bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of the Bali Province Food Security Action Plan towards Food Independence
Authors: WIDHIANTHINI Widhianthini , SUKENDAR Ni Made Classia , PURANTARA Anak Agung Gede
Published: March 2024

The problem of hunger is one of the problems that still occur in Indonesia. The problem of hunger is closely related to the problem of staple foods, such as the unmet security of staple food, rice as the community's main food, and the increasing demand for staple foods. This research aims to analyze the challenges faced by Bali Province in maintaining sustainable food security and to design food security action designs in Bali Province towards food independence. The data used in this research are primary data and secondary data with a descriptive analysis method using ISM analysis. The results of the research show that food challenges that occur in Bali Province include reduced agricultural land, unbalanced supply and demand for food commodities, weak use and mastery of technology, lack of farming management and product marketing, the proportion of crop loss and food waste is still quite high, food loss due to inaccuracy in handling food, the area of agricultural land per capita is very limited, the number of young people interested in working in the agricultural sector is still problematic, the age of farmers over 45 years reaches 64.2%, Indonesia is also still facing three times the burden of nutrition, climate change, and hydrometeorological disasters. The Bali Province's food security design towards food independence consists of farmers, government, companies, financial institutions, and agricultural cooperatives who are interconnected with each other.
An Importance-Performance Analysis of Accessible Tourism: A Tourist and Resident Perspective with Empirical Insights from Phuket
Authors: FUCHS Kevin
Published: March 2024

The fundamental principle of accessible tourism revolves around advocating for the inclusion and empowerment of individuals with disabilities, aiming to facilitate complete engagement for individuals with disabilities within tourism experiences. Previous research established a five-dimensional exploratory framework revealing several barriers that prevent Phuket Island from fully engaging in accessible tourism and increasing its global market share in this emerging market segment. This study sought to build upon previous findings by empirically investigating these barriers through the utilization of the importance-performance analysis method. Methodologically, survey data was collected from 391 tourists and residents in Phuket. The findings align with previous research, highlighting the preparedness of Phuket's international airport, diverse luxury accommodation options, and internationally accredited medical facilities. These elements stand out as exemplary in meeting the needs of accessible tourism. Conversely, the present infrastructure, insufficient transportation systems, and limited recreational options pose significant challenges, marking them as pivotal bottlenecks. The article discusses practical implications to rectify these limitations and advances the discussion about using the importance-performance analysis as a managerial tool to evaluate the quality of tourism experiences in the context of accessible tourism.
Geusun Ulun Museum as Sumedang Larang Kingdom Assets Entry Points of Tourism Destinations in Sumedang
Authors: NURBAETI Nurbaeti , RATNANINGTYAS Heny , PANTJA DJATI Sundring
Published: March 2024

Visit to the Geusun Ulun Museum are still very low compared to other tourist attractions in West Java; a management strategy for the Geusan Ulun Museum is needed. This study aims to apply a SWOT analysis to the Prabu Geusan Ulun Palace as an entry point for Sumedang tourist destinations. The research was conducted by observation and interviews. The results showed that the Geusun Ulun Museum had the highest score of 3.82 in quadrant/position I, which means that the condition of the Geusun Ulun Museum is very profitable and has opportunities and strengths so that it can take advantage of current opportunities; the strategy used is the SO/Strenght Opportunity strategy including: (1) Improving the presentation of collections to be more informative and conceptual; (2) The Nazir Prince Wakaf Sumedang Foundation, the manager of the Geusun Ulun Museum, is actively promoting and developing the Royal Sunda Museum; (3) The strategic location of the Museum is the main attraction for tourists; (4) The remaining land area is still widely used for facilities and infrastructure that still need to be created; (5) Cooperating with the private sector to promote through the internet about the Geusun Ulun Museum; (6) Package and synergize tour packages with travel agents.
Experimental investigation of generating superheated steam using a parabolic dish with a cylindrical cavity receiver: A case study
Authors: Obaid Naseer W. , Abdulkareem Mishaal A.
Published: March 2024

This study uses solar energy to convert steam from a saturated to a superheated state using a solar steam superheater system. This collector system comprised a parabolic dish with a cylindrical cavity. The parabolic dish is of 2 m diameter and 0.83 m focal distance, covered with a reflective surface made of 1,283 rectangular pieces of mirrors, each of 3.5 cm × 4 cm that were fixed in place with glue type (FnTai). The receiver is a stainless-steel cylindrical cavity having a diameter of 17 cm and a length of 25 cm. A helical copper coil with a diameter of 10 mm and a length of 6 m was inserted inside the cylindrical cavity. The experimental work utilized saturated steam produced separately from an auxiliary electric boiler system, which was made along with other system components. A 0.011 kg/s of saturated steam at a temperature of 112°C enters the copper coil and is heated by the solar radiation reflected by the parabolic dish onto the receiver. As a result, the temperature of the steam is increased to 169.5°C at the receiver outlet. It was found that the collector efficiency is 55.6%. In addition, the convection and radiation heat losses are 12.14 and 10.98%, respectively. Also, the heat losses of (spillage, reflection, and conduction) were estimated to be 21.18%. The mass flow rate and pressure of the saturated steam from the boiler and entering the receiver affected the superheated steam production process. The process of superheating the steam, coupled with the subsequent improvement in thermal performance, indicates an increased efficiency of the collector. This is achieved by boosting the generation of useful heat and mitigating heat losses.
Distributed generation aggregators considering low-carbon credits optimize dispatch strategies
Authors: Wang Ruohan , Xing Hongwei , Chen Yunlong , Zhang Jianhui , Li Entang , Li Jing
Published: March 2024

