bluuebunny/crossref_metadata_2025 huggingface dataset:
DEVELOPMENT OF TERRORIST INSTITUTIONS IN SUPER MAXIMUM SECURITY (SMS) INSTITUTIONS IN PUBLIC PERSPECTIVE
Authors: Rachmayanthy Rachmayanthy , Anwar Umar , Zulfikri Zulfikri
Published: April 2021

The Super Maximum Scurity Penitentiary is a new Technical Implementation Unit in the ranks of prisons, which functions specifically to foster Terrorist prisoners or other high risk prisoners, the difference between this institution compared to other Correctional UPTs is that the security is very tight with one person and one prisoner cell. and the method of guidance provided to prisoners in Super Maximum Scurity (SMS) Lapas is different from other prison guidance. The issues raised in this researchare: How is the implementation of coaching terrorist prisoners in Super Maximum Security Prison based on Regulation of the Minister of Law and Human Rights No. 35 of 2018? And how is the development of terrorist inmates at Super Maximim Security Prison from a prison perspective? The theory used is by using coaching theory and descriptive qualitative research methods by direct interviews with officers of the Super Maximum Security (SMS) prison. Based on the results of the research, it is found that in the development of Terrorist inmates at the Super Maximum Security Prison, because in the implementation of the guidance, the difficulty of the prisoners' movement cannot be directly fostered by the officers having to regulate. Then coaching in terms of the goals of the correctional system can be reviewed because it is different from the goals of different systems, so it requires the best thinking and solutions so that coaching can be carried out in accordance with the objectives of the correctional system, namely prisoners are aware of mistakes, improve themselves and no longer commit acts that violate the law , are accepted by the community and can be active and productive in development and able to live their lives as good and responsible citizens.
THE ROLE OF PUBLIC SUPERVISORS IN IMPLEMENTING THE ASSIMILATION AND INTEGRATION OF PROVIDERS IN COVID-19
Authors: Parakas Marlan
Published: April 2021

Expenditures of prisoners with assimilation and integration during the Covid-19 Pandemic had an impact on new problems and without any assessment carried out by Community Advisors as one of the conditions. The problem raised was how the role of Community Guides in the implementation of assimilation and integration of prisoners during the Covid-19 Pandemic. The theory used is policy theory and descriptive qualitative research methods by describing the impact of assimilation and integration on prisoners. The results of the research show that presenting assimilation and integration for inmates during the Covid-19 pandemic experienced problems in society with the presence of several prisoners who did this and this also occurred due to the lack of implementation by social advisers.
Eugene O'Neill, George Bellows, and the Lincoln Arcade
Authors: Brietzke Zander
Published: April 2021

O'Neill lived in the New York studio of Ashcan artist George Bellows for about nine months in 1908–9. Bread and Butter (1914) is ostensibly about an O'Neill-like hero, a painter, whose family destroys him because it fails to or refuses to understand him. The real hero, though, is the protagonist's roommate, modeled after Bellows, whose eventual hard-earned success prompts the protagonist to commit suicide in despair. O'Neill dramatizes for the first time the tragedy of abandoned hopes and dreams, a subject and theme he pursues next with Beyond the Horizon, then The Great God Brown (1925), and finally Long Day's Journey Into Night (1941). His early vow to become “an artist or nothing” can be evaluated in terms of his relationship with Bellows, to whom he would compare and against whom he would compete throughout his career.
The subject advantage in relative clauses: A review
Authors: Lau Elaine , Tanaka Nozomi
Published: April 2021

The question of whether there exists a universal subject preference in relativization has stimulated research in a wide range of languages and across different domains, yielding an extensive body of literature in relative clause acquisition and processing. In this article, we aim at consolidating the efforts of existing research in order to inform further exploration of the universality of the subject preference with a comprehensive analysis of relevant work (including journal articles on empirical studies, dissertations, and conference proceedings). We present an overview of the proposals regarding the source(s) of the subject-object asymmetry from a cross-linguistic perspective and discuss commonly used methodologies in this research area, and we survey the research on relative clause processing and acquisition of different linguistic communities, including native speakers, second language learners, clinical populations, and heritage speakers.
ASSOCIAÇÃO ENTRE VARIÁVEIS NUTRICIONAIS E SARCOPENIA EM LONGEVOS
Authors: Rosa Francine Da Rocha Flores Giediel , Beuren Amanda Guterres , Dalla Corte Roberta Rigo , Mello Renato Gorga Bandeira de
Published: April 2021

Introdução: No Brasil, a faixa etária com idade igual ou superior a 80 anos é a que mais cresce proporcionalmente. À medida que a população envelhece, torna-se cada vez mais evidente a necessidade do estudo dos fatores associados à sarcopenia. Objetivo: Investigar a associação entre variáveis nutricionais e sarcopenia em longevos. Metodologia: Estudo transversal, arrolou indivíduos com idade igual ou superior a 80 anos em acompanhamento ambulatorial. Para consumo alimentar, utilizou-se o recordatório alimentar de 24 horas. Estado nutricional foi categorizado conforme a Miniavaliação Nutricional. Sarcopenia foi diagnosticada através dos critérios do European Working Group on Sarcopenia in Older People de 2010 e 2018. Para aferição das medidas aplicou-se o exame de Biompedância elétrica, dinamometria de preensão manual e velocidade de marcha aferida em teste de 4 metros. Resultados: A amostra foi composta por 119 longevos, população predominantemente feminina (n=67; 56,3%), com média de idade de 83,4 anos (±3,0). As prevalências de sarcopenia variaram significativamente conforme o critério utilizado, sendo maior quando se adotou diagnóstico conforme critérios diagósticos de 2010 ou 2018 (46,7% vs 17,6%). Sexo feminino e baixa pontuação na Miniavaliação Nutricional aumentaram o risco para sarcopenia segundo pelo critério de 2010. Valor energético total reduzido e ingesta proteica elevada associaram-se significativamente com maior prevalência de sarcopenia e sarcopenia grave, independentemente do critério diagnóstico utilizado ou de fatores de confusão testados. Conclusão: Estado nutricional pela Miniavaliação Nutricional, consumo energético total reduzido e dieta hiperproteica, associaram-se a maior prevalência de sarcopenia.
FRUTO AMAZÔNICO TEM EFEITO PRÓ-CICATRICIAL EM MODELO DE FERIDA IN VITRO
Authors: Monteiro Pillar Danieli , Esteves Ribeiro Filho Euler , Farina Azzolin Verônica , Bonotto Nathália , Aguiar Maia-Ribeiro Ednea , Beatrice Mânica da Cruz Ivana , Barbisan Fernanda
Published: April 2021

