bluuebunny/crossref_metadata_2025 huggingface dataset:
Uma visão global do “munus docendi” na Igreja
Authors: Neves Rogério Augusto das
Published: February 2019

O Código de Direito Canônico de 1983 foi elaborado de modo a seguir um novo esquema de pensamento, qual seja, a eclesiologia própria do Concílio Vaticano II. Essa disposição põe em relevo a realidade do tríplice munus, consagrado nos documentos do Concílio, e oferece à missão de anunciar o Evangelho uma colocação especial ao estabelecer-lhe um livro próprio. A essa novidade urge descobrir as consequências de tal proposta. Desse modo, o legislador apresenta a sua disposição de tornar concreta na vida pastoral da Igreja a eclesiologia que emerge do mesmo Concílio. Tratando-se do Livro III, que trata da missão de ensinar da Igreja, encontramos a determinação ousada de se transformar um simples título do Código antigo em uma verdadeira parte do Código novo. De sua parte, o Livro III se subdivide em cinco títulos: Título I. Do ministério da Palavra de Deus (capítulo I. Da pregação da Palavra de Deus; capítulo II. Da formação catequética); Título II. Da ação missionária da Igreja; Título III. Da educação católica (capítulo I. Das escolas; capítulo II. Das universidades católicas e outros institutos de estudos superiores; capítulo III. Das universidades e faculdades eclesiásticas); Título IV. Dos meios de comunicação social e em especial dos livros e Título V. Da profissão de fé. O presente artigo se propõe discorrer brevemente sobre esses títulos a fim de oferecer uma panorâmica sobre o munus de ensinar da Igreja no Livro III do atual Código de Direito Canônico.
A natureza especial da prova pericial
Authors: Arroba Conde Manuel Jesús
Published: February 2019

A especialidade da perícia em relação às suas dificuldades; a perícia e a finalidade do processo: “votum” e “peritia sensu technico”; a necessidade de periciar pelo menos os autos: o objeto do relatório; a avaliação da perícia direta e indireta.
A novíssima missão do defensor do vínculo
Authors: Sampel Edson Luiz
Published: February 2019

Este artigo procura demonstrar a grande importância do múnus de defensor do vínculo após as mudanças levadas a efeito pelo papa Francisco em 2015, com a alteração do processo de nulidade de casamento. A ideia perfilhada neste estudo é que o defensor do vínculo tornou-se personagem-chave na missão de salvaguardar o casamento válido e consumado contra todo tipo de decisões judiciais eventualmente frágeis ou condescendentes.
The Internalization Effort of Student Scientific Attitude through Inductive Teaching Method in Basic Physics Practical Course, Biology Study Program - PMIPA FKIP UR
Authors: Zulhelmi Zulhelmi , Nur Muhammad
Published: February 2019

The purpose of this study is to know the internalization improvement of scientific attitude of Biology Education Student - PMIPA FKIP UR through the application of Inductive Teaching Methods in the Basic Physics Practical course. The approach used in this study was a Classroom Action Research (CAR) with cyclic pattern which consists of planning, implementation, observation and reflection. After two time actions, the results of the assessment of the scientific attitude of the students increased from 28.46% to 51.50% in cycle 1 and to 79.96% in cycle 2. In general, the indicator scientific attitude has been quite embedded in students. Assessment of student activity increased from 12.56% to 65.50% in cycle 1 and to 78.06% in cycle 2. This result shows that the learning activity by applying the Inductive Teaching Methods has been understood by the students. Assessment on student performance in the implementation of the lab also increased, from the average of 80.55% in cycle 1 to 81.87% in cycle 2. Based on the results of the analysis, it can be concluded that through the application of inductive Teaching Methods in the Basic Physics Practical course in Biology Education Study Program PMIPA FKIP UR can escalation the internalize scientific attitude of student.
Perceptions of Certified EFL Teachers Pertaining to Teacher Certification Program in Central Sulawesi, Indonesia
Authors: Syafar Anshari
Published: February 2019

The state and condition of Indonesian teachers have gradually changed to a better nuance due to the compensation of teacher certification program (TCP). The program has conceivably raised the status of the teachers in social and economic lives. However, the impact of the program on the improvement of overall teacher‘s quality—teaching performance as mandated by Teacher and Lecturer Law remains questionable, and the big question is what and how teachers perceive and act in response to the objective of the program. The program aims not only to increase the teachers‘ salary, but also to improve the quality of their teaching performance based on the teacher standard competence, that is pedagogical, personality, social, and professional competences. Therefore, the study explore and describe certified EFL teachers‘ perceptions concerning benefits of the program on thier social and economic lives, improvement and quality of their teaching practices; perceptions on the ways management ran the program; and expectations for better services of the TCP management.
Insight stories: Looking into teacher support in enhancing scientific thinking skills among pre-school students
Authors: Monnas Latifah Binti
Published: February 2019

