bluuebunny/crossref_metadata_2025 huggingface dataset:
Planning for Bone Excision in Ewing Sarcoma
Authors: Thévenin-Lemoine Camille , Destombes Louise , Vial Julie , Wargny Matthieu , Bonnevialle Paul , Lefevre Yan , Gomez Brouchet Anne , Sales de Gauzy Jérome
Published: January 2018

Background:

In determining the level of bone resection in Ewing sarcoma, the most suitable time at which to perform magnetic resonance imaging (MRI) remains controversial. Current guidelines recommend that surgical planning be based on MRI performed prior to neoadjuvant chemotherapy. The goal of this study was to determine whether pre-chemotherapy or post-chemotherapy MRI provides greater accuracy of tumor limits for planning bone excision in the management of Ewing sarcoma.

Methods:

This was a single-center, retrospective study. MRI was performed using 3 sequences: T1-weighted, T1-weighted with contrast enhancement by gadolinium injection, and a fluid-sensitive sequence (STIR [short tau inversion recovery] or proton-density-weighted with fat saturation). The tumor extent as assessed on pre-chemotherapy and post-chemotherapy MRI was compared with histological measurement of the resected specimen.

Results:

Twenty patients with Ewing sarcoma of a long bone were included. In 6 cases, the tumor was located on the femur, in 5, the tibia; in 5, the fibula; and in 4, the humerus. The median patient age at diagnosis was 9.7 years. We found greater accuracy of measurements from MRI scans acquired after chemotherapy than from those acquired before chemotherapy. For both pre-chemotherapy and post-chemotherapy MRI, the greatest accuracy was achieved with the nonenhanced T1 sequence. There was no benefit to gadolinium enhancement. The median difference between T1 MRI and histological measurements was 19.0 mm (interquartile range [IQR], 4.3 to 32.8 mm) before chemotherapy and 5.0 mm (IQR, 2.0 to 13.0 mm) after chemotherapy. Adding a minimum margin of 20 mm to the limit of the tumor on post-chemotherapy T1 MRI always led to safe histological margin.

Conclusions:

Post-chemotherapy MRI provided a more accurate assessment of the limits of Ewing sarcoma. Surgical planning can therefore be based on post-chemotherapy MRI. Surgical cuts can be, at minimum, 20 mm from the limits as seen on MRI.
Telephone-Based Intervention to Improve Rehabilitation Engagement After Spinal Stenosis Surgery
Authors: Skolasky Richard L. , Maggard Anica M. , Wegener Stephen T. , Riley Lee H.
Published: January 2018

Background:

Spine surgery outcomes are variable. Patients who participate in and take responsibility for their recovery have improved health outcomes. Interventions to increase patient involvement in their care may improve health outcomes after a surgical procedure. We conducted a prospective interventional trial to compare the effectiveness of health behavior change counseling with usual care to improve health outcomes after lumbar spine surgical procedures.

Methods:

In this study, 122 patients with lumbar spinal stenosis undergoing a decompression surgical procedure from December 2009 through August 2012 were enrolled. Participants were assigned, according to enrollment date, to health behavior change counseling or usual care. Health behavior change counseling is a brief, telephone-based intervention intended to increase rehabilitation engagement through motivational interviewing strategies that elicit and strengthen motivation for change. Health behavior change counseling was designed to identify patients with low patient activation, to maximize postoperative rehabilitation engagement, to decrease pain and disability, and to improve functional recovery. Participants were assessed before the surgical procedure and for 3 years after the surgical procedure for pain intensity (Brief Pain Inventory), disability (Oswestry Disability Index), and physical health (12-Item Short-Form Health Survey, version 2). Differences in changes in health outcomes after the surgical procedure were compared between the health behavior change counseling group and the usual care group.

Results:

By 12 months, health behavior change counseling participants reported significantly greater reductions in pain intensity (p = 0.008) and disability (p = 0.028) and significantly greater improvement in physical health compared with usual care participants (p = 0.025). These differences were attenuated by 24 and 36 months after the surgical procedure. Early improvements in health outcomes were mediated by improvements in physical therapist-rated engagement and self-reported attendance at physical therapy sessions in the health behavior change counseling group.

Conclusions:

Health behavior change counseling improved health outcomes during the first 12 months after the surgical procedure through changes in rehabilitation engagement. Wider use of health behavior change counseling may lead to improved outcomes not only after lumbar spine surgery but also in other conditions for which rehabilitation is key to recovery.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Long-Term Outcomes of Distal Femoral Extension Osteotomy and Patellar Tendon Advancement in Individuals with Cerebral Palsy
Authors: Boyer Elizabeth R. , Stout Jean L. , Laine Jennifer C. , Gutknecht Sarah M. , Araujo de Oliveira Lucas H. , Munger Meghan E. , Schwartz Michael H. , Novacheck Tom F.
Published: January 2018

Background:

We examined long-term outcomes across the domains of the International Classification of Functioning, Disability and Health for 2 groups of participants with cerebral palsy who demonstrated crouch gait at clinical gait analysis. One group underwent a distal femoral extension osteotomy with patellar tendon advancement (DFEO + PTA). The other group received other treatments (non-DFEO + PTA).

