bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing military penetrating brain injuries in the war zone: lessons learned
Authors: Fathalla Hussein , Ashry Ahmed , El-Fiki Ahmed
Published: February 2019

OBJECTIVE

Managing penetrating military brain injuries in a war zone setting is different than managing common civilian penetrating brain injuries. Triage, i.e., deciding on which patients to treat or not treat, and which to be flown back home, is essential to avoid wasting valuable limited resources. In this study the authors aim to identify reliable predictors of mortality and poor outcome to help develop a protocol for treating their patients in the battlefield. They also demonstrate all the lessons learned from their collective experience regarding some of the controversial management issues.

METHODS

This study was a retrospective review of 102 patients with penetrating military missile head injuries treated by the authors in various facilities in northern Sinai between 2011 and 2018. Patient demographics, clinical characteristics, imaging characteristics, postoperative complications, and Glasgow Outcome Scale (GOS) scores were recorded for each patient. Several variables associated with mortality and poor outcome that were derived from the literature were analyzed, in addition to variables obtained by direct observation by the authors over time.

RESULTS

There were 50 patients (49%) with GOS score of 1 (death), 12 patients (11.8%) with GOS score of 2 (survivors in persistent vegetative state), and 40 survivors (39.2%) with varying degrees of disability on the last follow-up evaluation. The authors identified an anatomical danger zone that was found to predict mortality when traversed. Bilateral dilated fixed pupils and low Glasgow Coma Scale score on admission were also found to be independent predictors of mortality and poor outcome. Based on these findings, a protocol was developed for managing these patients in the war zone.

CONCLUSIONS

Managing military penetrating head injuries in the war zone is different than civilian gunshot head injuries encountered by most neurosurgeons in urban cities. The authors developed a simple protocol for managing military penetrating injuries in the war zone. They also describe important lessons learned from this experience.
Lumbar drain trial outcomes of normal pressure hydrocephalus: a single-center experience of 254 patients
Authors: El Ahmadieh Tarek Y. , Wu Eva M. , Kafka Benjamin , Caruso James P. , Neeley Om J. , Plitt Aaron , Aoun Salah G. , Olson Daiwai M. , Ruchinskas Robert A. , Cullum C. Munro , Barnett Samuel , Welch Babu G. , Batjer H. Hunt , White Jonathan A.
Published: February 2019

OBJECTIVE

A short-term lumbar drain (LD) trial is commonly used to assess the response of normal pressure hydrocephalus (NPH) patients to CSF diversion. However, it remains unknown whether the predictors of passing an LD trial match the predictors of improvement after ventriculoperitoneal shunting. The aim of this study was to examine outcomes, complication rates, and associations between predictors and outcomes after an LD trial in patients with NPH.

METHODS

The authors retrospectively reviewed the records of 254 patients with probable NPH who underwent an LD trial between March 2008 and September 2017. Multivariate regression models were constructed to examine predictors of passing the LD trial. Complications associated with the LD trial procedure were recorded.

RESULTS

The mean patient age was 77 years and 56.7% were male. The mean durations of gait disturbance, cognitive decline, and urinary incontinence were 29 months, 32 months, and 28 months, respectively. Of the 254 patients, 30% and 16% reported objective and subjective improvement after the LD trial, respectively. Complications included a sheared LD catheter, meningitis, lumbar epidural abscess, CSF leak at insertion site, transient lower extremity numbness, slurred speech, refractory headaches, and hyponatremia. Multivariate analyses using MAX-R revealed that a prior history of stroke predicted worse outcomes, while disproportionate subarachnoid spaces (uneven enlargement of supratentorial spaces) predicted better outcomes after the LD trial (r2 = 0.12, p < 0.05).

CONCLUSIONS

The LD trial is generally safe and well tolerated. The best predictors of passing the LD trial include a negative history of stroke and having disproportionate subarachnoid spaces.
Long-term effect of subthalamic nucleus deep brain stimulation on freezing of gait in Parkinson’s disease
Authors: Kim Ryul , Kim Han-Joon , Shin Chaewon , Park Hyeyoung , Kim Aryun , Paek Sun Ha , Jeon Beomseok
Published: February 2019

OBJECTIVE

Subthalamic nucleus deep brain stimulation (STN DBS) is effective against freezing of gait (FOG) in Parkinson’s disease (PD); however, whether this effect persists over the long term is debated. The aim of the current study was to investigate the long-term effect of STN DBS on FOG in patients with PD.

METHODS

Data on 52 cases in which PD patients received bilateral STN DBS were obtained from a prospective registry. The authors blindly analyzed FOG incidence and its severity from the videotapes of a 5-m walking task at the baseline and at the 1-, 2-, and 5- or 7-year follow-up visits. They also compared the axial score from the Unified Parkinson’s Disease Rating Scale (UPDRS) part III, UPDRS part II (UPDRS-II) item 14, and the FOG questionnaire (FOG-Q). Postoperatively, video-based FOG analysis and the axial score were evaluated under 4 conditions (off-medication/off-stimulation, off-medication/on-stimulation, on-medication/off-stimulation, and on-medication/on-stimulation), and UPDRS-II item 14 and the FOG-Q score were evaluated under 2 conditions (off-medication/on-stimulation and on-medication/on-stimulation).

RESULTS

During the off-medication state, the on-stimulation condition improved FOG outcomes, except for video-based FOG severity, up to the last follow-up compared with the baseline. Video-based FOG outcomes and the axial score during the off-medication state were improved with the on-stimulation condition up to the last follow-up compared with the off-stimulation condition. During the on-medication state, the on-stimulation condition did not improve any FOG outcome compared with the baseline; however, it improved video-based FOG outcomes up to the 2-year follow-up and the axial score up to the last follow-up compared with the off-stimulation condition.