Due to the revision of the National Pre-School Standard Curriculum (KSPK) 2017, the strengthening of Science and Technology Support and STEM integration early childhood education in Malaysia is now being aggressively developed in line with national education policies. This case study is conducted to find out how pre-school teachers apply science process elements in their teaching and learning activities. Observation was carried out on a pre-school teacher during a lesson in one of the national pre-schools in Tawau. Observation findings show that preschool teachers understand the need for  early science education though they lack the knowledge and application of the scientific skills. Therefore, it is highly recommended for pre-school teachers to improve appropriate pedagogical practices, and support the early process of science in early childhood education by contextually emphasizing and linking  their teaching to the 21st century curriculum.
Development of interactive multimedia based on Lectora Inspire in chemistry subject in junior high school or madrasah tsanawiyah
Authors: Herdini Herdini , Linda Roza , Abdullah Abdullah , Shafiani Nur , Darmizah Fitri ‘Alaina , Dishadewi Praslita
Published: February 2019

The research aims to develop interactive multimedia based Lectora Inspire on science chemistry subjects for SMP/MTs. The research method using the design of research and development (Research and Development) with a model Plomp, which consists of four phases; initial investigation, design, realization and construction, and validation, test and revision. The research was conducted at the University of Riau FKIP. The object of research is interactive multimedia Lectora Inspire. Data collected by validating based interactive multimedia Lectora Inspire to 3 validator (media expert and subject matter experts) and limited trial by users that teachers and students in SMP 4 and SMP Babussalam Pekanbaru. The results showed an average score of validator 98.20% . Score of limited trial based on questionnaire responses of teachers and students each obtained an average score of 98.78% and 97.03%. From the result of the average score of the validation and limited trial of interactive multimedia based Lectora Inspire for chemistry subjects for SMP / MTs valid and can be used as a learning media.
The use of google earth as the learning media in geosciences education
Authors: Islami Nur
Published: February 2019

In studying geosciences, students sometimes face some problems because occasionally they are not able to visualize the earth in their minds. This difficulty is increasingly moreover, if it concerns the distance and height of the topography of the earth, as well as the earth and its relationship to all aspects of life. In this study, the use of google earth as the learning media has been examined to help students understanding in learning geosciences. Students were given guidelines of google earth usage and then students were asked to create a mini project in terms of using of google earth. After that students were given a questioner that is questioned about understanding of the learned material with the help of google earth. The results show that almost all students are fully aware of what they are doing. They also gave an average score of 3.8 (scale 4) in terms of the google earth utilities in learning geosciences. It can be concluded that google earth is able to provide a deeper understanding to the students in studying the concept of physics of earth.
Managerial development model of head of SMA in Padangsidempuan to achieve quality school
Authors: Siagian Dunia , Rukun Kasuk , Marsidin Sufyarma , Anwar Syafri
Published: February 2019

The aim of this study is to develop a model of leadership managerial competence of head of High School in Padangsidimpuan. The expected model can be used as a reference for school supervisors in conducting guidance of managerial competence of head of SMA Padangsidimpuan. This research was done using research and development (R and D) by applying the procedural model. The data of this research are consisted of (1) qualitative data that was obtained from observation, interview, and documentation of the study and it was analyzed using descriptive statistics. (2) quantitative data by using questionnaire. The qualitative data were analyzed using three ways, ie data reduction, data presentation, and taking conclusions. The findings of this study are (1) The coaching is focused on the administrative aspect and has not yet touched the managerial competence of the principal of SMA Padangsidimpuan and (2) the coaching process has not been done properly. This research resulted a model of managerial competence development for the head of SMA Padangsidimpuan consisting of two components, namely (1) the identification instrument of managerial competence and, (2) the steps of coaching the managerial competence of the principal of SMA Padangsidimpuan. This model is equipped with a support system that includes a program of leadership managerial competence of senior high school Padangsidimpuan. The test results show that this model is practical and effective for use in improving the managerial competence of SMA Padangsidimpuan. How well the model of guiding the managerial competence of the principal produced will not mean anything if its use does not get support from the parties related to the principal guidance in particular and general education management. It is therefore necessary to support the school superintendent to use this model within the Padangsidimpuan.
Demonstration of the Google Earth as a Tool in Learning the Earth Physics
Authors: Islami Nur
Published: February 2019

Earth Physics is a course at the Physics Education Program Study, University of Riau, Indonesia. The problem facing by students were the student commonly not able to imagine the rotation effect and the tilt of rotation axis to some phenomenon. Furthermore the students were difficult to imagine the subduction zone of two tectonic plates. This study was demonstrate some assignments to the student regarding the use Google Earth in the learning the earth physically. In this study, a total of 38 students were chosen to use the Google Earth as an interactive learning media. To demonstrate the Google Earth in the learning process, several assignments have been given to the students. The first was to compare the distance measurement manually and through Google Earth. The second demonstration was to define some selected areas. The third was to demonstrate the tilt axis of rotation effect on the earth. The last was a mini project to demonstrate the use of Google Earth in imagine of the subduction of two tectonic plates. The result shows that mostly students (92%) were able to reconstruction the process involved in the assignment although a few of them cannot explain well. Whilst, 8% of the student were still difficult to reconstruction the process involved in the assignment, although they can submit all the assignments with fairly well. Finally, the Google Earth is generally success used in the demonstration of earth physics subject learning media.
Model Rapid Application Development Dalam Perancangan Aplikasi Reservasi Hotel Dengan Konsep Pemrograman Terstruktur
Authors: Darwati Ida , Sari Retno
Published: February 2019

