bluuebunny/crossref_metadata_2025 huggingface dataset:
Studies on the Biology of the Upper Illinois River
Authors: Forbes Stephen , Richardson R. E.
Published: May 2020

The paper here presented is intended as a preliminary summary only of the principal conclusions, scientific and economic, to be drawn from our studies of the last few years, and it is to be followed presently by a series of special papers on the various divisions of the investigation.
Vegetation of Skokie Marsh
Authors: Sherff Earl
Published: May 2020

With the rapid encroachment of city and town upon the outlying districts about Chicago, and the consequent despoilation of the native flora, it has seemed to the writer advisable to undertake a careful study of a certain restricted area, while there is yet an opportunity, and to place these results on record.
The Challenges of COVID-19 for People Living With Diabetes: Considerations for Digital Health
Authors: Gamble Anissa , Pham Quynh , Goyal Shivani , Cafazzo Joseph A
Published: May 2020

The coronavirus disease (COVID-19) is a global pandemic that significantly impacts people living with diabetes. Diabetes-related factors of glycemic control, medication pharmacodynamics, and insulin access can impact the severity of a COVID-19 infection. In this commentary, we explore how digital health can support the diabetes community through the pandemic. For those living with diabetes, digital health presents the opportunity to access care with greater convenience while not having to expose themselves to infection in an in-person clinic. Digital diabetes apps can increase agency in self-care and produce clinically significant improvement in glycemic control through facilitating the capture of diabetes device data. However, the ability to share these data back to the clinic to inform virtual care and enhance diabetes coaching and guidance remains a challenge. In the end, it requires an unnecessarily high level of technical sophistication on the clinic’s part and on those living with diabetes to routinely use their diabetes device data in clinic visits, virtual or otherwise. As the world comes together to fight the COVID-19 pandemic, close collaboration among the global diabetes community is critical to understand and manage the sustained impact of the pandemic on people living with diabetes.
Associations between Leadership Style and Employee Resistance in a Healthcare Setting
Authors: Garcia Tanisha D.
Published: May 2020

Purpose: Health reform is forcing healthcare administrators to make rapid changes. A tendency to resist change can present problems for the leaders of health care organizations, including the large, not-for profit Catholic healthcare systems. The transformational leadership style has been shown to be positively correlated with change however, the relationship among leadership styles, employees’ behaviors, and motivation to change are still not well understood and require further study. Further, although Oreg’s Resistance to Change (RTC) approach has been researched in direct patient care areas, RTC research in non-patient settings is lacking. Methods: This study focused on the relationship of transformational leadership to RTC and if the relationships leaders’ have with subordinates’ influence change. A customized survey that included the Multifactor Leadership Questionnaire, RTC, and Leader Member Exchange (LMX 7) was emailed to 500 random individuals of various ages and races from three non-patient areas. Thirty leaders (included directors and managers) and 133 raters (those under the direction of a director or manager) responded. Results: The regression analysis showed a strong correlation between transformational leadership and RTC. Additionally, each of the variables from the LMX 7 section of the survey showed associations indicating the relationship leaders develop with their subordinates and leader transformational scores were positive. Conclusion: This study may contribute to the awareness of RTC and utilizing transformational leadership style to move change in a positive direction for a healthcare setting.
Apoyo social y percepción de los padres en adolescentes fumadores y no fumadores
Authors: Villar Aguirre Everardo , Tamayo Calderón Jehú Arturo , Tamayo Calderón Jehú Arturo
Published: May 2020

Objetivo: evaluar la asociación entre el apoyo social funcional y la percepción de la relación con sus padres en adolescentes fumadores y no fumadores. Métodos: estudio transversal analítico realizado en la Unidad de Medicina Familiar (umf) no. 64 del Instituto Mexicano del Seguro Social (imss) de marzo a mayo de 2018; participaron 250 adolescentes de trece a diecisiete años de edad, contestaron la escala argentina de percepción de la relación con los padres y el cuestionario de apoyo social funcional Duke-unc. Se realizó estadística descriptiva, cálculo de frecuencias y relación de variables mediante χ2. Resultados: la relación entre apoyo social funcional y ser o no fumador reportó una χ2de 0.733 con una p=0.392; la asociación percepción de la relación con el padre o la madre con ser o no fumador registró una χ2 de 2.147 y 3.129 respectivamente, con un valor de p>0.05 para ambos casos. Conclusiones: no existe una relación estadísticamente significativa entre el apoyo social funcional y la percepción de la relación con sus padres con el tabaquismo en los adolescentes evaluados.
El águila, el jaguar y la serpiente: Miguel Covarrubias y el debate del difusionismo
Authors: Eder Rita
Published: May 2020

