bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: design of a randomized controlled trial
Authors: ter Meulen Bastiaan C. , Maas Esther T. , Vyas Amrita , van der Vegt Marinus , de Priester Koo , de Boer Michiel R. , van Tulder Maurits W. , Weinstein Henry C. , Ostelo Raymond W. J. G.
Published: May 2017

Background

Transforaminal epidural injections with steroids (TESI) are used increasingly for patients with sciatica. However there is much debate about their safety and effectiveness. It is important to identify patients that benefit most from TESI and only few trials have yet evaluated the effects in patients with acute sciatica.

Methods

We describe a prospective, randomized controlled trial (RCT), with the aim to evaluate the hypothesis that TESI plus Levobupivacaine (TESI-plus) added to oral pain medication is more effective compared to pain medication alone or compared to transforaminal injection with a local anesthetic of short duration among patients with acute sciatica. We will recruit a total of 264 patients with sciatica (<8 weeks) caused by a herniated disc, from two clinical sites. Participants are randomly assigned one of three study groups: 1) oral pain medication (control group), 2) oral pain medication and TESI-plus (intervention group one), 3) oral pain medication and transforaminal epidural injection (TEI) with Levobupivaine and saline solution (intervention group two). Primary outcomes are functional status (Roland-Morris Disability Questionnaire), pain intensity for both leg and back, (100 mm visual analogous scale (VAS)), and global perceived recovery (GPR, reported on a 7-point Likert scale, dichotomized into ‘recovered’ and ‘not recovered’). The secondary outcomes are health-related quality of life (EQ5D-5 L) and patient satisfaction (7-point Likert scale). We will also collect information on healthcare utilization and costs, to perform an economic evaluation. All outcomes are measured at three and six weeks, three and six months after randomization. We defined a minimal clinically relevant difference between groups as a difference between both intervention groups and the control group of 20 points for pain (100-point VAS), four points for functional status (24-point RDQ) and a 20% difference on dichotomized GPR (recovered versus not recovered).

Discussion

A clinically relevant outcome in favor of TESI-plus implies that future patients with acute sciatica should be recommended TESI-plus within the first few weeks rather than being treated with pain medication alone in order to relieve pain and improve their functioning. In case of a negative result (no relevant differences in outcome between the three study arms), pain medication will remain the mainstay of treatment in the acute stages of sciatica.

Trial registration

Dutch National trial register:NTR4457(March, 6th, 2014)
Identifying high quality medical education websites in Otolaryngology: A guide for medical students and residents
Authors: Yang Nathan , Hosseini Sarah , Mascarella Marco A. , Young Meredith , Posel Nancy , Fung Kevin , Nguyen Lily H. P.
Published: May 2017

Background

Learners often utilize online resources to supplement formalized curricula, and to appropriately support learning, these resources should be of high quality. Thus, the objectives of this study are to develop and provide validity evidence supporting an assessment tool designed to assess the quality of educational websites in Otolaryngology- Head & Neck Surgery (ORL-HNS), and identify those that could support effective web-based learning.

Methods

After a literature review, the Modified Education in Otolaryngology Website (MEOW) assessment tool was designed by a panel of experts based on a previously validated website assessment tool. A search strategy using a Google-based search engine was used subsequently to identify websites. Those that were free of charge and in English were included. Websites were coded for whether their content targeted medical students or residents. Using the MEOW assessment tool, two independent raters scored the websites. Inter-rater and intra-rater reliability were evaluated, and scores were compared to recommendations from a content expert.

Results

The MEOW assessment tool included a total of 20 items divided in 8 categories related to authorship, frequency of revision, content accuracy, interactivity, visual presentation, navigability, speed and recommended hyperlinks. A total of 43 out of 334 websites identified by the search met inclusion criteria. The scores generated by our tool appeared to differentiate higher quality websites from lower quality ones: websites that the expert “would recommend” scored 38.4 (out of 56; CI [34.4–42.4]) and “would not recommend” 27.0 (CI [23.2–30.9]). Inter-rater and intra-rater intraclass correlation coefficient were greater than 0.7.

Conclusions

Using the MEOW assessment tool, high quality ORL-HNS educational websites were identified.
Subsidies for Oral Chemotherapy and Use of Immunomodulatory Drugs Among Medicare Beneficiaries With Myeloma
Authors: Olszewski Adam J. , Dusetzina Stacie B. , Eaton Charles B. , Davidoff Amy J. , Trivedi Amal N.
Published: May 2017

Purpose

The low-income subsidy (LIS) substantially lowers out-of-pocket costs for qualifying Medicare Part D beneficiaries who receive orally administered chemotherapy. We examined the association of LIS with the use of novel oral immunomodulatory drugs (IMiDs; lenalidomide and thalidomide) among beneficiaries with myeloma, who can receive either orally administered or parenteral (bortezomib-based) therapy.

Methods

Using SEER-Medicare data, we identified Part D beneficiaries diagnosed with myeloma in 2007 to 2011. In multivariable models adjusted for sociodemographic and clinical characteristics, we analyzed associations between the LIS and use of IMiD-based therapy, delays between IMiD refills, and select health outcomes during the first year of therapy.

