bluuebunny/crossref_metadata_2025 huggingface dataset:
Control of the chemical composition of heat-resistant nickel alloys upon manufacturing products from these alloys using additive technologies
Authors: Dvoretskov R. M. , Slavin A. V. , Tikhonov M. M. , Kuko I. S.
Published: April 2021

Heat-resistant alloys (superalloys) widely used for manufacturing parts of various components of aircraft engines are complex nickel-based systems which contain apart from alloying (Al, Cr, Co, Ti, Mo, W, etc.) and microalloying additives (B, Mg, REM, etc.) different amounts of the impurities (Mn, Fe, Si, Pb, As, Sn), including gas-forming (O, N, C, S) ones. The use of additive technologies (AT) in manufacturing of complex-shaped parts made of these alloys makes it possible to increase the material utilization coefficient and shorten the technological process. However, the use of AT requires real-time control of the composition of semi-products and finished products at all stages of production. Study of various stages of manufacturing parts from ZhS6K and VZh159 alloys using an AT of selective laser alloying (SLA) is carried out using analytical control systems of the laboratory of the Testing Center (TC) of FSUE «VIAM». A complex of methods for atomic emission, mass spectrometric and X-ray fluorescence determination of different groups of elements was used for the analysis of charge materials, cast bar blanks, metal-powder compositions (MPC) and synthesized parts. The results of analysis of nickel N-1u and chromium Kh99N1 used upon and after smelting of cast billets, as well as analysis of MPC of these alloys carried out by different methods are presented (gas analyzers were used to determine the gas-forming impurities). Monitoring on the chemical composition of materials throughout the process of additive manufacturing ensure their compliance with the regulatory requirements and predict the properties of finished products. The work was carried out within the framework of complex scientific direction 2.1 «Fundamental research» («Strategic directions for the development of materials and technologies for their processing for the period up to 2030»).
Characteristics of SARS-CoV-2 variants of concern B.1.1.7, B.1.351 or P.1: data from seven EU/EEA countries, weeks 38/2020 to 10/2021
Authors: Funk Tjede , Pharris Anastasia , Spiteri Gianfranco , Bundle Nick , Melidou Angeliki , Carr Michael , Gonzalez Gabriel , Garcia-Leon Alejandro , Crispie Fiona , O’Connor Lois , Murphy Niamh , Mossong Joël , Vergison Anne , Wienecke-Baldacchino Anke K. , Abdelrahman Tamir , Riccardo Flavia , Stefanelli Paola , Di Martino Angela , Bella Antonino , Lo Presti Alessandra , Casaca Pedro , Moreno Joana , Borges Vítor , Isidro Joana , Ferreira Rita , Gomes João Paulo , Dotsenko Liidia , Suija Heleene , Epstein Jevgenia , Sadikova Olga , Sepp Hanna , Ikonen Niina , Savolainen-Kopra Carita , Blomqvist Soile , Möttönen Teemu , Helve Otto , Gomes-Dias Joana , Adlhoch Cornelia ,   on behalf of COVID study groups
Published: April 2021

We compared 19,207 cases of SARS-CoV-2 variant B.1.1.7/S gene target failure (SGTF), 436 B.1.351 and 352 P.1 to non-variant cases reported by seven European countries. COVID-19 cases with these variants had significantly higher adjusted odds ratios for hospitalisation (B.1.1.7/SGTF: 1.7, 95% confidence interval (CI): 1.0–2.9; B.1.351: 3.6, 95% CI: 2.1–6.2; P.1: 2.6, 95% CI: 1.4–4.8) and B.1.1.7/SGTF and P.1 cases also for intensive care admission (B.1.1.7/SGTF: 2.3, 95% CI: 1.4–3.5; P.1: 2.2, 95% CI: 1.7–2.8).
DIVERSITY AND POPULATION STRUCTURE OF LOCAL AND EXOTIC LABLAB PURPUREUS ACCESSIONS IN KENYA AS REVEALED BY MICROSATELLITE MARKERS
Authors:   1Kenya Agriculture and Livestock Research Organization. P.O. Box 57811-00200, Nairobi, Kenya. 2University of Eldoret, School of Agriculture and Biotechnology. P.O. BOX 1125, Eldoret, Kenya. 3World Agroforestry P.O. BOX 30677-00100, Nairobi
Published: April 2021

Lablab purpureus is an important pulse crop in some parts of sub-Saharan Africa and Asia but has largely remained underutilized. Understanding the genetic diversity is prerequisite for genetic improvement and utilization of this leguminous crop. The relationships of the local lablab genotypes and those collected from other diverse geographic origins including the wild accessions remain unknown in Kenya. The study was undertaken to determine genetic diversity and population structure of germplasm accessions collected from Kenya and other global regions. Eight simple sequence repeat primer pairs were used to genotype the 189 lablab accessions. A total of 39 alleles were revealed by eight SSR with an average of 4.88 alleles per polymorphic loci. The average PIC was 0.42. The gene diversity among the accessions ranged from 0.26 to 0.52 with an average of 0.38, indicating moderate genetic diversity. Germplasm collected from Kenya showed a moderate genetic diversity of 0.36. Higher genetic diversity (He<0.5) was detected within the Ethiopian and South Africa populations. Analysis of molecular variance (AMOVA) revealed that 94% of the allele diversity was attributed to individuals within populations while only 6% was distributed among the populations. The Bayesian model-based Structure method and Principal coordinate analysis (PCoA) scatter plot clustered the accessions into three groups with germplasms collected from Kenya showing distribution among all the three groups. The wild accessions clustered mainly with those from Southern and Eastern Africa confirming earlier suggestions that lablab is of African origin. The results of this study are discussed in light of the crop improvement of this crop.
Benzetilmiş Tavlama Algoritması İle Fazör Ölçüm Birimlerinin Optimal Yerleşimi
Authors: ŞIK Emre , TOSUN Salih
Published: April 2021