Este trabajo analiza la adhesión de Covarrubias a las hipótesis de con-tactos culturales y raciales entre el Pacífico, las Américas y el Viejo Mundo (China e India). Las investigaciones sobre el tema que más le llamaron la atención provenían de especialistas europeos y estadounidenses como Robert Heine-Geldern, Gordon Eckholm y Carl Schuster, las cuales influyeron en la redacción del primer tomo de su obra: El águila, el jaguar y la serpiente: arte indígena en las Américas (1954). En las primeras páginas de este libro, el autor se declara culpable de “desviaciones difusionistas subversivas” y menciona con entusiasmo el XXIX Congreso de Americanistas, celebrado en el American Museum of Natural History de Nueva York en septiembre de 1949, foro donde se debatieron ampliamente diversos temas y problemas relativos al difusionismo. Al mismo tiempo se montó la exposición “Across the Pacific” (A lo largo del Pacífico), cuyo objetivo era mostrar —por medio de objetos artísticos, rituales y cotidianos—, paralelismos en caminados a comprobar hipótesis de contacto. La muestra sugirió una forma de organizar la cultura material dentro de la diversidad y enfatizó la importancia de los estudios comparativos por medio de la forma. Para Covarrubias, estas ideas ya habían sido desarrolladas par-cialmente en los mapas del Pacífico (1939) y en su libro Mexico South (1946). Sin embargo, el énfasis sobre lo visual/estructural que ocurrió en el XXIX Congreso de Americanistas dejó una huella mayor con relación al contacto entre culturas que Covarrubias pudo desarrollar más ampliamente en Arte indígena de las Américas.
RECOUNTING AS REALIZATION OF BROWN AND LEVINSON’S POSITIVE POLITENESS STRATEGIES IN INSTRUCTIONAL INTERACTIONS
Authors: Pramujiono Agung , Suhari Suhari , Indrayanti Tri , Rochmawati Dyah
Published: May 2020

Dalam interaksi instruksional, seorang dosen dituntut mampu membangun harmoni di kelas sehingga terbangun suasana kelas yang kondusif sehingga tujuan pembelajaran dapat tercapai. Penelitian ini bertujuan mendeskripsikan bercerita sebagai realisasi strategi kesantunan positif Brown dan Levinson dalam interaksi instruksional di kelas. Subjek penelitian ini adalah enam orang dosen Universitas Kristen Satya Wacana Salatiga. Data penelitian berupa ujaran dosen dalam perkuliahan.  Data dikumpulkan dengan menggunakan metode simak dengan teknik rekam dan wawancara mendalam. Analisis data dilakukan dengan menggunakan teknik deskriptif mengikuti model alir Miles dan Huberman. Berdasarkan hasil analisis data ditemukan cerita yang digunakan meliputi cerita tentang diri dosen, cerita tentang mahasiswa, cerita tentang pengalaman dosen, dan cerita tentang tokoh/sikap tokoh. Selain berfungsi membangun kedekatan hubungan dengan interaktan, strategi bercerita juga berfungsi untuk menanamkan nilai karakter dan untuk memotivasi mahasiswa.
ANALISIS STRUKTUR NARATIF A.J. GREIMAS DALAM NOVEL LELAKI HARIMAU KARYA EKA KURNIAWAN
Authors: Yuniasti Herlinda
Published: May 2020

Penelitian ini membahas novel Lelaki Harimau karya Eka Kurniawan untuk membantu pembaca dalam memahami runtutan alur novel serta wacana yang terdapat dalam novel. Teori yang dimanfaatkan dalam penelitian ini adalah naratologi A.J. Greimas. Metode yang digunakan dalam penelitian ini adalah metode deskriptif kualitatif. Sumber data penelitian berasal dari novel Lelaku Harimau karya Eka Kurniawan. Penelitian diawali dengan mengidentifikasi struktur aktan, dilanjutkan dengan menyusun model fungsional. Analisis terhadap novel ini menunjukkan bahwa alur cerita novel Lelaki Harimau secara berurutan adalah Bab III – Bab II – Bab IV – Bab V – Bab I. Selain itu, hasil analisis juga menggambarkan fenomena kekerasan dalam rumah tangga (KDRT) yang dilakukan oleh Komar terhadap Nuraeni. Dengan demikian, dalam bentuk struktur maupun isi, Lelaki Harimau merupakan salah satu novel yang menyuarakan KDRT terhadap perempuan.
Education Research - GIM
Authors: Cumyn Annabelle , Card Sharon E , Gibson Paul
Published: May 2020

Background

Obstetric Medicine is an area of expertise within General Internal Medicine (GIM) in Canada. Essential content for clinical rotations for GIM residents was identified by subject-matter experts (N=204 items). However, this work did not address the perspective of curriculum stakeholders.

Methods

Members of the Canadian GIM Specialty Committee (GIMSC) were surveyed to obtain their perspective on essential content that GIM residents should acquire in Obstetric Medicine.

Results

GIMSC members (N=14) selected “core content” which reduced the initial content blueprint by 72%. Some sections of the blueprint were left largely unchanged (e.g., hypertensive disorders of pregnancy), whereas others were removed entirely (e.g., transplant medicine).

Interpretation

GIMSC were more selective than Canadian Obstetric Internists in choosing the essential content for GIM residents, with a moderate overall agreement of 78% (kappa coefficient of 0.53). Comparison of perspectives and content mapping may provide useful validity evidence for further work.
Listening to Stories: Narrative Medicine in Internal Medicine Practice
Authors: Nowaczyk Małgorzata J.M. , Douketis (ED) James
Published: May 2020

Message from the Editor-in-Chief
Cramps and the Casual Consultation
Authors: Baillie Hector M
Published: May 2020

2 casual consultations, home visits really, that formed a learning experience for a young doctor.
A Case of Neurosarcoidosis Initially Diagnosed as Multiple Sclerosis
Authors: Kosalka Pauline , Hassan Ayman
Published: May 2020

AbstractNeurosarcoidosis is an inflammatory disorder characterized by noncaseating granulomas of the central nervous system. Due to its rarity and nonspecific presentation, the diagnosis may initially be confused with other neurologic disorders such as multiple sclerosis (MS). We present a case of a 44-year-old Caucasian woman in Thunder Bay initially diagnosed with MS who developed atypical imaging findings of expanding bilateral mesial temporal lesions on magnetic resonance imaging. Brain biopsy followed by axillary lymph node biopsy established a diagnosis of neurosarcoidosis.