Introdução: O envelhecimento cutâneo, é um fenômeno fisiológico gradativo que envolve degradação do colágeno, estresse oxidativo e inflamação, esses aspectos somados ao fato de muitos idosos terem dificuldade de movimentação ou serem portadores de outras doenças como o diabetes, favorecem o aparecimento de lesões de pele de difícil cicatrização, as quais prejudicam qualidade de vida e são um problema de saúde pública. O Camu-camu (Myrciaria dúbia) é um fruto Amazônico, com alto teor de vitamina C e outras molécula bioativas que podem ter efeito pró-cicatricial. Objetivo: Avaliar os efeitos do Camu-camu na cicatrização em modelo in vitro de lesão de pele. Metodologia: Linhagem celular de fibroblastos (HFF-1) obtida comercialmente e cultivada em condições padrão, submetida a uma arranhadura (modelo de lesão in vitro) e após suplementada com extrato de Camu-camu, concentrações de 250μG/mL e 500 μG/mL, após 24 e 72 horas avaliou-se a produção de espécies reativas de oxigênio (EROs) via ensaio da 2,7 diclorofluoresceína diacetato  e o efeito na cicatrização através da comparação das imagens microscópicas via Digimizer Image Analysis Software para avaliação da arranhadura. Resultados: Ambas as concentrações do extrato de Camu-camu, em 24 e 72 horas, atuaram na diminuição da produção de EROs, o Camu-camu induziu aumento na taxa de migração dos fibroblastos para o local da arranhadura, juntamente com a ampliação da proliferação celular, ou seja, favoreceu a cicatrização. Conclusão: O efeito pró-cicatrização do Camu-Camu foi demonstrado sendo este o primeiro estudo do tipo, entretanto mais estudos precisam ser realizados para confirmação desta hipótese.
EFEITOS DA FISIOTERAPIA ASSOCIADA À MÚSICA NO EQUILÍBRIO E NA FORÇA MUSCULAR DE IDOSOS INSTITUCIONALIZADOS
Authors: Hansen Costa Dinara , Bartz Eduarda , Almeida Pôncio Natália , Billig Garces Solange Beatriz , Boettge Rosa Carolina , Thum Cristina
Published: April 2021

Introdução: O envelhecimento predispõe os indivíduos a maior vulnerabilidade e a fragilidade. Muitas vezes a família não está preparada para oferecer os cuidados necessários aos idosos que demandam maior atenção. Surge assim a Instituição de Longa Permanência para Idosos (ILPI) como um dos recursos de auxílio no cuidado e a fisioterapia nestes espaços é um forte aliado para manutenção das condições físicas dos idosos, podendo associar a música durante as sessões realizadas. Objetivo: verificar os efeitos da fisioterapia associada à música na força muscular de membros inferiores e no equilíbrio de idosos institucionalizados. Métodos: estudo experimental com amostra composta por 5 idosos, residentes de uma ILPI do noroeste do Rio Grande do Sul, submetidos a 12 sessões de fisioterapia. A amostra foi dividida em dois grupos: grupo 1 (G1) fisioterapia associada à música (n=3), e grupo 2 (G2) somente fisioterapia (n=2). A avaliação pré e pós intervenção foi realizada através dos testes Time Up And Go (TUG), Sentar e Levantar de 30 segundos (TSL 30) e Escala de Equilíbrio de Berg (EEB) com dados analisados descritivamente. Resultados: idosos de ambos os grupos obtiveram melhora no resultado do TSL 30 e da EEB após as intervenções. Somente um idoso (G1) manteve o resultado do TUG e os demais obtiveram piores resultados na reavaliação. Conclusão: tanto a fisioterapia convencional quanto a associada à música foram efetivas na melhorada força muscular dos membros inferiores e no equilíbrio dos idosos institucionalizados, destacando a importância do acompanhamento desta população pelos profissionais da fisioterapia.
"Pode contar comigo e com o grupo pro que precisar”: autoria, ética e participação na pesquisa com jovens internautas
Authors: Couto Junior Dilton Ribeiro , Oswald Maria Luiza Magalhães Bastos , Ferreira Helenice Mirabelli Cassino , Carvalho Felipe da Silva Ponte de
Published: April 2021