Nowadays promotions and transactions via the internet are not uncommon, many companies have used the internet as a medium of promotion and even transactions online, because using a website is believed to be able to expand the area of promotions and transactions that do not know the time and place. The wider the range of promotions, the greater the chance of a transaction, which can be done from anywhere and at any time with the condition of being connected to the internet network, so as to provide convenience for both the customer and the company. Likewise with hotels that already use internet facilities, it can make it easier for customers to know what types of rooms are available and can make reservations online. In addition, customers can look at room types and find out information about room facilities offered. The author uses the RAD model to design a web-based hotel reservation program.
Sistem Informasi Ekspedisi Ekspor Impor Pada PT. Bongsoikrama Lintas Usaha Jakarta
Authors: Widiati Wina , Farhan Hafian Tubagus Ahmad
Published: February 2019

Ekspedisi Ekspor Impor adalah jasa layanan yang bergerak dalam bidang layanan dan jasa pengirimanbarang import melalui jalur laut, darat atau udara. Kegiatan ekspedisi di PT. Bongsoikrama meliputimenyewa kontainer, mengangkut kontainer ke pelabuhan, menumpuk barang di pelabuhan sampai naik kekapal. Setelah barang tiba ada proses bongkar muatan meliputi menurunkan kontainer dari kapal danmengirimkan barang ke tempat tujuan. PT. Bongsoikrama berusaha merubah sistem informasi perusahaandengan memaksimalkan informasi komputer dan teknologi saat ini. Karena sistem informasi perusahaanmasih minim akan sumber daya manusia yang mengurusi administratif terkait proses ekspedisi ekportimport dan hanya banyak karyawan sebagai pekerja lapangan saja. Oleh karena itu penelitian ini akanmembuat sistem informasi yang dibutuhkan oleh perusahaan agar kegiatan administratif menjadi lebihmudah dan informatif. Program yang dibuat menggunakan software Microsoft Visual Basic 6.0 dengandatabase MySql. Sistem informasi ini menghasilkan output laporan eksport import, bukti bayar dan lembarpenagihan kepada customer. Diharapkan kinerja perusahaan akan meningkat dan lebih efektif, efisiendengan mengurangi human error dan mempercepat proses pembuatan laporan.
Clinical Performance Scores of Internationally Educated Physical Therapists during Clinical Education in a Bridging Programme
Authors: Kalu Michael E. , Switzer-McIntyre Sharon , Quesnel Martine , Donnelly Catherine , Norman Kathleen E.
Published: February 2019

Purpose: We describe the numerical ratings assigned by clinical instructors to the performance of internationally educated physical therapists (IEPTs) during their clinical internships while enrolled in a bridging programme. Method: We conducted a secondary analysis of the quantitative data for IEPT learners attending the Ontario Internationally Educated Physical Therapist Bridging Program using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) tool. We extracted the scores from each IEPT’s ACP form at the midterm and final evaluations for two internships and conducted a descriptive analysis. Results: We obtained 318 data sets for 61 IEPTs. By the final point of the second internship, (1) items about communication pertaining to ethical professional relationships, conducting oneself within legal and ethical requirements, and respecting the individuality and autonomy of the client had high mean ratings; (2) most items rated achieved advanced intermediate performance and many indicated entry-level performance; and (3) most IEPTs (84%) either had high scores throughout or improved from lower scores to at least advanced intermediate performance. Conclusions: Items relating to professional conduct and effective communication in professional relationships were relatively high among the IEPTs. By the end of the second internship, most IEPTs in this bridging programme had improved their clinical performance toward or up to the entry-level standard for Canadian physiotherapists.
The Genesis and First Production of Louis Riel
Authors: Elliott Robin
Published: February 2019

The premiere performance of the opera Louis Riel on 23 September 1967 was a landmark event in the history of Canadian opera. The circumstances of the genesis of the opera and its first production are examined. The birth of Louis Riel took place in the context of Canada’s centennial celebrations, which saw several other dramatic works about Riel created and also a number of other new Canadian operas. The revivals of the first production of the opera in 1968 and 1975 are discussed, as are the radio (1967) and television (1969) broadcasts and the recordings on LP (1985) and DVD (2011). The critical reception of the first production of Louis Riel is examined for the light it can shed on the nature and quality of the opera as a collaborative work of art.
Haunting Riel
Authors: Renihan Colleen
Published: February 2019

This article considers the many productive forms of theatrical, historical, and musical haunting in Harry Somers’s 1967 opera Louis Riel. Although the opera has been criticized for its datedness, an examination of the several layers of haunting and manipulations of embodiment and sound/silence in the score and libretto suggest that the opera has the potential to resonate beyond its original historical context to create meaning for contemporary Canadians. A consideration of how the 2017 Canadian Opera Company’s production, directed by Peter Hinton, amplified these hauntings reveals that the opera presents opportunities for both the past and present to haunt one another.
The development of method and software for assessing the technical condition of a metal production facility exemplified by the main pipeline
Authors: Liutak I. Z. , Liutak Z. P.
Published: February 2019

The analysis of the methods of acoustic control of the availability of nonuniformities in the wall of the metal pipeline is carried out. The basic mathematical equations describing the propagation and interaction of an acoustic wave with nonuniformity in an elastic medium are given. The method of calculation is presented and the results for the interaction of an acoustic wave with nonuniformity in the form of an ellipsoid are presented.
The choice of criteria for environmental risks management system during oil and gas wells construction
Authors: Yatsyshyn T. M.
Published: February 2019

