bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency of supplement and multi-vitamins uses rate among Ardabil medical students, Iran
Authors: Ojaghi Habib , Abbasi Vahid , Masoumi Rahim , Barak Manouchehr , Kahnamouei-aghdam Fariba
Published: December 2016

Background: Today, the tendency to use supplements such as multivitamins and minerals in different communities and especially among young people and students has been increased. The aim of this study was to investigate the consumption rate of supplements and multi-vitamin pills among Ardabil medical college students.Methods: Methods: This descriptive-analytical study has been done on 100 students which selected randomly from Ardabil medical university. Data Collected by a questionnaire and analyzed by statistical methods in SPSS.16.Results: 47% of students were male and the mean age of them were 20.8±1.6. 90% of all students were single and 62% have moderate economic level. 47% of students used the supplement and multi-vitamin pills in recent year which 42.6% of them pointed to “lack of vitamin” as the main reason for their use. 38.3% of students which used supplement pills pointed that their own physician have main role in their supplements usage.Conclusions: Results showed that the prevalence of using supplement and multi-vitamin pills among medical students were in moderate level which need for doing more research and educational interventions in future for decreasing rate of supplement usage among them.
Outcome of children with tuberculous meningitis: a prospective study from a tertiary care centre in Southern India
Authors: Mohan Jesinth , P. S. Rakesh , Moses Prabhakar D. , Varkki Sneha
Published: December 2016

Background: TB Meningitis is one of the most serious forms of Tuberculosis. Objective of the current study was to assess the clinical outcome of children presented with TB Meningitis in a tertiary care centre in southern India by following them up and assess their present state in terms of neurological deficits, hearing and visual deficits, learning difficulties and day to day performances.Methods: Children between 0 - 15 years diagnosed to have TB meningitis in a 2700 bedded hospital in Tamilnadu, India, during the time period 1999-2003 were identified through medical records. These children were called back after 2 to 7 years and health status in terms of neurological deficits, learning deficits, persisting seizures and day to day performance, hearing, ophthalmologic assessment and Intelligence quotient assessment were assessed.Results: Nearly one third of the children with TB meningitis showed complete recovery. One third died and another one third had some disability. Major problem (46%) encountered in TB meningitis survivors was behavioural problems; the commonest being hyperactivity. Ten out of 27 children had poor scholastic performances, six had neurological deficits and four had seizure disorders. Of 17 children assessed, two had hearing impairment and five had visual impairment. All children with hydrocephalus and were shunted within five days had fully recovered. Of the children shunted later, 9 children (60%) had some sequelae.Conclusions: Childhood TB meningitis has very poor outcomes. Poor prognosis and difficult early diagnosis emphasise the importance of preventive therapy for child contacts of patients with tuberculosis.
Substance abuse pattern among medical college students in Tumkur, Karnataka, India: a cross sectional study
Authors: Mir Ashiq Rashid , S. H. Mahesh , M. S. Rajanna , J. Ashok , Singh Debeshwar
Published: December 2016

Background: Globally, there are 2 billion alcohol users, 1.3 billion smokers and 185 million are drug users. These are accounting for 12.4% of all deaths worldwide. The doctors are vulnerable to substance abuse due to their ready accessibility to the substance of abuse. Medical training is identified as full of stress and it is also observed that students undergo tremendous stress during various years of medical training. Repeated use of drugs can damage essential decision making and effect judgment of actions. This could be disastrous if substance abusers are medical professionals who have direct dealing with human lives.  Methods: A cross sectional study was conducted at a medical college in Tumkur district of Karnataka. A semi structured questionnaire was used to interview 379 medical students who were willing to participate.Results: Prevalence of substance abuse among the students was found to be 25.9%. Substance abuse was highest among VII term students (IIIrd year) which was 25.3%. Alcohol was the single most preferred substance of abuse which was used by 36.40% of students. Curiosity for experience (42.4%) was major reason for initiation of substance abuse. Majority of students (45.5%) attained the harmful substances through friends. 76.6% of hostellers used harmful substances.Conclusions: Prevalence of substance abuse among medical college students was high. Students preferred alcohol products and tobacco most. Hosteller students are more likely to be exposed to substance abuse.
Evaluation of anthropometric measurements of central obesity as screening tools in children: multi receiver operating characteristic analysis
Authors: Bullappa Asha , B. R. Harish , B. J. Mahendra
Published: December 2016

Background: Obesity in children is often expressed by indicators like Body Mass Index, Waist Circumference, Waist-to-Hip ratio etc. Each of these has its own merits and demerits. Among these, BMI is commonly used to assess overweight/obesity but the central obesity is more important than the body mass as it has shown strong association with risk for coronary heart disease, adverse lipid profile and hyper insulinaemia in children.  The objectives were to assess the validity of waist-hip ratio, waist-to-height ratio, conicity index as indicators of central obesity in children as measured by waist circumference.Methods: This is a cross sectional study conducted on 4663 students who were enrolled in 8th to 10th standard of government and private schools of Mandya city. Weight, height, waist and hip circumference are measured following WHO guidelines. The data was analyzed using mean, standard deviation, proportion, cut off, sensitivity, and specificity. ROC curves were drawn to assess the validity of the anthropometric measurements.Results: Using the WC percentiles given by Kuriyan R, the prevalence of overweight/obesity was found to be 7.59% with 8.85% in girls and 6.03% in boys. Waist-to-Height ratio performed significantly better than waist-to-hip ratio and conicity index in identifying central obesity in both girls and boys as indicated by the AUCs.Conclusions: The age and sex specific cut off points for waist-to-hip ratio, waist-to-height ratio and conicity index can be used to detect overweight/obesity in Indian Children aged 11-16 years.
Varied presentations of gestational trophoblastic disease in Asian women: one year follow up
Authors: Bachani Sumitra , Pruthi Neha , Tiwari Sana , Mittal Pratima
Published: December 2016