Against the backdrop of China’s implementation of the “dual carbon” target and carbon emissions trading policies, renewable energy generation technologies have matured and received support from related policies. Distributed power sources have played a crucial role in the power system, and aggregators have integrated a large number of distributed power sources with diverse characteristics, shielding the complex characteristics of the underlying distributed power sources from grid scheduling. This article introduces the revenue optimization of low-carbon integration to optimize the aggregator’s scheduling model, designs distributed renewable energy generation units, and studies the solution strategy based on quantum genetic algorithms for large-scale optimization scheduling problems. The aggregator’s optimization variables divide the entire optimization problem and consider low-carbon integration to achieve distributed management of green energy parks, providing a feasible theoretical framework for the further development of distributed power sources. It has important practical significance in energy conservation, emissions reduction, and ecological environmental protection.
Pituitary stalk interruption syndrome due to novel ROBO1 mutation presenting as combined pituitary hormone deficiency and central diabetes insipidus
Authors: Misgar Raiz Ahmad , Chhabra Ankit , Qadir Ajaz , Arora Sidharth , Wani Arshad Iqbal , Bashir Mir Iftikhar , Masoodi Shariq Rashid
Published: March 2024

Objectives

The genetic causes of pituitary stalk interruption syndrome (PSIS) remain elusive in 95 % of cases. The roundabout receptor-1 gene (ROBO1) plays critical roles in axonal guidance and cell migration. Recently, mutations in the ROBO1 gene have been reported patients with PSIS.

Case presentation

We report a 2.9-year-old boy with PSIS who presented with combined pituitary hormone deficiency, central diabetes insipidus, and the classical triad of MRI findings. Through clinical exome sequencing using next-generation sequencing techniques, a previously unidentified novel heterozygous frame shift mutation in the ROBO1 gene was identified. This is the first report of ROBO1 mutation associated with posterior pituitary dysfunction.

Conclusions

We conclude and emphasize that ROBO1 should be investigated in patients with PSIS. Our case is unique in the published literature in that we are first time reporting posterior pituitary dysfunction as manifestation of ROBO1 mutation. The full clinical spectrum of the mutations may not be fully known.
The role of bile acids in human aging
Authors: Jin Lihua , Shi Linsen , Huang Wendong
Published: March 2024

Bile acids are recognized as important signaling molecules that enable fine-tuned inter-communication from the liver, through the intestine, to virtually any organ, thus encouraging their pleiotropic physiological effects. Aging is a complex natural process defined as a progressive decline in cellular and organismal functions. A causal link between bile acids and the aging process is emerging. However, there are gaps in our understanding of the molecular mechanisms and precise targets responsible for the alteration of bile acid profiles and their role in the aging process. Intestinal barrier dysfunction leads to endotoxemia, systemic inflammation, insulin resistance, diabetes, lipid accumulation, obesity and fatty liver diseases, and health decline and death. In fact, intestinal barrier dysfunction is suggested to be an evolutionarily conserved hallmark of aging. Bile acids may modulate the aging process by regulating intestinal barrier integrity.
Scholem’s Kafka: Not a Nihilistic, but Rather a Secular, Kabbalist
Authors: Weinberg Steven
Published: March 2024

Gershom Scholem devised the ironic formulation that Kafka’s literature depicts the Kabbalah from a secular perspective. This declaration, when unraveled, offers an indispensable key to understanding Scholem’s views on Kafka. Scholem’s formulation stems from his dialectical perspective of Jewish history and his reliance on the notion of Zimzum therewith. For Scholem, Kafka’s literature manifests the tenor of the Kabbalah without the Kabbalah’s content. The kabbalistic tenor of his literature reflects Kafka’s actual world in which God’s commandments have dissipated but the faintest whisperings of God can still be sensed. This state of the world is that of the Zimzum at its nadir. Scholem describes Kafka as caught on the border between religion and nihilism; he cannot be religious because when the Zimzum is at its nadir all religious content has disappeared. Yet, Kafka is also not a nihilist because he holds on to the possibility of God’s return in a future epoch. In fact, ironically, it is Kafka’s depiction of God’s hiddenness which causes Scholem to write so adoringly of him despite his bordering on nihilism. That is because for Scholem, one who depicts God’s hiddenness, while seeming to embrace nihilism, is actually prophesizing, albeit unconsciously, Judaism’s glorious return.
The Jewish Risk: Philip Roth in Sixties West Germany
Authors: Sina Kai
Published: March 2024

When Philip Roth died in May 2018, he was the best-known American writer in Germany. By that point, his difficult early years on the German book market were long forgotten. If one investigates the archives of Rowohlt Verlag, where Roth’s first books were published in Germany, there is explicit talk of a “risk.” The publisher feared that Roth’s portrayal of Jewish characters in all their ambivalence and complexity could affirm anti-Semitic sentiment in Germany. Therefore, Rowohlt’s efforts to position Roth in the literary field of the Federal Republic were accompanied by deliberate risk management. This paper reconstructs the publishing house’s strategy and its contexts.
Hollow core optical fiber enabled by epsilon-near-zero material
Authors: Zhang Leon , Love Stuart , Anopchenko Aleksei , Lee Ho Wai Howard
Published: March 2024

