bluuebunny/crossref_metadata_2025 huggingface dataset:
SIMULATION OF FINAL DIRECT EXTRUSION STAGE FOR LARGE RODS WITH LOW EXTRUSION RATIO
Authors: Kargin V. R. , Deryabin A. Yu.
Published: November 2018

The direct extrusion of large 7075 alloy bars 188, 214, 252, 283, 326, 560 mm in diameter was simulated with 0 and 0,5 friction coefficients, 80° and 90° die cone angles from the 800 mm diameter container at the 200 MN press using the DEFORM-2D software package. It provided the distribution of metal flow radial velocities on the dummy block working surface versus the contact friction value, die cone angle and extrusion ratio factor at the main and final stages of extrusion. Butt-end height at the beginning of back-end extrusion defect formation was taken equal to a distance between the dummy block plane and the plane of extruded metal feeding into flat or cone die openings. The joint effect of the extrusion ratio factor, friction coefficient and die cone angle on the butt-end height, extrusion force, deformation and stress intensity factors, and die opening edge temperature was studied. Numerical experiments were performed based on the 23 complete factorial design for the following parameter variability intervals: Х1 = 3÷9, Х2 = 0÷0,5, Х3 = 80÷90°. Friction between the tool and the blank at the final extrusion stage has a negative effect due to a noticeable radial velocity reduction. This leads to the earlier initiation of central back-end extrusion defect formation. Extrusion into the conical die and increasing the extrusion ratio factor, on the contrary, speeds up radial flow velocity and ensures that the back-end extrusion defect starts forming later. The main factor that determines butt-end height is the extrusion ratio factor. A mathematical model is proposed to select the butt-end thickness for specific conditions of extruding large bars with low extrusion ratios.
Structure, mechanical properties and oxidation resistance of MoSi2, MoSiB and MoSiB/SiBC coatings
Authors: Kiryukhantsev-Korneev F. V. , Potanin A. Yu.
Published: November 2018

Magnetron sputtering was used to obtain single-layer MoSi2, MoSiB and multilayer MoSiB/SiBC coatings. Coating structures were studied using X-ray phase analysis, scanning electron microscopy and glow discharge optical emission spectroscopy. Mechanical properties of the coatings were determined by nanoindentation. The coatings were tested for oxidation resistance and thermal stability at temperatures between 600 °С and 1200 °С. It was found that single-layer MoSiB coatings have a hardness of 27 GPa, elasticity modulus of 390 GPa and elastic recovery of 48 % and exhibit short-term oxidation resistance up to 1500 °С inclusive due to a SiO2-based protective film formed on their surfaces. MoSi2coatings have hardness comparable to that of MoSiB but slightly lower oxidation resistance. Multilayer MoSiB/SiBC coatings feature 23–27 GPa hardness and oxidation resistance limited to 1500 °С, but at the same time they have higher elastoplastic properties as compared to MoSiB.
Women’s Coalitions beyond the Laicism–Islamism Divide in Turkey: Towards an Inclusive Struggle for Gender Equality?
Authors: Çağatay Selin
Published: November 2018

In the 2010s in Turkey, the ruling Justice and Development Party’s (AKP) authoritarian-populist turn accompanied the institutionalization of political Islam. As laicism was discredited and labeled as an imposed-from-above principle of Western/Kemalist modernity, the notion of equality ceased to inform the state’s gender policies. In response to AKP’s attempts to redefine gender relations through the notions of complementarity and fıtrat (purpose of creation), women across the political spectrum have mobilized for an understanding of gender equality that transcends the laicism–Islamism divide yet maintains secularity as its constitutive principle. Analyzing three recent attempts of women’s coalition-building, this article shows that, first, gender equality activists in the 2010s are renegotiating the border between secularity and piety towards more inclusive understandings of gender equality; and second, that struggles against AKP’s gender politics are fragmented due to different configurations of gender equality and secularity that reflect class and ethnic antagonisms in Turkish society. The article thereby argues for the need to move beyond binary approaches to secularism and religion that have so far dominated the scholarly analysis of women’s activism in both Turkey and the Nordic context.
Gender and Struggles for Equality in Mining Resistance Movements: Performing Critique against Neoliberal Capitalism in Sweden and Greece
Authors: Landén Angelika Sjöstedt , Fotaki Marianna
Published: November 2018

This article explores the intersections of gender and centre–periphery relations and calls for theoretical and political involvement in gendered struggles against colonial and capitalist forces across different national contexts. The article raises questions about the possibility of resisting inequality and exploitation arising from capitalist expansion and extraction of natural resources in Sweden and Greece, outside of urban contexts. It does so by highlighting women’s role in protest movements in peripheral places and questioning power relations between centre and periphery. The article also argues that making visible women’s struggles and contributions to protest movements brings about vital knowledge for realizing democratic worlds that do not thrive on the destruction of natural resources and the institutionalization of inequalities.
Prolonged duration of response in lenvatinib responders with thyroid cancer (Russian translation)
Authors: Gianoukakis A. G. , Dutcus C. E. , Batty N. , Guo M. , Baig M.
Published: November 2018

