bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Gaussian Graphical Models with the Posterior Predictive Distribution and Bayesian Model Selection
Authors: Williams Donald Ray , Rast Philippe , Pericchi Luis , Mulder Joris
Published: February 2019

Gaussian graphical models are commonly used to characterize conditional independence structures (i.e., networks) of psychological constructs. Recently attention has shifted from estimating single networks to those from various sub-populations. The focus is primarily to detect differences or demonstrate replicability. We introduce two novel Bayesian methods for comparing networks that explicitly address these aims. The first is based on the posterior predictive distribution, with Kullback-Leibler divergence as the discrepancy measure, that tests differences between two multivariate normal distributions. The second approach makes use of Bayesian model selection, with the Bayes factor, and allows for gaining evidence for invariant network structures. This overcomes limitations of current approaches in the literature that use classical hypothesis testing, where it is only possible to determine whether groups are significantly different from each other. With simulation we show the posterior predictive method is approximately calibrated under the null hypothesis ($\alpha = 0.05$) and has more power to detect differences than alternative approaches. We then examine the necessary sample sizes for detecting invariant network structures with Bayesian hypothesis testing, in addition to how this is influenced by the choice of prior distribution. The methods are applied to post-traumatic stress disorder symptoms that were measured in four groups. We end by summarizing our major contribution, that is proposing two novel methods for comparing GGMs, which extends beyond the social-behavioral sciences. The methods have been implemented in the R package BGGM.
Book Review - "Sex Cultures" by Amin Ghaziani
Authors: Bridges Tristan
Published: February 2019

This is a book review of Amin Ghaziani's, "Sex Cultures" (2017, Polity Press).
Uneven Writing Spaces in Academic Publishing: A Case Study on Internationalisation in the Disciplines of Biochemistry and Molecular Biology
Authors: Rivera-López Bárbara Sofía
Published: February 2019

More than 70% of the output of the highest impact international journals is produced by American and British scholars in the disciplines of Human Geography and Marketing (Gutierrez and Lopez-Nieva, 2001; Rosenstreich and Wooliscroft, 2006; Bański and Ferenc, 2013). Additionally, 85.3% of the editorial board members of international Marketing journals are based in the US (Rosenstreich and Wooliscroft, 2006). Furthermore, 95% of the journals in the Web of Science database use English as their language of publication (Paasi, 2015). These empirical data seem to indicate that international publication spaces are dominated by US and UK-based research (Paasi, 2015). In this context, this research seeks to deepen the debate by focusing on a new research unit: references. Through case studies on the referencing of the three higher impact journals in the disciplines of Biochemistry and Molecular Biology (PLoS Biology, Cell, and Reviews of Biochemistry) it was possible to identify, describe and visually represent the spatial patterns of knowledge production. The main findings support previous literature; 74.9% of the references surveyed had at least one author from either the US or the UK. Moreover, there was a notable predominance of authors from the US (69.9%). Furthermore, there was a high preponderance of authors from English speaking countries (88.32%). Finally, it was determined that there is an uneven writing space created by three factors: marginalization, governmental and institutional evaluation practices and the use of English. As a conclusion, a series of managerial and linguistic suggestions for academic publishers is provided in order to promote ethnic diversity and genuinely global journal publishing spaces.
Rancang Bangun Sistem Pengambilan Keputusan Dalam Menentukan Atlet Jujitsu Mengikuti Kejurnas Menggunakan Metode Simple Additive Weighting
Authors: Fridayanthie Eka Wulansari , Praditya Gomos
Published: February 2019

Dengan berkembangnya Jujitsu di Indonesia semakin pesat dibutuhkan atlet berkualifikasi yang mampumengangkat nama Indonesia di dunia internasional. Namun, tidak semua atlet dapat berpartisipasi dalamkompetisi nasional dan internasional, hanya yang terbaik yang dapat berpartisipasi melalui Training Center(TC). Dalam sistem seleksi ini, PBJSI menemukan kesulitan untuk mendapatkan atlet terbaik yang akandikirim ke permainan berdasarkan objektivitas Tanpa mencari subjektivitas. Untuk menentukan atletbergabung kejurnas, diperlukan sistem pendukung keputusan yaitu dengan menggunakan metode SimpleAdditive Weighting (SAW). Jadi setelah proses pemilihan atlet Jujitsu dengan metode ini akan mendapatkanhasil peringkat yang akan menentukan atlet mana dari masing-masing kelas akan mewakili Banten untukmengikuti Kejuaraan Nasional.
Sistem Komputerisasi Inventory Alat (Studi Kasus : PT. Geo-Informatika Solusindo)
Authors: Kuryanti Sandra Jamu , Khasanah Siti Nur , Hermanto Hermanto
Published: February 2019