Gelişen teknoloji ve artan nüfus ile birlikte elektrik enerjisine olan ihtiyaç ve talep her geçen gün artmaktadır. Enerji talebindeki artış güç sistemlerini kararlılık sınırlarına yakın bölgelerde çalışmaya zorlamaktadır. Bu durum güç sistemlerinde gerilim kararsızlığı ve gerilim çökmesi gibi sonuçlar doğurmaktadır. Güç sistemlerinin kararlılık durumunun gerçek zamanlı olarak takip edilmesi kritik önem taşımaktadır. Bu sebeple güç sistemlerinin izlenebilirliği ve kontrolünü sağlayan sistemlere duyulan ihtiyaç da artmıştır. Fazör Ölçüm Birimi (FÖB) bu sistemlerden birisidir. FÖB’ler Global Positioning System (GPS) yardımıyla gerilim, akım ve faz açısının anlık olarak takip edilmesine imkan sağlamaktadır. Ancak maliyet kısıtı nedeniyle FÖB’ler iletim hatlarında tüm baralara yerleştirilememektedirler. Bu yüzden FÖB’leri şebekeye maksimum gözlenebilirliği sağlayacak optimal bir şekilde yerleştirmek önem arz etmektedir. Optimal yerleşim için literatürde pek çok yöntem kullanılmaktadır. Bu çalışmada Benzetilmiş Tavlama Algoritması kullanılarak Enterkonnekte güç sisteminin bir kısmı olan Trakya Güç Sistemi’ne optimal FÖB yerleşimi yapılmıştır. Benzetilmiş Tavlama Algoritması ile elde edilen sonuçlar, Power System Analysis Toolbox (PSAT) programı ile FÖB yerleşim algoritmalarından çıkan sonuçlarla karşılaştırılmıştır. Bu çalışma ile sistemin tamamını anlık olarak takip edebilmek için kullanılan FÖB’lerinin, Trakya Güç Sistemi’nde hangi baralara yerleştirilmesi gerektiği tespit edilmiş ve optimal yerleşim gerçekleştirilmiştir.
Joint influence of measurement errors and randomized response technique on mean estimation under stratified double sampling
Authors:   Department of Applied Statistics, Financial Mathematics and Actuarial Science Jaramogi Oginga Odinga University of Science and Technology P.o Box 210, Bondo-Kenya, Onyango Ronald , Oduor Brian ,   Department of Applied Statistics, Financial Mathematics and Actuarial Science Jaramogi Oginga Odinga University of Science and Technology P.o Box 210, Bondo-Kenya, Odundo Francis ,   Department of Applied Statistics, Financial Mathematics and Actuarial Science Jaramogi Oginga Odinga University of Science and Technology P.o Box 210, Bondo-Kenya
Published: April 2021

The present study proposes a generalized mean estimator for a sensitive variable using a non-sensitive auxiliary variable in the presence of measurement errors based on the Randomized Response Technique (RRT). Expressions for the bias and mean squared error for the proposed estimator are correctly derived up to the first order of approximation. Furthermore, the optimum conditions and minimum mean squared error for the proposed estimator are determined. The efficiency of the proposed estimator is studied both theoretically and numerically using simulated and real data sets. The numerical study reveals that the use of the Randomized Response Technique (RRT) in a survey contaminated with measurement errors increases the variances and mean squared errors of estimators of the finite population mean.
Occurrence of Anguilla luzonensis in the tributaries along the Lagonoy Gulf, Philippines
Authors: Canon Katrina L. , Nieves Plutomeo M. , Mendoza Jr. Antonino B. , C. Nolial John Christopher , Celestial Niño C. , Mediario Ronnie O. , Bradecina Raul G. , Avila Teresa N. , Kubota Satoshi
Published: April 2021

Anguillids are а valuable fish commodity worldwide. Although Anguilla luzonensis have been abundantly found in the northern Philippines and collected for trade, no available records show that it recruited in the mid-part where Lagonoy Gulf, Bicol is situated. In this study, we investigated the occurrence of A. luzonensis in the tributaries along the Lagonoy Gulf, Philippines using molecular tools. Glass eel specimens were collected in 2018–2019 from the Comun river, Albay; the Lagonoy river, Camarines Sur; and the Bato river, Catanduanes. For the first time, A. luzonensis was identified by molecular analysis in the Lagonoy Gulf. A. luzonensis was the second most abundant species in the Comun and Lagonoy rivers (9.5 and 22.4 %, respectively). Anguilla luzonensis collected from the Comun and Lagonoy rivers did not show a significant difference (FST= 0.00825, p>0.05). Anguilla marmorata was the most dominant species in all tributaries (71.1–98.0 %). In the Comun and Lagonoy rivers, A. bicolor pacifica was the third most abundant species (7.7 and 6.5%, respectively). In addition, Anguilla celebesensis was only found rarely in the Comun river (0.9 %). This study provides important information for sustainable resource management and effective utilization of the eel species in these regions.
An Overview of Pain Management
Authors: Dahl June L.
Published: April 2021

