bluuebunny/crossref_metadata_2025 huggingface dataset:
Etnomatematika: Eksplorasi gamelan Jawa karawitan dengan pendekatan science, technology, engineering, and mathematics (STEM)
Authors: Nuryadi Nuryadi , Kholifa Isna
Published: January 2021

Penelitian ini bertujuan diperolehnya deskripsi kajian matematika dalam gamelan jawa karawitan khususnya alat-alat musik dengan pendekatan STEM. Melalui pembelajaran berbasis STEM siswa dapat menguasai pengetahuan, sikap, dan keterampilan mengidentifikasi pertanyaan dan masalah dalam kehidupan siswa, menjelaskan fenomena alam, merancang dan menarik kesimpulan berdasarkan bukti tentang masalah yang terkait budaya. Penelitian ini merupakan penelitian kualitatif dengan pendekatan etnografi yaitu mendeskripsikan alat musik gamelan sebagai media pembelajaran di Sekolah khususya Sekolah Menengah Kejuruan Kesenian.  Prosedur penelitian kualitatif model etnografi dimulai dengan menetapkan seorang guru sebagai informan kunci (key informant), melakukan wawancara, pengamatan alat-alat musik karawitan jawa, dan memulai mengajukan pertanyaan deskriptif. Analisis data yang digunakan adalah analisis domain, yaitu memperoleh gambaran umum dan menyeluruh dari alat-alat musik karawitan sebagai objek penelitian, kemudian mengkaji secara matematika dengan pendekatan STEM, yaitu mengindentifikasi objek, merencanakan dan melakukan penyelidikan, menganalisis dan menginterpretasikan data, dan membuat sebuah kesimpulan secara deskriptif. Hasil penelitian menunjukkan bahwa adanya keterkaitan antara alat musik gamelan jawa karawitan dengan pembelajaran  matematika. Terutama pada kajian unsur-unsur  dan sifat yang memiliki bentuk lingkaran, trapesium, persegi panjang, tabung, balok,  bola, dan kerucut.  Kajian sifat-sifat alat musik gamelan karawitan jawa  kemudian disesuaikan dengan Kompetensi Dasar SMK Kejuruan Kesenian, sehingga dapat dijadikan media pembelajaran matematika dikelas.
Ginger (Zingiber officinale) and its Bioactive Components with Protective and Therapeutic Potential against Cancer
Authors: Bobde MV , Yadav S , Sibi G
Published: January 2021

Ginger can be an important complementary medicine for prevention and treatment of different types of cancers, owing to its natural origin, safety, and low cost relative to synthetic cancer drugs. Ginger contains volatile oils, anthocyanins, tannins, phenolic compounds and sesquiterpenes anticancer effects of ginger may arise from the ability to induce changes in a number of cellular processes, including cell division, apoptosis and differentiation. In this study, anticancer activity of ginger extract against various cancer cells both in vitro and in vivo were investigated. The evidence in this review suggests that ginger and its compounds in diet may lower cancer risk and affect tumor behavior.
God and Morality
Authors: Bruxvoort Lipscomb Benjamin J.
Published: January 2021

God and Morality, by Anne Jeffrey. Cambridge University Press, 2019. Pp. 84. $18 (paperback).
SAÚDE MENTAL FEMININA E CICLO REPRODUTIVO: UMA REVISÃO DE LITERATURA
Authors: Medrado Ana Carolina , Lima Mônica
Published: January 2021

Este artigo objetiva refletir criticamente sobre a produção na literatura a respeito do adoecimento mental de mulheres em relação ao ciclo reprodutivo feminino, com destaque para marcadores sociais como raça e classe social. Trata-se de um recorte da revisão de literaura de uma tese que selecionou 80 artigos, correspondente à categoria “ciclo reprodutivo”, totalizando 22 artigos. Na introdução fazemos uma retomada histórica da associação do ciclo reprodutivo à saúde mental feminina, advinda de uma leitura essencialista da mulher e da medicalização de seu corpo. Como referencial teórico, adotamos a Psicologia Social Construcionista e o Feminismo Interseccional. A pesquisa foi realizada na Biblioteca Virtual em Saúde e caracteriza-se como revisão de literatura integrativa. Na seleção consideramos artigos em inglês, português e espanhol no período entre 2014 a 2018. Os textos foram divididos em subtemas relacionados ao objetivo do artigo, considerando o transtorno mental e algum período do ciclo reprodutivo feminino. Os achados da revisão enfocam os determinantes sociais envolvidos no adoecimento feminino, como pobreza, sobrecarga de trabalho e violência. Concluímos que as informações do estudo permitem desessencializar o adoecimento mental feminino, indicando que as atribuições sociais às mulheres têm sido fonte de adoecimento para elas.
RESILIENCE IN CONDITIONS OF UNCERTAINTY
Authors: Махнач А.В.
Published: January 2021

В статье подчеркивается актуальность исследований жизнеспособности человека и семьи в условиях неопределенности. Приводится определение понятий «жизнеспособность человека» как сложного психического образования, «неопределенность» - как значимой, внешней по отношению к субъекту характеристики определенного периода времени, его состояния во временном пространстве. Проанализированы несколько подходов к изучению жизнеспособности человека: социокультурный (экологический) подход: позволяющий рассмотреть факторы риска и факторы жизнеспособности (ресурсы) в рамках четырех контекстов развития человека, а также проследить их взаимовлияние. Другой подход: системно-субъектный подход, благодаря введению категории субъекта, дает возможность обратиться к целостному изучению жизнеспособности человека. Третий подход к изучению жизнеспособности человека - контекстный подход, наиболее часто встречающийся в современных исследованиях жизнеспособности и позволяющий различать внутренний контекст жизнедеятельности семьи посредством изучения их индивидуально-психологических особенностей, знаний, умений, опыта. Проанализированы работы и подходы к изучению неопределенности как предмета исследования в психологии, обсуждена взаимосвязь понятий неопределенность и жизнеспособность человека. Делается вывод о необходимости разведения этих понятий и их дальнейшей оперционализации.

