bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving patient information leaflets: Developing and applying an evaluative model of patient centeredness for text
Authors: Fage-Butler Antoinette
Published: March 2014

The purpose of this paper is to present an evaluative model of patient-centredness for text and to illustrate how this can be applied to patient information leaflets (PILs) that accompany medication in the European Union. Patients have criticized PILs for sidelining their experiences, knowledge and affective needs, and denying their individuality. The health communication paradigm of patient-centredness provides valuable purchase on these issues, taking its starting point in the dignity and integrity of the patient as a person. Employing this evaluative model involves two stages. First, a Foucauldian Discourse Analysis is performed of sender and receiver and of the main discourses in PILs. These aspects are then evaluated using the perspectives of patient-centredness theory relating to the medical practitioner, patient and content. The evaluative model is illustrated via a PIL for medication for depression and panic attacks. Evaluation reveals a preponderance of biomedical statements, with a cluster of patient-centred statements primarily relating to the construction of the patient. The paper contributes a new method and evaluative approach to PIL and qualitative health research, as well as outlining a method that facilitates the investigation of interdiscursivity, a recent focus of critical genre analysis.
Communicating moral reasoning in medicine as an expression of respect for patients and integrity among professionals
Authors: Kaldjian Lauris Christopher
Published: March 2014

The communication of moral reasoning in medicine can be understood as a means of showing respect for patients and colleagues through the giving of moral reasons for actions. This communication is especially important when disagreements arise. While moral reasoning should strive for impartiality, it also needs to acknowledge the individual moral beliefs and values that distinguish each person (moral particularity) and give rise to the challenge of contrasting moral frameworks (moral pluralism). Efforts to communicate moral reasoning should move beyond common approaches to principles-based reasoning in medical ethics by addressing the underlying beliefs and values that define our moral frameworks and guide our interpretations and applications of principles. Communicating about underlying beliefs and values requires a willingness to grapple with challenges of accessibility (the degree to which particular beliefs and values are intelligible between persons) and translatability (the degree to which particular beliefs and values can be transposed from one moral framework to another) as words and concepts are used to communicate beliefs and values. Moral dialogues between professionals and patients and among professionals themselves need to be handled carefully, and sometimes these dialogues invite reference to underlying beliefs and values. When professionals choose to articulate such beliefs and values, they can do so as an expression of respectful patient care and collaboration and as a means of promoting their own moral integrity by signalling the need for consistency between their own beliefs, words and actions.
In defense of P values
Authors: Murtaugh Paul A.
Published: March 2014

Statistical hypothesis testing has been widely criticized by ecologists in recent years. I review some of the more persistent criticisms of P values and argue that most stem from misunderstandings or incorrect interpretations, rather than from intrinsic shortcomings of the P value. I show that P values are intimately linked to confidence intervals and to differences in Akaike's information criterion (ΔAIC), two metrics that have been advocated as replacements for the P value. The choice of a threshold value of ΔAIC that breaks ties among competing models is as arbitrary as the choice of the probability of a Type I error in hypothesis testing, and several other criticisms of the P value apply equally to ΔAIC. Since P values, confidence intervals, and ΔAIC are based on the same statistical information, all have their places in modern statistical practice. The choice of which to use should be stylistic, dictated by details of the application rather than by dogmatic, a priori considerations.
Assessing nutrient limitation in complex forested ecosystems: alternatives to large‐scale fertilization experiments
Authors: Sullivan Benjamin W. , Alvarez-Clare Silvia , Castle Sarah C. , Porder Stephen , Reed Sasha C. , Schreeg Laura , Townsend Alan R. , Cleveland Cory C.
Published: March 2014