Hollow core optical fibers of numerous guiding mechanisms have been studied in the past decades for their advantages on guiding light in air core. This work demonstrates a new hollow core optical fiber based on a different guiding mechanism, which confines light with a cladding made of epsilon-near-zero (ENZ) material through total internal reflection. We show that the addition of a layer of ENZ material coating (e.g. indium tin oxide layer) significantly reduces the loss of the waveguide compared to the structure without the ENZ layer. We also show that the propagation loss of the ENZ hollow core fiber can be further improved by integrating ENZ materials with lower loss. This study presents a novel type of hollow core fiber, and can find advanced in-fiber photonic applications such as laser surgery/spectroscopy, novel gas-filled/discharge laser, in-fiber molecular/gas sensing, and low-latency optical fiber communication.
Karol Wojtyła as Philosopher of Encounter
Authors:   Pontifical College Josephinum in Columbus, Ohio, USA, Ignatik Grzegorz
Published: March 2024

The article’s presupposition is that the encounter with the other is one of the central themes in Karol Wojtyła’s works. In order to show Karol Wojtyła as a philosopher of encounter, the article examines his epistemological method and its purpose, his concept of freedom and love, and finally his understanding of man in the ethical perspective. First, the article describes Wojtyła’s attitude of realism and turning to experience as indispensable elements of his personalism. Wojtyła’s idea of human freedom is then discussed against the backdrop of determinism and indeterminism and in the context of the autonomy of created things. Next, the article outlines Wojtyła’s concept of love by applying his hermeneutics of the gift. The ontological and moral dimension of love in and between human persons is explained through the reality of the law of the gift. Finally, the discussion on love is complemented by the ethical reflections on the hierarchy of values, including the objective and subjective aspects of ethos.
A New Beginning: On the Power and Powerlessness (Macht und Ohnmacht) of Thinking and Believing
Authors:   University of Warsaw, Wierciński Andrzej
Published: March 2024

Thinking Incarnation as a New Beginning (ein neuer Anfang) is a challenging hermeneutic task. The power of God’s self-manifestation in and through the divine Word calls for considering Logos as the principle of life. In the task of understanding, what is most difficult is to bring together the beginning (ἀρχή) and the end (ἔσχατον): Protology and eschatology belong together (zueiandergehören). This task of thinking together is addressed not only to dogmatic theologians but to every human being encountered by the mystery of the Incarnation. As with every mystery, our human responsibility is to face divine self-epiphany not as a problem to be answered and solved in formal statements but as a genuine call for thinking (Denkauftrag).
Modeling of the blood oxygen and heart rate measurement system
Authors: Nykyrui R.I. , Goyanyuk I.V. , Lyashenyk A.V.
Published: March 2024

Monitoring heart rate and blood oxygen content is an integral part of monitoring health and physiological parameters of a person’s condition. Thus, measurement of oxygen content and heart rate becomes a rather popular problem. To solve the task set in this work, it is necessary to conduct a detailed analysis of the area and determine the main physical properties of blood at different indicators of the oxygen content in it. Also, when conducting this study, attention should be paid to the influence of the oxygen content in the blood on the heart rhythm of a person.
Electronic energy structure of the (100) In4Se3 surfaces at different preparation and treatment in ultraviolet photoelectron spectroscopy study
Authors: Tuziak O.Ya. , Makar T.R. , Dzyuba V.I. , Nenchuk T.M. , Galiy P.V.
Published: March 2024

The (100) surface of In4Se3 layered crystal was obtained in situ, ions sputtered and exposed to UHV for hours. The UPS spectra for these surfaces, atomically clean, and after the mentioned treatments, were recorded and analyzed to obtain electronic spectra of In4Se3 (100) surface. The first-principles calculations were performed by DFT-GGA method, and for the In4Se3 underestimated (0.21 eV) band gap was attained. The calculated total density of states of In4Se3 in general coincides with a UPS spectrum for an atomically clean cleaved  surface. Thus the study of the band structure of (100) In4Se3 cleavage surfaces after the ion sputtering or exposure to UHV for more than several hours is uninformative, and such effects on the sample should be avoided.
A Historical Perspective Review of the Environmental Pollution
Authors: Winter Johnson
Published: March 2024

Pollution of the surroundings has remained an enduring obstacle throughout human history, significantly influencing the dynamic between civilization and the natural environment. Thoroughly examining the development of the phenomenon, culminated in the industrial revolution and the subsequent escalation of pollution levels, followed early concerns and awareness of environmental pollution. Through an examination of significant environmental movements, legislative turning points, technological progress, and worldwide influences, our objective is to gain a comprehensive understanding of the profound consequences that pollution has on both ecosystems and society at large. By adopting this historical perspective, we will additionally investigate prospective trajectories and potential resolutions to the complex and urgent matter of environmental pollution.
Microplastic Pollution: The Real Potential Threats to Human Being
Authors: Manosuthi Juntima
Published: March 2024

The emergence of microplastic pollution has become a significant environmental concern that has far-reaching consequences for ecosystems and human health on a global scale. Microplastics, which are defined as plastic particulates smaller than five millimeters, are pervasive in our surroundings and originate from a variety of sources, including industrial processes, plastic products, and the degradation of larger plastics. This article examines the tangible risks that microplastic pollution presents to human beings, encompassing its origins, distribution, health consequences, and contamination of soil, water, food, and air. Through an analysis of ongoing regulatory initiatives, mitigation tactics, and the necessity for additional investigation, our objective is to elucidate the intricacies of this matter and underscore the critical nature of confronting microplastic pollution in order to safeguard the environment and human health.
Surface Energy Characterization of Surface Modiﬁed Cellulosic Fibres by Inverse Gas Chromatography (IGC)
Authors:   Swedish Pulp and Paper Research Institute, (STFI), Lundqvist Asa , Ödberg Lars ,   Swedish Pulp and Paper Research Institute, (STFI)
Published: March 2024

