bluuebunny/crossref_metadata_2025 huggingface dataset:
Public Support for Higher Taxes on the Wealthy: California’s Proposition 30
Authors: Tolbert Caroline J. , Witko Christopher , Wolbers Cary
Published: June 2019

It has long been argued that growing inequality would lead to growing demands for redistribution, especially from less affluent individuals who would benefit most from redistribution. Yet, in many countries we have not seen tax increases and even when ballot initiatives allow individuals to directly vote to raise taxes on the wealthy they decline to do so. This raises the question of how economic self-interest shapes voting on tax proposals, and what factors may weaken the links between economic self-interest and tax policy preferences. In the U.S. context partisanship is a factor that has a major influence on attitudes about taxation. To explore how self-interest sometimes overcomes partisanship we take advantage of competing initiatives that were simultaneously on the ballot in California in 2012. California’s Proposition 30, a successful 2012 initiative, significantly increased taxes on the wealthy. By comparing voting on Proposition 30 to voting on Proposition 38, which would have raised taxes on nearly everyone, we observe that when tax hikes are focused only on the wealthy a substantial number of lower income Republicans (i.e., conservatives) defect from their party position opposing taxation. We identify these low-income Republicans as “populists.” Lower income Republicans are also less supportive of income tax increases on the lower and middle classes, and are more sensitive to income tax increases than sales tax increases. We argue that economic self-interest causes heterogeneity within the parties in terms of attitudes toward tax increases.
The Promise and Perils of Direct Democracy: An Introduction
Authors: Donovan Todd
Published: June 2019

Direct democracy promises politics that improve links between citizens and their representatives, and satisfies popular demand for increased engagement. In practice it may fall well short, given limited citizen capacity, poor information from campaigns, and ill-designed processes. The articles here represent the opportunities that direct democracy offers for the study of these promises and perils.
Ageing in Suburban Neighbourhoods: Planning, Densities and Place Assessment
Authors: Ioannou Byron
Published: June 2019

The article examines the environmental qualities perceived by ageing populations in suburban low-density and car-oriented neighbourhoods in comparison to more dense and central areas. The study focuses on Nicosia, Cyprus, a city that suffers from extended sprawl and car dependency in almost every urban district. The aim of the article is to investigate how older adults perceive and evaluate their place of residence and if this assessment relates to the suburban or the city centre profile of their neighbourhoods. For this reason, the study takes five residential districts, two central and three suburban areas, as case studies. Each of the selected residential districts performs differently in terms of percentage of the population over the age of 65; scale and street layout; adequacy in supporting land uses; building density; distance from the city centre and public space availability and condition. The almost exclusive use of private cars, as the main transportation mode is a common feature of all older adults interviewed in these areas. The older adults’ perceptions of place are assessed through the Place Standard (PS), a simple recently awarded framework which structures conversations about place in regard to its physical elements as well as its social composition. PS is used as an interview tool, which allows the mapping/visualization of qualitative data. Qualitative in-depth interviews conclude to an evaluation of fourteen aspects that outline a residential district profile from mobility to green and urban image attractiveness, and from facilities to social contact and safety, covering almost every aspect of daily life. The article concludes that the neighbourhood assessment from older residents varies depending on the nature of the suburban neighbourhood. Density, layout and distance from the city centre matter according to the participants’ evaluation and there is a clear preference towards suburban low-density areas.
Benches as Materialisations of (Active) Ageing in Public Space: First Steps towards a Praxeology of Space
Authors: Moulaert Thibauld , Wanka Anna
Published: June 2019

In its promotion of “active ageing” through Age-Friendly Cities and Communities (AFCC) and the Global Network on AgeFriendly Cities and Communities (GNAFCC), the World Health Organization has developed a vision of ageing that links socio-spatial environments to personal lifestyles and community support. Approaching age-friendly environments from a “doing” perspective shifts our focus from such ideals to social practices, materialisations, and representations produced. Regularly referred to in AFCC discourse, public benches offer a great illustration for such materialisations. This article asks: what do benches tell us about the way ageing is framed and shaped in the AFCC discourse? How do benches themselves exhibit agency in it? Theoretically based on Lefebvrian social theory and critical gerontology, our reflexive article explores promotional/policy documents supporting AFCC worldwide, “good practices” shared by GNAFCC, and a series of European field observations around AFCC and benches and, finally, personal observations of ageing in public space around benches. Drawing on the Lefebvrian differentiation between representational benches, representations of benches, and social practices of benches, we show how benches can be considered as a socio-technical “assemblage” able to: 1) forge ambivalent representations and solutions for “active ageing” in public space, 2) illustrate, beyond the symbolic of space, the symbolic difficulties of “real” participative and multi-stakeholders governance promoted through “age-friendliness”, and 3) explore everyday life practices of “spatial expulsion” of “ageing in public space” for older adults. In conclusion, we suggest a major shift for the AFCC program by finding inspiration in African practices of “ageing in public space”.
The Development of ‘Age Appropriate’ Living Environments: Analysis of Two Case Studies from a Social Work Perspective
Authors: Fabian Carlo , Janett Sandra , Bischoff Tobias , Pardini Riccardo , Leitner Johanna , Knöpfel Carlo
Published: June 2019