CONCLUSIONS

Our findings suggest that STN DBS has a long-term effect on FOG in the off-medication state. However, STN DBS did not show a long-term effect on FOG in the on-medication state, although it had a short-term effect until the 2-year follow-up.
Predictors of patient satisfaction and survey participation after spine surgery: a retrospective review of 17,853 consecutive spinal patients from a single academic institution. Part 2: HCAHPS
Authors: Hopkins Benjamin S. , Patel Mit R. , Yamaguchi Jonathan Tad , Cloney Michael Brendan , Dahdaleh Nader S.
Published: February 2019

OBJECTIVE

Patient satisfaction is a new and important metric in the American healthcare system. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a common modality used to assess patient satisfaction in inpatient settings. Despite the existence of data, neurosurgical literature on patient satisfaction following spinal surgery is scarce.

METHODS

A total of 17,853 patients who underwent spinal procedures at the authors’ institution were analyzed retrospectively for HCAHPS survey participation. Appropriate demographic, surgical, comorbidity, and complication data were collected; 1118 patients had patient satisfaction survey data, and further survey metrics were collected for this subset of patients.

RESULTS

Male patients, patients with urgent/emergency procedures, and patients with a longer length of stay were less likely to complete an HCAHPS survey (OR 0.820, p < 0.001; OR 0.818, p = 0.042; and OR 0.983, p < 0.001, respectively). Posterior approach was negatively associated with HCAHPS survey participation (OR 0.868, p = 0.007). Patients undergoing fusion procedures were more likely to participate in HCAHPS surveys (OR 1.440, p < 0.001). Of the completed HCAHPS surveys, there were no positive predictors associated with perfect scores. High Charlson Comorbidity Index (OR 0.931, p = 0.007), increasing elapsed time since surgery or discharge (OR 0.992, p = 0.004), and increasing length of stay (OR 0.928, p < 0.001) were all negatively associated with a perfect score. Finally, patient sex and race did not influence the likelihood of a perfect or low survey score.

CONCLUSIONS

Participation in HCAHPS surveys was correlated with preoperative and postoperative factors. Among these, procedure approach and type, length of stay, and complications seemed to influence participation the most. No factors were associated with an increased likelihood of receiving a perfect score. Similarly, length of stay and time elapsed since surgery to survey completion were significant negative predictors of receiving perfect HCAHPS survey scores. Increasing comorbid burden was also found to be a negative predictor for high scores. Further study on predictors of inpatient satisfaction within spine surgery is needed.
The impact of the reserve military neurosurgeon: practice, community, and service
Authors: Menger Richard , Mundell Benjamin F. , Robbins J. Will , Letarte Peter , Bell Randy , _ _
Published: February 2019

OBJECTIVE

Papers from 2002 to 2017 have highlighted consistent unique socioeconomic challenges and opportunities facing military neurosurgeons. Here, the authors focus on the reserve military neurosurgeon who carries the dual mission of both civilian and military responsibilities.

METHODS

Survey solicitation of current active duty and reserve military neurosurgeons was performed in conjunction with the AANS/CNS Joint Committee of Military Neurosurgeons and the Council of State Neurosurgical Societies. Demographic, qualitative, and quantitative data points were compared between reserve and active duty military neurosurgeons. Civilian neurosurgical provider data were taken from the 2016 NERVES (Neurosurgery Executives Resource Value and Education Society) Socio-Economic Survey. Economic modeling was done to forecast the impact of deployment or mobilization on the reserve neurosurgeon, neurosurgery practice, and the community.

RESULTS

Seventy-five percent (12/16) of current reserve neurosurgeons reported that they are satisfied with their military service. Reserve neurosurgeons make significant contributions to the military’s neurosurgical capabilities, with 75% (12/16) having been deployed during their career. No statistically significant demographic differences were found between those serving on active duty and those in the reserve service. However, those who served in the reserves were more likely to desire opportunities for improvement in the military workflow requirements compared with their active duty counterparts (p = 0.04); 92.9% (13/14) of current reserve neurosurgeons desired more flexible military drill programs specific to the needs of practicing physicians. The risk of reserve deployment is also borne by the practices, hospitals, and communities in which the neurosurgeon serves in civilian practice. This can result in fewer new patient encounters, decreased collections, decreased work relative value unit generation, increased operating costs per neurosurgeon, and intangible limitations on practice development. However, through modeling, the authors have illustrated that reserve physicians joining a larger group practice can significantly mitigate this risk. What remains astonishing is that 91.7% of those reserve neurosurgeons who were deployed noted the experience to be rewarding despite seeing a 20% reduction in income, on average, during the fiscal year of a 6-month deployment.

CONCLUSIONS

Reserve neurosurgeons are satisfied with their military service while making substantial contributions to the military’s neurosurgical capabilities, with the overwhelming majority of current military reservists having been deployed or mobilized during their reserve commitments. Through the authors’ modeling, the impact of deployment on the military neurosurgeon, neurosurgeon’s practice, and the local community can be significantly mitigated by a larger practice environment.
Return-to-active-duty rates after anterior cervical spine surgery in military pilots
Authors: Miller Charles A. , Boulter Jason H. , Coughlin Daniel J. , Rosner Michael K. , Neal Chris J. , Dirks Michael S.
Published: February 2019

OBJECTIVE

Symptomatic cervical spondylosis with or without radiculopathy can ground an active-duty military pilot if left untreated. Surgically treated cervical spondylosis may be a waiverable condition and allow return to flying status, but a waiver is based on expert opinion and not on recent published data. Previous studies on rates of return to active duty status following anterior cervical spine surgery have not differentiated these rates among military specialty occupations. No studies to date have documented the successful return of US military active-duty pilots who have undergone anterior cervical spine surgery with cervical fusion, disc replacement, or a combination of the two. The aim of this study was to identify the rate of return to an active duty flight status among US military pilots who had undergone anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) for symptomatic cervical spondylosis.

METHODS

The authors performed a single-center retrospective review of all active duty pilots who had undergone either ACDF or TDR at a military hospital between January 2010 and June 2017. Descriptive statistics were calculated for both groups to evaluate demographics with specific attention to preoperative flight stats, days to recommended clearance by neurosurgery, and days to return to active duty flight status.