ResumeLa neurosarcoïdose est un trouble inflammatoire caractérisé par des granulomes non caséinants du système nerveux central. En raison de sa rareté et de sa présentation non spécifique, le diagnostic peut être initialement confondu avec d’autres troubles neurologiques tels que la sclérose en plaques (SEP). Nous présentons le cas d’une femme caucasienne de 44 ans, à Thunder Bay, chez qui la sclérose en plaques a été diagnostiquée initialement et qui a développé des résultats d’imagerie atypiques de lésions temporelles mésiales bilatérales en expansion sur l’imagerie par résonance magnétique. Une biopsie du cerveau suivie d’une biopsie des ganglions lymphatiques axillaires a permis d’établir un diagnostic de neurosarcoïdose.
The Voice of Canadian General Internists
Authors: Douketis James
Published: May 2020

Message from the Editor in Chief.
Rocky Mountain ACP/AMA Internal Medicine Conference
Authors: Dougmar Publishing Group
Published: May 2020

Conference Abstracts
A Multifaceted Quality Improvement Initiative to Reduce Unnecessary Laboratory Testing on Internal Medicine Inpatient Wards
Authors: Toman Inka , Mathura Pamela , Kassam Narmin
Published: May 2020

BackgroundThe American and Canadian Choosing Wisely campaigns recommend against routine complete blood count (CBC) and chemistry testing in the face of clinical stability in the inpatient internal medicine setting.

ProblemPatients on internal medicine units commonly have daily lab tests ordered at admission and lab testing is often bundled. Four ‘core’ lab tests (CBC, electrolytes, creatinine, and urea) account for more than half of all lab tests performed.

MethodsThe Model for Improvement and the Donabedian framework was used to define the problem, evaluate the baseline state, and generate targeted improvements. A quality improvement (QI) initiative consisting of education and process change was implemented on one general internal medicine unit and multiple plan-do-study-act cycles were carried out. The outcome measure was the total number of core labs performed, and the process measure was the proportion of patients with tests ordered on a repeating daily basis.

ResultsThe initiative led to an 18.9% decrease in the total number of core labs ordered and an 18.2% absolute decrease in repeating daily lab orders.

ConclusionsA multifaceted QI initiative aimed at reducing unnecessary lab testing was successful at reducing the number of lab tests ordered and changing lab ordering process.

ResumeContexteLes campagnes américaine et canadienne “Choisir judicieusement” recommandent de ne pas effectuer de tests de routine de numération globulaire complète (CBC) et de chimie face à la stabilité clinique des patients hospitalisés en médecine interne.

ProblèmeLes patients des unités de médecine interne doivent généralement passer des examens de laboratoire quotidiens à l’admission et les analyses de laboratoire sont souvent regroupées. Quatre tests de laboratoire “de base” (NFS, électrolytes, créatinine et urée) représentent plus de la moitié de tous les tests de laboratoire effectués.

MéthodesLe modèle d’amélioration et le cadre donabédien ont été utilisés pour définir le problème, évaluer l’état de référence et générer des améliorations ciblées. Une initiative d’amélioration de la qualité (AQ) consistant en un changement d’éducation et de processus a été mise en œuvre dans une unité de médecine interne générale et plusieurs cycles “planifier-faire-étudier-agir” ont été réalisés. La mesure des résultats était le nombre total de laboratoires de base effectués, et la mesure des processus était la proportion de patients dont les tests commandés se répétaient quotidiennement.

RésultatsCette initiative a permis de réduire de 18,9 % le nombre total de laboratoires de base commandés et de 18,2 % en valeur absolue le nombre de commandes quotidiennes répétitives.

ConclusionsUne initiative d’AQ à multiples facettes visant à réduire les tests de laboratoire inutiles a permis de réduire le nombre de tests de laboratoire commandés et de modifier le processus de commande des laboratoires.
Primary Staphylococcus aureus Pericarditis
Authors: Aziz Haya , Bienz Marc , Esmaiel Abdullah , Thanassoulis George
Published: May 2020

Bacterial pericarditis is a rare but fulminant disease that requires prompt diagnosis and management.  It most commonly occurs from direct extension of an adjacent focus of infection or by hematogenous spread to the pericardium from more distant septic foci.  Predisposing risk factors include immunosuppression, uremia, collagen vascular disease and thoracic surgery. We present the case of a 77-year-old gentleman with no previous pericardial disease who was diagnosed with primary Staphylococcus aureus pericarditis. The patient was treated with percutaneous pericardial effusion drainage and appropriate antibiotics resulting in complete resolution of his symptoms. This unusual case emphasizes that although it is frequently associated with significant morbidity and mortality, purulent pericarditis can present in a more indolent manner and in the absence of typical predisposing risk factors.