We present an updated analysis of lenvatinib in radioiodine-refractory differentiated thyroid cancer (RR-DTC) with new duration of response (DOR) data unavailable for the primary analysis. In this randomized, double-blind, multicenter, placebo-controlled phase 3 study, patients ≥18 years old with measurable, pathologically confirmed RR-DTC with independent radiologic confirmation of disease progression within the previous 13 months were randomized 2:1 to oral lenvatinib 24 mg/day or placebo. The main outcome measures for this analysis are DOR and progression-free survival (PFS). The median DOR for all lenvatinib responders (patients with complete or partial responses; objective response rate: 60.2 %; 95 % confidence interval (CI) 54.2–66.1) was 30.0 months (95 % CI 18.4–36.7) and was generally similar across subgroups. DOR was shorter in patients with greater disease burden and with brain and liver metastases. Updated median PFS was longer in the overall lenvatinib group vs placebo (19.4 vs 3.7 months; hazard ratio (HR) 0.24; 99 % CI 0.17–0.35; nominal P <0.0001). In lenvatinib responders, median PFS was 33.1 months (95 % CI 27.8–44.6) vs 7.9 months (95 % CI 5.8–10.7) in nonresponders. The median DOR of 30.0 months seen with patients who achieved complete or partial responses with lenvatinib (60.2 %) demonstrates that lenvatinib responders can have prolonged, durable and clinically meaningful responses. Prolonged PFS (33.1 months) was also observed in these lenvatinib responders.
Pretiree lifestyles in relation to musculoskeletal health: cross‐sectional data from the Geelong Osteoporosis Study
Authors: Pasco Julie A. , Holloway‐Kew Kara L , Hyde Natalie K , Tembo Monica C , Rufus Pamela G , Sui Sophia X , Berk Michael , Kotowicz Mark A
Published: November 2018

Aims

What happens in the early‐elderly ‘pretiree’ period potentially influences the divergent paths of healthy or unhealthy ageing. In this cross‐sectional study, we aimed to profile musculoskeletal health and lifestyle behaviours for men and women in their late‐fifties and sixties.

Methods and results

For 482 participants from the Geelong Osteoporosis Study, we measured DXA‐derived relative appendicular lean mass (rALM), bone mineral density (BMD) at the femoral neck and percentage body fat mass (%BF). Low‐rALM and low‐BMD referred to sex‐specific T‐scores<‐1.0. Associations between exposures and low‐rALM and/or low‐BMD were explored using multivariable logistic regression. Three‐quarters of participants had high %BF, 98(20.3%) had low‐rALM, 202(41.9%) had low‐BMD and 63(13.1%) had both low‐rALM and low‐BMD. Eight‐two (17.0%) were very active and one‐third participated in sports/recreational activities. Most [n=416(87.8%)] met the recommended daily intake (RDI) for protein; only 119(25.1%) met the RDI for calcium. Less than 10% smoked and one‐third exceeded recommended alcohol intakes. Independent of age, weight and sex, greater %BF and sedentary behaviour increased the likelihood of low‐rALM; high‐alcohol consumption increased the likelihood of low‐BMD; and greater %BF increased the likelihood of low‐rALM and low‐BMD combined.

Conclusions

One‐half of participants had rALM and BMD in the normal range. Only a few were involved in resistance‐training or weight‐bearing exercise, despite having the capacity to be physically active. As sedentary lifestyles, excessive adiposity and high alcohol use were associated with low‐rALM and/or low‐BMD, we propose that these adverse factors be potential targets among pretirees to minimise their risk of entering old age with poor musculoskeletal health.
Multispectral aerial image processing system for precision agriculture
Authors: Kharuf-Gutierrez Samy , Orozco-Morales Rubén , Aday Díaz Osmany de la C. , Pineda Ruiz Emma
Published: November 2018

Cuban agriculture has the growing need to increase its productivity. To achieve this, precision agriculture can play a fundamental role. It is necessary to develop an image processing system able to process all the crops information and calculate vegetation indexes in a satisfactory way. This will entail in accurate measurements of the nitrogen lack, the hydric stress, and the vegetal strength, among other aspects, seeking to improve the accuracy in the care of these aspects. This document reports the results of an investigation pointed to develop a procedure for capturing and processing multispectral aerial images obtained from Unmanned Aerial Vehicles [UAV]. This procedure searched to measure the vegetation indexes of sugarcane crops that may be correlated with the level of vegetal strength, the number of stems, and the foliar mass per lot. We used a USENSE-X8 UAV together with a Sequoia multispectral sensor and the QGIS processing software. The procedure was experimentally validated.
A study to evaluate the accuracy of MRI in comparison to knee arthroscopy in diagnosing cruciate ligament tear and meniscal tears in organized sports and physical exercise related knee injuries in armed forces personnel
Authors: Bucha Atul , Dashottar Sunita , Sharma Surabhi , Pany Preeth , Suthar Rushabh Bhikhanhai
Published: November 2018

Background: Knee injuries related to organised sports and physical training related activities are a major component of injuries sustained by armed forces personnel. Knee instability caused by meniscal and ligamentous injuries cause varying degree of disabilities to the trained soldier and have a serious implication on the battle preparedness of the armed forces. MRI of the knee being a non-invasive modality is being increasingly used in pre and post op evaluation of patients in such cases.Methods: A prospective observational study comprising of 161 patients of knee injuries sustained due to sports and physical training related activities was carried out. MRI and arthroscopic examination of the knee was done, and various statistical tests were performed to evaluate the accuracy of MRI in comparison to arthroscopy.Results: ACL tears were seen in 122 patients (75.5%), PCL tears were seen in 67 patients (41.6%), while medial and lateral meniscus tears were noted in 93 (57.7%) and 50 (31%) patients respectively. The sensitivity and specificity of MRI in detecting ACL tear, PCL tear and medial meniscus injury ranged from 84% - 90.5% and for lateral meniscus it was 72.92% to 86.73 %. The accuracy of MRI in detecting the tear of ACL, PCL and menisci ranged from 82.61% to 89.97%.Conclusions: The accuracy of MRI in detection of meniscal and ACL tears is very high. Pre-operative MRI in conjunction with adequate history and physical examination can help the clinician to make an accurate diagnosis and can help reduce unnecessary arthrosopic surgeries.
Fibrinogen levels in type II diabetes mellitus patients with microvascular complications
Authors: Chikkamath Vijayalakshmi , Darshan Arathi , Appajigol Jayaprakash S. , Angadi Naveen , T. G. Abhishek
Published: November 2018