RESULTS

Authors identified a total of 812 cases of anterior cervical surgery performed between January 1, 2010, and June 1, 2017, among active duty, reserves, dependents, and Department of Defense/Veterans Affairs patients. There were 581 ACDFs and 231 TDRs. After screening for military occupation and active duty status, there were a total of 22 active duty pilots, among whom were 4 ACDFs, 17 TDRs, and 2 hybrid constructs. One patient required a second surgery. Six (27.3%) of the 22 pilots were nearing the end of their career and electively retired within a year of surgery. Of the remaining 16 pilots, 11 (68.8%) returned to active duty flying status. The average time to be released by the neurosurgeon was 128 days, and the time to return to flying was 287 days. The average follow-up period was 12.3 months.

CONCLUSIONS

Adhering to military service-specific waiver guidelines, military pilots may return to active duty flight status after undergoing ACDF or TDR for symptomatic cervical spondylosis.
Successful application of stereotactic radiosurgery for multiply recurrent Rathke’s cleft cysts
Authors: West James L. , Soike Michael H. , Renfrow Jaclyn J. , Chan Michael D. , Laxton Adrian W. , Tatter Stephen B.
Published: February 2019

OBJECTIVE

Rathke’s cleft cysts (RCCs) are benign lesions of the sella turcica that usually come to neurosurgical attention due to compression of the optic apparatus (OA) and headaches. Treatment options for these lesions include observation, aspiration of cyst contents, or open resection of the cyst with the cyst wall. All of these options involve the potential for cyst recurrence or enlargement. In this study the authors report on a potential new therapeutic option for RCCs, i.e., stereotactic radiosurgery (SRS).

METHODS

A retrospective review was conducted of 5 patients with histologically confirmed, multiply recurrent RCCs who were treated with single-fraction SRS at a tertiary referral academic medical center.

RESULTS

The total cohort consisted of 5 female patients with an average age of 31.8 years. The most common presenting symptom was headache followed by blurry vision. The symptoms were present on average for 7 months before intervention. The median number of surgeries prior to radiosurgery was 2. The average volume of lesion treated was 0.34 cm3. The median SRS dose was 12.5 Gy prescribed to the 50% isodose line with an average prescription coverage of 96.6%. The median dose to the OA was 5 Gy. At last follow-up, 3 of 5 cysts had completely regressed, 1 had regressed by more than 50% but was still present, and 1 was stable, with an overall mean follow-up duration of 34.2 months. There were no neurological, endocrinological, or visual complications attributable to SRS during the follow-up period.

CONCLUSIONS

RCCs can be a challenging clinical entity to treat, especially when they are multiply recurrent. In patients with an average of 2 previous surgeries for resection, a single SRS session prevented recurrence universally, with an average follow-up of almost 3 years. These results indicate that further investigation of the treatment of RCCs with SRS is indicated.
Detection of delayed cerebral ischemia using objective pupillometry in patients with aneurysmal subarachnoid hemorrhage
Authors: Aoun Salah G. , Stutzman Sonja E. , Vo Phuong-Uyen N. , El Ahmadieh Tarek Y. , Osman Mohamed , Neeley Om , Plitt Aaron , Caruso James P. , Aiyagari Venkatesh , Atem Folefac , Welch Babu G. , White Jonathan A. , Batjer H. Hunt , Olson Daiwai M.
Published: February 2019

OBJECTIVE

Cerebral vasospasm causing delayed cerebral ischemia (DCI) is a source of significant morbidity after subarachnoid hemorrhage (SAH). Transcranial Doppler is used at most institutions to detect sonographic vasospasm but has poor positive predictive value for DCI. Automated assessment of the pupillary light reflex has been increasingly used as a reliable way of assessing pupillary reactivity, and the Neurological Pupil Index (NPi) has been shown to decrease hours prior to the clinical manifestation of ischemic injury or herniation syndromes. The aim of this study was to investigate the role of automated pupillometry in the setting of SAH, as a potential adjunct to TCD.

METHODS

Our analysis included patients that had been diagnosed with aneurysmal SAH and admitted to the neuro–intensive care unit of the University of Texas Southwestern Medical Center between November 2015 and June 2017. A dynamic infrared pupillometer was used for all pupillary measurements. An NPi value ranging from 3 to 5 was considered normal, and from 0 to 2.9 abnormal. Sonographic vasospasm was defined as middle cerebral artery velocities greater than 100 cm/sec with a Lindegaard ratio greater than 3 on either side on transcranial Doppler. Most patients had multiple NPi readings daily and we retained the lowest value for our analysis. We aimed to study the association between DCI and sonographic vasospasm, and DCI and NPi readings.

RESULTS

A total of 56 patients were included in the final analysis with 635 paired observations of daily TCD and NPi data. There was no statistically significant association between the NPi value and the presence of sonographic vasospasm. There was a significant association between DCI and sonographic vasospasm, χ2(1) = 6.4112, p = 0.0113, OR 1.6419 (95% CI 1.1163–2.4150), and between DCI and an abnormal decrease in NPi, χ2(1) = 38.4456, p < 0.001, OR 3.3930 (95% CI 2.2789–5.0517). Twelve patients experienced DCI, with 7 showing a decrease of their NPi to an abnormal range. This change occurred > 8 hours prior to the clinical decline 71.4% of the time. The NPi normalized in all patients after treatment of their vasospasm.

CONCLUSIONS

Isolated sonographic vasospasm does not seem to correlate with NPi changes, as the latter likely reflects an ischemic neurological injury. NPi changes are strongly associated with the advent of DCI and could be an early herald of clinical deterioration.
A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood
Authors: Yan Han , Toyota Eric , Anderson Melanie , Abel Taylor J. , Donner Elizabeth , Kalia Suneil K. , Drake James , Rutka James T. , Ibrahim George M.
Published: February 2019

OBJECTIVE

Drug-resistant epilepsy (DRE) presents a therapeutic challenge in children, necessitating the consideration of multiple treatment options. Although deep brain stimulation (DBS) has been studied in adults with DRE, little evidence is available to guide clinicians regarding the application of this potentially valuable tool in children. Here, the authors present the first systematic review aimed at understanding the safety and efficacy of DBS for DRE in pediatric populations, emphasizing patient selection, device placement and programming, and seizure outcomes.