In spite of major advances in pain management practices, the undertreatment of pain remains a major public health problem in the United States. A basic knowledge of pain assessment and management is critical to removing the barriers that are responsible for poor pain control. Pain assessment is the essential first step in the management of any type of pain as it guides the development of a rational approach to treatment. Pharmacologic therapies are often essential to successful pain management. Three major classes of pain medications are available: non-opioids, opioids, and adjuvant analgesics for special pain problems. This paper provides an overview of the various drugs in each of these classes as well as recommendations to guide their use. The goal of therapy is to reduce pain and improve function. A comprehensive approach to pain management should be based on the use of multimodal therapy, rational combinations of pharmacologic and non-pharmacologic treatments.
Professional Boundary Violations by Physicians
Authors: Gabbard Glen O. , Martinez Melissa
Published: April 2021

Boundary violations by non-psychiatric physicians have received relatively little attention in available literature. In this report, the authors reviewed 100 cases of professional boundary violations identified in physicians undergoing outpatient psychiatric evaluation. They included boundary violations with a patient, boundary violations with non-patients, such as family members, employees, and co-workers, and prescribing/treating irregularities. Fifty-three of the physicians had engaged in sexual boundary violations with patients. Twenty-two had engaged in sexual boundary violations with non-patients. Eighteen of the physicians had non-sexual violations involving financial matters, social relationships, confidentiality and other transgressions. Twenty-six of the 100 were involved in some type of prescribing/treating irregularity. Fifty-two percent of the physicians sampled met criteria for an Axis II personality disorder, 17 had a substance abuse diagnosis, and 13 had a paraphilia or sexual disorder. The implications of these findings are discussed in a context relevant to ethics and regulatory bodies.
Nursing Interns’ Perceptions of Telenursing: Implications for Nursing Education
Authors: Poreddi Vijayalakshmi , Bidadi Veerabhadraiah Kathyayani , Reddy SaiNikhil , Narayana Manjunatha , Channaveerachari NaveenKumar , BadaMath Suresh
Published: April 2021

Background: Telemedicine is a fast-emerging health sector in India. While nurses play an important role in delivering healthcare services through telemedicine, little is known about whether nursing interns are prepared adequately.
Aim: To evaluate nursing interns’ perceptions of telenursing and to find out their opinion on whether telenursing should be added to the curriculum.
Methods: This was a cross-sectional descriptive survey carried out among conveniently selected nursing interns (N = 183) from renowned colleges in Bangalore, South India. The data were collected using a self-reported questionnaire.
Results: In this study, a majority of the participants had smartphones (74.8%), were accessible to the internet (96.7%), and were using the internet for more than 3 h/day (73.3%). While a majority (65.6%) of the participants were able to correctly identify the definition of telenursing, only 33.9% of them rightly answered the definition of telemedicine. Most of the participants indicated that the inclusion of telenursing in undergraduate studies would be useful for future healthcare workers (92.4%), and telenursing can be practiced in all the medical specialties.
Conclusion: The majority of the nursing interns hold positive perceptions of telenursing and acknowledge its usefulness in nursing practice. However, their knowledge of telenursing is limited. Hence, the findings strongly suggest the need to introduce concepts of telenursing in curricula to prepare future healthcare providers to be able to provide safe and competent care in a highly technical and digital environment.
Tele-Mentoring and Monitoring of the National Mental Health Program: A Bird’s-Eye View of Initiatives from India
Authors: Gajera Gopi , Malathesh Barikar C. , Nirisha P. Lakshmi , Kumar Channaveerachari Naveen , Manjunatha Narayana , H.H. Suchandra , Ramachandraiah Sujai , Basavarajappa Chethan , Gowda K.M. Rajendra , Bada Math Suresh
Published: April 2021

Objective: To provide a glimpse of various digital programs and modules that are being implemented across the country by the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India (an institution of national importance under the Ministry of Health and Family Welfare, Government of India; one of its mandates is to develop innovative strategies to improve mental health capacity building as part of the National Mental Health Program, a publicly funded health program to cater to the public health need posed by psychiatric disorders).
Design: The information is presented in a narrative fashion by organizing the activities into three categories of digital training methods: webinar mode, blended mode and hybrid mode.
Results: Cadres ranging from lay-counsellors (volunteers in the community), non-specialist health workers to professionals including medical officers are covered with these initiatives. During the period from August 2016 till December 2020, more than 16 million man hours of training is delivered for more than 35,000 participants from across the country.
Conclusions: These have a tremendous potential to exponentially increase skilled human resources capable of providing quality care to hitherto unserved remote areas of the rural hinterland and ultimately reduce the burgeoning treatment gap. In-depth outcome assessments are the need of the hour.
Design of a Production Process for Poly(oxymethylene) Dimethyl Ethers from Dimethyl Ether and Trioxane
Authors: Breitkreuz Christian Frederik , Schmitz Niklas , Stöfer Eckhard , Burger Jakob , Hasse Hans
Published: April 2021

Abstract Poly(oxymethylene) dimethyl ethers (OME) are promising synthetic fuels. When compared to fossil diesel fuel, OME reduce the soot formation in diesel engines. OME can be produced from the C1 platform syngas via different routes. This work investigates an OME production process via dimethyl ether and trioxane. The process is simulated and optimized using process simulation with varying model depth. As no experimental data are available on the chemical equilibrium of the reaction of dimethyl ether and trioxane, chemical equilibrium constants are partly estimated from formation data of the reactants.
BIOGRAFI PANGERAN ANTASARI
Authors: Nursahid
Published: April 2021