Methods:

Fifty-one participants returned for a long-term gait analysis, physical examination, energy consumption test, knee radiographs, and questionnaires (median, 13 years post-DFEO + PTA or post-baseline [range, 8 to 21 years]). A subset of participants in the DFEO + PTA group also had a short-term analysis (9 to 24 months postoperatively).

Results:

Participants were reasonably well-matched at baseline, although the DFEO + PTA group demonstrated greater crouch: minimum knee flexion, a median of 37° (width of the interquartile range, 12°) compared with 27° (9°); and knee flexion contracture, a median of 15° (10°) compared with 10° (5°). The gait deviation index (GDI) and sagittal plane knee kinematics were most improved at short term for the DFEO + PTA participants, with a subsequent slight decline at long-term analysis. Fewer DFEO + PTA participants were in crouch at long term (37% compared with 65%). At the long-term assessment, group scores for function, mobility, participation, quality of life, and most pain questionnaires were similar. Knee pain and osteoarthritis ratings did not differ between the groups.

Conclusions:

At long-term analysis, DFEO + PTA improves stance phase knee extension and knee flexion contracture compared with conventional treatment, but these benefits do not translate to improved activity, participation, or knee pain in early adulthood.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Implemantation of Islamic Character Through Developing Material of Indonesian Language in 3rd Grade of Islamic Elementary School
Authors: Arifin Moch. Bahak Udin By , Fitria Kurnia Laili
Published: January 2018

This research has purpose to implementation of Islamic characteristic by developing material intensive reading of Indonesian language for third grade of Islamic elementary school Darussalam Sidoarjo. From the result of this research will produce a teaching material be in the form of intensive reading text book based on Islamic character for third grade of Islamic elementary school. This research used Research and Development (R&D) method or research development by using developing model of Walter Dick and Lou Carey. The instrument that used to collecting data is exercise test, questionnaire and rating scale.  By the implementation of Islamic character in the teaching material of Indonesian language, there should to integrated in value of Islamic character, religious and responsible to the material, implicitly, showing through the picture illustration , narration and teaching learning activity that has been done. From the result of assessment and analysis from all of third grade students of Islamic elementary school Darussalam Sidoarjo has shown the improvement and use religious and responsible character.
Implications of Observed and Simulated Soil Carbon Sequestration for Management Options in Corn‐based Rotations
Authors: Dell Curtis J. , Gollany Hero T. , Adler Paul R. , Skinner R. Howard , Polumsky Robert W.
Published: January 2018

Managing cropping systems to sequester soil organic C (SOC) improves soil health and resilience to changing climate. Perennial crops, no‐till planting, manure, and cover crops can add SOC; however, their impacts have not been well documented in the northeastern United States. Our objectives were (i) to monitor SOC from a bioenergy cropping study in Pennsylvania that included a corn (Zea mays L.)–soybean [Glycine max (L.) Merr.]–alfalfa (Medicago sativa L.) rotation, switchgrass (Panicum virgatum L.), and reed canarygrass (Phalaris arundinacea L.); (ii) to use the CQESTR model to predict SOC sequestration in the bioenergy crops (with and without projected climate change); and (iii) to use CQESTR to simulate influence of tillage, manure, cover cropping, and corn stover removal in typical dairy forage (silage corn–alfalfa) or grain corn–soybean rotations. Over 8 yr, measured SOC increased 0.4, 1.1, and 0.8 Mg C ha−1 yr−1 in the bioenergy rotation, reed canarygrass, and switchgrass, respectively. Simulated and measured data were significantly correlated (p < 0.001) at all depths. Predicted sequestration (8–14 Mg C ha−1 over 40 yr) in dairy forage rotations was much larger than with corn–soybean rotations (−4.0–0.6 Mg C ha−1 over 40 yr), due to multiple years of perennial alfalfa. No‐till increased sequestration in the simulated dairy forage rotation and prevented a net loss of C in corn–soybean rotations. Simulations indicated limited impact of cover crops and manure on long‐term SOC sequestration. The low solids content of liquid dairy manure is the likely reason for the less‐than‐expected impact of manure. Overall, simulations suggest that inclusion of alfalfa provides the greatest potential for SOC sequestration with a typical Pennsylvania crop rotation.

Core Ideas

Bioenergy crops sequestered significant quantities of SOC.

CQESTR accurately predicted SOC levels at the site.

Inclusion of alfalfa in rotation was predicted to significantly increase SOC.

No‐till was predicted to increase SOC in both dairy forage and corn–soybean rotations.

Cover crops and manure had limited impact on simulated long‐term SOC accumulation.
An Artificial Intelligence Platform for Asset Management Contributes to Better Decision‐making Tools for Operations, Maintenance, and Utility Management
Authors: Sen D. , Fashokun A. , Angelotti R. , Brooks M. , Bhaumik H. , Card C. , Lodhi A. , Godrej A. , Chung C.
Published: January 2018