The article emphasizes the relevance of studies of individual and family resilience in conditions of uncertainty. The definition of the concepts of "human resilience" as a complex mental formation, "uncertainty" - as significant, external in relation to the subject characteristics of a certain period of time, his state in time frame. Several approaches to the study of human resilience are analyzed: sociocultural (ecological) approach: allowing to consider risk factors and protective factors (resources) within the four contexts of human development, as well as to trace their mutual influence. Another approach: the system-subjective approach, due to the presence “the subject” as a category, makes it possible to turn to a holistic study of individual resilience, psychological characteristics, knowledge, skills, experience. The works and approaches to the study of uncertainty as a subject of research in psychology are analyzed, the relationship between the concepts of uncertainty and resilience is discussed. It is concluded that it is necessary to separate these concepts and their further operationalization.
Understanding the Essence of Mood Disorders through the Eyes of Poetry
Authors: Sidhu Gulbahar S , Gul Deepali
Published: January 2021

Psychiatric disorders have a history as old as mankind. The ancient literature is replete with vivid descriptions of various afflictions of the mind. Throughout history, the human intellect has assiduously tried to classify illnesses on the basis of common features between them. In fact, this tendency to classify extends far beyond the realms of illnesses to include virtually all phenomena that occur around us. 

Could poetry help in rediscovering this lost essence? This is the basic question that this research paper attempts to answer.
Spectroscopic Fourth-order Coronagraph for the Characterization of Terrestrial Planets at Small Angular Separations from Host Stars
Authors: Matsuo Taro , Itoh Satoshi , Ikeda Yuji
Published: January 2021

We propose a new approach for high-contrast imaging at the diffraction limit using segmented telescopes in a modest observation bandwidth. This concept, named “spectroscopic fourth-order coronagraphy,” is based on a fourth-order coronagraph with a focal-plane mask that modulates the complex amplitude of the Airy disk along one direction. While coronagraphs applying the complex amplitude mask can achieve the theoretical limit performance for any arbitrary pupils, the focal-plane mask severely limits the bandwidth. Here, focusing on the fact that the focal-plane mask modulates the complex amplitude along one direction, we noticed that the mask can be optimized for each spectral element generated by a spectrograph. We combine the fourth-order coronagraph with two spectrographs to produce a stellar spectrum on the focal plane and reconstruct a white pupil on the Lyot stop. Based on the wave-front analysis of an optical design applying an Offner-type imaging spectrograph, we found that the achievable contrast of this concept is 10−10 at 1.2–1.5 times the diffraction limit over the wavelength range of 650–750 nm for the entrance pupil of the LUVOIR telescope. Thus, this coronagraph concept could bring new habitable planet candidates not only around G- and K-type stars beyond 20–30 pc but also around very nearby M-type stars. This approach potentially promotes the characterization of the atmospheres of nearby terrestrial planets with future on- and off-axis segmented large telescopes.
Ganymede’s Surface Properties from Millimeter and Infrared Thermal Emission
Authors: de Kleer Katherine , Butler Bryan , de Pater Imke , Gurwell Mark A. , Moullet Arielle , Trumbo Samantha , Spencer John
Published: January 2021

We present thermal observations of Ganymede from the Atacama Large Millimeter Array (ALMA) in 2016–2019 at a spatial resolution of 300–900 km (0.″1–0.″2 angular resolution) and frequencies of 97.5, 233, and 343.5 GHz (wavelengths of 3, 1.3, and 0.87 mm); the observations collectively covered all Ganymede longitudes. We determine the global thermophysical properties using a thermal model that considers subsurface emission and depth- and temperature-dependent thermophysical and dielectric properties, in combination with a retrieval algorithm. The data are sensitive to emission from the upper ∼0.5 m of the surface, and we find a millimeter emissivity of 0.75–0.78 and (sub)surface porosities of 10%–40%, corresponding to effective thermal inertias of 400–800 J m−2 K−1 s−1/2. Combined with past infrared results, as well as modeling presented here of a previously unpublished night-time infrared observation from Galileo’s photopolarimeter–radiometer instrument, the multiwavelength constraints are consistent with a compaction profile whereby the porosity drops from ∼85% at the surface to

at depth over a compaction length scale of tens of centimeters. We present maps of temperature residuals from the best-fit global models, which indicate localized variations in thermal surface properties at some (but not all) dark terrains and at impact craters, which appear 5–8 K colder than the model. Equatorial regions are warmer than predicted by the model, in particular near the centers of the leading and trailing hemispheres, while the midlatitudes (∼30°–60°) are generally colder than predicted; these trends are suggestive of an exogenic origin.
Comparison of the Physical Properties of the L4 and L5 Trojan Asteroids from ATLAS Data
Authors: McNeill A. , Erasmus N. , Trilling D. E. , Emery J. P. , Tonry J. L. , Denneau L. , Flewelling H. , Heinze A. , Stalder B. , Weiland H. J.
Published: January 2021