The article studies the conditions that may cause environmentally hazardous emergency situations in oil and gas extraction industry. One of the most complicated emergencies is oil and gas leaks and open uncontrolled gushes. High degree of environmental risk typical of emergency situations like this needs measures to be taken in order to prevent them.
In order to improve environmental risks management in oil industry, the manifold study of inner technological processes and the condition of equipment as well as outer manifestations has been conducted. The causes of oil and gas gushes at different stages of oil and gas well lifecycle phases  have been analyzed. The factors that preceded oil and gas leaks and open gushes at 100 wells in different operating conditions have been given. The factors have been grouped in separate directions and the most powerful have been separated.  The main types of environmental hazard that accompany emergency oil and gas gushes have been defined. The criteria for controlling the environmental risks in order to prevent undesired consequences have been selected. The main constituents of those criteria are discussed and the possibilities of defining their numerical values. The proposed criteria make it possible to evaluate the threat adequately and to take certain proper measures in order to prevent emergency situations.
The use of gamma-spectrometry and gamma-gamma-density logging for the study of reservoir rocks of complex structures
Authors: Fedoriv V. V.
Published: February 2019

The results of the study of the poroperm properties of the complex structure reservoir rocks of the neogene deposits at the Letnianskyi gas condensate field are considered. The petrophysical model for determining the bulk content of the main components of oil and gas reservoirs is given by data of gamma-gamma-density logging and spectrometric gamma-logging. The petrophysical model of the joint use of the results of gamma-spectrometry and gamma-gamma-density logging is shown.
As a result of data analysis, it has been established that there is a close relationship between uranium content and bulk density. It should also be noted that there is a close relationship between the solid organic matter and the thorium content.
It has been shown that under the conditions of complex structure reservoirs, the complex processing of data of gamma spectrometry and gamma-gamma-density logging allows quantitatively to determine the following parameters in complex structures:  clayness, porosity, content of solid organic matter and rock density.
Modeling and identification of the main units of the thermal power plant (TPP) acting as automation objects
Authors: Shavranskyi M. V.
Published: February 2019

On the basis of the analysis of the heat and power processes, the modeling and identification of the main units of the TPP has been carried out in order to increase the efficiency and reliability of the functioning of the automatic control systems of the inertial circuits of the TPP boiler units, which ensures the system’s reduction in sensitivity to uncertainties of the object itself, external perturbations, time delay variations along the control channels and disturbance, and thus guarantees the given quality of regulation in maneuverable modes of operation. The investigated transfer functions (model structure) are easily implemented by software and do not require additional control equipment, additional signal measurement channels or special sensors for their implementation.
Decomposition algorithm and mathematical models of hierarchical structure of control of the process of primary oil processing
Authors: Melikov E. A.
Published: February 2019

The article considers the development of deterministic and probabilistic models and control algorithm for the technological process of primary oil processing, as well as the solution of the problem of optimal control in the form of stochastic programming. To solve the problem of optimization of the researched technological system functioning by means of the Lagrange multiplier method, the decomposition algorithm and a method based on the transformation of the original problem on the principle of a deterministic analog have been developed.
The principles of constructing an optimal control system based on the developed models, the optimization algorithm and the elements of automatic regulation of the regime parameters of the primary oil refining unit are proposed.
Rancang Bangun Sistem Pendingin Sekunder Untuk Kabin Mobil Dengan Memanfaatkan Thermoelektrik (TEC)
Authors: Ramadhan Faishal
Published: February 2019

The air conditioner (AC) system of the car will stop when the car's engine is turned off, this causes the temperature in the cabin of the car to increase. The increase in temperature is caused by the cabin being closed so that there is no air circulation and also influenced by the temperature of the environment. Designing, assembling and testing the cooling system using peltier, fan, heatsink and pump as the main component. The test was carried out for 1 hour 30 minutes, with variations in the number of peltier working 2, 4 and 6. The results obtained were 2 peltier 28oC, 4 peltier 27.5oC and 6 peltier 27.5oC. The same results at 4 and 6 peltier where at 6 peltier there is a temperature increase then a decrease occurs. This is because the voltage received by peltier is not stable. The best results are obtained by the number of peltier 4 pieces, because the voltage received is stable so the temperature drops constantly.
Utility of sodium fluorescein for achieving resection targets in glioblastoma: increased gross- or near-total resections and prolonged survival
Authors: Katsevman Gennadiy A. , Turner Ryan C. , Urhie Ogaga , Voelker Joseph L. , Bhatia Sanjay
Published: February 2019

OBJECTIVE

It is commonly reported that achieving gross-total resection of contrast-enhancing areas in patients with glioblastoma (GBM) improves overall survival. Efforts to achieve an improved resection have included the use of both imaging and pharmacological adjuvants. The authors sought to investigate the role of sodium fluorescein in improving the rates of gross-total resection of GBM and to assess whether patients undergoing resection with fluorescein have improved survival compared to patients undergoing resection without fluorescein.

METHODS

A retrospective chart review was performed on 57 consecutive patients undergoing 64 surgeries with sodium fluorescein to treat newly diagnosed or recurrent GBMs from May 2014 to June 2017 at a teaching institution. Outcomes were compared to those in patients with GBMs who underwent resection without fluorescein.