ResumeLa péricardite bactérienne est une maladie rare mais fulgurante qui nécessite un diagnostic et une prise en charge rapides. Elle survient le plus souvent dans le prolongement direct d’un foyer infectieux adjacent ou par propagation hématogène au péricarde à partir de foyers septiques plus éloignés. Les facteurs de risque prédisposants sont l’immunosuppression, l’urémie, les maladies vasculaires du collagène et la chirurgie thoracique. Nous présentons le cas d’un homme de 77 ans, sans antécédents de maladie péricardique, chez qui on a diagnostiqué une péricardite primaire à Staphylococcus aureus. Le patient a été traité par un drainage percutané d’effusion péricardique et des antibiotiques appropriés, ce qui a permis de résoudre complètement ses symptômes. Ce cas inhabituel souligne que, bien qu’elle soit fréquemment associée à une morbidité et une mortalité importantes, la péricardite purulente peut se présenter de manière plus indolente et en l’absence de facteurs de risque prédisposants typiques.
Gas
Authors: Baillie Hector M
Published: May 2020

Internists have all sorts of background training.   Mine included a year of Anaesthesia, which gave me a skill-set that was invaluable for rural ICU care.  One winter's night in Winnipeg was filled with excitement, and for one lucky patient, a remarkable cure.
A Brief Overview Presented at Dry Eye University of Inflammation in Chronic Dry Eye Disease
Authors: Robben Jerry
Published: May 2020

Inflammation is a common enemy of any chronic inflammatory disease. Dry eye is no different. Once this diagnosis is made, then one of the first objectives is to address and control the chronic inflammation appropriately.
Efficacy of Self-Administration of a Personal Mechanical Eyelid Device for the Treatment of Dry Eye Disease, Blepharitis and Meibomian Gland Disease
Authors: Schanzlin David , Olkowski John , Coble John , Gross Wendy , Dash Michael
Published: May 2020

PurposeA prospective study to evaluate the safety and efficacy of a novel mechanical eyelid device (NuLidsTM by NuSight Medical, LLC, Rancho Santa Fe, CA) used at home for the treatment of dry eye disease (DED), blepharitis (anterior and posterior) and meibomian gland disease (MGD).

MethodsSeventy-four (74) eyes of thirty-seven (37) patients were self-treated with the NuLidsTM device at home. Inclusion criteria included blepharitis, MGD and/or DED. After an initial training session, each eyelid was treated for 15 seconds (total of 1 minute per treatment session per day). The following tests were collected before the first treatment and after the final treatment: OSDI survey, BCVA, Tear Osmolarity Test (Tear Lab), Tear Break Up Time (TBUT), Meibomian Gland Score (MGS), Meibomian Glands Yielding Liquid Secre-tions (MGYLS), Sicca Ocular Staining Score. Satisfaction with treatment survey was taken after treatment.

ResultsAll measured parameters had a statistically significant improvement. Symptoms improved based on an average decrease in OSDI score from 54.2 ± 19.5 (mean ± SD) to 26.7 ± 18.4 (P < 0.001). Tear osmolarity improved from 315 ± 15.7 to 306 ± 13.9 (P = 0.002). TBUT was noted to improve from pre-treatment of 4.8 ± 1.7 seconds to post-treatment of 7.9 ± 4.1 seconds (P < 0.001). MGS improved from 8.9 ± 5.1 to 7.0 ± 5.9 (P = 0.01). MGYLS improved from 8.7 ± 6.2 to 15.8 ± 6.9 (P = 0.002). Sicca Ocular Staining Score improved from 2.7 ± 2.1 to 1.4 ± 1.5 (P = 0.002).There were no adverse events. No corneal or conjunctival trauma. No patients dropped out of the trial due to discomfort. 91% of participants agreed or strongly agreed that the device was easy and convenient to use. Of those previously using manual lid scrubs, 82% felt the NuLids device was easier and more comfortable to use. 89% described little or no discomfort. 95% were satisfied or very satisfied with the overall treatment.

ConclusionsA mechanical device was safely used by patients at home for 1 minute daily for 30 days to treat DED, blepharitis, and MGD. There was a statistically significant improvement in signs and symptoms of DED as shown by improved OSDI, tear osmolarity, TBUT, MGS, MGYLS, and Ocular Staining Score. High patient satisfaction along with the low risk of adverse events supports the use of this device as a valid tool to treat DED, blepharitis, and MGD.
Chronic Ocular Graft Versus Host Disease: An Update and Review
Authors: Bachman Groth Jane , Conto John , Pasquini Marcelo
Published: May 2020

An updated comprehensive literature review was completed of chronic ocular graft versus host disease (oGVHD) to identify current and future considerations as to the causes, diagnosis, and treatment of this complication after allogenic hematopoietic cell transplantation (HCT). Graft-versus-host disease involves multiple organ systems, including the eye, and is a leading cause of mortality and morbidity in these patients. This review consisted a comprehensive search of the PubMed, ClinicalTrials.gov and NIH.gov databases.

      oGVHD is a debilitating and potentially sight threatening condition. Commonly involved ocular structures include the cornea, conjunctiva, meibomian glands, eyelids, lacrimal gland and tear film. Identifying and treating the ocular complications at the early stages may improve final outcomes and quality of life in these patients. Aggressive lubrication, preservation of tear film and inflammation control, including minimizing surface scarring, are treatment goals. Co-management with HCT and other pertinent health care providers is critical for early diagnosis and to initiate prompt therapy to minimize the ocular damage. Stepped therapy, including the use of emerging systemic treatments can be useful in the management of oGVHD with stable visual function, quality of life and complication management as goals of treatment.
Gangrene of the Bladder
Authors: Britnell William , Hawthorne Rachel , Hadway Paul
Published: May 2020

Gangrene of the bladder is fortunatley now very rare, with better obstetric care and the advent of the antibioic era. It can present fulminatly with bladder rupture, or less commonly with the sequelae of necrotic urothlium and detrusor causing recurrent episiodes of sepsis, urinary retention or catheter blockages. A high level of morbidity and mortality is associated with the condition.

