bluuebunny/crossref_metadata_2025 huggingface dataset:
Pengaruh Status Nutrisi terhadap Kesintasan 30 Hari Pasien Geriatri yang Dirawat di Rumah Sakit
Authors: Lugito Nata Pratama Hardjo , Soejono Czeresna Heriawan , Wahyudi Edy Rizal , Dewiasty Esthika
Published: March 2018

Pendahuluan. Dengan meningkatnya jumlah populasi usia lanjut, masalah kesehatan yang dialami juga semakin banyak, salah satunya malnutrisi. Studi di luar negeri menunjukkan malnutrisi pada pasien geriatri yang dirawat di rumah sakit menurunkan kesintasan. Pasien usia lanjut di Indonesia mempunyai karakteristik yang berbeda dengan pasien usia lanjut di luar negeri. Di Indonesia belum ada studi tentang status nutrisi pasien usia lanjut yang dirawat di rumah sakit dan pengaruhnya terhadap kesintasan. Penelitian ini bertujuan mengetahui pengaruh status nutrisi terhadap kesintasan 30 hari pasien usia lanjut yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam rumah sakit.Metode. Penelitian kohort retrospektif, dengan pendekatan analisis kesintasan, dilakukan terhadap 177 pasien geriatri yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam Rumah Sakit Cipto Mangunkusumo selama bulan April–September 2011. Data demografis, diagnosis medis, kadar albumin, indeks ADL Barthel, geriatric depression scale, status nutrisi dengan mini nutritional assessment (MNA) dikumpulkan, dan diamati selama 30 hari sejak mulai dirawat untuk melihat ada tidaknya mortalitas. Perbedaan kesintasan kelompok pasien dengan status nutrisi baik, berisiko malnutrisi dan malnutrisi ditampilkan dalam kurva Kaplan-Meier, diuji dengan uji Log-rank, serta analisis multivariat dengan Cox proportional hazard regression model untuk menghitung adjusted Hazard Ratio dan interval kepercayaan 95% terjadinya mortalitas 30 hari dengan memasukkan variabel-variabel perancu sebagai kovariat.Hasil. Kesintasan antara subyek yang status nutrisinya baik, berisiko malnutrisi dan malnutrisi ialah 94,7% dengan 89,0% dan 80,7%, namun perbedaan kesintasan 30 hari tak bermakna dengan uji Log-rank (p=0,106). Pada analisis multivariat didapatkan adjusted HR setelah penambahan variabel perancu sebesar 1,49 (IK 95% 0,29 – 7,77) untuk kelompok berisiko malnutrisi dan 2,65 (IK 95% 0,47 – 14,99) untuk kelompok malnutrisi dibandingkan dengan pasien nutrisi baikSimpulan. Perbedaan kesintasan 30 hari pasien geriatri yang dirawat di rumah sakit yang menderita malnutrisi dan berisiko malnutrisi dibandingkan dengan status nutrisi baik pada awal perawatan belum dapat dibuktikan.
Pendekatan Diagnosis dan Tatalaksana Sindrom Mirizzi
Authors: Putra Ario Perbowo , Christine Griskalia , Amin Zulkifli , Fauzi Achmad
Published: March 2018

Penyakit batu empedu telah menjadi masalah kesehatan penting di banyak negara. Estimasi prevalensi penyakit batu saluran empedu yang menyertai penyakit batu empedu adalah sekitar 10-15% dan meningkat dengan usia lanjut. Sindrom Mirizzi adalah komplikasi dari penyakit batu empedu yang jarang terjadi. Karakteristik yang khas yaitu adanya impaksi batu empedu di duktus sistikus atau di leher kandung empedu sehingga menghasilkan obstruksi mekanik di duktus hepatikus dan menghasilkan striktur inflamasi di saluran empedu, sehingga menyebabkan ikterus obstruktif berkelanjutan. Kami laporkan sebuah kasus Sindrom Mirizzi pada laki-laki dewasa yang menyebabkan iketerus obstruktif dengan kolelitiasis.
Pengaruh Depresi Terhadap Perbaikan Infeksi Ulkus Kaki Diabetik
Authors: Auliana Arshita , Yunir Em , Putranto Rudi , Nugroho Pringgodigdo
Published: March 2018

Pendahuluan. Pasien Diabetes Melitus (DM) dengan ulkus kaki lebih banyak yang mengalami depresi dan memiliki kualitas hidup yang buruk. Dalam tatalaksana ulkus kaki diabetik perlu diperhatikan faktor psikososial karena diperkirakan dapat mempengaruhi penyembuhan luka melalui induksi gangguan keseimbangan neuroendokrin-imun. Penelitian ini bertujuan untuk mengetahui pengaruh depresi terhadap proses perbaikan infeksi ulkus kaki diabetik, serta tingkat depresi pada pasien ulkus kaki diabetik yang dirawat inap.Metode. Studi kohort prospektif dilakukan pada 95 pasien ulkus kaki diabetik terinfeksi yang dirawat di RSCM dan RS jejaring pada Maret-Oktober 2014. Subjek dibagi ke dalam dua kelompok yaitu kelompok depresi dan kelompok tidak depresi. Data klinis, penilaian depresi, dan data laboratorium diambil saat pasien masuk rumah sakit kemudian dinilai perbaikan infeksi ulkus kaki diabetik dalam 21 hari masa perawatan.Hasil. Dari 95 subyek penelitian, 57 orang (60%) masuk dalam kelompok depresi, yang didominasi oleh kelompok perempuan (70%). Penyakit komorbid terbanyak adalah hipertensi, dengan angka komorbiditas dan penyakit kardivaskular lebih tinggi pada kelompok depresi. Malnutrisi dan obesitas juga lebih banyak pada kelompok depresi (64,9% dan 31,6%), demikian pula dengan kontrol glikemik yang buruk (73,7%). Sebagian besar pasien (73,7%) yang masuk dalam kelompok depresi memiliki depresi ringan. Pada kelompok depresi 40,4% mengalami perbaikan infeksi dalam 21 hari masa perawatan, sedangkan 68,4% pada kelompok tidak depresi. Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik, walaupun setelah dilakukan penyesuaian terhadap variabel perancu, hasil tersebut tidak bermakna secara statistik (p = 0,07, adjusted OR 2,429 dengan IK 95% 0,890-6,632). Lebih banyak subjek dengan depresi sedang yang tidak mengalami perbaikan infeksi ulkus kaki diabetik dibandingkan dengan subjek dengan depresi ringan (93,3% dan 47,6%).Simpulan. Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik.
Faktor-Faktor yang Berperan terhadap Terjadinya Lipodistrofi pada Pasien HIV yang Mendapatkan Terapi Antiretroviral Lini Pertama
Authors: Kusumayanti Ratu Ratih , Yunihastuti Evy , Purnamasari Dyah , Witjaksono F , Dewiasty Esthika
Published: March 2018