Results

Among 3,038 beneficiaries, 41% received first-line IMiDs. Median out-of-pocket cost for the first IMiD prescription was $3,178 for LIS nonrecipients and $3 for LIS recipients, whereas the respective median costs for the first year of therapy were $5,623 and $6, respectively. Receipt of the LIS was associated with a 32% higher (95% CI, 16% to 47%) probability of receiving IMiDs among beneficiaries age 75 to 84 years and a significantly lower risk of delays between refills in all age groups (adjusted relative risk, 0.54; 95% CI, 0.32 to 0.92). Duration of therapy did not significantly differ between LIS recipients and nonrecipients (median, 7.6 months). Patients treated with IMiDs had significantly fewer emergency department visits and hospitalizations compared with patients receiving bortezomib (without IMiDs), but 1-year overall survival and cumulative Medicare costs were similar.

Conclusion

Medicare beneficiaries with myeloma who do not receive LISs face a substantial financial barrier to accessing orally administered anticancer therapy, warranting urgent attention from policymakers. Limiting out-of-pocket costs for expensive anticancer drugs like the IMiDs may improve access to oral therapy for patients with myeloma.
Ethics and Oncofertility: A Call for Religious Sensitivity
Authors: Hanselin Michele R. , Roybal Deborah L. , Leininger Thomas B.
Published: May 2017

For patients of reproductive age, treating cancer may come at the price of infertility. Literature regarding fertility preservation recommendations in this population has increased significantly, but this literature too often overlooks or insufficiently considers the relevance of religious preferences. Similarly, practice guidelines do not address the role of religion in the oncofertility discussion. The acceptance of oncofertility practices varies significantly among Christianity, Judaism, and Islam. A patient’s faith-based spirituality or secular morality may enhance his or her interpretation of the meaning of illness and should be incorporated into the informed-consent process. In this article, we describe the role of religious sensitivity in oncofertility care and argue for its importance in such care. We briefly summarize the views and moral reasoning about oncofertility in a few religions commonly encountered in many patient populations today. We recommend that clinicians discuss fertility options early in the decision process and, when relevant, incorporate the patient’s moral and religious preferences into the treatment plan. We encourage providers to be prepared to offer resources to patients who desire moral and spiritual guidance about fertility preservation options. Hospital chaplains should be able to provide such resources.
Hyperparathyroidism-Jaw Tumor Syndrome Associated With Large-Scale 1q31 Deletion
Authors: Rubinstein Jill C. , Majumdar Sachin K. , Laskin William , Lazaga Francisco , Prasad Manju L. , Carling Tobias , Khan Sajid A.
Published: May 2017

Hyperparathyroidism-jaw tumor syndrome (HPT-JT) is a rare autosomal dominant cause of familial hyperparathyroidism associated with benign, ossifying fibromas of the maxillofacial bones and increased risk of parathyroid carcinoma. The putative tumor suppressor gene CDC73 has been implicated in the syndrome, with a multitude of inactivating mutations identified; however, HPT-JT due to large-scale deletion of the chromosomal region containing the gene is exceedingly rare, and the clinical significance of this variant remains unclear. We report the case of a 32-year-old woman with a history of mandibular ossifying fibroma who presented with primary hyperparathyroidism and was found to harbor a large-scale, germline deletion on chromosome 1q31, including the CDC73 locus. HPT-JT is associated with loss of function of the putative tumor suppressor gene CDC73. Over 100 mutations and small insertions/deletions have been identified within the gene, the majority of which result in premature truncation of the parafibromin protein product. We report a case of HPT-JT associated with a large chromosomal deletion (4.1 Mb) encompassing the CDC73 gene locus. In the future, molecular testing in this autosomal dominant disorder should use techniques that allow for the detection of large-scale deletions in addition to the more commonly observed mutations and smaller-scale copy number alterations. Further investigation is needed to determine whether HPT-JT associated with a large-scale deletion carries increased risk of malignancy relative to the more common truncating mutations and what the implications are for genetic counseling.
Oral Histories as a Window to Sociolinguistic History and Language History: Exploring Earlier Ontario English with the Farm Work and Farm Life Since 1890 Oral History Collection
Authors: Denis Derek
Published: May 2017

Archival oral histories provide sociolinguists with invaluable empirical insight, particularly with respect to studying vernaculars of the past. Because the goal of the oral history methodology is to capture authentic, first-person accounts, the recordings are comparable to sociolinguistic interviews. In this audio feature, the Farm Work and Farm Life Since 1890 Oral History project, which contains interviews with elderly farmers in Ontario, Canada, born between 1890 and 1920, is used to exemplify the utility of oral histories, particularly for variationist sociolinguists. The audio feature first demonstrates the parallels between sociolinguistic interviews and oral histories: both exhibit Labovian “casual speech” and high-emotive topics, both diminish the role of the interviewer, and, perhaps most importantly for variationist sociolinguists, both contain sociolinguistic variation. The remainder of the audio feature highlights some of this variation, including negative concord, was/were variation, and discourse like, and closes with a discussion of two revelations about the sociohistorical and sociolinguistic nature of the speech communities examined.
Characterization of the mammalian RNA exonuclease 5/NEF-sp as a testis-specific nuclear 3′ → 5′ exoribonuclease
Authors: Silva Sara , Homolka David , Pillai Ramesh S.
Published: May 2017

