bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards an Economic Sociology of Race
Authors: Hirschman Daniel , Garbes Laura
Published: February 2019

Race is central to economic life, but race is not central to economic sociology. We argue that economic sociologists should treat racism as a constitutive, structuring force, analytically co-equal with capitalism, patriarchy, and nationalism. Our article has three aims. First, we document how canonical and award-winning works of economic sociology do not discuss race and racism, and do not engage with the contemporary sociology of race. Second, we identify six key insights from the sociology of race and suggest how they could influence economic sociology: the emergence of race out of racism, an understanding of racism as structural, the role of whiteness, the intersections between racism and other systems of oppression, the ideology of colorblind racism, and the fundamental connections between racism and capitalism. Third, we conclude by discussing recent research that bridges the two subfields and lays the groundwork for an understanding of "racialized markets" and "racialized economies".
Using gay bar listings to infer rates of gay bar closure in the United States, 1977-2017
Authors: Mattson Greggor
Published: February 2019

Widespread alarm over gay bar and lesbian bar closures has occurred in a vacuum of national data to assess trends. This visualization depicts changes in gay bar listings in the United States at five-year intervals by bar subtype for the years 1977-2017. Trends in gay bar listings support perceptions of recent gay bar decline. Gay bar listings declined by 20.6% between 2012 (N=1356) and 2017 (N=1077), their largest 5-year decline. Lesbian bar listings showed a similar 19.2% decline from much smaller numbers (31 to 21 between 2007 and 2017). The largest change in bar types is a phenomenon that has received little attention, the rise of gay bars serving men and women together; they became the largest single category of gay bar from 1997 onwards. Bars most at risk of closure receive the least popular attention, including bars for women, people of color, and men into radical sexualities.
Implementasi Sdlc Waterfall Dalam Pembuatan Game Edukasi Perjuangan Indonesia”Hisotira” Menggunakan Rpg Maker Mv Berbasis Android
Authors: Firmansyah Yoki , Jamilah Jamilah
Published: February 2019

System Development Cycle (SDLC) Waterfall merupakan salah satu metode yang sangat popular dikalanganpengembang sistem, baik itu aplikasi maupun sistem informasi, namun kurang popular di kalanganpembuatan game edukasi, padahal waterfall sangatlah fleksibel dan mudah untuk diimplementasikan untukpembuatan game edukasi, dan pada saat ini game edukasi sangat membantu anak anak untuk mempelajarisesuatu, seperti salah satunya adalah mengenai perjuangan Indonesia, dan dengan game anak anak lebihsenang mempelajari karena tidak hanya beriisikan text saja melainkan juga terdapat suara dan gambar,adapun aplikasi yang digunakan dalam penelitian ini adalah RPG Maker, dimana dengan aplikasi ini kitadapat membuat permainan yang sederhana namun menarik, dan dengan game berjenis RPG maka pemainakan seperti masuk kedalam permainan, dan pemain akan merasakan langsung sekali gus belajar mengenaiperjuangan kemerdekaan Indonesia.
EFEKTIVITAS PROGRAM PEMBERDAYAAN
Authors: Suwito Sugito
Published: February 2019

EFEKTIVITAS PROGRAM PEMBERDAYAAN Abstrak Tujuan penelitian ini menganalisis pengaruh variable kepemimpinan, tata pemerintahan dan etika pemerintahan terhadap efektivitas pemberdayaan dan dampaknya pada kesejahteraan keluarga miskin di kota Bekasi. Metode penelitian dilakukan berdasarkan survei terhadap responden keluarga miskin anggota Posdaya beserta para stakeholdernya dengan menggunakan kuesioner terstruktur. Data yang terkumpul kemudian diolah dan dianalisis dengan teknik Structural Equation Modeling (SEM). Hasil penelitian menunjukkan bahwa ketiga variable yang diteliti memiliki pengaruh signifikan pada efektivitas pemberdayaan yang selanjutnya berdampak pada kesejahteraan keluarga miskin. Kata kunci: efektifitas, tata pemerintahan yang baik, paradigma baru, SEM The Effectiveness of Empowerment Program Abstract The research objectiveis to test the influence of the variables on leadership, good governance and government ethics on empowerment‘s effectiveness and its effect on the welfare of the poor in Bekasi. The result has been processed and analyzed based on Structural Equation Modeling (SEM) technique. It shows that all of the three exogeneus variables are significantly influencing the process and the empowerment‘seffectiveness, in turn, will lead to the prosperity of the poor families at grass root level. Keywords: effectiveness, good governance, new paradigm, SEM
REKONSTRUKSI EKONOMI PANCASILA SEBAGAI PERWUJUDAN KEBERLANJUTAN PEMBANGUNAN NASIONAL
Authors: Agusalim Lestari , Karim Muhammad , Saefuddin Asep
Published: February 2019