In the present study, the surface properties of cellulosic fibres have been systematically varied and the dispersive and acid-base properties have been determined by inverse gas chromatography (IGC) at infinite dilution. Bleached kraft pulp fibres were carboxy methylated to different degrees. The results from the IGC measurements on the carboxymethylated fibres showed a linear relationship between the interaction energy with a basic probe (acidic properties) and the carboxylic acid group content. The extrapolation to zero degree of substitution ofcarboxylic acid groups indicates that,even in the absence of carboxylic groups, the fibres have acidic properties. The hydroxyl groups on the fibres obviously also contribute to the acidic properties. The interaction energy with an acidic probe (basic properties) was relatively constant with increasing carboxylic acid group content. An increase in the degree of carboxymethylation also seemed to slightly increase the dispersive part of the surface free energy. This could be a consequence of an increase in electron density, a more compact structure after drying the carboxymethylated fibres or removal of low molecular weight impurities. The dispersive as well as the acid-base properties are approximately the same for pulps in both their proton and sodium forms. The carboxymethylated fibres were peeled after the modification. The carboxylic group contents of the fibres and of the removed outer layers were determined by conductometric titration. The results showed that the carboxymethylation procedure is somewhat more effective in the outer layers of the fibres. IGC results for the peeled fibres pointed in the same direction. Diethylaminoethyl{DEAF}cellulose, which has a basic functional group was also characterised. The IGC results showed that the DEAE cellulose interacts more strongly with the acidic probe than the reference cellulose material.
The Exchange and Removal of the Metal Cations in Pulps
Authors:   Pulp and Paper Research Institute of Canada, Laivins G.V . , Scallan A.M. ,   Pulp and Paper Research Institute of Canada
Published: March 2024

Metal cations modify the optical and mechanical properties of pulps and in pulp mills can have adverse effects on such parameters as corrosion rate and recovery furnace temperature. With today’s emphasis on recycling effluents and on tighter control of all operations, there is a need for quantitative theory predicting the uptake of cations by pulps and the buildup of cations in process liquors. A variation of the Donnan Equilibrium Theory was recently developed to describe the partitioning of cations between the fibres and the liquor in a pulp suspension [1]. In this report we extend use of the theory to examine the ion-exchange of pulps from saturation with one cation to saturation with another. Theoretical predictions are closely duplicated by experiments using sodium, magnesium and lanthanum as model cations of different valencies. Pulps readily exchange cations even with very dilute solutions, preferentially taking up and most tenaciously holding the higher valency cations. Consequently, the replacement of high valency cations by monovalent cations requires higher concentrations of the replacement ion than for the reverse exchange. The differing tenacities by which cations are held are also shown during acid washing of pulps. Upon progressively lowering the pH of a suspension of pulp in mixed ionic form, monovalent, divalent and trivalent cations are successively released and replaced by hydrogen ions. The implication of these results for the “acid washing” of pulps is discussed.
Carboxylic Acid Groups and Fibre Bonding
Authors:   Institute of Paper Science and Technology Atlanta, GA, Barzyk D. , Page D. H. ,   Institute of Paper Science and Technology Atlanta, GA, Ragauskas A. ,   Institute of Paper Science and Technology Atlanta, GA
Published: March 2024

It has been known for a long time that carboxylic acid groups in cellulosic fibres increase swelling in fibres- and hence this impacts flexibility, bonded area, and strength. In a few recent publications, attention has been drawn to the possibility that carboxyl groups may serve another function. Those located at the fibre surface have an effect on specific fibre-fibre bond strength . The evidence for this possibility is at present indirect . Using a technique developed for this work, pulps were prepared with uniform distribution of carboxyl groups across the fibre cell wall, and with carboxyl groups located primarily at the fibre surface. Using values of light scattering coefficient, tensile strength, and z-bond strength, it was possible to determine the relative importance of increased bonded area caused by swelling, and increased bond strength caused by localized surface effects. It was found that specific bond strength could be enhanced roughly 50% by surface enrichment, and this could exceed the strength increase attributable to enhanced bonded area. Previous work on the effect of carboxyl groups on strength needs reevaluation to determine the extent of the two effects . The mechanism of strength increase by surface carboxylic acid groups is not understood . It may be an ionic effect, but it is possible that the increased localized surface swelling allows more molecular flexibility and more intimate molecular contact and interdiffusion as found in other polymers . In practice, there are opportunities, especially in bleaching or other pulp treatments, for enhancing fibre surface carboxyl group concentration, and these may have practical value. The field looks ripe for exciting developments.
Surface Energetics of Calcium Carbonate Powders by Inverse Gas Chromatography (IGC) and Cleaved Crystals by Contact Angle Measurement
Authors:   Empire State Paper Research Institute, Faculty of Paper Science and Engineering State University of New York College of Environmental Science and Forestry Syracuse, New York, Keller D. Steven , Luner Philip ,   Empire State Paper Research Institute, Faculty of Paper Science and Engineering State University of New York College of Environmental Science and Forestry Syracuse, New York
Published: March 2024