PT. Geo-Informatika Solusindo merupakan sebuah perusahaan yang telah dipercaya beberapa kalioleh BIG (Badan Informasi Geospasial) dalam mengerjakan beberapa proyek pemetaan dan surveipemetaan, dengan sistem manual yang berjalan saat ini, maka terjadi beberapa kendala seperti sistempencatatan dan pencarian inventaris alat menjadi lama. Melihat dari beberapa kendala tersebut, makadibuatlah sistem baru untuk mempercepat sistem komputerisasi inventory alat, yaitu denganmenggunakan program database. Metode yang digunakan pada pengembangan perangkat lunak inimenggunakan model waterfall, yang terdiri dari analisa kebutuhan, dan perancangan sistem danperangkat lunak. Metode pengumpulan data yang digunakan oleh penulis untuk mengumpulkandatanya adalah dengan cara observasi, wawancara, dan kepustakaan.
IMPLEMENTASI KOMPUDAYA SEBAGAI SARANA SUMBERDAYA BELAJAR BAGI MASYARAKAT
Authors: Warcito Warcito
Published: February 2019

IMPLEMENTASI KOMPUDAYA SEBAGAI SARANA SUMBERDAYA BELAJAR BAGI MASYARAKAT Abstrak Komputer untuk pemberdayaan keluarga (kompudaya) merupakan salah satu model pengembangan sarana dan prasarana teknologi dan informasi komunikasi (TIK) di pedesaan. Kompudaya sebagai wadahnya, sumberdaya belajar adalah isinya (konten). Tujuan dalam penelitian ini adalah meningkatkan pengetahuan dan keterampilan masyarakat pada 4 (empat) aspek, yaitu pendidikan, kesehatan, lingkungan dan ekonomi melalui kompudaya. Pendekatan penelitian ini adalah penelitian aksi (action research). Penelitian ini menggunakan analisis deskriptif eksplorasi. Hasil identifikasi kebutuhan pelatihan kelompok sasaran berkaitan dengan kompudaya diperoleh bahwa materi yang diinginkan kelompok sasaran, yaitu teknik pembelajaran online, manajemen konten, motivasi dan dinamika kelompok, pengantar TIK, dan learning organization. Berdasarkan hasil penelitian diperoleh bahwa kompudaya telah mampu meningkatkan daya serap pengguna terhadap konten yang telah dibuka. Model kelembagaan kompudaya merupakan teknik atau metode yang efektif dalam proses belajar masyarakat. Kompudaya mampu memberikan ruang bagi masyarakat untuk berperan aktif dalam penguatan di bidang pendidikan, ekonomi, kesehatan, dan lingkungan. Kata kunci: kompudaya, TIK, pemberdayaan masyarakat Kompudaya Implementation as a Means of Resources Learning Community Abstract Computers for Family Empowerment (kompudaya) is one of the infrastructure development models and Information Communication Technology (ICT) in rural areas. Kompudaya as a container, is a learning resource content. The purpose of this research is to increase knowledge and skills of the community in 4 (four) aspects, namely education, health, environment and an economy through kompudaya. The approach of this study is an action research. This study used a descriptive analysis. The results of the identification of the training needs of the target group related to that material obtained kompudaya desired target group, namely the technique of online learning, content management, motivation and group dynamics, the introduction of ICT, and learning organization. The result showed that kompudaya has been able to increase the absorptive capacity of users to the content that has been opened. Kompudaya institutional model is a technique or method that is effective for learning in the community. Kompudaya is able to provide space for people to play an active role in strengthening education, economy, health and environment aspects. Keywords: kompudaya, ICT, community empowerment
Rekayasa Sosial Aksesibilitas Nafkah Dan Ketersediaan Pangan Responsif Gender Suku Anak Dalam Analisis Kemandirian Masyarakat Melalui Posdaya
Authors: Sjaf Sjaf , Sofyan Sofyan , Titik Sumarti
Published: February 2019

Rekayasa Sosial Aksesibilitas Nafkah Dan Ketersediaan Pangan Responsif Gender Suku Anak Dalam Analisis Kemandirian Masyarakat Melalui Posdaya Abstrak Suku Anak Dalam (SAD) is one of the native communities transformed by the tension of transmigration and palm oil plantations. This study aims to determine the pattern of living, gender relations, and knowledge of local food in SAD community. By using qualitative research methods, this study showed that the SAD community condition is toward the threat of “livelihood and food security crisis“. Furthermore, this threat has implications for the inherent meaning of food security in SAD community, namely food as the identity, the exchange tools, and religion. This threat causes a shift in role of gender in SAD community in the distribution of work and responsibilities, access to resources assets, and relations to authority in decision making between men and women. However, the social and cultural strength in the form of SAD community kinship systems, beliefs and the cosmos, as well as knowledge of local food gives the meaning of importance of building SAD communities through economic empowerment and food institutions that can provide a living accessibility and gender responsive food availability for SAD community that reside both inside and outside the forest. Key words: SAD Community, food, gender Social Engineering of Livelihood Accessibility and Food Sustainability of Gender Responsivein Suku Anak Dalam Community Abstract Suku Anak Dalam (SAD) is one of the native communities transformed by the tension of transmigration and palm oil plantations. This study aims to determine the pattern of living, gender relations, and knowledge of local food in SAD community. By using qualitative research methods, this study showed that the SAD community condition is toward the threat of “livelihood and food security crisis“. Furthermore, this threat has implications for the inherent meaning of food security in SAD community, namely food as the identity, the exchange tools, and religion. This threat causes a shift in role of gender in SAD community in the distribution of work and responsibilities, access to resources assets, and relations to authority in decision making between men and women. However, the social and cultural strength in the form of SAD community kinship systems, beliefs and the cosmos, as well as knowledge of local food gives the meaning of importance of building SAD communities through economic empowerment and food institutions that can provide a living accessibility and gender responsive food availability for SAD community that reside both inside and outside the forest. Key words: SAD Community, food, gender
Membangun Sistem Pendidikan Nasional, Mewujudkan Manusia Indonesia yang Unggul dan Berkarakter
Authors: Saefuddin Asep
Published: February 2019