Pangeran Antasari merupakan Raja Banjar yang lahirnya di perkirakan sekitar tahun 1790 di kampung yang dikenal Sungai Batang, Martapura. Beliau merupakan anak dari keturunan bangsawan Banjarmasin yaitu Pangeran Mas’ud(Masohot) merupakan Ayahnya dan Mas Teroda merupakan Ibunya. Walau ia adalah keturunan bangsawan ia memiliki sifat sopan santun dalam pergaulan dan watak yang rendah hati. Tujuan penulisan artikel ini adalah membahas biografi dari salah satu raja pada masa kesultanan yaitu Pangeran Antasari. Guna membahas sejarah di Indonesia yang lebih mengarah tentang Pahlawan Nasional. Dengan menggunakan metode membaca beberapa referensi.
Assessment of the efficacy of SARS-CoV-2 vaccines in non-human primate studies - a systematic review
Authors: Counotte Michel Jacques , de Souza Santos Mariana Avelino , Stittelaar Koert L , van der Poel Wim HM , Gonzales Jose L
Published: April 2021

The outbreak of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) triggered the rapid and successful development of vaccines to help mitigate the effect of the coronavirus disease 2019 (COVID-19) and circulation of the virus. Preclinical vaccine trials provide a wealth of information about the presence and persistence of virus in different anatomical sites. We systematically reviewed all available preclinical SARS-CoV-2 candidate vaccine studies where non-human primates were challenged after vaccination. We found marked heterogeneity in experimental design between the studies. Most of the tested vaccines, only triggered a low or moderate reduction of viral RNA in the upper respiratory tract; We need to consider that most SARS-CoV-2 vaccines that protect against disease might not fully protect against infectiousness and vaccinated individuals might still contribute to SARS-CoV-2 transmission. Careful assessment of secondary attack rates from vaccinated individuals is warranted. Standardization in design and reporting of preclinical trials is necessary.
Neural evidence for age-related deficits in the representation of state spaces
Authors: Ruel Alexa , Bolenz Florian , Li Shu-Chen , Fischer Adrian Georg , Eppinger Ben
Published: April 2021

When under high cognitive demand older adults tend to resort to simpler, model-free decision strategies. This age-related shift in decision behaviour has been attributed to deficits in the representation of the cognitive maps, or state spaces, necessary for more complex model-based decision-making. Yet, the neural mechanism behind this shift remains unclear. We analysed performance on a modified two-stage Markov task using a novel neurocomputational approach including computational modeling and single-trial EEG analyses to establish neural markers of age-related changes in goal-directed decision-making under different representational demands. Our results reveal that the shift to simpler decision strategies in older adults is due a) impairments in the representation of the transition structure of the task and b) a diminished signaling of the reward value associated with decision options. Consistent with the diminished state space hypothesis of human aging, our findings reveal that deficits in goal-directed, model-based behavior in older adults results from impairments in the representation of state spaces of cognitive tasks.
No specific relationship between hypnotic suggestibility and the rubber hand illusion: a commentary with new and verification analyses
Authors: Ehrsson H. Henrik , Fotopoulou Aikaterini , Radziun Dominika , Longo Matthew , Tsakiris Manos
Published: April 2021

In a recent study, Lush et al. (Nat Commun 11, 4853, 2020) claimed that they found “substantial relationships” between hypnotizability and experimental measures of the rubber hand illusion. The authors proposed that hypnotizable participants control their phenomenology to meet task expectations arising from the experimental paradigm. They further suggest that the rubber hand illusion “may or may not” be entirely explained by hypnotic suggestions driven by task expectancies and therefore could reflect top-down control of perception, instead of multisensory mechanisms. However, in reanalyzing their data, we observe no significant relationships between hypnotic suggestibility and the rubber hand illusion when quantified using a control condition in line with the authors’ preregistered hypothesis. Furthermore, we note that the relationships that the authors describe are weak and observed for a visual “hallucination” control experience and in the control condition, indicating a general influence of hypnotizability on cognition, rather than sensations that specifically relate to the rubber hand illusion. Overall, the results fit well with the view that the rubber hand illusion is a perceptual illusion driven primarily by multisensory mechanisms.
Weighting Schemes and Incomplete Data: A Generalized Bayesian Framework for Chance-Corrected Interrater Agreement
Authors: Van Oest Rutger , Girard Jeffrey M.
Published: April 2021

Van Oest (2019) developed a framework to assess interrater agreement for nominal categories and complete data. We generalize this framework to all four situations of nominal or ordinal categories and complete or incomplete data. The mathematical solution yields a chance-corrected agreement coefficient that accommodates any weighting scheme for penalizing rater disagreements and any number of raters and categories. By incorporating Bayesian estimates of the category proportions, the generalized coefficient also captures situations in which raters classify only subsets of items; that is, incomplete data. Furthermore, this coefficient encompasses existing chance-corrected agreement coefficients: the S-coefficient, Scott’s pi, Fleiss’ kappa, and Van Oest’s uniform prior coefficient, all augmented with a weighting scheme and the option of incomplete data. We use simulation to compare these nested coefficients. The uniform prior coefficient tends to perform best, in particular, if one category has a much larger proportion than others. The gap with Scott’s pi and Fleiss’ kappa widens if the weighting scheme becomes more lenient to small disagreements and often if more item classifications are missing; missingness biases play a moderating role. The uniform prior coefficient usually performs much better than the S-coefficient, but the S-coefficient sometimes performs best for small samples, missing data, and lenient weighting schemes. The generalized framework implies a new interpretation of chance-corrected weighted agreement coefficients: These coefficients estimate the probability that both raters in a pair assign an item to its correct category without guessing. Whereas Van Oest showed this interpretation for unweighted agreement, we generalize to weighted agreement.
Síndrome de Marfan y embarazo gemelar, presentación de un caso
Authors: García Pumasunta Carolina , Mayorga Garcés Alejandro , Viteri Mejía Fausto
Published: April 2021