Background: Diabetes increases the morbidity and mortality due to its propensity to develop micro and macrovascular complications. Recently the role of haemostatic factors, particularly fibrinogen, in atherosclerosis and its complications has invited considerable attention. The present study was conducted to study plasma fibrinogen levels in type II diabetes mellitus patients with microvascular complications.Methods: One hundred patients aged 18years to 60years with type 2 diabetes mellitus with microvascular complications were included in the study. HBA1c, plasma fibrinogen, urine routine examination, fundoscopy, monofilament testing, FBS, PPBS were done. Descriptive statistics was used to analyse data.Results: Out of 100 diabetes patients with microvascular complication studies, 88 patients were found to have hyperfibrinogenaemia. Out of 100 patients 67 patients had HbA1c of more than 8%, and all of them had elevated fibrinogen levels (p <0.0001). The prevalence of hyperfibrinogenemia was higher in patients with diabetic retinopathy (90%), when compared to those without diabetic retinopathy (83.33%) although it was statistically not significant (p=0.266).Conclusions: Hyperfibrinogenemia among type 2 diabetes mellitus patients with microvascular complications was high. Glycaemic control has a significant impact on the fibrinogen levels. Longer the duration of diabetes, there was a higher prevalence of hyperfibrinogenemia.
BRICS ÜLKELERİNİN İKLİM VE ÇEVRE POLİTİKALARI: KARŞILAŞTIRMALI BİR ANALİZ
Authors: Tunçarslan Nilay
Published: November 2018

Ulus ötesi sorunların çözümü için devletlerin kolektif hareket etmesi gerekmekte, en önemli küresel problemlerden biri de iklim değişikliği ve çevresel bozulmalar olarak karşımıza çıkmaktadır. BM bünyesinde gerçekleştirilen uluslararası anlaşma ve protokollerden farklı olarak devletler bireysel olarak da girişimler başlatmakta; sera gazı salınımı, karbondioksit emisyonu, yenilenebilir enerjinin kullanımı gibi konularda verilen taahhütleri yerine getirmeye ve iklim değişikliğiyle mücadele etmeye çalışmaktadırlar. Yükselen güçler olarak karşımıza çıkan ve uluslararası politikada inisiyatif alma arzusunda olan BRICS ülkeleri de iklim konusunda çeşitli girişimlerde bulunmaktadır. Nüfus, ekonomik kapasite ve yüzölçümü bakımından dünyanın büyük bir kesimini oluşturan ülkelerin bu alanda başlatacakları girişimler de büyük önem teşkil etmektedir. Araştırmada BRICS grubunun iklim ve çevre politikalarının karşılaştırılmasında ülkelerin bireysel inisiyatiflerinin yanında, Çevresel Performans Endeksi ve İklim Değişikliği Performans Endeksi verilerinden de yararlanılmaktadır.
DISTRIBUTION IN LARGE URBAN CENTERS: MOBILITY DISABILITIES GENERATING COMPLEX LOGISTICS
Authors: Freitas Kenyth Alves de , Martins Ricardo Silveira
Published: November 2018

Urban population growth in developing countries has transformed mobility in large urban centers more dramatic. In this way, the routine of companies and citizens suggest that restrictions of urban mobility seem to affect the traditional business distribution in large cities. Therefore, this research proposes to analyze how the literature has dealt with the impact of deficiencies in urban mobility on logistic capacities. It was possible to verify that the deficiencies of urban mobility have led to economic activities dispersion by the environment, which implies in an increase of small vehicles fleet and, consequently, resulting in the worse in mobility of goods and people in these cities.
Aspectos relevantes del tamiz neonatal para hiperplasia suprarrenal congénita
Authors: Hinojosa Trejo Mirna Angélica , Arguinzoniz Valenzuela Sletza Lissete , Herrera Pérez Luz del Alba , Caamal-Parra Guillermo , Ibarra González Isabel , Vela Amieva Marcela , Bolaños Córdova Lidia Elizabeth , González Baqué Iñaki , García Flores Erika Paola
Published: November 2018

INTRODUCCIÓN: El beneficio del tamiz neonatal de la hiperplasia suprarrenal congénita está demostrado y la determinación de la 17 aOHP (17-aOHP) en sangre es el biomarcador más utilizado. En México no se conoce bien la prevalencia de esta enfermedad diagnosticada mediante tamiz neonatal.OBJETIVO: Dar a conocer la prevalencia de hiperplasia suprarrenal congénita alnacimiento y describir los valores de 17aOHP en recién nacidos mexicanos según el sexo, edad gestacional y edad de vida extrauterina al momento de la toma de la muestra, peso al nacimiento y condición de salud.MATERIALES Y MÉTODOS: Estudio retrospectivo y longitudinal efectuado en recién nacidos entre el 1 de enero de 2017 y 31 de mayo de 2018 en unidades médicas de la Secretaría de Salud de México. En todos los sujetos de estudio se efectuó la determinación cuantitativa de 17aOHP mediante fluoroinmunoensayo en sangre seca en papel filtro. Todas las muestras de recién nacidos con valor de 17aOHP mayor de 20 nmol/L se notificaron inmediatamente para su localización y efectuarles las pruebas confirmatorias.RESULTADOS: La prevalencia al nacimiento de hiperplasia suprarrenal congénita obtenida en este trabajo fue de 12.6 por cada 100,000 recién nacidos, es decir, 1:7920 recién nacidos tamizados. Las concentraciones de 17aOHP en sangre en papel filtro de los recién nacidos tuvieron diferencias significativas según el peso, edad gestacional y el estado de salud. La proporción de rellamados fue de 0.14%. Un hallazgo de este estudio es el elevado número de recién nacidos sospechosos que fallecieron sin poder ser confirmados (106 muertos de 1820 sospechosos, 5.82%).CONCLUSIÓN: La prevalencia al nacimiento de hiperplasia suprarrenal congénita en este trabajo fue de 12.6 por cada 100,000 (1:7920) recién nacidos tamizados en la Secretaría de Salud de México. Para disminuir el número de casos sospechosos no localizados es necesario reforzar el componente postanalítico del tamiz neonatal.PALABRAS CLAVE: Hiperplasia suprarrenal congénita; deficiencia de 21 hidroxilasa; 17a-hidroxiprogesterona; tamiz neonatal
Retos del Programa de Tamiz Metabólico de la Secretaría de Salud, México
Authors: Herrera Maldonado Nazarea , Vergara Vázquez Mónica , Hinojosa Trejo Mirna Angélica , García Flores Erika Paola
Published: November 2018