RESULTS

Complete or near-total (≥ 98%) resection was achieved in 73% (47/64) of fluorescein cases. Of 42 cases thought not to be amenable to complete resection, 10 procedures (24%) resulted in gross-total resection and 15 (36%) resulted in near-total resection following the use of sodium fluorescein. No patients developed any local or systemic side effects after fluorescein injection. Patients undergoing resection with sodium fluorescein, compared to the non–fluorescein-treated group, had increased rates of gross- or near-total resection (73% vs 53%, respectively; p < 0.05) as well as improved median survival (78 weeks vs 60 weeks, respectively; p < 0.360).

CONCLUSIONS

This study is the largest case series to date demonstrating the beneficial effect of utilizing sodium fluorescein as an adjunct in GBM resection. Sodium fluorescein facilitated resection in cases in which it was employed, including dominant-side resections particularly near speech and motor regions. The cohort of patients in which sodium fluorescein was utilized had statistically significantly increased rates of gross- or near-total resection. Additionally, the fluorescein group demonstrated prolonged median survival, although this was not statistically significant. This work demonstrates the promise of an affordable and easy-to-implement strategy for improving rates of total resection of contrast-enhancing areas in patients with GBM.
Repeat magnetic resonance imaging–guided focused ultrasound thalamotomy for recurrent essential tremor: case report and review of MRI findings
Authors: Weidman Elizabeth K. , Kaplitt Michael G. , Strybing Kristin , Chazen J. Levi
Published: February 2019

An 86-year-old right-handed man with medically refractory essential tremor was treated using left-sided MRI-guided focused ultrasound (MRgFUS) thalamotomy targeting the dentatorubrothalamic tract (DRTT) at its intersection with the ventral intermediate nucleus of the thalamus, with immediate symptomatic improvement and immediate postprocedure imaging demonstrating disruption of the DRTT. The patient experienced a partial return of symptoms 9 weeks following the procedure, and MRI demonstrated retraction of the left thalamic ablation site. The patient underwent repeat left-sided MRgFUS thalamotomy 4 months after initial treatment, resulting in reduced tremor. MR thermometry temperature measurements during the second MRgFUS procedure were unreliable with large fluctuations and false readings, likely due to susceptibility effects from the initial MRgFUS procedure. Final sonications were therefore monitored using the amount of energy delivered. The patient fared well after the second procedure and had sustained improvement in tremor control at the 12-month follow-up. This is the first report to describe the technical challenges of repeat MRgFUS with serial imaging.
Infection risk for Bactiseal Universal Shunts versus Chhabra shunts in Ugandan infants: a randomized controlled trial
Authors: Mbabazi-Kabachelor Edith , Shah Meghal , Vaughan Kerry A. , Mugamba John , Ssenyonga Peter , Onen Justin , Nalule Esther , Kapur Kush , Warf Benjamin C.
Published: February 2019

OBJECTIVE

Clinical and economic repercussions of ventricular shunt infections are magnified in low-resource countries. The efficacy of antibiotic-impregnated shunts in this setting is unclear. A previous retrospective cohort study comparing the Bactiseal Universal Shunt (BUS) and the Chhabra shunt provided clinical equipoise; thus, the authors conducted this larger randomized controlled trial in Ugandan children requiring shunt placement for hydrocephalus to determine whether there was, in fact, any advantage of one shunt over the other.

METHODS

Between April 2013 and September 2016, the authors randomly assigned children younger than 16 years of age without evidence of ventriculitis to either BUS or Chhabra shunt implantation in this single-blind randomized controlled trial. The primary outcome was shunt infection, and secondary outcomes included reoperation and death. The minimum follow-up was 6 months. Time to outcome was assessed using the Kaplan-Meier method. The significance of differences was tested using Wilcoxon rank-sum, chi-square, Fisher’s exact, and t-tests.

RESULTS

Of the 248 patients randomized, the BUS was implanted in 124 and the Chhabra shunt in 124. There were no differences between the groups in terms of age, sex, or hydrocephalus etiology. Within 6 months of follow-up, there were 14 infections (5.6%): 6 BUS (4.8%) and 8 Chhabra (6.5%; p = 0.58). There were 14 deaths (5.6%; 5 BUS [4.0%] vs 9 Chhabra [7.3%], p = 0.27) and 30 reoperations (12.1%; 15 BUS vs 15 Chhabra, p = 1.00). There were no significant differences in the time to primary or secondary outcomes at 6 months’ follow-up (p = 0.29 and 0.17, respectively, Wilcoxon rank-sum test).

CONCLUSIONS

Among Ugandan infants, BUS implantation did not result in a lower incidence of shunt infection or other complications. Any recommendation for a more costly standard of care in low-resource countries must have contextually relevant, evidence-based support.

Clinical trial registration no.: PACTR201804003240177 (http://www.pactr.org/)
Concordance between the interictal focal EEG pattern and MRI lesions as a predictor of a favorable surgical outcome in patients with epileptic spasms: a Chinese study
Authors: Xu Cuiping , Yu Tao , Zhang Guojun , Rajah Gary B. , Wang Yuping , Li Yongjie
Published: February 2019

OBJECTIVE

The aim of this study was to evaluate the electro-clinical features, etiology, treatment, and postsurgical seizure outcomes in patients with intractable epileptic spasms (ESs).