Ribonucleases catalyze maturation of functional RNAs or mediate degradation of cellular transcripts, activities that are critical for gene expression control. Here we identify a previously uncharacterized mammalian nuclease family member NEF-sp (RNA exonuclease 5 [REXO5] or LOC81691) as a testis-specific factor. Recombinant human NEF-sp demonstrates a divalent metal ion-dependent 3′ → 5′ exoribonuclease activity. This activity is specific to single-stranded RNA substrates and is independent of their length. The presence of a 2′-O-methyl modification at the 3′ end of the RNA substrate is inhibitory. Ectopically expressed NEF-sp localizes to the nucleolar/nuclear compartment in mammalian cell cultures and this is dependent on an amino-terminal nuclear localization signal. Finally, mice lacking NEF-sp are viable and display normal fertility, likely indicating overlapping functions with other nucleases. Taken together, our study provides the first biochemical and genetic exploration of the role of the NEF-sp exoribonuclease in the mammalian genome.
O primeiro planejamento estratégico da empresa ABC Software
Authors: Rocha Marcus José , Cancellier Éverton Luís Pellizzaro De Lorenzi
Published: May 2017

A ABC Software é uma empresa de tecnologia de pequeno porte, que distribui no Brasil o software de uma empresa dos EUA, no modelo SaaS (Software as a Service, ou Software como Serviço). A empresa percebe que não está alcançando os objetivos propostos pelos seus sócios, e também vem enfrentando diversas pressões do ambiente externo. O estilo de tomada de decisão estratégica, centralizado nos sócios e baseado em reações a acontecimentos pontuais, também não está funcionando. A partir dessa situação, o diretor-geral da empresa contrata o Sr. Smith, um consultor norte-americano que não fala português, para realizar um planejamento estratégico utilizando o método E-Myth, desconhecido para todos na empresa e que não prevê a análise SWOT. Tal situação de mudança representa diversos desafios para a ABC Software, principalmente na adaptação a um novo modelo de gestão e a uma nova metodologia de planejamento e execução das suas estratégias.
Em conexão com os cidadãos
Authors: Malaquias Rodrigo Fernandes
Published: May 2017

A Internet das Coisas permite novas soluções para gestão pública, governança, transporte, urbanismo, sustentabilidade, educação, saúde, segurança e economia.
Novos rumos para a gestão do desempenho
Authors: Lacombe Beatriz Maria Braga
Published: May 2017

As pessoas precisam agir de acordo com o novo sistema, em que a informalidade não significa ausência de regras e a avaliação se dissocia de recompensas monetárias.
Identidad Nacional y sus relaciones con la ideología y el bienestar en 5 países de América Latina
Authors: Espinosa Pezzia Agustín , Soares da Silva Alessandro , Contreras Ibáñez Carlos , Cueto Rosa María , García Rengifo Aldo , Ortolano Fabio , Valencia Juan , Vera Ruíz Angela
Published: May 2017

Este estudio busca analizar las relaciones entre los componentes de la identidad nacional, la ideología política, en sus manifestaciones autoritaria y de dominancia social, y las expresiones del bienestar subjetivo y social en muestras de 5 países de América Latina. Para tal fin, se desarrolló un estudio por encuestas en Brasil, Chile, Colombia, México y Perú (n=1039). Los resultados evidencian relaciones significativas entre las expresiones ideológicas con algunas dimensiones de la identidad. La ideología autoritaria se relaciona positivamente con los componentes identitarios, mientras que la ideología de dominancia social lo hace en menor medida y de manera inversa. Las relaciones entre los componentes de la identidad y el bienestar presentan un asociación positiva, y estas relaciones son más intensas en el caso del bienestar social que en el caso del bienestar subjetivo aunque cierta heterogeneidad por país también es observada. Se intentó proponer un modelo general de las relaciones entre las variables derivadas de los tres constructos pero esta no alcanzó buenos niveles de ajuste, lo que se explicaría por la heterogeneidad de los resultados obtenidos por país.
Intervenções com Pais e Bebês Prematuros Internados em UTIN: uma revisão sistemática
Authors: Márcia Márcia Schaefer
Published: May 2017

Este estudio es una revisión sistemática de la literatura acerca de intervenciones facilitadoras del vínculo padre-hijo celebrada con padres y bebés prematuros hospitalizados en Unidad de Cuidados Intensivos Neonatales, publicados en los últimos diez años. Fueron utilizados como términos de búsqueda “intervenciones and bebés prematuros and unidad de cuidados intensivos” y sus traducciones al inglés, incluyendo artículos empíricos, disponibles en su totalidad y publicados en inglés, portugués o español, que surge de la medicina, psicología, enfermería, psiquiatría o multidisciplinaria. Se analizaron los resultados por medio de diez categorías: tipos de publicación, año de publicación, continente y país de origen, investigadores académicos, idioma predominante en las publicaciones, objetivos del estudio, diseño, participantes, herramientas e intervenciones usadas, resultados. Se encontraron once artículos publicados principalmente en revistas médicas, compuestos por autores multidisciplinares, de diseño cuantitativo, y la díada madre-hijo como participante. No hubo artículos de solamente psicólogos, que compusieron dos estudios multidisciplinares, que muestra la necesidad de una comprensión de este fenómeno, ya que las repercusiones de los primeros eslabones de la evolución general de los individuos están profundamente cubiertos en psicología
Convergencia arte-ciencia: Comentario sobre la obra de Norberto Garcia Cairasco
Authors: Palta Jairo A.
Published: May 2017