As the growing number of older people, particularly in urban areas, and changing lifestyles are increasing the importance of continuing to live in the community (ageing in place), studies show that age-related planning of living environments is often shaped by stereotypes, and that the needs of present and future older people are not sufficiently taken into account. In this context, two case studies based on Henri Lefebvre’s theory presented in his book The Production of Space investigate how ‘age-appropriate’ living environments are conceived, practiced and lived, and to what extent age-related stereotypes affect these processes. The two cases examined are an intergenerational project to promote physical activity and the development of a new city square. For both cases, interviews and walkthroughs were conducted with experts from various planning disciplines, as well as with current and future older people. The findings show that in planning practice the notions of old age and older people often remain diffuse and, at the same time, older people are often seen as a homogeneous and fragile group. The results indicate that the importance given to neighbourhood in old age can vary greatly. For social work, this implies that older people should be even more involved in the design of their living environments, through participatory processes, in order to better meet the heterogeneity of their needs.
Talented Researcher of Developmental Education (to the 100- th Anniversary of G.I.Minskaya)
Authors: Isaev E.I. , Еzhkova N.S. , Pazukhina S.V.
Published: June 2019

The article highlights the main milestones of the scientific and pedagogical activity of G.I. Minskaya — a prominent representative of the research team that developed an innovative system of developing training in the form of educational activities. It has revealed an important role of tentative research activities in changing the forms of children’s thinking. It is emphasized that G.I. Minskaya was at the origins of a large-scale experiment under the leadership of D.B. Elkonin and V.V. Davydov — headed the experiment at school № 11 in Tula. She has contributed to the identification of psychological and pedagogical conditions of teaching younger students to solve mathematical problems with alphabetic data.
Some ϕ-fixed point results in b-metric spaces with applications
Authors: SANGURLU SEZEN Müzeyyen
Published: June 2019

The fixed point theory is the most important topic in mathematics anaysis. This topic has many applications in the different fields. It demonstrates the uniqueness of the existence of a mapping and how it can be found. The Banach contraction mapping principle is most important theorem in the fixed point theory. Most authors have introduced new contractions and they proved some fixed point theorems in metric spaces. On the other hand, some authors introduced new metric spaces as a generalization of metric spaces. Later, they proved fixed point theorems which generalize the Banach contraction principle for various mappings in several metric spaces. The purpose of this study is to introduce the existence and uniqueness of ϕ-fixed point for some new contractions in complete b-metric spaces. Firstly, we presented new definitions called (F,ϕ,α,θ)_{s} and (F,ϕ,α,θ)_{s}-weak contractions in complete b-metric spaces as a generalization of metric spaces. Later, we proved ϕ-fixed point theorems for (F,ϕ,α,θ)_{s} and (F,ϕ,α,θ)_{s}-weak contractions in complete b-metric spaces. The presented theorems extend and generalize some ϕ-fixed point results which are known in the literature. As applications, we derived some fixed point results in complete partial b-metric spaces as a generalization of partial metric spaces. The results in this paper generalizes may existing results in the literature.
Zernek Barajı Çevresi (Gürpınar-Van)’nin Florası
Authors: DEMİR İbrahim , BEHÇET Lütfi
Published: June 2019

Bu çalışmada; Zernek Barajı Çevresi’nin (Gürpınar - Van)Florası araştırıldı.
2007-2009 yılları arasında gerçekleştirilen bu araştırmanın arazi çalışmaları
ile 1856 bitki örneği toplandı. Toplanan bu bitki örneklerinin teşhisi sonucu
alanda; 57 familya ve 300 cins’e ait 500 tür, 135 alttür ve 91 varyete olmak
üzere toplam 726 tür ve türaltı takson tespit edildi. 726 taksonun 2’si Pteridophyta, 724’ü Spermatophyta divisiolarına aittir. Spermatophytaüyelerinden 1’i Gymnospermae
ve 723’ü Angiospermae alt
divisiosuna dahildir. Angiospermae’lerin
632’si Dicotyledoneae ve 91’i Monocotyledoneae sınıfında yer
almaktadır.

Astragalus guzelsuensis F. Ghahrem. – Nejad, L.
Behçet & İ. Demir taksonu araştırma alanımızdan tarafımızdan toplanıp,
bilim dünyasına kazandırılmıştır.

Tip toplamadan bilinen ve Van’ın Çaldıran ilçesinin kuzey doğusunda
toplanıp 1987 yılında yeni bir tür olarak dünyaya tanıtılan Calamintha caroli-henricana Kit Tan & Sorger taksonu,
ikinci defa alanımızdan tespit edilmiştir. Belirlenen taksonlardan 12 tanesi B9
karesi için yeni kayıttır.

Alandan toplam 60 endemik takson tespit
edilmiştir. Endemizm oranı ise % 8.26’dır. Endemik ve nadir olan taksonların
tehlike kategorilerine dağılımları şu şekildedir: 2 takson kritik “CR”, 3 takson tehlikede “EN”, 17 takson zarar görebilir “VU”, 17 takson tehdit altına girebilir
“NT”, 34 takson az endişe verici “LC” ve 1 takson veri yetersiz “DD” şeklindedir.

