with baseline moderate-severe TR, persistent moderate-severe TR at 30 days was associated with worsened overall survival (log-rank P = 0.02).

Conclusions

Baseline moderate-severe TR is not uncommon in patients undergoing TAVR, and frequently improves. However, the presence of AF suggests that that TR is likely to persist after TAVR and is also indicative of a poor long-term outcome. Whether redirecting such patients to surgery for concomitant tricuspid valve repair will further improve outcomes requires further study.
Aspergillus terreus Spondylodiscitis in an Immunocompromised Child
Authors: Sohn Young Joo , Yun Jung Ha , Yun Ki Wook , Kang Hyoung Jin , Choi Eun Hwa , Shin Hee Young , Lee Hoan Jong
Published: June 2018

We report the case of a 12-year-old immunocompromised boy with spondylodiscitis of the thoracolumbar spine caused by Aspergillus terreus. Microbiologic diagnosis was confirmed by inoculation of aspiration fluid into blood culture bottles. Because of noncompliance, the patient was treated with extended voriconazole therapy (23 months) with regular serum drug concentration monitoring and intermittent direct observation therapy in an outpatient clinic. The Aspergillus genus contains species that are important causes of morbidity and mortality in immunocompromised hosts. Although the lung is the main target of invasive Aspergillosis, more severe forms such as Aspergillus osteomyelitis can occur.
1

A. fumigatus is the most common cause of Aspergillus osteomyelitis, causing 55%–61% of all cases, whereas A. terreus causes 2.3%–2.8% of cases. The vertebral bodies are the most commonly affected sites, occurring in 46%–49% of cases.
2,3
Here, we report the case of an immunocompromised 12-year-old boy with thoracolumbar spondylodiscitis caused by A. terreus.
Chronic stress-associated visceral hyperalgesia correlates with severity of intestinal barrier dysfunction
Authors: Creekmore Amy L. , Hong Shuangsong , Zhu Shengtao , Xue Jing , Wiley John W.
Published: June 2018

In humans, chronic psychological stress is associated with increased intestinal paracellular permeability and visceral hyperalgesia, which is recapitulated in the chronic intermittent water avoidance stress (WAS) rat model. However, it is unknown whether enhanced visceral pain and permeability are intrinsically linked and correlate. Treatment of rats with lubiprostone during WAS significantly reduced WAS-induced changes in intestinal epithelial paracellular permeability and visceral hyperalgesia in a subpopulation of rats. Lubiprostone also prevented WAS-induced decreases in the epithelial tight junction protein, occludin (Ocln). To address the question of whether the magnitude of visceral pain correlates with the extent of altered intestinal permeability, we measured both end points in the same animal because of well-described individual differences in pain response. Our studies demonstrate that visceral pain and increased colon permeability positively correlate (0.6008, P = 0.0084). Finally, exposure of the distal colon in control animals to Ocln siRNA in vivo revealed that knockdown of Ocln protein inversely correlated with increased paracellular permeability and enhanced visceral pain similar to the levels observed in WAS-responsive rats. These data support that Ocln plays a potentially significant role in the development of stress-induced increased colon permeability. We believe this is the first demonstration that the level of chronic stress-associated visceral hyperalgesia directly correlates with the magnitude of altered colon epithelial paracellular permeability.
A Randomized Controlled Trial of Balloon Dilation as a Treatment for Persistent Eustachian Tube Dysfunction With 1-Year Follow-Up
Authors: Meyer Ted A. , O’Malley Ellen M. , Schlosser Rodney J. , Soler Zachary M. , Cai Jason , Hoy Mark J. , Slater Patrick W. , Cutler Jeffrey L. , Simpson Roger J. , Clark Michael J. , Rizk Habib G. , McRackan Theodore R. , D’Esposito Christopher F. , Nguyen Shaun A.
Published: June 2018

Objective:

Compare Eustachian tube balloon dilation versus continued medical therapy (control) for treating persistent Eustachian tube dysfunction (ETD).

Study Design:

Prospective, multicenter, randomized controlled trial.

Setting:

Tertiary care academic center and private practice.

Patients:

Diagnosed with medically refractory persistent ETD.

Interventions:

1:1 Randomization to balloon dilation or control. After 6 weeks, control participants had the option to undergo balloon dilation if symptoms persisted.

Main Outcome Measures:

Primary efficacy endpoint was the comparison between treatment arms in the mean change from baseline in the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. Primary safety endpoint was complication rate.

Results:

Sixty participants were randomized (31 balloon dilation, 29 control). Mean (SD) change in overall ETDQ-7 score at 6 weeks was −2.9 (1.4) for balloon dilation compared with −0.6 (1.0) for control: balloon dilation was superior to control (p < 0.0001). No complications were reported in either study arm. Among participants with abnormal baseline assessments, improvements in tympanogram type (p < 0.006) and tympanic membrane position (p < 0.001) were significantly better for balloon dilation than control. Technical success was 100% (91 successful dilations/91 attempts) and most procedures (72%) were completed in the office under local anesthesia. Improvements in the ETDQ-7 scores were maintained through 12 months after balloon dilation.

Conclusions:

Balloon dilation is a safe and effective treatment for persistent ETD. Based on improved ETDQ-7 scores, balloon dilation is superior to continued medical management for persistent ETD. Symptom improvement is durable through a minimum of 12 months. Procedures are well tolerated in the office setting under local anesthesia.