Case History

We present a case of a 75 year old male with multiple co-morbidities, including diabetes and vascular disease, who presented to the urology team with recurrent episodes of sepsis and frequent blockage of his long term urethral catheter. After months of no catheter problems, he was admitted to intensive care with severe sepsis following a catheter blockage at home. After discharge he suffered multiple further episodes of urinary sepsis and catheter blockages, requiring almost daily catheter changes. After multiple imaging investigations looking for a source of the recurrent severe infections, a cystoscopy under general anaesthtic revealed a large volume of necrotic tissue in his bladder, which, on biopsy, was found to be sloughed urothelium and detrusor muscle consistent with recent gangrene of the bladder. No problems with the ctaheter were reported after the bladder washout and cystoscopic debridement

Discussion

The diagnosis of bladder gangrene was delayed becuase of the patients insideous presentation. Had the imaging investigations revelaed an associated bladder rupture when he intially presented to ITU , it is likley that the diagnosis and appropriate debridement would have been perfomed sooner. The patient required muliple readmissions with a blocked catheter before the diagnosis was made, but the eventual cystoscopic debridement was successful.

Conclusion

Clinicians should keep gangrene of the bladder on the list of differential diagnoses for recurrent catheter blockages, particularly if recognised risk factors have been present. These include a history of catheterisation, vascular disease, diabetes, recent critical illness requiring inotropes and urinary tract infections.
Antegrade Ureteroscopy for an Obstructing Distal Ureteric Stone in a Partial Duplex System with Ectopic Distal Insertion
Authors: Manley Jonathan , Salim Ferekh , Patterson Jake
Published: May 2020

Urinary tract abnormalities such as ureteric duplication and ectopic insertion may result in difficulty accessing the distal ureter to treat obstructing stones. This case illustrates the feasibility of treating distal ureteric stones with antegrade flexible ureteroscopy.
Self-Administered Intravesical Hyaluronic Acid Improves Symptoms and Quality of Life in a Patient-Centred Approach To Bladder Pain Syndrome Management
Authors: Kitchen Mark O. , Thursby Helen , Taylor Monica , Willard Kay , Mistry-Pain Tina
Published: May 2020

Background and Objectives

Bladder pain syndrome (BPS) is an uncommon and potentially debilitating spectrum of chronic pain typically accompanied by lower urinary tract symptoms. Intravesical hyaluronic acid (HA) is a commonly used treatment option, but requires multiple follow-up clinic appointments. We introduced a novel patient-led ‘at-home’ pathway of self-administered HA treatment to reduce the number hospital visits required by patients.

We assessed and compared patient-reported outcome measures (PROMS) from patients receiving nurse-administered ‘in-hospital’ and patient-led self-administered ‘at-home’ intravesical HA (Cystistat® and Hyacyst®, respectively). Secondary outcome measures included differences between waiting times for treatment, frequency of treatments, number of clinician and nurse clinic appointments, and estimated financial costs.

Patients and Methods

Sixty consecutive patients commencing intravesical HA for BPS symptoms between 1st January 2016 and 31st March 2019 were included. O’Leary-Sant Interstitial Cystitis Symptom Index questionnaires were completed prior to, and following, six treatments. Relevant clinical and demographic data were also collected.

Results

Overall, 76.6% of the patients had improvement in symptoms after HA treatment. Mean O’Leary-Sant questionnaire symptom and problem scores were significantly improved following HA treatment (11.8 (range 6–17) to 8.5 (range 4–13) (p=0.00005) and 11.4 (range 4–16) to 7.9 (range 4–14) (p=0.0002), respectively. There were no significant differences in symptom improvements between patients on either pathway.

Mean waiting time for treatment and number of treatments were lower in the patient-led pathway, and number of hospital visits was significantly lower in the patient-led at home pathway. The patient-led pathway could ‘save’ approximately 76 nurse clinic and 11 outpatient clinic appointments per year, and confer cost-savings of more than £1,500 per patient, per year.

Conclusions

Our case series analyses suggest that patient-led ‘at-home’ intravesical HA administration (Hyacyst®) is acceptable to patients and confers similar symptomatic benefit to ‘in-hospital’ nurse-led HA (Cystistat®). In addition, it appears that BPS sufferers established on the patient-led pathway require fewer HA treatments and fewer hospital visits, and as such, the patient-led pathway may also confer financial cost savings, and relieve some pressures on clinic appointment availability.
Endoluminal and Endoscopic Management of Urethral Stricture
Authors: Mak Martin SY , Tsu James HL , Lam Wayne
Published: May 2020

Background and Objective

Urethral stricture in the male population is one the oldest described urological condition. Significant vari-ability in clinical practice means that standardized management of urethral stricture remains controversial. Since the first description of modern-day direct visual internal urethrotomy (DVIU) by Sachse in 1974, this, alongside with various endoscopic treatment techniques, continues to be by far the most commonly performed procedures for the management of urethral strictures. This article aims to summarise and review the latest literature on endoscopic management of urethral strictures.

Material and Methods

We conducted a Pubmed and Medline search to identify publications related to endoscopic management of male urethral strictures between 1980 and 2019. Preference was given to recent and larger studies. Original research articles, review articles, abstracts, and opinion articles were included. Keywords used for the search were “male urethral stricture,” “urethrotomy,” “DVIU,” “urethral dilation,” “urethral stent”, “intermittent self-catheterisation”, “mitomycin C”, “steroids”, and “urethroplasty.”

Recent Findings

The long-term efficacy of endoscopic management of urethral stricture is poor. Recent novel advances with adjunct treatment have yet to demonstrate improvement in long-term treatment success. Repeated endoluminal or endoscopic treatments, especially for long and recurrent urethral strictures, are ineffective. They appear to delay patients from receiving definitive treatments, and potentially increase complexity and decrease the success rate of any future urethral reconstructive treatment.