Pendahuluan. Seiring dengan perkembangan antiretroviral, harapan hidup pasien HIV terus meningkat namun menjadi rentan terhadap efek samping pengobatan. Salah satu efek samping pengobatan adalah sindrom lipodistrofi, meliputi lipoatrofi, lipohipertrofi, atau gabungan keduanya. Faktor risiko yang dikaitkan dengan lipodistrofi pada HIV adalah usia, jenis kelamin, lama terapi antiretroviral, CD4 awal, Stadium HIV, dan pemakaian Stavudin. Belum ada publikasi di Indonesia yang meneliti kejadian lipodistrofi pada populasi pasien HIV yang mendapat terapi ARV lini pertama serta faktor-faktor yang memengaruhinya. Berdasarkan hal tersebut, penelitian ini dilakukan untuk mengetahui kejadian lipodistrofi pada pasien HIV dalam terapi ARV lini pertama berbasis Stavudin dan Zidovudin minimal 6 bulan serta faktor-faktor yang memengaruhinya yang berobat di Pokdisus RSCM.Metode. Penelitian dilakukan dengan desain potong lintang dan kasus kontrol untuk mengetahui prevalensi lipodistrofi pada pasien HIV dengan ARV lini pertama serta faktor-faktor yang memengaruhinya. Analisis statistik menggunakan uji chi square atau uji Kolmogrof Smirnoff untuk mendapatkan hubungan antara masing-masing faktor risiko dengan terjadinya lipodistrofi. Analisis multivariat dilakukan dengan regresi logistik.Hasil. Sebanyak 346 pasien terlibat dalam penelitian ini. Didapatkan prevalensi lipodistrofi sebesar 27,5%, dengan rincian 70,5% lipoatrofi, 8,4% lipohipertrofi, dan 21,1% gabungan keduanya. Lokasi lipoatrofi terbanyak di daerah wajah. Prevalensi lipodistrofi pada subjek yang menggunakan Stavudin sebesar 43.3%, dan Zidovudin sebesar 10,7%. Faktor yang berhubungan dengan kejadian lipodistrofi adalah penggunaan Stavudin [p= <0,001; adjusted OR 5,34 IK95% (2,59 – 10.98)].Simpulan. Didapatkan prevalensi Lipodistrofi pada pasien HIV yang mendapatkan terapi ARV lini pertama adalah 27.5%, dan didapatkan hubungan antara kejadian lipodistrofi pada pasien HIV dengan penggunaan Stavudin.
Perdarahan Saluran Cerna sebagai Manifestasi Tuberkulosis Intestinum pada Pasien Lepra dengan Reaksi Reversal dan Riwayat Terapi Steroid Jangka Panjang
Authors: Gebrina Meutia , Nursyirwan Saskia Aziza , Soewondo Pradana , Fauzi Achmad , Renaldi Kaka
Published: March 2018

Tuberkulosis usus merupakan suatu kondisi yang cukup sulit ditegakkan diagnosisnya. Gejala penyakit ini tidak khas dan pemeriksaan penunjang yang dilakukan seringkali menunjukkan hasil negatif. Salah satu gejala yang tidak khas dari tuberkulosis usus adalah perdarahan saluran cerna, yang harus menjadi kewaspadaan praktisi klinis.Kata kunci: perdarahan saluran cerna, tuberkulosis Gastrointestinal Bleeding as a Manifestation of Intestinal Tuberculosis in Leprosy Patients with Reversal Reaction and History of Long-Term Steroid TherapyIntestinal tuberculosis is difficult to be diagnosed. Signs and symptoms usually are not specific, and the results of diagnostictools are frequently negative. One of the unusual symptoms of intestinal tuberculosis is gastrointestinal bleeding, whichshould increase the awareness of clinical practitioners.Keywords: gastrointestinal bleeding, tuberculosis
Problem Diagnostik dan Tata Laksana Primary Sclerosing Cholangitis
Authors: Nurleili Rezky Aulia , Airlina Intan , Lubis Anna Mira
Published: March 2018

Primary sclerosing cholangitis (PSC) merupakan penyakit hati kolestasis kronik dengan insiden yang cukup tinggi di Amerika yaitu sebesar 1/100.000 penduduk namun angka kejadiannya di Indonesia belum pernah dipublikasikan. Belum didapatkan tatalaksana yang terbaik pada penyakit ini. Pada artikel ini akan dibahas mengenai kasus PSC pada pasien laki-laki berusia 49 tahun di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta dan tatalaksana yang dilakukan.Kata Kunci: PSC, tata laksana Diagnostic and Treatment Problems of Primary Sclerosing CholangitisPrimary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease with high incidence reported in America (1/100.000 population), but there is still no data available in Indonesia. The best management of this disease is still not found. Thus, in this article author will discuss about the case of PSC in 49-years male patients hospitalized in Cipto Mangunkusumo hospital Jakarta and its treatment. Keywords: PSC, treatment
Pendekatan Diagnosis dan Tatalaksana Tuberkulosis Intestinal
Authors: Murwaningrum Artati , Abdullah Murdani , Makmun Dadang
Published: March 2018