An Artificial Intelligence system was developed and implemented for water, wastewater, and reuse plants to improve management of sensors, short and long‐term maintenance plans, asset and investment management plans. It is based on an integrated approach to capture data from different computer systems and files. It adds a layer of intelligence to the data. It serves as a repository of key current and future operations and maintenance conditions that a plant needs have knowledge of. With this information, it can simulate the configuration of processes and assets for those conditions to improve or optimize operations, maintenance and asset management, using the IViewOps (Intelligent View of Operations) model. Based on the optimization through model runs, it is able to create output files that can feed data to other systems and inform the staff regarding optimal solutions to the conditions experienced or anticipated in the future.
NORMAL VASCULAR REACTIVITY IS RESTORED BY APIGENIN IN DIABETIC RATS
Authors: El-bassossy Hany M. , Desoky Nora , Alahdal Abdulrahman M , Fahmy Ahmed
Published: January 2018

Objective: Diabetes is a disease whose complications have serious implications for the health of sufferers; one of the most serious such complications is the deterioration of vascular reactivity. Apigenin is a natural flavonoid with PKC inhibiting and antioxidant properties. In this study, the impact of apigenin on vascular reactivity deterioration was investigated.Methods: Insulin resistance (IR) and insulin deficiency (ID) were induced by fructose and streptozotocin respectively. The isolated aortae vasoconstriction response to phenylephrine (PE) and potassium chloride (KCl) in addition to the vasodilation response to acetylcholine (ACh) and sodium nitroprusside (SNP) were tested.Results: IR and ID were associated with significantly exaggerated vasoconstriction to KCl and PE while significantly impaired vasodilation to ACh. Response to SNP was not significantly affected by both IR and ID. In vitro incubation with apigenin (7 7µM) for 20 min restored normal responses to PE, KCl and ACh in aortae isolated from insulin-resistant or insulin-deficient rats. Incubation for one hour with the PKC stimulant, phorbol 12-myristate 13-acetate (PMA, 800 nM) resulted in aortic impairment similar to that seen in aortae isolated from IR and ID animals. Incubation with both apigenin prevented PMA-induced exaggerated vasoconstriction response to both PE and KCl.Conclusion: Apigenin alleviates vascular exaggerated vasoconstriction and impaired dilation associated with diabetes or PKC activated.
SEARCH FOR NEW ANTILEISHMANIAL CHEMOTHERAPEUTICS
Authors: Kar Nabanita , Ghosh Santanu , Kumari Leena , Chakraborty Shreyasi , Bera Tanmoy
Published: January 2018

Objective: The objective of this work was to screen a number of compounds for their antileishmanial efficacy and cytotoxicity profiling.Methods: Curry leaf oil, cypress oil and spikenard oil were identified by gas chromatography-mass spectrometry (GC/MS) analysis. Betulinic acid, spikenard oil, cypress oil and curry leaf oil were evaluated for their in vitro antileishmanial activity against Leishmania donovani AG83 wild-type, sodium stibogluconate resistant (SSG-resistant), paromomycin (PMM-resistant) and GE1 field type strains on axenic and cellular amastigote model and compared the results with standard drugs used to treat leishmaniasis.Results: Betulinic acid showed strong antileishmanial activity against wild-type (SI= 192.8), SSG-resistant (SI= 19.3) and GE1 strains (SI= 100), whereas cypress oil has produced highest antileishmanial activity against PMM-resistant strains (SI= 15.09) among all the tested drugs. The data obtained also revealed that cypress oil had the maximum CC50 value of 452.9 μl among all standard and tested drugs.Conclusion: All tested drugs had antileishmanial property but among them, betulinic acid possess strong antileishmanial activity in case of both wild-type and drug-resistant leishmaniasis.
MULTIPLE UNIT PELLET SYSTEM (MUPS) BASED FAST DISINTEGRATING DELAYED-RELEASE TABLETS FOR PANTOPRAZOLE DELIVERY
Authors: Patel Sandipkumar A. , Patel Nrupa G. , Joshi Abhijeet B.
Published: January 2018

Objective: The rationale for the study was to develop multiple unit pellet system (MUPS) of delayed release pantoprazole with desired physical properties and unaltered drug release profile from pellets even after compression into a fast disintegrating tablet.Methods: In the presented study, delayed release pellets of pantoprazole were developed by two methods, i.e. extrusion-spheronization and drug layering techniques, coated using enteric polymer and subsequently compressed in to tablet. In drug layering technique, pantoprazole was loaded on Celphere®102 (microcrystalline cellulose spheres) as well as on Suglet® (sugar spheres) in fluid bed processor. Acid resistant polymer Eudragit ND 30D was subsequently coated on each type of drug loaded pellets. Suitable tableting excipients were prepared such as soft pellets, Ceolus® (fibrous grade of microcrystalline cellulose) granules, Ludipress® (compressible lactose composition), Avicel® PH 200 and different combination of them. Various factors like property of pellets to be compressed, coating level, the composition of tableting excipient and ratio of drug-loaded pellets to tableting excipients were identified and optimized.Results: MUPS with delayed releasing pellets of pantoprazole proved to provide sufficient hardness, rapid disintegration property, and unaltered release profile after compression. Delayed release pantoprazole pellets prepared by drug layering on celphere® 102 followed by coating with Eudragit® NE 30D showed better compressibility to withstand the drug release properties. The combination of Ceolus® granules and Ludipress (in 1:1 ratio) was found to be suitable tableting excipient that helped compression of pellets without rupturing polymeric coat. Pellets to excipients ratio at 1:3 was found optimum.Conclusion: Compaction behaviour of pantoprazole delayed-release pellets without loss of original delayed release profile was achieved by formulating as MUPS based tablet of pantoprazole delayed release pellets using celephere® 102 was developed which was found suitable for desired release profile and physical properties.
MICROSCOPIC, PHYSICOCHEMICAL AND PHYTOCHEMICAL ANALYSIS OF GARDENIA JASMINOIDES (ELLIS)
Authors: Kesavan Keerthana , Gnanasekaran Jothi , Gurunagarajan Sridharan , Nayagam Agnel Arul John
Published: January 2018