REKONSTRUKSI EKONOMI PANCASILA SEBAGAI PERWUJUDAN KEBERLANJUTAN PEMBANGUNAN NASIONAL Abstrak Salah satu solusi untuk menghadapi berbagai permasalahan yang dihadapi oleh bangsa Indonesia saat ini adalah dengan menghidupkan kembali semangat Pancasila. Pancasila adalah intisari dari keberadaan Indonesia sebagai suatu negara. Pancasila berfungsi sebagai dasar negara, ideologi, filsafat, dan juga sebagai perwujudan dari prinsip dasar untuk Indonesia yang mandiri. Oleh karena itu, revitalisasi/kebangkitan kembali Pancasila seharusnya menjadi fokus utama dari program pemerintah, agar nilai Pancasila dapat dijiwai oleh setiap bangsa Indonesia. Para pendiri Indonesia berkeyakinan bahwa Pancasila dapat membebaskan rakyat dari kemiskinan, kelaparan, kesenjangan sosial dan korupsi, selain itu juga dapat menjadi landasan agar mampu menjalin kerjasama dengan negara lain secara menyeluruh. Hal tersebut dapat terwujud dengan menyatukan tekad, tindakan, dan integrasi/penggabungan dari berbagai bidang serta keterampilan untuk mencapai cita-cita kesejahteraan bagi seluruh bangsa Indonesia. Kata kunci: ekonomi Pancasila, ekonomi alternatif, kesejahteraan sosial. Reconstructing Pancasila Economy as a Manifestation for Sustainable National Development Abstract A possible best solution to overcome the various problems being faced by our nation is to return to the spirit of Pancasila. Pancasila is the centerpiece of Indonesia‘s existence as a nation. It serves as our country‘s foundation, ideology, philosophy, as well as the embodiment of basic principles of an independent Indonesia. Therefore, revitalizing Pancasila should be our country‘s main program, imbued by each and every one of its citizens. Our Founding Fathers once dreamed and believed that Pancasila would free us from poverty, hunger, economic disparity, and corruption, while also giving us the ability to stand up to cooperate with all countries equally. It needs our combined willpower, actions, and integration of various fields and expertises to achieve expected welfare for all Indonesian. Keywords: Pancasila Economy, alternative economy, social welfare
FAKTOR-FAKTOR YANG MEMPENGARUHI PENINGKATAN DERAJAT KESEHATAN KELUARGA MELALUI POSDAYA DI KOTA BEKASI
Authors: Budianti Sri
Published: February 2019

FAKTOR-FAKTOR YANG MEMPENGARUHI PENINGKATAN DERAJAT KESEHATAN KELUARGA MELALUI POSDAYA DI KOTA BEKASI Abstrak Studi ini untuk mengetahui seberapa jauh implementasi kebijakan, kepemimpinan, implementasi sumber daya manusia (SDM) dan partisipasi masyarakat dalam mempengaruhi kualitas pelayanan kesehatan yang dilaksanakan oleh pos pemberdayaan keluarga (posdaya). Metode yang digunakan adalah analisis statistik deskriptif dan analisis inferensial melalui kuesioner. Survei mencakup 240 responden dari 20 posdaya. Hasil survei menunjukkan bahwa terdapat pengaruh signifikan dari implementasi kebijakan, kepemimpinan, implementasi SDM dan partisipasi masyarakat terhadap kualitas pelayanan kesehatan, baik secara parsial maupun keseluruhan. Partisipasi masyarakat merupakan faktor pendukung utama yang mempengaruhi pelayanan kesehatan diikuti dengan implementasi SDM, implementasi kebijakan dan kepemimpinan sebagai faktor pendukung terakhir. Dalam rangka peningkatan kualitas pelayanan kesehatan secara lebih efektif, perlu peningkatan kapasitas posdaya dan kompetensi serta pengetahuan terutama untuk kader-kader kesehatan dalam program preventif dan promotif bidang kesehatan, antara lain melalui pelatihan dan bimbingan serta dilakukan pengawasan dan evaluasi secara berkala. Kata kunci: pemberdayaan keluarga, kualitas pelayanan kesehatan, partisipasi masyarakat Factors Affecting the Family Health Degree Improvement Through Posdaya in Bekasi Municipality Abstract The survey was conducted to search how far the policy implementation, the leadership, the human resources implementation and community participation influence the quality of health services done by family empowerment program (posdaya). The sample taken from with 240 respondents selected from 20 posdaya. The method used is descriptive statistical analysis and inferential analysis through questionnaires. The survey proved that there is significant influence of the policy implementation, leadership, the human resources implementation, and the community participation against the health service quality either partially or simultaneously. The community participation is a primary supporting factor that influence the quality of health service followed by the implementation of human resources, the policy implementation, and leadership is the last supporting factor. Thus, posdaya, in improving the health service quality to be more effective, should be up graded and raised the competence and knowledge primarily of the health cares in health preventive and promotive program through training, assistance, as well as monitoring, and periodic evaluation. Keywords: family empowerment, quality health service, community participation
ANALISIS GEOSPASIAL DAMPAK PERKEMBANGAN KEGIATAN PARIWISATA TERHADAP PERMUKIMAN KUMUH WILAYAH SARBAGITA, BALI
Authors: Dwi Yuliandari Yuliana Rini , Martha Luhur Fajar , Widodo Dwi Rustiono
Published: February 2019