Tuberkulosis (TB) telah menjadi masalah global yang terus membesar seiring dengan bertambahnya jumlah pasien TB. Infeksi TB masih merupakan hal yang umum ditemukan dan merupakan faktor penting terhadap angka kesakitan dan kematian, terutama pada negara yang belum dan sedang berkembang. Kasus Tuberkulosis usus (TB usus) juga meningkat seiring dengan meningkatnya jumlah kasus TB secara umum. Indonesia merupakan Negara ke-2 dengan prevalensi Tuberkulosis TB tertinggi di Asia Tenggara setelah Timor Leste pada tahun 2014. TB usus adalah manifestasi TB ekstrapulmonal terbanyak keenam.Manifestasi klinis yang tidak spesifik dan kadang menyerupai beberapa kondisi lain termasuk keganasan menyebabkan diagnosis TB usus sulit ditegakkan secara akurat. Temuan dari hasil endoskopi dan gambaran radiologi dari berbagai stage penyakit sudah sangat banyak, namun diagnosis tetap sulit dilakukan. Sampai saat ini belum ada metode tunggal yang dapat mendeteksi TB usus secara tepat dan akurat, berbagai metode investigasi telah digunakan dalam diagnosis TB usus. Diagnosis yang dilakukan sejak awal, pemberian terapi anti tuberculosis dan tindakan bedah adalah hal-hal esensial dalam pencegahan terjadinya kesakitan dan kematian akibat TB usus, sehingga dibutuhkan kombinasi penilaian klinis dan pemeriksaan berbagai modalitas. Pasien yang telah didiagnosis TB usus diberikan terapi obat anti tuberculosis (OAT) dan pertimbangan tindakan bedah jika mengalami komplikasi.Kata Kunci: diagnosis, tuberkulosis intestinal Diagnostic Approach and Treatment of Instestinal TuberculosisTuberculosis (TB) has become a resurgent global problem with increasing numbers of patients. TB infection is still common and remains an important cause of morbidity and mortality, particularly in underdeveloped and developing nations. Intestinal tuberculosis (intestinal TB) rates are rising, consistet with the overall trend. In 2014 Indonesia has the second highest TB prevalence in South East Asia after Timor Leste. Intestinal TB is the sixth highest manifestation of extrapulmonal TB. Manifestations can be non-specific and mimic many conditions, including malignancies causes’ intestinal TB diagnosis more difficult to be accurately determined. Findings from endoscopy and radiological imaging are countless, and depend on the stage of the disease and the time at which investigations are carried out. Hence, diagnosis can be difficult. Until recently there is no single method to identify intestinal TB accurately, various investigative methods have been used to aid in the diagnosis of intestinal TB. Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality. Combined clinical assessment and some modalities examinations are needed to determine intestinal TB. Patient whom has been diagnosed with intestinal TB will be given anti tuberculosis therapy and surgery if any complications occur. Keywords: diagnosis, intestinal tuberculosis
Tantangan dalam Tata Laksana Malaria Berat di Rumah Sakit Daerah Terpencil di Indonesia
Authors: Priantono Dimas , Purnama Asep , Nelwan Erni Juwita
Published: March 2018

Malaria falciparum merupakan infeksi yang disebabkan oleh Plasmodium falciparum (Pf) yang sering menimbulkan komplikasi hingga timbul malaria berat dengan mortalitas yang tinggi. Manajemen malaria di daerah terpencil memiliki tantangan tersendiri sebagai akibat dari kurangnya kemampuan sumber daya manusia dan fasilitas diagnosis dan tata laksana yang memadai. Pada artikel ini akan dibahas mengenai kasus infeksi Malaria Falciparum dengan diagnosis yang ditegakkan secara pasti melalui pemeriksaan mikroskopis darah yang menyatakan adanya parasit Pf. Pasien sudah menerima Artemisinin-Based Combination Therapy (ACT) berupa dihidroartemisinin (DHA)-piperakuin (PPQ) dan primakuin (PQ). Pada evaluasi setelah pemberian obat ACT dan primakuin, tidak ada perbaikan klinis dan mikroskopis. Pengobatan malaria lini kedua berupa kina, doksisiklin dan PQ diberikan dan memberikan perbaikan klinis dan mikroskopis.Kata Kunci: Artemisinin Combination Therapy, doksisiklin, kina, malaria falsiparum  Challenges in Providing Treatment of Severe Malaria Case in a District Hospital of Remote Area in IndonesiaSevere Malaria is commonly found due to Plasmodium falciparum infection, which is causing high mortality in patient. A Severe case might be difficult to treat optimally in the remote settings area that could be due to lack in awareness of disease manifestation and inadequate diagnostic facilities. We report a case of Severe Malaria Falciparum infection, confirmed by blood smear eamination of Plasmodium falciparum (Pf) parasites. Patient had received Artemicinin Based Combination Therapy (ACT), which consisted of dihydroartemisinin (DHA)-piperaquine and primaquine (PQ) with no clear clinical and microscopy improvement. The second line anti malaria consisted of quinine, doxycycline, and PQ was then initiated, showing clinical and microscopy responses.
Risiko Kardiovaskuler pada Pasien Artritis Reumatoid
Authors: Hidayat Rudy
Published: March 2018