En el Sistema de Salud se reconoce al programa de tamiz neonatal como un programa esencial de prevención en Salud Pública. Se entiende como el “esfuerzo organizado de la sociedad, principalmente a través de sus instituciones de carácter público, para mejorar, promover, proteger y restaurar la salud de las poblaciones por medio de actuaciones de alcance colectivo”.
Valores de glucosa-6-fosfato deshidrogenasa y su repercusión en el número de sospechas de tamiz neonatal
Authors: Maldonado Silva Karla , Hinojosa Trejo Mirna Angélica , Ibarra González Isabel , Vela Amieva Marcela , Herrera Pérez Luz del Alba , Caamal Parra Guillermo , Sulu Huicab Justo Eduardo , García Flores Erika Paola
Published: November 2018

INTRODUCCIÓN: La deficiencia de glucosa-6-fosfato deshidrogenasa (dG6PD) es la enzimopatía hereditaria más frecuente en el mundo. La mayoría de los casos son asintomáticos y algunos llegan a padecer anemia hemolítica aguda, ictericia neonatal o anemia hemolítica crónica no esferocítica. En países de Asia y el Mediterráneo y con alta incidencia de malaria, se practica el tamiz neonatal para la dG6PD, pero no existe un consenso universal para su implementación. OBJETIVO: Describir los valores de la actividad de G6PD en papel filtro en recién nacidos, analizar la prevalencia y la repercusión en el número de localizaciones a efectuar en el programa de tamiz neonatal nacional.MATERIAL Y MÉTODOS: Estudio retrospectivo de los resultados del programa de tamiz neonatal de la Secretaría de Salud de México. Se analizó la actividad de la glucosa- 6-fosfato deshidrogenasa dependiendo del tiempo de tránsito (tiempo trascurrido desde la obtención de la muestra de sangre del talón del recién nacido hasta su llegada al laboratorio). Se analizó la prevalencia según la actividad enzimática residual.RESULTADOS: De 1,076,918 recién nacidos tamizados, 343,272 tuvieron tiempo de tránsito adecuado (≤ 6 días). La actividad enzimática desciende significativamente después de ese tiempo. La prevalencia nacional al nacimiento fue de 4.26%, con porcentajes máximos en Veracruz, Nuevo León y Tabasco (21,20 y 15%, respectivamente). CONCLUSIÓN: 4.26% de los recién nacidos en México tienen dG6PD; es decir, un caso por cada 23 tamizados, lo que implica un elevado número de sujetos para localizar y evaluar en los programas de tamiz neonatal y en las instituciones que llevan a cabo el seguimiento clínico.PALABRAS CLAVE: Glucosa 6-fosfato deshidrogenasa, deficiencia de glucosa 6-fosfato deshidrogenasa, tamiz neonatal, prevalencia.
Avances y logros del programa de tamiz metabólico neonatal (2012-2018)
Authors: García Flores Erika Paola , Herrera Maldonado Nazarea , Hinojosa Trejo Mirna Angélica , Vergara Vázquez Mónica , Halley Castillo María Elizabeth
Published: November 2018

Los errores innatos del metabolismo representan un problema emergente de salud pública que requiere estrategias puntuales y esfuerzos continuos. Actualmente, el tamiz neonatal es el único método para la detección temprana de este tipo de enfermedades porque permite identificar a los recién nacidos afectados antes de que se genere el daño irreversible que causan estas enfermedades. En los últimos seis años, el panel de detección en la Secretaría de Salud ha pasado de 1 a 6 enfermedades. El financiamiento del programa ha sido fundamental para el desarrollo del tamiz neonatal porque lo ha garantizado como proceso integral, incrementando gradualmente los recursos asignados a esta política pública. La contratación de servicios especializados e integrales ha permitido una mejora sustancial en los indicadores del tamiz neonatal, agilizó la entrega de resultados, garantizó el acceso a pruebas confirmatorias al 100% de casos sospechosos en menos tiempo, lo que en conjunto ha conseguido reducir el tiempo de inicio del tratamiento y, por tanto, la limitación del daño o prevención de la discapacidad.PALABRAS CLAVE: Tamiz metabólico; errores innatos del metabolismo
Aquaporins in human platelets: intracellular localization and possible role in granule and lysosome secretion
Authors: Misztal Tomasz , Rusak Tomasz , Brańska-Januszewska Justyna , Gąsowska Marta , Szynaka Beata , Gołaszewska Agata , Bruczko Marta , Tomasiak Marian
Published: November 2018

This study was undertaken to establish the presence and the role of aquaporins (AQPs) in human platelets. Immunodetection with polyclonal antibodies and fluorescent microscopy suggest the presence of AQP isoforms – 0–7 and 9–12 – localized (in resting platelets) in the plasma membrane and in the dense and alpha granules. In thrombin- or monensin-treated platelets, the granules’ AQPs become visible in the whole cell body, indicating the granules’ swelling. In our studies on the role of AQPs in platelet responses we used tetrachloroauric acid (HAuCl4), a classical water channel blocker. We found that 10–100 µM of Au(III) inhibited the hypotonicity-, monensin (simulating the action of Na+/H+ exchanger)-, and collagen-evoked platelet swelling and reduced tritiated water uptake by platelets treated by collagen or monensin, indicating its ability to block water channels in these cells. HAuCl4, at the concentrations reducing water influx, did not induce cell lysis, alter the plasma membrane shape or the –SH group content. The inhibitor also failed to affect Na+ and Cl--related osmotic gradient formation and protein kinase D2 phosphorylation. In platelets activated by threshold concentrations of collagen, the thrombin receptor activating peptide, ADP, calcium ionophore A23187, phorbol ester and arachidonic acid, HAuCl4 (100 µM) completely inhibited secretion of ATP from dense granules but failed to reduce platelet aggregation. In collagen-stimulated platelets, HAuCl4 (10–100 µM) reduced secretion from dense and alpha granules, as well as lysosomes, in a dose-dependent manner. We conclude that human platelets possess numerous AQPs subtypes localized in the plasma and granule membranes. AQP-mediated water fluxes may be crucial for platelet volume regulation as well as secretion from dense and alpha granules and lysosomes.
Caracterização hidrológica de nascentes de sub-bacias hidrográficas na região do Alto Rio Grande, MG
Authors: Da Silva Lucas Alves , Da Silva Antônio Marciano , Coelho Gilberto , Pinto Leandro Campos , Eduardo Eliete Nazaré
Published: November 2018