Quantifying nutrient limitation of primary productivity is a fundamental task of terrestrial ecosystem ecology, but in a high carbon dioxide environment it is even more critical that we understand potential nutrient constraints on plant growth. Ecologists often manipulate nutrients with fertilizer to assess nutrient limitation, yet for a variety of reasons, nutrient fertilization experiments are either impractical or incapable of resolving ecosystem responses to some global changes. The challenges of conducting large, in situ fertilization experiments are magnified in forests, especially the high‐diversity forests common throughout the lowland tropics. A number of methods, including fertilization experiments, could be seen as tools in a toolbox that ecologists may use to attempt to assess nutrient limitation, but there has been no compilation or synthetic discussion of those methods in the literature. Here, we group these methods into one of three categories (indicators of soil nutrient supply, organismal indicators of nutrient limitation, and lab‐based experiments and nutrient depletions), and discuss some of the strengths and limitations of each. Next, using a case study, we compare nutrient limitation assessed using these methods to results obtained using large‐scale fertilizations across the Hawaiian Archipelago. We then explore the application of these methods in high‐diversity tropical forests. In the end, we suggest that, although no single method is likely to predict nutrient limitation in all ecosystems and at all scales, by simultaneously utilizing a number of the methods we describe, investigators may begin to understand nutrient limitation in complex and diverse ecosystems such as tropical forests. In combination, these methods represent our best hope for understanding nutrient constraints on the global carbon cycle, especially in tropical forest ecosystems.
Environmental correlates of temporary emigration for female Weddell seals and consequences for recruitment
Authors: Stauffer Glenn E. , Rotella Jay J. , Garrott Robert A. , Kendall William L.
Published: March 2014

In colonial‐breeding species, prebreeders often emigrate temporarily from natal reproductive colonies then subsequently return for one or more years before producing young. Variation in attendance–nonattendance patterns can have implications for subsequent recruitment. We used open robust‐design multistate models and 28 years of encounter data for prebreeding female Weddell seals (Leptonychotes weddellii[Lesson]) to evaluate hypotheses about (1) the relationships of temporary emigration (TE) probabilities to environmental and population size covariates and (2) motivations for attendance and consequences of nonattendance for subsequent probability of recruitment to the breeding population. TE probabilities were density dependent (βˆBPOP= 0.66,= 0.17; estimated effects [β] and standard errors of population size in the previous year) and increased when the fast‐ice edge was distant from the breeding colonies (βˆDIST= 0.75,= 0.04; estimated effects and standard errors of distance to the sea‐ice edge in the current year on TE probability in the current year) and were strongly age and state dependent. These results suggest that trade‐offs between potential benefits and costs of colony attendance vary annually and might influence motivation to attend colonies. Recruitment probabilities were greatest for seals that consistently attended colonies in two or more years (e.g.,= 0.56, SD = 0.17) and lowest for seals that never or inconsistently attended prior to recruitment (e.g.,= 0.32, SD = 0.15), wheredenotes the mean recruitment probability (over all years) for 10‐year‐old seals for the specified prebreeder state. In colonial‐breeding seabirds, repeated colony attendance increases subsequent probability of recruitment to the adult breeding population; our results suggest similar implications for a marine mammal and are consistent with the hypothesis that prebreeders were motivated to attend reproductive colonies to gain reproductive skills or perhaps to optimally synchronize estrus through close association with mature breeding females.
Taking the pulse of a continent: expanding site‐based research infrastructure for regional‐ to continental‐scale ecology
Authors: Peters Debra P. C. , Loescher Henry W. , SanClements Michael D. , Havstad Kris M.
Published: March 2014

Many of the most dramatic and surprising effects of global change on ecological systems will occur across large spatial extents, from regions to continents. Multiple ecosystem types will be impacted across a range of interacting spatial and temporal scales. The ability of ecologists to understand and predict these dynamics depends, in large part, on existing site‐based research infrastructures developed in response to historic events. Here we review how unevenly prepared ecologists are, and more generally, ecology is as a discipline, to address regional‐ to continental‐scale questions given these pre‐existing site‐based capacities, and we describe the changes that will be needed to pursue these broad‐scale questions in the future. We first review the types of approaches commonly used to address questions at broad scales, and identify the research, cyber‐infrastructure, and cultural challenges associated with these approaches. These challenges include developing a mechanistic understanding of the drivers and responses of ecosystem dynamics across a large, diverse geographic extent where measurements of fluxes or flows of materials, energy or information across levels of biological organization or spatial units are needed. The diversity of methods, sampling protocols, and data acquisition technologies make post‐hoc comparisons of ecosystems challenging, and data collected using standardized methods across sites require coordination and teamwork. Sharing of data and analytics to create derived data products are needed for multi‐site studies, but this level of collaboration is not part of the current ecological culture. We then discuss the strengths and limitations of current site‐based research infrastructures in meeting these challenges, and describe a path forward for regional‐ to continental‐scale ecological research that integrates existing infrastructures with emerging and potentially new technologies to more effectively address broad‐scale questions. This new research infrastructure will be instrumental in developing an “über network” to allow users to seamlessly identify and select, analyze, and interpret data from sites regardless of network affiliation, funding agency, or political affinity, to cover the spatial variability and extent of regional‐to continental‐scale questions. Ultimately, scientists must network across institutional boundaries in order to tap and expand these existing network infrastructures before these investments can address critical broad‐scale research questions and needs.
EEG study of visual reactivity in aphasic patients
Authors: Stojanovic Biljana , Djurasic Ljubomir , Jovic Stevan , Paspalj Dalibor
Published: March 2014