COMMUNICATION Membangun Sistem Pendidikan Nasional, Mewujudkan Manusia Indonesia yang Unggul dan Berkarakter Abstrak Tulisan pendek ini merupakan pemikiran awal yang dihasilkan dari pandangan penulis yang bertujuan untuk memperbaiki kondisi pendidikan di negeri ini dari tingkat dasar sampai perguruan tinggi. Tulisan ini menekankan bahwa pendidikan merupakan sebuah sistem yang kompleks yang tidak dapat dipisahkan dari konteks politik, budaya dan ekonomi baik di tingkat lokal, nasional, regional, maupun internasional. Pendidikan sebagai suatu sistem kompleks, terdiri atas banyak komponen yang berinteraksi pada beberapa lapisan organisasi dan pada skala waktu yang berbeda. Kata Kunci: pendidikan, sistem kompleks Building a National Education System, Realize of indonesian people that Characterless and Excellence Abstract This short article is an initial thoughts resulting from the view of the author that aims to improve the state of education in this country from primary to university level. This paper emphasizes that education is a complex system that can not be separated from the political, cultural and economic at the local, national, regional, and international levels. Education as a complex system, consisting of many components that interact at multiple levels of the organization and at different time scales. Keywords: education, complex systems
Koperasi dan Sistem Perekonomian Indonesia Catatan dan Apresiasi atas Buku Koperasi Indonesia
Authors: Hamid Edy Suandi
Published: February 2019

COMMUNICATION Koperasi dan Sistem Perekonomian Indonesia Catatan dan Apresiasi atas Buku Koperasi Indonesia Membaca buku ini, serasa membawa saya kembali ke masa-masa Orde Baru, masa pemerintahan Presiden Soeharto, yang semangat untuk membangun kelembagaan koperasai sungguh luar biasa. Lepas dari hasil pengembangan itu yang masih bisa diperdebatkan, namun memang tidak bisa dipungkiri bahwa hak hidup koperasi pada masa itu sebagai badan usaha yang wajib dikembangkan sebagai amanat konstitusi memang tidak terbantahkan. Koperasi eksis di perkotaan hingga pelosok pedesaan. Koperasi eksis di perkotaan hingga pelosok pedesaan. Koperasi sangat akrab dengan masyarakat di manapun. Stimulus untuk berkoperasi dilakukan di mana-mana. Tidak hanya pemerintah yang terlibat dalam menggemakan koperasi agar menjadi badan usaha yang mengangkat kesejahteraan rakyat banyak, tetapi juga Badan-badan Usaha Milik Negara dan perusahaan-perusahaan swasta diminta dan didorongagarterlibatdalamperkoperasianini. Dalam perusahaan dan BUMN bukan saja didirikan koperasi karyawan, bahkan perusahaan didorong agar dalam kepemilikan perusahaan ada saham koperasi.
aradigma Human Rights Based Dalam Kerangka Hukum Penyandang Disabilitas
Authors: Widyantini Ambar Retnosih
Published: February 2019

Abstrak Tulisan ini bertujuan untuk menganalisis urgensi Undang-Undang Penyandang Disabilitas sebagai payung hukum bagi masyarakat minoritas penyandang disabilitas. Penyandang Disabilitas di Indonesia sampai saat ini masih mengalami marjinalisasi, diskriminasi dari berbagai kalangan masyarakat, kelompok intelektual dan kekuasaan. Peraturan Undang-Undang Nomor 4 Tahun 1997 tentang Penyandang Cacat dan Peraturan Pemerintah Nomor 43 Tahun 1998 tentang Upaya Peningkatan Kesejahteraan Penyandang Cacat masih belum memadai dalam memenuhi affirmative action bagi penyandang disabilitas. Indonesia telah meratifikasi Convention on the Rights of Persons with Disabilities (CRPD) melalui UU Nomor 19 Tahun 2011. Konvensi internasional ini memberikan kerangka internasional bagi negara-negara pihak untuk memberikan perlindungan dan pemenuhan hak asasi manusia bagi penyandang disabilitas. Analisis menunjukkan kesadaran pemerintah dalam memberikan kesetaraan hak, peran dan kewajiban bagi penyandang disabilitas hanya bisa dilakukan melalui transisi paradigma human right based dalam penyusunan UU Penyandang disabilitas. Untuk menyempurnakan pemenuhan hak asasi manusia, UU Penyandang Disabilitas dilengkapi turunan aturan dalam peraturan pemerintah dan peraturan daerah. Kata Kunci:
Perancangan Situs Web Sarana Pemasaran Online Produk UMKM Binaan Posdaya
Authors: Krishnasari Erneza Dwi , Baskoro M. Lahandi
Published: February 2019