Con mucha frecuencia se ha considerado al arte y la ciencia como polos opuestos del conocimiento. Posiblemente esta apreciación tenga su origen en el hecho de que, en nuestra época de colegiales, se nos enseñó a mirarlos como entidades separadas. Este paradigma nos marcó hasta tal punto que, en el momento de seleccionar una carrera, hicimos que nuestra elección apuntara a uno solo de losdos –arte o ciencia- y, como resultado, “quedamos anclados” a un solo lado del cerco.
What Motivates Buy-Side Analysts to Share Recommendations Online?
Authors: Crawford Steven , Gray Wesley , Johnson Bryan R. , Price Richard A.
Published: May 2017

We examine why buy-side analysts share investment ideas on SumZero.com, a private social networking website designed to facilitate interaction and information sharing among buy-side professionals. We explore labor market motivations for information sharing and document that analysts with strong incentives to build a reputation (i.e., those who did not attend a top 10 university and those employed at small funds) are significantly more likely to share recommendations. Our findings indicate that analysts who share ideas are more likely to change jobs and that the likelihood of employment change is positively related to the ratings provided by peers. We also document that analyst recommendations generate significant returns when they are posted on SumZero and that prices drift in the direction of the recommendation. Long-window returns are particularly strong for contrarian buy recommendations and for most sell recommendations. Overall, we show that buy-side analysts share valuable private information in an online social network and that this can be an effective reputation-building and job-seeking tool.

This paper was accepted by Mary Barth, accounting.
Analysis of Traffic Statics and Dynamics in Signalized Networks: A Poincaré Map Approach
Authors: Gan Qi-Jian , Jin Wen-Long , Gayah Vikash V.
Published: May 2017

An understanding of traffic statics and dynamics is critical for developing effective and efficient control strategies for a signalized road network with turning movements, especially under oversaturated conditions. In this study, we first describe traffic dynamics in a signalized double-ring network with the link queue model, which is a space-continuous approximation of the network kinematic wave model, and rewrite it as a switched affine system, assuming a triangular traffic flow fundamental diagram. Then we define periodic density evolution orbits as stationary states in the network and introduce a Poincaré map in densities, whose fixed points correspond to stationary states. With short cycle lengths and identical green times and retaining ratios in both rings, we are able to derive the closed form of the Poincaré map, from which we can analytically solve stationary states and study their stability properties; it is found that a stationary state can be asymptotically stable, Lyapunov stable, or unstable. By defining the network flow-density relation in stationary states as the macroscopic fundamental diagram (MFD), we analytically derive an approximate closed-form formula for MFD with green ratios and retaining ratios as parameters. We confirm that in stationary states the network flow rate may not be uniquely defined, and the network can reach a gridlock state at relatively low densities. We also analyze the convergence patterns to asymptotically stable gridlock states with different retaining ratios and initial densities. With more general signal settings and retaining ratios, we develop a secant method to numerically solve the fixed points of the Poincaré maps and plot the corresponding MFDs. Furthermore, numerical simulations are used to study traffic statics in a homogeneous signalized grid network; simulation results reveal a high level of similarity in traffic patterns between the signalized double-ring and grid networks and validate analytical insights obtained from the former. This study provides a springboard for future analytical and numerical studies on traffic statics and dynamics in more general signalized road networks.

The online appendix is available at https://doi.org/10.1287/trsc.2017.0740
Will royal patronage improve perceptions of mental illness?
Authors: Glasper Alan
Published: May 2017

Emeritus Professor Alan Glasper, from the University of Southampton, discusses the stigma still suffered by people with mental health disorders and whether a recently launched campaign can help challenge it
Cardiac Papillary Fibroelastoma with Coronary Artery Anomaly: A Case Report
Authors: Xu Hongfei , Chen Liangwei , Ye Chengmeng , Owusu-Ansah Kwabena Gyabaah , Ni Yiming , Li Weidong
Published: May 2017

Primary cardiac tumors are extremely rare with occurrence range of about 0.0017-0.28%. Papillary fibroelastoma is a benign cardiac neoplasms. Improvement in the early diagnosis has been made possible with the help of high-resolution imaging technology, such as transesophageal echocardiography, combined with ischemic or embolic complications which patients typically present with clinically. We herein present a 51-year-old female patient with a papillary fibroelastoma on the aortic cusp, with its origin from the left coronary sinus. Her only clinical manifestation was angina-like chest pain and syncope. Surgical resection with aortic valve replacement due to the defect as a result of the resected tumor was performed with the patient on cardiopulmonary bypass. The patient recovered uneventfully and was discharged.  A 2-year follow-up showed an intact valve without tumor recurrence.
Congenital Giant Right Atrial Aneurysm: Echocardiographic Diagnosis and Surgical Management
Authors: Wang Yao , Liu Aijun , Ye Weihua
Published: May 2017

Congenital right atrial aneurysm is a rare abnormality and may easily be confused with various anomalies, such as pericardial effusion, pericardial cysts, tumors, and Ebstein’s anomaly. Patients with right atrial aneurysm may be asymptomatic; but some patients may develop life-threatening complications, such as arrhythmias, congestive heart failure, or pulmonary embolism. Therefore, it is essential for correct diagnosis and appropriate patient management. We report a case of giant right atrial aneurysm in a 7-year-old boy who presented with progressive protrusion of chest. Echocardiography established the definitive diagnosis and surgical resection was successful.
Lessons from Crew Resource Management for Cardiac Surgeons
Authors: Marvil Patrick , Tribble Curt
Published: May 2017