As pesquisas que investigam no contexto das redes sociais digitais vêm se tornando mais comuns nas ciências humanas. Privilegiamos uma relação de parceria com os sujeitos, reconhecendo que a interação com eles é imprescindível na formulação dos caminhos metodológicos do estudo. Esses percursos de pesquisa na internet são o foco de discussão deste artigo, que busca compreender os processos de participação, ética e autoria implicados numa investigação fruto de pesquisa de doutorado recentemente concluída. Para isso, partimos da abordagem histórico-cultural, centralizando nossos esforços teórico-metodológicos nas contribuições de dialogismo e alteridade de Mikhail Bakhtin e de seus interlocutores, que privilegiam a participação do outro na escolha dos percursos metodológicos e na produção do conhecimento.
A participação dos entes federados no financiamento ao esporte e lazer no Brasil
Authors: Carneiro Fernando Henrique Silva , Athayde Pedro Fernando Avalone , Mascarenhas Fernando
Published: April 2021

Objetivo do estudo: Analisar o financiamento da Função Desporto e Lazer (FDL) pelos Municípios, Estados/Distrito Federal (DF) e União ao longo de 2013 a 2018.Metodologia/abordagem: Pesquisa descritivo-exploratória de cunho qualitativo com realização de análise documental a partir de dados do Sistema de Informações Contábeis e Fiscais do Setor Público Brasileiro (SICONFI) e do SIGA Brasil. A análise de dados foi baseada no indicador magnitude do gasto.Originalidade/Relevância: Realização de análise inédita sobre a totalidade e a participação dos diferentes entes federados do Estado brasileiro no financiamento orçamentário do esporte e lazer.Principais resultados: A maior parte do gasto com a FDL foi realizado pelos Municípios, seguida pelos Estados/DF e, por último, a União. Embora os Municípios e Estados/DF sejam os entes federados que menos têm recursos para serem gastos com as diferentes políticas públicas, são justamente eles que direcionam mais recursos do orçamento público para a FDL. Em todos os anos analisados a União e todos os Estados/DF gastam com a FDL, sendo que mais de cerca de 90% dos Municípios também tiveram esse tipo de gasto.Contribuições teóricas/metodológicas: O estudo demonstra a totalidade do gasto orçamentário do Estado brasileiro com a FDL, bem como a participação dos diferentes entes federados. O protagonismo do financiamento orçamentário do esporte e lazer tem sido dos Municípios, logo eles são os principais promotores de políticas públicas do setor.
The Ottoman Empire and Europe from the late Westphalian order to the Crimean system: the ’Eastern Question’ Revisited
Authors: Leanca Gabriel
Published: April 2021

The ‘Eastern Question’ is one of the most controversial and persistent subjects in the history of international relations. This article looks at two aspects in the evolution of the relations between the Ottoman Empire and Europe. The first one focuses on the importance of the 18th century in the emergence of the ’Eastern Question’. The second one emphasizes on several episodes that may reopen the debate on the origins of the Crimean War. Our research is an attempt to demonstrate that the ’Eastern Question’ was only a piece of a larger puzzle. The more Russia was influential in world politics, the more her contribution became valuable for the stability of the international system. The idea to challenge in the early 1850’s the heritage of the 18th century in world politics (meaning to marginalize Russia in European affairs), did not serve on the long run neither to the security of the Ottoman Empire, neither to the ’new multilateralism’ put forward by Napoleon III.
The End of the Ottoman Empire and the Evolution of the Middle East Security Complex
Authors: Lasmar Jorge Mascarenhas , Santa Rita Leonardo C. A.
Published: April 2021

Desde o fim do Império Otomano, o Oriente Médio passou por várias mudanças políticas abruptas e se tornou o palco de uma série de conflitos regionais e disputas entre as grandes potências que impactaram fortemente a forma como este complexo de segurança regional evoluiu. Usando o arcabouço teórico da Escola de Copenhague e da Escola Inglêsa, retraçamos como essas dinâmicas de segurança e insegurança estão em um processo ainda não terminado de constante evolução desde a queda do Império e como esses processos estão inseridos no contexto mais amplo e sistêmico da administração das grandes potências.
Integration, conflict, and autonomy among religious minorities in the late Ottoman Empire: the Greek-Catholic (Melkite) Church and sectarian turmoil in Mount Lebanon and Damascus
Authors: Cherem Youssef Alvarenga , Zahreddine Danny
Published: April 2021

The 19th century was a time of social and political upheaval for the Ottoman Empire. To contend with dwindling territories, uprisings, unrest, and international military, political, and economic pressure, it had to overcome structural deficiencies in the armed forces, economy, and State bureaucracy that kept it lagging behind its European counterparts. The modernizing impetus ultimately took the form of full-fledged legal and institutional reform by mid-century, transforming but also unsettling the Ottoman State and society. In this article we discuss a central component of those reforms and of the international relations of the Ottoman Empire in the 19th century: the legal status of non-Moslem minorities. We frame our discussion in the analysis of two moments: the official recognition of the Greek-Catholic (Melkite) religious community in 1848 and the sectarian civil conflict in Mount Lebanon and Damascus in 1860. The intersecting vectors of economical, religious and political interests in their local, regional and international dimensions will be fleshed out, evincing a more nuanced and multilayered, and less monolithic and state-centered, approach toward the international relations of the late Ottoman Empire and the working of its institutions.
Studying the Middle East from Brazil: reflections on a different worldview
Authors: Clemesha Arlene , Ferabolli Silvia
Published: April 2021