Objective: To evaluate the microscopical, physicochemical and phytochemical analysis of Gardenia jasminoides (Ellis).Methods: The leaves of Gardenia jasminoides (Ellis) was studied through macroscopic, microscopic, physicochemical standards such as moisture content, ash values, extractive values and phytochemical analysis includes preliminary screening and quantification of important secondary metabolites were carried out as per the standard procedures are given in Indian Ayurvedic Pharmacopeia.Results: Microscopic studies of leaf showed the presence of epidermis, 4-5 layers of collenchymas cells, xylem, phloem and vascular bundles. The determination of physicochemical studies of leaves showed that it contains Total ash (6.98%), Water and Acid insoluble ash values and extractive values of 0.31% in Hexane, 0.87% in chloroform and 0.42% in Ethyl acetate. Preliminary phytochemical screening revealed the presence of Alkaloid, Flavonoid, Saponin, Tannin and phenol.Conclusion: The results obtained from the study provide information for proper identification and standardization of plant for its medicinal property, ensuring the quality of plant drug and also useful to distinguish it from its related species.
CORTICOSTERIODS INDUCED ECCHYMOSIS
Authors: P. Joshisree K. , G. Rajesh , R. Siddarama
Published: January 2018

Corticosteroids are the steroid hormones which are mainly used in the treatment of various diseases like rheumatoid arthritis, osteoarthritis, rheumatic fever, gout, allergic reactions, renal diseases and haematological diseases. Prolonged use of corticosteroids causes a number of undesirable effects. Major adverse drug reaction (ADR’s) includes ulcers/gastrointestinal bleeding, osteoporosis, increased risk of heart diseases and decreased in bone density. Here we report a case of male patient of 72years old who was confirmed with cervical osteoarthritis and using oral corticosteroid (OCS) (methylprednisolone) since 6 y. While the patient was on therapy ecchymosis was noticed. The relation between suspected drug and ADR was established by performing ADR assessment scale, whereas both de-challenge and re-challenge was done, and ADR assessment scales like Naranjo’s scale, WHO UMC scales showed probable ADR, it can be managed by stopping the drug or using alternative days. Close monitoring of blood cortisol levels in a patient using oral corticosteroids (OCS) should be done.
HYALURONAN-A NOVEL POLYMER ISOLATED FROM MUTATED CLINICAL BACTERIAL ISOLATE
Authors: K. Natarajan , Chandy Vineeth , A. Sirajudeen M.
Published: January 2018

Objective: This study was done to optimize the production parameters involved in the isolation of hyaluronan (HA) from UV mutated a clinical strain of Klebsiella pneumonia (M 3020).Methods: Glucose and nitrogen enriched media (D-glucose, L-glutamic acid, and peptone) were utilized to cultivate the clinical isolate K. pneumoniae. The strain was Ultra Violet (UV) radiation mutated (254 nm, 25 min) and HA production was optimized by parameters such as pH and temperature. The isolated HA from the fermented broth was subjected to purification by isopropyl alcohol and silica gel and further dried by lyophilization. Produced HA was confirmed with UV and Fourier Transform Infra-Red (FT-IR) spectroscopy.Results: UV treated strain at 254 nm for 25 min predominantly produce a high quantity of HA (3.5 g/l) in 37 °C, 300 rpm and pH 6.8 at 24 h run. UV and IR spectrum of produced HA showed strong similarity with the standard hyaluronan.Conclusion: To conclude, high quantity and quality of HA can be isolated from mutated clinical strains of K. pneumoniae.
THE HDAC INHIBITOR SODIUM PHENYLBUTYRATE ENHANCES THE CYTOTOXICITY INDUCED BY 5-FLUOROURACIL, OXALIPLATIN, AND IRINOTECAN IN COLORECTAL CANCER CELL LINES
Authors: Al-keilani Maha S. , Alsmadi Dua H.
Published: January 2018