ANALISIS GEOSPASIAL DAMPAK PERKEMBANGAN KEGIATAN PARIWISATA TERHADAP PERMUKIMAN KUMUH WILAYAH SARBAGITA, BALIAbstrak Peningkatan kegiatan ekonomi di wilayah Sarbagita yang terutama didorong oleh kegiatan pariwisata berpeluang menjadi sarana untuk meningkatkan kemampuan ekonomi masyarakat. Masyarakat diharapkan memperoleh kehidupan yang layak di masa mendatang, yang salah satunya terwujudkan dengan relatif baiknya permukiman mereka. Penelitian ini bertujuan untuk menguji hubungan asosiatif antara perkembangan kegiatan pariwisata dengan perkembangan permukiman kumuh di wilayah Sarbagita, serta mengidentifikasi efek spasial (spillover) atau pengaruh perkembangan satu desa/kelurahan terhadap desa/kelurahan tetangganya. Alat analisis yang digunakan adalah model spasial yang menggunakan pembobot simple contiguity (contiguity-rook) untuk mengetahui ada tidaknya autokorelasi spasial. Beberapa temuan yang dihasilkan diantaranya: (1) meningkatnya kegiatan pariwisata yang direpresentasikan dengan pembangunan restoran dan hotel di suatu desa/kelurahan, dimana hal ini akan mendorong naiknya intensitas keluarga yang tinggal di permukiman kumuh di desa tersebut; (2) hasil uji interaksi spasial antardesa/kelurahan menunjukkan pembangunan restoran, hotel atau kegiatan lainnya di desa/kelurahan tetangga tidak berdampak terhadap intensitas keluarga yang tinggal di permukiman kumuh di suatu desa/kelurahan. Kata kunci: Sarbagita, interaksi spasial, migrasi THE IMPACT OF TOURISM DEVELOPMENT FOR SLUM AREA: GEOSPATIAL ANALYSIS SARBAGITA REGION IN BALI Abstract The economic activities development in Sarbagita region is mainly driven by tourism activities which as a means to improve the local economy. This paper aims to examine the associative relationship between the development of tourism activities and the development of slums area in Sarbagita region, as well as identifying spatial effects (spillover) or influence the development of the rural/village to village/neighbors village. The analytical tool used is a spatial model that uses a simple contiguity (contiguity-rook) to determine the existence of spatial autocorrelation. The results indicated that: (1) the growth of tourism activities represented by the expansion of a restaurant and hotel in a rural/village area, thus it will encourage the intensity of living families in slums area in the village; (2) spatial interaction tests among villages/village show that the development of a restaurant, hotel or other activities in the village/neighboring villages had no impact with the density of the family who lived in a slum in a village/village. Keywords: Sarbagita, spatial interaction, migration
Pengaruh Intellectual Capital Terhadap Kinerja Non Keuangan Perusahaan
Authors: Simarmata Salomo Jimmiyanto Martogi Raja
Published: February 2019

Pengaruh Intellectual Capital Terhadap Kinerja Non Keuangan Perusahaan Abstrak Pengukuran modal intelektual menjadi agenda utama yang paling banyak dilakukan perusahaan pada abad ke-21 ini. Karya tulis ini menitikberatkan pada pengelolaan pengetahuan dan membahas bagaimana pentingnya mengukur aset pengetahuan di dalam perusahaan. Aset pengetahuan merupakan pondasi dan kompetensi utama dalam setiap organisasi. Karya tulis ini mengulas berbagai pendekatan yang ada untuk mengukur pengaruh modal intelektual terhadap kinerja non keuangan perusahaan. Secara konseptual, modal intelektual dibagi atas empat komponen utama, yaitu: modal manusia, modal pelanggan, modal organisasi, dan modal inovasi. Penilaian atas kinerja perusahaan dapat mencakup berbagai pengukuran. Oleh karena itu, penulis berusaha menggabungkan berbagai kinerja yang meliputi: retensi karyawan, retensi pelanggan, kualitas proses, dan inovasi. Kita mengetahui bahwa sebenarnya setiap perusahaan memiliki nilai yang tersembunyi dan sebab itu perusahaan sangat berminat pada pemikiran akan skill, inovasi, dan kemampuan karyawannya. Kesimpulan akhir ditemukan bahwa modal intelektual mempengaruhi kinerja non keuangan perusahaan. Kata kunci: modal intelektual, modal manusia, modal pelanggan, modal organisasi, modal inovasi, retensi pelanggan, retensi karyawan, kinerja non keuangan.Abstract Measuring intellectual capital is on the agenda of the most 21st century organizations. This paper takes a knowledge-based view of the firm and discusses the importance of measuring organizational knowledge assets. Knowledge assets underpin capabilities and core competencies of any organizations. Therefore, they play a key strategic role and need to be measured. This paper reviews the existing approaches for measuring intellectual capital towards non financial performance which is integrate existing approaches in order to achieve comprehensiveness Conceptually, intellectual capital as being comprised of four primary components: human capital, customer capital, organizational capital, and innovation capital. An assessment of an organization's performance should include multiple measures. Accordingly, we utilized a composite performance consisting of employee retention, customer retention, process quality, and innovation. We just knew that there was hidden value in their companies and that it was somehow wrapped up in the thoughts, skills, innovations, and abilities of their employees. Finally, the final result found that intellectual capital influence to non financial performance. Keywords: intellectual capital, human capital, customer capital, organizational capital, innovation capital, customer retention, employee retention, non financial performance.
EFISIENSI EKONOMI USAHATANI TEBU DI KECAMATAN DAWE, KABUPATEN KUDUS
Authors: Fadlillah Ummi , Karno Karno , Ekowati Titik
Published: February 2019