Summary

There is overwhelming evidence to suggest limited long-term efficacy of endoluminal or endoscopic treat-ments for urethral stricture. Novel adjunctive therapies showed promising initial results, but none have yet to demonstrate durable efficacy. Endoscopic treatment of urethral stricture disease should only be reserved for patients who are not willing to undergo reconstructive surgery, or not fit for anesthetics.
Metastatic Adenocarcinoma of Para-Urethral Gland Presenting as Inguinal Lymph Node and Recurrent Bulbar Urethral Stricture
Authors: Jones Adam , Mills Samuel , Naguleswaran Sinthuja , Newton Tom , Pillai Mohan
Published: May 2020

Para-urethral gland carcinoma is a rare urological malignancy that has a male predominance and has an age-adjusted incidence of 1.5–4.3/million. There are various histological subtypes of para-urethral carcinoma, with adenocarcinoma representing only 16.4% of these. Treatment is dependent on site, stage and patient factors. A multimodal approach is often adopted for the treatment of this malignancy. This includes radical surgery based on site of malignancy and there have been various case reports describing the role of adjuvant chemotherapy. However, there is still no agreed recommendation or available evidence for treatment of this infrequently encountered malignancy. The majority of patients present with symptoms of advanced disease and outcomes remain poor. We report a case of para-urethral gland adenocarcinoma presenting as recurrent bulbar urethral stricture and inguinal lymph node metastasis. This case report aims to highlight the rarityof the disease and discuss treatment options for this uncommon urological malignancy.
Implicaciones hepáticas en la pandemia por COVID-19
Authors: León Gómez Juanita , Gómez Aldana Andrés José , Tapias Mantilla Mónica Lorena
Published: May 2020

La infección generada por el coronavirus, denominado SARS-CoV-2, llamada coronavirus disease 2019 (COVID-19), surgió en China a finales de diciembre de 2019. Actualmente ha sido categorizada como una pandemia por la Organización Mundial de la Salud (OMS). Se han documentado alteraciones de pruebas hepáticas, sin embargo, los estudios se han enfocado en los efectos cardíacos, pulmonares y renales de esta infección. La alteración de pruebas hepáticas en el contexto de COVID-19 puede ser consecuencia de hepatitis viral, toxicidad farmacológica, inflamación o choque. También se considera como un marcador de pronóstico y gravedad de la enfermedad. El impacto de la infección por SARS-CoV-2 en pacientes con enfermedad hepática preexistente o receptores de trasplante hepático no es claro, y se plantean distintas hipótesis sobre mayor o menor riesgo de enfermedad grave y de descompensación de la enfermedad de base.
Dispositivo de bajo costo para disminuir el efecto de aerosol durante la endoscopia de vías digestivas altas en COVID-19
Authors: Villareal Ricardo , Cabrera Luis Felipe , Pedraza Mauricio , Cuervo Jhon Eric , Santos Jorge Hernán , Jurado Jose Roberto
Published: May 2020

Los procedimientos endoscópicos, al estar asociados a la exposición de la vía aérea superior, tienen un mayor riesgo de transmisión del virus SARS-CoV-2; por esta razón, es necesario el planteamiento de intervenciones para atenuar o eliminar la exposición a éste. En este artículo nos permitimos presentar una estrategia de mitigación de bajo costo, ya que con el progreso de la pandemia se podría estar en un estado de austeridad de recursos económicos, lo cual haría estos dispositivos totalmente válidos.
Biodegradable polymers, current trends of research and their applications, a review
Authors: Colnik Maja , Knez-Hrncic Masa , Skerget Mojca , Knez Zeljko
Published: May 2020

Biodegradable polymers have been developing rapidly in the last years and are widely used today in the fields of pharmacy, clinical biomedicine, cosmetic, medical, and packing industries, tissue engineering, agriculture and other areas. The interest in biodegradable polymers has been increasing, mainly due to rising oil prices, which is the basic feedstock of plastic derived from petroleum, and also due to the problem of the removal of waste plastics that accumulate in the environment. Biodegradable polymers have many advantages in contrast to synthetic polymers and can be decomposed in the environment to non-hazardous substances. Biodegradable polymers are classified into two classes based on their synthesis, i.e., synthetic and natural polymers. They are derived either from petroleum resources or from biological resources. The following review presents an overview of the different biodegradable polymers and their properties, current scientific research, applications, global production of bioplastic and replacement of conventional plastic.
Penggunaan Model Pembelajran Cooperative Integrated Reading and Composition (CIRC) untuk Meningkatkan Prestasi Belajar Bahasa Inggris
Authors: Ardana Gusti Ngurah Alit
Published: May 2020

Penelitian tindakan kelas ini dilaksanakan di SMP Negeri 1 Gianyar tahun pelajaran 2018/2019 semester II dengan tujuan untuk meningkatkan prestasi belajar Bahasa Inggris siswa kelas IX H di SMP Negeri 1 Gianyar melalui penerapan model pembelajaran Cooperative Integrated Reading and Composition (CIRC). Subjek penelitian ini adalah siswa kelas IX H SMP Negeri 1 Gianyar yang berjumlah 39 orang dalam mata pelajaran Bahasa Inggris. Data tentang prestasi belajar siswa diperoleh dengan menggunakan metode tes dengan instrumanya yaitu berupa tes prestasi belajar. Data tersebut kemudian dianalisis dengan menggunakan teknik analisis deskriptif kuantitatif. Hasil penelitian ini adalah Penerapan model pembelajaran Cooperative Integrated Reading and Composition dapat meningkatkan prestasi belajar Bahasa Inggris siswa kelas IX H SMP Negeri 1 Gianyar pada semester II tahun pelajaran 2018/2019. Skor rata-rata prestasi belajar siswa menunjukkan adanya peningkatan dari siklus I ke siklus II. Rata-rata kelas prestasi belajar pada awal pembelajaran hanya mencapai 67,94, siklus I meningkat menjadi 74,61 pada siklus II menjadi 83,58. Ketuntasan klaksikal awal hanya mencapai 41,02%, pada siklus I meningkat menjadi 61,53% dan pada siklus II menjadi 92,30%.
Refusal Strategies Used By Multi-Nationality Students
Authors: Dewi I Ar , Tantra D.K. , Artini L.P. , Ratminingsih N.M.
Published: May 2020