Crew resource management (CRM) describes a system developed in the late 1970s in response to a series of deadly commercial aviation crashes. This system has been universally adopted in commercial and military aviation and is now an integral part of aviation culture. CRM is an error mitigation strategy developed to reduce human error in situations in which teams operate in complex, high-stakes environments. Over time, the principles of this system have been applied and utilized in other environments, particularly in medical areas dealing with high-stakes outcomes requiring optimal teamwork and communication. While the data from formal studies on the effectiveness of formal CRM training in medical environments have reported mixed results, it seems clear that some of these principles should have value in the practice of cardiovascular surgery.
Pentecostalism and the Encounter with Traditional Religion in Tanzania
Authors: Lindhardt Martin
Published: May 2017

This research article explores how expressions of Pentecostal/Charismatic Christianity in Tanzania have taken shape through a complex entanglement with African traditional religion and traditional healing. On the one hand, Tanzanian Pentecostals/Charismatics conceive of figures associated with the world of tradition (witches, traditional healers, different kinds of spirits) as the main adversaries in the spiritual warfare they understand themselves to be engaged in. At the same time I show how many of the beliefs that we might lump under the category of “tradition” constitute something of a common cultural ground that cuts across ethnic and religious divides. While Pentecostal/Charismatic Christianity does in some ways represent a particular religious culture, I argue that we are also well served by considering Pentecostals/Charismatics as participants in a common and highly vibrant religious/spiritual/medical field where different kinds of interchanges, overlaps and mutual inspirations occur. For instance, I show how a concern with healing inspires multifaceted practices of positioning as Pentecostals/Charismatics both demonize traditional healers, and simultaneously take pains to highlight similarities between the power of God and the powers of traditional healing. Finally, I argue that processes of adaptation and the highlighting of similarities also imply a risk of confusion, as it sometimes becomes difficult to distinguish the power of God from the powers of healers and witchcraft.
Wet swelling effect on crack performance of facing concrete for rockfill dams
Authors: Xu Wenbin , Li Qingbin , Hu Yu , Li Shuguang
Published: May 2017

The swelling of aged concrete is a significant issue in the operation of dams such as concrete-faced rockfill dams (CFRDs). Swelling of concrete is one cause of tensile stress, which is typically related to water movement in concrete pores, especially around the water surface. In this study, the change in the interior relative humidity and deformation in aged concrete specimens around the surface of the water were measured. The experimental results revealed that the swelling of the concrete above the water surface was correlated with an increase in interior relative humidity due to water diffusion, while the swelling of the concrete submerged in the water developed in early and late stages and was dominated by capillary absorption and diffusion. A new theoretical swelling model was developed to predict the deformation development, and the theoretical predictions were validated by the experimental data. The swelling model was applied in a finite-element analysis of a CFRD to obtain more realistic stress distributions. The analysis indicated that the wet swelling of concrete had a significant impact on the increase in tensile stress distribution in the concrete slab around the water surface.
Glomerulosclerosis Induced by Deficiency of Membrane-Associated Guanylate Kinase Inverted 2 in Kidney Podocytes
Authors: Shirata Naritoshi , Ihara Kan-ichiro , Yamamoto-Nonaka Kanae , Seki Takuto , Makino Shin-ichi , Oliva Trejo Juan Alejandro , Miyake Takafumi , Yamada Hiroyuki , Campbell Kirk Nicholas , Nakagawa Takahiko , Mori Kiyoshi , Yanagita Motoko , Mundel Peter , Nishimori Katsuhiko , Asanuma Katsuhiko
Published: May 2017

Membrane-associated guanylate kinase inverted 2 (MAGI-2) is a component of the slit diaphragm (SD) of glomerular podocytes. Here, we investigated the podocyte-specific function of MAGI-2 using newly generated podocyte-specific MAGI-2–knockout (MAGI-2–KO) mice. Compared with podocytes from wild-type mice, podocytes from MAGI-2–KO mice exhibited SD disruption, morphologic abnormalities of foot processes, and podocyte apoptosis leading to podocyte loss. These pathologic changes manifested as massive albuminuria by 8 weeks of age and glomerulosclerosis and significantly higher plasma creatinine levels at 12 weeks of age; all MAGI-2–KO mice died by 20 weeks of age. Loss of MAGI-2 in podocytes associated with decreased expression and nuclear translocation of dendrin, which is also a component of the SD complex. Dendrin translocates from the SD to the nucleus of injured podocytes, promoting apoptosis. Our coimmunoprecipitation and in vitro reconstitution studies showed that dendrin is phosphorylated by Fyn and dephosphorylated by PTP1B, and that Fyn-induced phosphorylation prevents Nedd4–2–mediated ubiquitination of dendrin. Under physiologic conditions in vivo, phosphorylated dendrin localized at the SDs; in the absence of MAGI-2, dephosphorylated dendrin accumulated in the nucleus. Furthermore, induction of experimental GN in rats led to the downregulation of MAGI-2 expression and the nuclear accumulation of dendrin in podocytes. In summary, MAGI-2 and Fyn protect dendrin from Nedd4–2–mediated ubiquitination and from nuclear translocation, thereby maintaining the physiologic homeostasis of podocytes, and the lack of MAGI-2 in podocytes results in FSGS.
Forceful arrests: an overview of section 49 of the Criminal Procedure Act 51 of 1977 and its recent amendments
Authors: Botha Rinda , Visser Jo-Mari
Published: May 2017