AIM: to compare patients with good and poor recovery after 1 and 3 months
from onset of poststroke aphasia and to correlate the quality of recovery
with quantitative EEG (QEEG) measures (frequency analysis with the limits of
variability, and index of asymmetry). METHODS: The investigation was
performed on the sample of 32 patients with poststroke aphasia, 15 females
(46.88%) and 17 males (53.12%), mean age + standard deviation (SD) being
50.65+9.93 years. QEEG measures of this sample were compared with those in a
group of 86 healthy controls, 39 (45.35%) females and 47 (54,65%) males, mean
age +SD being 51.08+10.08 years. Frequency analysis was performed in eyes
closed and eyes open conditions in both controls and in aphasics who were
tested just before and two month after rehabilitative treatment with speech
therapy. RESULTS: We have got normal distribution for all derivations and all
frequency bands in the group of healthy subjects. On the basis of this
finding, we determined coefficients of variation in patients with poststroke
aphasia and discovered that their maximal variability scores were
significantly decreased. Compared to healthy subjects, the index of asymmetry
between two hemispheres and between main brain regions was significantly
higher in the aphasic patients than in controls. However, the differences in
the index of asymmetry and limits of variability significantly decreased
after two month treatment in the subgroup of patients with good improvement
compared with the subgroup of patients with poor improvement of poststroke
aphasia. CONCLUSION: QEEG measures may have predicitive value in post-stroke
aphasia.
Somatostatin-producing duodenal carcinoma: Clinicopathological description of a case
Authors: Masulovic Dragan , Stevic Ruza , Filipovic A. , Micev Marjan , Ivanovic Aleksandar
Published: March 2014

Somatostatinomas are rare functioning neoplasms usually arising in the
pancreas and duodenum. They are seldom associated with typical clinical
symptoms. Their diagnosis is confirmed only by histological and
immunohistochemical studies and the presence of specific hormones. Two
distinct clinicopathological forms of somatostatinoma exist: duodenal and
pancreatic somatostatinomas. Clinically, compared to pancreatic
somatostatinomas, duodenal somatostatinomas are more often associated with
nonspecific symptoms and neurofibromatosis, but less often with
somatostatinoma syndrome or metastasis. We report a case of
somatostatin-producing duodenal carcinoma in a 45-year-old female with
neither neurofibromatosis nor somatostatinoma syndrome. Abdominal computed
tomography showed a 18-mm mass in the duodenum which had given rise to
multiple lymph node metastases. Although the endoscopic biopsies were free of
malignancy, the patient subsequently underwent Whipple?s operation for the
duodenal mass. Immunohistochemical analysis confirmed the diagnosis of
somatostatin-producing carcinoma.
Bacterial flora on the surface of oral squamous cell carcinoma
Authors: Cankovic Milos , Bokor-Bratic Marija , Loncar Jovana , Marinoski Jovan , Ilic Miroslav
Published: March 2014

Background: The aim of the study was to determine the microbial presence and
type in the biofilms present on the surface of oral squamous cell carcinomas
and benign lesions of oral mucosa. Methods: Thirty new (untreated) patients
with oral squamous cell carcinoma were examined. The control group consisted
of thirty subjects with benign lesions of oral mucosa. Swab samples were
taken from the superficial layer of the carcinoma and benign lesions for
bacteriological examination. Swabs were transported within 2 hours and
immediately sown and incubated. Oral health index was assessed in all
patients. Results: The prevalence of pathological bacterial microflora was
significantly higher in cancer patients (p<0.01). No significant associations
were found between bacterial presence and gender, localization, cigarette
smoking, alcohol consumption and denture wearing (p>0.05). Poor oral hygiene
was also registered in cancer patients. Conclusion: Possibility of microflora
retention on irregular oral carcinoma surface possibly contributes to chronic
inflammation often observed on the surface of oral carcinomas.
On linear and nonlinear fractional PDEs
Authors: Ahmad Jamshad , ul Hassany , Mohyud-Din Syed
Published: March 2014