This paper describes and analyses the experiences of two Brazilian professors in teaching History and International Relations of the Middle East and the Arab World, both at undergraduate and graduate levels. Essentially, this paper is an exercise of comparison between the limits faced – but also the possibilities found – by the authors in the development of their activities as Latin American professors promoting the study of the Middle East and the Arab World in Brazil. Its main aim is to help scholars involved with these subject-matters to reflect on their pedagogical practices and on the knowledge they are promoting (or inhibiting) with their research proposals and teaching procedures. Anchored in the methodological techniques of participant observation and critical curriculum analysis, this paper reaches the conclusion that the socialisation of Brazilian scholars in the Anglo-Saxon literature on the Middle East when not mediated by a critical posture towards these parochial knowledges that pretend to be global, can make them more reproducers of the discourses produced in the North about the region than thinkers of the Global South capable of offering their educatees a space of knowledge production that is meaningful to them as Brazilian students.
Expression of matrix metalloproteinase-9 in acquired middle ear cholesteatoma
Authors: Vranješ Dalibor , Spremo Slobodan , Šolaja Siniša
Published: April 2021

Introduction. Matrix metalloproteinase-9 (MMP-9) plays one of the key roles in the migration of inflammatory cells and the destructive behavior of acquired middle ear cholesteatoma. The aim of the study was to determine the expression levels of MMP-9 in chronic otitis media, with and without acquired cholesteatoma, as well as to determine the correlation between them and the pathomorphological changes in the tympanic membrane (TM). Methods. Immunohistochemical study included 178 patients of both sexes, aged 5-75 years, who underwent microsurgical treatment of chronic otitis media (COM) at the Ear, Nose and Throat Department of the University Clinical Center of the Republic of Srpska in Banja Luka from 2015 to 2018. Patients were divided into two groups on the basis of the presence or absence of acquired cholesteatoma: 97 (CCOM) and 81 (COMWC). The samples of the perimatrix of acquired cholesteatoma (n=97) and inflamed middle ear mucosa (n=81) were taken intraoperatively. The presence of retraction and certain types and subtypes of TM perforations were examined by intraoperative exploration. MMP-9 expression levels were determined by immunohistochemical analysis. Results. In the presence of cholesteatoma and highly positive expression of MMP-9, the marginal type of TM perforation was more likely to occur (p<0.01) while in negative expression of MMP-9 in the COMWC group, the central type was more likely to occur (p<0.01). There was a higher probability of the presence of attic subtype of TM perforation in patients with cholesteatoma and moderate positive expression of MMP-9 (p<0.01). There was not a statistically significant contribution of any of the factors in the prediction of the influence on the occurrence of TM retraction. Conclusion. The presence of acquired middle ear cholesteatoma and highly positive expression of MMP-9 are statistically significant predictors of the presence of marginal type and attic subtype of TM perforation. Expression levels of MMP-9 may have potential clinical significance in the development of irreversible pathomorphological changes on TM in middle ear cholesteatoma.
Orbital complications of acute rhinosinusitis in children: Case study
Authors: Krsmanović Ljiljana , Turuntaš Vladimir
Published: April 2021

Introduction. Acute rhinosinusitis (ARS) encompasses a heterogeneous group of inflammatory disorders affecting nasal mucosa and paranasal sinuses. Rhinosinusitis is the most common condition in the United States. It is estimated that over 30 million people annually visit the doctor due to this condition, while every sixth adult suffers from ARS. Among all ARS complications, over 91% are orbital complications (OC) with an average prevalence of 6% and a higher incidence in children compared to adults. Case report. Twelve-year-old boy, accompanied by his mother, was urgently referred to the Department of Otorhinolaryngology at the University Hospital in Foca due to a sudden red and painful left periorbital edema, pain in the left eye and a fever reaching 38.5ºC. After laboratory and CT scan diagnostics, an ophthalmologic examination and inpatient clinical findings after 36 hours of parenteral triple antibiotic therapy, the patient was referred to a tertiary-type institution for further treatment. The same procedure was performed conservatively during the hospitalization within 6 days. Conclusion. The initial treatment of orbital complications in children is conservative. Treatment should be started empirically, using triple antibiotic therapy. The choice of antibiotics and treatment protocols among pediatric population have not been agreed yet. If 36-48 hours after the beginning of the conservative treatment, there is lack of the clinical response, surgical treatment is absolutely indicated, regardless of the stage of orbital complication.
Scrapping Probabilities and Committed CO2 Emissions of the International Ship Fleet
Authors: Held Maximilian , Stolz Boris , Hoffmann Jan , Georges Gil , Bolla Michele , Boulouchos Konstantinos
Published: April 2021

Fighting climate change demands action in all sectors. International shipping faces the challenge of long lifetimes of vessels compared to other modes of transportation like cars or aircraft. Decisions on energy carriers and propulsion technologies that are made now have a long-lasting impact on the emissions of the sector. An essential part to understand how long vessels will stay in the fleet are cumulative survival probabilities, i.e. the probability with which a vessel is still in service at a specific age. However, literature and data on this topic are scarce. We fill this gap by providing cumulative survival probability curves for the international vessel fleet, resolved by vessel size and type. We illustrate how this knowledge can be used in a stock and flow model in order to project future CO2 emissions. Preliminary findings show that the shipping industry needs to ramp up efforts in providing carbon-neutral technology solutions now. Otherwise, climate targets are out of sight and more and more emissions from fossil fuel-powered vessels are locked-in.
The Importance of Measuring the Performance of IMO Member States
Authors: Peppa Sofia
Published: April 2021

The International Maritime Organization (IMO) plays a key role in the development and promotion of international standards for shipping ensuring their effective implementation through the member states. The ability to measure the performance of IMO member states in terms of implementation and enforcement of international legislation in maritime safety is critical. Here we discuss the benefits of the IMO Audit Scheme towards capacity-building and review the performance of flag states. An analysis and assessment of recent audit summary results is presented, demonstrating the contribution of the Audit Scheme towards better performance of member states. Finally, we will discuss areas for research, where additional actions/interventions could lead to future improvements in safeguarding global maritime safety.
The Status of Chemotherapy in Metastatic Breast Cancer: Insights for the Advanced Practitioner
Authors: Hanna, PharmD, BCPS, BCOP Kirollos , Mayden, MSN, FNP, AOCNP Kelley
Published: April 2021