Inverse gas chromatography (IGC) and sessile drop contact angle measurement were used to study the surface energetics of calcium carbonates from different sources and the effects of surface conditioning . A compilation of the results using these two methods to determine the apolar and polar nature of the surface is given . The results of the two analytical methods are summarized individually . IGC analysis provided a sensitive tool for detecting differences in surface energy attributed to variation in surface water, or by contamination with other chemisorbed species. Basic probes were used to characterize surface acidic sites. Acidic probes, however, were found too reactive with the calcium carbonate to enable a quantification of the surface basicity. Strong adsorption of acidic probes indicates the presence of a strong basic component at the surface. The susceptibility of the IGC method to misinterpretation retention data obtained from chemisorbed probes was also identified . Contact angle experiments were conducted on cleaved calcite samples using multiple wetting liquids and two techniques to separate the polar and apolar contributions of surface energy. The results demonstrate a strong interaction of water with the calcite surface and the reduction of total surface energy when the surface is treated with alkylketene dimer. A comparison of results from both methods is provided . Differences in the application of the results of the two methods to access the surface energetics are addressed. The importance of distinguishing between the thermodynamics of gas/condensed and condensed/condensed phase interactions when comparing the results from IGC and wetting experiments is also discussed . For calcium carbonate, the trends observed by the two approaches are consistent, although a defining link between the two was not established.
Digital Twin and Physical Cyber Systems Applied to Ionizing Radiation: State of the Art in Metrology 4.0
Authors: Macedo Eric Matos , Garcia Igor , Silva Fellipe Souza , Jeovana Ferreira  , Jr Samuel Façanha , Almeida Monaliza , Peixoto José Guilherme Pereira
Published: March 2024

The Fourth Industrial Revolution has brought society many benefits, such as technological advances, and many challenges to be overcome. To increase the synergy between physical and digital systems, most often used in the optimization processes of physical systems, metrology 4.0 has become an essential tool for their development. A state-of-the-art paper is significant in understanding how these applications develop, focusing on Cyber-Physical Systems and Digital Twins in ionizing radiation. The online search was conducted in general and specific databases with keywords in English. Thus, twelve articles were analyzed and discussed, divided into three main themes: indirect applications, ionizing radiation metrology projects, and systematic reviews. It was possible to notice that the number of articles related to these technologies in ionizing radiation is still tiny compared to other areas, especially when compared to the industry, making it even more challenging.
A Two-Generation, Early Childhood Advanced Primary Care Model
Authors: McCord Mary , Fierman Arthur , Sisco Sarah , Canfield Caitlin , Manjunath Sanjana , Cohen Natalie , Havens Jennifer , Wilcox Wendy , Tomopoulos Suzy , Albert Marcy Stein , Abraham Tanya , Charney Ariel , Acri Mary , Piwnica-Worms Katherine
Published: March 2024

It is well recognized that early experiences produce long-term impacts on health outcomes, yet many children are at risk of not achieving their full potential because of health and service disparities related largely to poverty and racism. Although many pediatric primary care (PPC) models address these needs, most are isolated, add-on efforts that struggle to be scalable and sustainable. We describe 3-2-1 IMPACT (Integrated Model for Parents and Children Together), an initiative to transform the model of PPC delivered within New York City Health + Hospitals, the largest public hospital system in the United States, to address the full range of child and family needs in early childhood. Taking advantage of the frequent contact with PPC in the early years and linking to prenatal services, the model assesses family mental, social, and physical health needs and offers evidence-based parenting supports and integrated mental health services. Launching and sustaining the model in our large health system has required coalition building and sustained advocacy at the state, city, and health system levels. Long-term sustainability of the IMPACT model will depend on the implementation of early childhood-focused advanced payment models, on which we have made substantial progress with our major contracted Medicaid managed care plans. By integrating multiple interventions into PPC and prenatal care across a large public-healthcare system, we hope to synergize evidence-based and evidence-informed interventions that individually have relatively small effect sizes, but combined, could substantially improve child and maternal health outcomes and positively impact health disparities.
Doppler ultrasound-based evaluation of hemodynamic changes in the ophthalmic artery and central retinal artery in patients with type 1 diabetes mellitus without retinopathy and with mild non proliferative retinopathy
Authors:   Ophthalmology Department, Laser Clinic, Mazovian Brodnowski Hospital, Warsaw, Poland, Pauk-Domańska Magdalena , Wilczewska Agnieszka ,   Diabetology Department, Diabetic Clinic, Mazovian Brodnowski Hospital, Warsaw, Poland, Jaguś Dominika ,   Department of Ultrasound Diagnostics and Mammography, Ultrasonography Clinic, Mazovian Brodnowski Hospital, Warsaw, Poland, Kaczyński Bartosz ,   Department of Medical Informatics and Telemedicine, Informatics Unit, Medical University of Warsaw, Warsaw, Poland, Jakubowski Wiesław ,   Department of Ultrasound Diagnostics and Mammography, Ultrasonography Clinic, Medical University of Warsaw, Warsaw, Poland
Published: March 2024