Jupiter has nearly 8000 known co-orbital asteroids orbiting in the L4 and L5 Lagrange points called Jupiter Trojan asteroids. Aside from the greater number density of the L4 cloud, the two clouds are in many ways considered to be identical. Using sparse photometric data taken by the Asteroid Terrestrial-impact Last Alert System for 863 L4 Trojans and 380 L5 Trojans, we derive the shape distribution for each of the clouds and find that, on average, the L4 asteroids are more elongated than the L5 asteroids. This shape difference is most likely due to the greater collision rate in the L4 cloud that results from its larger population. We additionally present the phase functions and c − o colors of 266 objects.
Correlation between Local Eid-al-Fitr Homecoming (Mudik) with Coronavirus Disease-19 during Ramadhan Season Amidst Large-scale Social Distancing in Indonesia
Authors: Veruswati Meita , Asyary Al , Alnur Rony Darmawansyah , Guspianto Guspianto
Published: January 2021

BACKGROUND: In anticipation of coronavirus disease (COVID)-19’s transmission peak, Eid-al-Fitr homecoming (mudik) has officially been banned by the Indonesian government interlocal but not local in welcoming this religious Muslim celebration. This local Mudik is held by traveling among regional provinces and is still allowed by each local government, including Java, which has the highest transmission of COVID-19 in Indonesia.
AIM: This study aims to present the difference between COVID-19 status before and during local Mudik on Java during Ramadhan with the implementation of large-sale social distancing applied in Jakarta, Indonesia.
METHODS: This research was employed by secondary data analysis that was obtained from surveillance data from related authorities, including the Ministry of Health and all local governments of Java, which consisted of four provinces and Jakarta. Incidence and suspect statuses of COVID-19, which were examined in the study, were presented in daily rates with before and during local Mudik in four provinces: Jawa Barat, Yogyakarta, Banten, and Jawa Tengah.
RESULTS: The number of positive confirmed patients differed significantly with before and during local Mudik (p < 0.05; mean difference = −/negative values).
CONCLUSION: This study’s findings showed that the local Mudik increased the number of COVID-19 cases in four provinces in Java, which these provinces were designated as Mudik destinations by travelers coming from Jakarta during the end of Ramadhan season.
Sex differences in patients with COVID-19: a retrospective cohort study and meta-analysis
Authors: Li Zhijun , Feng Lina , Cui Wenyu , Zhang Jian , Huang Yingxin , Zhao Yunhong , Teng Fei , Wu Donglin , Wang Hui , Deng Liquan , Yu Qiong
Published: January 2021

BACKGROUND: Accumulated evidence revealed that male was much more likely to higher severity and fatality by SARS-CoV-2 infection than female patients, but few studies and meta-analyses have evaluated the sex differences of the infection and progression of COVID-19 patients.
AIM: We aimed to compare the sex differences of the epidemiological and clinical characteristics in COVID-19 patients; and to perform a meta-analysis evaluating the severe rate, fatality rate, and the sex differences of the infection and disease progression in COVID-19 patients.
METHODS: We analyzed clinical data of patients in Changchun Infectious Hospital and Center, Changchun, Northeast China; and searched PubMed, Embase, Web of Science, and Cochrane Library without any language restrictions for published articles that reported the data of sex-disaggregated, number of severe, and death patients on the confirmed diagnosis of adult COVID-19 patients.
RESULTS: The pooled severe rate and fatality rate of COVID-19 were 22.7% and 10.7%. Male incidence in the retrospective study was 58.1%, and the pooled incidence in male was 54.7%.
CONCLUSION: The pooled severe rate in male and female of COVID-19 was 28.2% and 18.8%, the risky of severe and death was about 1.6folds higher in male compared with female, especially for older patients (> 50 y).
Acute Ischemic Stroke as Complication in COVID-19 with Acute Respiratory Distress Syndrome in Intensive Care Unit: A Review
Authors: Laksmidewi Anak Agung Ayu Putri , Sitanggang Prysta
Published: January 2021

Coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has broad spectrum of manifestation ranging from asymptomatic cases to multi-organs failures. Cerebrovascular disease COVID-19 patients are still a big issue among neurologist. Neurologic manifestations are shown to be the first or late presentation in patients with SARS-CoV-2 infection. Ischemic stroke had happened majority than hemorrhage stroke in patients hospitalized with severe COVID-19 and comorbid such as hypertension, diabetes mellitus, or cardiovascular disease. Acute respiratory distress syndrome is predictable complication of COVID-19 that will ended with prolonged hospitalization and comprehensive management in intensive care unit (ICU). Anticoagulant is believed to have proven advantage to prevent this thrombogenesis. Patients with acute ischemic stroke as COVID-19 have poorer prognosis. Managing patients with ischemic stroke within the ICU are challenging due to prior use of anticoagulant as preventive of thrombosis that increase the risk of intracranial hemorrhage.
Are the Obese Patients and Patients with Severe Malnutrition at Increased Risk of Severe Coronavirus Disease 2019 during Hospital Admission?
Authors: Markovska Zorica , Mijakoski Dragan , Kuzmanova Katerina , Meshkova Iskra , Tusheva Ivana , Stoleski Sasho
Published: January 2021