Caracterização hidrológica de nascentes associadas à dinâmica local têm se mostrado um instrumento importante na gestão dos recursos hídricos. Neste sentido, realizou-se a caracterização morfométrica das áreas de recarga, a modelagem hidrológica das vazões e a quantificação do uso e ocupação do solo, em dez nascentes das sub-bacias hidrográficas dos Ribeirões Lavrinha e Marcela, sendo cinco em cada sub-bacia. Verificou-se grande variabilidade espacial e temporal das vazões das nascentes durante o de 2008. As duas sub-bacias hidrográficas monitoradas apresentaram grande diferença em termos de produção de água em suas nascentes, podendo estas diferenças ser atribuídas ao regime pluviométrico de cada localidade. Nas duas sub-bacias existem relações importantes entre as condições de uso e ocupação do solo, características topográficas, características de forma e manejo do solo com a capacidade de manutenção do fluxo de água durante o ano, rendimento específico médio mensal e o deflúvio anual das nascentes.
Análise de tendência de mudanças climáticas para a região sul do estado de Minas Gerais no período de 1976 a 2006
Authors: Lemos Brenda Carolina dos Santos , Silva Leonara Padilha da , Miranda Wezer Lismar , Abreu Leandro Garcia de
Published: November 2018

As alterações climáticas relacionadas ao aquecimento global podem afetar ecossistemas, biomas e ambientes variados, o que vem acarretando amplas discussões no ambiente acadêmico, político e social com o intuito de desenvolver métodos para reduzir este processo fortemente influenciado pelas ações antrópicas. No entanto, para se constatar tais mudanças é necessário a utilização de critérios científicos, dessa forma, objetivou-se com este trabalho analisar a variação da precipitação e das temperaturas mínima, máxima e média do ar nas cidades de Lambari e Lavras, situadas no sul do estado de Minas Gerais. Para tanto, foram coletados dados diários de temperatura mínima, média e máxima do ar ao longo do período de 1976 à 2006 oriundos de Estações Climatológicas Principais, instaladas nas cidades citadas. Foram calculadas as temperaturas médias anuais para toda a série por meio da média aritmética dos valores diários, para as temperaturas máximas, mínimas e médias. Para a precipitação pluvial calculou-se o acumulado anual e em seguida foi feita análise de regressão linear para os referidos valores. Os resultados indicaram tendência de aumento da temperatura máxima, média e mínima do ar ao longo do tempo. Quanto à precipitação, não ficou caracterizado uma tendência de acréscimo ou decréscimo, em função do baixo valor do coeficiente de determinação.
Efficacy of Hematological and Coagulation Parameters in the Diagnosis and Prognosis of Patients with Acute Coronary Syndrome
Authors: Adam Arsalan Majeed , Ali Muhammad Armughan , Shah Arshad Ali , Rizvi Ather Hasan , Rehan Aiman , Godil Ansab , Abbas Abdul Haseeb , Durrani Najam Ul Ain , Shaikh Ali Tariq , Mallick Muhammad Saad Ali , Lashari Muhammad Nawaz
Published: November 2018

Background: The diagnosis and management of acute coronary syndrome (ACS) have improved significantly over the past few decades; however, the recognition of myocardial ischemia still proves to be a dilemma for cardiologists. The aim of this study was to determine the role of hematological and coagulation parameters in the diagnosis and prognosis of patients with ACS.
Methods: This prospective study recruited 250 patients with ACS and 250 healthy controls. The diagnostic role of hematological and coagulation parameters was assessed by comparing the patients with ACS with the control group. The relationships between these parameters and mortality were determined by dividing the patients into 2 groups: Group A (discharged) and Group B (patients who died within 30 days of follow-up). Multivariate Cox regression analysis was performed to calculate the hazard ratio (HR).
Results: The mean age of the patients was 55.14±10.71 years, and 65.2% of them were male.  Prothrombin time (P<0.001), activated partial thromboplastin time (P<0.001), mean platelet volume (MPV) (P<0.001), white blood cell (WBC) count (P<0.001), and red blood cell distribution width (RDW) (P<0.001) were significantly higher in the case group than in the control group. WBC count (P<0.001), RDW (P<0.001), and MPV (P<0.001) were significantly higher in the controls than in the case group. The Cox regression model showed that RDW above 16.55% (HR=6.8), MPV greater than 11.25 fL (HR=2.6), and WBC higher than 10.55×103/μL (HR=6.3) were the independent predictors of mortality.
Conclusion: In addition to being the independent predictors of short-term mortality, RDW, WBC, and MPV when used together with the coagulation profile may aid in the diagnosis of ACS in patients presenting with chest pain.
Severe Bradycardia Prior to Coronary Artery Bypass Graft Surgery: A Case Report
Authors: Harky Amer , Bashir Mohamad , Grafton-Clarke Ciaran , Lees Martin , Fendius Sarah , Roberts Neil
Published: November 2018