Objective: The main objective of this study was to evaluate the ability of sodium phenylbutyrate (NaPB) to enhance the cytotoxicity of 5-fluorouracil, oxaliplatin, and irinotecan against colorectal cancer cell lines expressing wild-type and mutant p53.Methods: The antiproliferative effect of NaPB alone or in combination with 5-fluorouracil, oxaliplatin, or irinotecan in HCT-116 and HT-29 colorectal cancer cell lines was investigated using the MTT cell proliferation assay. IC50 values were calculated using Compusyn Software 1.0 (Combosyn Inc.). Synergy values (R) were calculated using the ratio of IC50 of each primary drug alone divided by combination IC50s. For each two pairs of experiments, student’s t-test was used for analysis. In combination studies, one-way ANOVA test; Tukey post-hoc testing was performed using R 3.3.2 software. P-value<0.05 was considered significant.Results: NaPB inhibited the growth of HCT-116 and HT-29 cell lines in a dose-dependent manner (IC50s 4.7 mmol, and 10.1 mmol, respectively). HT-29 cell lines (mutant p53) were more sensitive to NaPB at low concentrations (<4 mmol). Moreover, the addition of NaPB to HCT-116 and HT-29 with 5-fluorouracil, oxaliplatin, or irinotecan synergistically induced the antiproliferative effect (R>1.6, p-value<0.05).Conclusion: NaPB enhanced the cytotoxicity of conventional chemotherapy against colorectal cancer cell lines harboring wild-type or mutant p53. Thus NaPB is a promising potential adjuvant chemotherapy in colorectal cancer.
6-SHOGAOL RICH GINGER OLEORESIN LOADED MIXED MICELLES ENHANCES IN VITRO CYTOTOXICITY ON MCF-7 CELLS AND IN VIVO ANTICANCER ACTIVITY AGAINST DAL CELLS
Authors: Kemkar Kiran , L. Sathiyanarayanan , Sathiyanarayanan Arulmozhi , Mahadik Kakasaheb
Published: January 2018

Objective: Ginger oleoresin (GO) plays an important role on the attenuation of complications associated to the cancer which is attributed to 6-shogaol (6-SGL). The major challenge in using 6-SGL for therapeutic applications is its poor aqueous solubility, low stability in GI and low bioavailability. Considering the potent anticancer nature of 6-SGL and its synergistic activity with other constituents in GO, there is a need to develop a suitable drug delivery system.Methods: Thus in the present study, 6-SGL rich GO (6-SRGO) was incorporated into mixed micelles using phospholipid (Soya Lecithin) as a carrier. The prepared 6-SRGO loaded mixed micelles (6-SRGO-LMM) were characterized physically and chemically using Fourier transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC) and further evaluated for stability study, in vitro release study, in vitro cytotoxicity study and in vivo anticancer activity in comparison with 6-SRGO.Results: The composition such as, drug content (86.27±1.56), encapsulation efficiency (81.55±1.05) and particle size (356.11±4.07) were optimized using 32 factorial design. FTIR and DSC study confirm that the 6-SGL from 6-SRGO was entrapped in the core of phospholipid by self-assembly method to form mixed micelles. The 6-SRGO-LMM exhibited significant in vitro (GI50-23.2 μg/ml) and in vivo anticancer activity in comparison with 6-SRGO.Conclusion: We have developed and investigated mixed micelles composed of phospholipids (soya lecithin S80) and SCH as an effective nanocarrier for the delivery of a natural lipophilic anticancer bioactive 6-SGL from 6-SRGO.
VIOLÊNCIA URBANA, SAÚDE E “SENTIMENTO”: PERCEPÇÃO DOS PROFISSIONAIS DA ESTRATÉGIA SAÚDE DA FAMÍLIA
Authors: Kebian Luciana Valadão Alves , Cecchetto Fátima
Published: January 2018

A violência urbana que atravessa a rotina de trabalho dos profissionais da saúde atuantes nas equipes de saúde da família pode ter como consequência alterações de saúde tanto física quanto mental. Este estudo tem por objetivo identificar como a violência urbana tem sido abordada nos estudos sobre a saúde dos profissionais da Estratégia Saúde da Família. Foi realizada revisão bibliográfica, em outubro 2012, nas bases de dados científicas disponíveis na Biblioteca Virtual em Saúde. Nove publicações foram selecionadas e submetidas à leitura crítica. Os resultados possibilitaram a identificação de diversos sentimentos diante de situações de violência urbana, como o medo. Para minimizar os danos da violência urbana na população, os profissionais desenvolviam ações que transcendiam o seu papel, remetendo à dádiva. Concluiu-se que a violência urbana, abordada nos estudos revisados, repercutia tanto na saúde física quanto mental dos profissionais da saúde da Estratégia Saúde da Família que atuavam nessas áreas. Palavras-chave: Violência. Saúde da família. Saúde do trabalhador. Atenção primária à saúde.
SÍNDROME DE BURNOUT NO CONTEXTO DA ENFERMAGEM
Authors: Mourão Artemísia Lima , Costa Anne Carolinne de Carvalho , Silva Erica Micaelle Melo , Lima Katherine Jeronimo
Published: January 2018

A síndrome de burnout é um transtorno associado às atividades laborais que acomete cada vez mais os profissionais de saúde. O objetivo deste estudo foi abordar as experiências inerentes ao contexto dos profissionais da enfermagem e suas possíveis relações com a síndrome de burnout. Trata-se de uma revisão crítico-reflexiva. Os resultados mostraram que, entre os transtornos por situações de estresse no âmbito da enfermagem, essa síndrome está presente como um transtorno ocupacional que vem impactando na prestação da assistência desses trabalhadores. Concluiu-se que é preciso traçar estratégias que propiciem prevenção, intervenção e manejo adequado do enfrentamento dessa síndrome, para que se possa alcançar maior qualidade dos serviços prestados e melhorias à saúde e qualidade de vida desses profissionais.Palavras-chave: Estresse. Enfermagem. Qualidade de vida. Síndrome de burnout.
Síntomas neurológicos de fístula carotídeo carvenosa: reporte de caso
Authors: Torres Zambrano Martin , Rubio Rodríguez Wolfang , Conde Cardona Giancarlos , Polo Verbel Luis , Padilla Espinoza Karen , Gamero Tafur José , García Sánchez Carolina
Published: January 2018