İran-Turan fitocoğrafik bölgesinde yer alan
çalışma alanında tespit edilen taksonların fitocoğrafik bölgelere göre dağılımı
şöyledir; İran-Turan % 44.63, Avrupa-Sibirya %4.55, Akdeniz % 1.10, Öksin %
0.41, Hirkan-Öksin % 0.14 ve çok bölgeli veya fitocoğrafik bölgesi
bilinmeyenler % 49.17’
dir. İçerdikleri tür ve türaltı takson sayılarına göre alanda en büyük ilk 10
familya sırasıyla; Asteraceae 99 (%
13.64),  Fabaceae 77 (% 10.61), Brassicaceae, 76 (% 10.47), Lamiaceae 49, (% 6.75), Caryophyllaceae 49 (% 6.75), Poaceae 43 (% 5.92), Scrophulariaceae 33 (% 4.55) Apiaceae 29 (% 3.99), Boraginaceae 29 (% 3.99) ve Liliaceae 26 (% 3.58)’dır.
Gravitasyonel Alan Denklemleri ve Özellikleri
Authors: BATURAY Şilan , BİNBAY Figen
Published: June 2019

Gravitasyonel etkileşimleri ve buna bağlı olarak evrenin yapısını açıklayan genel görelilik teorisinin temel denklemleri olan ve 1915 yılında Einstein tarafından elde edilen genel görelilik alan denklemlerinin kozmolojik sabit (λ) içeren biçiminin çözümünün elde edilmesinden buyana alan denklemlerinin λ kozmolojik terim ve  evrensel gravitasyonel sabitin değişimi ile birlikte düşünülmesi genel görelilik çerçevesinde oldukça ilgi görmektedir. Bu çalışmada, içerisinde bulunan kütle, enerji ve momentumun varlığıyla eğrilen dört boyutlu bir Lorentz manifoldu olan uzay-zamanın eğriliği ile enerji-momentum tensörü arasındaki bağıntının Einstein alan denklemi ile sağlanacağı konusu incelenmiştir. Bu denklemlerin evrenin doğasını anlamaya yönelik getireceği yenilikler üzerinde durulmuştur. Bu bağlamda, evrenin ilk anlardaki (enflasyon evresi) fiziksel durumunun anlaşılmasını sağlayan genel göreliliğin temel ilkelerine dayalı gravitasyonel alan denklemleri kuramsal olarak irdelenmiştir. Ayrıca, son yıllarda tespit edilmeye çalışılan gravitasyonel dalgalar genel görelilik çerçevesinde araştırılmış ve bunların evrenin doğasını incelerken getirdiği yenilikler üzerinde durulmuştur.
Atıktan Türetilmiş Yakıtın Demineralizasyonu
Authors: BAŞAKÇILARDAN KABAKCI Sibel , GENÇ ÇELİKÇİ Gizem
Published: June 2019

Çalışma, atıktan türetilmiş yakıtın (ATY) yapısındaki kül oluşturan elementlerin su ve farklı konsantrasyonlarda asit çözeltileri ile özütlenerek yakıtın modifiye edilmesini ve bu demineralizasyon işleminin yakıtın temel özelliklerine (elementel analiz, ısıl değer, piroliz ve yanma karakteristikleri) etkisinin incelenmesini içermektedir. Su, HCl (%2, %5 ve %10) ve HNO3(%2, %5 ve %10) çözeltileri ile yapılan özütlemelerden sonra kurutulan ATY'ların yakıt özelliklerine bakıldığında, özütlemenin, yakıt özelliklerinden kül içeriğini, elementel bileşimini, piroliz kademelerini, tutuşma sıcaklığı ve tükenme sıcaklığını etkilediği görülmüştür. Özütleme işleminin gerçekleştiği karıştırma süresinin etkin bir parametre olmadığı belirlenmiştir. Fakat özütlemenin su, HCl ya da HNO3çözeltileri ile gerçekleştirilmesinin ve özellikle asit konsantrasyonunun yakıtın özelliklerinde etkin bir parametre olduğu gözlemlenmiştir. Özütleme işleminde kullanılan asit çözeltisinin türüne ve konsantrasyonuna bağlı olarak kül içeriğinin %34’ten %14’e kadar indiği (%5 HCl çözeltisi); ısıl değerin %13 oranında arttığı (%5 ve %10 HCl çözeltisi); karbon yüzdesinin ise %38 oranında arttığı (%10 HCl çözeltisi) gözlemlenmiştir. Asit çözeltileriyle yapılan özütleme sonrası ATY'ların pirolizinin iki adımda gerçekleştiği, tutuşma sıcaklıklarının 4-24°C ötelendiği, tükenme sıcaklığının ise 32-140°C azaldığı tespit edilmiştir.
3-Boyutlu Minkowski Uzayında İnvolüt-Evolüt Eğrilerinin T*B* ve N*B* -Smarandache Eğrileri
Authors: KALKAN Özgür , ZEYBEK Damla
Published: June 2019

Bu çalışmada;  (alpha*,alpha) involüt-evolüt eğri
çifti,  alpha*  spacelike evolüt eğri
ve  alpha*  ile bağlantılı
timelike evolüt eğri  alpha olmak üzere alpha*  eğrisinin Frenet
vektörleri konum vektörleri olarak alındığında  T*B* ve N*B* -Smarandache eğrisinin eğrilik ve torsiyonu alpha  timelike evolüt
eğrisine bağlı olarak hesaplanmıştır. Son olarak, elde edilen sonuçlar ile
ilgili örnekler verilmiştir.
The Determination on the Science Teaching Candidates’ Awareness about the Recycling
Authors: AKSAN Zeynep , ÇELIKLER Dilek , YENIKALAYCI Nisa
Published: June 2019