This descriptive qualitative study was aimed at exploring refusal strategies used by the students of primary level of Gandhi Memorial Intercontinental School (GMIS) Bali in requesting, offering, inviting, and suggesting. The students being involved as the subject of this study were multi nationality (Indonesian, Indian, Russian, and Japanese) male and female students of the third, fourth and fifth grade which were determined using purposive sampling technique. Data collection was conducted through observation, recording, and note taking employing video recorder, camera, and field note as the instruments of the data collection. Data analysis in this study was done through four concurrent activities covering data collection, data reduction, data display, and conclusion. The result shows that, in context of request across nationalities, view from the frequency (percentage of refusals) it shows direct refusal is highly used by Russian while it is lowest used by Indonesian students. On the contrary indirect strategy is more often used by Indonesian students. while in context of refusing an offer. it reflects that Indonesian is mostly to refuse it in direct way but this is contrast with Russian who perform direct refusal in less frequent. This condition is in context of refusing in indirect way. the data reveals that Russian are more often to refuse the offering in indirect way while Indonesian is the lowest. In context of refusing invitation, nationality which is the highest used of direct refusal is Indian while nationality which was prefer to perform indirect refusal is Russian. In addition, in context of Suggestion, direct refusal is highly performed by Russian whereas indirect refusal is more often used by Japanese students.
Improving Written Communication Skills and Mathematical Disposition of Tenth Grade IPS 4 Students by Using Think-Talk-Write (TTW) Learning Strategy at SMAN 50 Jakarta
Authors: . Radiusman , Noornia A. , Ambarwati L.
Published: May 2020

The aim of this research was to improve mathematical written communication and mathematical disposition of students by using think-talk-write (TTW) learning strategy in tenth grade IPS 4 students at SMAN 50 Jakarta 2017/2018 academic year. The design of this study was a classroom action research. The subject of this research consists of 6 students, 2 students with low written communication skills with moderate disposition skills, 2 students having medium-skilled and medium disposition ability and 2 students who have high disposition ability with medium and high disposition ability. The data collection techniques were consist of    1) Giving mathematics written communication ability test, 2) Spreading mathematic disposition questionnaire, 3) Doing filed notes, 4) Interviewing with the research subjects. The result was based on the end of the third cycle, it was obtained all subject experienced has increase in mathematical written communication ability and 4 out of 6 subjects experienced has increase in mathematical disposition ability. Based on the results, it can be concluded that the TTW learning strategy can increase mathematical written communication and mathematical disposition ability in tenth grade IPS 4 students at SMAN 50 Jakarta 2017/2018 academic year. In this research, an improvement made at the thinking stage was to write answers on the worksheet so that students will be more passionate about thinking of how to solve problems. On the talking stage, students were not only explaining completion but also helping team members who having difficulties. On the write stage, students could write the answer using their own phrase so that they will understand more about the completion based on observations and the results of questionnaires to increase the ability of mathematical disposition it can be seen that students experience increased self-confidence in explaining the ideas obtained, able to solve problems in various ways and have the willingness to solve mathematical problems. Besides, when the teacher asks students to re-examine the result of the work, it can be seen that students check their work while checking if there was a problem-solving problem.
Adolescence Student Behavioral Engagement In Mathematics Class
Authors: Hidayat Dylmoon , Kim Tina , Listiani Tanti , Setianingsih Agustina Reni
Published: May 2020

Mathematics becomes one of many subjects which shows low student engagement. This paper aims to understand students’ attitudes toward school and mathematics, the impact of student behavioral engagement, influential factors, obstacles in promoting student behavioral engagement, and how to promote student behavioral engagement. Students’ interests of school decrease in high school. Behavioral engagement impacts academic achievement, meaning of learning, and self-esteem. Influential factors of student behavioral engagement are motivation, the role of parents and teachers, and peer support. Obstacles in promoting student behavioral engagement are building intrinsic motivation, teachers’ beliefs about student behavioral engagement, and parental styles. Some ways to promote student behavioral engagement are using various teaching method, keeping optimal learning environment, and focusing on peer. Conclusion and suggestion emphasize on the role of teachers in their authority in the class and cooperate with parents.
Digital Flipbook Empowerment as A Development Means for History Learning Media
Authors: A Muhammad Abror , Suryani Nunuk , Ardianto Deny Tri
Published: May 2020