Artritis reumatoid (AR) adalah salah satu penyakit autoimun di bidang reumatologi yang paling banyak ditemukan dalam praktik sehari-hari. Penyakit autoimun ini bersifat sistemik dan non-organ spesifik, sehingga selain manifestasi artikuler (sinovitis poliartikular), juga didapatkan manifestasi ekstra-artikuler. Salah satu manifestasi ekstra-artikuler yang saat ini menjadi perhatian para klinisi dan para peneliti adalah keterlibatan kardiovakuler, yang secara signifikan memberikan kontribusi peningkatan angka morbiditas dan mortalitas pasien AR.
Integrin-based diffusion barrier separates membrane domains enabling the formation of microbiostatic frustrated phagosomes
Authors: Maxson Michelle E , Naj Xenia , O'Meara Teresa R , Plumb Jonathan D , Cowen Leah E , Grinstein Sergio
Published: March 2018

Candida albicans hyphae can reach enormous lengths, precluding their internalization by phagocytes. Nevertheless, macrophages engulf a portion of the hypha, generating incompletely sealed tubular phagosomes. These frustrated phagosomes are stabilized by a thick cuff of F-actin that polymerizes in response to non-canonical activation of integrins by fungal glycan. Despite their continuity, the surface and invaginating phagosomal membranes retain a strikingly distinct lipid composition. PtdIns(4,5)P2 is present at the plasmalemma but is not detectable in the phagosomal membrane, while PtdIns(3)P and PtdIns(3,4,5)P3 co-exist in the phagosomes yet are absent from the surface membrane. Moreover, endo-lysosomal proteins are present only in the phagosomal membrane. Fluorescence recovery after photobleaching revealed the presence of a diffusion barrier that maintains the identity of the open tubular phagosome separate from the plasmalemma. Formation of this barrier depends on Syk, Pyk2/Fak and formin-dependent actin assembly. Antimicrobial mechanisms can thereby be deployed, limiting the growth of the hyphae.
Protecting the nerve terminals
Authors: Glass Jonathan D
Published: March 2018

Maintaining the connections between nerve cells and muscle could help to slow the progression of amyotrophic lateral sclerosis.
Tea saponin reduces the damage of Ectropis obliqua to tea crops, and exerts reduced effects on the spiders Ebrechtella tricuspidata and Evarcha albaria compared to chemical insecticides
Authors: Zeng Chi , Wu Lingbing , Zhao Yao , Yun Yueli , Peng Yu
Published: March 2018

Background

Tea is one of the most economically important crops in China. However, the tea geometrid (Ectropis obliqua), a serious leaf-feeding pest, causes significant damage to tea crops and reduces tea yield and quality. Spiders are the most dominant predatory enemies in the tea plantation ecosystem, which makes them potentially useful biological control agents of E. obliqua. These highlight the need for alternative pest control measures. Our previous studies have shown that tea saponin (TS) exerts insecticidal activity against lepidopteran pests. Here, we investigate whether TS represents a potentially new alternative insecticide with no harm to spiders.

Methods

We investigated laboratory bioactivities and the field control properties of TS solution against E. obliqua. (i) A leaf-dip bioassay was used to evaluate the toxicity of TS to 3rd-instar E. obliqua larvae and effects of TS on the activities of enzymes glutathione-S-transferase (GST), acetylcholinesterase (AChE), carboxylesterase (CES) and peroxidase (POD) of 3rd-instar E. obliqua larvae in the laboratory. (ii) Topical application was used to measure the toxicity of 30% TS (w/v) and two chemical insecticides (10% bifenthrin EC and 50% diafenthiuron SC) to two species of spider, Ebrechtella tricuspidata and Evarcha albaria. (iii) Field trials were used to investigate the controlling efficacy of 30% TS against E. obliqua larvae and to classify the effect of TS to spiders in the tea plantation.

Results

The toxicity of TS to 3rd-instar E. obliqua larvae occurred in a dose-dependent manner and the LC50 was 164.32 mg/mL. Activities of the detoxifying-related enzymes, GST and POD, increased in 3rd-instar E. obliqua larvae, whereas AChE and CES were inhibited with time by treatment with TS. Mortalities of E. tricuspidata and E. albaria after 48 h with 30% TS treatment (16.67% and 20%, respectively) were significantly lower than those with 10% bifenthrin EC (80% and 73.33%, respectively) and 50% diafenthiuron EC (43.33% and 36.67%, respectively). The highest controlling efficacy of 30% TS was 77.02% at 5 d after treatment, which showed no difference to 10% bifenthrin EC or 50% diafenthiuron SC. 30% TS was placed in the class N (harmless or slightly harmful) of IOBC (International Organization of Biological Control) categories for natural enemies, namely spiders.

Conclusions

Our results indicate that TS is a botanical insecticide that has a good controlling efficacy in E. obliqua larvae, which suggests it has promise as application in the integrated pest management (IPM) envisaged for tea crops.
Conformal invariance of (0, 2) sigma models on Calabi-Yau manifolds
Authors: Jardine Ian T. , Quigley Callum
Published: March 2018

Abstract

Long ago, Nemeschansky and Sen demonstrated that the Ricci-flat metric on a Calabi-Yau manifold could be corrected, order by order in perturbation theory, to produce a conformally invariant (2, 2) nonlinear sigma model. Here we extend this result to (0, 2) sigma models for stable holomorphic vector bundles over Calabi-Yaus.
Instantons from geodesics in AdS moduli spaces
Authors: Ruggeri Daniele , Trigiante Mario , Van Riet Thomas
Published: March 2018