Perancangan Situs Web Sarana Pemasaran Online Produk UMKM Binaan PosdayaAbstrak Pada tahun 2014, tidak kurang dari 88,1 juta orang Indonesia sudah terhubung ke internet dan angkanya akan terus bertambah lagi dari tahun ke tahun. Penetrasi akses internet ini pun secara langsung mendorong pertumbuhan UMKM yang mulai menggunakan internet sebagai cara untuk memasarkan produknya. Posdaya adalah gerakan yang mendorong kesejahteraan keluarga dengan berbagai penguatan fungsi keluarga, salah satunya melalui kewirausahaan. Dengan gerakan Posdaya yang sudah menyebar dan membina banyak UMKM, sangat disayangkan tidak ditemukannya sarana pemasaran online dimana calon pembeli bisa melihat dan memesan produk-produk unggulan binaan Posdaya. Tujuan dari penelitian ini adalah merancang suatu toko online sederhana sebagai sarana pemasaran produk-produk unggulan Posdaya dengan metode komparasi terhadap toko online yang sudah ada di Indonesia. Kata Kunci: Posdaya, UMKM, e-commerce, online store. Designing Online Marketing Medium for Top SMEs Product Under Posdaya Abstract In 2014, no less than 88.1 million Indonesian people are connected to the internet, and this number will continue to grow. The growth of internet penetration rate is also affecting the growth of SMEs which starting to adopt the internet as a way to market their products online. Posdaya is a movement which aim for empowering family to reach prosperous condition through a variety of family streghtening program, one of them is through entrepreneurship. Within the popularity of Posdaya that already help many Indonesian SMEs through training and financing, it is almost none of those SMEs product could be ordered online. This is an unfortunate conditions because there might be prospective buyers which interested with the top products from those SMEs. The aim of this study is to design a simple online store as a marketing medium for top products from SMEs under Posdaya. Keywords: Posdaya, SMEs, e-commerce, online store.
FAKTOR YANG MEMPENGARUHI NON PERFORMING LOAN PADA BANK DI INDONESIA
Authors: Margaretha Farah , Kalista Vanya
Published: February 2019

FAKTOR YANG MEMPENGARUHI NON PERFORMING LOAN PADA BANK DI INDONESIAAbstrak Penelitian ini bertujuan untuk mengetahui pengaruh cost inefficiency, financial capital, loans to assets ratio, bank size, good performance, credit growth, soft budget constrain, deposit rate, dan reserve ratio terhadap non- performing loan pada bank umum swasta nasional devisa dan non devisa di Indonesia periode 2009-2012. Variabel independen (x) yang diteliti adalah cost inefficiency, financial capital, loans to assets ratio, bank size, good performance, credit growth, soft budget constrain, deposit rate, dan reserve ratio, sedangkan variable dependen (y) adalah non-performing loan. Jumlah sampel yang digunakan adalah 31 bank dengan metode purposive sampling. Hasil empiris dari penelitian ini menunjukkan bahwa bank size dan soft budget constrain memiliki pengaruh terhadap non-performing loan secara signifikan, sedangkan cost inefficiency, financial capital, loans to assets ratio, good performance, credit growth, deposit rate, dan reserve ratio tidak memiliki pengaruh terhadap non-performing loan. Hal ini mengindikasikan bahwa ukuran suatu bank dapat meningkatkan tingkat non-performing loan bank tersebut. Sedangkan pemberian soft budget constrain terhadap kredit dapat menurunkan tingkat non-perfoming loan. Manajer bank dapat memanfaatkan hasil penelitian untuk mengontrol sebaran kredit yang diberikan dan mengelola resiko kredit denga nmemberi suku bunga rendah. Kata kunci: Bank Size, Credit, Non-performing loan,Performance, Soft Budget Constrain. INFLUNCE FACTORS ON NON-PERFORMING LOANS OF COMMERCIAL BANKS IN INDONESIA Abstract This study aims to determine the effect of cost inefficiency, financial capital, loans to assets ratio, bank size, good performance, credit growth, soft budget constraint, deposit rate, and reserve ratio against non-performing loans of commercial banks in Indonesia 2009-2012. Independent variables in this study (x) are the cost inefficiency, financial capital, loans to assets ratio, bank size, good performance, credit growth, soft budget constraint, deposit rate, and reserve ratio, while the dependent variable (y) is non-performing loan. The samples used were 31 banks with purposive sampling method. The empirical results of this study indicate that bank size and soft budget constraint has no effect on non-performing loans significantly, while the cost inefficiency, financial capital, loans to assets ratio, good performance, credit growth, deposit rate, and reserve ratio has no influence against non-performing loans. This indicates that the size of a bank can increase the level of non- performing loans of the banks. While giving credit with the soft budget constraint may reduce the level of non- performing loan. Bank managers can use the results of research to control the distribution of loans and manage credit risk by giving low interest rate. Keywords: Bank Size, Credit, Non-performing loan,Performance, Soft Budget Constrain.
Les tactiques d’un intellectuel clérical progressiste : le père Georges-Henri Lévesque, 1945 à 1955
Authors: Racine St-Jacques Jules
Published: February 2019