BACKGROUND: Recently, authorities highlighted the need for nutritional management of individuals with severe acute respiratory syndrome coronavirus 2 infection.
AIM: The aim of the study was to evaluate the use of body mass index (BMI) and nutrition risk index (NRI) on hospital admission for detecting patients at risk for malnutrition and obesity and their association with patients’ outcomes (disease type, length of hospital and home stay, and inflammatory markers).
METHODS: The study of 100 patients with confirmed diagnosis Coronavirus Disease-19 (COVID-19). Assessment of patients took place at City General Hospital 8th September, Skopje, transformed into main COVID-19 Center during pandemic. Primary outcomes were NRI and BMI scores, while secondary ones: length of home and hospital stay, number of symptoms, presence of co-morbidities, type of disease, serum albumin, and C-reactive protein (CRP).
RESULTS: Patients were classified according to BMI and NRI scores. Increased BMI and NRI were associated with a severe type of disease. Most of the patients with severe disease were: obese (83.3%) and patients with risk for malnutrition (53.3%). Obese patients had a longer length of home stay and higher CRP levels, but the level of albumin was lower in a group with a risk for malnutrition.
CONCLUSION: Future studies are needed to identify and quantify specific screening tool for nutrition deficiency in patients with COVID-19 infection.
Provenancing turquoise: a difficult task
Authors: Queffelec Alain
Published: January 2021

Turquoise is a blue-green phosphate gem used for millennia in the lapidary artwork of numerous past societies. It was one of the first gemstones, and has proved to be a valuable material that was part of long-distance exchange networks on every continent where it is available. Nonetheless, provenance studies for this material is absent from gemological literature, and scarce in the archaeological literature. This work reviews the mineralogy, geology, geographical and archaeological distribution of this gemstone, and presents different mineralogical, geochemical and spectroscopic approaches used in provenance studies. Sophisticated methods are needed to reconstruct the origin of turquoise and the commercial networks in the ancient times for this lapidary raw material, and we show that, even with these methods, a lot of work still remains to be done.
Hommage à Anne Tresset (1963-2019)
Authors: Vigne Jean-Denis
Published: January 2021

Anne Tresset était Directrice de recherche au CNRS néolithicienne, spécialiste des interactions entre sociétés humaines et monde animal. En janvier 2019, à l’âge de 55 ans, elle nous a quittés, après cinq années de combat contre la maladie, cinq années durant lesquelles elle a mis à profit chaque répit pour continuer sa recherche et donner à tout son entourage de fantastiques leçons d’espoir et de courage.
Contrastes intra-urbains de la fécondité bruxelloise
Authors: Buelens Mathieu
Published: January 2021

Peu d’études considèrent les variations de la fécondité à une échelle spatiale détaillée. En considérant à la fois l’intensité (nombre d’enfants mis au monde) et le calendrier de la fécondité (l’âge de la mère à la naissance), l’analyse présentée ici dresse un panorama des pratiques reproductives à Bruxelles. Puisque les facteurs individuels tels que le niveau de revenu influencent les comportements féconds, la géographie des profils de fécondité rappelle les grands contrastes socio-spatiaux intra-urbains, mais tend également à montrer l’influence de facteurs contextuels qui restent toutefois à étudier.
Intra-urban contrasts regarding fertility in Brussels
Authors: Buelens Mathieu
Published: January 2021

Few studies consider fertility variations on a detailed spatial scale. By considering both the intensity (the number of children born) and the timing of fertility (the age of the mother when she gives birth), the analysis presented here provides an overview of reproductive trends in Brussels. As individual factors such as income level influence fertility patterns, the geography of these patterns points to major intra-urban socio-spatial contrasts, and also tends to show the influence of contextual factors which remain to be studied.
Effect of Nanocellulose on Water-Oil Interfacial Tension
Authors: Ledyastuti Mia , Jason Joseph , Aditama Reza
Published: January 2021

Interfacial tension is an important parameter in enhanced oil recovery (EOR). The interaction between water and oil phase is a determinant factor of the interfacial tension. The interfacial tension changes if another component is added to the water-oil system. This study investigates the effect of adding nanocellulose to the water-oil system. To determine the molecular interactions that occur, a molecular dynamics simulation was carried out using the GROMACS-2018 software. The simulation shows that addition of nanocellulose slightly decreases the water-oil interface tension. Further, based on the density profile, nanocellulose may act as an emulsifier due to its geometric position in the water-oil interface. This is similar to asphaltene, which is a natural emulsifier in crude oil. The nanocellulose performs better in the presence of 1% NaCl as compared to pure water.
Graft Copolymerization of Cinnamic Acid to Cassava Starch and its Viscosity Measurements
Authors: Rachmawati Rachmawati , Rahmawati Midrathul
Published: January 2021

In this study, the modification of starch was conducted through graft copolymerization of cinnamic acid to result in starch-g-poly(cinnamic acid). The cinnamic acid polymerization was carried out via radical polymerization using cerium ammonium nitrate (CAN) as an initiator. The viscosity of the graft copolymer 10000 ppm dissolved in 16% NaOH solution was measured at a temperature range of 25-75 °C. The results showed that the higher the temperature the lower the viscosity. The activation energy of viscous flow for the copolymer was 18.4 kJ.mol-1. The viscosity values of the copolymer solutions were also measured in saline solutions with NaCl contents of 3−20%(w/v). For the measurements in these saline solutions, the highest viscosity was 3.39 cP at room temperature for the copolymer solution containing 5%(w/v) NaCl.
Modification of Starch Using Itaconic Anhydride and its Characterizations
Authors: Rengganis Dita , Rachmawati Rachmawati
Published: January 2021

In this study, the chemical modification of starch was conducted using itaconic anhydride as an esterifying agent. The results showed that sulphuric acid is more effective as a catalyst for esterification of starch compared to sodium hydroxide. The presence of attached itaconic anhyride in the starch affected the thermal behaviour and crystallinity of the resulting products as shown by the TGA, DSC, and the XRD data. In addition, the SEM micrographs also indicated that the modified starch exhibited a unique morphology in the form of block with different sizes ranging from 1 to 20 μm in length.
A Facile Synthesis of HKUST-1 MOF through Reductive Electrosynthesis Method
Authors: Beladona Siti Unvaresi M. , Rochliadi Achmad , Patah Aep
Published: January 2021