Aim: Determination of blood flow parameters in the ophthalmic artery and central retinal artery using Doppler ultrasound in patients with type 1 diabetes mellitus without fundus signs of diabetic retinopathy and with mild non-proliferative retinopathy. Material and methods: To eliminate the impact of other sys- temic factors on vascular flow, the study enrolled a total of 80 patients with type 1 diabetes mellitus, aged between 18 and 45 years. The study participants did not have any diabetic complications or other systemic or ocular comorbidities. The control group comprised 81 healthy individuals within a similar age range. Color Doppler ultrasound examinations of the ophthalmic artery and central retinal artery were performed to evaluate selected blood flow parameters including peak systolic velocity, end-diastolic velocity, and re- sistance index. Results: Patients with type 1 diabetes mellitus exhibited statistically significant decrease in both systolic and end-diastolic velocities in the central retinal artery, accompanied by an elevation in resistance index, compared to the control group. The study revealed differences in blood flow parameters between the patients without fundus changes and those exhibiting mild non-proliferative retinopathy. Spe- cifically, patients with retinopathy showed a significant decrease in both systolic velocity and end-diastolic velocity in the central retinal artery. No differences were observed for the same parameters in the ophthal- mic artery. When analyzing the patients’ blood flow parameters in relation to the degree of diabetes control, as determined by glycated hemoglobin levels, a statistically significant reduction in systolic velocity was identified in both the ophthalmic and central retinal arteries in the group with poorly controlled diabetes. Conclusions: Examination of the orbital vessels using Doppler ultrasound in patients with type 1 diabetes mellitus holds promise as an effective method for early detection of vascular abnormalities.
An assessment of the relationship between urethral hypermobility as measured by ultrasound and the symptoms of stress urinary incontinence in primiparous women 9–18 months postpartum
Authors:   Department of Perinatology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland, Pająk Paulina , Wlaźlak Edyta ,   Department of Operative Gynecology and Gynecologic Oncology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland, Surkont Grzegorz ,   Department of Operative Gynecology and Gynecologic Oncology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland, Kalinka Jarosław ,   Department of Perinatology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
Published: March 2024

Aim: The aim of the study was to estimate the relationship between bladder neck hypermobility as assessed by ultrasound and the occurrence of stress urinary incontinence as measured with the UDI-6 questionnaire in primiparous women 9–18 months postpartum. Materials and methods: The study included 100 women 9–18 months after their first delivery, 19% of whom (study group) presented with urethral hypermobility. Ultrasound was used to determine the position and mobility of the bladder neck in order to assess the urethral hypermobility. A vector of ≥15 mm was defined as urethral hypermobility. Symptoms of stress urinary incontinence were assessed using question 3 of the UDI-6 questionnaire, in which the presence of symptoms was defined as a response rated from 1 to 4. Results: We demonstrated a statistically significant relationship between urethral hypermobility and the symptoms of stress urinary incontinence with a statistical significance level of p <0.002. Conclusions: Stress urinary incontinence is a common disorder in women, the pathophysiology of which is not fully understood. It has adverse effects on the quality of life, perception of one’s own body and sexual function. Impairment of urethral fixation may play an important role in the pathophysiology of this common form of urinary incontinence. The study showed that urethral hypermobility, as assessed by ultrasound, contributes to stress urinary incontinence, as measured with the UDI-6 score. Although stress urinary incontinence is a multifactorial disorder influenced by anatomical changes and congenital anatomical features, it is easily diagnosed. Suburethral slings are an effective surgical technique; however, the incidence of postoperative voiding dysfunction or recurrent stress urinary incontinence is 10–20%. Therefore, an assessment of anatomical changes in stress urinary incontinence may help individualize the surgical strategy.
Uterine vascular abnormalities linked to pregnancy complications: color and power Doppler-assisted transvaginal ultrasound evaluation
Authors:   Department of Radiology, Faculty of Medicine, Fayoum University, Fayoum, Egypt, Youssef Ashraf Talaat
Published: March 2024

Aim: Abnormal uterine vascular pattern can be observed during transvaginal ultrasound examination used for investigating post-abortion bleeding and secondary postpartum hemorrhage. The purpose of this series of cases was to evaluate almost all the rare causes of uterine vascular abnormalities linked to pregnancy complications, and determine how to arrive at the diagnosis to optimize patient management, which is crucial for preventing life-threatening massive vaginal bleeding. Material and methods: Retro- spective observational case series study including 20 women with postpartum or post-abortion vaginal bleeding who were found to have an abnormal uterine vascular pattern during a transvaginal color duplex assessment. Results: The study yielded the following findings: 10 cases of enhanced myometrial vascular- ity, two cases of pseudoaneurysm in the uterine artery, one case of myometrial venous varix, one case of large uterine venous pseudoaneurysm, one case of uterine arteriovenous malformation, one case of re- tained placental polyp, one case of invasive vesicular mole, and three cases of subinvolution of the placen- tal implantation site. Conclusions: Transvaginal color duplex ultrasound plays a crucial role in detecting uterine vascular abnormalities as a cause of post-abortion or secondary postpartum hemorrhage and can help differentiate the pathologies responsible for the abnormal vascular pattern, which is highly recom- mended to optimize patient management.
Problematikus evési magatartások és evészavarok az élsportban
Authors: Kovács Réka Erika , Boros Szilvia
Published: March 2024

