bluuebunny/crossref_metadata_2025 huggingface dataset:
Green supply management and green marketing strategy on green purchase intention: SMEs cases
Authors: Sugandini Dyah , Muafi Muafi , Susilowati Christin , Siswanti Yuni , Syafri Wirman
Published: February 2020

Purpose: This study aims to analyze green supply chain management (GSCM) and green marketing strategies (GMS) to green purchasing intentions (GPI). This study conducts on craft SMEs in the Special Region of Yogyakarta, Indonesia. Design/methodology/approach: This study uses primary data which is obtained through questionnaires. The unit of analysis in this study is organizations and individuals. The sampling technique is purposing sampling, with the criteria of SMEs that conduct environmentally friendly production processes and consumers who have ever bought green products. Data analysis uses structural equation modeling. Research limitations/implications: This study is limited by relatively small sample size. The sample is only environmentally oriented SMEs. Large companies that are also environmentally friendly have not been included as samples in this study, so the results of this study only generalized to SMEs. Future research should accommodate these two types of companies, namely SMEs and companies, so that it can be easier to generalize the findings and allow different tests of GSCM to be applied to SMEs and large companies. This study only analyzed GSCM from two dimensions, namely GP and GCC. Other variables that can be used to explain GSCM are internal environmental, green information systems, eco-design and packaging. Practical implications: GSCM can be started with conducts the right GP and always coordinating with consumers which related to green products. GP (green purchasing) and GCC (green consumer cooperation) as GSCM elements have a strong association in predicting the success of a green marketing strategy. It is expected that SMEs should pay attention to the raw material purchase so that the problem of environmentally friendly raw materials can be truly obtained to enter the production process and produce environmentally friendly products. Originality/value: This study analyzes the relationship between GSCM practices and organizational performance in the green marketing and business strategies context, where there is still a scarcity of studies in this context. Besides that, there is an increase in awareness of green operations and green marketing in Asia, but the relevant studies in Asian countries have not been conducted much, especially in Southeast Asia. The result of this study proves that the GSCM model can increase value along the supply chain by emphasizing green supply chain management and green marketing.
Top management role in improving the state of QMS under the influence of employee's involvement: Best practice from the food processing industry
Authors: Stanojeska Marija , Minovski Robert , Jovanoski Bojan
Published: February 2020

Purpose: The role of the top management in Quality Management System (QMS) is undeniable and emphasized by many researchers. On the other hand, the employees’ involvement is recognized as one of the main prerequisites for improvement of QMS. Although investigated to a certain extent, the influence of the top management and the employees’ involvement on the successful transition from ISO 9001 QMS to TQM is still a vague area. The main objective of the presented research is to investigate the influence of top management commitment on the state of QMS, through optimal management of employees’ motivation.Design/methodology/approach: In order to identify the influential factors, a comprehensive literature survey was conducted, followed by survey of the companies in the food industry in the Republic of Macedonia. The selected influential factors on QMS and employee motivation are used as initial set of variables for creation of the dynamic model.Findings: As a result, the findings demonstrate how the top management can influence on the state of QMS and implementation of TQM practices in a shorter period of time. In that sense, numerous experiments with SD model have been carried out and most appropriate ratio of coefficient of commitment of top management has been determined.Originality/value: The model represents a kind of a platform for further analysis in direction of improvement the QMS towards the TQM under the influence of employees’ motivation.
Nursing Students' Perceptions of Anxiety-Producing Situations in the Clinical Setting
Authors: Kleehammer Kelly , Hart A Louise , Keck Juanita Fogel
Published: February 2020

ABSTRACT

Aspects of nursing students' clinical experiences are anxiety provoking. High anxiety may contribute to decreased learning. The purpose of this study was to identify potentially anxiety-producing clinical experiences for student nurses. Thirty-nine junior and 53 senior nursing students from a BS degree program completed the "Clinical Experience Assessment form," a 16-item Likert scale. The items included communication and procedural aspects of patient care, interpersonal relationships with healthcare providers, and interactions with faculty. An open-ended question asked students to identify the most anxiety-producing aspect of their clinical practice. The students expressed the highest anxiety for the initial clinical experience on a unit and the fear of making mistakes. Faculty evaluation and observation were also anxiety-producing. The results of the student t-test indicated that juniors were significantly higher in their expression of anxiety than seniors. The main theme from the content analysis was that students' anxiety was increased in the clinical setting by their perceptions of nonsupportive faculty.
Stigma & Help Seeking Related to Depression: A Study of Nursing Students
Authors: Halter Margaret J.
Published: February 2020

The stigmatization of people with mental illnesses and its effect on help-seeking behaviors have been identified by the Surgeon General and the President’s New Freedom Commission on Mental Health as significant issues on the nation’s health care agenda. Negative perceptions regarding depression and its treatment contribute to the 30,000 suicides committed annually in the United States.

Nurses have the potential to exert tremendous influence toward overcoming this problem, contingent on their attitudes toward depression and its treatment. As nurses and future nurses, students enrolled in both a basic and degree-completion baccalaureate program comprised a sample that represented the influence of the educational process.