METHODS

The authors retrospectively studied the medical records of all patients who had presented with medically intractable ESs and had undergone surgery in the period between October 2009 and August 2015. The interictal electroencephalography (EEG) pattern, MRI studies, magnetoencephalography findings, and postsurgical seizure outcomes were compared.

RESULTS

Twenty-six patients, 12 boys and 14 girls (age range 3–22 years), were eligible for study inclusion. Of these 26 patients, 84.6% (22) presented with multiple seizure types including partial seizures (PSs) independent of the ESs (30.8%); ESs followed by tonic seizures (30.8%); myoclonic seizures (19.2%); tonic seizures (19.2%); ESs followed by PSs (19.2%); focal seizures with secondary generalization (15.4%); atypical absence (11.5%); PSs followed by ESs (7.7%); and myoclonic followed by tonic seizures (7.7%). Seventeen patients underwent multilobar resection and 9 underwent unilobar resection. At the last follow-up (mean 36.6 months), 42.3% of patients were seizure free (outcome classification [OC] 1), 23.1% had > 50% reduction in seizure frequency (OC2–OC4), and 34.6% had < 50% reduction in seizure frequency or no improvement (OC5 and OC6). Predictors of favorable outcomes included an interictal focal EEG pattern and concordance between interictal EEG and MRI-demonstrated lesions (p = 0.001 and 0.004, respectively).

CONCLUSIONS

A favorable surgical outcome is achievable in a highly select group of patients with ESs secondary to structural lesions. Interictal EEG can help in identifying patients with the potential for favorable resective outcomes.
The occipitoatlantal capsular ligaments are the primary stabilizers of the occipitoatlantal joint in the craniocervical junction: a finite element analysis
Authors: Phuntsok Rinchen , Ellis Benjamin J. , Herron Michael R. , Provost Chase W. , Dailey Andrew T. , Brockmeyer Douglas L.
Published: February 2019

OBJECTIVE

There is contradictory evidence regarding the relative contribution of the key stabilizing ligaments of the occipitoatlantal (OA) joint. Cadaveric studies are limited by the nature and the number of injury scenarios that can be tested to identify OA stabilizing ligaments. Finite element (FE) analysis can overcome these limitations and provide valuable data in this area. The authors completed an FE analysis of 5 subject-specific craniocervical junction (CCJ) models to investigate the biomechanics of the OA joint and identify the ligamentous structures essential for stability.

METHODS

Isolated and combined injury scenarios were simulated under physiological loads for 5 validated CCJ FE models to assess the relative role of key ligamentous structures on OA joint stability. Each model was tested in flexion-extension, axial rotation, and lateral bending in various injury scenarios. Isolated ligamentous injury scenarios consisted of either decreasing the stiffness of the OA capsular ligaments (OACLs) or completely removing the transverse ligament (TL), tectorial membrane (TM), or alar ligaments (ALs). Combination scenarios were also evaluated.

RESULTS

An isolated OACL injury resulted in the largest percentage increase in all ranges of motion (ROMs) at the OA joint compared with the other isolated injuries. Flexion, extension, lateral bending, and axial rotation significantly increased by 12.4% ± 7.4%, 11.1% ± 10.3%, 83.6% ± 14.4%, and 81.9% ± 9.4%, respectively (p ≤ 0.05 for all). Among combination injuries, OACL+TM+TL injury resulted in the most consistent significant increases in ROM for both the OA joint and the CCJ during all loading scenarios. OACL+AL injury caused the most significant percentage increase for OA joint axial rotation.

CONCLUSIONS

These results demonstrate that the OACLs are the key stabilizing ligamentous structures of the OA joint. Injury of these primary stabilizing ligaments is necessary to cause OA instability. Isolated injuries of TL, TM, or AL are unlikely to result in appreciable instability at the OA joint.
Optimal tether configurations and preload tensioning to prevent proximal junctional kyphosis: a finite element analysis
Authors: Buell Thomas J. , Bess Shay , Xu Ming , Schwab Frank J. , Lafage Virginie , Ames Christopher P. , Shaffrey Christopher I. , Smith Justin S.
Published: February 2019

OBJECTIVE

Proximal junctional kyphosis (PJK) is, in part, due to altered segmental biomechanics at the junction of rigid instrumented spine and relatively hypermobile non-instrumented adjacent segments. Proper application of posteriorly anchored polyethylene tethers (i.e., optimal configuration and tension) may mitigate adjacent-segment stress and help prevent PJK. The purpose of this study was to investigate the impact of different tether configurations and tensioning (preloading) on junctional range-of-motion (ROM) and other biomechanical indices for PJK in long instrumented spine constructs.

METHODS

Using a validated finite element model of a T7–L5 spine segment, testing was performed on intact spine, a multilevel posterior screw-rod construct (PS construct; T11–L5) without tether, and 15 PS constructs with different tether configurations that varied according to 1) proximal tether fixation of upper instrumented vertebra +1 (UIV+1) and/or UIV+2; 2) distal tether fixation to UIV, to UIV−1, or to rods; and 3) use of a loop (single proximal fixation) or weave (UIV and/or UIV+1 fixation in addition to UIV+1 and/or UIV+2 proximal attachment) of the tether. Segmental ROM, intradiscal pressure (IDP), inter- and supraspinous ligament (ISL/SSL) forces, and screw loads were assessed under variable tether preload.