Gestational trohoblastic tumors are rare tumors which constitute less than 1% cancers of female reproductive system. They have varied presentations of which hydatidiform mole is most common. The incidence is higher in Asia and South America as compared to the rest of the world. We present a total of 5 cases of Gestational trophoblastic disease (GTD) constituting 12.2% of admissions in Gynaecology ward of a tertiary care hospital over one year. There are various risk factors which predispose to GTD include maternal age less than 20 years or more than 35 years, prior GTD, prior miscarriages, Asian ethnicity and blood group A. Commonly the woman  presents with vaginal bleeding in first trimester. Sonography and β-hCG are decisive in establishing the diagnosis and further management. Follow up of the patient is very crucial. Early diagnosis and timely management results in good prognosis.
Risk of blood splashes in otorhinolaryngology surgery: do we really require protection?
Authors: Shrestha Bikash Lal , Amatya Ram Chayya Man
Published: December 2016

Background: Surgeons are particularly at risk from blood borne pathogens like hepatitis and HIV during interventions or surgeries. They do take precaution to avoid the needle stick injuries but few pay attention on blood or body fluid splashes into eye. The main aim of the study was to know the risk of blood splashes in glass, gown and mask during ENT –HNS (ear, nose and throat and head and neck surgery).

Methods: The prospective study conducted in Department of ENT-HNS of Dhulikhel Hospital, Kathmandu University Hospital from 1st July 2016 to 30th September 2016. All the elective cases were included for study. Surgery was performed by the single surgeon. The surgeon wore the glass and mask during the surgery. At the end of the surgery, the glass, mask and gown was inspected by the surgeon for any blood splashes and information was recorded.  

Results: There were total 62 patients with male 30 and female 32. Regarding the age, most of the patients lie between 20-50 years. The amount of blood splatter in glass, mask and gown is most common in modified radical mastoidectomy surgery. Likewise, the blood splatter is most common in tonsillectomy in throat surgery and in head and neck surgery, the blood splatter is common in all head and neck surgery.

Conclusions: The blood splashes is high even in various ENT surgeries. So it is important to take precaution by surgeon like protective mask and glass worn during surgeries to protect from various blood-borne infection transmissions. 
Emphysematous gastritis: a case report
Authors: Sulaimani Mohammed , Alshehri Abdulaziz Rashed , Hmoud Mohammed , Waggas Najat , Aboalsamh Ghaleb
Published: December 2016

Emphysematous gastritis (EG) is a rare disease entity related to infection of the gastric wall. It is caused by gas-forming pathogens including Enterobacter species, Clostridium perfringens and others. EG patients clinically present with symptoms similar to acute abdomen and can have a mortality that can reach up to 80%. Alcoholism was identified as a risk factor for such a disease. Different diseases like diabetes mellitus, ulcerative colitis and use of nonsteroidal anti-inflammatory agents were found to be associated with EG. To date, no clear guidelines regarding EG management, however, early detection and management is crucial to prevent related deaths. In the acute setting, the role of surgery is limited. Surgical interventions might be needed if obstruction of gastric outlet or perforation ensues. Fifty six years old male, heavy smoker, alcoholic with a history of ischemic heart disease, presented to Emergency Department with a complaint of severe epigastric abdominal pain for two days. The patient was vitally stable, conscious, oriented, however, looks in severe pain. His lab investigations were within normal ranges. Computed tomography (CT) of the abdomen was consistent with emphysematous gastritis. To our knowledge, this is the first case of emphysematous gastritis reported in Saudi Arabia using only radiological modality.
Comercialização de plantas medicinais por raizeiros, na feira livre, em São José de Piranhas, Paraíba
Authors: Figueiredo Carla Heloísa Alencar de , Alencar Maria Carmem Batista de , Ribeiro Samara Raquel Souza
Published: December 2016

As plantas medicinais são formas de tratamento alternativo e, para algumas pessoas a única opção para essa finalidade. Assim objetivou-se realizar uma investigação sobre a diversidade de recursos vegetais comercializados em feira livre, no município de São José de Piranhas no estado da Paraíba, uma vez que o estudo das espécies medicinais trará subsídios para a sua correta indicação e forma de uso. A coleta de informações foi realizada por meio de visitas à feira livre, a fim de estabelecer contato, e observando-se os feirantes que comercializam plantas medicinais no município. A etnobotânica nos mostra a importância dos comerciantes de plantas medicinais para informação sobre o devido uso, de modo que fazem a ligação entre produção/venda e o uso destes produtos. Foram citados pelos erveiros da feira livre de São José de Piranhas 18 espécies e 10 famílias de plantas medicinais comercializadas. A venda e utilização de plantas medicinais nas mais diversas formas e finalidades é uma prática bem difundida na cidade de São José de Piranhas-PB.