Breast cancer is the most frequently diagnosed cancer in the United States and ranks second as the most common cause of cancer-related death among women (Siegel et al., 2020). According to American Cancer Society (ACS) estimates, approximately 276,480 new cases of breast cancer would have been diagnosed in 2020, and greater than 42,000 deaths would be attributed to breast cancer (ACS, 2020). Although only 7% of all cancer-related deaths are from breast cancer every year, it is the leading cause of death among women between the ages of 40 and 49 years (Siegel et al., 2020). The death rate associated with breast cancer, however, has decreased by 1.3% annually from 2013 to 2017.
Chemotherapy Treatment Considerations in Metastatic Breast Cancer
Authors: Hanna, PharmD, BCPS, BCOP Kirollos , Mayden, MSN, FNP, AOCNP Kelley
Published: April 2021

Historically, metastatic breast cancer (MBC) was primarily treated with surgery and chemotherapy. To that end, a wide array of chemotherapy agents are currently available for the treatment of MBC. To date, there has been considerable progress in the understanding of the molecular underpinnings of breast cancer, which has led to the development of targeted agents. Despite this, eventually all patients with metastatic disease will receive single-agent or combination chemotherapy either to control spread or as a palliative measure. Currently, combinations of targeted agents and chemotherapy are under investigation, thereby indicating that chemotherapeutic agents will continue to be the backbone of future breast cancer therapy. However, there remains an unmet need to optimize the sequencing of chemotherapy agents based on individual patient characteristics and gene expression profiles in order to reduce toxicities and improve outcomes for patients.
Hemorrhagic plaques in the oral cavity: A clue to diagnosing thrombocytopenia
Authors: Raj Aswathi , Asfiya Amina , Pinto Malcolm , Shenoy M Manjunath , Hegde Spandana P , Bejai Vishal , Razak Ashmiya Abdul
Published: April 2021

Idiopathic thrombocytopenic purpura is a disorder with a myriad of possible clinical presentations. The mechanism of thrombocytopenia involves both increased platelet destruction and impaired platelet production. The patient can manifest a wide range of symptoms: from asymptomatic or minimal gingival bleeding to profuse bleeding from any site. The disease may first present itself to the dermatologist in cutaneous findings such as petechiae, purpura, and mucosal manifestations in the form of gingival bleeding and hemorrhagic bullae. The diagnosis of idiopathic thrombocytopenic purpura is mostly done by exclusion. In this report, we present two cases with characteristic oral manifestations, who were diagnosed, on investigation, with idiopathic thrombocytopenic purpura. The patients were successfully treated with immunosuppressive therapy. The report aims to raise awareness that would help in enabling prompt referral to the appropriate specialty, especially because of the rarity of this presentation.
The initial impact of low-level laser therapy on a traumatic leg ulcer
Authors: Pereira de Godoy Jose Maria , Pereira de Godoy Lívia Maria , Pacheco Esteban Fortuny , Guerreiro Godoy Maria de Fátima
Published: April 2021

Low-level laser therapy (LLLT) has been used as an effective, safe, and noninvasive treatment for wound healing. This paper reports the case of a 78-year-old female who had suffered trauma to the anterior tibial region of the leg. The injury continued to worsen for a month, along with an increase in pain, even with medical treatment involving antibiotics and conventional bandaging. An examination revealed a hyperemic injury with secretions, and LLLT was proposed, with red laser at 3 J and 660 mW and for a 25 s exposure time. The patient returned after four days reporting a substantial improvement in both the pain and the wound. Low-level laser therapy (LLLT) proved effective at controlling pain and improving the healing of a traumatic ulcer that had been worsening with conventional treatment.
Quando a democracia incuba desigualdade e heteronomia: autoritarismo e nacionalismo na UE
Authors: Casanova José Luís , Almeida João Ferreira de
Published: April 2021

Neste estudo analisamos a base social dos partidos autoritários e nacionalistas (AN) na União Europeia a partir de uma teoria que articula dimensões sociais e culturais. Pretende-se caracterizar e compreender este eleitorado, e explicar o seu crescimento, considerando a sua classe social, escolaridade, rendimento, orientações sociais, valores humanos e atitudes relativamente aos imigrantes, e observando trajetórias de desigualdades. Os dados são do European Social Survey e de informação contextual ao nível nacional sobre desigualdades económicas e escolares, e sobre mobilidade social. Observa-se que os votantes nos partidos AN são sobretudo operários e trabalhadores agrícolas, com escolaridade muito baixa e rendimento baixo. Caracterizam-se pela orientação social da heteronomia, uma disposição conformista paradigmática que combina conformidade com a desigualdade e conformidade com a hetero-determinação da própria posição social, aqui definida pela baixa importância atribuída aos valores humanos da igualdade e da criatividade. A heteronomia permite compreender um largo espectro de traços culturais desta população como a sua atitude excludente relativamente aos imigrantes. E verifica-se que a expansão deste eleitorado acompanha processos de crescimento da desigualdade, nomeadamente escolar, bem como de mobilidade descendente, e de exclusão social.
Three new Luticola D.G.Mann (Bacillariophyta) species from Rapa Nui (Easter Island) found in terrestrial diatom assemblages dominated by widely distributed taxa
Authors: Peszek Łukasz , Rybak Mateusz , Lange-Bertalot Horst , Kociolek John Patrick , Witkowski Andrzej
Published: April 2021

Background

Rapa Nui (Easter Island = Isla de Pasqua) is of volcanic origin, best known for about 900 man-made stone statues known as moai. It is one of the most isolated inhabited islands on Earth and studies on the diatoms of Rapa Nui are very few.