It is possible

with the people’s consciousness and awareness on the recycling that the

vital-importance of recycling becomes common for a healthier environment by

being an act in a society. Thus, it has been aimed to determine the science

students’ awareness of the recycling of wastes in this research. The research

sampling consists of 81 science students in total that they receive their

education at the 1. grade in the Department of Science Teaching in the Faculty

of Education in a state university located north part of Turkey. “The Awareness

Scale on The Recycling”, which was developed by Aksan and Çelikler (2017), has

been used as a data collection tool in this research. When it is considered

that 195.75 is mean of the scores which were obtained by the students from the scale

in the study, it can be highlighed that the awareness about recycling of the

students is high.
Una mirada a los procesos en torno a la educación con los pueblos indígenas en Colombia
Authors: Rojas Curieux Tulio
Published: June 2019

Increasing attention is being paid to various realities and their cultural practices. These processes have evidenced tensions, one of them being the awareness not only of sharing the world with other people, but also that there are cultural practices that are far from being extinguished or hidden. One of the areas where these tensions are expressed is education, and even more so when in national states various societies claim differences at different levels, either in historical processes, in health, in the conceptions of the law and, above all, in the conceptions and practices of education. The need for differentiated education has been strengthened in the state’s proposed Ethnic Education and in the proposals of indigenous organizations; first, Bilingual Education; then Intercultural Bilingual Education; Own; and, most recently, Indigenous Education System Own – SEIP (in Spanish). A look at these processes will be presented, paying special attention at how to build bridges to construct a deliberately democratic and inclusive society, aware that indigenous peoples are and have been in permanent relationship with the national society.
A Multiplurilingual Space for Language Education. How Can Teacher Education Respond to the Linguistic and Cultural Diversity in a Given Place?
Authors: Bes Asunción , Ehrhart Sabine
Published: June 2019

Luxembourg is one of the countries with the highest degree of linguistic variety in Europe. The situation of the Luxembourgish classroom is challenging as at least three school languages meet children with a multilingual background in their families, very frequently of a different type of repertoire (with more than 50% of the school population having a migration background). The school system has tried to find solutions by adapting teaching models for newly arrived students and pupils according to their individual profile. The research project presented here is based on two pillars: an institutional co-construction between teachers and researchers, aiming for mutual empowerment, and an international cooperation between two researchers. The latter formed a tandem with more than two wheels due to their experience in teacher education and educational research in various multilingual spaces, including Luxembourg as well as Spain, France, Germany, Russia, the South Pacific, Madagascar, and Siberia.
Materialese as Border Thinking: The Multimodal Voice of Bilingual Learning Materials
Authors: Aldana Yeraldine
Published: June 2019

This paper discusses the emerging and multidimensional category in a study about the development of a didactic material for Spanish learning in bilingual and multimodal settings. Since didactic materials for L2 education seemed to rely on geopolitics of linguistic knowledge and on second generation-based interaction in distance learning, this study aimed at creating a bilingual didactic resource for learning in a hybrid and intercultural environment. This blended material for Spanish as a second language learning was developed through a methodological path with a threefold purpose: creation, application and evaluation. This descriptive-interpretive study was framed within the qualitative paradigm. Data collection instruments were images or visual data along with field notes taken during the application of the didactic resource in a simulated experience. Findings center on an emerging category presented as a neologism. This category embraces the concept of materialese, understood as the didactic objects’ language, which involves linguistic, social and cultural dimensions. This multimodal voice of materials allows for intercultural spaces where emergent bilinguals can interact and learn from their border thinking (Mignolo, 2000; Icaza, 2017). Languages´ role and sociocultural practices were negotiated through intercultural communication in our didactic guide’s multimodal voice. The impact of didactic materials seems mediated by their voice acquired before, during and after their development.
Transthoracic ultrasound guided fine needle aspiration cytology of peripheral lung lesions: an experience of a pulmonologist
Authors: Sultan Sheikh Tariq , Dar Khurshid Ahmad , Ansari Mohd Haris Gulraize , Mehfooz Nazia , Shah Naveed Nazir , Farooq Syed Suraiya , Datta Bikram Singh , Malik Abdul Hamid , Sheikh Bilal Ahmad
Published: June 2019

Background: Ultrasound (USG) guided fine needle aspiration cytology (FNAC) is a simple and cost-effective method for the diagnosis of various peripheral lung lesions. Being radiation free and easily available in most of centres, it has become an important diagnostic modality for early diagnosis of peripheral lung lesions. Besides procedure is simple and complications if occur, can be managed by a pulmonologist effectively. This study was aimed to evaluate the role of Transthoracic ultrasound guided FNAC in diagnosis of peripheral lung lesion.Methods: This prospective observational study was conducted at Government Chest Diseases Hospital Srinagar over a period of one year from January 2018-December 2018. 61 patients who fulfilled inclusion criteria were included in this study. After properly explaining the procedure and taking informed consent, USG guided FNAC was done in patients with peripheral lung lesions under local anaesthesia. Radiological and cytological data of enrolled patients was collected prospectively and analysed.Result: About 61 patients were included in this study comprising of 39 males and 22 females in age range of 17- 90 years. Malignancy was the most common cytological diagnosis (78.57%). while as benign diagnosis was reached in 21.43%. In 8.19% of patients, FNAC was inconclusive. Among the malignant group, adenocarcinoma (47.72%) was most common cytological diagnosis. The overall diagnostic yield of USG guided FNAC in this study was 91.8%.Conclusion: USG guided FNAC of peripheral lung lesions is a simple procedure with high accuracy and less complication rate which can be performed by a pulmonologist for diagnosis.
Association of sleep quality and internet addiction among the medical students
Authors: Nagori Nidhi , Vasava Kinjal , Vala Ashok U. Vala U. , Ratnani Imran J.
Published: June 2019