In this study, Variational Iteration Method (VIM) has been applied to obtain
the analytical solutions of fractional order nonlinear partial differential
equations. The iteration procedure is based on a relatively new approach
which is called Jumarie?s fractional derivative. Several examples have been
solved to elucidate effectiveness of the proposed method and the results are
compared with the exact solution, revealing high accuracy and efficiency of
the method.
Stroh-like formalism for Kirchhoff anisotropic thermoelastic plates
Authors: Wang Xu , Schiavone Peter
Published: March 2014

A Stroh-like formalism is developed for the heat conduction and the coupled
stretching and bending deformations of a laminated anisotropic thermoelastic
thin plate based on Kirchhoff theory. For the heat conduction problem, a
Stroh-like quartic formalism is developed. Twodimensional generalized
temperature and heat flux function vectors are introduced. The structure of
the introduced 4x4 fundamental plate matrix for heat conduction is the same
as that of the 8x8 fundamental elasticity matrix in the Stroh sextic
formalism for generalized plane strain elasticity. Consequently, the
orthogonality and closure relations for heat conduction in thin plates is
established. For the thermoelastic problem, an inhomogeneous particular
solution is derived rigorously. We obtain an octet formalism in which the
general solution is composed of the well-known homogeneous solution developed
by Cheng and Reddy (isothermal case) and the inhomogeneous particular
solution arising from the thermal effect.
State responsibility for damage caused by unfair sentence or unfounded arrest
Authors: Mrvic-Petrovic Natasa , Petrovic Zdravko
Published: March 2014

The legal basis of state responsibility for damage caused by unfair sentence
or unfounded arrest is the need to protect fundamental human rights and
freedoms guaranteed by the Constitution and generally accepted international
rules. The right to compensation on this basis (although subjective civil
right) has a sui generis legal nature, because it is connected with the
protection of human rights. Joint public-private legal nature of such a
request is expressed in the legislation of the Republic of Serbia, because
the circle of authorized persons and the conditions under which they may be
entitled to compensation is determined by the criminal procedural rules,
while the existence of a legally recognized forms of damage and the extent to
which the damage may be reimbursed is estimated according to the general
rules of Law of obligations. While the legislation is very progressive, it is
observed that, in practice, the applications for compensation are usually
submitted because of the most unreasonable detention of up to one month or
three months, and the inefficiency of the criminal proceedings, suspended
upon the expiration of the absolute limitation of prosecution. The state
could easily affect these practices. Also, the priority of state must be
meeting its financial obligations with regard to final adjustments, and the
imposition of demands for compensation.
Diplomatic protection in international law and the United Nations
Authors: Milisavljevic Bojan
Published: March 2014

The paper deals with the issue of the diplomatic protection in international
law and its development through the history of the international community.
In this sense, the author investigates the practice of states regarding the
application of diplomatic protection and the steps taken by the International
Law Commission of the United Nations on the codification of this area. In
2004 International Law Commission adopted at first reading a full set of
draft articles. In this paper is presented judicial practice, especially of
the International Court of Justice, in the field of diplomatic protection in
order to evaluate whether the approach of the Court to diplomatic protection
has become more human-rights oriented in the last few years. Author presents
the development of customary law rules relating to diplomatic protection and
its transition into a whole system of rules through the work of the
International Law Commission. In this sense, these are the basic stages in
the codification of rules on diplomatic protection and the United Nations
contribution to the protection of the rights of foreign nationals. This
article points the development of universal and regional mechanisms to
protect human rights and highlights the impact of those mechanisms on
traditional measures of diplomatic protection.
The experience of loneliness in the adolescence
Authors: Milovanovic Radmila
Published: March 2014