Penelitian bertujuan mengetahui efisiensi ekonomi usahatani tebu menggunakan metode survey sejak bulan Februari hingga April 2016 di Kecamatan Dawe, Kabupaten Kudus. Penentuan lokasi penelitian yang digunakan adalah metode purposive, metode pengambilan sampel menggunakan snowball sampling. Jumlah responden ditetapkan menggunakan metode slovin, sebanyak 216 orang, dibagi menjadi 4 kelompok berdasarkan status tanam, yaitu tanaman 1, ratoon1, ratoon 2, dan ratoon 3. Metode analisis dengan menggunakan fungsi produksi Cobb – Douglas untuk mencari nilai koefisien regresi faktor produksi kemudian membandingkan antara Nilai Produk Marjinal dan Biaya Marjinal Faktor ke – i (NPM/BKM), dimana efisiensi ekonomi telah tercapai jika Nilai Produk Marjinal (NPM) sama dengan Biaya Korbanan Marjinal (BKM). Hasil analisis efisiensi usahatani tebu di Kecamatan Dawe, Kabupaten Kudus menunjukkan bahwa : Faktor produksi luas lahan, benih atau ratoon, dan pupuk Za penggunaanya belum efisien, pada status tanam tanaman 1, ratoon 1, ratoon 2, dan ratoon 3; faktor produksi pupuk phonska belum efisien hanya pada status tanam ratoon 3. Faktor produksi pupuk phonska dan tenaga kerja penggunaannya tidak efisien pada status tanam tanaman 1, ratoon 1, dan ratoon 2. Kata Kunci: Efisiensi, korbanan marjinal, produk marjinal, ratoon, tebu.The purpose of this study was to analyze economic efficiency of sugarcane farming. A survey research was carried out from February to April 2016 in Dawe District, Kudus Regency. Determination of research location used purposive method, sampling method used snowball sampling. Number of sampel were 216 farmers based slovin method, which were divided into four groups based on the status of planting, which were the plant cane, 1st ratoon cane, 2nd ratoon cane, and 3rd ratoon cane. Analysis of method used Cobb – Douglas production function to obtaine the regression coefficient of factors production and comparing the Marginal Value Product with Marginal Cost Product i factor (NPM/BKM), where economic efficiency have been achieved if the Marginal Value Product (NPM) is equal to Marginal Cost Product (BKM). The research results showed that : production factors of land, seed or ratoon, and Za fertilizer usage were not efficient on plant cane, 1st ratoon cane, 2nd ratoon cane, and 3rd ratoon cane; production factor phonska fertilizer was not efficient only on 3rd ratoon cane. Production factors of phonska fertilizer usage were not efficient on plant cane, 1st ratoon cane, 2nd ratoon cane. Keywords: Efficiency, marginal cost, marginal product, ratoon, sugarcane.
“Happy-Go-Lucky Fellow”: Lone-Actor Terrorism, Masculinity, and the 1966 Bombing on Parliament Hill in Ottawa
Authors: Hewitt Steve
Published: February 2019

On 18 May 1966, Paul Joseph Chartier blew himself up outside of the Canadian House of Commons in Ottawa. His target had been members of parliament, but he succeeded in killing only himself. The bombing received widespread attention at the time and prompted an investigation involving both the rcmp and fbi. Using the more than 1,300-page file compiled by the police, I stress the importance of a historical approach to the study of terrorism as the article examines Chartier’s deed in the context of lone-actor terrorism, both within Canada and internationally. Ultimately, I conclude that the reason Chartier carried out the attack is unknowable. However, I argue that a strong correlation existed between the motivation for Chartier’s act of extreme violence and masculinity, a connection often ignored in scholarship about terrorism, especially lone-actor terrorism. Chartier fell considerably short of the hegemonic masculine ideals of postwar Canada, which he blamed, in populist fashion, on a corrupt Canadian political system. In the end, he turned to a traditional response by some men, both in Canada and internationally, an act of extreme violence, to salvage something from his life by striking back against those he blamed for his failures.
The impact of financial strain and external locus of control on psychological distress among single CAF members with children
Authors: Skomorovsky Alla , Wan Cynthia
Published: February 2019

Introduction: Military families are often confronted with unique financial stressors related to the military lifestyle, including relocations, loss of spousal job, or child care expenses. Moreover, the impact of financial stressors may be exacerbated in single-parent military families. Although there is an increasing number of single-parent families in the Canadian Armed Forces (CAF), research concerning the role of financial stressors in their psychological well-being is limited. Methods: The goal of this study was to examine the role of financial stressors in the psychological well-being of single and married CAF members with and without children ( n = 1,781). Results: Single CAF members with children reported significantly higher financial strain and psychological distress than other CAF members. In addition, hierarchical regression analyses revealed that financial strain and an external locus of control played important roles in psychological distress even when family structure was taken into account. Discussion: Organizational implications, including recommendations related to financial education services aimed at single CAF members with children and the development of programs to promote an internal financial locus of control, are discussed.
The unique financial situation of a Primary Reservist: Satisfaction with compensation and benefits and its impact on retention
Authors: Williams Lisa , Anderson Joanna
Published: February 2019