Abstract

We investigate supergravity instantons in Euclidean AdS5 × S5/ℤk. These solutions are expected to be dual to instantons of

$$ \mathcal{N} $$

N

= 2 quiver gauge theories. On the supergravity side the (extremal) instanton solutions are neatly described by the (lightlike) geodesics on the AdS moduli space for which we find the explicit expression and compute the on-shell actions in terms of the quantised charges. The lightlike geodesics fall into two categories depending on the degree of nilpotency of the Noether charge matrix carried by the geodesic: for degree 2 the instantons preserve 8 supercharges and for degree 3 they are non-SUSY. We expect that these findings should apply to more general situations in the sense that there is a map between geodesics on moduli-spaces of Euclidean AdS vacua and instantons with holographic counterparts.
Nonequilibrium dynamics of the O(N ) model on dS3 and AdS crunches
Authors: Kumar S. Prem , Vaganov Vladislav
Published: March 2018

Abstract

We study the nonperturbative quantum evolution of the interacting O(N ) vector model at large-N , formulated on a spatial two-sphere, with time dependent couplings which diverge at finite time. This model - the so-called “E-frame” theory, is related via a conformal transformation to the interacting O(N ) model in three dimensional global de Sitter spacetime with time independent couplings. We show that with a purely quartic, relevant deformation the quantum evolution of the E-frame model is regular even when the classical theory is rendered singular at the end of time by the diverging coupling. Time evolution drives the E-frame theory to the large-N Wilson-Fisher fixed point when the classical coupling diverges. We study the quantum evolution numerically for a variety of initial conditions and demonstrate the finiteness of the energy at the classical “end of time”. With an additional (time dependent) mass deformation, quantum backreaction lowers the mass, with a putative smooth time evolution only possible in the limit of infinite quartic coupling. We discuss the relevance of these results for the resolution of crunch singularities in AdS geometries dual to E-frame theories with a classical gravity dual.
Static black hole and vacuum energy: thin shell and incompressible fluid
Authors: Ho Pei-Ming , Matsuo Yoshinori
Published: March 2018

Abstract

With the back reaction of the vacuum energy-momentum tensor consistently taken into account, we study static spherically symmetric black-hole-like solutions to the semi-classical Einstein equation. The vacuum energy is assumed to be given by that of 2-dimensional massless scalar fields, as a widely used model in the literature for black holes. The solutions have no horizon. Instead, there is a local minimum in the radius. We consider thin shells as well as incompressible fluid as the matter content of the black-hole-like geometry. The geometry has several interesting features due to the back reaction of vacuum energy. In particular, Buchdahl’s inequality can be violated without divergence in pressure, even if the surface is below the Schwarzschild radius. At the same time, the surface of the star can not be far below the Schwarzschild radius for a density not much higher than the Planck scale, and the proper distance from its surface to the origin can be very short even for very large Schwarzschild radius. The results also imply that, contrary to the folklore, in principle the Boulware vacuum can be physical for black holes.
Exploring the association between whole blood Omega-3 Index, DHA, EPA, DHA, AA and n-6 DPA, and depression and self-esteem in adolescents of lower general secondary education
Authors: van der Wurff I. S. M. , von Schacky C. , Bergeland T. , Leontjevas R. , Zeegers M. P. , Kirschner P. A. , de Groot R. H. M.
Published: March 2018

Purpose

Depression is common in adolescents and long-chain polyunsaturated fatty acids (LCPUFA) are suggested to be associated with depression. However, research in adolescents is limited. Furthermore, self-esteem has never been studied in relation to LCPUFA. The objective here was to determine associations of depression and self-esteem with eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), Omega-3 Index (O3I), n-6 docosapentaenoic acid (n-6 DPA, also called Osbond acid, ObA), n-3 docosapentaenoic acid (DPA), and arachidonic acid (AA) concentrations in blood of adolescents attending lower general secondary education (LGSE).

Methods

Baseline cross-sectional data from a krill oil supplementation trial in adolescents attending LGSE with an O3I ≤ 5% were analysed using regression models built with the BayesFactor package in R. Fatty acids and O3I were determined in blood. Participants filled out the Centre for Epidemiologic Studies Depression (CES-D) scale and the Rosenberg Self-Esteem scale (RSE).

Results

Scores indicative of depression (CES-D ≥ 16) were found in 29.4% of the respondents. Of all fatty acids, we found extreme evidence [Bayes factor (BF) > 100] for a weak negative association between ObA and depression score [− 0.16; 95% credible interval (CI) − 0.28 to − 0.04; BF10 = 245], and substantial evidence for a weak positive association between ObA and self-esteem score (0.09; 95% CI, − 0.03 to 0.20; BF10 = 4). When all fatty acids were put in one model as predictors of CES-D or RSE, all of the 95% CI contained 0, i.e., no significant association.

Conclusion

No evidence was found for associations of DHA, EPA and O3I with depression or self-esteem scores in LGSE adolescents with O3I ≤ 5%. The associations of higher ObA status with lower depression and higher self-esteem scores warrant more research.
Galanin Administration Partially Restores Erectile Function After Cavernous Nerve Injury and Mediates Endogenous Nitrergic Nerve Outgrowth In Vitro
Authors: Weyne Emmanuel , Hannan Johanna L. , Gevaert Thomas , Soebadi Mohammad Ayodhia , Matsui Hotaka , Castiglione Fabio , van Renterghem Koenraad , De Ridder Dirk , Van der Aa Frank , Bivalacqua Trinity J. , Albersen Maarten
Published: March 2018

Background

Previously, we found that the neuropeptide galanin was strongly upregulated soon after bilateral cavernous nerve injury (BCNI) and that galanin and its receptors were expressed in nitrergic erectile innervation. Galanin has been observed to exert neuroregenerative effects in dorsal root ganglion neurons, but evidence for these effects in the major pelvic ganglion (MPG) after BCNI is lacking.

Aim

To evaluate the neurotropic effects of galanin receptor agonists and antagonists in vitro in nitrergic neurons and MPG and in vivo in rats after BCNI.