Las fístulas carótido-cavernosas son comunicaciones anormales entre la arteria carótida interna o externa; o alguna de sus ramas (sistema arterial) y el seno cavernoso (sistema venoso); el espectro de presentación de esta entidad es muy variable, sin embargo existe un gran número de pacientes en los cuales los síntomas neurológicos conllevan a sospecha clínica. Los síntomas pueden variar desde cefalea de intensidad variable, síntomas de origen auditivo, tinitus, hipoacusia y vértigo hasta manifestaciones que son clínicamente evidenciables y signos derivados de congestión orbitaria como proptosis, quemosis, soplos orbitarios y pérdida de la visión, causas que motivan un diagnóstico y tratamiento oportuno. Se realiza reporte de un caso de un paciente de 60 años de edad que acude al servicio hospitalario de la Fundación Centro Colombiano y Enfermedades Neurológicas FIRE, con cefalea de 2 meses de evolución, consulta por diplopía binocular, dolor ocular bilateral, inyección conjuntival, secreción purulenta, epifora bilateral, vértigo con miositis orbitaria aguda, fístula carótido-cavernosa en ojo derecho y parálisis del sexto par craneal izquierdo. La panangiografía cerebral reporta fístula carótida-cavernosa indirecta tipo B de Barrow por aferencias del tronco meningohipofisiario derecho e izquierdo por lo que es llevado a terapia endovascular con obliteración exitosa de la fístula.
Isquemia talámica bilateral secundaria a trombosis venosa cerebral: tratamiento endovascular, presentación de un caso
Authors: Zamora Adrián , Bastos Victor Hugo , Márquez Juan Camilo , Zuleta Jessica
Published: January 2018

La trombosis venosa cerebral (TVC) es una entidad poco frecuente y potencialmente devastadora que se presenta con mayor frecuencia en adultos jóvenes, especialmente en mujeres. La TVC representa el 0,5 % a 1 % de todos los ACV, su amplio espectro clínico la convierte en un desafío diagnóstico, especialmente en aquellos casos de mujeres jóvenes sin factores protrombóticos conocidos que debutan con cefalea como único síntoma. La TVC puede ocasionar isquemia o infartos talámicos y gangliobasales bilaterales con delirio y deterioro del estado de conciencia, en especial cuando hay compromiso del sistema venoso profundo. El diagnóstico se confirma con resonancia magnética cerebral (RM) y venografía por resonancia. La anticoagulación sigue siendo la piedra angular del tratamiento; sin embargo, los pacientes que no responden a terapia médica intensiva pueden beneficiarse de la trombectomía endovascular mecánica (TEM). A continuación presentamos el caso clínico de una paciente de 29 años con una isquemia talámica y gangliobasal bilateral secundaria a trombosis venosa cerebral que fue llevada a trombectomía endovascular mecánica.
Revisión sistemática de la calidad de vida relacionada con la salud en niños latinoamericanos con trauma craneoencefálico
Authors: Gutiérrez-Ruiz Karol , Audivet Diana Luna , Mosquera Valoy Yoissy
Published: January 2018

La calidad de vida relacionada con la salud (CVRS) es una medida que permite cuantificar las consecuencias del traumatismo craneoencefálico (TCE). En países angloparlantes la CVRS después del TCE infantil es un área importante de estudio, sin embargo, poco se conoce sobre el estado actual de la investigación en este tema en la población hispana.

OBJETIVO:
El propósito de este trabajo es realizar una revisión de la literatura sobre la CVRS después de un TCE en niños y adolescentes latinos con el fin de conocer el estado actual de la investigación al respecto e identificar áreas de futuros estudios.

MÉTODO:
Se revisaron las bases de datos MEDLINE, PubMed, Scopus, Cochrane Central, Redalyc y Scielo; solo tres de 209 registros cumplieron con los criterios de inclusión.

RESULTADOS:
La CVRS después del TCE infantil es un campo de estudio que ha sido poco explorado, la calidad de la evidencia científica disponible es regular en 2 de los 3 estudios identificados. En los trabajos revisados se pone de manifiesto que pacientes que han presentado TCE moderado-severo se ven afectados en su CVRS durante los años que le siguen al daño cerebral. Se sugiere que la esfera psicosocial suele verse más afectada, lo que tiene implicaciones importantes en el funcionamiento escolar y en el bienestar psicológico del niño, ya que el desempeño académico puede verse comprometido debido a las secuelas cognitivas y a la aparición de conductas agresivas e irritabilidad. Es necesario desarrollar investigaciones en este campo con diseños metodológicos rigurosos que evalúen el curso de la CVRS después de un TCE, los predictores potenciales, estrategias de intervención y su impacto en el bienestar de la niñez latinoamericana.
Microfiltration with periodic gas backwashing as an alternative technique for increasing permeate flux
Authors: Urosevic Tijana , Povrenovic Dragan , Vukosavljevic Predrag , Urosevic Ivan
Published: January 2018