RESULTS

PS construct junctional ROM increased abruptly from 10% (T11–12) to 99% (T10–11) of baseline. After tethers were grouped by most cranial proximal fixation (UIV+1 vs UIV+2) and use of loop versus weave, UIV+2 Loop and/or Weave most effectively dampened junctional ROM and adjacent-segment stress. Different distal fixation and use of loop versus weave had minimal effect. The mean segmental ROM at T11–12, T10–11, and T9–10, respectively, was 6%, 40%, and 99% for UIV+1 Loop; 6%, 44%, and 99% for UIV+1 Weave; 5%, 23%, and 26% for UIV+2 Loop; and 5%, 24%, and 31% for UIV+2 Weave.

Tethers shared loads with posterior ligaments; consequently, increasing tether preload tension reduced ISL/SSL forces, but screw loads increased. Further attenuation of junctional ROM and IDP reversed above approximately 100 N tether preload, suggesting diminished benefit for biomechanical PJK prophylaxis at higher preload tensioning.

CONCLUSIONS

In this study, finite element analysis demonstrated UIV+2 Loop and/or Weave tether configurations most effectively mitigated adjacent-segment stress in long instrumented spine constructs. Tether preload dampened ligament forces at the expense of screw loads, and an inflection point (approximately 100 N) was demonstrated above which junctional ROM and IDP worsened (i.e., avoid over-tightening tethers). Results suggest tether configuration and tension influence PJK biomechanics and further clinical research is warranted.
Neurological recovery following traumatic spinal cord injury: a systematic review and meta-analysis
Authors: Khorasanizadeh MirHojjat , Yousefifard Mahmoud , Eskian Mahsa , Lu Yi , Chalangari Maryam , Harrop James S. , Jazayeri Seyed Behnam , Seyedpour Simin , Khodaei Behzad , Hosseini Mostafa , Rahimi-Movaghar Vafa
Published: February 2019

OBJECTIVE

Predicting neurological recovery following traumatic spinal cord injury (TSCI) is a complex task considering the heterogeneous nature of injury and the inconsistency of individual studies. This study aims to summarize the current evidence on neurological recovery following TSCI by use of a meta-analytical approach, and to identify injury, treatment, and study variables with prognostic significance.

METHODS

A literature search in MEDLINE and EMBASE was performed, and studies reporting follow-up changes in American Spinal Injury Association (ASIA) Impairment Scale (AIS) or Frankel or ASIA motor score (AMS) scales were included in the meta-analysis. The proportion of patients with at least 1 grade of AIS/Frankel improvement, and point changes in AMS were calculated using random pooled effect analysis. The potential effect of severity, level and mechanism of injury, type of treatment, time and country of study, and follow-up duration were evaluated using meta-regression analysis.

RESULTS

A total of 114 studies were included, reporting AIS/Frankel changes in 19,913 patients and AMS changes in 6920 patients. Overall, the quality of evidence was poor. The AIS/Frankel conversion rate was 19.3% (95% CI 16.2–22.6) for patients with grade A, 73.8% (95% CI 69.0–78.4) for those with grade B, 87.3% (95% CI 77.9–94.8) for those with grade C, and 46.5% (95% CI 38.2–54.9) for those with grade D. Neurological recovery was significantly different between all grades of SCI severity in the following order: C > B > D > A. Level of injury was a significant predictor of recovery; recovery rates followed this pattern: lumbar > cervical and thoracolumbar > thoracic. Thoracic SCI and penetrating SCI were significantly more likely to result in complete injury. Penetrating TSCI had a significantly lower recovery rate compared to blunt injury (OR 0.76, 95% CI 0.62–0.92; p = 0.006). Recovery rate was positively correlated with longer follow-up duration (p = 0.001). Studies with follow-up durations of approximately 6 months or less reported significantly lower recovery rates for incomplete SCI compared to studies with long-term (3–5 years) follow-ups.

CONCLUSIONS

The authors’ meta-analysis provides an overall quantitative description of neurological outcomes associated with TSCI. Moreover, they demonstrated how neurological recovery after TSCI is significantly dependent on injury factors (i.e., severity, level, and mechanism of injury), but is not associated with type of treatment or country of origin. Based on these results, a minimum follow-up of 12 months is recommended for TSCI studies that include patients with neurologically incomplete injury.
A systematic comparative outcome analysis of surgical versus percutaneous techniques in the management of symptomatic sacral perineural (Tarlov) cysts: a meta-analysis
Authors: Sharma Mayur , SirDeshpande Pooja , Ugiliweneza Beatrice , Dietz Nicholas , Boakye Maxwell
Published: February 2019

OBJECTIVE

Symptomatic perineural or Tarlov cysts (TCs) are a rare cause of chronic low-back pain. Given the rarity of the disease, there is no literature consensus regarding the optimal management of these cysts.

METHODS

The authors conducted a systematic comparative outcome analysis of symptomatic TCs treated with surgery (group A, 32 studies, n = 333) or percutaneous interventions (group B, 6 studies, n = 417) analyzing the demographic characteristics, baseline characteristics of the cysts, clinical presentations, types of interventions, complication rates, and the recurrence rate in both treatment groups. The literature search was performed using the PubMed, MEDLINE, Cochrane, and Ovid databases up to 2018. The MeSH search terms used were “Tarlov cyst,” “sacral perineural cyst,” “sacral nerve root cyst,” “meningeal cyst of the sacral spine,” “extra meningeal cyst with spinal nerve root fibers,” “spinal extradural arachnoid pouch,” and “cyst of the sacral nerve root sheath.” The authors used statistical tests for two proportions using the “N-1” chi-square test with the free version of MedCalc for Windows for comparison among the groups.