El síndrome de Marfan es un trastorno hereditario del tejido conectivo. Aquellas mujeres embarazadas que padecen este síndrome, tienen un riesgo incrementado de complicaciones cardiacas cuando el diámetro aórtico es mayor de 40 mm. Relatamos el caso de una mujer que presentó un embarazo gemelar y preeclampsia, en quien el diagnóstico de síndrome de Marfan se realizó de manera tardía. Se discute la necesidad de un diagnóstico precoz, consejería preconcepcional y un manejo multidisciplinario en este tipo de patología.
Cardiomiopatía por citomegalovirus en el feto. Reporte de un caso
Authors: Lacunza Paredes Rommel Omar , Zumalave Grados Isabel
Published: April 2021

La infección fetal por citomegalovirus puede ser detectado por signos ultrasonográficos en diversos órganos. El compromiso del corazón es informado con poca frecuencia, pero puede abarcar desde efusión pericárdica aislada hasta miocardiopatía con calcificaciones. Comunicamos un caso de citomegalovirus fetal con afectación cardiaca.
Cáncer de vagina: reporte de un caso
Authors: Gonzales-Montúfar Frida , Vera Vera Juana , Gamarra Paredes Mario , Fernández López Manuel , Céspedes Mendoza Elmer
Published: April 2021

El cáncer de vagina tiene una baja incidencia en la población femenina. Una mujer de 77 años acudió al hospital con antecedentes de sangrado vaginal posmenopáusico y diagnóstico inicial de cáncer de cérvix. Se le realizó biopsia vaginal por lesión ulcerada exofítica de 3 x 2 cm en el tercio superior de la pared vaginal posterior, cuyo resultado patológico fue cáncer escamoso pobremente diferenciado de la vagina. La patología de la pieza operatoria mostró carcinoma de células escamosas, infiltrante, no queratinizante, medianamente diferenciado de vagina. Presentamos el caso, en el que pudo haber confusión en el diagnóstico y/o manejo por la similitud de la sintomatología con el cáncer de cuello uterino, debido a la localización anatómica y la proximidad de ambos tejidos.
Tejido mamario ectópico activo en vulva en paciente posparto. Reporte de un caso
Authors: De La Vega Guillermo Antonio , Jean Qureshey Emma
Published: April 2021

El tejido mamario ectópico (TME) ocurre en 0,3 a 6% de las mujeres y generalmente se localiza en la axila, pero también puede ser encontrado en la vulva. El diagnóstico a menudo ocurre cuando hay cambios hormonales que influyen en el crecimiento y desarrollo del tejido mamario. Generalmente, se recomienda la escisión debido a la sintomatología y al potencial maligno de este tejido ectópico. Presentamos el caso de una mujer de 31 años de edad, grávida 1 para 1001 que fue evaluada por una masa vulvar indolora cuatro semanas después de un parto vaginal. Se realizó incisión, drenaje y biopsia de la masa, obteniendo 30 mL de líquido lechoso. El resultado de la biopsia reveló tejido mamario ectópico con cambios de lactancia. La paciente fue sometida a vulvectomía parcial simple que mostró cambios fibroquísticos y de lactancia en el tejido mamario de la vulva, sin atipia ni malignidad. Nuestro caso es un hallazgo raro de tejido mamario aberrante en una paciente posparto.
La pandemia por COVID-19 y cambios en el vivir sobre la tierra
Authors: Pacheco-Romero José
Published: April 2021

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Malformación arteriovenosa uterina gigante. Presentación de un caso
Authors: Lacunza Paredes Rommel Omar , Zumalave Grados Isabel
Published: April 2021

Se presenta el caso de una paciente que cursó con hemorragia uterina anormal debido a malformación arteriovenosa adquirida diagnosticada por ecografía Doppler y resonancia magnética. Dicha patología es hallada cada vez con mayor frecuencia y consecuencias graves, si no se realiza un manejo adecuado y oportuno.
La incógnita del coronavirus – Variantes y vacunas - La gestante y su niño
Authors: Pacheco-Romero José
Published: April 2021

A finales de 2020 se aprobaron las vacunas desarrolladas en el mundo occidental contra el virus SARS-CoV-2, que ya están siendo inoculadas, conjuntamente con vacunas chinas y rusas. Mientras tanto, estamos en una segunda oleada de la enfermedad y el nuevo coronavirus se ha ido transformando para permitirse una mejor propagación, alojamiento y replicación en el ser humano. La enfermedad se manifiesta ahora con nueva sintomatología, mayor contagio, inclemencia y variación en el número de fallecimientos. La infección de la gestante por coronavirus se está presentando con severidad y consecuencias materno perinatales. Ya se inició la vacunación en gestantes y madres lactantes, previa conversación con su ginecólogo sobre los riesgos y beneficios. Este artículo ofrece un breve relato de los acontecimientos que tuvieron lugar durante la transición de 2020 a 2021.
Inversión uterina no puerperal: primer caso reportado en el Perú
Authors: Aguilar-Cieza Aldo , Castro-Reyna Américo
Published: April 2021