This descriptive, correlational study measured attitudes toward an individual with depression, described in a vignette, and personal help-seeking intention, and examined the effects of personal variables on help-seeking intention. Students who believed depression was not under personal control were more likely to endorse help seeking for themselves. Individuals who were women, older, upperclassmen, and Catholic reported greater acceptance of seeking psychological help. The role of the psychiatric-mental health nursing class and rotation were identified as improving stigmatizing attitudes and increasing help-seeking intention.
Logotherapy to Mitigate the Harmful Psychological Effects of Current Events: A Tool for Nurses
Authors: Mortell Susan
Published: February 2020

Evidence suggests that political or current events can have adverse effects on mental health. Since the 2016 election, many mental health professionals have also noted a surge among Americans who associate their mental health symptoms with current events. It is therefore possible that when nurses speak with patients, discussions of current events will arise. Logotherapy is introduced as a tool that can help facilitate these discussions and a way that nurses might assist patients who are adversely affected by current events. [
Journal of Psychosocial Nursing and Mental Health Services, 58
(4), 38–42.]
The Influence of Stigma on Suicide Bereavement: A Systematic Review
Authors: Evans Amy , Abrahamson Kathleen
Published: February 2020

Suicide loss affects a significant proportion of the population, and despite its prevalence there remains a stigma surrounding death by suicide. It is important for health professionals to understand the effects of suicide stigma on surviving friends and family members so that they can respond appropriately and provide effective support. A systematic review of the literature was conducted to evaluate the impact of public stigma on bereavement of suicide survivors. A total of 11 qualitative and quantitative studies were reviewed. Suicide survivors reported feeling shamed, blamed, and judged. They perceived a general discomfort and awkwardness surrounding the suicide, which contributed to avoidance and secrecy. Higher perceived stigma levels were associated with global psychological distress, depression, self-harm, and suicidality. Despite the recognized negative impact of suicide stigma on the bereaved, studies on grief interventions for suicide survivors are scarce. There is a critical need for research and evidence-based recommendations on how to best to support this vulnerable population. [
Journal of Psychosocial Nursing and Mental Health Services, 58
(4), 21–27.]
Pozzolanic activity of argentine vitreous breccia containing mordenite
Authors: Bonavetti V. L. , Rahhal V. F. , Locati F. , Irassar E. F. , Marfil S. , Maiza P.
Published: February 2020

A vitreous breccia with variable amount of mordenite was studied for its use as pozzolan. The raw material was characterized by optical and scanning electron microscopy (SEM), X-ray diffraction (XRD), and the zeolite content was estimated by the methylene blue staining technique. After being ground, physical characteristics, cation exchange capacity (CEC), pozzolanicity, and the compressive strength activity index (SAI) were determined. The staining technique and the CEC measurement were used to evaluate the average content of zeolite. The vitreous breccia has pozzolanic activity after 7 days, the water demand increases slightly, and its addition stimulates the early hydration of portland cement. At later ages, the pozzolanic reaction around the grains, as revealed by SEM studies, improves the compressive strength of blended cements having a SAI > 0.85 at 28 days.
Intercultural Learning in Pre-mobility Teletandem
Authors: Cappellini Marco , Macré Nicola
Published: February 2020

Our study focuses on a teletandem (Telles) environment for pre-mobility language and intercultural development. The telecollaborations’ main pedagogical objective was the development of the intercultural competence with a shift from more savoir-based culturalist development (Abdallah-Pretceille and Porcher) to a development in terms of savoir-apprendre (Byram and Zarate). This aim was pursued by the design of six teletandem tasks. Moreover, to enable students to reflect on their learning and to share their learning strategies and reflections, within the telecollaborations we set up two collective reflective blogs (Cappellini, “Du carnet”) where the students had to post an entry after each teletandem session. By analyzing the students’ posts in these blogs, we observe convergence and divergence between the pedagogical intentions of the telecollaboration designers (or task-as-workplan, “Divergent perceptions”) and the actual outcomes (or task-as-process). Finally, we draw some pedagogical suggestions on how to improve task design for autonomous intercultural learning.
Student-educator Tandem in the Pedagogy of Endangered Languages in Australia
Authors: Charon Christiane
Published: February 2020

The aim of this paper is to propose a practical solution to one of Australia's biggest educational challenges: the absence of many Indigenous languages from school. Research on bi- and multilingual education in the 21st century and considerations on intercultural communication constitute starting points for an enquiry into tandem learning involving Indigenous languages. All students in the pilot study cohort are Indigenous Australians, boarding at a residential college in Darwin, the capital of Australia's Northern Territory. In a specifically devised tandem model in which the students teach their home languages to their non-Indigenous tutor, a variety of teaching and feedback strategies emerge. They delineate the characteristics of student-educator tandem through the exploration of multimodal forms of learning and literacy.
Towards Developing Tandem Learning in Formal Language Education
Authors: Batardière Marie-Thérèse , Jeanneau Catherine
Published: February 2020