The paper deals with the phenomenon of loneliness, the emotional state which
is characterized by the feeling of emptiness and isolation, exclusion and
isolation from other people. It is the state connected with many
psychological troubles, behavioral and social problems and can seriously
threaten mental and physical health of the adolescents and grown-up young
people. The goal of the research is to examine the frequency of the
experience of loneliness in the population of the adolescents, the connection
of loneliness with other psychological difficulties, and also with the
effects of socialization. A modified questionnaire about the ways of the
expression of the crisis in the adolescence (Kondic and co.), the short form
of the UCLA Loneliness Scale (University of California Los Angeles Loneliness
Scale) and the battery of the tests of socializations (Momirovic and co.) are
used in this research. The research is conducted on the sample of 300 first
year students from the Faculty of Pedagogy in Jagodina, Medical Faculty in
Belgrade, Faculty of Philology and Arts in Kragujevac and College of Health
Studies in Cuprija, of the average age 19.1 years. The results received by
the application of the same questionnaire on the sample of the students in
the final year of high schools in the interval of 5 years starting from 1985
until 2010 are used for the comparison (100 adolescents for each researched
year). The results of the research have shown that 32% of the adolescents in
the researched sample declare as lonely (the comparison points to the trend
of the increase of loneliness in the population of the adolescents in
relation to the previous year), that the loneliness is statistically
significantly connected to other psychological difficulties (depression,
self-image disorders, eating disorders, sleep disorders) and with the
emphasized effects of socialization, that is, exaggerated socialization
(where the solution of this serious problem can be searched).
Manisa ilinde aile hekimlerinin 2011 yılındaki iş yükü ve insan gücünün değerlendirilmesi
Authors: Tay Ziya , Tuncal Ayşe Nur , Atasoylu Gonca , Sertel Mustafa , Köroğlu Galip
Published: March 2014

Amaç: Manisa ilindeki aile hekimliği birimlerinde 2011 yılında sunulan hizmetler ve kayıtlı nüfusun sayısal olarak değerlendirilmesi; bölge ve ülke verisiyle karşılaştırılması; kayıtlı hizmetlere göre iş yükünün incelenmesi ve ideal birim hizmet süreleri göz önüne alınarak gereken aile hekimi sayısının belirlenmesidir.Yöntem: Araştırma, 2012 yılında yürütülmüş kesitsel bir çalışmadır. Aile hekimleri ve hizmetlerine yönelik veri Manisa-AHBS’den derlenmiş; sayma ve karar verme arayüzleri için php-Oracle ortamları kullanılmıştır. Yıllık iş yükü ve iş gücü açığı, her hizmet türü için Bakanlık veya araştırmacı tarafından belirlenen süre ile yıllık fiili çalışma süresi dikkate alınarak hesaplanmıştır. Tanımlayıcı istatistikler yüzde ve aritmetik ortalama±standart sapma olarak verilmiştir. Çözümlemede SPSS for Windows 15.0 programından yararlanılmıştır. Verilerin analizinde ki-kare ve bağımsız gruplarda t testi kullanılmıştır.Bulgular: Aile hekimlerinin (n=378) %74.9’u erkek, yaş ortalaması 44.5±5.7’dir. Aile sağlığı merkezlerinin (n=154) %53.2’si, hekimlerinin %28.8’i kırsal bölgededir. Aile hekimlerinin %51.9’u, nüfusun %18.4’ünü oluşturan gezici nüfusa (n=242.402) hizmet sunmaktadır. Aile hekimlerinin ortalama nüfusu 3486.6±465.9; bebek sayısı 47.1±18.2; 15-49 yaş kadın 915.4±176.4; 65 yaş ve üzeri nüfusu 324.2±116.6’dır. Aile hekimlerinin 2011’de sunduğu hizmetlerin (n=6.272.831) %56.1’i poliklinik, %24.0’ü laboratuvar+poliklinik, %7.1’i aşılama, %12.8’i izlemlerdir. Aile hekimi başına ortalama günlük poliklinik sayısı 60.2, aşılama 5.4, bebek izlem 1.4, çocuk izlem 1.6, gebe izlem 1.3, kadın/aile planlaması izlem 4.3, lohusa izlem 0.4, obezite izlem 0.7'dir. Manisa'da gebeler 5.1, bebekler 6.9; 1-5 yaş çocuklar 1.5; lohusalar 1.6; 15-49 yaş kadınlar 1.0 ortalama ile aile hekimleri tarafından izlenmişlerdir. Kişi başına yıllık ortalama poliklinik sayısı 4.3’tür. Nüfusun %75.7’si poliklinik hizmetinden yararlanmıştır. Yararlananların %40.0’ı 1-5 kere hizmet almıştır. Yıllık poliklinik ortalamaları 0 yaşta 3.2; 65 yaş ve üzerinde 7.4’tür. Üretilen hizmete göre, ilde bulunması gereken aile hekimi sayısı 446 olarak belirlenmiştir.Sonuç: AH’lerinin iş yükünün %80’ini poliklinik hizmetleri oluşturmaktadır. Bu oran %76.8’lik KDS 2011 Türkiye ve %70’lik Birleşik Krallık 2006/2007 iş yükü araştırması verisinden yüksektir. Manisa’daki AH’leri günlük ortalama 60 başvuruyu karşılamakta olup; Birleşik Krallık’ta bu sayı 35’tir. AH’lerinin kayıtlı nüfus planlanmasında hizmete en çok ihtiyaç duyan gruplar dikkate alınmalıdır. Yöneylem çalışmaları için aile sağlığı personelinin de dahil edildiği çalışana özel iş yükü ve performans değerlendirilmelerine ihtiyaç duyulmaktadır.
Research on absolute gravity variations in geodynamic laboratory in Książ in the period of 2007- 2011
Authors: Kaczorowski Marek , Olszak Tomasz , Walo Janusz , Barlik Marcin
Published: March 2014