A Nemzetközi Olimpiai Bizottság 2019. évi jelentése szerint a problematikus evési
magatartások és/vagy evészavarok aránya a sportolónők körében 6–45%, a férfi
sportolóknál 0–19% között volt. Az arány folyamatosan nő, és a problematikus
evési magatartások és/vagy evészavarok gyakrabban fordulnak elő a sportolók
között, összehasonlítva a nem sportoló populációval. Bármely sportágban
megjelenhetnek, de bizonyos sportolók kiemelt rizikócsoportba sorolhatók, főként
az esztétikai, súlycsoportos és állóképességi sportágakban. A mérési módszerek
nagy diverzitást mutatnak, a legtöbbször kérdőíveket alkalmaznak, amelyek csak a
rizikócsoportok szűréséhez alkalmazhatók. A diagnózis felállításához
multidiszciplináris szemléletben sportorvos, csapatorvos, sportpszichológus és
sportdietetikus együttműködésére van szükség. A problémás evési viselkedések
kiindulópontja gyakran a fogyókúra, amikor a sportolók különböző okok miatt
(például teljesítményfokozás, a fizikai megjelenés javítása, súlycsoport elérése
stb.) befolyásolni szeretnék súlyukat, testösszetételüket, s ezek
kivitelezéséhez szakember felügyelete nélküli, szakmailag megalapozatlan
alkalmaznak. Az evészavarok optimális táplálkozással kezdődnek, amelyek
problematikus evési magatartásokba, majd klinikai evészavarokba alakulnak át.
Jelenleg kevés olyan longitudinális kutatás áll rendelkezésre, amely
kifejezetten a problémás evési viselkedések és evészavarok kontinuitását
vizsgálja, jóllehet az eddigi kutatási eredmények felhívják a figyelmet a
problémás evési magatartás kiszűrésére és az orvos-pszichológus-dietetikus
együttműködésének szükségességére már az evészavar kialakulása előtt. Hiánypótló
lehet a folyamat feltérképezése minél több sportágban. Orv Hetil. 2024; 165(8):
291–296.
Szorongás, depresszió, valamint fizikai tüneti terhek felmérése és összefüggéseik megismerése daganatos betegek körében
Authors: Varga Gergely , Horváth Rita , Busa Csilla , Virág Edit , Mangel László , Csikós Ágnes
Published: March 2024

Bevezetés: A daganatos megbetegedésekre jellemzőek a
megnövekedett pszichés terhek. A jelentős fizikai tüneti terhek, a
multimorbiditás, a szorongás és a depresszió kialakulásának kockázati tényezői
lehetnek daganatos betegekben, mely összefüggések vizsgálatára tudomásunk
szerint eddig még nem került sor Magyarországon. Célkitűzés:
Célunk volt (1) felmérni a szorongás és (2) a depresszió szintjét daganatos
betegek körében, (3) megvizsgálni, hogy milyen fizikai tüneti terhek jelennek
meg leginkább az onkológiai betegek között, (4) megismerni a szorongás, a
depresszió és a fizikai tüneti terhek és (5) a multimorbiditás összefüggéseit.
Módszer: Keresztmetszeti vizsgálatunkba 18. életévüket
betöltött, daganatos megbetegedés diagnózisával rendelkező betegeket vontunk be.
A kvantitatív adatok feldolgozása során az eredményeket 0,05 alatti p-érték
esetén tekintettük szignifikánsnak. Eredmények: A vizsgálatban
113 beteg vett részt. A válaszadók 29,2%-ában a normális határértéknél magasabb
szintű szorongást mértünk, a depresszió pedig 36,2%-ban volt jelen különböző
súlyosságban. Alvási nehézségekről a megkérdezettek 69,5%-a, fáradtságról 66,3%,
fájdalomról 52,2% számolt be. A normálérték feletti szorongást és depressziót
mutatók átlagosan több fizikai tüneti terhet említettek. Szignifikáns
összefüggés volt kimutatható a normálérték feletti depressziót mutatók és a
fáradtság, valamint a fájdalom között. A multimorbiditást tekintve a normálérték
feletti szorongást mutatók átlagosan több krónikus betegséggel rendelkeztek.
Megbeszélés: Vizsgálatunkban a szorongás szintje magasabb,
a depresszió szintje azonban egyezik a nemzetközi adatokkal. Az alvási
nehézségek nagyobb arányban fordulnak elő vizsgálatunkban, a fáradtság és a
fájdalom előfordulása azonban összhangban áll a nemzetközi kutatások
eredményeivel. Az eddig publikált nemzetközi vizsgálatokhoz hasonlóan
vizsgálatunk is a multimorbiditás, a megnövekedett fizikai tüneti terhek,
továbbá a szorongás és a depresszió közötti jelentős összefüggésre utal.
Következtetés: A szorongás és a depresszió nagy arányban
van jelen onkológiai betegekben. A legnagyobb arányban az alvási nehézségek
fordulnak elő, ezt követi a fáradtság és a fájdalom. A szorongás és depresszió
mértéke összefüggést mutat a fizikai tüneti terhekkel, valamint a
multimorbiditás is fokozza a betegek szorongásszintjét. Orv Hetil. 2024; 165(8):
309–317.
Vazopresszin használata szeptikus sokkos betegek ellátásában
Authors: Hajdu Endre , Berhés Mariann , László István , Oláh Zsolt , Fülesdi Béla , Asztalos László
Published: March 2024