METHODS

The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations. Relevant articles were identified from 3 electronic databases (MEDLINE, Embase, and Cochrane CENTRAL) from their inception to November 17, 2017. Inclusion criteria of individual studies were 1) diagnosis of DRE; 2) treatment with DBS; 3) inclusion of at least 1 pediatric patient (age ≤ 18 years); and 4) patient-specific data. Exclusion criteria for the systematic review included 1) missing data for age, DBS target, or seizure freedom; 2) nonhuman subjects; and 3) editorials, abstracts, review articles, and dissertations.

RESULTS

This review identified 21 studies and 40 unique pediatric patients (ages 4–18 years) who received DBS treatment for epilepsy. There were 18 patients with electrodes placed in the bilateral or unilateral centromedian nucleus of the thalamus (CM) electrodes, 8 patients with bilateral anterior thalamic nucleus (ATN) electrodes, 5 patients with bilateral and unilateral hippocampal electrodes, 3 patients with bilateral subthalamic nucleus (STN) and 1 patient with unilateral STN electrodes, 2 patients with bilateral posteromedial hypothalamus electrodes, 2 patients with unilateral mammillothalamic tract electrodes, and 1 patient with caudal zona incerta electrode placement. Overall, 5 of the 40 (12.5%) patients had an International League Against Epilepsy class I (i.e., seizure-free) outcome, and 34 of the 40 (85%) patients had seizure reduction with DBS stimulation.

CONCLUSIONS

DBS is an alternative or adjuvant treatment for children with DRE. Prospective registries and future clinical trials are needed to identify the optimal DBS target, although favorable outcomes are reported with both CM and ATN in children.
Znaczenie i rola Izaaka i Jakuba w historii Izraela według Syracha (Syr 44,22-23)
Authors: Piwowar Andrzej
Published: March 2019

The article is devoted to the analysis of the Greek text of Sir 44:22-23, but it also takes into account the Hebrew version of the praise of Isaac and Jacob. The main aim of the article is to read Sirach’s depiction of these two patriarchs in his Praise of the Fathers (Sir 44:1 – 50:24) and the role and significance that he attributes to them in Israel’s history. The analysis conducted shows that the Jerusalem sage based his presentation of Isaac and Jacob exclusively on the Book of Genesis, not referring to any theological traditions connected with the patriarchs that were known during the Second Temple period. The principal role played by the two patriarchs in the history of the chosen nation is passing on to the subsequent generation the covenant that God made with Abraham and the promises related to it (Isaac’s substantial passivity in this role has to be pointed out). It is this motif that is emphasized in Sir 44:22-23, as a result of which other important events from the patriarchs’ lives are completely overlooked, including the justification of Jacob’s stealing of Isaac’s blessing for his firstborn son.
Michael Vicko Zolondek, We Have Found the Messiah. How the Disciples Help Us Answer the Davidic Messianic Question (Eugene, OR: Pickwick, 2016)
Authors: Pietrzak Jacek
Published: March 2019

Book review: Michael Vicko Zolondek, We Have Found the Messiah. How the Disciples Help Us Answer the Davidic Messianic Question (Eugene, OR: Pickwick, 2016)
Działalność Instytutu Nauk Biblijnych KUL w roku akademickim 2017/2018
Authors: Bąk Tomasz Bartłomiej
Published: March 2019

Działalność Instytutu Nauk Biblijnych KUL w roku akademickim 2017/2018
Marteloscopes au service de la sylviculture proche de la nature
Authors: Junod Pascal
Published: March 2019

Marteloscopes in the service of close-to-nature silviculture

In Switzerland, close-to-nature silviculture is recognised as strategically important. It is part of the management principles prescribed in Article 20 of the Federal Act on Forests. The implementation of this type of silviculture is based on a holistic understanding of the forest, which is considered both as a complex habitat and as a multifunctional production system. Marking is the core activity of forest management. It is an integrative decision-making act at the interface between planning and timber harvesting. Since 2011, the silvicultural department in Lyss has been using marteloscopes for training purposes. They are valued as didactic tools and enable practice of a forest management that is carried out in accordance with the overarching legal objectives of sustainability, naturalness and multifunctionality. Thanks to the georeferencing of the trees and the recording of their characteristics, it is possible to compare the various marking proposals visually and quantitatively. The marteloscope exercises, carried out in a spirit of healthy competition, are one of the pillars of the training of forest professionals.
Disciplina e poder: breves considerações sobre a questão do corpo na filosofia de Michel Foucault
Authors: Costa Leandro Sousa , Camargo Leonardo Nunes
Published: March 2019

Este artigo tem por finalidade apresentar alguns aspectos relacionados à questão do corpo na filosofia de Michel Foucault. Para isso, a nossa investigação se dará em dois momentos: no primeiro momento analisaremos a relação do corpo com a medicina para percebermos como a visão deste saber sobre o corpo se modificou a partir do século XVII, veremos que há uma relação entre o olhar médico e o corpo em si. O segundo momento será dedicado a uma explicitação acerca da relação entre poder e corpo; será possível notar que as práticas subjetivas são determinadas a partir de dispositivos culturais próprios de uma realidade cultural. No esteio disso, o poder disciplinar, que tem o seu ideal no panóptico, foi elemento preponderante para o projeto de domesticação dos corpos. Enfim, não é possível afirmar uma teoria sobre o corpo, no pensamento do filósofo francês, pois a sua investigação traz à tona a complexidade das estruturas culturais que determinam as diversas percepções a respeito desse corpo.
A filosofia de Ludwig Wittgenstein à luz do diagnóstico de autismo
Authors: Silva Gustavo Augusto Fonseca
Published: March 2019