La inversión uterina no puerperal es muy rara. Se comunica un caso asociado con leiomiomatosis. Se trató de una multípara de 45 años que manifestó sangrado vaginal grave, dolor pélvico y sensación de cuerpo extraño vaginal. Se diagnosticó mioma uterino en fase abortiva. Se programó para miomectomía con probable histerectomía abdominal y se encontró inversión uterina completa. Este reporte constituye un caso anecdótico de inversión uterina no puerperal, cuyo tratamiento quirúrgico fue exitoso.
Colloid cysts of the third ventricle in children
Authors: McCrea Heather J , Lara-Reyna Jacques , Perera Imali , Uribe Rafael , Chotai Silky , Savage Nicole , Hersh Eliza H , Haussner Therese , Souweidane Mark M
Published: April 2021

OBJECTIVE

The rarity of colloid cysts in children makes it difficult to characterize this entity and offer meaningful advice on treatment. Infrequent case reports exist, but to date there has been no age-specific assessment. The purpose of this study was to define any differences between children and adults who are evaluated and treated for colloid cysts of the third ventricle.

METHODS

Patients with colloid cysts were reviewed and stratified by age. Individuals ≤ 18 years of age were defined as pediatric patients and those > 18 years of age as adults. Clinical and radiographic data, treatment, and postoperative outcomes were compared between both groups. Bivariate analysis was conducted using the Fisher exact test for categorical variables and Mann-Whitney U-test for continuous variables.

RESULTS

Of 132 endoscopic resections (121 primary, 10 secondary, and 1 tertiary) of a colloid cyst, 9 (6.8%) were performed in pediatric patients (mean age 14.1 years, range 9–18 years) and 123 (93.2%) were performed in adult patients (mean age 43.8 years, range 19–73 years). Cases were found incidentally more commonly in pediatric than adult patients (66.7% vs 37.4%, p > 0.05), and pediatric patients had lower rates of hydrocephalus than adult patients (11.1% vs 63.4%, p < 0.05). Acute decompensation at presentation was found in 8 adults (6.5%) but no children. Complete cyst removal (88.9% vs 90.2%, p > 0.05) and length of stay (1.6 days vs 2.9 days, p > 0.05) were not significantly different between the groups. Postoperative complications (6.5% in adults, 0% in children) and recurrence (2.4% in adults, 0% in children) were rare in both groups, and there were no treatment-related deaths. The mean postoperative radiological follow-up was longer in pediatric patients (45 months, range 4–89 months) than adults (44.1 months, range 1–171 months).

CONCLUSIONS

While differences exist between children and adults regarding colloid cyst presentation, these are in keeping with the predicted evolution of a slow-growing lesion. Consistent with this observation, children had lower rates of hydrocephalus and a smaller mean maximal cyst diameter. Contrary to the published literature, however, sudden deterioration was not observed in pediatric patients but occurred in adult patients. In this limited pediatric sample size, the authors have not recorded any postoperative complications or recurrences to date. These encouraging results with endoscopic removal may positively impact future decisions related to children given their protracted life expectancy and projected rates of progression.
Pipeline embolization of cerebral aneurysms in pediatric patients: combined systematic review of patient-level data and multicenter retrospective review
Authors: Shlobin Nathan A , Raz Eytan , Shapiro Maksim , Moretti Luke , Cantrell Donald R , Lam Sandi K , Hurley Michael C , Ansari Sameer A , Nossek Erez , Riina Howard A , Nelson Peter K , Jahromi Babak S , Shaibani Ali , Potts Matthew B
Published: April 2021

OBJECTIVE

Cerebral aneurysms in the pediatric population are rare and optimal treatment strategies are not as well characterized as in adults. The Pipeline embolization device (PED) is an endoluminal flow diverter that is commonly used to treat aneurysms in adults, but experience with this device in children is limited. The authors sought to further characterize PED use and outcomes in this specific population by performing both a systematic review of patient-level data from studies reporting the use of the PED to treat pediatric aneurysms and a retrospective review of their experience.

METHODS

A systematic review of the PubMed, Embase, and Scopus databases was performed to identify studies reporting the use of the PED in pediatric patients (age ≤ 18 years). Disaggregated data regarding demographics, aneurysm characteristics, treatment, and outcomes were collected. Retrospective data from the authors’ two institutions were also included.

RESULTS

Thirty studies comprising patient-level data on 43 pediatric patients with 47 aneurysms were identified. An additional 9 patients with 9 aneurysms were included from the authors' institutions for a total of 52 patients with 56 aneurysms. The mean patient age was 11.1 years. Presentations included aneurysm rupture (17.3%) and symptomatic mass effect (23.1%). Aneurysms were located in the anterior circulation in 55.4% of cases, and 73.2% were described as nonsaccular. Imaging follow-up was available for 89.3% with a mean follow-up of 13.3 months. Aneurysm occlusion was reported in 75%, with 1 case each (1.8%) demonstrating significant in-stent stenosis and parent vessel occlusion. Clinical follow-up was reported in 90.4% with a mean follow-up of 14.7 months. Good functional outcomes (modified Rankin Scale score of 0–1 or Glasgow Outcome Scale score of 5) were reported in 65.4% of the total population. Two major complications were reported, including 1 death.