Commercialization of medicinal plants by raizers, at the fair, in São José de Piranhas, state Paraíba

Abstract: Medicinal plants are alternative forms of treatment and, for some people, still the only option for such. The objective of this work was to carry out an investigation about the diversity of vegetal resources commercialized in a fair, in the municipality of São José de Piranhas in the state of Paraiba, since the study of medicinal species will provide subsidies for its correct indication and form of use. The collection of information was carried out through visits to the fair, in order to establish contact, and observing the herbs that market medicinal plants in the municipality. Ethnobotany shows us the importance of the traders of medicinal plants for information about the proper use, so that they make the connection between production / sale and the use of these products. There were 18 species and 10 families of medicinal plants marketed by them. It can be concluded that the sale and use of medicinal plants in the most diverse forms and purposes is a well-known practice in the city of São José de Piranhas-PB.

 
LITERATURA, MEMÓRIA E A CONSTRUÇÃO DE UMA PERSPECTIVA NACIONAL ANGOLANA
Authors: PEREIRA MATHEUS SERVA
Published: December 2016

CARVALHO FILHO, Silvio de Almeida. Angola: história, nação e literatura (1975-1985). Curitiba: Editora Prisma, 2016.
What do trade unions think about continuing education for teachers in Galicia?
Authors: Ampudia Baena , Tilve Ana M. FernÃ¡ndez , Dolores M.
Published: December 2016

The common ups and downs of school agendas coupled with the existence of new educational challenges have created a complicated scenario that places the issue of continuing education for teaching staff directly under the spotlight. As a consequence, the role of teachers' trade unions as with other requirements of continuing education is now put centre stage. Within these considerations, we have carried out an unprecedented and ongoing survey in Galicia with the intention of taking a closer look at continuing education for non-university teachers promoted by trade union organisations. For this purpose we put forth a qualitative and quantitative methodological approach while using documentary analysis as a tool for gathering data as well as discussion groups and Likert type assessment scale questionnaires. In this essay we provide the data obtained during the intensive-qualitative stage of the investigation. The resulting findings although provisional and partial reveal that an improvement in students' education should go hand in hand with the continuing education of teaching staff. It also becomes apparent that training activities are being substantially conditioned by the legislative jungle that is shrouding continuing education, by the lack of resources and by the pragmatic lines followed by the Education Administration. Furthermore, certain pending issues are cropping up such as the need to channel learned contents into our classrooms, to satisfy the emerging concerns of training recipients regarding their training, to perform follow-up and evaluation tasks regarding the training actions that are being undertaken and to strive for an improved coordination between management staff, users and knowledge workers.

 

Keywords: Non-university personnel, continuing education, professional development, union organisations, education needs or requirements
Pedagogía, feminismo y emociones: una lectura de “Lección de cocina” de Rosario Castellanos
Authors: López Helena
Published: December 2016

Este artículo propone un examen de la relación entre pedagogía, literatura, feminismo y emociones. Con este fin, he dividido mi trabajo en tres secciones. Primero, exploro las estrategias para una pedagogía de la literatura comprometida con una crítica feminista. Después explico la productividad de la noción de cuerpo y algunas de las premisas de los Estudios de las Emociones. Por último, me centro en una lectura discursiva y emocional de “Lección de cocina” de Rosario Castellanos que ilumine varios de los puntos teóricos anteriores.
Profanar cuerpos / profanar naciones. Acerca de La emancipada como novela fundacional de la literatura ecuatoriana
Authors: Marín Lara Karina
Published: December 2016

Este trabajo pretende realizar una lectura alternativa a aquello que podemos entender como representación del cuerpo, con el fin de problematizar conceptos como los de novela fundacional y literatura nacional. Se espera formular otros modos de mirar aquellas imágenes corporales que han sido relegadas bajo los escombros ocasionados por el empeño de construcción de una historia literaria, específicamente la historia de la literatura ecuatoriana. En el caso de La emancipada de Miguel Riofrío (1863), considerada la primera novela ecuatoriana, sugiero pensar: si el cuerpo muerto y en estado de descomposición de su protagonista, Rosaura, no logra tener una apariencia decente, ¿cómo se entiende que sea ese cuerpo el que se instaure como la imagen de la consolidación de un corpus literario? ¿Cómo puede ser viable una historia literaria nacional que se funda sobre la representación de una imagen corporal desmembrada e imposible?
De la palabra hipoteca como significante al goce con el tiempo en El perseguidor: una lectura desde el psicoanálisis
Authors: Fonseca Jiménez Hernán Joaquín
Published: December 2016