Introduction: Within the Canadian Primary Reserves (P Res), members can be employed in various classes of service, and they often balance simultaneous civilian and military employment. The aim of the current study was to examine P Res members’ reliance on their military income, their satisfaction with the compensation and benefits, and whether compensation and benefits was related to 5-year turnover intentions. Methods: A P Res Retention Survey was completed by 3,669 members. Participants reported their reliance on their military income, employment status, satisfaction with 11 aspects of P Res compensation and benefits, and 5-year turnover intentions. The data were weighted by key demographic variables. Results: Most members reported a reliance on their P Res income and had some satisfaction with their pay and benefits. General linear model analyses were conducted to examine differences in members’ satisfaction across classes of service. Results demonstrated that members employed full-time within the P Res were less satisfied with their rates of pay, while part-time members were less satisfied with the medical and dental benefits. Furthermore, an association was found between P Res members’ satisfaction with compensation and benefits and their 5-year turnover intentions. Discussion: Although members tend to rely on their military incomes, their satisfaction varied by the level of their P Res employment. The Canadian Armed Forces may consider tailoring its financial services to aid P Res members with their financial management.
Understanding Non-Technical Competencies: Compassion and Communication among Fourth-Year Veterinarians-in-Training
Authors: Hess-Holden Chelsey L. , Jackson Deborah L. , Morse David T. , Monaghan Christy L.
Published: February 2019

Over the past several decades, non-technical competencies have been given an increasing amount of emphasis in veterinary medical training. However, additional research is needed to continue understanding the role that non-technical competencies play in veterinary success and wellness. An inter-related pair of non-technical competencies that needs further empirical investigation is communication and the influence of compassion on veterinarians. This research study investigated the relationship between compassion experiences and communication styles of fourth-year veterinarians-in-training using a canonical correlation analysis. The compassion fatigue resilience (CFR) model was the theoretical framework used to conceptualize how communication behaviors may contribute to compassion fatigue and compassion satisfaction. Compassion experiences were measured using a version of the Professional Quality of Life (ProQOL) scale. Communication style was measured using the Communication Styles Inventory (CSI). Results indicated that communication style is statistically significantly related to compassion experiences ( n = 281; Function 1, Rc= .552, p < .001; Function 2, Rc= .369, p < .001). Compassion fatigue was found to have a statistically significant association with the communication styles of emotionality ( r = .467, p < .001), impression manipulativeness ( r = .191, p = .001), and verbal aggressiveness ( r = .239, p = .001). Results indicated support for veterinary training programs to continue adapting their curricula to include communication training and intervention programs to address communication and compassion fatigue, as well as to consider how the relationship between these two constructs may influence the wellness and success of veterinarians-in-training and veterinarians. More research is needed to understand the role of impression manipulativeness in veterinary wellness.
Nota Editorial
Authors: Castrillón Vizcarra Alfonso
Published: February 2019

El séptimo número de Illapa coincide con el inicio de un nuevo escenario en el sector cultural peruano: la creación del Ministerio de Cultura. Este proyecto hace tiempo deseado, refleja un momento de crecimiento económico que debe tener como correlato el planteamiento de políticas culturales que contemplen el uso inteligente de los fondos del Estado para la gestión responsable de nuestro patrimonio. Su existencia significa que realmente reconocemos a la cultura como un factor clave de desarrollo, equiparándola con otros sectores fundamentales que sostienen un país.
Assessment of motion error for frame-based and noninvasive mask-based fixation using the Leksell Gamma Knife Icon radiosurgery system
Authors: Carminucci Arthur , Nie Ke , Weiner Joseph , Hargreaves Eric , Danish Shabbar F.
Published: February 2019

OBJECTIVE

The Leksell Gamma Knife Icon (GK Icon) radiosurgery system can utilize cone-beam computed tomography (CBCT) to evaluate motion error. This study compares the accuracy of frame-based and frameless mask-based fixation using the Icon system.

METHODS

A retrospective cohort study was conducted to evaluate patients who had undergone radiosurgery with the GK Icon system between June and December 2017. Patients were immobilized in either a stereotactic head frame or a noninvasive thermoplastic mask with stereotactic infrared (IR) camera monitoring. Setup error was defined as displacement of the skull in the stereotactic space upon setup as noted on pretreatment CBCT compared to its position in the stereotactic space defined by planning MRI for frame patients and defined as skull displacement on planning CBCT compared to its position on pretreatment CBCT for mask patients. For frame patients, the intrafractionation motion was measured by comparing pretreatment and posttreatment CBCT. For mask patients, the intrafractionation motion was evaluated by comparing pretreatment CBCT and additional CBCT obtained during the treatment. The translational and rotational errors were recorded.

RESULTS

Data were collected from 77 patients undergoing SRS with the GK Icon. Sixty-four patients underwent frame fixation, with pre- and posttreatment CBCT studies obtained. Thirteen patients were treated using mask fixation to deliver a total of 33 treatment fractions. Mean setup and intrafraction translational and rotation errors were small for both fixation systems, within 1 mm and 1° in all axes. Yet mask fixation demonstrated significantly larger intrafraction errors than frame fixation. Also, there was greater variability in both setup and intrafraction errors for mask fixation than for frame fixation in all translational and rotational directions. Whether the GK treatment was for metastasis or nonmetastasis did not influence motion uncertainties between the two fixation types. Additionally, monitoring IR-based intrafraction motion for mask fixation—i.e., the number of treatment stoppages due to reaching the IR displacement threshold—correlated with increasing treatment time.