Methods

Male Sprague-Dawley rats underwent BCNI and sham surgery. Organ culture and single-cell neuron culture of the MPG were performed. Osmotic pump treatment with the galanin agonist in vivo and measurement of erectile response to electrostimulation after BCNI, immunohistochemical localization of galanin and receptors in the human neurovascular bundle, and myographic analysis of rat corpus cavernosum smooth muscle relaxation to galanin receptor agonists were investigated.

Outcomes

Neurite outgrowth in vitro and erectile response to electrostimulation after BCNI in vivo, immunohistochemical localization of galanin and receptors, and penile muscle relaxation in vitro.

Results

Galanin showed neurotrophic action in vitro and inhibition of endogenous galanin significantly impaired neurite outgrowth in nitrergic but not in sympathetic MPG neurons. In vivo administration of a selective galanin receptor-2 agonist, M1145, resulted in partial recovery of erectile function (EF) after BCNI. Galanin did not act as a direct vasodilator on corpus cavernosum muscle strips.

Clinical Translation

Endogenous neurotrophins such as galanin could be used as a strategy to improve EF for patients after BCNI from radical prostatectomy.

Strengths and Limitations

We evaluated the effect of galanin on nerve regeneration and EF recovery in vivo and in vitro. Limitations include the lack of washout period for the in vivo experiment and absence of differences in the expression of neuronal markers between treatment groups.

Conclusions

We identified galanin as a potential endogenous mechanism for nerve regeneration after BCNI, which could play a physiologic role in EF recovery after radical prostatectomy. In vivo treatment with exogenous galanin was beneficial in enhancing EF recovery after BCNI, but further research is necessary to understand the underlying mechanisms.
Sexual Functioning After Childhood Abuse: The Influence of Post-Traumatic Stress Disorder and Trauma Exposure
Authors: Bornefeld-Ettmann Pia , Steil Regina , Lieberz Klara A. , Bohus Martin , Rausch Sophie , Herzog Julia , Priebe Kathlen , Fydrich Thomas , Müller-Engelmann Meike
Published: March 2018

Background

Impairments in sexual functioning and sexual satisfaction are very common in women who have experienced childhood sexual abuse (CSA). A growing body of literature suggests a high prevalence of sexual distress in patients with post-traumatic stress disorder (PTSD). However, the influence of sexual trauma exposure per se and the influence of PTSD symptoms on impairments in sexual functioning remain unclear.

Aim

The aim of this study was to investigate the influence of sexual trauma exposure and PTSD on sexual functioning and sexual satisfaction by comparing 3 groups of women.

Methods

Women with PTSD after CSA (N = 32), women with a history of CSA and/or physical abuse but without PTSD (trauma controls [TC]; N = 32), and healthy women (N = 32) were compared with regards to self-reported sexual functioning and sexual satisfaction. Trauma exposure was assessed with the Childhood Trauma Questionnaire, and PTSD was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Outcomes

Sexual functioning was assessed with the Sexual Experience and Behavior Questionnaire, and sexual satisfaction was assessed with the questionnaire Resources in Sexuality and Relationship.

Results

PTSD patients had significantly lower sexual functioning in some aspects of sexual experience (sexual aversion, sexual pain, and sexual satisfaction) but did not significantly differ in sexual arousal and orgasm from the other 2 groups. TC and healthy women did not significantly differ from each other on the measures of sexual functioning or sexual satisfaction.

Clinical Translation

Results suggest that the development of PTSD has a greater impact on sexual functioning than does the experience of a traumatic event. This emphasizes the importance to address possible sexual distress and sexual satisfaction in women with PTSD by administering specific diagnostic instruments and by integrating specific interventions targeting sexual problems into a trauma-specific treatment.

Conclusions

The study is the first comparing PTSD patients and TC with healthy women with regards to sexual functioning. Limitations are selection and size of the samples, the assessment of sexual functioning by self-report measures only, and lack of consideration of other potentially relevant factors influencing sexuality. The findings suggest that the experience of sexual abuse does not necessarily lead to sexual impairment, whereas comparably low levels of sexual functioning seem to be prominent in PTSD patients after CSA. Further research is needed on how to improve treatment for this patient group.
Prime Minister v. Parliament of Catalonia
Authors: Garrido-Muñoz Asier
Published: March 2018

Few in Spain would have imagined two years ago that so much attention would be paid to questions such as the allocation of powers to hold referenda or the constitutional tools to enforce compliance with the 1978 Constitution (Constitution). But since the celebration of a “referendum” on October 1, 2017, and the subsequent declaration of independence and immediate suspension thereof by the president of Catalonia, numerous international voices have taken a stance on Catalonia's right to unilateral secession.
Left ventricular outflow tract pseudoaneurysm diagnosed with point-of-care ultrasound in the emergency department
Authors: Kapur Puneet , Baimel Melanie , Chenkin Jordan
Published: March 2018

Left ventricular outflow tract pseudoaneurysms are a rare but life-threatening disorder, often caused by complications of cardiac surgery or myocardial infarction. We present a case report of a patient with no prior risk factors who presented with a six-month history of progressive exertional dyspnea, bilateral leg swelling and cough. Point-of-care ultrasound revealed an unexpected outpouching of the left ventricle. He was diagnosed with a left ventricular outflow tract pseudoaneurysm and subsequently went into cardiogenic shock secondary to extension of pseudoaneurysm causing extrinsic compression of the coronary arteries. The patient underwent successful emergency surgical repair and made a full recovery.
Scaling diode-pumped, high energy picosecond lasers to kilowatt average powers
Authors: Reagan Brendan A. , Baumgarten Cory , Jankowska Elzbieta , Chi Han , Bravo Herman , Dehne Kristian , Pedicone Michael , Yin Liang , Wang Hanchen , Menoni Carmen S. , Rocca Jorge J.
Published: March 2018