In this paper, the influence of operating parameters (transmembrane pressure, temperature, the flow rate of retentate) on the cross - flow microfiltration of synthetic fruit juice and periodic backwashing with air was examined. In the experiments, the Kerasep W5 ceramic membrane with a separation limit of 0.2 ?m was used. The results of experiments in which different transmembrane pressures were used showed that stationary fluxes, at stationary conditions, after 60 minutes, have similar values. So, it can be concluded that the value of the driving force is irrelevant at steady state conditions. However, until the steady state conditions are established, a positive effect of the increase in the driving force is opposed to the negative effect of the increased polarization resistance, as a result of the driving force increase. Thus, the optimal transmembrane pressure was determined amounting to 2 bars. The optimum temperature of the process of clearing the fruit juices by microfiltration is reported as 55?C. Higher temperatures are not used due to a degrading effect on the chemical composition of the juice and a long microfiltration process. With an increase in the temperature of retentate from 22?C to 55?C, the permeate flux increased up to 60%. Increasing the flow rate of retentate reduces the thickness of the formed layer on the surface of the membrane. Due to limitations of the experimental setup and the large surface area of the membrane, the specific velocity of the retentate was low, so that the effects of cross-flow filtration were absent. The use of cross-flow filtration is one of the main requirements for increasing permeate flux, but in the present case it was in overall insufficient, so we have applied periodic air backwashing for improving fruit juice flux during membrane clarification. With this technique, the deposited layer on the membrane is lifted and the permeate flux is maintained at high levels preventing establishment of the steady state in the low flux zone. The time spent for the periodic backwashing was low as compared to the benefits of the increase in the collected permeate quantity. In all experiments with periodic backwashing with air, the collected permeate quantity is higher for up to 72.5 % as compared to experiments without backwashing. By increasing the backwashing duration, the flux increase is up to 5 %, which can be significant for microfiltration at industrial scale. Therefore, this technique is certainly recommended for microfiltration in the production of fruit juices.
Normative and strategic framework of foreign policy of the Republic of Serbia: “Europeanisation” and (non)transparency
Authors: Todic Dragoljub
Published: January 2018

The aim of the paper is to determine the characteristics of the foreign
policy of the Republic of Serbia (RS) based on the analysis of regulations
and strategic documents relevant for foreign policy. The first part of the
paper points out the general context of the discussion. In the second part of
the paper, an overview of the most important regulations and strategic
documents relevant to foreign policy is presented. The analysis shows that
key characteristics of the foreign policy of the RS are the ?Eurocentrism?
and (thus derived) ?Europeanization? as a process of reforming the legal and
political system of the RS. The author emphasizes the importance of the
foreign policy decision?making process. Two elements of the legislative
procedure are analyzed from the point of view of the possibility of public
participation in the decision?making processes. These are the following: 1)
ratification of the international treaties, and 2) the process of
harmonization of national regulations with EU regulations. The open issues
and ambiguities in the way of regulating these issues are emphasized. In
addition, in the legislative procedure, the regulatory impact assessment also
takes a special place. However, there are some open issues in the application
of the regulatory impact assessment. In conclusion, it is noted that the EU
membership is a key foreign policy objective of the RS with a strong
influence on the internal legal and political system. However, in the two
analyzed formal procedures which represent the elements of the foreign policy
of the RS (within the process of ?Europeanization?), guarantees for the
transparent implementation, i.e. effective public participation in their
implementation have not been contained. This can have a significant impact on
the quality of the activities which are being carried out and the results of
the process of ?Europeanization?, as a strategic foreign policy commitment of
the RS.
Clinical Impact of ITCA 650, a Novel Drug-Device GLP-1 Receptor Agonist, in Uncontrolled Type 2 Diabetes and Very High Baseline HbA1c: The FREEDOM-1 HBL (High Baseline) Study
Authors: Henry Robert R. , Rosenstock Julio , Denham Douglas S. , Prabhakar Prakash , Kjems Lise , Baron Michelle A.
Published: January 2018

OBJECTIVE

ITCA 650 is a subdermal osmotic mini-pump that continuously delivers exenatide subcutaneously for 3–6 months. The efficacy, safety, and tolerability of ITCA 650 added to diet and exercise alone or combined with metformin, sulfonylurea, or thiazolidinedione monotherapy or a combination of these drugs was evaluated in poorly controlled patients with type 2 diabetes (T2D) who were ineligible for participation in a placebo-controlled study (FREEDOM-1) because of severe hyperglycemia (HbA1c >10% [86 mmol/mol]).

RESEARCH DESIGN AND METHODS

This 39-week, open-label, phase 3 trial enrolled patients aged 18–80 years with HbA1c >10% to ≤12% (86–108 mmol/mol) and BMI 25–45 kg/m2. Patients received ITCA 650 20 μg/day for 13 weeks, then 60 μg/day for 26 weeks. The primary end point was change in HbA1c at week 39.

RESULTS

Sixty patients were enrolled. At baseline, mean HbA1c was 10.8% (94.7 mmol/mol) and mean (± SD) duration of diabetes was 8.6 (± 5.3) years. At week 39, there was a mean reduction in HbA1c of −2.8% (−30.3 mmol/mol; P < 0.001 vs. baseline) and in body weight of −1.2 kg (P = 0.105), and 25% of patients achieved HbA1c <7% (53 mmol/mol). A reduction in HbA1c of ≥1% (≥10.9 mmol/mol) occurred in 90% of patients. The most common adverse events were nausea, vomiting, diarrhea, and headache. Gastrointestinal adverse events were generally transient and subsided over time; only 4 patients (6.7%) discontinued for gastrointestinal events.