CONCLUSIONS

Compared to frame-based fixation, mask-based fixation demonstrated larger motion variations. The variability in motion error associated with mask fixation must be taken into account when planning for small lesions or lesions near critical structures.
Assessment of MR stereotactic imaging and image co-registration accuracy for 3 different MR scanners by 3 different methods/phantoms: phantom and patient study
Authors: Paštyková Veronika , Novotný Josef , Veselský Tomáš , Urgošík Dušan , Liščák Roman , Vymazal Josef
Published: February 2019

OBJECTIVE

The aim of this study was to compare 3 different methods to assess the geometrical distortion of two 1.5-T and one 3-T magnetic resonance (MR) scanners and to evaluate co-registration accuracy. The overall uncertainty of each particular method was also evaluated.

METHODS

Three different MR phantoms were used: 2 commercial CIRS skull phantoms and PTGR known target phantom and 1 custom cylindrical Perspex phantom made in-house. All phantoms were fixed in the Leksell stereotactic frame and examined by a Siemens Somatom CT unit, two 1.5-T Siemens (Avanto and Symphony) MRI systems, and one 3-T Siemens (Skyra) MRI system. The images were evaluated using Leksell GammaPlan software, and geometrical deviation of the selected points from the reference values were determined. The deviations were further investigated for both definitions including fiducial-based and co-registration–based in the case of the CIRS phantom images. The same co-registration accuracy assessment was also performed for a clinical case. Patient stereotactic imaging was done on 3-T Skyra, 1.5-T Avanto, and CT scanners.

RESULTS

The accuracy of the CT scanner was determined as 0.10, 0.30, and 0.30 mm for X, Y, and Z coordinates, respectively. The total estimated uncertainty in distortion measurement in one coordinate was determined to be 0.32 mm and 0.14 mm, respectively, for methods using and not using CT as reference imaging. Slightly more significant distortions were observed when using the 3-T than either 1.5-T MR units. However, all scanners were comparable within the estimated measurement error. Observed deviation/distortion for individual X, Y, and Z stereotactic coordinates was typically within 0.50 mm for all 3 scanners and all 3 measurement methods employed. The total radial deviation/distortion was typically within 1.00 mm. Maximum total radial distortion was observed when the CIRS phantom was used; 1.08 ± 0.49 mm, 1.15 ± 0.48 mm, and 1.35 ± 0.49 mm for Symphony, Avanto, and Skyra, respectively. The co-registration process improved image stereotactic definition in a clinical case in which fiducial-based stereotactic definition was not accurate; this was demonstrated for 3-T stereotactic imaging in this study. The best results were shown for 3-T MR image co-registration with CT images improving image stereotactic definition by about 0.50 mm. The results obtained with patient data provided a similar trend of improvement in stereotactic definition by co-registration.

CONCLUSIONS

All 3 methods/phantoms used were evaluated as satisfactory for the image distortion measurement. The method using the PTGR phantom had the lowest uncertainty as no reference CT imaging was needed. Image co-registration can improve stereotactic image definition when fiducial-based definition is not accurate.
Medial Gamma Knife thalamotomy for intractable pain
Authors: Urgosik Dusan , Liscak Roman
Published: February 2019

OBJECTIVE

Ablative procedures are still useful in the treatment of intractable pain despite the proliferation of neuromodulation techniques. In the paper the authors present the results of Gamma Knife thalamotomy (GKT) in various pain syndromes.

METHODS

Between 1996 and 2016, unilateral GKT was performed in 30 patients suffering from various severe pain syndromes in whom conservative treatment had failed. There were 20 women and 10 men in the study population, with a median age of 80 years (range 53–89 years). The pain syndromes consisted of 8 patients with classic treatment-resistant trigeminal neuralgia (TN), 6 with postherpetic TN, 5 with TN and constant pain, 1 with TN related to multiple sclerosis, 3 with trigeminal neuropathic pain, 4 with thalamic pain, 1 with phantom pain, 1 with causalgic pain, and 1 with facial pain. The median follow-up period was 24 months (range 12–180 months). Invasive procedures for pain release preceded GKT in 20 patients (microvascular decompression, glycerol rhizotomy, balloon microcompression, Gamma Knife irradiation of the trigeminal root, and radiofrequency thermolesion). The Leksell stereotactic frame, GammaPlan software, and T1- and T2-weighted sequences acquired at 1.5 T were used for localization of the targeted medial thalamus, namely the centromedian (CM) and parafascicularis (Pf) nucleus. The CM/Pf complex was localized 4–6 mm lateral to the wall of the third ventricle, 8 mm posterior to the midpoint, and 2–3 mm superior to the intercommissural line. GKT was performed using the Leksell Gamma Knife with an applied dose ranging from 145 to 150 Gy, with a single shot, 4-mm collimator. Pain relief after radiation treatment was evaluated. Decreased pain intensity to less than 50% of the previous level was considered successful.

RESULTS

Initial successful results were achieved in 13 (43.3%) of the patients, with complete pain relief in 1 of these patients. Relief was achieved after a median latency of 3 months (range 2–12 months). Pain recurred in 4 (31%) of 13 patients after a median latent interval of 24 months (range 22–30 months). No neurological deficits were observed.