Methods

Light (LM) and electron microscopic (SEM) observations of a single sample collected from Rapa Nui are presented. The samples (mix of soil and organic detritus) were collected from ground of cave entrance.

Results

The samples were characterized by low diatom diversity and strongly dominated by terrestrial (soil) forms. Among the taxa present in the material studied were cosmopolitan forms of the genera Humidophila, Nitzschia, Angusticopula, Orthoseira, Tryblionella and Luticola. Whereas most of taxa of the enumerated genera were identifiable, only one among four Luticola species distinguished in the samples studied was identified. This taxon was L. ectorii, a cosmopolitan species known previously from South America (Brazil) and Asia (China). The three remaining species could not be assigned to any established species. Therefore, based on external and internal morphological features from light and scanning electron microscopic analysis, we describe here three species new to science, including: L. georgzizkae, L. rapanuiensis and L. moaiorum. All three taxa new to science are compared to established Luticola species and their significance for the global distribution of the genus is discussed.
Analysis of the Perception of the department of Tourism and Hotel Management Associate Degree Students about the Concept of
Authors: GÜL Kudret , GÜL Melike
Published: April 2021

Değişime son derece duyarlı üniversite öğrencileri arasında yiyecek içecek tercihleri ve bu tercihleri etkileyen faktörler sürekli değişim göstermektedir. Bu kapsamda çalışmanın amacı, demografik değişkenlere dayalı üniversite öğrencilerinin
yiyecek içecek seçimini etkileyen faktörler algısını belirlemektir. Veriler Ocak-Şubat 2020 ayları arasında Balıkesir Üniversitesi merkez yerleşkesinde 10 farklı fakülte/yüksekokulda öğrenim gören ve anket formunu doldurmayı kabul
eden 503 öğrenciden elde edilmiştir. Katılımcılar, zümrelere göre örnekleme yöntemi ile her fakülte/yüksekokulu temsilen 30-70 öğrenci arasından basit tesadüfi örneklem tekniği ile seçilmiştir. Veri analizinde betimleyici istatistik,
korelasyon ve varyans analizi kullanılmıştır. Araştırma bulguları, öğrencilerin yiyecek içecek seçimini etkileyen faktörlerin fiziki koşullar faktörleri, psiko-sosyal faktörler, yiyecek-içeceğe ilişkin faktörler, ekonomik faktörler,
psikolojik faktörler, demografik faktörler ve kültürel faktörler olarak sıralanabileceğini ortaya koymaktadır. Öğrencilerin yiyecek içecek seçimini etkileyen faktörler algısının cinsiyete dayalı olarak farklılaştığı ve kız öğrencilerin
yiyecek içecek seçiminde erkek öğrencilere kıyasla daha duyarlı oldukları tespit edilmiştir. Anne eğitim düzeyinin de öğrencilerin yiyecek içecek seçimi algısını etkilediği, anne eğitim düzeyi ilkokul ve üniversite/lisansüstü olan
öğrencilerin, anne eğitim düzeyi lise olanlara kıyasla yiyecek içecek seçimini etkileyen faktörlerden daha fazla etkilendiği ortaya çıkmıştır. Ayrıca üniversite öğrencilerin yiyecek seçimi algısının en fazla fakülte/YO değişkenine
dayalı olarak farklılaştığı ortaya çıkmıştır.
Triple Therapy of Fluticasone Furoate, Umeclidinium, Vilanterol- A Compelling Choice in Severe Chronic Obstructive Pulmonary Disease
Authors: Nathan B Jagan , Sahay Melina I , Gautham AK , Sriram DK , George Melvin
Published: April 2021

Trelegy Ellipta (GlaxoSmithKlineTM) is the first single inhaler triple combination therapy comprising of umeclidinium, vilanterol and fluticasone approved by the United States Food and Drug Administration (US FDA) for patients with severe COPD in 2019. Clinical trials comparing this triple combination with dual therapy including a Long Acting β2-Agonist/Long Acting Muscarinic Antagonist (LABA/LAMA) or Long Acting β2-Agonist/Inhaled Corticosteroids (LABA/ICS) were evaluated. Triple combination did show improvement through the mean Forced Expiratory Volume per second (FEV1), St. George questionnaire, and reduced hospitalisation due to acute exacerbation of COPD. This medication should be prescribed cautiously for certain populations. Although this triple combination is used only in patients with the most advanced forms of disease who have frequent exacerbations and remain uncontrolled, there are certain additional indications that may be explored in future trials. The convenience associated with using a single device for three different classes of drugs could be its biggest trump card and it will not be surprising to see its preference among patients avoiding the need for multiple dosing. Nevertheless, it remains to be seen if this improved adherence would translate into improved outcomes such as reduced mortality in real world practice among patients with severe COPD. The availability of a single inhaler device for delivering a triple combination of LABA/LAMA/ICS is a small success story in the quest to identify better therapies for patients with severe COPD, who are so prone to repeat acute exacerbations which could eventually turn fatal.
An Analysis of Drug-Drug Interactions in a Tertiary Care Hospital in Kerala: A Retrospective Study
Authors: Shajahan Jihana
Published: April 2021