The purpose of this research was to help empower the atmosphere and climate of learning students who had different learning styles with the prior generation by using a digital-based instructional media such as digital flipbook. The research methods used were Research and Development, ADDIE model. Data collection obtained through interviews, questionnaires or questionnaires with direct observation. The data analysis technique used was an Independent sample test of hypothesis testing via SPSS version 26. The objects of the research were 11th grade students of Public High School 1 Dagangan, academic year 2019/2020. The results of the research development of digital flipbook learning media on the effectiveness test stage through post-test of the control class and the experimental class showed the mean difference or the average grade of the experimental class (XI Social Sciences 2) 91.6 and grade control (XI Social Sciences 1) 83.5. Thus, digital flipbook learning media that have been developed have succeeded in gaining a significant increase in students' grades as well as succeeding as delivering information media to students in the classroom.
DIVERSITY OF BACTERIA IN SEDIMENT FROM MANGROVE AND BEKANTAN CONSERVATION AREA (KKMB) IN TARAKAN CITY
Authors: Yulma Yulma , Satriani Gloria Ika , Awaludin Awaludin , Ihsan Burhanuddin , Pratiwi Bella
Published: May 2020

Bacteria in sediment plays an important role in various biochemical processes in the waters area, for instance degradation of organic matter, biogeochemical cycle, controlling ammonium, nitrates and nitrites concentration, food source for fauna, primary production, and pollution remediation. The purpose of this study was to determine the diversity of bacteria (Genus) in sediment on the Mangrove and Bekantan Conservation Area (KKMB), Tarakan City. The method used was explorative descriptive method with genus identification as parametric test. Bacterial identification parameters were tested using Gram-test, main test and further test was carried out at the Laboratory of Fish Quarantine, Quality Control and Safety Fishery Products Class II Tarakan. The bacteria found in the sediments on the KKMB were 16 genera i.e. Enterobacteria, Eubacterium, Listeria, Actinobacillus, Bacteriodes, Streptococcus, Plesiomonas, Corynebacterium, Pseudomonas, Aeromonas, Bordetella parapertussis, Micrococcus, Staphylococcus, Clostridium, Neisseria, and the dominant numbers found was Bacillus.
EFFECT OF Pilsbryoconcha exilis AS ORGANIC MATTER REMOVAL IN THE RECIRCULATING AQUAPONIC SYSTEM
Authors: Yulianto Herman , Delis Putu Cinthia , Damai Abdullah Aman , Diantari Rara , Suparmono Suparmono , Penmau Defrilasio Eldes , Febriani Seﬁa
Published: May 2020

Aquaponics is a combination of aquaculture and hydroponics system. This system is expected to be able to overcome the problems of waste from aquaculture by utilizing Nitrogen (N) and Phosphorus (P) for vegetables. There are several obstacles found in aquaponics systems such as high suspended organic matter produced from the feed residue and fish metabolism. The addition of natural filters, namely freshwater mussels (Pilsbryoconcha exilis) is expected to solve these problems. This research was conducted for 40 days. The design used in this study was Factorial Completely Randomized Design with two main factors namely mussels density as factor-A and time of observation as factor-B. The treatments were P1 (0 mussels density), P2 (15 mussels density), and P3 (30 mussels density) for factor-A while time of observation were factor-B (D-0, D-10, D-20, D-30 and D-40). Each treatment was conducted in three repetition. The results showed that the time observation gave significantly different on water condition changes (P <0.05), which will increase TSS, turbidity and chlorophyll value along with the increasing of time. P exilis in aquaponics was effective in reducing turbidity and chlorophyll concentration (P <0.05). Therefore, aquaponics system with the highest mussels density (P3) with has lower turbidity and chlorophyll value than the one with 0 mussels density (P1).
Los conceptos sensibilizadores y el nuevo movimiento metateórico
Authors: Abreu Cláudio
Published: May 2020

Resumen: La noción de concepto sensibilizador constituye una importante herramienta metateórica para entender el desarrollo del conocimiento sociológico. Empero puede aportar aún más a las discusiones metateóricas. La tesis que motiva este estudio es que la concepción de teoría que sirve de trasfondo para dichas discusiones limita su potencial. El objetivo del artículo es explicitar dicha limitación. La estrategia argumentativa será presentar las ventajas de adoptar una concepción contemporánea de teoría. Una vez expuesta la noción de concepto sensibilizador, serán presentadas las fases de desarrollo de la filosofía de la ciencia; dos concepciones de conceptos científicos, y las ideas básicas de la metateoría estructuralista, de ley fundamental de una teoría y de contrastación de dichas leyes. A partir de esto se realiza el análisis de la noción de concepto sensibilizador. Se concluye que, teniendo por trasfondo la metateoría estructuralista, la noción de concepto sensibilizador puede ser potencializada.
Entrevista com o Dr. Marcel Sigrist
Authors: Vieira Fernando Mattiolli
Published: May 2020

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Mucocele of the middle turbinate: A rare entity
Authors: Gupta Nitin , Kalia Madhur , Dass Arjun , Singhal Surinder K
Published: May 2020

BACKGROUND. Mucocele is a benign expansile cyst-like lesion seen in the paranasal sinuses, which has a tendency to expand and erode the surrounding sinus walls. These mucoceles develop as a result of obstruction of the sinus ostium and superadded infection. As such, the frontoethmoidal area is the most common site, followed by the maxillary sinus and the sphenoid sinus. Rarely, mucocele may also develop in abnormally aerated bones, such as middle turbinate (concha bullosa), clinoid process and pterygoid process.

CASE REPORT. We report two infrequent cases of mucocele of concha bullosa, clinically presenting as the cause of nasal obstruction, which were completely removed endoscopically, and patients were symptomatically relieved.

CONCLUSION. Mucocele of the middle turbinate represents a diagnostic challenge to surgeons both in terms of symptoms and risk of complications. Therefore, the condition should be considered as a possible cause of progressive nasal obstruction by otolaryngologists, and careful examination of the nasal cavity is necessary to determine the existence of this rare condition.