La crítica literaria ha señalado que de lo que se trata con Johnny Carter, en El perseguidor, es de la crisis espiritual de un artista; sin embargo, a partir de postulados del Psicoanálisis, como disciplina que se encarga de estudiar lo inconsciente, se puede apreciar que el músico está atravesado por una problemática que implica lo inconsciente y de la que se pueden señalar aspectos específicos para comprender las palabras, actitudes, acciones y reacciones del personaje; se trata de ofrecer una lectura que ilustre ciertos rasgos de la problemática y ayude a esclarecer de lo que se trata con el ser del sujeto-artista. Para conseguir este objetivo, el presente texto lleva a cabo una presentación de la relación significante y cuerpo en la perspectiva psicoanalítica como fundamento de una lectura alternativa del relato literario El perseguidor de Julio Cortázar. El propósito es referir cómo un significante, una palabra, toca el cuerpo del sujeto, lo traspasa y lo pone a gozar. En el caso de El perseguidor, la palabra hipoteca pone a gozar al sujeto con el tiempo. Esto significa referir el tema del goce y de qué sujeto se trata en el caso del músico: un sujeto en una crisis permanente por la incidencia significante.
Palabras clave: inconsciente, goce, significante, tiempo, artista, Cortázar.
Poéticas del intruso. Jacques Rancière, lector de Mallarmé
Authors: Bejarano Alberto
Published: December 2016

Este artículo analiza el significado de la figura del poeta como “intruso” en la obra de Stéphane Mallarmé, tal  como es estudiada por el filósofo y ensayista francés Jacques Rancière en La política de la sirena y La palabra muda. Nuestra intención apunta a mostrar otras definiciones del rol del poeta y del espacio literario en uno de los creadores más destacados del arte contemporáneo.

Palabras clave: Mallarmé, Rancière, poesía francesa, filosofía, literatura comparada.
Exhumación informática en el Archivo de Daniel Moyano. Una reflexión sobre soportes, materialidades y el devenir de originales y borradores
Authors: Vigna Diego
Published: December 2016

El trabajo aborda nociones centrales en torno a los archivos de escritores a partir de una experiencia llevada a cabo en el Archivo Virtual Daniel Moyano: la recuperación de textos a partir de un dispositivo informático obsoleto. Textos que Moyano conservó en soportes de almacenamiento hoy inaccesibles y que logramos recuperar, en un trabajo conjunto entre el CRLA-Archivos (Francia) y la Universidad Nacional de Córdoba (Argentina). Desde un enfoque hermenéutico, la exhumación informática permitió articular con estos documentos la génesis de los procesos de ficcionalización del autor, no restringidos a textos que podrían pensarse a primera vista como literarios, con una reflexión sociotécnica sobre esas prácticas, que ha inspirado interrogantes sobre cómo ha mutado el lugar de la técnica en la relación entre arte y sociedad.
Palabras clave: Daniel Moyano, archivos virtuales, análisis hermenéutico de obras, exhumación informática, originales y copias.
Estudio filológico para una edición crítica de Horas y Fronda lírica, de Julio Flórez
Authors: Avendaño de Barón Gloria Smith
Published: December 2016

Con el apoyo en los planteamientos teóricos de la Edición Crítica de Textos, en el método de la Nueva Filología y en las directrices lingüísticas de la Real Academia Española, se emprendió un recorridoecdótico con miras a rescatar la obra completa del poeta colombiano Julio Flórez, desentrañar alteraciones en su proceso de transmisión editorial, depurarla, editarla e interpretarla. Algunos resultados de esa investigación mostraron inconsistencias lingüísticas y estéticas, es recurrente la introducción injustificada de variantes de tipo sustancial y accidental que, en su mayoría, alteran el sentido y el estilo poético, por ello se subsanaron en la elaboración de una edición crítica conformada por nueve libros de poesía, 120 poemas sueltos y uno inédito. En este artículo se presenta únicamente algunos comentarios sobre Horas (1893) y Fronda lírica (1908 y 1922), su tradición directa, la descripción y el análisis de variantes sustanciales y accidentales detectadas.
Lectores y textos escolares durante la primera mitad del siglo XX en Colombia
Authors: Guzmán Méndez Diana Paola , Marín Colorado Paula Andrea
Published: December 2016

Este artículo presenta algunos aspectos de la historia de la lectura en Colombia durante la primera mitad del siglo XX, así como la caracterización de algunas prácticas lectoras que se hicieron evidentesdurante el mismo período. Los intelectuales de los gobiernos de la República Liberal actuaron como agentes culturales claves para ejecutar diversas campañas que coadyuvaron en la ampliación del público lector, entre ellas, los programas de alfabetización, la creación de bibliotecas y misiones culturales. Dentro de estas campañas de alfabetización, se hicieron presentes importantes cambios en el diseño y empleo de los materiales para la enseñanza de la lectura que apuntaron a la diferenciación entre lectores rurales y urbanos.Palabras clave: historia de la lectura en Colombia, enseñanza de la lectura, textos escolares, público lector, bibliotecas.
THE USE OF CAUSAL MAPS AS INTERDISCIPLINARY DIDACTIC REDUCTION METHOD
Authors: Shmatkov Daniyil
Published: December 2016