Background: The side effects of Internet overuse have been emerging progressively causing the emergence of a problem that is defined as internet addiction or problematic internet use. It also disrupts the sleep wake cycle so adversely affecting quality of sleep. This study is a preliminary step toward understanding the effect of internet addiction on sleep quality among medical college students in India.Methods: This was an observational, cross-sectional, single-centred, and self-assessable. Questionnaire based study administrated among 525 consenting medical students. The participants were assessed by proforma containing demographic details, variables related with internet use, questionnaires of IAT (Internet Addiction Test for Internet Use) and PSQI (Pittsburgh Sleep Quality Index for Sleep quality. Statistical data were analysed by Graph Pad InStat version 3.06 using Chi–square test and Mann-Whitney test.Results: There were 9.3% of all participants were considered problematic internet users with frequency of internet addiction 0.9%. Participants with problematic internet use are likely to have poor sleep quality (p<0.0001). 23.8% of all participants had poor sleep quality and 76.2% of the students had good quality of sleep. Participants with poor quality of sleep were having high IAT scores in comparison to participants with good quality of sleep. Severity of poor sleep quality is positively correlated with internet addiction (r2=0.233, p<0.0001).Conclusions: Participants with problematic internet use were more likely to have poor quality of sleep and vice a versa.
Current clinical trends in the management of gram positive infections in Indian critical care settings: a survey
Authors: Rampal Ritika , Ahdal Jaishid , Kaushik Kriti , Jain Rishi
Published: June 2019

Background: In India, gram-positive infections (GPIs) particularly, methicillin-resistant Staphylococcus aureus (MRSA) prevalence is reported to increase exponentially. The overall mortality rate among patients with multi drug resistant GPIs in ICU setting are as high as 16%, despite the availability of various therapeutic options. Aim of the study is to determine the burden of GPIs in critical care settings and to understand the practising behaviour among the specialists in the management of MRSA infections.Methods: The survey was conducted among 264 critical care specialists who attended the Annual National Conference of Indian Society of Critical Medicine held in February 2019 at Mumbai. The delegates were administered a validated 10 question survey.Results: In the survey, 72% of the respondents agreed to the rising prevalence of MRSA and associated increased mortality rate of >16%. Empirical gram positive cover is being given to 30-40% of ICU patients, with ABSSSI being listed as a major indication followed by CAP, VAP, CLABSI and DFI. 46% of the doctors listed vancomycin as their preferred anti-MRSA agents followed by teicolplanin and linezolid. However, more than 80% of the doctors feel that nephrotoxicity in vancomycin, thrombocytopenia in linezolid and poor biofilm penetration are major limitations of these anti-MRSA agents.Conclusions: The survey highlighted the increasing trend in the prevalence and associated mortality in GPIs in critical care settings in India. Further, the limitations of existing anti-MRSA agents have invoked the need for a newer agent with a broad spectrum anti-bacterial activity along with improved safety profile and effective biofilm penetration, which can be used as a suitable alternative empiric therapy to manage GPIs.
Clinical comparison of different cardiovascular risk scores for cardiovascular risk prediction in Indian patients
Authors: Salam Azad Abdul , Unni T. Govindan , Benjamin Bino , K. Prasanna C. , Ravi Manoj
Published: June 2019

Background: Cardiovascular diseases (CVD) are the main cause of mortality and disability in India. Early and sustained exposure to behavioral risk factors leads to development of CVD. The present study was conducted to compare different cardiovascular calculators for CVD risk assessment models in young Indian patients presenting with myocardial infarction.Methods: This study included 85 patients with myocardial infarction (MI). Their predicted 10-year risk of CVD was calculated using three clinically most relevant risk assessment models viz. Framingham Risk score (RiskFRS), American College of Cardiology/American Heart Association (RiskACC/AHA) and the 3rd Joint British Societies risk calculator (RiskJBS).Results: RiskFRS recognized the highest number of patients (15.4%) at high CVD risk while RiskACC/AHA and RiskJBS calculators provided inferior risk assessment but statistically significant relationship. RiskFRS and RiskACC/AHA (Pearson's r 0.870, p<0.001).Conclusions: RiskFRS seems to be as most useful CVD risk assessment model in young Indian patients. RiskFRS is likely to identify the number of patients at ‘high-risk’ as compared to RiskJBS and RiskACC/AHA.
Anaesthetic management of a pregnant woman with uncorrected tetralogy of fallot for caesarean section
Authors: Badhan Anjana , Chandel Ankita , Adhikari Shreya Das
Published: June 2019

Tetralogy of fallot (TOF) is the most commonly encountered congenital cyanotic heart disease in pregnant females and maternal mortality approaches 10% in unrepaired TOF. General anesthesia is classically considered the technique of choice for incidental surgery in TOF and neuraxial anesthesia is considered relatively contraindicated. However, general anesthesia for caesarean section can increase maternal morbidity. Author report a case of caesarean section performed under epidural anesthesia in patient with uncorrected TOF.
Knowledge and practice regarding the use of emergency contraception among the higher secondary students of Nepal
Authors: Bhatta Ramesh , Godar Susmita , Aryal Kabita
Published: June 2019