Metal-organic frameworks (MOFs) are porous crystalline materials that consist of metal ions bind to organic ligands as linkers by coordination covalent bonds. MOF properties, such as the presence of open metal sites, large surface area, high porosity, high thermal stability, tunable structure, and feasibility in modification are controlled and determined by metal cations, organic linkers, and applied synthetic method. Reductive electrosynthesis is a popular and interesting MOF synthetic method on the surface of conductive substrates. This method is based on electroreduction of oxoanions to generate hydroxide anions that lead to selective deposition of MOFs on conductive surfaces to form a thin MOFs film. The applied potentials during electrosynthesis affect the properties and applications of the produced MOFs. Here, Cu-based MOFs with the type of CuBTC (H3BTC: 1,3,5-benzenetricarboxylic acid) known as HKUST-1 films were synthesized using different cathodic potentials and time, at room temperature, on the surface of brass. The reductive electrosynthesis was found to be fast and mild for preparing HKUST-1. This method allows direct surface modification which in turn affect the HKUST-1 applications as electrode material for electrochemical sensing such as glucose.
Improving the Viscosity of Partially Hydrolyzed Polyacrylamide (PHPAM) Solution for Enhanced Oil Recovery (EOR) Application
Authors: Arifin Ihsan , Kadja Grandprix Thomryes Marth , Radiman Cynthia L.
Published: January 2021

Enhanced Oil Recovery (EOR) is a promising technology for increasing crude oil production, especially from old wells. Polymer flooding is one of the techniques used in EOR in which the water-soluble polymer is added to increase the viscosity of the injected fluid. However, this technique has not been implemented in Indonesia due to the unavailability of locally-synthesized polymers. Therefore, this research aims to synthesize polyacrylamides and their partially-hydrolyzed derivatives and to study the possibility of their utilization for the EOR application. Various polymerization conditions using potassium persulfate (KPS) as initiators have been realized and the resulting polymers were characterized using FTIR spectroscopy and rheology measurement. It was found that higher monomer concentration resulted in higher viscosity-average molecular weight of polyacrylamide. Further study revealed that the hydrolysis of polyacrylamide by alkaline solution significantly increased the viscosity of 1000 ppm solution from 1.5 to 145.40 cP at room temperature, which is comparable to one of the commercial products. These results showed that the simple synthesis and hydrolysis method could be effectively used to produce water-soluble polymers for the EOR application.
Regulatory T Cell–Derived TRAIL Is Not Required for Peripheral Tolerance
Authors: Dadey Rebekah E , Grebinoski Stephanie , Zhang Qianxia , Brunazzi Erin A , Burton Amanda , Workman Creg J , Vignali Dario A A
Published: January 2021

TRAIL (Tnfsf10/TRAIL/CD253/Apo2L) is an important immune molecule that mediates apoptosis. TRAIL can play key roles in regulating cell death in the tumor and autoimmune microenvironments. However, dissecting TRAIL function remains difficult because of the lack of optimal models. We have now generated a conditional knockout (Tnfsf10L/L) for cell type–specific analysis of TRAIL function on C57BL/6, BALB/c, and NOD backgrounds. Previous studies have suggested a role for TRAIL in regulatory T cell (Treg)–mediated suppression. We generated mice with a Treg-restricted Tnfsf10 deletion and surprisingly found no impact on tumor growth in C57BL/6 and BALB/c tumor models. Furthermore, we found no difference in the suppressive capacity of Tnfsf10-deficient Tregs and no change in function or proliferation of T cells in tumors. We also assessed the role of TRAIL on Tregs in two autoimmune mouse models: the NOD mouse model of autoimmune diabetes and the myelin oligodendrocyte glycoprotein (MOG) C57BL/6 model of experimental autoimmune encephalomyelitis. We found that deletion of Tnfsf10 on Tregs had no effect on disease progression in either model. We conclude that Tregs do not appear to be dependent on TRAIL exclusively as a mechanism of suppression in both the tumor and autoimmune microenvironments, although it remains possible that TRAIL may contribute in combination with other mechanisms and/or in different disease settings. Our Tnfsf10 conditional knockout mouse should prove to be a useful tool for the dissection of TRAIL function on different cell populations in multiple mouse models of human disease.
Structure and Functional Characterization of a Humanized Anti-CCL20 Antibody following Exposure to Serum Reveals the Formation of Immune Complex That Leads to Toxicity
Authors: Thomson Andrew S. , Mai Shing H. , Bouma Gerben , Herdman Michael , Byrne Michael , Hottenstein Charles S. , Minetti Joseph , Trulli Stephen , Taylor J. David , White John R. , Chen Shugui
Published: January 2021