The debate concerning the use of violence by the police force is an endless one. Section 49 of the Criminal Procedure Act 51 of 1977 serves as a framework for the use of violence by police officers during arrests in South Africa. While some hold the opinion that the powers of the police in this respect should be restricted, others  see the 2003 redefined  section 49 as a legislative guarantee of a suspect’s right to flee. Against this background this article has as its focus a critical discussion of the historical development of section 49 as well as the recent amendments of the same. The current legal position in South Africa is also compared with that in the United States of America as well as in the United Kingdom. Finally, certain conclusions and recommendations are made in order to enhance more favourable regulation of the employment of force in effecting arrests.
Sustentabilidade Empresarial e Governança Corporativa: Uma Análise da Relação do ISE da BM&FBOVESPA com a Compensação dos Gestores de Empresas Brasileiras
Authors: Guimarães Thayse Machado , Peixoto Fernanda Maciel , Carvalho Luciana
Published: May 2017

O objetivo deste artigo foi identificar a influência da sustentabilidade empresarial na compensação dos gestores das empresas brasileiras não financeiras da BM&FBOVESPA de 2009 a 2013. Entende-se que o estudo da compensação dos gestores e da sustentabilidade empresarial proporciona reflexões sobre os problemas decorrentes da Teoria de Agência, bem como permite visualizar a teoria dos Stakeholders e a busca pelo valor em longo prazo. Para o desenvolvimento deste trabalho, espera-se que as empresas que estão listadas no Índice de Sustentabilidade Empresarial (ISE) da BM&FBOVESPA concedam melhores remunerações a seus administradores. Dessa forma, foi utilizado o método de regressão com dados em painel, com estimação por efeitos fixos, com a finalidade de testar a relação existente entre as variáveis propostas. Como resultados principais, notou-se relação positiva e estatisticamente significativa da remuneração total dos gestores com o ISE, com a variável de qualidade da governança corporativa (empresas listadas no Novo Mercado) e com o valor de mercado (market-to-book). Ademais, observou-se uma relação negativa da remuneração total dos administradores com a volatilidade dos retornos. Desse modo, pode-se inferir que as empresas mais sustentáveis tendem a conceder maiores remunerações a seus gestores, o que corrobora a hipótese central da pesquisa e os pressupostos da teoria dos Stakeholders.
Making water flow in Bengaluru: planning for the resilience of water supply in a semi-arid city
Authors: Unnikrishnana Hita , Mundoli Seema , Nagendra Harini
Published: May 2017

The south Indian city of Bengaluru (formerly Bangalore) has a long history of human occupation. Today as one of the fastest growing cities in the world, Bengaluru is unusual in the fact that it is an old city, located at a distance from perennial sources of fresh water. While in the precolonial past, it depended upon an interconnected system of rainwater harvesting via lakes and wells, today it relies on water that is pumped from a river at a distance of over a hundred kilometres.This paper traces the evolution of Bengaluru’s water supply infrastructure from the precolonial past into the present day. We posit that the shift of the city’s dependence on water from local to distant sources, with the advent of technology and the introduction of centralized piped water, has weakened local residents’ and policy makers’ awareness of the importance of conservation of local ecosystems. The resulting degradation and conversion of the city’s water bodies has reduced the resilience of Bengaluru to flooding and drought, especially affecting the poorest and most vulnerable of its residents. The disruption of the links between water and other forms of commons, including grazing lands, fishing areas and wooded groves, has further fragmented the once-organic connection between the city and its ecosystems, with widespread construction on wetlands leading to flooding and water scarcity in different seasons.  In an era of increasing climate change, cities in semi-arid environments such as Bengaluru will be hit by problems of water scarcity. We stress the need to develop an integrated perspective that considers the importance of local ecosystems as commons for increased urban resilience.
Enhancing Bengaluru’s public transport network: approaches and challenges
Authors: Mukherjee Aloke , Toshniwal Roshan , Mulukutla Pawan
Published: May 2017

In recent decades, Bengaluru as a metropolis has witnessed explosive growth – both in terms of population, which has doubled since 2001, and growth in vehicles, which have more than quadrupled in the same period (RTO 2016). This has significantly stressed the city’s road infrastructure, leading to congestion and increases in pollution. Economic losses due to congestion for two of the city’s Information Technology corridors alone are estimated at INR227.7 billion annually (Bharadwaj 2015), without taking into account the health costs of increased emissions due to a surge in the number of vehicles plying in the city. ‘Conventional’ solutions addressing congestion within the city — such as road widening, creating one ways and building grade separators such as flyovers and underpasses — have failed to address the issue, and at the current rate of increasing vehicular volumes, the city’s roads are forecast to be completely saturated by 2025.This paper’s premise is that public transport serves as the sole sustainable solution to Bengaluru’s chronic congestion; only a large mode-shift towards public transport by 2025 can help reduce congestion on the city’s roads. The paper advocates the Avoid-Shift-Improve strategy to achieve this, focusing on transport-specific improvements required to incentivise commuters to shift to public transport and identifies institutional and financial changes in the way of enhancing public transport in the city. The paper also forewarns against neglecting the city’s conventional bus system in favour of other, capital-intensive modes of mass-transit, forecasting that buses will continue to meet over 75% of the city’s public transport demand even after the completion of Phase I and II of the city’s metro and the introduction of a functional commuter rail system.
Effect of hormonal and copper IUDs on genital microbial colonisation and clinical outcomes in North-Western Nigeria
Authors: Saidu Abdulhadi D. , Tunau Karima A. , Panti Abubakar A. , Nwobodo Emmanuel I. , Mohammed Yahaya , Amin Jamila , Garba Jamila A.
Published: May 2017