À partir de décembre 1945, le père dominicain Georges-Henri Lévesque se trouve plongé au cœur d’une controverse impliquant une part influente du clergé autour de la question de la non-confessionnalité des coopératives. Jusqu’à sa démission du poste de doyen de la Faculté des sciences sociales de l’Université Laval en 1955, le dominicain sera la cible de nombreuses attaques de la part des pouvoirs clérical et politique. Pour résister à ces charges, il mobilise différentes tactiques dont l’analyse permet de mieux cerner la spécificité de l’intellectuel clérical dans le Canada français duplessiste.
Financial stress, financial stability, and military spousal well-being
Authors: Wang Zhigang , Pullman Lesleigh E.
Published: February 2019

Introduction: Not only do military families face similar financial stressors as civilian families, but they also face a number of unique financial stressors as a result of the military lifestyle. In this article, we explore factors that contribute to military spouses’ perceived financial stress and the effect of financial stability on military spouses’ psychological well-being and life satisfaction. Methods: The data sets used in the analyses include female civilian spouses of Canadian Armed Forces (CAF) Regular Force members who completed the Quality of Life (QOL) survey administered in 2009 ( N = 1,518) and 2013 ( N = 1,189). In Study 1, we conducted a series of analyses to assess whether CAF spouses’ socio-demographic and military lifestyle characteristics contribute to their perceived level of financial stress (2009 QOL data). In Study 2, we conducted a series of analyses to assess whether financial stress and stability contribute to CAF spouses’ well-being and life satisfaction (2009 and 2013 QOL data). Results: Results showed that socio-demographic and military lifestyle characteristics predicted military spouses’ financial stress and that more financial stress and less financial stability reduced their psychological well-being and life satisfaction. Discussion: These findings suggest that reducing military spouses’ financial stress and improving their financial stability may enhance their well-being.
The association between risky health behaviours and socio-economic status in Canadian Armed Forces recruits: the mediating effect of health-risk attitudes
Authors: Edge Heather J. McCuaig , Oliver L. Kathleen
Published: February 2019

Introduction: Socio-economic status (SES) is significantly associated with health outcomes and behaviours. Low SES in childhood has been found to predict poor health outcomes in young adulthood. Furthermore, low SES has been linked to poor health-risk attitudes. It is important to understand the correlates of risky health behaviours and the nature of the relationships among risky health behaviours, SES, and attitudes favouring risky health behaviours. Methods: The Recruit Health Questionnaire (RHQ) was developed to determine demographic information and health behaviours of Canadian Armed Forces (CAF) recruits and is collected during the early weeks of basic military training. We examined the relationship between SES (as measured by previous year’s household income) and risky health behaviours (e.g., smoking, risky drinking), and explored the mediating effect of attitudes favouring health risks (e.g., likelihood of drinking heavily at a social function). We analyzed data from 3,465 CAF recruits (83% male; 76% non-commissioned member recruits; 43% between the ages of 20 and 24 years; 63% having completed at least some post-secondary studies) who completed the RHQ between 2013 and 2014. Results: Low SES was associated with smoking, and high SES with binge drinking and driving under the influence, but, when controlling for age, sex, rank, and education level, there was a significant indirect effect of SES on all risky health behaviours through health-risk attitudes. This suggests that SES prior to military enlistment may affect health behaviours, but health-risk attitudes play a significant role in contributing to risky behaviours. Discussion: It is important to understand the role of SES background on recruits and its role in determining attitudes toward health and risky health behaviours in order to influence policies and targeted health promotion programming to reduce risky health behaviours. Knowing that health-risk attitudes play a significant role in risky health behaviours can influence programming to promote attitudes that are more averse toward health and safety risks.
The design of bottomhole assembly with two rock cutting tools for directional drilling
Authors: Voievidko I. V. , Tokaruk V. V. , Bodzian M. A.
Published: February 2019

On the basis of the theoretical analysis and practical studies of hole drilling of large diameter, a method for designing the BHA with two rock cutting tools is proposed, taking into account the geological and technical factors that have an impact on the formation of the trajectory. The calculation of BHA with two rock cutting tools and a different number of supporting and centralizing components for different geological conditions of drilling is carried out and the analysis of their work in the process of drilling is conducted. The graphic dependences of the deviation intensity variation and the inclination angle with the sinking of borehole of the large diameter for the BHA that can be used for the drilling of vertical and directional wells.
A novel method to determine the natural course of unruptured brain arteriovenous malformations without the need for follow-up information
Authors: Karlsson Bengt , Johansson Arne V. , Yang Huai-Che , Jokura Hidefumi , Yamamoto Masaaki , Martínez-Álvarez Roberto , Kawagishi Jun , Guo Wan-Yuo , Beute Guus , Pan David H. C. , Chung Wen-Yuh , Söderman Michael , Aiyama Hitoshi , Yeo Tseng Tsai
Published: February 2019

OBJECTIVE

There is a strong clinical need to accurately determine the average annual hemorrhage risk in unruptured brain arteriovenous malformations (AVMs). This need motivated the present initiative to use data from a uniquely large patient population and design a novel methodology to achieve a risk determination with unprecedented accuracy. The authors also aimed to determine the impact of sex, pregnancy, AVM volume, and location on the risk for AVM rupture.