The present paper provides an insight into the use of a tandem learning approach as an active and flexible mode of learning to support Internationalisation at Home (IaH) (Beelen and Jones) in higher education. More specifically, it reports on a 25-year experience of tandem learning between international and home students in the context of a language exchange programme (informal curriculum), a translation class and an online forum (formal curriculum). The study outlines a major trend in the development of the tandem learning activities in the last ten years which has led to new grouping configuration. It then explores learners’ level of engagement in the learning process (Chen et al.), whether it is student involvement in tasks and subject knowledge or student commitment to partnership. Preliminary results point to the potential causal relationship between instructional strategies and students’ level of engagement in tandem learning.
Échanges linguistiques et interculturels en tandem en français sur objectifs spécifiques
Authors: Zsak Helga
Published: February 2020

Avec la création d'un contexte et de tâches d'apprentissages internationaux et multidisciplinaires en tandem, nous nous sommes efforcés de favoriser l'accès à la langue par la collaboration entre les étudiants hongrois de la faculté de tourisme Budapest et les étudiants français des établissements partenaires. Le domaine ciblé a été celui du français sur objectif spécifique (FOS) : le curriculum du tourisme des affaires. S’inscrivant dans la lignée théorique d’éducation des « Écoles nouvelles », répandues en Hongrie, des théories socioconstructivistes, et nous inspirant des résultats de recherches scientifiques hongroises sur le fonctionnement mental dans l’interaction sociale. Le travail des étudiants s'est articulé autour de cinq rencontres en tandem en français et anglais hors cours. La tâche à accomplir fut de créer un projet interculturel commun sur une thématique culturelle ou patrimoniale. D'après l’observation des contributions initiale et finale des étudiants, il semble que les projets élaborés et réunis sur des sites Internet, ont contribué à améliorer les dimensions cognitives, affectives et comportementales des compétences interculturelles des apprenants et leur niveau linguistique. Les éléments nouveaux du code culturel ont peut-être aidé au façonnement individuel et collectif de leur personnalité
Rheological Study on Cemented Coal Gangue Fly-Ash Backfill Slurry Associated with Fly Ash Impacts
Authors: Yang Jie
Published: February 2020

The cemented coal gangue-fly ash backfill (CGFB) slurry has commonly been used to control subsidence damage caused by underground coal mining. This paper discusses the CGFB slurry rheological characteristic associated with the various percentage of the fly ash within the configuration of the mixture. A general description about CGFB slurry fluidity in the pipe transportation is provided. The physical, chemical and rheological characteristic of the CGFB have been determined in the test. The fly ash was mixed with 18%, 20% and 22% of solid concentration with respects to 12%, 10% and 8% for cement on various concentrated CGFB slurry ranges 76.05%, 78.05% and 80.05%. The tests verify the CGFB slurry exhibits non-Newtonian behavior in nature as Bingham plastic fluid. The experimental data show CGFB slurry rheological characteristic is noticeable influenced by the slurry solid concentration and the proportion of the fly ash, which affects the value of yield stress and viscosity. The lower value of the rheological parameters was observed on 22 % fly ash other than the 18 % case based on the same solid concentration of CGFB slurry.
The Effect of Plasma Pretreatment of Dyeability of Silk with Acid Dye
Authors: Wang Wen Yi , Ma Wing Chun , Kan Chi Wai , Sarikanon Cholthicha , Sarikanon Chamlong , Kunadiloke Saranya , Mongkholrattanasit Rattanaphol
Published: February 2020

Plasma technology provides an effective way to modify the surface of polymeric materials and thus improve the physicochemical properties of this material. This study was a preliminary study in exploring the application of plasma technology in the surface modification of silk fiber. Experimental results revealed that the dyeability of silk fabric with acid dye was improved after plasma treatment.
Finite Strain Elastoplastic J2-Flow Model for Automatically, Accurately Simulating Pseudo-Elastic Effects of SMAs
Authors: Wang Si Yu , Zhan Lin , Xi Hui Feng , Xiao Heng
Published: February 2020

Finite strain elastoplastic J2-flow equations are established toward the purpose of automatically, accurately simulating pseudo-elastic effects of SMAs. The uniaxial responses derived from these equations in each loading-unloading cycle exactly produce a closed stress-strain curve of any given shape. Then, any given test data for pseudo-elastic hysteresis loops of SMAs may be accurately fitted by means of a new technique for combining linear spline functions into a unified, smooth interpolating function, in a sense with no need to identify any unknown parameters.
Optimization of Cutting Parameters for Improving Surface Roughness during Hard Milling of AISI H13 Steel
Authors: Do The Vinh , Nguyen Quoc Manh , Pham Minh Tan
Published: February 2020

In metal cutting, surface roughness plays an important role in assessing the quality of processed products. The roughness depends greatly on the selection of machining parameters such as cooling conditions and cutting parameters. For this purpose, cooling conditions including dry, MQL, and Silica-based nanofluid MQL as well as cutting parameters including cutting speed, depth-of-cut and feed-rate were investigated to determine their influence on machining roughness during hard milling of AISI H13 steel. The DOE method developed by G. Taguchi was used to design the experiments. An analysis of the signal-to-noise response and ANOVA were carried to obtain the optimal values of cutting parameters for minimizing surface roughness. The results of the present study show that Silica-based nanofluid MQL, minimum feed-rate, minimum depth-of-cut, and maximum cutting speed is an optimal cutting condition for reducing machining roughness.
Investigation of Burr on Strips Cast by Vertical-Type High-Speed Twin Roll Caster
Authors: Haga Toshio , Yamashiki Takuya , Watari Hisaki , Niahida Shinichi
Published: February 2020