mAbs have revolutionized the treatment of autoimmune disorders. Even though mAbs have shown impressive efficacy in blocking T cell or B cell activation and/or recruitment to sites of inflammation, this group of biologicals are not devoid of adverse effects. The most serious adverse effects include infusion reactions, including the activation of the complement pathway. In this study, we present a detailed structure–function study of an anti-CCL20 humanized IgG1 mAb that neutralizes CCL20 chemokine and prevents the recruitment of Th17 cells to sites of inflammation. We demonstrate that the anti-CCL20 Ab changes significantly following administration to humans and monkeys and exposure to human serum. Analysis of the drug product revealed that the anti-CCL20 Ab has unexpectedly high C1q binding. This high binding was linked to immune complex formation in vivo but not during in vitro serum incubation. The immune complex contained multiple complement components. Anti-CCL20 Ab-mediated, complement-dependent cytotoxicity occurred when the Ab bound to CCL20 tethered to the cell membrane of target cells. Taken together, these results provide a likely cause for the animal toxicity observed. In addition, anti-CCL20 revealed progressive acidification because of N100 (located in CDR) deamidation over time, which did not directly impact Ag binding. Our study demonstrates that the safety profiling of mAbs should include the evaluation of effector functions in addition to typical stressed conditions.
Temporomandibular joint ankylosis: Late presentation, report of 2 cases and review of literature
Authors: Adetayo Adekunle Moses , Oladapo Olanike Abosede , Taiwo Abdurrazaq Olanrewaju , Akinola Ayodele Moses , Oyedele Ayodeji Titus , Adetayo Modupe Olusola
Published: January 2021

The Temporomandibular Joint (TMJ) is a unique joint because both the right and left joints must open synchronously for function, Ankylosis of the TMJ refers to bony or fibrous adhesion of the anatomical components of the joint and their ensuing loss of function. Early presentation means that the patient will require a less extensive surgical treatment. The reality, however, is that many patients present to the surgeons, years or decades after the initial injury, and so TMJ ankylosis would have been fully established. Causes of TMJ ankylosis include trauma and infections. Surgery with aggressive post-operative physiotherapy is the mainstay of management. There is paucity of reports on the presentation and management of this condition from our centre. We present two patients, 16 and 20 years old, with TMJ ankylosis in our centre. Both of them presented after 12 and 18 years, respectively, of initial injury to the TMJs.
Availability of personnel, facilities and services in Primary Health Care Centres in a Local Government Area in Benin City, Nigeria
Authors: Adam Vincent Yakubu , Nwaogwugwu Joy Chinyere
Published: January 2021

Background: Effective delivery of healthcare services especially at the Primary Health Care level requires availability of adequate infrastructure, basic diagnostic medical equipment, drugs and well-trained medical personnel. Quality Primary Health Care initiatives have been recognized as fundamental to improving health outcomes. This study assessed the resources available for Primary Health Care delivery in a Local Government Area in Benin City, Nigeria.

Materials and Methods: This was a descriptive cross-sectional study. All the public primary health centres in Egor LGA, Benin City, Nigeria were assessed for availability of personnel, facilities/ equipment and services using an adapted observational checklist.

Results: All the 10 public primary health centres were assessed. The primary health centres had inadequate skilled-manpower: only 1 (10.0%) had a medical officer, Community Health Officers and nurse/midwives were adequate in only 2 (20.0%), and none of them (0.0%) had a medical record officer and pharmacy technician. Basic equipment for examination of clients were available in 3 of the health facilities (30.0%). All 10 of the health centres (100.0%) offered basic services but not for 24 hours. Essential drugs were not regularly available in all the facilities.

Conclusions: Basic healthcare services were rendered but not for 24 hours. Several challenges such as inadequate skilled health personnel, lack of basic amenities, and shortage of essential drugs affect the primary health centres. Basic hospital facilities/equipment needed to enhance 24 hours’ service delivery at the primary health centres should be provided by the Local Government.
Preoperative anaemia in surgical patients: Intravenous iron and erythropoiesis-stimulating agents (ESAs) to the rescue
Authors: Nwosu Arinze D.G.
Published: January 2021

Despite the propensity for allogeneic blood transfusion by clinicians, the space for this therapy is steadily being contracted by limited evidence of benefit from its use in most situations, adverse effects of its use, high cost, limited supply and rejection by some religious faithfuls. Available literature concedes to the high prevalence of preoperative anaemia in diverse surgical settings irrespective of geography and reflects the global burden of anaemia. Beyond the poorer surgical outcome directly attributed to preoperative anaemia, it has also been recognized as the major predictor of allogeneic blood transfusion with attendant morbidity and mortality. The concept of Patient Blood Management (PBM) seeks to minimize exposure of patients to allogeneic blood and is based on three pillars of maximizing total red cell mass, minimizing iatrogenic blood loss and harnessing patient’s physiological tolerance of anemia. Consequently, PBM places great premium on correcting preoperative anaemia in surgical patients. With the limited success of leucodepletion and other measures at addressing the complications of allogeneic blood transfusions new interest is expanding in PBM. Several of these have been evaluated and among them the use of newer formulations of intravenous iron with or without erythropoiesis– stimulating agents has been most studied and credited with substantial success and good safety profile. Insight is also offered on the oversubscribed misconception of iron overload in HbSS patients while elucidating on the basis for iron supplementation in proven cases of iron deficiency. Some prevailing barriers, however, threaten the full realization of the potentials of these therapies.
Dalla clonazione dell’animale alla clonazione dell’uomo?
Authors: Di Pietro Maria Luisa
Published: January 2021

La notizia che alcuni ricercatori inglesi sono riusciti a produrre la pecora “Dolly” mediante clonazione del patrimonio genetico di una pecora adulta, ha suscitato nell’opinione pubblica una catena di reazioni nel timore che l’esperimento possa essere ripetuto anche sull’uomo, con la conseguente organizzazione di dibattiti anche parlamentari e nelle commissioni istituite ad hoc, e l’emanazione di direttive a livello sia nazionale sia internazionale. Ma la paventata clonazione di individui umani è eticamente accettabile o meno? E quale sarebbe il significato antropologico di questa operazione? Dopo una breve premessa sugli aspetti scientifici della clonazione e sulle giustificazioni che vengono avanzate a sostegno non solo della clonazione di animali, ma anche di individui umani, l’Autrice fa un’analisi dei criteri che sono stati utilizzati nei documenti dei vari organismi per elaborare il giudizio morale su tale pratica: dal “contrattualismo” al “consequenzialismo” ad una cosiddetta “valutazione globale”.
L’educazione alla salute in adolescenza: strategie di intervento e risposte individuali
Authors: Di Pietro Maria Luisa
Published: January 2021