Em Meu pensamento filosófico, Bertrand Russell afirma que a segunda filosofia de Ludwig Wittgenstein lhe parecia inteiramente ininteligível e constituída de doutrinas positivas triviais e de doutrinas negativas infundadas. Essas críticas ainda hoje são largamente consideradas como decorrentes do fato de Russell não ter compreendido as ideias tardias de Wittgenstein. Em oposição a esse julgamento, neste artigo argumenta-se que o diagnóstico póstumo de que Wittgenstein era autista suscita uma nova interpretação tanto de suas doutrinas positivas quanto de suas doutrinas negativas, levando a uma revalorização do parecer de Russell sobre elas.
Shopdropping
Authors: Mürlebach Mara
Published: March 2019

This article brings together a feminist sloth, a cultural activist practice and a Human Geography student. That student, the author of this article, shopdropped a sloth sticker to protest the discriminatory body politics of diet magazines. Through a practice-based and autoethnographic approach, she tries to make sense of her own experience and of shopdropping as an activist practice. Drawing on the geographical concepts of place and movement, shopdropping is situated within the debates around subversive material cultures and creative interventions into places of consumption. Shopdroppers‘ disobedient things lend themselves to thinking through the connections between geography, art, and activism and for contemplating the effects of creative engagements with cultures of consumption.
Extensive hyperdense zone in the mandible. A case report.
Authors: Molina Magdalena , Romero Valeria , Domínguez Darío , Aguilar José , Fuentes Arturo
Published: March 2019

Hyperdense zones are considered a generic term to define an area of increased density regardless of its cause. Idiopathic hyperdense zones are referred in literature as enostosis, focal osteosclerosis, periapical osteopetrosis or bone scar and are found as imaging finding during a rutine radiograph. They have greater predilection for long bones, but can also appear in the maxillary bones in certain occasions, often located in the jaw, especially in the molar region, with an informed incidence rate that varies from 2,3 to 9,7% depending on the population in which the study is being applied. In 40% of the cases, in spite of being of idiopathic origin, they seem to be associated with patients with occlusal trauma or can be a result of a predominant development of isolated bone during bone growth. The case of a 36-year-old female patient is described, who presents hyperdensity that differs in form, location and imaging features from the commonly documented in this type of anatomical variations. It was diagnosed as idiopathic osteosclerosis, periodic imaging controls were established. The purpose of this case report is to emphasize the importance of performing an appropriate differential diagnosis among hyperdense lesions at maxillofacial level.
建筑钢结构工程安装施工及其安全防护的探析
Authors: 李 春
Published: March 2019

随着科技的进步发展以及城市化建设的不断推进,使得建筑钢结构工程日趋增多,为了保障钢结构工程质量及其顺利实施,本文简述了建筑钢结构工程的优势特征,对建筑钢结构工程安装施工要点及其安全防护管理进行了探讨分析。
关于建筑工程施工阶段造价控制的探讨
Authors: 李 文学
Published: March 2019

建筑工程施工阶段造价控制是项目工程成本控制的关键阶段,其是有效降低项目工程成本以及提高项目工程经济效益的重要途径,因此为了保障建筑工程施工阶段造价控制的有效性,本文阐述了建筑工程施工阶段造价控制的主要特征,对建筑工程施工阶段造价控制存在的问题及其策略与建议进行了探讨分析,旨在提高建筑项目工程建设的经济效益。
简述市政道路工程排水管道施工技术要点
Authors: 粟 利芬
Published: March 2019

随着经济建设的发展,我国的市政道路工程建设数量不断增多,在为人们生活提供便利的同时,也对地方经济的发展产生了很大的推动作用,而在市政道路工程当中,排水管道施工是一项非常关键的内容,其施工质量会对市政道路工程的整体质量造成直接的影响,关系到工程的正常使用以及综合效益发挥,因此,本文针对市政道路工程当中的排水管道施工技术进行讨论,对相关排水管道施工的主要特点加以了解,并对相关施工技术要点加以探讨和描述,希望能够对市政道路工程整体质量的提升产生一定的推动作用。
跨海大桥桥梁助航标志防腐技术探讨宁波航标处
Authors: 李 继光
Published: March 2019

随着国家对发展现代海洋经济的重视,20世纪90年代以来,我国海洋经济以两位数的年增长率快速发展。在以加强区域与区域间的交通、岛屿与岛屿之间的交通的急迫需求下,再加上我国造桥技术的日益成熟,近20年来,我国跨海大桥的建设,可谓发展非常之快,一些跨海大桥的建成,成了地域间经济交流的纽带,在带动地方经济的快速发展方面起着重要作用。在东海海区,大型的跨海大桥就有杭州湾跨海大桥、东海跨海大桥、金塘跨海大桥、象山港大桥、嘉绍跨海大桥等,在大桥配套的桥涵标巡检维护工作中,发现桥涵标的防腐工作需进一步加强。
土木建筑地基基础工程建设的软土地基施工处理技术
Authors: 沈 丽君
Published: March 2019

现代土木建筑地基基础工程普遍存在软土地基现象,使得地基基础工程施工中存在严重的地基不稳、地基软化、地基抗震性差、地基沉降等问题,这些问题严重影响建筑物的质量,因此为了保障建筑工程建设的顺利进行,本文阐述了土木建筑地基基础工程建设的主要特征,对土木建筑地基基础工程常用的软土地基施工处理技术及其施工处理技术要点进行了探讨分析。
房屋建筑装配式混凝土结构建造技术的研究和分析
Authors: 梁 华志
Published: March 2019

装配式混凝土结构建造技术对于现代房屋建筑工程建设具有重要作用,该施工技术通过使用单一的材料进行混合,建造出新型混凝土结构,提高了原材料施工质量,同时提高了房屋建筑整体施工质量和后期使用效能,从而促进建筑业的可持续发展。基于此,本文阐述了房屋建筑装配式混凝土结构建造技术的优势特征,对房屋建筑装配式混凝土结构建造技术及其存在的问题与措施进行了探讨分析,旨在提高房屋建筑装配式混凝土结构建造技术水平。
市政工程的安全监理特点及实物
Authors: 王 胜浩
Published: March 2019