The factors affecting the shape and size of burrs that form at the edges of strips cast by a vertical type twin roll caster were investigated in this study. The size of the burr was found to be affected by the Si content of the strip. When the Si content was larger than 7 mass%, the burrs became larger. The position of the lower edge of the side dam plate also affected the shape of the burr. The burrs that formed were generally perpendicular to the strip surface but changed to being parallel to the strip surface as the position of the lower edge of the side dam plate was displaced upward from the center of the rolls.
Forming Technology and Simulation of Large Head Forgings
Authors: Jia Xiang , Liu Jian Sheng , An Hong Ping , Qin Min
Published: February 2020

Head forging is an indispensable part of major technical equipment, which is required to produce high quality products because of its large volume and complex structure and long service under high temperature and high pressure. By means of DEFORM-3D numerical simulation and scaling experiment, the dynamic recrystallization dynamics model of SA508-3CL steel is established. Meanwhile, the head forming scheme is designed. The effects of different blank height-diameter ratio size, punch shape size and upper and lower die matching relationship on forging forming are emphatically analyzed. Finally, the reasonable head forming scheme is determined, and the 1:8 head forming scale test is carried out. The results show that the size of the head forging basically coincides with the design size and meets the load of the hydraulic press, which proves the rationality of the forming process of the head. The study provides a theoretical basis for the manufacture of the same type of large variable wall thickness head forgings.
Effect of Process Conditions on Residual Stress in Laser-MAG Welding of High Strength Steel
Authors: Tian Zhong Feng , Li Jun Feng , Chen Zhi Xuan , Wang Zhao Nan
Published: February 2020

In this paper, the finite element method is used to simulate and analyze the laser-MAG composite welding of 4mm thick cylinder of high strength steel 30CrMnSiA, and the variation law of welding residual stress under different technological conditions is obtained. By comparing and analyzing the welding residual stress of the actual test plate by blind hole method with theoretical calculation value, the two methods are in good agreement, and the rationality of the model is verified.
Phenomenological Methodology for Designing Optimal Styling in the Design of Panels of Aircraft Structures Made of Laminated Composite Material
Authors: Grishsenko Sergei V.
Published: February 2020

The article solves the problem of rapid design of optimal stacking of a polymer laminated composite material of the traditional scheme. The existing engineering technique for laying design is based on constructive-force decomposition. However, this approach does not take into account the joint work of the layers. A solution is proposed that is based on the search for phenomenological dependencies for designing optimal styling parameters. The problem is solved by calculating the carrying capacity of a large number of styling options, searching among them for optimal solutions.
Study of the Behaviour of Senegalese Ballast Materials during Compaction with the C-Mould: Case of Bandia Limestone and Diack Basalt
Authors: Sow Libasse
Published: February 2020

Work presented in this article focuses on the study of the behaviour of materials from Senegalese quarries during compaction. These are Bandia Limestone (Sindia, Thiès Region) and Diack Basalt (Ngoundiane, Thiès Region). The grain size studied is 25/50 mm as for any material studied for use as railway ballast. The Proctor C-Mould for compacting large diameter materials was made for the occasion. With γdmax = 2.142 g/cm3 and WOPM = 5.3%, the compaction results clearly show the poor behaviour of the limestone under the effect of repeated loads and water. It shows a reduction in fine elements of the aggregates of initial diameter 25/50, as well as a significant cohesion under the effect of water with the formation of a muddy paste. The compaction references that characterize Diack Basalt are: γdmax = 2.15 g/cm3 and WOPM = 0.37%. Diack Basalt's compaction behaviour shows good performance. It does not break down into fine particles and the settling observed during compaction is similar to just tightening the grains and then stabilizing the material.
Effect of Water Conditions on Macro-Cell Corrosion Potential Difference and Current Density of Reinforcing Steel in Concrete
Authors: Cao Zhong Lu
Published: February 2020

In marine concrete structure, corrosion behaviors of reinforcing steel in atmosphere, splash, water-level-fluctuating and underwater zone are significantly different. This paper investigated and analyzed the effect of water conditions on the macro-cell corrosion potential difference and macro-cell current density of steel in concrete free of chloride and concrete contaminated by chloride. Results indicated that in concrete that is free of chloride and with low water content, its resistance becomes the limiting factor for the formation of macro-cell current. The increase of water content of concrete could promote the flow of macro-cell current. In concrete contaminated with chloride, only the water-saturated state of anode was little helpful to inhibit the macro-cell current, but the increase of water content of concrete around the cathodic steel could weaken the macro-cell corrosion. The water condition of cathode and anode could play an important role in controlling the ratio of magnitude of macro-cell current to micro-cell current.
Strength Design of the Eccentric Load in Unequal Single Angle
Authors: Hsu Wei Ting , Liu Rou Yin , Chung Shu Ti
Published: February 2020