CONCLUSIONS

Treatment with ITCA 650, the first injection-free glucagon-like peptide 1 receptor agonist, resulted in significant improvements in glycemic control in poorly controlled long-standing T2D patients with a high baseline HbA1c >10%.
Contente, Claudia. Familias en la tormenta. Tierra, familia y transmisión del patrimonio en el Río de la Plata, siglos XVIII y XIX. Buenos Aires, Prometeo Libros, 2015, 228 págs.
Authors: Arias María Angélica
Published: January 2018

Reseña
CANDI KETHEK: KARAKTER DAN LATAR BELAKANG AGAMA
Authors: Purwanto Heri , Titasari Coleta Palupi , Sumerata I Wayan
Published: January 2018

Each temple building has style and character building its own and built on background a reliegion. As submitted by Soekmono that the temple located in central Jawa with temple in eastern Jawa has style that is different, foundation worship of different. This article presented characters and religious background of Kethek Temple. Goal was to provide information about history of Gunung Lawu. Data collection was done through observation and literature review. Data analysis was using qualitative, comparative, and kontekstual with symbol theory. Result showed that Kethek Temple has special characteristic; is structured from unprocessed andesite. It utilized the wide natural rock order for terrace border, likes was seen on second and third terrace. Religious background Kethek Temple is Hindu. This was based from finding of turtle sculpture in which is symbol Vishnu. Elements worships toward accentors were still visible, considering terraces is form mountain in which was believed as place where the soul of ancestors live. Setiap bangunan candi memiliki gaya dan karakter bangunan tersendiri dan dibangun atas latar belakang agama tertentu. Salah satunya Candi Kethek, yang juga memiliki gaya, karakter, dan latar belakang agama tertentu. Atas pernyataan itu, maka penelitian ini berusaha mengungkap karakter bangunan dan latar belakang agama yang mendasari pendirian Candi Kethek. Metode pengumpulan data yang digunakan meliputi observasi dan kajian pustaka. Analisis yang digunakan ialah kualitatif, komparatif, dan kontekstual. Hasil dari penelitian ini menunjukkan bahwa Candi Kethek mempunyai karakter yang khusus, yaitu tersusun oleh batuan andesit yang tidak mengalami pengerjaan secara menyeluruh. Memanfaatkan tatanan batuan alam yang cukup besar untuk memberi batas teras, seperti yang terdapat pada teras dua dan tiga. Latar belakang agama Candi Kethek bersifat Hinduistik. Hal ini bersandar pada temuan arca kurakura yang merupakan simbol dari Wisnu. Anasir pemujaan terhadap roh nenek moyang juga masih terlihat. Mengingat teras berundak merupakan wujud dari gunung, yang dianggap sebagai tempat bersemayamnya leluhur yang telah meninggal.
Medication Experiences of Hispanic People Living with HIV/AIDS
Authors: Sánchez Luz Dalia
Published: January 2018

Objective: The objective of this study was to describe the medication experiences of Hispanic people living with HIV/AIDS. Specific aims were to describe their current medication experiences and to describe how they viewed their medication history in order to determine essential themes for improving culturally-appropriate medication therapy management services.

Methods: A qualitative, phenomenological research methodology was employed. Ten adults living with HIV/AIDS were audiotaped during semi-structured, in-depth interviews conducted in Spanish. In addition to audiotaping, field notes were taken. Thematic analysis of text was done to obtain themes consistent with the research objectives. Analysis was accomplished in two phases. The first phase applied Van Manen's lifeworld existentials of lived body, lived time, lived relation and lived space as the organizing framework for identifying themes. The second phase identified "essential themes" using holistic, selective, and detailed approaches that were applied to the themes identified in the first phase.

Results: The results showed that lifeworld existentials were relevant medication experiences for Hispanic patients living with HIV/AIDS and their medication-taking behavior during their lives. Ten themes were identified. From these, we identified an overall "essential theme" comprised of: (1) Duality of Living with HIV/AIDS and (2) Primacy of Medications for Hispanic HIV/AIDS patients.

Conclusions: The findings revealed that the medication taking experiences for Hispanic people living with HIV/AIDS can be described in terms of the duality of living with HIV/AIDS as "living dead" patients and in terms of the centrality that medications take in their lives, even to the point of a spiritual level.

Type: Original Research
Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative
Authors: Westberg Sarah M. , Beeksma Kathrine
Published: January 2018

Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic.

Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit.

Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation.

Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting.

Type: Original Research
Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management
Authors: Branham Ashley , Moose Joseph , Ferreri Stefanie
Published: January 2018

Objective: To determine if pharmacist-provided medication therapy management (MTM) improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient's prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR).

Design: Retrospective analysis of medication adherence, pre-post comparison.

Setting: Three independent pharmacies in North Carolina.

Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR).

Intervention: MTM services provided by community pharmacists.

Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC) and change in medication costs for patients and third party payers.

Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8). Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43). However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08) following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR.

Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs.

Type: Original Research