METHODS

The present study does not consider any specific management of the AVMs, but only uses the age distribution for the first hemorrhage, the shape of which becomes universal for a sufficiently large set of patients. For this purpose, the authors collected observations, including age at first hemorrhage and AVM size and location, in 3425 patients. The average annual risk for hemorrhage could then be determined from the simple relation that the number of patients with their first hemorrhage at a specific age equals the risk for hemorrhage times the number of patients at risk at that age. For a subset of the patients, the information regarding occurrence of AVM hemorrhage after treatment of the first hemorrhage was used for further analysis of the influence on risk from AVM location and pregnancy.

RESULTS

The age distribution for the first AVM hemorrhage was used to determine the average annual risk for hemorrhage in unruptured AVMs at adult ages (25–60 years). It was concluded to be 3.1% ± 0.2% and unrelated to AVM volume but influenced by its location, with the highest risk for centrally located AVMs. The hemorrhage risk was found to be significantly higher for females in their fertile years.

CONCLUSIONS

The present methodology allowed the authors to determine the average annual risk for the first AVM hemorrhage at 3.1% ± 0.2% without the need for individual patient follow-up. This methodology has potential also for other similar types of investigations. The conclusion that centrally located AVMs carry a higher risk was confirmed by follow-up information. Follow-up information was also used to conclude that pregnancy causes a substantially greater AVM hemorrhage risk. The age distribution for AVM hemorrhage is incompatible with AVMs present at birth having the same hemorrhage risk as AVMs in adults. Plausibly, they instead develop in the early years of life, possibly with a lower hemorrhage risk during that time period.
Radiosurgery for growth hormone—producing pituitary adenomas
Authors: Zhang Nan , Pan Li , Wang En Min , Dai Jia Zhong , Wang Bin Jiang , Cai Pei Wu
Published: February 2019

Object. The authors sought to evaluate the effect of gamma knife radiosurgery (GKS) on growth hormone (GH)—producing pituitary adenoma growth and endocrinological response.

Methods. From 1993 to 1997, 79 patients with GH-producing pituitary adenomas were treated with GKS. Seventysix patients had acromegaly. Sixty-eight patients were treated with GKS as the primary procedure. The tumor margin was covered with a 50 to 90% isodose and the margin dose was 18 to 35 Gy (mean 31.3 Gy). The dose to the visual pathways was less than 10 Gy except in one case. Sixty-eight patients (86%) were followed for 6 to 52 months. Growth hormone levels declined with improvement in acromegaly in all cases in the first 6 months after GKS. Normalization of the hormone levels was achieved in 23 (40%) of 58 patients who had been followed for 12 months and in 96% of cases for more than 24 months (43 of 45), or more than 36 months (25 of 26), respectively. With the reduction of GH hormone levels, 12 of 21 patients with hyperglycemia regained a normal blood glucose level (p < 0.001). The tumor shrank in 30 (52%) of 58 patients who had been followed for 12 months (p < 0.01), 39 (87%) of 45 patients for more than 2 years (p = 0.02), and 24 (92%) of 26 patients for more than 36 months. In the remainder of patients tumor growth ceased.

Conclusions. Gamma knife radiosurgery for GH-producing adenomas showed promising results both in hormonal control and tumor shrinkage. A margin dose of more than 30 Gy would seem to be effective in improving the clinical status, reducing high blood glucose levels, and normalizing hypertension.
Early complications following gamma knife radiosurgery for intracranial meningiomas
Authors: Singh V. P. , Kansal S. , Vaishya S. , Julka P. K. , Mehta V. S.
Published: February 2019

Object. The purpose of this paper was to assess the early complications, defined as occurring within 1 year, following gamma knife radiosurgery (GKS) for the treatment of intracranial meningiomas.

Methods. Seventy-seven of 306 patients undergoing GKS in the last 2.5 years harbored meningiomas. There were 35 men and 42 women with a mean age of 32.4 years (range 10–80 years). Tumor volume ranged from 0.35 to 28.6 cm3 (mean 7.9 cm3). Gamma knife radiosurgery was the primary therapy in 28 patients and followed surgery in 49 patients. There were 50 basal and 27 nonbasal meningiomas. The most common sites were parasagittal (23 patients) and cerebellopontine angle (14 patients). Ten to 15 Gy was administered to the tumor margins.

Clinical and radiological follow up with a mean duration of 122 months was available in 40 patients. Seizures and increased headache were found in five and four patients, respectively. A temporary worsening of hemiparesis was seen in two patients (both with parasagittal tumors). One patient with a cavernous sinus meningioma developed a herpes labialis eruption. Perilesional edema was demonstrated in nine patients and was symptomatic in six. Six (22%) of the 27 patients with nonbasal tumors had edema (all parasagittal) and four patients were symptomatic. Only three (6%) of the 50 basal meningiomas had edema, and only one patient was symptomatic. The occurence of edema did not correlate with tumor volume, margin or maximum dose, or with radiation received by adjacent brain. A reduction in tumor size was seen in seven patients. In one patient a new recurrent lesion developed adjacent to the previously treated tumor.