Background: Emergency contraception or post coital contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. Among the adolescents, premarital and unplanned sexual intercourse mostly result unintended pregnancy. In such conditions, emergency contraception is effective, safe and relatively inexpensive and can prevent pregnancies up to 95% if taken immediately or within 5 days after the sexual intercourse. Emergency contraception is available in pill form and IUD. Objective of this study was to assess the knowledge and practice of emergency contraception use among the higher secondary level students.Methods: Study includes descriptive cross-sectional method with total 190 respondents who were selected though census method of sampling. Study data were collected through semi structured questionnaire and the data was analyzed by using the SPSS version 20.Results: Mean age of the respondent was 17.8 years and 98.4% of them were unmarried. Among the total respondents only 63.7% of them have heard about the emergency contraception. About 14.2% of the respondents had experience sexual intercourse, out of those 51.8% have used emergency contraceptive method to prevent them from unintended pregnancies. Among those who had experience sexual intercourse, 22% of them got unintended pregnancies, which were managed through surgical abortion (83.3%) and medical abortion (16.7%).Conclusions: Knowledge on proper use of emergency contraceptives can prevent unintended pregnancies that may occur among the adolescents due to premarital and unplanned sexual intercourse. However, only two third of respondents have heard about the emergency contraceptives. So it is important to raise awareness on emergency contraception and its rational use among the adolescents.
Happiness level among medical students of a medical college
Authors: Kulkarni Surendra , Sanjeev Chincholikar
Published: June 2019

Background: In psychology, happiness is recognized as “emotion”. Emotion is divided into “negative emotion” and “positive emotion”. Psychologists believe that three main components of happiness are as follows: The relative existence of positive emotion, the lack of negative emotions and life satisfaction. Medical field is one of the fields that due to the clinical period and the pressures of hospitals and stressful environment have considerable effects on happiness and their job performance. Medical students are the future healers of the society. Happiness level of the students has effects on their performance. Hence the present study is an attempt to assess the happiness level of medical students.Methods: A cross-sectional study was carried out among medical students of a private medical college in Maharashtra. The participants in the study were medical students of all academic years enrolled in a private medical college. Happiness was measured by using Oxford Happiness Questionnaire.Results: It can be observed that happiness level of medical students is 70%. Female students are slightly more happy than male students. It was found that 49% study participants are unhappy as they are having insufficient pocket money.Conclusions: The level of happiness among students does not depend on their number of attempts in previous examinations. It was evident that percentage of happiness is much more in students living with their family. It was also observed Percentage of happiness is much more in students having some hobby. The study also revealed that level of happiness decreases marginally as the academic year progresses.
Prevalence and pattern of risk factors for non-communicable diseases in urban population of Jaipur, Rajasthan
Authors: Kumar Chabbil , Dobhal Priyanka , Kashyap Amita
Published: June 2019

Background: Majority of the risk factors for NCDs are measurable and modifiable thus continuous surveillance of the levels and pattern of these risk factors is of fundamental importance. Taking cognizance of Jaipur city rapidly adopting to metropolitan culture; this study may mark an important milestone in surveillance activities and setting preventive priorities for NCDs in the state of Rajasthan. Aim of the study is to measure prevalence and associated variables of major risk factors for NCDs in the age group of 25-64 years.Methods: It is a cross sectional, descriptive study, conducted on 1454 person aged 25 to 64 years, residing in Jaipur city, from 1st June 2012 to 31st December 2013, using two steps of ‘standard WHO STEPS structured instrument’. Categorical data were expressed in form of percentage. Chi-square test was used to analyse difference in proportions. Continuous data were summarized in form of mean and SD. The differences in means were analysed by student’s t test.Results: At least one risk factor was present in all persons moreover 35% had multiple risk factors. Multiple risk factors were present even in 20% of relatively young adults (25-34 years). Tobacco and alcohol consumption was seen in 28% and 29% respectively. Standard of living index was associated with obesity, hypertension and low physical activity but not with alcohol use, smoking and daily consumption of fruit & vegetable. Male consumed more alcohol, indulged in less physical activity and smoked more than twelve times than females.Conclusions: Educating younger population for healthy lifestyle adoption and focused educational intervention with strict enforcement of existing laws will be helpful in controlling this epidemic of NCD.
A descriptive study on quality of life, depression and anxiety in chronic urticaria patients attending a tertiary care hospital in Bengaluru, South India
Authors: Gowda Giriyanna , Athani Sweta Balappa
Published: June 2019

Background: Chronic urticaria (CU) is a common skin disorder characterized by the recurrent appearance of wheals typically associated with pruritis and/or angioedema for more than 6 weeks. It has a significant impact on patient’s quality of life (QoL). Hence it is of utmost importance to identify the impact of CU on the patient’s life and psychiatric comorbidities associated with it. The objectives of the study were to assess the effect of chronic urticaria on the quality of life of the patient; to assess the depression in patients with chronic urticaria; to assess the anxiety in patients with urticaria.Methods: A total of 106 patients with chronic urticaria attending allergy clinic, KIMS Hospital during November-January 2019 (3 months) were included in the study. Informed consent was obtained. Each patient was interviewed using pretested questionnaire developed using chronic urticaria on quality of life: (CU-Q2oL), patient health questionnaire-9 (PHQ-9) and general anxiety disorder-7 (GAD-7). Data was entered in Epi-info7 and descriptive statistics were used.Results: There were 43 (40.6%) males and 63 (59.4%) females. The mean age of the patients was 36.5±11.7 years. Quality of life was affected A lot in 9.5% of the patients and is somewhat affected in 38.7% of the CU patients. As much as 42.5% of them suffered from some grade of depression and 34.9% of them suffered from anxiety.Conclusions: Chronic urticaria has a significant role in impairment of QOL and also leads to mental illnesses such as depression and anxiety.
Identification of undernutrition in under five children: Z score or a composite index of anthropometric failure?
Authors: Titoria Reena , Ponnusamy Prabhu , Mehra Sunil
Published: June 2019