Usually the angle steel is attached to the bracket to withstand tensile or compressive forces. The single-angle steel section is an asymmetrical section, and the nature of the section involves a complex analysis. The load is transmitted to the single-angle steel through the steel plate, thus causing eccentric load behaviour. The eccentric load will cause the single angle steel to bear the action of the axial pressure and the bending moment. The process of design and analysis is difficult based on the asymmetry of single angle steel. The behaviour of axial force and bending moment involves warping and torsion, and the analysis and design process is complicated. The eccentric load behaviour of single angle steel is based on complex formula analysis, and the 2010 AISC specification [1] also provides a table lookup function. This study collated the analytical formula of a single angle steel with complex eccentric loads. According to the theory of beam-column interaction, different lengths and positions are considered. The article provides a reference for the correct analysis of the user and improves the correctness of the analysis of the single angle steel.
HIV-1 gp120–CD4-Induced Antibody Complex Elicits CD4 Binding Site–Specific Antibody Response in Mice
Authors: Galkin Andrey , Chen Yajing , Guenaga Javier , O’Dell Sijy , Acevedo Roderico , Steinhardt James J. , Wang Yimeng , Wilson Richard , Chiang Chi-I , Doria-Rose Nicole , Grishaev Alexander V. , Mascola John R. , Li Yuxing
Published: February 2020

Elicitation of broadly neutralizing Ab (bNAb) responses toward the conserved HIV-1 envelope (Env) CD4 binding site (CD4bs) by vaccination is an important goal for vaccine development and yet to be achieved. The outcome of previous immunogenicity studies suggests that the limited accessibility of the CD4bs and the presence of predominant nonneutralizing determinants (nND) on Env may impede the elicitation of bNAbs and their precursors by vaccination. In this study, we designed a panel of novel immunogens that 1) preferentially expose the CD4bs by selective elimination of glycosylation sites flanking the CD4bs, and 2) minimize the nND immune response by engineering fusion proteins consisting of gp120 Core and one or two CD4-induced (CD4i) mAbs for masking nND epitopes, referred to as gp120–CD4i fusion proteins. As expected, the fusion proteins possess improved antigenicity with retained affinity for VRC01-class, CD4bs-directed bNAbs and dampened affinity for nonneutralizing Abs. We immunized C57BL/6 mice with these fusion proteins and found that overall the fusion proteins elicit more focused CD4bs Ab response than prototypical gp120 Core by serological analysis. Consistently, we found that mice immunized with selected gp120–CD4i fusion proteins have higher frequencies of germinal center–activated B cells and CD4bs-directed memory B cells than those inoculated with parental immunogens. We isolated three mAbs from mice immunized with selected gp120–CD4i fusion proteins and found that their footprints on Env are similar to VRC01-class bNAbs. Thus, using gp120–CD4i fusion proteins with selective glycan deletion as immunogens could focus Ab response toward CD4bs epitope.
An overview of the new rifampicin-resistant tuberculosis regimens available at decentralised drug-resistant tuberculosis sites for persons older than six years
Authors: Muller Madeleine
Published: February 2020

No abstract available.
Required Treatment Expenditures for Hepatitis C Virus Infection and Advantage in the Reduction of Hepatocellular Carcinoma Incidence: Analysis of Possible Options in an Endemic Area
Authors: Joob Beuy , Wiwanitkit Viroj
Published: February 2020

Background: Hepatitis C virus (HCV) infection is a known underlying factor contributing to hepatocellular carcinogenesis. The use of direct-acting antiviral (DAA) medication is a form of clinical management for controlling HCV infection and reducing the hepatocellular carcinoma incidence. This medication is introduced to several endemic areas. The big concern is on the treatment expenditures. Several alternative options are proposed and it is required to assess the effect of each alternative option. Objective: Here, the authors assessed and estimated the required treatment expenditures for HCV infection and advantage in the reduction of hepatocellular carcinoma incidence based on the analysis of possible options in an endemic area. Methods: A medical economics analysis was done. Results: According to the cost–utility analysis, the best alternative option that is hereby recommended is DAA medication coverage for all cases. Conclusion: DAA medication coverage for all cases is recommended.
Histopathological Spectrum of Bone Changes in Skeletal Metastasis
Authors: Baliyan Asif , Punia Rajpal Singh , Kundu Reetu , Dhingra Harshi , Aggarwal Purnima , Garg Sudhir Kumar
Published: February 2020