市政工程是促进城市经济发展,推进民生保障的主动力,为提高市政工程建设水平,首要前提是积极落实工程安全监理工作,完善城市基础配套设施,为居民提供优质服务。基于此,本文围绕市政工程的安全监理特点及实物展开深度探究。
浅析园林绿化工程建设的施工要点及其注意事项
Authors: 赵 恒斌
Published: March 2019

园林绿化工程施工是一项综合性较强的工作,作为从业人员既要掌握理论知识,还必须对施工要点的具体操作加以控制,才能保证园林绿化工程施工质量。基于此,本文阐述了影响园林绿化工程建设的主要因素及其施工要求,对园林绿化工程建设的施工要点及其注意事项进行了探讨分析。
关于“互联网+”创新创业人才培养的思考
Authors: 曾 君
Published: March 2019

在“互联网+”背景下,信息技术是引领社会发展与进步的关键技术,正从本质上改变社会的生产方式与生活方式,各行各业都不断调整发展模式以便适应互联网时代实现自身的长足发展。因此,教育事业更应顺势而为,通过教育为社会输送更多实用性人才,文章结合当前社会发展需要以及“互联网+”时代对人才的要求,对培养“互联网+”创业创新人才展开了深入的思考,探究有效的培养策略。
氩弧熔敷原位自生(Ti,Nb)C增强镍基复合涂层工艺研究
Authors: 郭 天师
Published: March 2019

本文以Ni60A、Ti、C和Nb粉末为原料,利用氩弧熔覆技术在16Mn钢基体表面原位合成TiC和(Ti,Nb)C增强Ni基复合涂层。试验采用不同的电流、预敷粉末配比(含Nb不同的混合粉末)进行试验。使用金相显微镜、扫描电镜和X射线衍射仪等分析检测方法,对表面层的宏观形貌、相组成、微观组织进行观察及分析,并测试不同成分复合涂层的显微硬度及摩擦磨损性能。结果表明：昀佳熔覆工艺参数为：粉末涂层厚度为0.5-1.0mm,熔覆工艺电流为130A；熔敷层与基体呈冶金结合,无裂纹、气孔等缺陷,TiC和(Ti,Nb)C颗粒弥散分布于熔敷层中；复合涂层的显微硬度昀高达到900HV,相对耐磨性较基体提高9倍。
以学生为本，用科学人文教育手段，促进课堂有效教学
Authors: 杨 光新
Published: March 2019

大课题中提到“凡是能够有效地促进学生的发展,有效实现预期教学效果的教学活动,都可称之为‘有效教学’。根据我们综合组老师教学经验和新课程改革中的课程理念,我们再把它细化一点,认为:在制定教学目标时必须以学生为本,利用科学,适合学生特点的教育方式促进学生的全面发展,昀终实现教学目标的都可以称之为“有效教学”。
在高校开展赛艇运动的价值与意义
Authors: 石 磊 , 汪 一鸣 , 胡 浩 , 王 惠敏 , 杨 侃
Published: March 2019

现代赛艇运动是人类体能和智能的完美呈现,其核心文化精髓是追求人与自然的和谐以及积极奋斗的精神理念。校园赛艇在我国得到了很快的发展,但仍处于起步状态,保证校园赛艇训练的科学化程度和健康的成长需要多方面的努力。在高校开展赛艇运动有广阔的前景,在心理健康和社会适应能力这两大课程目标的培养上发挥着重要的作用,是对体育传统教学新的补充,对推动传统教育模式的改革和大学生整体素质的提高具有重要意义。
在美术活动中渗透科学教育
Authors: 卜 祥红
Published: March 2019

小学美术的课程内容主要是绘画,随着社会的发展,形式多样的美术活动可以融入到课堂中。绘画是美术课堂昀基础的教学内容,但美术课堂的教学不能仅仅局限于绘画,对于色彩的认识是很关键的,色彩基础的学习是六年级美术的重要学习阶段,学生的自主能动性更强,课程教学中更要关注学生,重视课程内容与教育目的的融合,把多方面的美术知识传达给学生。教师要抓住学生年龄阶段的特点,通过合理的方式提高学生辨别和搭配色彩的视觉能力,学习美术文化与生活的关系,适应世界色彩的多元化。
The conflict of interests of economic entities and to minimize its consequences by reducing the risks of corporate lending
Authors: Ushanov, A. E.
Published: March 2019

This article is devoted to the construction of a risk-oriented model of credit risk reduction in the course of the life cycle of the loan in the provision of a commercial Bank loan to a corporate client. The work demonstrates, firstly, the need to introduce innovative solutions that reduce the risk of non-repayment of the loan by the borrower, and secondly — the mechanism of using such elements of the model as a new system of limits and risk profiles, the Institute of underwriting, IRB-approach to determine the risk category of the application and the body authorized to make.
Suvremena turistička izgradnja na području Rovinja - zona
Monte Mulini, Istra
Authors: Krošnjak Stefan , Mrak Iva , Matan Cela , Franković Marko
Published: March 2019

U radu je dan povijesni pregled razvoja turizma u
Rovinju te je razvoj zone Monte Mulini analiziran kao posebno zanimljiv s
aspekta novije hotelske izgradnje u Hrvatskoj. Na relativno malom području uz
rub parka šume Zlatni Rt u posljednjih desetak godina sagrađena su čak tri
visoko kategorizirana hotela na mjestu postojećih te je renoviran hotel Eden
arhitekata Bartolića i Begovića. U radu se analiziraju osnovne karakteristike
nove gradnje i rekonstrukcije hotela Eden te urbanističke i arhitektonske
karakteristike ove zone.
Statistička obrada podataka o vremenskim neprilikama u svrhu određivanja mjesečnog intervala s matematički očekivanim danima zastoja pri radu gradilišta na području grada Rijeke
Authors: Šopić Martina , Car-Pušić Diana
Published: March 2019