Recent results in the development of diode-driven high energy, high repetition rate, picosecond lasers, including the demonstration of a cryogenic Yb:YAG active mirror amplifier that produces 1.5 J pulses at 500 Hz repetition rate (0.75 kW average power) are reviewed. These pulses are compressed resulting in the generation of ${\sim}5~\text{ps}$ duration, 1 J pulses with 0.5 kW average power. A full characterization of this high power cryogenic amplifier, including at-wavelength interferometry of the active region under ${>}1~\text{kW}$ average power pump conditions, is presented. An initial demonstration of operation at 1 kW average power (1 J, 1 kHz) is reported.
The Economic Value of the Centers for Disease Control and Prevention Carbapenem-Resistant Enterobacteriaceae Toolkit
Authors: Bartsch Sarah M. , Huang Susan S. , McKinnell James A. , Wong Kim F. , Mueller Leslie E. , Miller Loren G. , Lee Bruce Y.
Published: March 2018

OBJECTIVE

While previous work showed that the Centers for Disease Control and Prevention toolkit for carbapenem-resistant Enterobacteriaceae (CRE) can reduce spread regionally, these interventions are costly, and decisions makers want to know whether and when economic benefits occur.

DESIGN

Economic analysis

SETTING

Orange County, California

METHODS

Using our Regional Healthcare Ecosystem Analyst (RHEA)-generated agent-based model of all inpatient healthcare facilities, we simulated the implementation of the CRE toolkit (active screening of interfacility transfers) in different ways and estimated their economic impacts under various circumstances.

RESULTS

Compared to routine control measures, screening generated cost savings by year 1 when hospitals implemented screening after identifying ≤20 CRE cases (saving $2,000–$9,000) and by year 7 if all hospitals implemented in a regional coordinated manner after 1 hospital identified a CRE case (hospital perspective). Cost savings was achieved only if hospitals independently screened after identifying 10 cases (year 1, third-party payer perspective). Cost savings was achieved by year 1 if hospitals independently screened after identifying 1 CRE case and by year 3 if all hospitals coordinated and screened after 1 hospital identified 1 case (societal perspective). After a few years, all strategies cost less and have positive health effects compared to routine control measures; most strategies generate a positive cost-benefit each year.

CONCLUSIONS

Active screening of interfacility transfers garnered cost savings in year 1 of implementation when hospitals acted independently and by year 3 if all hospitals collectively implemented the toolkit in a coordinated manner. Despite taking longer to manifest, coordinated regional control resulted in greater savings over time.

Infect Control Hosp Epidemiol 2018;39:516–524
Viscous drops on a layer of the same fluid: from sinking, wedging and spreading to their long-time evolution
Authors: Bergemann Nico , Juel Anne , Heil Matthias
Published: March 2018

We study the axisymmetric spreading of drops deposited on a pre-existing horizontal layer of the same viscous fluid. Using a combination of experiments, numerical modelling based on the axisymmetric free-surface Navier–Stokes equations and scaling analyses, we explore the drops’ behaviour in a regime where the flow is driven by gravitational and/or capillary forces while inertial effects are small. We find that during the early stages of the drops’ evolution there are three distinct spreading behaviours depending on the thickness of the liquid layer. For thin layers the fluid ahead of a clearly defined spreading front is at rest and the overall behaviour resembles that of a drop spreading on a dry substrate. For thicker films, the spreading is characterised by an advancing wedge which is sustained by fluid flow from the drop into the layer. Finally, for thick layers the drop sinks into the layer, accompanied by significant flow within the layer. As the drop keeps spreading, the evolution of its shape becomes self-similar, with a power-law behaviour for its radius and its excess height above the undisturbed fluid layer. We employ lubrication theory to analyse the drop’s ultimate long-term behaviour and show that all drops ultimately enter an asymptotic regime which is reached when their excess height falls below the thickness of the undisturbed layer.
Breaking Free from Smoking: A Novel Digital Smoking Cessation Intervention for Offenders in UK Prisons
Authors: Dugdale Stephanie , Ward Jonathan , Elison-Davies Sarah , Davies Glyn , Brown Emma
Published: March 2018

Introduction: The level of smoking cessation support across UK prisons is variable, with most offering pharmacological support, such as nicotine replacement therapy. However, with a complete smoking ban in prisons in England now imminent, additional standardised behavioural support is necessary to help offenders go smoke-free.

Aims: This study used the Behaviour Change Wheel to aim to develop the content of an online smoking cessation intervention for offenders, with consideration of their capability, motivation and opportunity for behaviour change.

Methods: This was an intervention development study. The Behaviour Change Wheel was used to map cognitive, behavioural, physiological and social targets for the intervention, onto appropriate intervention techniques for inclusion in the smoking cessation programme for offenders.

Results: Psychological capability, social opportunity and reflective and automatic motivation were identified through deductive thematic analysis as areas of change required to achieve smoking cessation. A total of 27 behavioural change techniques were chosen for this smoking cessation intervention and were mapped onto the Lifestyle Balance Model which provided the theoretical basis on which the components of the programme are conceptualised. This included strategies around increasing motivation to quit, anticipating smoking triggers, modifying smoking-related thoughts, regulating emotions, managing cravings, replacing smoking and rewarding nicotine abstinence and adopting a healthier lifestyle.