Background: Metastatic carcinoma is the most common secondary malignant tumor affecting the bone. Bone is the third most common site for metastasis after lung and liver. The present study was planned to analyze the histomorphological patterns of bone changes in metastatic tumors and their correlation with the radiological findings. Materials and Methods: The current prospective study was conducted over a span of 2 years, encompassing 150 patients with clinically and radiologically suspected metastatic bone disease. Bone biopsy samples were studied for the pattern of bone changes. Results: Of 150 total cases, 30 cases had metastatic bone tumors. The age of the patients ranged from 37 to 84 years (mean: 57.57 ± 11.9 years). Male-to-female ratio was 2:1. All patients with metastasis presented with a complaint of pain followed by tenderness (20, 66.7%). The lesions were commonly located in the vertebral column (14, 46.7%), followed by femur (6, 20%). The primary site was known in 21 (70%) cases. The tumor histotypes were adenocarcinoma (23, 76.7%), squamous cell carcinoma (5, 16.7%), pleomorphic sarcoma (1, 3.3%), and malignant melanoma (1, 3.3%). Histomorphological patterns of bone changes were osteolytic (16, 53.3%), mixed (8, 26.7%), and osteoblastic (6, 20.0%). Correlation between the radiological findings and histopathological patterns of metastases was found to be statistically significant. Conclusions: Histomorphological assessment of bone changes in metastasis is an important parameter. Besides the histological categorization of metastatic bone disease, it plays a pivotal role in identification of the primary tumor site.
Giant Sacrococcygeal Teratoma in Neonate: A Case Report and Review of Literature
Authors: Meshram Rajkumar Motiram , Nikila R , Nagdive Nilesh
Published: February 2020

Sacrococcygeal teratoma is considered the most common tumor in the neonatal period with a female-to-male ratio of 3–4:1. They are believed to arise early in gestation from the totipotential cells of Hensen’s node and the derived ectoderm, mesoderm, and endoderm. A 2.25 kg cesarean-delivered male, term neonate presented with large nonpulsatile, globular erythematous mass with lobulated surface and variable consistency. Magnetic resonance imaging of the lumbosacral spine showed multilocular cystic and solid lesion with foci of calcification and subtle communication with spinal canal. Histopathological examination showed mature endodermal, ectodermal, and mesenchymal elements such as cartilage, glial tissues, keratin cyst, and glandular elements with focus of primary neuroepithelial and pancreatic elements. Entire tumor was excised. The baby expired secondary to wound infection. Early diagnosis by improving antenatal care with timely surgical intervention and good nursing care improves the outcome.
Thyroid Transcription Factor-1 Expression in Adenocarcinoma Lung and Its Association with Histomorphological Features
Authors: Shukla Saumya , Husain Nuzhat , Anand Nidhi , Kant Surya , Garg Rajiv , Verma SK , Kumar Santosh , Prakash Ved
Published: February 2020

Objectives: Thyroid transcription factor-1 (TTF-1) expression is frequently associated with adenocarcinoma lung. This study was undertaken with the objectives to assess the expression of TTF-1 in non-small cell lung carcinoma (NSCLC) with adenocarcinoma phenotype and to evaluate the TTF-1 expression with clinicopathological and histomorphological features. Materials and Methods: This was a tertiary care hospital-based case series that included 250 cases of NSCLC. TTF-1 immunostaining along with a basic panel of immunohistochemistry markers was performed. The histomorphological analysis was done to compare the morphological features of TTF-1-positive versus TTF-1-negative cases. Results: TTF-1 was positive in 144 cases (57.6%), while 106 cases were negative for TTF-1. The M: F ratio in the TTF-1-positive group was 1:2, and the mean age of the cases that expressed TTF-1 was 48.5 years. The most common pattern in the TTF-1-positive group was loose clusters or singly dispersed cells (77.78%), followed by the acinar (54.86%) and solid pattern (42.36%). In the TTF-1-negative group, 86.79% of cases had singly dispersed cells or loose cohesive clusters, followed by a solid pattern in 50.94% cases. Conclusion: TTF-1 is a useful and reliable marker for pulmonary adenocarcinoma. TTF-1 expression does not have any association with the patterns and degree of differentiation evident in the tumor.
The Conundrum of Dual Primary Malignancies: Four Years’ Experience of a Single Tertiary Care Institute in India
Authors: Bisht Niharika , Singh Sankalp , Sarin Arti , Gupta Samir , Singh Harinder Pal , Kapoor Amul , Mulajker Deepak , Joshi Richa , Purkayastha Abhishek , Mishra Prabha Shankar , Shelly Divya
Published: February 2020

Background: Encountering more than one malignancy in a cancer patient is no longer uncommon; this increasing incidence is mostly attributable to the improvements in life expectancy, awareness, and diagnostic facilities. This article aims to highlight this institute’s experience in diagnosis and treatment of patients of multiple primary malignancies and a comprehensive review of literature. Materials and Methods: This is a descriptive study of retrospectively collected data of a single institution over 4 years from 2013 to 2016. Known cases of cancer who were diagnosed with a second primary malignancy were included in the study. Various details such as age, sex, site of disease, temporal relation of two cancers (synchronous or metachronous), family history, tobacco use, treatment given, and survival at 1 year were recorded, organized in a tabular form, analyzed, and described. Results: A total of 29 cases of dual malignancies comprising 0.74% of a total of 3879 patients of cancer were encountered. Seventy-two percent of the cases were metachronous and 5 years was the mean time interval between tumors. There was a female preponderance, and the average age was 56 years. Breast was the most common site of malignancy. At 1 year from diagnosis of second primary, 69% of the patients were alive and 27% were disease-free. Conclusion: Second primary in a patient of cancer is becoming increasingly common and the suspicion of the same should always be borne in mind during follow-up. Prognosis as well as intent of treatment depends on respective stages of the two malignancies.
Secondary Osteosarcoma of Pelvic Bone: Long-Term Complication of Bladder Cancer Radiotherapy
Authors: Prasad K Siva , Bala Stalin , Ravichandran Ambalathandi , Sadashivudu Gundeti
Published: February 2020