Intraventricular conduction abnormalities following cardiac surgery have been thoroughly described, especially after valvular surgery. It is also widely known that several anesthetic factors can cause autonomic disturbances resulting in the unmasking of sinus node dysfunction, significant bradycardia, and cardiovascular collapse during the intraoperative period. However, little is known about asymptomatic episodes, especially those occurring prior to coronary artery bypass grafting (CABG). We report a rare occurrence of an intraventricular conduction defect that presented in an asymptomatic patient following non–ST-elevation myocardial infarction prior to urgent CABG. Our patient presented with sudden-onset chest pain, and following coronary angiography he was found to have triple-vessel coronary disease. During anesthetic induction for inpatient CABG surgery, he developed episodes of acute sinus tachy-brady episodes, requiring a stat dose of adrenaline to maintain the heart rate prior to the establishment of cardiopulmonary bypass. The arrhythmia persisted postoperatively, necessitating the insertion of a permanent dual-chamber pacemaker for complete heart block. The patient was later discharged without further complications, and upon follow-up 12 months later, he remains in good health.
Unusual Type of Pulmonary Stenosis Evaluated by 2D and 3D Transesophageal Echocardiography
Authors: Hosseinsabet Ali
Published: November 2018

A 19-year-old male patient was referred to our echocardiography department for a better evaluation of his pulmonary stenosis. His chief complaint was dyspnea on exertion (New York Heart Association functional class II). Physical examinations revealed the presence of pectus excavatum and systolic murmurs at the right parasternal border with II/VI severity. Transthoracic echocardiography was not significantly informative due to the chest deformity; accordingly, 2D and 3D transesophageal echocardiography was done, which demonstrated thickening of the pulmonary valve cusps and restriction of their motion. Additionally, the tip of the posterolateral pulmonary cusp was attached to the sinotubular junction, resulting in the malcoaptation of the pulmonary valve cusp, moderately severe pulmonary regurgitation, and stenosis (peak pressure gradient=62 mmHg) (Figures 1 & 2). In some cases, evaluation of the pulmonary valve via transesophageal echocardiography is more informative and comprehensive than that via transthoracic echocardiography.
Comparison of Efficacy in Improving Cardiopulmonary Resuscitation Performance between Video Training and the Standard Method
Authors: Tavan Hamed , Sahebi Ali , Golitaleb Mohamad
Published: November 2018

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Gangguan Tidur pada Lanjut Usia
Authors: Sunarti Sri , Helena Helena
Published: November 2018

Sekitar 50% orang lanjut usia mengalami kesulitan tidur gangguan tidur memberikan pengaruh negatif yang signifikan pada kesehatan fisik dan mental, terutama pada orang lanjut usia. Gangguan tidur pada orangtua dapat bersifat akut atau kronis, dapat disebabkan karena faktor intrinsik atau gangguan tidur primer atau sekunder akibat penyakit lain, gangguan psikologis atau fisik, faktor lingkungan dan efek samping obat. Gangguan tidur dapat mempengaruhi kualitas hidup pada orangtua, menurunkan status imunologi, gangguan hormonal dan endokrinologi, serta penurunan fungsi kognitif. Manajemen untuk gangguan tidur ini meliputi terapi non-farmakologis dan farmakologis. Perubahan perilaku dan modifikasi diet pada beberapa penyebab gangguan tidur terbukti efektif. Intervensi non-farmakologis seperti sleep hygiene dan terapi perilaku kognitif merupakan terapi lini pertama pada berbagai gangguan tidur.
Pengetahuan Perawat Ruang Rawat Inap Tentang Penerapan Sasaran Keselamatan Pasien
Authors: Riskiyah Riskiyah -
Published: November 2018

Keselamatan pasien (patient safety) merupakan bagian penting dari mutu pelayanan kesehatan di rumah sakit. Perawat yang memiliki pengetahuan tentang keselamatan pasien dapat memperkecil risiko terjadinya hal yang membahayakan maupun merugikan pasien.  RS X  merupakan rumah sakit Ibu dan Anak dimana disana masih ada insiden keselamatan pasien yang terjadi meskipun sosialisasi dan pelatihan tentang patient safety sudah dilakukan. Tujuan penelitian ini untuk mengeksplorasi secara mendalam pengetahuan perawat tentang penerapan sasaran keselatan pasien. Metode yang dipakai adalah kualitatif fenomenologi. Wawancara secara mendalam kepada 8 informan. Hasil penelitian didapatkan enam tema yaitu pengetahuan perawat tentang penerapan SKP berupa ketepatan identifikasi pasien;  peningkatan komunikasi  yang efektif; peningkatan keamanan obat yang perlu diwaspadai; kepastian tepat lokasi, tepat prosedur dan tepat pasien operasi; pengurangan risiko infeksi; pengurangan risiko pasien jatuh. Kesimpulannya sebagian besar perawat rawat inap RS X mempunyai pengetahuan dan pemahaman yang baik tentang penerapan sasaran keselamatan pasien.

Kata kunci : patient safety, sasaran keselamatan pasien, pengetahuan

 
Pisom Qaq’al: la majestad envuelta. Poder, reliquias y el "poder de las reliquias" entre los mayas prehispánicos.
Authors: Maza García de Alba Rocío
Published: November 2018