Presented article is devoted to theoretical substantiation and development of interdisciplinary didactic reduction method, based on the use of causal maps. The article discusses properties of causal maps in the context of its use in teaching methods. It was determined that the creation of the causal maps that reflect all connections between and / or within the three information blocks should be an effective reduction method of learning content of the topics about measurements of the various sciences. The blocks are named: “The physical basis of measurement”, “The elements of the measuring instrument” and “The measurement technique”. The article establishes that the method of using of causal maps in related topics of natural sciences, engineering, social sciences and humanities corresponds to properties of didactic reduction methods, due to abstraction and providing the omission of factors that do not have a determining influence on the situation, and getting in the vertices concepts less volume than learning texts. The method can provide an illustrative or symbolic representation of complex information on causal maps, review situations based on known models. The research justifies the possibility of constructing of quantitative variables in formulas to their qualitative explanations and presentation of the relationship between them in the causal maps. The process of tasks’ decision, that has different difficulty levels, using causal maps allows to influence on additional perception channels, and through the students' understanding of causality allows intensifying the development of mental processes.
APPROACHES TO DETERMINING THE STAGES OF THE LANGUAGE TEACHING METHODS DEVELOPMENT IN WESTERN UKRAINE (1867-1939)
Authors: Labinska Bogdana
Published: December 2016

The article under discussion focuses on scientific works, dedicated to the development of language teaching methods. We have analysed the criteria for singling out the stages of contemporary scholars’ methods of development and created our own criteria regarding language teaching methods in Western Ukraine (1867-1939). According to the selected criteria, we have determined the basic stages of development methods on a particular territory, in a specific chronological framework: stage I – 1867–1890 – the emergence of the language teaching methods; stage II – 1890–1918 – the formation of foreign language teaching methods; stage III – 1918–1939 – further development of language teaching methods. These stages have been marked with certain innovative ideas of foreign language teaching approaches. They have also set certain scientific practice standards and theoretical postulates, preserving, at the same time, the teaching theories, concepts, approaches, principles, foreign language teaching methods, accepted by the professional community. Certain approaches to curricula development, in accordance with the peculiarities of each region, some principles of creating the educational materials, regarding the students’ age and interests, are inherent to each phase of the development of Linguistic Didactics in Western Ukraine. In our studies, we have proved that grammar translation, textual translation, direct and mixed methods of foreign language teaching have been implemented in accordance with the characteristic features of the outlined area and within the fixed chronological frames. We have highlighted the provisions of foreign language teaching methods that have remained unchangeable in the process of foreign language teaching in Western Ukraine. The latter methods have acquired new features and emerged in foreign language teaching methods on Western Ukrainian territories during their implementation within a specified period of time.
FLUTTER BY, BUTTERFLY: OR WONDER-FULL WRITING TOOLS. A review of Technique in Nonfiction: The Tools of the Trade, by Steven Darian. Linus Learning, 2016, 271 p.
Authors: Ilchenko Olga M.
Published: December 2016

I am a great believer that writing can be brilliant. But how can one master this art? Some say it’s even impossible… Or is it? Perhaps the answer to this question is learning from the best teachers who generously share with us their tools of the trade.“Technique in Nonfiction: The Tools of the Trade” by Professor Steven Darian is doing exactly this. But first, why butterflies? Well, they will be mentioned thrice throughout the review, but each time to convey a slightly different thing. Let’s start by saying that some books do have the so-called “butterfly effect” – the potential to significantly influence the future for years ahead...
The Variability of Seed Viability and Seed Vigour of Mindi (Melia azedarachlinn.) from Several Populations in The Community Forest of West Java
Authors: Bramasto Yulianti , Wijayanto Nurheni , Siregar Iskandar Z , Darma I.G.K. Tapa
Published: December 2016

The procurement of good quality seeds for the development of mindi (Melia azedarach L.) in the community forest is absolutely necessary. The purpose of this research is to investigate the diversity of the viability and seedling vigor of mindi from different populations with various treatments of dormancy breaking. The sample materials were mindi seeds that were collected from 6 locations (6 seed lots) or seed sources which were located in the community forest of West Java. There are 10 treatments of dormancy breaking that were applied in this study. The experiment design was Randomized Complete Design (RAL). The breaking dormancy  was focused to the delignification of hard seed coat.  Results showed that the most effective dormancy breaking for mindi seed was soaking in consentrated Sulfuric Acid (H2SO4) as long as 30 to 45 minutes. The first count for germination of mindi was on the 16 day and the final count was on the 31 day.The average value of germination percentage (DB) for all seed sources was 40 %, while the highest which is 60% was mindi from Sumedang seed source. The highest value of germination rate that is 6,543%/etmal was seed  from Sumedangand seed from Gambung was the lowest (1,400 %/etmal). Keywords : community forest, Melia azedarach L., variation, viability, vigor.
Breast Cancer Brain Metastases: Clonal Evolution in Clinical Context
Authors: Saunus Jodi M. , McCart Reed Amy E. , Lim Zhun Leong , Lakhani Sunil R.
Published: December 2016