Introduction: Concomitant use of several drugs for a patient is often necessary for achieving therapeutic response. Understanding the profile of Drug-Drug Interactions (DDI) will help health care providers to optimise therapy for better patient outcomes, reinforcing the concept of rational drug use. Aim: To analyse the frequency, mechanisms and severity of DDIs in a tertiary care hospital at Kerala. Materials and Methods: A retrospective cross-sectional study among 350 inpatients of a tertiary care hospital in Kerala from August 2020 to September 2020. Prescriptions containing ≥3 drugs were collected from inpatient medical records. A drug interaction check was performed using the Lexicomp drug interaction checker software. Results: DDIs were present in 74.6% of prescriptions and the average number of interactions was found to be 2.78. Most number for interactions was in the age group 61-80. Average number of DDI was significantly high among patients >60 years. Percentage of prescriptions with DDI and average number of DDI was found to be increasing with increase in number of drugs. Average number of interactions were maximum (5.01) in the group >10. Drug groups most commonly involved in interactions were antiplatelets, oral hypoglycaemic agents, bronchodilators, antibiotics, diuretics, insulin, statins, beta blockers, Proton Pump Inhibitors (PPI) and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). The most common interventions for minimising the impact of DDIs were changing the timing of drug administration, monitoring for symptoms/signs/lab values/drug levels or both. There was a significant positive correlation between duration of hospital stay and number of DDI. Conclusion: This study threw light upon the pattern and profile of DDIs among inpatients of a tertiary care hospital in Kerala. Elderly people (>60 years) were most prone for DDIs. Percentage of prescriptions with DDI and average number of DDIs was found to be increasing with increase in number of drugs. There was a positive correlation between duration of hospital stay and number of DDI.
Appraisal of Inter-rater Agreement among Assessment Scales and Retrospective Analysis of Validated Reports of Cutaneous Adverse Drug Reactions at Tertiary Care Hospital in Eastern India
Authors: Kumar Mukesh , Manjhi Pramod Kumar , Singh Shruti , Soni . , Singh Dheeraj Kumar , Deo Sanmita
Published: April 2021

Introduction: Cutaneous Adverse Drug Reactions (CADRs) share significantly to Adverse Drug Reactions (ADRs) comprising 10%-30% of all ADR reporting in India. Multi Drug Therapy for Leprosy (MDT-L) and antimicrobials contribute remarkably to the overall CADRs burden. Aim: To show distinctive pictures of CADRs profile and to assess inter-rater agreement of assessment scales among study populations. Materials and Methods: A retrospective analysis was done for 245 CADRs reported from March 2018 to March 2020. Cohen kappa statistics was applied for inter-rater agreement study for causality (World Health Organisation-Uppsala Monitoring Cente {WHO-UMC} Scale and Naranjo’s Algorithm), severity (Hartwig and Siegel scale) and preventability assessment (Modified Schumock and Thornton scale). Results: CADRs contribute 45.54% of total ADRs reported during study period. Male (60.41%) and age group 21-40 years (22.45%) were predominant sex and age group, respectively. Multidrug therapy for leprosy (51.83%) was the most common offending agent and hyperpigmentation (20.82%), dryness (13.1%), and both (11%) were the most prevalent CADRs. Causality of WHO–UMC Scale was higher with ‘Possible’ than ‘Probable’. Whereas, ‘Probable’ was maximally found with Naranjo’s Algorithm. Severity assessment showed maximum ‘mild’ cases i.e., 66.53% (manual) and 69.8%% (app). Preventability assessment depicted mostly ‘Definite’, 66.53% (manual) and 85.71% (app). Inter-rater agreement study showed ‘Substantial agreement’ for WHO-UMC Scale (K=0.678) and Naranjo’s algorithm (K=0.820), when manual vs app ratings were compared. ‘Almost perfect’ for severity assessment (K=0.893) and ‘Moderate’ for preventability assessment (K=0.434) were noticed. ‘Fair’ agreement was observed when manual (WHO-UMC scale) vs manual (Naranjo’s algorithm) were compared with K=0.290 and also, in app (WHO-UMC scale) vs app (Naranjo’s algorithm) with K=0.319. Conclusion: CADRs were most prevalent among ADRs which have a distinctive picture in eastern India. WHO- UMC scale and Naranjo’s algorithm concluded significant differences in causality with only ‘fair’ agreement between them. Severity and preventability assessment done by manually little varied in their results with pharmvigill app and is still more reliable and popular.
End of Life Care: Healthcare Provider’s Mindset, Needs and Barriers
Authors: Mathew Sherry P , Kuldeep GB , Chawan Seema Ramesh
Published: April 2021

Introduction: In India, End of Life (EOL) care practice has gained momentum. EOL can have significant impact on physical, emotional and financial aspect. Care planning, coordination and good communication are important if the needs and preferences of people are to be met for their EOL care. There is very minimal information available on awareness, attitude, planning and provision of EOL care. Aim: To assess the Knowledge, Attitude and Practice (KAP) among hospital administrators, doctors and nurses on EOL care and to the decision-making aspects and possible barriers in the provision of EOL care. Materials and Methods: A descriptive survey-based study was conducted at the Department of Hospital Administration, Vydehi Institute of Medical Science and Research Centre Bengaluru, Karnataka. The questionnaire was distributed among 100 healthcare providers including hospital administrators, doctors and nurses involved in EOL care. A structured questionnaire containing 15 questions were used to gather data from the respondents wherein question no. 1 to 5 were based on the knowledge and question no. 6 to 13 were based on practice and question no. 14 and 15 were based on the attitude. All data were entered in MS Excel and statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) Version 20.0. Results: Majority of respondents belonged to the group ranging from 25-35 years of age, wherein 58 were males and 42 were females. Ninety participants out of 100 were aware of the concept of “EOL care”, 59 were aware about the current laws concerning EOL care and 17 participants had their medical staff in the hospital being educated and trained on EOL care (p>0.05). Around 29 participants have experienced lack of communication while giving EOL care to patients; 54 out of 100 participants have experienced fury from patient/attender during their practice and 66 participants felt that the hospital should take into consideration of spiritual, religious and cultural beliefs in dealing with EOL care patient. Furthermore, Chi-square test revealed significant (p<0.001) relation between the factors such as age of the patient, duration of disease, economic factors, health insurance, patient suffering, emotional distress among patient/attender and no hope of good quality of life in making decision during EOL. Conclusion: Along with improvements in rules and regulations, there is an urgent need for increasing in awareness among stakeholders who are involved in EOL care practice.
Giant Cell Tumour of Clivus: A Rare Case Report
Authors: Goswami Swapan Shantiram , Jain Sonal , Nagori Shalin
Published: April 2021