Conclusions. Although GKS provides good results for selected patients with meningiomas, caution is required in treating patients with parasagittal tumors as the incidence of perilesional edema is considerable.
Radiosurgery for malignant meningioma: results in 22 patients
Authors: Ojemann Steven G. , Sneed Penny K. , Larson David A. , Gutin Philip H. , Berger Mitchel S. , Verhey Lynn , Smith Vernon , Petti Paula , Wara William , Park Elaine , McDermott Michael W.
Published: February 2019

Object. The initial treatment of malignant meningiomas in the past has included surgical removal followed by fractionated external-beam radiotherapy. Radiosurgery has been added to the options for treatment of primary or recurrent tumors over the last 10 years. The authors report their results of using gamma knife radiosurgery (GKS) to treat 22 patients over an 8-year period.

Methods. Twenty-two patients who underwent GKS for malignant meningioma between December 1991 and May 1999 were evaluated. Three patients were treated with GKS as a boost to radiotherapy and 19 for recurrence following radiotherapy. Outcome factors including patient survival, freedom from progression, and complications were analyzed. In addition, in the recurrent group, variables such as patient age, sex, tumor location, target volume, margin dose, and maximum dose were also analyzed. Univariate and multivariate analyses were performed.

Overall 5-year survival and progression-free survival estimates were 40% and 26%, respectively. Age (p ≤ 0.003) and tumor volume (p ≤ 0.05) were significant predictors of time to progression and survival in both univariate and multivariate analyses. Five patients (23%) developed radiation necrosis. Significant relationships between complications and treatment variables or patient characteristics could not be established.

Conclusions. Tumor control following GKS is greater in patients with smaller-sized tumors (< 8 cm3) and in younger patients. Gamma knife radiosurgery can be performed to treat malignant meningioma with acceptable toxicity. The efficacy of GKS relative to other therapies for recurrent malignant meningioma as well as the value of GKS as a boost to radiotherapy will require further evaluation.
Gamma knife radiosurgery in the management of cavernous sinus meningiomas
Authors: Roche Pierre-Hugues , Régis Jean , Dufour Henry , Fournier Henri-Dominique , Delsanti Christine , Pellet William , Grisoli Francois , Peragut Jean-Claude
Published: February 2019

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS).

Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS.

The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred.

Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.
Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery
Authors: Chang Jong Hee , Chang Jin Woo , Park Yong Gou , Chung Sang Sup
Published: February 2019

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion.

Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated.

Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.
Staged radiosurgical treatment for large benign cerebral lesions
Authors: Pendl Gerhard , Unger Frank , Papaefthymiou Georg , Eustacchio Sandro
Published: February 2019

Object. Large brain lesions are considered unamenable to gamma knife treatment because of possible adverse effects. The proximity of eloquent brain to a target location, including some arteriovenous malformations (AVMs), still poses a challenge to the neurosurgeon. Because meningiomas and AVMs often show a slow or absent growth rate, partial radiosurgical treatment in cases with risk of unacceptable surgery-related morbidity is an alternative. The authors evaluated the results of staged treatment.

Methods. Since April 1992, 12 patients suffering from large benign tumors (meningiomas) and seven with AVMs considered inoperable underwent gamma knife radiosurgery in staged procedures. All patients with tumors underwent primary open surgery for partial removal of recurrent growth and subsequent radiosurgical treatment. Four men and eight women ranging in age from 26 to 73 years harbored tumors that ranged in volume from 19 to 90 cm3. Marginal dose ranged from 10 to 25 Gy prescribed in the 30 to 50% isodose. The time interval between the radiosurgical treatments varied from 1 to 8 months. Follow up ranged from 5 and 89 months. Three female and four male patients (age range 10–48 years) had undergone previous AVM embolization and were treated with margin doses of 18 to 22 Gy in the 40 to 50% isodose. The volume range of these AVMs was 11 to 25 cm3. The time interval between radiosurgical treatments ranged from 5 to 36 months. The mean follow up was 22.6 months.

Neurological follow-up examinations showed clinical improvement in 11 patients (58%), whereas five (26%) remained unchanged. Among tumor patients no deterioration or further tumor growth was observed. Tumor necrosis demonstrated noticed in five patients (26%). One patient with an AVM suffered from seizures and hemiparesis. Follow-up magnetic resonance imaging of the residual nidus disclosed no rebleeding.

Conclusions. For selected patients with large benign lesions staged gamma knife radiosurgery could be an alternative, as evidenced by the authors' series in which there was no mortality and low incidence morbidity.
Evaluation of gamma thalamotomy for parkinsonian and other tremors: survival of neurons adjacent to the thalamic lesion after gamma thalamotomy
Authors: Ohye Chihiro , Shibazaki Tohru , Ishihara Junji , Zhang Jie
Published: February 2019

Object. The effects of gamma thalamotomy for parkinsonian and other kinds of tremor were evaluated.

Methods. Thirty-six thalamotomies were performed in 31 patients by using a 4-mm collimator. The maximum dose was 150 Gy in the initial six cases, which was reduced to 130 Gy thereafter. The longest follow-up period was 6 years. The target was determined on T2-weighted and proton magnetic resonance (MR) images. The point chosen was in the lateral-most part of the thalamic ventralis intermedius nucleus. This is in keeping with open thalamotomy as practiced at the authors' institution. In 15 cases, gamma thalamotomy was the first surgical procedure. In other cases, previous therapeutic or vascular lesions were visible to facilitate targeting.