Conclusions: Through the utilisation of the Behaviour Change Wheel, the development process of this digital smoking cessation intervention was achieved. Further research is planned to evaluate the clinical effectiveness of this intervention and to explore how the programme is implemented in practice within prison settings.
Conformity Voting and the Value of Public Information
Authors: Garro Haritz
Published: March 2018

I study how the quality of information affects politician selection in a two-candidate model where voters want to vote for the best candidate but also for the winner. Voters receive private and public signals about candidates’ relative valence. Public information has a stronger effect on equilibrium outcomes because voters use it to infer other voters’ beliefs. Contrary to what might be expected, more precise public information does not always benefit the better candidate’s electoral prospects: when voters’ private information is precise enough, improving public information hurts the better candidate’s electoral prospects. The model provides a rationale for the prevalence of large swings in voter sentiment in close elections, and for front-runner candidates’ tendency to avoid face-to-face television debates with the underdog.
Dairy product consumption and its association with metabolic disturbance in a prospective study of urban adults
Authors: Beydoun May A. , Fanelli-Kuczmarski Marie T. , Beydoun Hind A. , Dore Greg A. , Canas Jose A. , Evans Michele K. , Zonderman Alan B.
Published: March 2018

The role of dairy foods and related nutrients in cardiometabolic health aetiology is poorly understood. We investigated longitudinal associations between the metabolic syndrome (MetS) and its components with key dairy product exposures. We used prospective data from a bi-racial cohort of urban adults (30–64 years at baseline (n 1371)), the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS), in Baltimore City, MD (2004–2013). The average of two 24-h dietary recalls measured 4–10 d apart was computed at baseline (V1) and follow-up (V2) waves. Annual rates of change (Δ) in dairy foods and key nutrients were estimated. Incident obesity, central obesity and the MetS were determined. Among key findings, in the overall urban adult population, both cheese and yogurt (V1 and Δ) were associated with an increased risk of central obesity (hazard ratio (HR) 1·13; 95 % CI 1·05, 1·23 per oz equivalent of cheese (V1); HR 1·21; 95 % CI 1·01, 1·44 per fl oz equivalent of yogurt (V1)]. Baseline fluid milk intake (V1 in cup equivalents) was inversely related to the MetS (HR 0·86; 95 % CI 0·78, 0·94), specifically to dyslipidaemia–TAG (HR 0·89; 95 % CI 0·81, 0·99), although it was directly associated with dyslipidaemia–HDL-cholesterol (HR 1·10; 95 % CI 1·01, 1·21). Furthermore, ΔCa and ΔP were inversely related to dyslipidaemia–HDL and MetS incidence, respectively, whereas Δdairy product fat was positively associated with incident TAG–dyslipidaemia and HDL-cholesterol–dyslipidaemia and the MetS. A few of those associations were sex and race specific. In sum, various dairy product exposures had differential associations with metabolic disturbances. Future intervention studies should uncover how changes in dairy product components over time may affect metabolic disorders.
RE-THEORISING CONSUMER LAW
Authors: Willett Chris
Published: March 2018

This article develops a new theoretical framework for understanding consumer contract law, one based on competing ethics of self-interest/reliance and need. It shows how this is a better way of understanding choices as to levels of protection than the traditional “freedom versus fairness” framework. The self-interest/reliance ethic favours rules allowing traders to use processes to escape responsibility for poor quality and harsh outcomes, while the need ethic is concerned with consumer weaknesses and better protects against such outcomes. The article also shows that need-based rules are usually more effective at improving clarity and certainty, and where such rules cause uncertainty, at least as much uncertainty is caused by the alternative self-interest/reliance-based rules.
‘You Can Do Anything With a Temple’: Religion, philanthropy, and politics in South London and Sri Lanka
Authors: MAUNAGURU SIDHARTHAN , SPENCER JONATHAN
Published: March 2018

Our title quotation is taken from an interview with the chief trustee of a leading Hindu temple in south London, and captures the curious mixture of philanthropy, politics, and individual ambition that has emerged around Sri Lankan Tamil temples in the diaspora. During the long years of civil war, temples became centres of mobilization for the growing Tamil diaspora, and were often accused of channelling funds to the LTTE (Liberation Tigers of Tamil Eelam) and its various front organizations. Since the end of the war, in 2009, the same temples now support orphanages and other good works in Sri Lanka, and their efforts are starting to be emulated by temples in Sri Lanka itself. At the heart of our article is a dispute between the UK Charity Commission and the chief trustee of a London temple, who is accused of misuse of temple funds and ‘failure to dissociate’ the temple from a terrorist organization. A close reading of the case and its unexpected denouement reveals the difficulties of bounding the zone of philanthropy.
Giving Becomes Him: The posthumous fortune(s) of Pachaiyappa Mudaliar
Authors: RAMASWAMY SUMATHI
Published: March 2018

This article explores the ways in which Pachaiyappa Mudaliar (1754?–1794) has been panegyrized as the quintessential benefactor of our times in Tamil prose, poetry, and pictures over the course of the past century and a half. In the bureaucratic and legal documents of the colonial state, he appears as a rapacious moneylender and behind-the-scenes wheeler-dealer, a member of that hated class of ‘Madrasdubashes’, a ‘most diabolical race of men’. In contrast, Tamil memory work since at least the 1840s has differently recalled this shadowy eighteenth-century man as a selfless philanthropist whose vast wealth financed some of the earliest educational institutions in the Madras Presidency. I track the posthumous fate of Pachaiyappa's bequest to argue that even as the founding of the public trust and its educational philanthropy departed radically from his willed intentions, a new complex of living, dying, and giving for the sake of native education was put in place in the Tamil country in the age of colonial capital and pedagogic modernity.
Religious experience and desire
Authors: ELLIS FIONA
Published: March 2018

I offer a new approach to the old question of the epistemic value of religious experience. According to this approach, religious experience is a species of desire, desire in this context involving a kind of experience which is cognitive and unmediated. The account is inspired by Levinas and Heidegger, and it involves a conception of experience which is shared by a disjunctivist account of perception. Perceptual disjunctivism is my starting point, and it provides the ground for the ensuing discussion of desire. In the final section of the article I argue that the parallel between perceptual disjunctivism and a Levinasian conception of desire points to a further strength in the account of desire here presented, namely, by suggesting the possibility of a disjunctive style response to scepticism about religious experience.