Brain metastases are highly evolved manifestations of breast cancer arising in a unique microenvironment, giving them exceptional adaptability in the face of new extrinsic pressures. The incidence is rising in line with population ageing, and use of newer therapies that stabilise metastatic disease burden with variable efficacy throughout the body. Historically, there has been a widely held view that brain metastases do not respond to circulating therapeutics because the blood-brain-barrier (BBB) restricts their uptake. However, emerging data are beginning to paint a far more complex picture where the brain acts as a sanctuary for dormant, subclinical proliferations that are initially protected by the BBB, but then exposed to dynamic selection pressures as tumours mature and vascular permeability increases. Here, we review key experimental approaches and landmark studies that have charted the genomic landscape of breast cancer brain metastases. These findings are contextualised with the factors impacting on clonal outgrowth in the brain: intrinsic breast tumour cell capabilities required for brain metastatic fitness, and the neural niche, which is initially hostile to invading cells but then engineered into a tumour-support vehicle by the successful minority. We also discuss how late detection, abnormal vascular perfusion and interstitial fluid dynamics underpin the recalcitrant clinical behaviour of brain metastases, and outline active clinical trials in the context of precision management.
Higher Total Knee Arthroplasty Revision Rates Among United States Blacks Than Whites
Authors: Bass Anne R. , McHugh Kelly , Fields Kara , Goto Rie , Parks Michael L. , Goodman Susan M.
Published: December 2016

Background:

Reportedly 2% to 5.7% of total knee arthroplasties (TKAs) require revision within 5 years. The purpose of this study was to determine whether blacks are at higher risk of TKA revision than whites in the United States.

Methods:

We performed a systematic review of English-language articles published from 2000 to 2015. Study inclusion criteria were (1) performance of the study in the United States, (2) TKA as the primary procedure studied, (3) a follow-up period at least 2 years, (4) reporting of revision rates, and (5) analysis of patient race as an independent predictor of revision. We then performed a random-effects meta-analysis to calculate a pooled hazard ratio for TKA revision in blacks compared with whites.

Results:

A total of 4,286 studies were identified and screened by title; 106, by abstract; and 24, by full text. Six studies met the inclusion criteria. Only 4 of the 6 studies could undergo meta-analysis because of overlapping study populations in 3 of them. The meta-analysis represented 451,960 patients who underwent TKA, of whom 28,772 (6.4%) were black. Of the total, 31,568 patients (7.0%) underwent revision surgery. The risk of revision TKA was significantly higher among blacks than whites (pooled hazard ratio, 1.38; 95% confidence interval, 1.20 to 1.58; p < 0.001). Analysis of the 3 studies with overlapping study populations demonstrated discordant results as a result of adjustment compared with non-adjustment for insurance eligibility, a surrogate for socioeconomic status.

Conclusions:

Blacks in the United States are at higher risk of revision TKA than whites. Socioeconomic status contributed to revision risk and is an important confounder in analyses of race.

Level of Evidence:

PrognosticLevel III. See Instructions for Authors for a complete description of levels of evidence.
Preoperative Prevalence of and Risk Factors for Venous Thromboembolism in Patients with a Hip Fracture
Authors: Shin Won Chul , Woo Seung Hun , Lee Seung-Jun , Lee Jung Sub , Kim Choongrak , Suh Kuen Tak
Published: December 2016

Background:

This retrospective cohort study investigated the prevalence of and risk factors for preoperative venous thromboembolism (VTE) in patients with a hip fracture and a delay of >24 hours from injury to surgery.

Methods:

This observational study included 208 patients with a hip fracture surgically treated at 1 university hospital between December 2010 and August 2014. Patients underwent indirect multidetector computed tomographic (MDCT) venography for preoperative VTE detection after admission. Overall VTE risk and median time from injury to CT scan were calculated. Age, sex, fracture type, time from injury to CT scan, body mass index, preinjury mobility score, previous anticoagulation treatment, previous hospitalization for VTE, varicose veins, and medical comorbidities were considered potential risk factors.

Results:

The prevalence of preoperative VTE was 11.1% (23 of 208 patients), including 12 patients with deep vein thrombosis alone, 7 patients with pulmonary embolism alone, and 4 patients with both. The mean time from injury to CT scan was 4.9 days. The delay from the time of injury to CT scan averaged 7.6 days for patients who developed preoperative VTE, compared with 4.2 days for patients who had not developed VTE. In the adjusted models, female sex, subtrochanteric fracture, pulmonary disease, cancer, previous hospitalization for VTE, and varicose veins were risk factors for VTE. The final multivariate logistic regression analysis demonstrated that female sex (odds ratio [OR] = 5.86; 95% confidence interval [CI] = 1.21 to 28.21), subtrochanteric fracture (OR = 22.17; 95% CI = 4.02 to 122.06), pulmonary disease (OR = 21.10; 95% CI = 5.35 to 83.21), and previous hospitalization for VTE (OR = 16.36; 95% CI = 3.41 to 78.43) increased the risk of VTE.

Conclusions:

Our findings show a high prevalence of preoperative VTE in patients with a hip fracture. Therefore, preoperative investigation for VTE should be routinely considered for patients in whom surgery is delayed for >24 hours. At this time, indirect MDCT venography seems to be effective and useful.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Transient Local Bone Remodeling Effects of rhBMP-2 in an Ovine Interbody Spine Fusion Model
Authors: Bae Hyun W. , Patel Vikas V. , Sardar Zeeshan M. , Badura Jeffrey M. , Pradhan Ben B. , Seim Howard B. , Turner A. Simon , Toth Jeffrey M.
Published: December 2016

Background:

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is a powerful osteoinductive morphogen capable of stimulating the migration of mesenchymal stem cells (MSCs) to the site of implantation and inducing the proliferation and differentiation of these MSCs into osteoblasts. Vertebral end-plate and vertebral body resorption has been reported after interbody fusion with high doses of rhBMP-2. In this study, we investigated the effects of 2 rhBMP-2 doses on peri-implant bone resorption and bone remodeling at 7 time points in an end-plate-sparing ovine interbody fusion model.