Background: Undernutrition continues to be the primary cause of ill health and premature mortality. The sustainable development goal 2 aims to end all forms of hunger by 2030 and lead towards an improvement in child health. The national data categorize the level of undernutrition as underweight, wasting and stunting. The weight for age estimates used under ICDS misses out the other forms of malnutrition. This study was conducted to assess the prevalence of undernutrition using a composite index of anthropometric failure (CIAF) and compare it with conventional indices.Methods: A community based setting and cross-sectional study design. By simple random sampling 265 under-five children residing in a marginalized community of North West district of Delhi. Interviewer administered questionnaire was used to collect information and anthropometric measurements were taken using standard operative procedures. Z scores were calculated by WHO-ANTHRO software version 3.2.2. Descriptive analysis was conducted using statistical package for social sciences version 22.Results: The prevalence of anthropometric failure by CIAF was 60.5% and based on other indices undernutrition was found as 44.5% stunting, 35.4% underweight and 26.4% wasting. MUAC detected 23.7% of undernourished. CIAF provides a better picture of undernutrition compared to other indices.Conclusions: Since CIAF is more than that estimated by any of the conventional indicators, it proves to be a better indicator in assessing the overall burden of under-nutrition in a population. Development of policies based on CIAF to reduce the burden of undernutrition may prove to be more effective.
Prevalence and clinical characteristics of otitis externa among patients attending Otorhinolaryngology Department at Muhimbili National Hospital, Tanzania
Authors: Abraham Zephania Saitabau , Tarimo Onesmo , Kahinga Aveline Aloyce , Ntunaguzi Daudi , Mapondella Kassim Babu , Massawe Enica Richard
Published: June 2019

Background: Otitis externa is among the otological diseases with significant impact on the quality of life of sufferers. Little is known in Sub Saharan countries despite being the focus of such disease. The study aimed to determine the prevalence and clinical characteristics of otitis externa at Muhimbili National Hospital, Tanzania’s largest tertiary hospital.

Methods: This was a hospital based descriptive cross sectional study where 1200 participants were recruited from June 2016 to January 2017. Data was analyzed using SPSS program version 20.  

Results: A total of 1200 patients were recruited in this study and majority 601(50.1%) were females. Majority 672(56%) were in age group 0–10 years. Among 1200 patients, 138 (11.5%) were diagnosed to have otitis externa and male predominance (55.1%) was found. Majority 120 (87%) had diffuse otitis externa and with 0-10 years (25.83%) being the commonly affected age group by variant. The commonest risk factor was self-ear cleansing 87(53.7%) and only 2.9% were found to have complications of otitis externa.

Conclusions: Otitis externa was found to be prevalent and with male predominance. Self-ear cleansing was the commonest risk factor. Complications of otitis externa were found to be rare. Public awareness on otitis externa should be advocated in our country.
Powered endoscopic endonasal dacrocystorhinostomy using inferiorly based mucosal flap: our experience
Authors: B. Ramya , M. H. Suprabha , M. D. Prakash
Published: June 2019

Background: The most critical element for successful management of lacrimal system pathology distal to common canaliculus that requires endoscopic endonasal dacrocystorhinostomy (EEDCR) is the creation of widest possible marsupialisation of the medial wall of the lacrimal sac. With minor modifications and simplication of the original technique of EEDCR, common surgical failures like obstruction of neo-ostium by granulation tissue or infolding of flap can be avoided. To determine the success of EEDCR using inferiorly based mucosal flap, removal of overlying bone using Kerrison’s punch followed by vertical incision of the medial wall of lacrimal sac with microdebrider assisted trimming of the lacrimal sac flaps.

Methods: A total of 31 patients with epiphora secondary to nasolacrimal duct obstruction (NLDO) were operated using the above technique with 3 bilateral cases amounting to a total of 34 procedures. The surgical outcome and long term patency of neo-ostium were evaluated.  

Results: Of the 34 procedures, 32 procedures (94.1%) had complete resolution of epiphora at the end of one year follow up. The 2 failures were due to canaliculitis.

Conclusions: Powered EEDCR with trimming of medial wall of lacrimal sac and inferiorly based mucosal flap preservation to cover the exposed part of bone is a simple procedure with favourable long term outcome.
Study of benign neck swellings of anterior neck triangle at a tertiary care centre
Authors: Khokle Pradipkumar Digambar , Kandakure Vinod Tukaram , Kolekar Ujjwala Madhukar
Published: June 2019

Background: Tumors of the neck are interesting to surgeons especially because of the complex neck anatomy and difficult differential diagnosis. The aim is to study different types of neck swellings i.e. thyroid swelling, salivary gland swelling, other neck swellings such as thyroglossal cyst, branchial cyst, lymphangioma and also the miscellaneous and rare lumps in the neck. The study also discusses their age and sex-wise distribution, clinical features, presentation, diagnostic modalities and treatment.

Methods: This is a prospective study, conducted at our institute Government Medical College, Latur from June 2017 to May 2018 for a duration of one year.  