RESULTS

Overall symptomatic improvement was reported in 83.5% of patients in both groups; however, exacerbation of preprocedural symptoms was significantly higher in group B than group A (10.1% vs 3.3%, p = 0.0003). The overall complication rates in the surgical and nonsurgical groups were 21% and 12.47%, respectively. Transient sciatica was the most common complication in both groups (17% vs 8%, respectively; p = 0.017). The incidence of cyst recurrence was much lower in group A than group B (8% vs 20%, p = 0.0018). The mean follow-up duration for the surgical group was 38 ± 29 months (25 studies, n = 279), while that for the nonsurgical group was 15 ± 12 months (4 studies, n = 290) (p < 0.0001).

CONCLUSIONS

The authors noted that although the surgical interventions were associated with higher postprocedural complication rates, long-term efficacy and success in terms of cyst resolution were superior following surgery compared to percutaneous procedures in the management of symptomatic TCs. There was no difference in symptom recurrence with either of the techniques.
Carotid–vertebral artery bypass with saphenous vein graft for symptomatic vertebrobasilar insufficiency
Authors: Duan Hongzhou , Mo Dapeng , Zhang Yang , Zhang Jiayong , Li Liang
Published: February 2019

OBJECTIVE

Symptomatic steno-occlusion of the proximal vertebral artery (VA) or subclavian artery (ScA) heralds a poor prognosis and high risk of stroke recurrence despite medical therapy, including antiplatelet or anticoagulant drugs. In some cases, the V2 segment of the cervical VA is patent and perfused via collateral vessels. The authors describe 7 patients who were successfully treated by external carotid artery (ECA)–saphenous vein (SV)–VA bypass.

METHODS

Seven cases involving symptomatic patients were retrospectively studied: 3 cases of V1 segment occlusion, 2 cases of severe in-stent restenosis in the V1 segment, and 2 cases of occlusion of the proximal ScA. All patients underwent ECA-SV-VA bypass. The ECA was isolated and retracted, and the anterior wall of the transverse foramen was unroofed. The VA was exposed, and then the 2 ends of the SV were anastomosed to the VA and ECA in an end-to-side fashion.

RESULTS

Surgical procedures were all performed as planned, with no intraoperative complications. There were 2 postoperative complications (severe laryngeal edema in one case and shoulder weakness in another), but both patients recovered fully and measures were taken to minimize laryngeal edema and its effects in subsequent cases. All patients experienced improvement of their symptoms. No new neurological deficits were reported. Postoperative angiography demonstrated that the anastomoses were all patent, and analysis of follow-up data (range of follow-up 12–78 months) revealed no further ischemic events in the vertebrobasilar territory.

CONCLUSIONS

The ECA-SV-VA bypass is a useful treatment for patients who suffer medically refractory ischemic events in the vertebrobasilar territory when the proximal part of the VA or ScA is severely stenosed or occluded but the V2 segment of the cervical VA is patent.
Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms
Authors: Wang Long , Lu Shuaibin , Cai Li , Qian Hai , Tanikawa Rokuya , Shi Xiang’en
Published: February 2019

OBJECTIVE

The rapid innovation of the endovascular armamentarium results in a decreased number of indications for a classic surgical approach. However, a middle cerebral artery (MCA) aneurysm remains the best example of one for which results have favored microsurgery over endovascular intervention. In this study, the authors aimed to evaluate the experience and efficacy regarding surgical outcomes after applying internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs).

METHODS

All IMA bypasses performed between January 2010 and July 2018 in a single-center, single-surgeon practice were screened.

RESULTS

In total, 12 patients (9 males, 3 females) with CMCAAs managed by high-flow IMA bypass were identified. The mean size of CMCAAs was 23.7 mm (range 10–37 mm), and the patients had a mean age of 31.7 years (range 14–56 years). The aneurysms were proximally occluded in 8 cases, completely trapped in 3 cases, and completely resected in 1 case. The radial artery was used as the graft vessel in all cases. At discharge, the graft patency rate was 83.3% (n = 10), and all aneurysms were completely eliminated (83.3%, n = 10) or greatly diminished (16.7%, n = 2) from the circulation. Postoperative ischemia was detected in 2 patients as a result of graft occlusion, and 1 patient presenting with subarachnoid hemorrhage achieved improved modified Rankin Scale scores compared to the preoperative status but retained some neurological deficits. Therefore, neurological assessment at discharge showed that 9 of the 12 patients experienced unremarkable outcomes. The mean interval time from bypass to angiographic and clinical follow-up was 28.7 months (range 2–74 months) and 53.1 months (range 19–82 months), respectively. Although 2 grafts remained occluded, all aneurysms were isolated from the circulation, and no patient had an unfavorable outcome.

CONCLUSIONS

The satisfactory result in the present study demonstrated that IMA bypass is a promising method for the treatment of CMCAAs and should be maintained in the neurosurgical armamentarium. However, cases with intraoperative radical resection or inappropriate bypass recipient selection such as aneurysmal wall should be meticulously chosen with respect to the subtype of MCA aneurysm.