Meteorološki i klimatski uvjeti mogu uvelike utjecati na kontinuirani i zadovoljavajući tijek izvođenja radova na gradilištu. Posebno je važno, ali nedovoljno primijenjeno u praksi, prilikom izrade vremenskog plana i definiranja roka za građenje uzeti u obzir i moguće zastoje pri radu gradilišta zbog nepovoljnih vremenskih uvjeta. Meteorološki i klimatski uvjeti imaju različit utjecaj ovisno o lokaciji gradilišta. Iz tog razloga, kako bi se statistički obradio utjecaj vremenskih neprilika na području grada Rijeke, s pripadajućom umjereno toplom, vlažnom klimom i vrućim ljetima (Cfa - Köppen-ova klasifikacija klime), od Državnog hidrometeorološkog zavoda (DHMZ) zatraženi su meteorološki podaci o vremenskim neprilikama za vremensko razdoblje od 25 godina, izmjerenih i zabilježenih u glavnoj meteorološkoj postaji u gradu Rijeci. Vremenske neprilike za koje su zatraženi podaci, a koje su karakteristične za klimatsko područje grada Rijeke, su Oborine (≥ 10 mm), Olujni vjetar, Hladni dani (Tmin < 0 °C) i Vrući dani (Tmax ≥ 30 °C). Zatraženi meteorološki podaci su u obliku ukupnog broja dana u mjesecu sa zabilježenim djelovanjem pojedine vremenske neprilike. Ciljevi ovog rada su, primjenom odgovarajućih statističkih testova, testiranje različitosti na razini značajnosti od 5 %, među skupinama vremenskih neprilika (Kruskal-Wallis test, Mann-Whitney test) te, zatim, određivanje 95 % pouzdanog intervala s matematički očekivanim danima zastoja pri radu gradilišta za svaki mjesec pojedinačno (intervalna procjena očekivanja u skupini s normalnom distribucijom podataka). Mjesečni intervali dobiveni statističkom obradom s matematički očekivanim danima zastoja, zbog vremenskih neprilika predstavljaju vrijedan ulazni parametar u svrhu preciznije izrade vremenskog plana i definiranja roka za građenje na području grada Rijeke.
Prekoračenja rokova i proračuna građevinskih projekata – studija slučajeva
Authors: Tijanić Ksenija , Car-Pušić Diana
Published: March 2019

Građevinski projekt je nerutinski, neponovljivi i jedinstveni pothvat koji ima zasebne vremenske, financijske i tehničke izvedbene ciljeve. Upravljati građevinskim projektom znači primijeniti znanja, vještine i tehnike radi regulacije tijeka projektnih aktivnosti kako bi se ostvarili ciljevi projekta. To primarno znači završetak unutar ugovorenog roka i proračuna projekta, uz zadovoljavajuću kvalitetu izvedbe. Problem prekoračenja ugovorenog roka i proračuna globalna je pojava, kako u razvijenim, tako i u zemljama u razvoju. Stoga je i često u središtu istraživačkog interesa s različitih aspekata promatranja. Pritom se koriste razne istraživačke metode i matematički alati obrade podataka. Cilj ovog rada je prepoznati veličine i uzroke prekoračenja u projektima te dati smjernice za njihovo smanjenje. U svrhu istraživanja korištena je „multiple case-study“, tj. studija više slučajeva. Prikupljeni su podaci za dvanaest različitih projekata koji su se izvodili na području Republike Hrvatske u 2018. godini. Podaci uključuju tehničke karakteristike objekata, ugovorene rokove i troškove, kvalitetu izvedbe, veličine prekoračenja te uzroke njihovog nastanka. Podaci su prikupljeni uvidom u dokumentaciju te intervjuiranjem voditelja svakog pojedinog gradilišta. Analizom i obradom podataka prepoznati su trendovi prekoračenja, kao i slabe točke u planiranju i vođenju navedenih projekata, na temelju čega su dane smjernice i preporuke u svrhu smanjenja prekoračenja rokova i troškova u budućim projektima.
Projekt konstrukcije staklene stijene ovješene na prednapetim kablovima
Authors: Milovan Franko , Buljan Nebojša , Bjelanović Adriana
Published: March 2019

Na primjeru projekta izvedene staklene stijene ovješene na prednapetim vertikalnim kablovima, u radu su kratko opisane njihove konstrukcijske značajke, a detaljnije razrađena načela proračuna. Uspoređeni su rezultati primjene dvaju pristupa u modeliranju: integralnog, koji uključuje i glavnu nosivu konstrukcije te interakciju u zonama oslonaca ostakljenja, te pojednostavnjenog, sa sekvencijalno modeliranim kablovima i simulacijom interakcije s glavnom konstrukcijom oprugama zamjenskih krutosti u točkama sidrenja kablova. Analizirane su prednosti, razlozi i posljedice primjene modela na ponašanje staklene stijene i cjelovite konstrukcije.
Hemoglobina glicosilada como signo de alarma
Authors: Martín-Regidor Manuel , Bonache-Castejón Nakaire , Fernández-Pérez María Esther , Martínez-Alonso Ana , Sancho-Pascual Gerard
Published: March 2019

Mujer de 67 años diabética tipo 2, que tras varios años de buen control glucémico, con cifras de hemoglobina glicosilada (HbA1c) en torno a 6,5%, consulta por clínica cardinal con poliuria, pérdida de peso y astenia. La analítica inicial muestra cifras de HbA1c de 14%, razón por la que se deciden ampliar estudios. Finamente, se evidencia en colangio-resonancia magnética nuclear una masa pancreática que, tras realización de
ecoendoscopia con toma de biopsias, confirma la presencia de un adenocarcinoma anaplásico de páncreas.
Removal of silicon from green liquor with low-temperature precausticizing
Authors: Xia Xinxing , Wang Fang , Sun Shan , Hu Qian
Published: March 2019