Methods:

Twenty-one female sheep underwent an end-plate-sparing discectomy followed by interbody fusion at L2-L3 and L4-L5 using a custom polyetheretherketone (PEEK) interbody fusion device. The PEEK interbody device was filled with 1 of 2 different doses of rhBMP-2 on an absorbable collagen sponge (ACS): 0.13 mg (1×) or 0.90 mg (7×). Bone remodeling and interbody fusion were assessed via high-resolution radiography and histological analyses at 1, 2, 3, 4, 8, 12, and 20 weeks postoperatively.

Results:

Peri-implant bone resorption peaked between 3 and 8 weeks in both the 1× and the 7× rhBMP-2/ACS-dose group. Osteoclastic activity and corresponding peri-implant bone resorption was dose-dependent, with moderate-to-marked resorption at the 7×-dose level and less resorption at the 1×-dose level. Both dose (p < 0.0007) and time (p < 0.0025) affected bone resorption significantly. Transient bone-resorption areas were fully healed by 12 weeks. Osseous bridging was seen at all but 1 spinal level at 12 and at 20 weeks.

Conclusions:

In the ovine end-plate-sparing interbody fusion model, rhBMP-2 dose-dependent osteoclastic resorption is a transient phenomenon that peaks at 4 weeks postoperatively.

Clinical Relevance:

Using the U.S. Food and Drug Administration (FDA)-approved rhBMP-2 concentration and matching the volume of rhBMP-2/ACS with the volume of desired bone formation within the interbody construct may limit the occurrence of transient bone resorption.
Comments: Trying to Get in Balance
Authors: Donnelly John
Published: December 2016

Editor's column

All signs point to another bleak year for the oil and gas industry. Major operators have begun announcing significant capital spending cuts, and analysts see no quick fix to the current global supply/demand imbalance.

ConocoPhillips’ and Chevron’s announcements last month of deep cuts in 2016 capital spending were likely the first in what is expected to be a wave of further reductions by operators in the wake of the lowest oil prices in a decade. Chevron plans to slash its budget 24% to USD 27 billion, with the most spending on international exploration and production projects and the second-largest amount going to US projects, including shale development in Texas. ConocoPhillips said it will spend USD 7.7 billion this year, a 25% decline from the reduced levels it spent in 2015.

Other major operators echoed those sentiments that this year may be even more difficult than 2015. The outlook for 2016 was on the minds of many executives at last month’s International Petroleum Technology Conference in Doha. Global oil supply is still increasing faster than demand despite the plunge in oil prices and it will take a while to reverse that trend, Total Chief Executive Officer (CEO) Patrick Pouyanné told reporters at the conference, which is organized by SPE and other industry associations. “The market is oversupplied and production capacity will continue to grow because a lot of projects were sanctioned in 2013 and 2014. Many of those projects will be coming on line this year and in 2017,” he said. “(Total) does not expect a price recovery in 2016.”

Oil production from the US Gulf of Mexico is currently rising, as many megaprojects invested in several years ago are now coming on line. Output from the Gulf of Mexico is about 19% higher now than it was a year ago, according to the US Energy Information Administration.

ConocoPhillips’ Ryan Lance CEO said at the conference that US production is now running at about 9.1 million B/D, down from 9.6 million B/D in the first half of last year. US output will likely decline another 500,000 B/D this year, he said. That may not be enough, depending on the amount of oil Iran produces this year and with the world oversupply currently estimated at 2 million B/D. Iranian production could add anywhere from 500,000 B/D to 700,000 B/D to the market in 2016, according to a recent estimate from Barclays. Saudi Aramco’s CEO had a more positive view of the world oil market. Amin Nasser said he thought the market would begin to balance this year and that his company was continuing to invest in upstream projects to meet future world demand.

Analysts Tudor, Pickering, Holt and Co. said that oil companies have canceled or delayed final investment decisions on about 150 projects in the past year that would have produced 125 billion bbl of oil equivalent. That could leave the world oil-short a few years from now if global demand continues to rise as expected. JPT
Guest Editorial: Engineering Design in the “Lower for Longer” Environment
Authors: Read Alex
Published: December 2016

Guest editorial

A recurring theme in the earning statements of oil and gas companies in recent months is the desire to survive not only “lower (prices) for longer,” but to use the current market downturn, and the resulting urgency, as an opportunity to reshape organizations to ensure that they are stronger and better able to thrive in the years ahead. Clearly, the industry needs to reduce costs and continue to innovate without compromising safety, but how? In other industry crunches, such as that experienced by automotive manufacturers in 2008–09, simulation played a key role in helping to reduce engineering design costs and lead times, while allowing manufacturers to continue to deliver new and innovative solutions.