Results: A total of 57 patients were studied during this period. Out of the 57 patients, 47 of them were midline swellings (82.45%) and 10 among them were lateral neck swellings (17.55%). People over a wide range of age group between 5-60 years were affected. Midline neck swelling were more common than lateral neck swellings.

Conclusions: Among the midline benign neck swellings, thyroid swelling was found to be the commonest followed by thyroglossal cyst. Thyroid swellings occur more commonly in the females than males. Ultrasound guided FNAC is the most common, effective and safe investigation that aids in the diagnosis. Treatment of choice for benign, non-inflammatory and non-malignant neck swelling is mostly surgical excision rather than medical management.
A study on correlation of size and site of tympanic membrane perforation with degree of conductive hearing loss in chronic otitis media
Authors: John Nikhil Mathew , Shamanna Karthik , Rodrigues Allen Joe
Published: June 2019

Background: The objective of the study was to evaluate the size and site of tympanic membrane perforation, to assess hearing loss in patients with dry tympanic membrane perforation and to correlate the relationship between degree of conductive hearing loss with the size and site of tympanic membrane perforation.

Methods: Study (n=150) done to correlate the site and size of tympanic membrane perforations and conductive hearing loss in cases of inactive tubotympanic COM from October 2013 to December 2015. Size of the tympanic membrane perforation was assessed under microscope using a measuring template. Patients were divided into four groups according to size; based on the site: anterior group, posterior group, combined group and divided in to three groups based on the duration of the disease.  

Results: Anterior perforations were most common 74 (49.3%). Hearing loss increased as the size of the perforation increased IV>III>II>I [(46.97±6.59)>(38.69±2.63)>(35.13±2.98)>(27.67±1.85) p<0.0001)]. Statistical significance for hearing loss at combined site (41.37±5.9) was higher compared to Posterior (35.21±4.6, p=0.0001) and Anterior (31.7±5.7, p=0.0001). There was statistically significant difference in hearing loss between all three groups (p=0.0001). Degree of hearing loss increased as the duration of the disease increased.

Conclusions: Hearing loss is directly proportional to the size of perforation; more for the posterior quadrant perforations when compared to the anterior quadrant perforations of same size; also, hearing loss increases as the duration of the disease process increases.
Association of nasal blockage and prevalence of anatomical variants on CT scan of nose and paranasal sinuses
Authors: Venugopalan Shruti , Khavadu Paresh J. , Chavada Payal S. , Lavana Yash D. , Mehta Manish R. , Mistry Sejal N.
Published: June 2019

Background: Nasal blockage is the most common nasal symptom with which patients present in ENT OPD. Sometimes, it is associated with headache and facial pain. The symptoms are secondary to mucosal contact points in the nasal cavity without any observable nasal mass, nasal discharge or turbinate hypertrophy, hence, known as rhinogenic headache or facial pain syndrome.

Methods: This is a prospective study done in the department of otorhinolaryngology, at P.D.U. Medical College and Hospital, Rajkot, for a period of twenty months from May 2017 to December 2018. A total number of 100 CT scans of patients aged above 5 years of both genders who presented with complaints of nasal blockage at department of otorhinolaryngology, P.D.U. Hospital, Rajkot.  

Results: Out of 100 patients above 5 years with symptoms of nasal blockage and CT scan showing anatomical variants, 78 patients had deviated nasal septum as the most common anatomical variant presenting with nasal blockage. Males (62%) were more commonly affected with different anatomical variants; 25-45 year old age group (48%) was the most common affected age group. The other anatomical variants: concha bullosa (13%), paradoxically curved middle turbinate (4%), Onodi cell (2%), Haller cell (2%) and unilateral choanal atresia (1%).

Conclusions: Nasal blockage is more common in 25-45 year old males and deviated nasal septum is the most common anatomical variant.
A comparative study of microdebrider assisted versus conventional endoscopic sinus surgery for nasal polyposis
Authors: Datta Ranganath Kumar , Bandadka Ramya , Shelly Lakshmi Priya
Published: June 2019

Background: Nasal polyps are benign, chronic, inflammatory lesions arising from the mucosa of the nasal sinuses or from the mucosa of the nasal cavity. They are a challenge to treat due to their uncertain etiology and tendency to recur. Therapy involves both medical and surgical treatment. Surgical management includes Endoscopic sinus surgery using conventional instruments or by microdebrider.

Methods: We conducted a study on 80 patients with nasal polyposis in whom conservative management failed. They were equally randomised into powered and conventional instruments Endoscopic Sinus Surgery (ESS) groups. The groups were compared for surgical outcomes, intra and postoperative complications and recurrence rates.  

Results: Age of patients suffering from bilateral nasal polyposis ranged from 18 to 55 years with maximum number of patients in the group 31 to 40 years. Nasal polyps were more commonly seen in men (53.75%) than women (46.25%). Most common symptom experienced was nasal obstruction (100%), followed by olfactory disturbance in 88.7% and nasal discharge in 76.25%. There was statistically significant difference in operative time, blood loss and postoperative synechiae, with the microdebrider group showing better outcomes. There was no statistically significant difference in the postoperative VAS (visual analogue score) and recurrence rates between the two groups.

Conclusions: Powered endoscopic sinus surgery offers a better therapeutic approach for patients with nasal polyposis than with conventional instruments. It provides bloodless operative field with better visualisation for a more precise, less traumatic procedure with shorter operative time.