Two types of tissue reaction were onserved on MR imaging: a simple oval shape and a complex irregular shape. Neither of these changes affected the clinical course. In the majority of cases, the tremor subsided after a latent interval of approximately 1 year after irradiation. The earliest response was demonstrated at 3 months. In five cases the tremor remained. In four of these cases, a second radiation session was administered. One of these four patients as well as another patient with an unsatisfactory result underwent open thalamotomy with microrecording. In both cases, depth recording adjacent to the necrotic area revealed normal neuronal activity, including the rhythmic discharge of tremor. Minor coagulation was performed and resulted in immediate and complete arrest of the remaining tremor.

Conclusions. Gamma thalamotomy for Parkinson's disease seems to be an alternative useful method in selected cases.
Magnetic source imaging guidance of gamma knife radiosurgery for the treatment of epilepsy
Authors: Smith Joseph R. , King Don W. , Park Yong D. , Lee Mark R. , Lee Gregory P. , Jenkins Patrick D.
Published: February 2019

Object. The purpose of this study was to determine if magnetic source (MS) imaging could provide useful information in the planning and performance of gamma knife radiosurgery (GKS) for epilepsy.

Methods. Magnetic source imaging of interictal epileptiform dipoles was studied in 53 epilepsy surgery candidates. All patients underwent volumetric magnetic resonance (MR) imaging. Subsequently, magnetoencephalography (MEG) was performed using single or dual 37—channel units. The MR images and MEG recordings were then coregistered to produce the MS imaging data. Magnetic source imaging epileptiform data were reviewed in a blinded fashion and spatial distributions were classified as focal, regional, multiple, scattered, or none. Postresection operative photographs were compared with MS image results to determine whether extensive or partial/no resection of the MS image focus had been accomplished. Magnetoencephalography dipoles were identified in 47 patients (89%), in 46 of whom the lesions were resected. This included 20 (80%) of 25 anterior temporal lobe (ATL) cases, and 26 (93%) of 28 extratemporal lobe (ETL) cases. Of the six patients who underwent extensive ATL resections, three (50%) were seizure free. Of 14 patients who underwent partial/no resection of the ATL, seven (50%) were seizure free. There was no clear relation between MS image spatial distribution and surgery-related outcome. Of the seven ATL cases with hippocampal atrophy, five patients (71%) were seizure free. Of 12 ETL cases (three lesional), 10 patients (83%) were seizure free. Of 14 patients who underwent partial/no ETL resections (three lesional), two (14%) were seizure free. Of five nonlesional ETL cases with focal MS image dipoles, four patients (80%) were seizure free. Of five nonlesional ETL cases with regional dipoles, three patients (60%) were seizure free. Of eight ETL cases with multiple MS image dipoles, two patients (25%) were seizure free. Spatial agreement of MS imaging and electrographic data had no apparent effect on outcome of either ATL or ETL cases.

Conclusions. Nonlesional ETL cases with focal (and in some cases multiple or regional) epileptiform MS image dipole distributions benefit significantly from inclusion of the MS image epileptiform focus in the resections. Nonlesional ETL cases suitable for GKS may similarly benefit from including the MS image focus in the irradiated area.
Gamma knife radiosurgery for trigeminal neuralgia: dose—volume histograms of the brainstem and trigeminal nerve
Authors: Brisman Ronald , Mooij R.
Published: February 2019

Object. The purpose of this study was to assess the relationship between the volume of brainstem that receives 20% or more of the maximum dose (VB20) and the volume of the trigeminal nerve that receives 50% or more of the maximum dose (VT50) on clinical outcome following gamma knife radiosurgery (GKS) for trigeminal neuralgia (TN).

Methods. Patients with TN were treated with a single 4-mm isocenter with a maximum dose of 75 Gy directed at the trigeminal nerve close to where it leaves the brainstem. The VB20 and VT50, as determined on dose—volume histograms, were correlated with clinical outcomes at 6 and 12 months, laterality, presence of multiple sclerosis (MS), and each other.

At 6 months excellent pain relief (no pain or required medicine) was achieved in 27 of 48 patients (p = 0.009) when VB20 was greater than or equal to 20 mm3 and in 25 of 78 when VB20 was less than 20 mm3, when all patients are considered. At 12 months excellent pain relief was achieved in 16 of 32 patients (p = 0.038) when VB20 was greater than or equal to 20 mm3 and in 14 of 52 when VB20 less than 20 mm3, when all patients are considered. When VB20 was less than 20 mm3 in MS patients, five of 21 had an excellent result at 6 months and two of 13 at 12 months. The VB20 was 20 mm3 or more in 38 of 64 on the right side and in eight of 41 on the left side (p < 0.001) in patients with TN and without MS. There is a difference between left and right dose—volume histograms even when the same isodose is placed on the surface of the brainstem.

The VB20 was 20 mm3 or more in 45 of 105 patients with TN and without MS but in only three of 21 patients with TN and MS (p = 0.014). There was an inverse relationship between VB20 and VT50 (p = 0.01).

Conclusions. Isocenter proximity to the brainstem, as reflected in a higher VB20, is associated with a greater chance of excellent outcome at 6 and 12 months. Worse results in patients with TN and MS may be partly explained by a lower VB20.