Si sta verificando negli ultimi anni un incremento dei cosiddetti “comportamenti a rischio”(taking-risk behaviors) tra gli adolescenti. Si tratta di comportamenti che sono, in modo diretto o indiretto, responsabili di danno per la salute e/o per la vita di chi li agisce e dell’aumentata incidenza di morbilità e di mortalità in un’età della vita, che è meno esposta alla malattia e alla morte. Questa aumentata incidenza di patologie secondarie a comportamenti a rischio ha interpellato ed interpella, in senso preventivo, sia gli educatori sia quanti sono responsabili della salute pubblica che hanno proposto diverse modalità di intervento: dalla cosiddetta “riduzione del rischio” alla “strategia della paura” all’educazione alla salute.

Questo articolo cerca di valutare le ricadute delle diverse strategie di intervento sul comportamento degli adolescenti, al fine di individuare se gli eventuali fallimenti o successi dipendano dai contenuti dei programmi di prevenzione o dalla personalità degli educandi. Tale valutazione è preceduta dall’analisi del perchè gli adolescenti agiscono, con elevata frequenza, comportamenti a rischio: infatti, la conoscenza del “perché”‚ è elemento fondamentale per stabilire il “come” (intervenire).
Aspetti specifici del supporto psicologico nella relazione medico-paziente terminale
Authors: Fassino Secondo
Published: January 2021

Le comunicazioni medico – paziente, anche non verbali, attivano trasformazioni emotive e poi biologiche, che agiscono sui sistemi di reazione dell’organismo specie nelle fasi terminali della malattia. La reazione psicologica del malato è il risultato di difese regressive e anche progressive fruibili per processi più avanzati di adattamento e di “senso”. Le reazioni psicologiche del medico sono condizionate da difese dall’angoscia e motivazioni inconsce alla professione, tra sentimenti di impotenza e di onnipotenza. La condanna alla sconfitta induce una riformulazione costante del progetto di cura: la morte come oggetto di cura, non solo fine della cura. È richiesto un supporto psicologico specifico al paziente terminale. La strategia è quella dell’accompagnamento del paziente attraverso le fasi della malattia verso la morte, piuttosto che dell’esplorazione dei vissuti profondi di colpa, indegnità, aggressività. Questi aspetti vengono proposti soltanto se il paziente segnala di volerli e poterli affrontare; in genere, occorre favorire un impiego ottimale dei meccanismi di negazione, di scissione e dei bisogni di trascendenza. L’accompagnamento è una “presenza significativa” che considera il transfert di conoscenza, il contratto di non abbandono, i bisogni di significato e di trascendenza, le dinamiche della separazione, la compromissione di identità, ecc. Tali interventi sono attuabili oltre che da psichiatri o psicologi clinici, anche da medici oncologi e infettivologi, purché formati alla “relazione terapeutica”. Il training deve considerare non solo gli aspetti cognitivi, ma soprattutto quelli emotivi e personali, anche in considerazione dei rischi elevati di burn out che ripetuti interventi di questo tipo comportano.

Le competenze sui bisogni psicologici del morente sono parte dei metodi della buona pratica clinica: tra i suoi obiettivi c’è anche la qualità della morte.
Intestinal mucormycosis in an adult with H1N1 pneumonia on extracorporeal membrane oxygenation
Authors: Dev GJ Himaal , Venkategowda Pradeep M , Sutar Anand R , Shankar V
Published: January 2021

Gastrointestinal mucormycosis involving ileum is a very rare phenomenon. We present a case of 52-year-old male, known case of diabetes mellitus requiring extracorporeal membrane oxygenation (ECMO) for H1N1 pneumonia with severe acute respiratory distress syndrome (ARDS). The patient had small bowel obstruction with impending perforation requiring emergency bowel resection and ileostomy. The resected bowel segment histopathology showed mucormycosis. He was treated with conventional Amphotericin-B and later changed to Posaconazole. The patient responded very well and was gradually weaned from ventilator and successfully discharged home. This case report highlights rare site of mucormycosis. Early diagnosis and timely intervention can reduce mortality.
External tracheal manipulation for bronchial blocker placement in children undergoing thoracic surgery requiring one lung ventilation
Authors: Kapoor Ravish , Owusu- Agyemang Pascal , Thakar Dilip R , Heir Jagtar Singh
Published: January 2021

Limited options exist for pediatric one lung ventilation (OLV). Compared to adults, pediatric OLV can be more challenging due to physiological/anatomical differences, various pathologies, and size limitations of lung isolation devices. Fiberoptic bronchoscopy can be harder due to the restricted tube sizes through which bronchial blockers (BB) and scopes can appropriately fit, while providing adequate oxygenation and ventilation. Recent literature is sparse concerning facilitation of BB placement in children. A 2-, 8-, and 10-year-old presented for thoracic surgeries requiring OLV. External tracheal manipulation (ETM) facilitated BB placement in each case and can potentially offer unique advantages in pediatric OLV.
Efficacy of paravertebral block in “Fast-tracking” pediatric cardiac surgery - Experiences from a tertiary care center
Authors: Sahajanandan Raj , Varsha A V , Kumar D Sathish , Kuppusamy Balaji , Karuppiah Sathappan , Shukla Vinayak , Thankachen Roy
Published: January 2021

Introduction:

Fast tracking plays a crucial role in reducing perioperative morbidity and financial burden by facilitating early extubation and discharge from hospital. Paravertebral block (PVB) is becoming more popular in paediatric surgeries as an alternative to epidural and caudal analgesia. There is scarcity of data regarding the efficacy and safety of PVB in paediatric cardiac surgery.