CONCLUSIONS

Despite substantial differences in aneurysm location and type between published pediatric and adult patient populations treated with the PED, the use of the PED in the pediatric population appears to be safe. While the short-term effectiveness is also similar to that of adults, additional studies are needed to further characterize the long-term outcomes and better define the use of this device in pediatric patients.
What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?
Authors: Iqbal M. Omar , Samdani Amer F. , Pahys Joshua M. , Newton Peter O. , Shah Suken A. , Bastrom Tracey P. , Sponseller Paul D. , Miyanji Firoz , Hwang Steven W.
Published: April 2021

OBJECTIVE

Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS.

METHODS

The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1–4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)–22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model.

RESULTS

The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement.

CONCLUSIONS

Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1–4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.
The efficacy of neurosurgical intervention on sleep-disordered breathing in pediatric patients with Chiari malformation type I
Authors: Voutsas Giorge , St-Laurent Aaron , Hutchinson Crystal , Amin Reshma , Drake James , Narang Indra
Published: April 2021

OBJECTIVE

Chiari malformation type I (CM-I) involves the herniation of the cerebellar tonsils through the foramen magnum. CM-I is associated with both obstructive sleep apnea (OSA) and central sleep apnea (CSA) in children. The primary management of symptomatic CM-I remains surgical decompression. There is, however, a paucity of data evaluating the efficacy of decompression surgery on outcomes related to sleep-disordered breathing (SDB). The objective of this study was to evaluate SDB outcomes, specifically the need for respiratory support following decompression in pediatric patients with CM-I.

METHODS

This was a retrospective chart review of all children diagnosed with CM-I when younger than 18 years of age who had polysomnography (PSG) studies pre- and postsurgery, between January 2008 and October 2018 at the Hospital for Sick Children in Toronto. Patient demographics, symptoms, PSG data, ongoing respiratory support, and surgical notes were recorded. Differences in PSG studies obtained pre- and postsurgery were compared using the Wilcoxon test for paired samples.

RESULTS

A total of 15 children with 15 interventions met inclusion criteria with pre- and postsurgery PSG studies and were considered for statistical analysis. Of the 15 subjects included for analysis, preoperative OSA was present in 2 (13.3%), CSA in 5 (33.3%), mixed SDB (both OSA and CSA) in 4 (26.7%), and no significant SDB in 4 (26.7%). Postoperatively, OSA was present in 3 (20.0%), CSA in 4 (26.7%), mixed SDB in 0 (0%), and no significant SDB in 8 (53.3%). The presence of severe OSA decreased from 4/15 (26.7%) to 2/15 (13.3%) postoperatively, and severe CSA decreased from 5/15 (33.3%) to 2/15 (13.3%) postoperatively. Following decompression surgery, 7/15 subjects (46.7%) required positive airway pressure for management of their SDB. Overall, significant improvements were observed in a number of respiratory parameters following decompression including the following: the total apnea-hypopnea index (AHI) (17.5 ± 48.2 vs 6.1 ± 32.7 events/hour; p = 0.001), obstructive AHI (2.1 ± 16.1 vs 1.0 ± 6.6 events/hour; p = 0.005), central AHI (6.3 ± 48.9 vs 2.7 ± 33.0 events/hour; p = 0.005), and the desaturation index (16.7 ± 49.6 vs 3.8 ± 25.3; p = 0.001).

CONCLUSIONS

Although decompression surgery led to a significant reduction in obstructive and central events, many children continued to have persistent SDB and required additional positive airway pressure therapy. This information is important and relevant for anticipatory guidance around decompression surgery and the necessity for respiratory support for the management of SDB in pediatric patients with CM-I.
Imaging characteristics associated with surgery in Chiari malformation type I
Authors: Alford Elizabeth N , Atchley Travis J , Leon Tofey J , Laskay Nicholas M. B , Arynchyna Anastasia A , Smith Burkely P , Aban Inmaculada , Johnston James M , Blount Jeffrey P , Rozzelle Curtis J , Oakes W. Jerry , Rocque Brandon G
Published: April 2021

OBJECTIVE

In Chiari malformation type I (CM-I), a variety of imaging findings have been purported to be important; however, results have been inconclusive, inconsistent, or not replicated in independent studies. The purpose of this study was to report imaging characteristics for a large cohort of patients with CM-I and identify the imaging findings associated with surgical decompression.

METHODS

Patients were identified using ICD-9 codes for CM-I for the period from 1996 to 2017. After review of the medical records, patients were excluded if they 1) did not have a diagnosis of CM-I, 2) were not evaluated by a neurosurgeon, or 3) did not have available preoperative MRI. Retrospective chart review was performed to collect demographic and clinical data. Imaging parameters were measured according to the Chiari I Malformation Common Data Elements.

RESULTS

A total of 731 patients were included for analysis, having a mean follow-up duration of 25.5 months. The mean age at presentation was 8.5 years. The mean tonsil position was 11.4 mm below the foramen magnum, and 62.8% of patients had a pegged tonsil shape. Two hundred patients (27.4%) underwent surgery for life-dominating tussive headache, lower cranial nerve dysfunction, syrinx, and/or brainstem dysfunction. Surgical treatment was associated with a syrinx (OR 20.4, 95% CI 12.3–33.3, p < 0.0001), CM-1.5 (OR 1.797, 95% CI 1.08–2.98, p = 0.023), lower tonsil position (OR 1.130, 95% CI 1.08–1.18, p < 0.0001), and congenital fusion of cervical vertebrae (OR 5.473, 95% CI 1.08–27.8, p = 0.040). Among patients with benign CM-I, tonsil position was statistically significantly associated with future surgery.