CONCLUSIONS

These results suggest that GKT in patients suffering from severe pain syndromes is a relatively successful and safe method that can be used even in severely affected patients. The only risk of GT for the patients in this study was failure of treatment, as no clinical side effects were observed.
Neurocognitive changes in pituitary adenoma patients after Gamma Knife radiosurgery
Authors: Tooze Alana , Sheehan Jason P.
Published: February 2019

OBJECTIVE

Pituitary adenomas and the treatment required for the underlying neuropathology have frequently been associated with cognitive dysfunction. However, the mechanisms for these impairments remain the subject of much debate. The authors evaluated cognitive outcomes in patients treated with or without Gamma Knife radiosurgery (GKRS) for an underlying pituitary adenoma.

METHODS

This was a retrospective, institutional review board–approved, single-institution study. A total of 51 patients (23 male, 28 female) treated for pituitary adenoma were included in this neurocognitive study. Twenty-one patients underwent GKRS following transsphenoidal surgery, 22 patients were treated with transsphenoidal surgery alone, and eight patients were conservatively managed or were treated with medical management alone. Comparisons using psychometric tests of general intellectual abilities, memory, and executive functions were made between the treatment groups, between male and female patients, and between patients with Cushing’s disease and those with nonfunctioning adenoma (NFA).

RESULTS

The entire patient sample, the NFA group, and the GKRS group scored significantly below expected on measures of both immediate and delayed memory, particularly for visually presented information (p ≤ 0.05); however, there were no significant differences between the patients with Cushing’s disease and those with NFA (t ≤ 0.56, p ≥ 0.52). In those who underwent GKRS, memory scores were not significantly different from those in the patients who did not undergo GKRS (t ≤ 1.32, p ≥ 0.19). Male patients across the sample were more likely to demonstrate impairments in both immediate memory (t = −3.41, p = 0.003) and delayed memory (t = −3.80, p = 0.001) than were female patients (t ≤ 1.09, p ≥ 0.29). There were no impairments on measures of general intellectual functioning or executive functions in any patient group. The potential contributions of tumor size and hormone levels are discussed.

CONCLUSIONS

Overall, pituitary adenoma patients demonstrated relative impairment in anterograde memory. However, GKRS did not lead to adverse effects for immediate or delayed memory in pituitary adenoma patients. Cognitive assessment of pituitary adenoma patients is important in their longitudinal care.
A novel index for assessing treatment plan quality in stereotactic radiosurgery
Authors: Dimitriadis Alexis , Paddick Ian
Published: February 2019

OBJECTIVE

Stereotactic radiosurgery (SRS) is characterized by high levels of conformity and steep dose gradients from the periphery of the target to surrounding tissue. Clinical studies have backed up the importance of these factors through evidence of symptomatic complications. Available data suggest that there are threshold doses above which the risk of symptomatic radionecrosis increases with the volume irradiated. Therefore, radiosurgical treatment plans should be optimized by minimizing dose to the surrounding tissue while maximizing dose to the target volume. Several metrics have been proposed to quantify radiosurgical plan quality, but all present certain weaknesses. To overcome limitations of the currently used metrics, a novel metric is proposed, the efficiency index (η50%), which is based on the principle of calculating integral doses: η50% = integral doseTV/integral dosePIV50%.

METHODS

The value of η50% can be easily calculated by dividing the integral dose (mean dose × volume) to the target volume (TV) by the integral dose to the volume of 50% of the prescription isodose (PIV50%). Alternatively, differential dose-volume histograms (DVHs) of the TV and PIV50% can be used. The resulting η50% value is effectively the proportion of energy within the PIV50% that falls into the target. This value has theoretical limits of 0 and 1, with 1 being perfect. The index combines conformity, gradient, and mean dose to the target into a single value. The value of η50% was retrospectively calculated for 100 clinical SRS plans.

RESULTS

The value of η50% for the 100 clinical SRS plans ranged from 37.7% to 58.0% with a mean value of 49.0%. This study also showed that the same principles used for the calculation of η50% can be adapted to produce an index suitable for multiple-target plans (Gη12Gy). Furthermore, the authors present another adaptation of the index that may play a role in plan optimization by calculating and minimizing the proportion of energy delivered to surrounding organs at risk (OARη50%).

CONCLUSIONS

The proposed efficiency index is a novel approach in quantifying plan quality by combining conformity, gradient, and mean dose into a single value. It quantifies the ratio of the dose “doing good” versus the dose “doing harm,” and its adaptations can be used for multiple-target plan optimization and OAR sparing.
The 2018 AANS Presidential Address. The privilege of service
Authors: Valadka Alex B. , Valadka Jaclyn S. , Valadka Patrick R. , Valadka Patricia C.
Published: February 2019

The theme of the 2018 American Association of Neurological Surgeons Annual Meeting was “The Privilege of Service.” In the current climate of rapid change in healthcare delivery and increasing pressure on physicians, this theme was chosen to remind us of our true priorities and of the amazing opportunities that we have as neurosurgeons. In parallel to the classic triple-threat practitioner who excels in teaching, research, and clinical care, future neurosurgeons will need to acquire mastery in three areas of service, which have been summarized as the three A’s: administration, advocacy, and altruism. The blessings that we enjoy afford us a platform from which we can take advantage of the many opportunities to experience the privilege of serving others.
Gamma knife treatment for multiple metastatic brain tumors compared with whole-brain radiation therapy
Authors: Serizawa Toru , Iuchi Toshihiko , Ono Junichi , Saeki Naokatsu , Osato Katsunobu , Odaki Masaru , Ushikubo Osamu , Hirai Shinji , Sato Motoki , Matsuda Shinji
Published: February 2019

Object. The purpose of this retrospective study was to compare the effectiveness of gamma knife radiosurgery (GKS) for multiple cerebral metastases with that of whole-brain radiation therapy (WBRT).