A szepszis az orvostudomány fejlődése ellenére továbbra is releváns, komplex
kórkép, mely szeptikus sokkba kibontakozva jelentős mortalitással jár. A
szeptikus sokk egyik jellemzője a vasodilatatióval, hypotensióval és nem
megfelelő szöveti perfúzióval jellemezhető hemodinamikai instabilitás. A
hagyományosan, folyadékresuscitatiót és katecholamin vazopresszorokat alkalmazó
ellátás gyakran nem képes helyreállítani a megfelelő perfúziót és javítani a
kimenetelt. Következésképpen egyre nagyobb érdeklődés mutatkozik az alternatív
vazoaktív szerek feltárása iránt. Az egyik ilyen szer a vazopresszin, mely
ígéretes kiegészítőnek bizonyult a szeptikus sokk kezelésében. A szeptikus
sokkban a vazopresszin hatékonyságát és biztonságosságát tanulmányozó klinikai
vizsgálatok eltérő eredményeket hoztak, ami folyamatos vitát és további
vizsgálatokat váltott ki. Alkalmazásában egyelőre nincs egyöntetű konszenzus.
Számos randomizált, kontrollált vizsgálat értékelte a vazopresszin alkalmazását
a hagyományos terápia kiegészítéseként, és olyan lehetséges előnyöket mutattak
ki, mint a hemodinamikai stabilitás javulása és az enyhébb szeptikus betegek
esetében a mortalitás csökkentése. Az ellentmondásos eredmények és a
nemkívánatos eseményekkel, köztük az ischaemiás szövődményekkel kapcsolatos
aggályok azonban szükségessé teszik az optimális adagolás, időzítés és a
megfelelő betegszelekció átfogó megértését. Összefoglaló közleményünk célja,
hogy átfogó áttekintést adjon a vazopresszinről és használatáról a szeptikus
sokk ellátásában. Összefoglalja a klinikai vizsgálatokból származó jelenlegi
eredményeket, miszerint a vazopresszin-terápia költséghatékony kiegészítő
vazopresszor a noradrenalinterápia mellé. Hatékonyan csökkenti a betegek
katecholamin-igényét, csökkentheti a vesepótló kezelések szükségességét és az új
arrhythmiák előfordulását, de a sokszor ellentmondásos vagy biztonsággal nem
reprodukálható vizsgálati eredmények miatt jelenleg erős evidencia hiányában
másodvonalbeli szerként ajánlják. Orv Hetil. 2024; 165(8): 283–290.
A COVID–19-fertőzéssel és -immunizációval szerzett tapasztalatok felnőtt cystás fibrosisos betegcsoportban
Authors: Örlős Zoltán , Miklós Zsuzsanna , Horváth Ildikó
Published: March 2024

Bevezetés: Habár a nem transzplantált, cystás fibrosisban
szenvedő betegek többségében enyhe lefolyást mutat a COVID–19-fertőzés, a
betegek kis hányadában súlyos lefolyású kórforma alakul ki.
Célkitűzés: A célok között szerepelt azoknak a
rizikófaktoroknak az azonosítása, amelyek megnövelik a koronavírussal fertőzött
cystás fibrosisos betegek hospitalizációs igényét, emellett a betegek
átoltottságát és a fertőzésben alkalmazott kezeléseket is vizsgálni kívántuk.
Módszer: Az Országos Korányi Pulmonológiai Intézet Cystás
Fibrosis Részlegén gondozott 145 beteg adatait elemeztük retrospektív módon a
pandémia kitörése és 2022. december 31. között. Eredmények: A
vizsgált időszakban a betegek 85,5%-a részesült SARS-CoV-2-alapimmunizációban, a
beadott védőoltások 70,9%-a mRNS-alapú volt. A betegek 49,65%-a vészelte át a
fertőzést, a fertőzöttek 13,9%-a kórházi ellátást igényelt. A súlyos lefolyású
COVID–19 legfontosabb prediktora az erőltetett kilégzési másodpercvolumen
(FEV1) 35%-os vagy annál alacsonyabb értéke (OR: 6,25, p = 0,01).
Megbeszélés: Vizsgálati eredményeink azt mutatják, hogy
súlyos, kórházi ellátást igénylő COVID–19-fertőzés gyakrabban alakul ki az eleve
kisebb FEV1-értékkel rendelkező cystás fibrosisos betegek körében.
Felmérésünk alapján a felnőtt cystás fibrosisos betegek oltási fegyelme
jelentősen meghaladja az országos átlagot, többségük már emlékeztető oltásban is
részesült. Következtetés: A prediktorok ismerete segíthet
meghatározni azokat a cystás fibrosisos betegeket, akiknél fokozott figyelem és
gyors terápiás döntéshozatal szükséges COVID–19-infekció akvirálása esetén. Orv
Hetil. 2024; 165(9): 332–337.
Engaging with written corrective feedback
Authors: Ekanayaka Waruni Iresha , Ellis Rod
Published: March 2024

This paper extends a similar study by Kim and Emeliyanova (2021) by comparing the effects of self-revision (R) and peer-discussion (D) on linguistic accuracy following semi-focused direct written corrective feedback WCF. The study involved three groups of low-intermediate English as a second language (ESL) learners in a Sri Lankan university. The two experimental groups (R and D) received semi-focused WCF on ten problem-solution writing tasks. The R group (n = 30) revised each task and the D Group B (n = 31) discussed corrections for each task in pairs. A Control group (n = 31) just completed the tasks without WCF. Grammatical accuracy in all ten tasks was measured using obligatory occasion analysis. Both experimental groups (but not the Control group) improved in accuracy over the ten tasks. The R group was consistently more accurate than the D with medium effect sizes but the difference was not statistically significant. Overall, the findings echo those reported by Kim and Emeliyanova. The results are discussed in terms of the writers’ cognitive, behavioural and attitudinal engagement with WCF, drawing on findings from an exit questionnaire and interviews.
‘English Language Teaching Now and How It Could Be’ Geoff Jordan and Mike Long (2022)
Authors: Benati Alessandro
Published: March 2024

English Language Teaching Now and How It Could BeBy Geoff Jordan and Mike Long (2022)Newcastle-upon-Tyne: Cambridge Scholars Publishing, 315pp.