CONCLUSIONS

Comprehensive imaging characteristics for a large cohort of patients with CM-I are reported. Analysis showed that a lower tonsillar position, a syrinx, and CM-1.5 were associated with undergoing posterior fossa decompression. This study demonstrates the importance of considering imaging findings in the context of patient symptomatology.
دليل القاضي العدلي في تطبيق الفصل 49 من الدستور
Authors: Al-Ghazwani Malik
Published: April 2021

أحدث الفصل ٤٩ من الدستور تغييراَ جذرياً في منظومة حماية حقوق الإنسان في تونس، إذ يكاد يكون المادة الجامعة الوحيدة في الدساتير العربية التي تضع الشروط والمعايير المتعلقة بتنظيم الحقوق والحريات وضبط إطار لتدخّل المشرع ومختلف السلط العمومية بالاستناد إلى مبدأ التناسب بين ضوابط تقييد الحقوق وموجباتها. فقد تم بمقتضى الفصل ٤٩ دسترة مبدأ قانوني هام وهو مبدأ التناسب باعتباره منهجاً واختباراً من الضروري إعماله من قبل كافة المتدخلين في هذا المجال حتى تتم عقلنة هذا التدخل وضمان حماية أنجع وأدق للحقوق والحريات. ولئن كان المشرع والقاضي الدستوري المخاطبان الأساسيان بالفصل ٤٩، فإن ضمان احترام الحقوق والحريات يستوجب استبطان جميع المتدخلين لهذا المنهج ولمختلف ضوابط الفصل ٤٩، ومن بينهم القاضي العدلي. وفي هذا الإطار، تقدم المؤسسة الدولية للديمقراطية والانتخابات هذا الدليل للقاضي العدلي باعتباره معنياً بتطبيق أحكام الفصل ٤٩ الذي كلف جميع ’الهيئات القضائية‘ بحماية الحقوق والحريات من أي انتهاك. وتختلف الزاوية التي يتولى من خلالها القاضي العدلي تطبيق مقتضيات الفصل ٤٩ وخاصة مبدأ التناسب عن رقابة الدستورية التي يعملها القاضي الدستوري. ويبرز الدليل تجذر مبدأ التناسب في مختلف فروع القانون الخاص وأوجه إعماله من قبل القاضي العدلي واختلاف النظام الإجرائي لرقابة التناسب حسب درجات التقاضي. كما يقوم الدليل بجرد وتقييم لإعمال رقابة التناسب من قبل القاضي العدلي مبرزاً أهمية هذه الرقابة في جعل الأحكام القضائية الصادرة في مجال الحقوق والحريات متوافقة مع مقتضيات الفصل ٤٩ من الدستور.
Higher Depression of Patients with Alzheimer’s Disease During than Before the Lockdown
Authors: El Haj Mohamad , Moustafa Ahmed A. , Gallouj Karim
Published: April 2021

We assessed depression in 72 patients with Alzheimer’s disease (AD) who live in retirement homes during the COVID-19-related lockdown. We invited caregivers of 72 patients with AD who live in retirement homes to rate depression in the patients both before and during the lockdown. Analysis demonstrated increased depression in the patients during the lockdown. We attribute this increased depression to the restrictive measures on activities, visits, and physical contact between patients with AD and family members during the lockdown.
Launching a statewide Employment First initiative: Indiana’s work to include coalition
Authors: Rogan Patricia , Rinne Susan
Published: April 2021

BACKGROUND: After decades of local, state and national efforts to increase employment outcomes for individuals with disabilities, progress has been slow, with a mere 17.9% of persons with a disability employed in 2020 compared to 61.8% for persons without a disability (U.S. Bureau of Labor Statistics, February 2021). Individuals with disabilities have demonstrated their abilities and desire to work, including those with significant disabilities, yet our country remains entrenched in outdated and ineffective models of day services (i.e., sheltered workshops, non-work programs) and precious public dollars continue to be used for these services that congregate and segregate individuals, pay subminimum wages, and deny individuals their human and civil rights. OBJECTIVE: The purpose of this article is to describe one state’s efforts to advance employment for working age individuals with disabilities through a statewide Employment First initiative called Work to Include. Indiana is now in its third year of this grassroots initiative driven by a coalition of self-advocates. Major activities of the initiative are discussed, including passing Indiana’s Employment First law, holding statewide Town Hall meetings, establishing 11 local Work to Include teams, developing and implementing a state Employment First plan, launching local and statewide Disability Employment Awareness month campaigns, using social media and webinars to disseminate information, hosting Employment First Summits, and collaborating with employers and state agencies to promote employment outcomes. CONCLUSION: Next steps toward systems change are discussed, including the establishment of an Employment First office at the state and securing an Executive Order from the governor to make the state a model employer.
Tracking metrics that matter for scaling up employment outcomes
Authors: Migliore Alberto , Butterworth John , Pavlak Jeannine , Petrick Michael , Aalto Stephen
Published: April 2021

BACKGROUND: Supporting employment consultants in their work with job seekers is critical for increasing the employment outcomes of people with disabilities. OBJECTIVE: To better understand how to leverage data for supporting employment consultants, including what metrics to track, what to do with the data, and what can be improved. METHODS: A panel of three directors of employment programs addressed these questions as part of the Association of People Supporting Employment First (APSE) 2020 conference. RESULTS: Most employment service providers collect data for billing and compliance reporting. Innovative providers leverage data for quality improvement. CONCLUSIONS: Tracking metrics designed specifically for monitoring the implementation of effective employment supports is key for leveraging data for continuous quality improvement and thus improving job seekers’ employment outcomes.