La preservación de restos humanos, muchas veces contenidos en envoltorios, fue una práctica común entre los mayas prehispánicos. Este artículo explica el interés por conservar tales reliquias en virtud del contenido anímico que resguardaban, que parece haber sido una cualidad solar, masculina, con poder seminal y de manifestación majestuosa. En un primer momento discuto, a través de la información presente en fuentes históricas, algunos de los tratamientos mortuorios que conducían a la generación de reliquias, así como los contextos en los que éstas eran conservadas y los usos sociales a los que estaban destinadas en tiempos cercanos a la llegada de los españoles. Distingo tres tipos principales de reliquias: las reliquias domésticas relacionadas con un linaje, las de los dioses o ancestros fundadores, de importancia comunitaria, y las de los sacrificados y cautivos, asociadas con la noción de trofeos de guerra. El análisis conjunto de estas categorías abre las vías para interrogar las concepciones mayas sobre los ancestros, la conformación de la persona y el ejercicio de la autoridad, que explican la importancia ritual de las reliquias y su papel en la legitimación del poder. A partir de estas cuestiones, indago en un segundo momento en la naturaleza del poder intrínseco que se adjudicaba a dichos objetos. Para ello parto de la denominación dada al envoltorio sagrado de los fundadores quichés: pisom q’aq’al, término que revela la consideración de las reliquias como custodias de cierto “fuego”, q’aq’, o “majestad”, q’aq’al, identificable con una fuerza o calor vital asociado con el poder, que ha sido documentado tanto etnográficamente como en fuentes históricas y lingüísticas coloniales entre distintos grupos mayas con nombres variables, pero manteniendo rasgos característicos que dan cuenta de una concepción compartida, con antecedentes en las cualidades solares de los señores del período Clásico.
Optimasi Kombinasi Pati Umbi Gembili (Dioscorea esculenta (Lour.) Burk) dan Pati Umbi Ganyong (Canna edulis Ker.) Sebagai Bahan Pengisi Tablet Ibuprofen dengan Metode Simplex Lattice Design
Authors: Maghfiroh Nailul , Ermawati Dian Eka , Rohmani Sholichah
Published: November 2018

Pati umbi gembili dan ganyong merupakan bahan pangan yang belum banyak pemanfaatannya dalam bidang farmasi terutama sebagai bahan pengisi tablet. Tablet masih populer sebagi sistem penghantaran obat di masyarakat. Penggunaan pati umbi, sebagai bahan pengisi memberikan gagasan baru dan diharapkan dapat mengurangi efek samping ibuprofen pada lambung, yang biasanya dikonsumsi bersamaan dengan makanan. Tujuan dari penelitian ini untuk mengetahui proporsi kombinasi optimum campuran pati gembili-ganyong yang menghasilkan sifat fisik granul, tablet dan disolusi sesuai persyaratan tablet yang baik. Optimasi proporsi pati gembili-ganyong menggunakan metode Simplex Lattice Design dengan Software Design Expert. Tablet ibuprofen dibuat dengan metode granulasi basah dalam 8 formula dari SLD dengan respon stabilitas fisik : waktu alir, keseragaman bobot, dan waktu hancur. Formula dengan respon tertinggi merupakan formula optimum. Hasil pengujian formula optimum dengan hasil prediksi SLD dilakukan uji statistika menggunakan analisa statistika uji-t, selanjutnya dilakukan uji disolusi. Hasil optimasi menunjukkan nilai perbandingan pati umbi gembili-ganyong yang optimum adalah 82,11% : 17,89%. Hasil analisa statistika uji-t dari formula optimum dengan formula prediksi SLD tidak terdapat perbedaan yang signifikan dengan nilai p-value > 0,05. Hasil sifat fisik formula optimum ibuprofen meliputi; waktu alir sebesar 4,92 detik ± 0,46 dan sudut diam 26,960 ± 1,35; keseragaman tablet 501,72 mg ± 2,29; kekerasan 7,45 Kg ± 0,38; kerapuhan 0,81% ± 0,01; waktu hancur 9,16 menit ± 0,75; kadar zat aktif tablet 92,49%-105,76% dan uji disolusi dengan nilai DE% sebesar 78,25%.
Clinical and Radiographic Outcomes of a Posteriorly Augmented Glenoid Component in Anatomic Total Shoulder Arthroplasty for Primary Osteoarthritis with Posterior Glenoid Bone Loss
Authors: Ho Jason C. , Amini Michael H. , Entezari Vahid , Jun Bong Jae , Alolabi Bashar , Ricchetti Eric T. , Iannotti Joseph P.
Published: November 2018

Background:

The primary objectives of this study were to evaluate the ability of a posteriorly stepped augmented glenoid component, used in patients with primary glenohumeral osteoarthritis with B2 or B3 glenoid morphology, to correct preoperative retroversion and humeral head subluxation and to identify factors associated with radiographic radiolucency and patient-reported clinical outcomes.

Methods:

We identified 71 shoulders with B2 or B3 glenoid morphology that underwent anatomic total shoulder arthroplasty with use of a posteriorly stepped augmented glenoid component and with a preoperative 3-dimensional computed tomography (3D-CT) scan and a minimum of 2 years of clinical and radiographic follow-up. The Penn Shoulder Score (PSS), shoulder range of motion, glenoid center-peg osteolysis, and postoperative version and humeral head subluxation were the main outcome variables of interest.

Results:

Follow-up was a median of 2.4 years (range, 1.9 to 5.7 years); the mean patient age at treatment was 65 ± 7 years (range, 51 to 80 years). PSS, range of motion, humeral head centering, and glenoid version were significantly improved among all patients (p < 0.0001). Patients with persistent posterior subluxation of the humeral head postoperatively had worse preoperative fatty infiltration of the teres minor and greater postoperative component retroversion (p < 0.05). Patients with center-peg osteolysis had more preoperative joint-line medialization and posterior glenoid bone loss (p < 0.05). Patients with more preoperative humeral head posterior subluxation had a lower PSS, adjusting for confounders (p < 0.05).

Conclusions:

Posteriorly stepped augmented glenoid components can improve pathologic retroversion and posterior subluxation of the humeral head in B2 and B3 glenoids, with significant improvements found in clinical outcome scores at a minimum of 2 years of follow-up in the vast majority of patients.

Level of Evidence:

TherapeuticLevel IV. See Instructions for Authors for a complete description of levels of evidence.
Safety of Overlapping Inpatient Orthopaedic Surgery
Authors: Dy Christopher J. , Osei Daniel A. , Maak Travis G. , Gottschalk Michael B. , Zhang Alan L. , Maloney Michael D. , Presson Angela P. , O’Keefe Regis J.
Published: November 2018

Background:

Although overlapping surgery is used to maximize efficiency, more empirical data are needed to guide patient safety. We conducted a retrospective cohort study to evaluate the safety of overlapping inpatient orthopaedic surgery, as judged by the occurrence of perioperative complications.