Second cancer in the irradiated area is one of the complication of radiotherapy of which bone and soft tissue sarcomas predominate. Radiation-induced osteosarcoma (RIOS)accounts for 3.4%–5.5% of all osteosarcoma cases. A 70-year old male presented with complaints of swelling and pain in left gluteal region without any antecedent trauma. On clinical examination 8 × 8 cm size swelling palpable in left gluteal region arising form left iliac bone. He had history of bladder carcinoma 20 years ago for which he received concurrent chemoradiation. CT scan showed a large, erosive and lytic lesion of left iliac bone and biopsy of the lesion was suggestive of osteosarcoma. In view of extensive lesion eroding left half of pelvic bone, surgery was not done, and chemotherapy was planned.
Management and Long-term Outcomes of Giant Mediastinal Germ Cell Tumors in Children
Authors: Khanna Kashish , Agarwala Sandeep , Bishoi Akshay Kumar , Bakhshi Sameer , Bhatnagar Veereshwar
Published: February 2020

Purpose: The purpose of the study is to evaluate the outcome of children with giant mediastinal germ cell tumors (GCTs). Materials and Methods: A retrospective study of children diagnosed with GCTs treated at our hospital from 1998 to 2014 was performed. They were evaluated for their tumor size, malignancy, treatment, complications, and outcome. Results: Twelve giant mediastinal GCT patients were included in the study. Age ranged from 7 to 144 months (median 12 months) and all except one were males. The average tumor size was 10.4 cm (range 6 cm × 5 cm–16 cm × 13 cm) and in four patients, they were large enough to occupy nearly the entire hemithorax. Nine children had benign tumors, and these were resected upfront. The remaining three cases with malignant disease received neoadjuvant chemotherapy. No significant reduction in size was noticed in these patients, but alpha-fetoprotein levels decreased in all the three, and they were later resected. Eight (67%) were resected through posterolateral thoracotomy and 4 (33%) through median sternotomy approach. One patient had a dumbbell-shaped thoracoabdominal tumor extending through a Bochdalek hernia. He required additional laparotomy as well as diaphragmatic repair. There were no postoperative complications. The malignant GCTs received total four courses of PEB. All patients were alive and asymptomatic at a mean follow-up of 55.4 months (range 10–146 months). Conclusions: Mediastinal GCTs have bimodal age distribution and show male preponderance. Malignant mediastinal GCTs responded well to neoadjuvant chemotherapy through a reduction in size was not noticed. Complete excision often in coordination with cardiothoracic-vascular surgeons can lead to long-term symptom-free survival even in giant tumors.
Choroid Plexus Carcinoma Enmasked with Soft Signs and Symptoms
Authors: Appaji Shruti , Prasad KNV
Published: February 2020

Choroid plexus carcinomas (CPCs) are rare brain tumors, with preponderance in infants. They are highly invasive tumors with a dismal prognosis. The 5-year survival rates for CPC vary between 10% and 50%. They commonly arise from the lateral ventricles. CPCs in infants present with the subtle features of raised intracranial tension (ICT). Surgical resection is the mainstay of management with adjuvant chemotherapy and radiotherapy. We report a case of 11-month-old child with CPC, presented with subtle nonspecific signs and symptoms of raised ICT, treated by surgical resection and chemotherapy.
Treatment Adherence and Abandonment in Acute Myeloid Leukemia in Pediatric Patients at a Low-Resource Cancer Center in India
Authors: Sinha Sudha , Brattström Gustav , Palat Gayatri , Rapelli Vineela , Segerlantz Mikael , Brun Eva , Wiebe Thomas
Published: February 2020

Aim: One of the causes for lower cure rates in acute childhood leukemia in low- and middle- income countries (LMIC) compared to high-income countries is abandonment from treatment. The International Society of Pediatric Oncology (SIOP) defines abandonment as failure to begin treatment or an absence of 4 weeks during treatment. The aim of this study was to evaluate the extent of abandonment among patients diagnosed with acute myeloid leukemia (AML) at the pediatric ward at a low-resource cancer center in India. Methods: Medical records of all patients, aged 0–15 years, diagnosed with AML between January 1, 2014, and March 31, 2015, at the hospital were reviewed. Age, sex, date of diagnosis, and survival during the short follow-up time after completed treatment and information regarding abandonment were collected. SIOP definition of abandonment was used. Eight patients were diagnosed with AML at the hospital whereof 65 met the inclusion criteria of this study. Results: Of the included 65 patients, 6 died before treatment could be initiated and 3 were referred to palliative care upfront. Thus, 56 patients were offered curatively intended treatment. Of these patients, six refused treatment at this stage and another five abandoned during therapy. Altogether, 11 children abandoned treatment. Conclusion: In this study, the abandonment rate from treatment of childhood AML was 20%, which is in concordance from other studies conducted in India and other LMIC, stating that abandonment is a problem and hindrance when treating with a curative intent.
Mucoepidermoid Carcinoma of the Vulva: A Distinct Pathological and Clinical Entity
Authors: Sinha Satyendra Narayan , Choudhary Brajesh Kumar , Kumar Sanjay , Singh Manisha
Published: February 2020