Nonwood materials contain a high percentage of silicon, which causes numerous problems in the chemical recovery section. Researchers previously proposed the method of silicon removal by two-stage causticizing at temperatures of 90ºC to 95ºC, finding that the desilication rate was about 72.9% and the causticizing efficiency was 22.7% when 30% of the causticizing quicklime (calcium oxide; CaO) was added. The present paper deals with the desilication of green liquor recovered from wheat straw black liquor by a low-temperature precausticization method. The results showed that about 89.3% silicon removal and 10.3% causticizing efficiency were achieved under the following precausticizing conditions: added lime amount of 20%, temperature of 20ºC, and reaction time of 60 min. While precausticizing at 90ºC with the same lime amount, only about 63.5% silicon removal and 13.0% causticizing efficiency were gained. Therefore, precausticizing with low temperature was beneficial for silicon removal and retention of carbonate (CO3 2-).
Paper coated with sonochemically synthesized zinc oxide nanoparticles: Enhancement of properties for preservation of documents
Authors: MAJUMDAR SUCHISMITA , ROY ANIRBAN , NANDI ISITA , BANERJEE PRANTIK , BANERJEE SWAPNA , GHOSH MAHUA , CHAKRABARTI SAMPA
Published: March 2019

Sonochemically synthesized zinc oxide (ZnO) nanoparticles were coated on paper for enhancing its properties in view of the preservation of documents. The paper used for accession register was used as substrate. Physical, chemical, optical, hydrophobic, and antifungal properties of the coated and uncoated papers were compared. Nanoparticles were synthesized with ultrasound from organic precursors and were characterized by X-ray diffraction (XRD) and field emission scanning electron microscopy (FESEM), whereas coated and uncoated papers were examined following standard procedures as described by the Bureau of Indian Standards (BIS). It was observed that coating with nanoparticles imparted mechanical strength, water repellence, and antifungal properties to the paper without compromising its printability. Hence, coated paper is comparatively more suitable for preservation of written or printed documents than uncoated paper.
MARKETING STRATEGY AT RANCABUAYA BEACH USING THE ANALYSIS FACTORS OF EXPANDED MARKETING MIX AND PROMOTION MIX
Authors: Basuki Teguh Iman
Published: March 2019

West Java is one of the provinces in Indonesia that has strong potential and wisdom, mountains range from the east to the west of the Bogor Peak area, as well as the southern region which has attractive coastal views and panoramas from Pangandaran district to sukabumi district. One of the southern parts of West Java which has the potential of coastal tourism is Garut regency, one of them is the Rancabuaya beach, the potential of Rancabuaya beach tourism is now being developed to attract tourists, located in Purbayani village in Caringin sub-district with an area of 10 hectares while the current area used as a new tourism area of 2 hectares, which is also directly adjacent to the Indian Ocean with the characteristics of having big tide and large rocks and rock cliffs that are quite high, another potential tourism attraction is the presence of a waterfall directly facing the beach. However, Rancabuaya beach is very beautiful, but the level of tourist visits is less than the total visitors to other southern Jabar (west Java) beach attractions, which is Pangandaran beach. Visitors to rancabuaya beach are very crowded only in certain events such as, New year, Eid or other National holiday. This study aims to find out what the right marketing model can be applied at Rancabuaya beach tourism area. The results of this study indicate that the indicators of income mix and promotion mix get a good response from the respondents and have a strong relationship to the factors that are formed. Keywords: Rancabuaya beach, promotion, marketing
Meningkatkan Kinerja Pelayanan Birokrasi Pemerintahan Melalui Penguasaan Teknologi Informasi
Authors: Hernita Sahban
Published: March 2019

The capacity of End-User Computing, and information intelligence have an influence on employee performance and to find out which dominant variables affect employee performance. This study uses primary data through surveys using a sample of 23 employees who served in the IT department. The results of this study indicate that the mastery of computer hardware and software has no significant effect, the capacity of End-User Computing has insignificant influence and information intelligence has a positive and significant influence on employee performance. The most dominant variable affecting employee performance is information intelligence. This means that information intelligence such as the ability of employees to utilize facilities, compile, implement and report solutions in the use of computer devices combined with End-User Computing capacity related to the task can encourage employee performance improvement.
The effect of health literacy on treatment adherence in maintenance haemodialysis patients: a cross-sectional study
Authors: Esterman Adrian
Published: March 2019

Background: Treatment non-adherence may be prevalent in patients requiring haemodialysis (HD). Health literacy plays an important role in self-management. However, most research has only assessed basic literacy skills in the haemodialysis cohort.
Aim: To determine the association between a multidimensional concept of health literacy and self-reported treatment adherence in HD patients.
Method: A cross-sectional survey was undertaken with 42 maintenance HD patients from two South Australian dialysis centres. The Functional, Communicative and Critical Health Literacy (FCCHL) tool was used to assess health literacy. Treatment adherence was measured using a self-report tool developed by the researchers.
Results: Higher overall health literacy was associated with increased adherence to food (OR 3.66; 95% CI 1.08–12.43; p=0.038), fluid (OR 4.92; 95% CI 1.13–21.35; p=0.033) and medications (OR 11.88; 95% CI 2.26–62.44; p=0.003).
Conclusion: Interventions should be designed to facilitate a multidimensional concept of health literacy to assist patients to follow treatment recommendations.
Transformation of Writing Habit on Students at Junior High School and Vocational High School Awal Karya Pembangunan Lubuk Pakam
Authors: Putri Dian Marisha , Putri Liza Amalia , Rangkuti Rahmadsyah
Published: March 2019

Writing Learning must still be based on Core Competencies (KI) which are then announced in Basic Competencies (KD) and Indicators through learning material. Similarly, the writing material results from field observations and observations. Add another competition for scientific publication of adolescents conducted at the District / City, Provincial and National Level. While the material can be achieved and competitions can be followed. In this paper, it is discussed giving habit transformation of writing through concepts and for example making students see general writing, then students look for references and field data. Only to discuss the substance of scientific writing needs field reinforcement data carried out by students and must be guided directly by the guidance teacher through habit transformation of writing so that the validity and writing of scientific writings can be accounted for. The results of habit transformation in adolescent students are quite significant, so that the 5 texts that have begun to be seen develop and several texts in the process of improvement. Of the seven texts prepared the results are quite encouraging. 2 manuscripts have started the results of their writings by fulfilling the rule of writing.