Methods. Ninety-six consecutive patients with cerebral metastases from nonsmall cell lung cancer were treated between 1990 and 1999. The entry criteria were the presence of between one and 10 multiple brain lesions at initial diagnosis, no surgically inaccessible tumors with more than a 30-mm diameter, no carcinomatous meningitis, and more than 2 months of life expectancy. The patients were divided into two groups: the GKS group (62 patients) and the WBRT group (34 patients).

In the GKS group, large lesions (> 30 mm) were removed surgically and all other small lesions (≤ 30 mm) were treated by GKS. New distant lesions were treated by repeated GKS without prophylactic WBRT. In the WBRT group, the patients were treated by the traditional combined therapy of WBRT and surgery. In both groups, chemotherapy was administered according to the primary physician's protocol. The two groups did not differ in terms of age, sex, initial Karnofsky Performance Scale (KPS) score, type, lesion number, and size of lesion, systemic control, and chemotherapy.

Neurological survival and qualitative survival of the GKS group were longer than those of the WBRT group. In multivariate analysis, significant poor prognostic factors were systemically uncontrolled patients, WBRT group, and poor initial KPS score.

Conclusions. Gamma knife radiosurgery without prophylactic WBRT could be a primary choice of treatment for patients with as many as 10 cerebral metastases from nonsmall cell cancer.
Gamma knife radiosurgery for brainstem arteriovenous malformations: preliminary results
Authors: Massager Nicolas , Régis Jean , Kondziolka Douglas , Njee Théodore , Levivier Marc
Published: February 2019

Object. This study was undertaken to assess the efficacy and safety of gamma knife radiosurgery (GKS) for the treatment of arteriovenous malformations (AVMs) located within the brainstem.

Methods. The results of GKS performed in 87 patients with brainstem AVMs at two centers with experienced physicians are reviewed. The mean patient age was 37 years and the population included 19 children. The male/female ratio was 56:31. The malformation was located in the upper brainstem in 52 patients. Seventy-four percent of the patients had suffered a hemorrhage before GKS. For 70% of the patients no other treatment had been proposed before GKS. The mean AVM volume was 1.3 cm3. The lesions were treated with one to eight isocenters, with a margin dose ranging between 11.5 Gy and 30 Gy. The mean clinical follow-up period was 3.2 years. Ninety-five percent of the patients improved or remained neurologically stable. Rebleeding occurred in three patients at 3, 6, and 16 months, respectively, after GKS. Two patients in whom rebleeding occured recovered, and one died. The AVM obliteration rate was 63% at 2 years and 73% at 3 years after GKS. A second GKS was performed in six patients in whom only partial obliteration was demonstrated on angiography 3 years after the first procedure.

Conclusions. Gamma knife radiosurgery may be a valuable first-choice therapy for the treatment of AVMs located within the brainstem.
Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations
Authors: Pan D. Hung-Chi , Guo Wan-Yuo , Chung Wen-Yuh , Shiau Cheng-Ying , Chang Yue-Cune , Wang Ling-Wei
Published: February 2019

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume.

Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months.

There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant.

Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.
Gamma knife surgery for mesial temporal lobe epilepsy
Authors: Régis Jean , Bartolomei Fabrice , Rey M. , Hayashi Motohiro , Chauvel Patrick , Peragut Jean-Claude
Published: February 2019

Object. Gamma knife radiosurgery (GKS) allows precise and complete destruction of chosen target structures containing healthy and/or pathological cells, without causing significant radiation damage to adjacent tissues. Almost all the well-documented cases of radiosurgery for epilepsy are for epilepsies associated with space-occupying lesions. These results prompted the authors to investigate the use of radiosurgery as a new way of treating epilepsy not associated with space-occupying lesions.

Methods. To evaluate this new method, 25 patients who presented with drug-resistant mesial temporal lobe epilepsy (MTLE) were selected. A follow up of more than 24 months is now available for 16 patients. The preoperative evaluation was performed as it usually is in patients selected for microsurgery for MTLE. In lieu of microsurgery, the treatment of amygdalohippocampal structures was performed using GKS.

Thirteen (81%) of these 16 patients are seizure free, and two are improved. The median latent interval from GKS to seizure cessation was 10.5 months (range 6–21 months). Two patients were immediately seizure free. The median latency in aura cessation was 15.5 months (range 9–22 months). Morphological changes on magnetic resonance imaging were visible at 11 months (median) after GKS (range 7–22 months). During the onset period of these radiological changes, three patients experienced headache associated, in two cases, with nausea and vomiting. In these three patients the signs resolved immediately after prescription of low doses of steroids. No cases of permanent neurological deficit (except three cases of nonsymptomatic visual field deficit), or morbidity, or mortality were observed.

Conclusions. This initial experience indicates that there is short- to middle-term efficiency and safety when using GKS to treat MTLE. Further long-term follow up is required. It seems that the introduction of GKS into epilepsy treatment can reduce the invasiveness and morbidity.