While each company’s view on how to tackle this new paradigm will differ, for many it will be to continue the day job (deliver quality and innovative products and solutions), but at reduced development time and cost, without compromising safety. First principles-based engineering simulation tools will be a key enabler, as companies will increasingly rely on simulation-based design exploration. The initial driver will be to reduce engineering costs and time, but companies will also benefit from simulation as an innovation enabler.

Key to this has been the rapid improvement in computer hardware and software technology, as well as innovative licensing models that enable, rather than penalize, the use of high-performance computing and cloud solutions. Through the development of cloud computing, engineers now have ready and cost-effective access to computer resources that would have been unimaginable a decade ago. These improvements allow engineers to increase the number of design and operating conditions evaluated, and to move beyond the physical test to simulate real-world conditions at full scale, such as subsea separators with real process fluids at high temperature and pressure, or the behavior of a floating platform during a hurricane.

The importance of simulation is evident in three specific examples: two from the recent CD-adapco Oil, Gas, and Chemical Computational Fluid Dynamics (CFD) Conference, and one from outside our industry.
Offshore Seismic Feeling Pressures to Change
Authors: Rassenfoss Stephen
Published: December 2016

Seismic surveys are created using bursts of acoustic energy that are referred to as “marine sound, or noise, depending on your perspective.”

With that thought, John Young, director of the sound business line for CSA Ocean Sciences, introduced a recent panel discussion that included seismic innovators working on new sound sources designed to produce better subsurface images as well as scientists and regulators concerned about the environmental impact of that noise. At that session and others at the recent annual meeting of the Society of Exploration Geophysicists (SEG), there was discussion about multiple ways to move away from the intense pulses of acoustic energy produced by air guns. The industry standard emits both useful sound for seismic imaging and higher-frequency noise that dissipates in the ground.

One sign that this talk may lead to alternatives to air guns for marine seismic is a joint industry project by three major oil companies backing a new generation of offshore seismic sound sources designed to reduce noise and improve the seismic signal.

Their goal is to “de-risk” vibrator technology, said Mike Jenkerson, geophysical advisor for marine seismic at Exxon Mobil, who represented the Marine Vibrator Joint Industry Project ( JIP) at the conference. The JIP managed by Texas A&M University is supporting development and testing to determine if there is an alternative to air guns that is effective and reliable even with a smaller acoustic signal.

The signal is the critical difference between sounds created using controlled vibrations and air guns, which are called impulsive sound sources and create loud, sharp booms as a large volume of air is emitted. Marine science and regulatory experts on the SEG panel indicated that research on the impact of subsea noise on sea life is likely to gradually lead to increasing limits on seismic surveys, where noise regulation is already a costly fact of life.
Technology Focus: Mature Fields and Well Revitalization
Authors: Lee Jesse
Published: December 2016

Technology Focus

In last year’s Technology Focus concerning mature fields, I highlighted safety, well integrity, and digital technology as the three enablers for achieving sustainable returns. In light of the challenging environment our industry is facing, I would suggest that JPT readers become familiar with refracturing techniques, technology/methodology that improves efficiency, and opportunities that achieve positive financial impact and exceed environmental responsibility.

First of all, the surge in unconventional completions over the last decade has created ample candidates for hydraulic refracturing. With the proper implementation of new and improved techniques, followed by diligent economic analysis, refracturing has been demonstrated to be a viable alternative to the more expensive endeavor of drilling and completing new wells. There are numerous informative and enlightening SPE publications on this topic.

Speaking of technology and methodology that improves efficiency, these are the technologies that will be embraced and adopted quickly by the industry, especially in this challenging environment. One of the examples is a methodology that precisely and effectively locates the remaining oil in mature reservoirs. In addition to identifying potential opportunities, it also serves to derisk project investment and allows key decisions to be made in a timely manner.

The other example is a stimulation technique that is designed to deliver pinpoint accuracy. These are technology enablers that, when combined, could significantly improve well performance through precisely addressing isolation, diversion, and placement, for example.

The last point is about achieving investment returns and, at the same time, exceeding corporate environmental responsibility. It seems unlikely that we can have our cake and eat it, too. However, I have witnessed enough examples (mostly outside of our industry) to realize that this certainly can be achieved. The journey will not be easy. Some examples take more than 15 years of persistence and investment to become established. I sincerely encourage JPT readers to incorporate this aspect into their professional responsibility and continue to challenge themselves and their teams.

In this editorial, I talked about refracturing, efficiency, and environmental responsibility. Therefore, I have selected several papers on these topics to share with you. We all know 2016 will be a challenging year for our industry; however, I am sure this is the driving force that we need to take our industry to the next level. JPT

Recommended additional reading at OnePetro: www.onepetro.org.

IPTC 17718 Successful Restimulation of Western Siberian Oil Fields With Channel Fracturing Technique by Alexey Yudin, Schlumberger, et al.

SPE 173340 Refracturing in Eagle Ford and Bakken To Increase Reserves and Generate Incremental NPV—Field Study by YagnaDeepika Oruganti, Baker Hughes, et al.

SPE 173601 Reduced Emissions and Increased Production Through Gas Compressors: Pilot Case in Colombia by J.C.M. Escobar-Remolina, Ecopetrol, et al.