Methods:

All inpatient orthopaedic surgical procedures performed at 5 academic institutions from January 1, 2015, to December 31, 2015, were included. Overlapping surgery was defined as 2 skin incisions open simultaneously for 1 surgeon. In comparing patients who underwent overlapping surgery with those who underwent non-overlapping surgery, the primary outcome was the occurrence of a perioperative complication within 30 days of the surgical procedure, and secondary outcomes included all-cause 30-day readmission, length of stay, and mortality. To determine if there was an association between overlapping surgery and a perioperative complication, we tested for non-inferiority of overlapping surgery, assuming a null hypothesis of an increased risk of 50%. We used an inverse probability of treatment weighted regression model adjusted for institution, procedure type, demographic characteristics (age, sex, race, comorbidities), admission type, admission severity of illness, and clustering by surgeon.

Results:

Among 14,135 cases, the frequency of overlapping surgery was 40%. The frequencies of perioperative complications were 1% in the overlapping surgery group and 2% in the non-overlapping surgery group. The overlapping surgery group was non-inferior to the non-overlapping surgery group (odds ratio [OR], 0.61 [90% confidence interval (CI), 0.45 to 0.83]; p < 0.001), with reduced odds of perioperative complications (OR, 0.61 [95% CI, 0.43 to 0.88]; p = 0.009). For secondary outcomes, there was a significantly lower chance of all-cause 30-day readmission in the overlapping surgery group (OR, 0.67 [95% CI, 0.52 to 0.87]; p = 0.003) and shorter length of stay (eβ, 0.94 [95% CI, 0.89 to 0.99]; p = 0.012). There was no difference in mortality.

Conclusions:

Our results suggest that overlapping inpatient orthopaedic surgery does not introduce additional perioperative risk for the complications that we evaluated. The suitability of this practice should be determined by individual surgeons on a case-by-case basis with appropriate informed consent.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Michigan Arthroplasty Registry Collaborative Quality Initiative Experience: Improving the Quality of Care in Michigan
Authors: Hughes Richard E. , Zheng Huiyong , Igrisan Rochelle M. , Cowen Mark E. , Markel David C. , Hallstrom Brian R.
Published: November 2018

The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) is a regional quality improvement effort that is focused on hip and knee arthroplasty. From its inception in 2012, MARCQI has grown to include data from 66 hospitals and surgery centers, and contains over 209,000 fully abstracted cases in its database. Using high-quality risk-standardized outcomes data, MARCQI drives quality improvement through a collaborative and nonpunitive structure. Quality improvement initiatives have included transfusion reduction, infection prevention, venous thromboembolism reduction, and reduction of discharge to nursing homes. In addition, MARCQI focuses on postmarket surveillance of implants by computing revision-risk estimates based on the cases that were registered prior to the end of 2016. This paper describes the impact of MARCQI on the quality of hip and knee arthroplasty care in the state of Michigan since its inception in 2012, and it briefly summarizes the recently released 5-year report.
Open Reduction and Tunneled Suspensory Device Fixation Compared with Nonoperative Treatment for Type-III and Type-IV Acromioclavicular Joint Dislocations
Authors: Murray Iain R. , Robinson Patrick G. , Goudie Ewan B. , Duckworth Andrew D. , Clark Kathryn , Robinson C. Michael
Published: November 2018

Background:

Nonoperative management of complete acromioclavicular (AC) joint dislocation has yielded reasonable results, although patients may report dissatisfaction with the outcome. The purpose of this prospective, randomized, controlled trial was to compare patient outcome following nonoperative care versus operative treatment with open reduction and tunneled suspension device (ORTSD) fixation for acute, type-III or IV disruptions of the AC joint.

Methods:

Sixty patients aged 16 to 35 years with an acute type-III or IV disruption of the AC joint were randomized to receive ORTSD fixation or nonoperative treatment, following a power analysis to determine sample size. Functional outcomes were assessed with use of the Disabilities of the Arm, Shoulder and Hand (DASH) as the primary outcome measure and the Oxford Shoulder Scores (OSS) and Short Form (SF-12) as secondary outcome measures at 6 weeks, 3 months, 6 months, and 1 year after treatment. Reduction was evaluated with use of radiographs. Any complications were noted at each assessment. The economic implication of each treatment was evaluated.

Results:

ORTSD and nonoperative groups were similar with regard to demographics at baseline. The mean degree of radiographic displacement was significantly less in patients following ORTSD fixation (1.75 mm) compared with patients who received nonoperative treatment (10.61 mm, p < 0.0001). At 1 year postoperatively, the mean DASH score was 4.67 in the nonoperative treatment group and 5.63 in the ORTSD group, and the mean OSS was 45.72 and 45.63, respectively. Patients managed with ORTSD fixation had inferior DASH scores at 6 weeks (p < 0.01). There were 5 patients who experienced failed nonoperative treatment and subsequently underwent a surgical procedure. ORTSD fixation (£3,359.73) was associated with significantly higher costs than nonoperative treatment (£796.22, p < 0.0001).

Conclusions:

ORTSD fixation confers no functional benefit over nonoperative treatment at 1 year following type-III or IV disruptions of the AC joint. Although patients managed nonoperatively generally recovered faster, a substantial group of patients remained dissatisfied following nonoperative treatment and required delayed surgical reconstruction. We were unable to identify any demographic or injury-related factors that predicted a poorer outcome in these patients.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Estimaciones de la población actual (ePOBa) a nivel municipal. Discrepancias censo-padrón a pequeña escala
Authors: Goerlich Gisbert Francisco José
Published: November 2018

Texto resumen.
La región metropolitana de Barcelona. Dinámicas territoriales recientes
Authors: Miralles-Guasch Carme , Tulla Pujol Antoni F.
Published: November 2018

Texto resumen.