Background: Intrauterine devices are one of the popular long term reversible contraceptive methods. Earlier forms were associated with genital infections, however more recent types such copper IUDs and hormonal types have been shown to have better safety profile. However, there is no conclusive evidence to demonstrate that hormonal IUD is less associated with genital infection when compared with copper IUDs. The objectives include determination of prevalence of genital tract infections among IUD users, to determine the type of IUD that is less associated with genital infection, and also determine clinical features seen among IUD users.Methods: We conducted a descriptive, cross sectional study of clients who were at 6 months following IUD insertion. Endocervical and high vaginal samples were taken to isolate microbes.Results: The prevalence of genital tract infection was 20% in Copper IUD users and 8.6% among LNG-IUS users. Genital infection was significantly higher among copper IUD users compared to hormonal IUD users (p=0.038, OR= 2.88). Abnormal vaginal discharge was the commonest symptoms among IUD users and formal education was associated with less risk of genital infections (p=0.048).Conclusions: Hormonal IUDs are less associated with genital tract infection compared to copper IUDs and women with formal education are less likely to have genital infection among IUD users.
Epidemiology of epithelial ovarian cancer: a tertiary hospital based study in Goa, India
Authors: Jindal Dweep , Sahasrabhojanee Mrinalini , Jindal Manjusha , D’Souza Joachim
Published: May 2017

Background: Ovarian malignancy is seventh most common cancer in women globally. With increase in longevity, the incidence of epithelial ovarian cancer is increasing and its etiopathology remains unknown. We present preliminary epidemiological findings to help prioritize research.Methods: Present epidemiological study is retrospective, descriptive study over two years. The collected data was analyzed using SPSS software for overall survival, with respect to stage of disease and histopathology type. Multivariate analysis was done to know independent risk factors.Results: 114 cases of primary ovarian epithelial cancer were analyzed. Patients' mean age at diagnosis was 52.1±8.96 years (median=52). 52.6% patients had stage III disease at first visit. Serous adenocarcinoma (85.05%) was the most prevalent type of histopathology followed by mucinous (7.1%), clear cell (6.1%) and Endometroid carcinoma (1.75%). Surgery followed by combination of taxane and platinum chemotherapy was first line treatment in 35%. The mean age at diagnosis was more with advancing stage (stage one 44±9.53 and stage four 55.35±9.74 years) but it was not statistically significant (p=0.098) Advancing age demonstrated poor survival (log-rank p=0.05) but survival was not significantly different in relation to histopathology (log-rank =0.629). On multivariate regression analysis age of patient (p=0.004), and stage of disease (p=0.005) were found to be independent risk factors while histopathology was not an independent risk factor (p=0.688) for survival.Conclusions: Research should be aimed to find tools for screening and early diagnosis as well as better therapeutic approaches for advanced epithelial ovarian cancer.
Comparative study between intravaginal misoprostol and extra-amniotic instillation of ethacridine lactacte for second trimester abortion
Authors: Karande Suryaprakash Jagdevappa , Gunjotikar Meena Shantanu
Published: May 2017

Background: The methods of terminating pregnancy in the first trimester are simple, safe and effective. Factors like lack of knowledge about availability of MTP services, ignorance, denial of pregnancy, fear of society may account for decrease in number of first trimester abortions. The aims of the present study were to compare the efficacy, induction abortion interval and side effects of intravaginal misoprostol with extra amniotic installation of ethacridine lactate for second trimester abortion.Methods: 60 women coming to MTP clinics requesting second trimester pregnancy termination between 12 to 20 weeks were selected. Detail history and examination was carried out in each patient. They divided into two groups, Group A (30) intravaginal misoprostol 400 initially followed by 400 micrograns every 6 hourly if required. Group B (30) extra-amniotic 0.1% ethacridine lactate 150 cc.Results: In Group A success rate was 100% while in Group B it was 76.66%, which is highly statistically significant (P< 0.01). Mean I – A interval in Group A was 14.58+5.25 hours was highly significantly less than in Group B, it was 33.91 + 3.97 hours (p<0.0001). In Group A complete abortion has occurred in 28 cases (93.33%) and in Group B in 12 cases (52.17%).Conclusions: We conclude that, as compared to extra-amniotic instillation of ethacridinelactate intravaginal misoprostol is the preferred regimen in second trimester abortion because of its high efficacy, shorter induction abortion interval, high incidence of completeness of abortion, low incidence of side effects and better tolerance by the patient.
Evaluation of pelvic organ prolapse by standardized POP Q system for vaginal hysterectomy
Authors: Dhama Vandana , Chaudhary Rachna , Singh Shakun , Singh Manisha
Published: May 2017