Unlike their major salivary gland counterparts, primary mucoepidermoid carcinoma of the vulva is extremely rare tumor. Here, we describe an unusual case of MEC arising from vulva and a short review of literature. This report describes an interesting and unusual case of mucoepidermoid carcinoma of vulva. A 42-year female presented with approx. 3.5 x 3.0 cm size painless polypoidal growth on right labia majora. CT scan abdomen & pelvis showed 30 x 27 cm size well defined lobulated polypoidal lesion is noted in right side of labia majora. Wide local excision had done with margin. Histological evaluation revealed a typical MEC with negative margin. Our tumor board has decided to keep on close follow-up because of the aggressive behaviour of such type of tumour. Follow-up at 6 months has revealed no evidence of recurrence. This is, to our knowledge, the first report of MEC arising from vulva in India. We report a very rare case of primary mucoepidermoid carcinoma of the vulva and this is the first case reported in India. Treatment strategy for MEC vulva yet to decide and patients should be closely followed-up for life to rule out late recurrence.
Clinical Implication of Concordant or Discordant Genomic Profiling between Primary and Matched Metastatic Tissues in Patients with Colorectal Cancer
Authors: Choi Jung Yoon , Choi Sunho , Lee Minhyeok , Park Young Soo , Sung Jae Sook , Chang Won Jin , Kim Ju Won , Choi Yoon Ji , Kim Jin , Kim Dong-Sik , Lee Sung-Ho , Seok Junhee , Park Kyong Hwa , Kim Seon Hahn , Kim Yeul Hong
Published: February 2020

PurposeThe purpose of this study was to identify the concordant or discordant genomic profiling between primary and matched metastatic tumors in patients with colorectal cancer (CRC) and to explore the clinical implication.Materials and MethodsSurgical samples of primary and matched metastatic tissues from 158 patients (335 samples) with CRC at Korea University Anam Hospital were evaluated using the Ion AmpliSeq Cancer Hotspot Panel. We compared genetic variants and classified them as concordant, primary-specific, and metastasis-specific variants. We used a combination of principal components analysis and clustering to find genomic groups. Kaplan-Meier curves were used to appraise survival between genomic groups. We used machine learning to confirm the correlation between genetic variants and metastatic sites.ResultsA total of 282 types of deleterious non-synonymous variants were selected for analysis. Of a total of 897 variants, an average of 40% was discordant. Three genomic groups were yielded based on the genomic discrepancy patterns. Overall survival differed significantly between the genomic groups. The poorest group had the highest proportion of concordant KRAS G12V and additional metastasis-specific SMAD4. Correlation analysis between genetic variants and metastatic sites suggested that concordant KRAS mutations would have more disseminated metastases.ConclusionDriver gene mutations were mostly concordant; however, discordant or metastasis-specific mutations were present. Clinically, the concordant driver genetic changes with additional metastasis-specific variants can predict poor prognosis for patients with CRC.
Kähler manifolds with geodesic holomorphic gradients
Authors: Derdzinski Andrzej , Piccione Paolo
Published: February 2020

We prove a dichotomy theorem about compact Kähler manifolds admitting nontrivial real-holomorphic geodesic gradient vector fields, which has the following consequence: either such a manifold satisfies an additional integrability condition, or through every zero of the real-holomorphic geodesic gradient there passes an uncountable family of totally geodesic, holomorphically immersed complex projective spaces, each carrying a fixed multiple of the Fubini–Study metric. We also obtain a classification result for the case where the integrability condition holds, implying that the manifold must then be biholomorphically isometric to a bundle of complex projective spaces with a bundle-like metric.
Precipitation enhancement in stratocumulus clouds through airbourne seeding: sensitivity analysis by UCLALES–SALSA
Authors: Tonttila Juha , Afzalifar Ali , Kokkola Harri , Raatikainen Tomi , Korhonen Hannele , Romakkaniemi Sami
Published: February 2020

Abstract. Artificial enhancement of precipitation via hygroscopic cloud seeding is investigated with a numerical large-eddy simulation model coupled with a spectral aerosol-cloud microphysics module. We focus our investigation on marine stratocumulus clouds and evaluate our model results by comparing them with recently published results from field observations. Creating multiple realizations of a single cloud event with the model provides a robust method to detect and attribute the seeding effects, which reinforces the analysis based on experimental data. Owing to the detailed representation of aerosol-cloud interactions, our model successfully reproduces the microphysical signatures attributed to the seeding, that were also seen in the observations. Moreover, the model simulations show up to a 2–3 fold increase in the precipitation flux due to the seeding, depending on the seeding rate and injection strategy. However, our simulations suggest that a relatively high seeding particle emission rate is needed for a substantial increase in the precipitation yield, as compared with the estimated seeding concentrations from the field campaign. In practical applications, the seeding aerosol is often produced by flare burning. It is speculated, that the required amount of large seeding particles suggested by our results could pose a technical challenge to the flare-based approach.