Methods:

We performed a review of records of paediatric cardiac patients who underwent cardiac surgery under general anaesthesia with single shot PVB and compared the analgesia and postoperative outcomes with matched historical controls who underwent cardiac surgery with same anaesthesia protocol without PVB.

Results:

The data from 200 children were analysed. 100 children who received paravertebral block were compared with a matched historical controls. The median time to extubation was shorter in the PVB group (0 hr, IQR 0-3 hrs) compared to the control group (16 hrs, IQR 4-20 hrs) (P value 0.017*). Intraoperative and postoperative fentanyl requirement was much lower in the PVB group (3.49 (0.91)) compared to the control group (9.86 (1.37)) P value <0.01*. Time to first rescue dose of analgesic was longer (7 hrs vs 5 hrs, P 0.01*), while time to extubation and duration of ICU stay were significantly less in PVB group . Mean postoperative pain scores were significantly lower in the PVB group at the time of ICU admission (0.85 vs 3.12, P 0.001*) till 4 hours (2.11 vs 3.32, P 0.001*).

Conclusion:

PVB provides an effective and safe anaesthetic approach which can form an important component of “fast-track” care in paediatric cardiac surgery.
The Glenn procedure
Authors: Tariq Muhammad , Zahid Ibrahim , Hashmi Shiraz , Amanullah Muneer , Shahabuddin Syed
Published: January 2021

Objectives:

Congenital heart defects (CHDs) affect more than 40,000 children annually in Pakistan. Approximately 80% of patients require at least one surgical intervention to achieve a complete or palliative cardiac repair. The Glenn shunt, a palliative procedure is established between superior vena cava (SVC) and the right pulmonary artery to provide an anastomosis offering minimal risk to patients with univentricular heart disease. The aim of this study was to assess the clinical outcomes of the Glenn shunt procedure in patients with complex congenital heart diseases in a developing country like Pakistan.

Materials and Methods:

A retrospective chart review was conducted on patients who underwent a bidirectional Glenn shunt procedure from July 2006 to June 2017. Data were collected on a structured questionnaire and analyses performed on SPSS version 22. Frequencies and percentages were computed for categorical variables while mean and standard deviation for continuous variables where appropriate.

Results:

A total of 79 patients underwent the Glenn shunt procedures. The median age was 1.9 years and 54.5% were male. Tricuspid atresia was the primary diagnosis in 30.4% of the patients. Common morbidities included arrhythmias (6.3%), pleural effusion (8.9%), wound infection (3.8%), pneumonia (2.5%), and seizures (3.8%); reopening was required in 2.5% of the patients and 8.8% were readmitted within 30 days of index operation. There were three (3.8%) deaths in total.

Conclusions:

Bidirectional Glenn shunt procedure can be performed safely in patients with ideal characteristics as the first stage palliation and has favorable results with acceptable rate of complications.
Left atrial thrombus in a case of severe aortic stenosis with severe left ventricular dysfunction
Authors: Dixit Aanchal , Tewari Prabhat , Chandra Bipin
Published: January 2021

Left atrial thrombus in a patient with aortic stenosis and aortic regurgitation in sinus rhythm is an infrequent finding and is most commonly associated with cases of mitral stenosis. This case report emphasizes upon the importance of suspecting the presence of left atrial thrombus in other valvular lesions when additional risk factors such as dilated left ventricle are present. The undeniable role of comprehensive perioperative transesophageal echocardiography is also depicted in this case report.
Image Analysis-Assisted Nuclear Morphometric Study of Benign and Malignant Breast Aspirates
Authors: Niranjan Pandian Dayal Johan , Ramdas Anita , Ambroise M. Moses
Published: January 2021

Background:

Fineneedle aspiration cytology of the breast is well accepted and accurate for the diagnosis of benign and malignant lesions, however, it remains a subjective evaluation.

Aims and Objectives:

The present study was carried out to assess the utility of nuclear morphometry in differentiating benign and malignant breast aspirates. Importantly, we wanted to evaluate the utility of nuclear density parameters using Image J software.

Materials and Methods:

Nuclear morphometry was carried out using image analysis software Image J 1.44 on 20 selected benign and malignant breast aspirates. Assessment was carried out on a total of 1000 cells in benign and 1000 cells in malignant aspirates counting 50 intact nuclei in nonoverlapping cells for each case. Six parameters including three size parameters, namely nuclear area, nuclear diameter, and nuclear perimeter; one shape parameter, i.e., axis ratio; and two nuclear chromasia parameters, namely density (integrated and raw), were measured.

Results:

There were significant differences between nuclear area, perimeter, diameter, integrated density, and raw integrated density of benign and malignant lesions. No significant difference was found for axis ratio. Receiver operating characteristic curve analysis revealed that nuclear area, perimeter, diameter, integrated density, and raw integrated density are helpful in discriminating benign and malignant aspirates.

Conclusions:

Thus, Image J is helpful in the evaluation of nuclear size as well as chromasia. We conclude that nuclear size and density parameters can be used to derive cutoff values of various parameters to differentiate between benign and malignant cells in breast cytology.