Giant Cell Tumours (GCT) of the skull is rare, being less than 0.05% of all skeletal tumours. They are usually located in the middle cranial fossa affecting the temporal, sphenoid, petrosal and occipital bone. Clival GCT is rarer and 15 cases are described in the literature. Authors report a case of a female patient aged 20 years, who complained of headache with decrease in vision of left eye. Neurological examination revealed left optic nerve palsy. Laboratory test of Vitamin B12, blood urea, Serum Creatinine, Serum Electrolytes were within normal range. Complete blood count showed mild anaemia. The serum calcium and parathyroid hormones were within normal range. Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) were done, which demonstrated expansile destructive lytic lesion involving sphenoid bone and clivus, reaching upto sellar, parasellar regions, sphenoid sinus and left posterior ethmoid sinus, effacing left optic foramina and posteriorly effacing prepontine cistern. The left internal carotid artery was partially encased by the mass. The tumour was partially removed by endoscopic trans-nasal trans-sphenoidal approach. Histopathology confirmed it as a benign GCT. Surgical treatment of clival GCTs are fraught with complication because of its close proximity to vital structures. High vascularity, potential malignant behaviour, inaccessibility and very few published cases preclude a definite outcome of this lesion. Histopathology is necessary to differentiate various lytic lesion like chordoma, aneurysmal bone cyst, invasive pituitary adenoma, chondrosarcoma and brown tumour (parathyroidism).
Effectiveness and Safety of Ginkgo biloba, Vinpocetine and Piracetam as a Single Agent and Fixed Dose Combination in Patients with Subjective Tinnitus
Authors: Mathai Paul , Chandran Anu , Das Sourav
Published: April 2021

Introduction: Owing to the lack of any standard treatment, subjective tinnitus can be debilitating, manifesting a varied population response to tinnitus management. There is, therefore, an unmet need to optimise the existing treatment options and generate data to help physicians provide the best possible care for individual patients. Aim: To compare the effectiveness and safety of Ginkgo biloba, vinpocetine, and piracetam as a single agent and their Fixed Dose Combination (FDC) in patients with subjective tinnitus. Materials and Methods: Patients with complaints of subjective tinnitus were enrolled in this longitudinal cohort, single centre study which was conducted at Outpatient Clinic of the ENT Department of Justice KS Hegde Charitable Hospital, Karnataka, India. Patients received one of the five treatments, oral route, three times a day, {group 1: Ginkgo biloba (40 mg); group 2: vinpocetine (5 mg); group 3: piracetam (400 mg); group 4: FDC of Ginkgo biloba (60 mg) and piracetam (400 mg); group 5: FDC of Ginkgo biloba (60 mg), piracetam (800 mg) and vinpocetine (5 mg)} and were followed-up for six weeks using a modified version of Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS), before and after the treatment. Data for safety were also recorded. The association between each attribute and the presence of tinnitus was assessed through chi-square tests. Results: A total of 130 out of 149 enrolled patients completed the study. All the groups showed significant improvement in the severity of symptoms at the end of six weeks as assessed by the modified THI and VAS scores. The improvement was found to be better in group 5 than in other groups, which was evident from the percentage improvement at the end of the treatment compared to other groups. No adverse drug reactions were associated with any of the treatment groups. Conclusion: Though all the drugs were found to be effective and safe in reducing the intensity of subjective tinnitus, FDC of Ginkgo biloba-piracetam-vinpocetine may be considered a better alternative than Ginkgo biloba-piracetam combination and Ginkgo biloba, piracetam, or vinpocetine as single agents.
Molecular Docking Study of Some Nitro Diazo Dye Derivatives as Antiviral Candidates of COVID-19
Authors: Al–Douh Mohammed Hadi , Selim Elham Abdalrahem Bin , Abdallah Hassan Hadi , Abdullah Hewa Y. , Al–Bakri Aisha Khalid , Al–Nohey Dahab Salim , Mahram Samia Mabrook Bin , Yusr Khulood Mahfoudh , Hawiel Faten Abdulaziz Bin
Published: April 2021

In this study, the computerized molecular docking method was used to investigate the interactions of five nitro diazo dye derivatives 1-5 with COVID-19, CLpro, RAF and PLpro as very important viral proteins to target the coronavirus SARS-CoV-2. Among the used diazo dyes, compound 5 showed the highest binding free energies and the lowest inhibition constants Ki with all studied proteins, and it exhibits a large effect to inhibit the activities of the RAF and COVID-19. Therefore, compound 5 may be useful as an antiviral candidate that worth more trials for COVID-19 disease. The binding sites of compound 5 with the tested viral proteins were evaluated.