Background: Uterovaginal prolapse is a common condition affecting women in reproductive and perimenopausal age groups. Evaluating pelvic organ prolapse in an objective, reproducible, easy to apply method is required for proper management. Aim of the study was preoperative and postoperative evaluation of pelvic organ prolapse by POP Q system in patients undergoing vaginal hysterectomy.Methods: In this observational study, 100 patients having pelvic organ prolapse, (average age 48±12 years), underwent elective vaginal hysterectomy at Lala Lajpat Rai Memorial Medical College Meerut during June 2015 to July 2016. POP Q was done preoperatively and after completion of surgery by the same surgeon.Results: The mean of genital hiatus preoperatively was 6.4 and post operatively it was 3.64 i.e. the genital hiatus was reduced by 2.76. The mean of total vaginal length pre-operatively was 8.07 and post operatively was 7.2. There was only 0.9 cm reduction in the vaginal length. The mean of perineal body pre-operatively was 2.64 and post operatively was 3.64. The points preoperatively were Aa 2.35, Ba 2.61, C 2.57, Ap 2.24, Bp 0.96, D-4.79 and post-operative the value of the points was -2.19, -2.04,-5.57,-2.98,-2.52 respectively and D point absent due to hysterectomy.Conclusions: The post-operative POP Q was analysed and the patients having grade 0 were 63 (optimum anatomical outcome) and patients having grade 1 were 36 (satisfactory anatomical outcome).
Fertility management in Kallmann syndrome: a step towards optimization
Authors: Bathwal Shikha , Sharma Sunita , Agarwal Nupur , Chakravarty Baidyanath
Published: May 2017

Kallmann syndrome (KS) is a genetic disorder with an incidence of one per 50,000 women. It is associated with hypogonadotropic hypogonadism and anosmia/hyposmia. An important aspect of managing KS is to achieve successful pregnancy. We hereby present a case series of three patients with KS who successfully conceived with human menopausal gonadotropin (HMG) induction. One patient achieved pregnancy with ovulation induction, second with fresh embryo transfer and the third with frozen embryo transfer. Two of these three women delivered at term and both babies were doing well at one year of follow up. Both received cyclical hormone therapy (HT) since adolescence. The third patient received HT only for six months before starting ovulation induction. She conceived twice but miscarried at both occasions. At times, it may be challenging to attain fertility in Kallmann syndrome but with persistent efforts results are usually rewarding. It is important to diagnose KS and start hormone therapy at appropriate time so that satisfactory fertility outcome can be achieved.
Maternal and perinatal outcome in a pregnancy with nephrotic syndrome
Authors: Mishra Vineet , Agarwal Himani , Lamba Sunita , Chaudhary Sumesh , Roy Priyankur , Goel Sugandha
Published: May 2017

The influence of pregnancy on the subsequent course of pre-existing nephrotic syndrome is controversial as also the effect of membranous glomerulonephritis on maternal and perinatal outcome. We describe a case of successful pregnancy outcome in Hepatitis B reactive patient with pre-existing nephrotic syndrome (renal biopsy proven case of Membrano-proliferative Glomerulonephritis). She had regular nephrology consultation and her renal disease was well compensated. After sonographic confirmation of live intrauterine pregnancy at 9th gestational week, patient was given methylprednisolone (5mg once daily). Antihypertensive drugs were also given. At 35 weeks of gestation, patient went in labour and cesarean section was performed in view of previous caesarean section. Feto-maternal outcome was good. The intrapartum and postpartum period was uneventful. Renal functions were well preserved. A vigourous healthy 1.93 kg baby was discharged with mother in a stable condition after receiving hepatitis B immunoglobulin.
A clinical study of continuous and interrupted fascial closure in emergency midline laparotomy at a tertiary care centre
Authors: Kunju Rahul D. , Thakkannavar Vinayak , K. Shrivathsa Merta , G. Sachin H. , Netto Allen , J. Suraj , Pawar Praveen M.
Published: May 2017

Background: Commonest approach in emergency open abdominal surgeries remains to be midline laparotomy because it is simple, saves time and causes minimal blood loss. Optimal technique for laparotomy wound closure has been a topic of debate since long. Risk factors for development of incisional hernia and burst abdomen are wound infection, systemic illnesses of patient and closure technique. Factors related to patients like age, gender, body mass index (BMI), systemic illnesses are not modifiable when an emergency laparotomy is the only option. Hence closure technique is one factor where surgeon has total control, which can bring down the incidence of burst abdomen and incisional hernias.Methods: Prospective study conducted in 150 patients who underwent emergency midline laparotomy from December 2014 to February 2016 in Krishna Rajendra Hospital attached to Mysore Medical College and Research Institute, Mysore, Karnataka, India with 6 months’ follow-up after surgery.Results: Most of patients in the study belonged to 30-40-year group and were males (78%). Gastrointestinal perforation peritonitis (52%) was the single most common indication for emergency midline laparotomy. In the continuous and interrupted groups, post-operative wound infection was found in 54.6% and 34.6%, wound dehiscence was found in 16% and 6.6% and incisional hernia in 14.4% and 4% respectively.Conclusions: Interrupted suturing is superior to continuous technique in emergency midline laparotomy wound closure in terms of complications and post-operative morbidity.