In 2006 a gravimetric pavilion was installed inside the Geodynamic Laboratory (LG) in Książ. The pavilion was equipped with two pillars intended to serve relative and absolute gravimetric measurements. Installation of measurement platform for absolute gravity measurements inside gravimetric pavilion of LG made it possible to perform four sessions of absolute gravity measurements: two of them in 2007 (June 10-12 and Nov. 21-22), one in 2008 (Apr. 21-22) and one in 2011 (June 19-21). In 2007 the absolute measurements were performed using two FG5 ballistic gravimeters. In April 2007 the measurements were performed by Dr Makinen from Geodetic Institute of Finnish Academy of Science with application of FG5 No. 221 absolute gravimeter. In June 2007 and in the years 2008 and 2011 such gravimetric measurements were performed by the team from Department of Geodesy and Astronomical Geodesy of Warsaw University of Technology using FG5 No. 230 absolute gravimeter. Elaboration of observation sessions from both gravimeters was performed in the Department of Higher Geodesy following the procedures used in constituting of uniform gravimetric system of geodynamic polygons reference. This constituting of gravimetric system comprised inter alia application of identical models of lithospheric tides (global model by Wenzel, 1997) and ocean tides (Schwiderski, 1980) (reduction of absolute measurements with tidal signals). Observations performed during summer of 2007, autumn of 2007, and spring of 2008 and 2011 indicated existence of small changes of absolute gravity of the order of 1 Gal. Maxima of accelerations appear in the spring period, and minima in the autumn period. This effect is connected with the influence of global hydrological factors the annual amplitude of which is ca 1,5 Gal and achieve extreme values in the spring-autumn interval. Very small value of observed amplitude of gravity changes in the period of extreme variability suggests that the observed gravity changes in LG are caused only by global phenomenon. This proves high degree of „independence” of gravimetric measurement base in LG from the local environmental factors such as ground water level variations, ground humidity, impact of snow cover, etc. At this moment the instrumental environment of absolute measurements obtains particular value, especially in the case of the tiltmeters and relative the gravimeter Lacoste& Romberg (LR-648). The relative gravity measurements as performed simultaneously with absolute gravity measurements enable us to determine the local tidal ephemeredes which makes it possible to replace the global tidal modal with ocean tidal model with the more realistic, locally determined tidal parameters (the local tidal ephemeredes).
Low-threshold monopolar motor mapping for resection of lesions in motor eloquent areas in children and adolescents
Authors: Schucht Philippe , Seidel Kathleen , Murek Michael , Stieglitz Lennart Henning , Urwyler Natalie , Wiest Roland , Steinlin Maja , Leibundgut Kurt , Raabe Andreas , Beck Jürgen
Published: March 2014

Object

Resection of lesions close to the primary motor cortex (M1) and the corticospinal tract (CST) is generally regarded as high-risk surgery due to reported rates of postoperative severe deficits of up to 50%. The authors' objective was to determine the feasibility and safety of low-threshold motor mapping and its efficacy for increasing the extent of lesion resection in the proximity of M1 and the CST in children and adolescents.

Methods

The authors analyzed 8 consecutive pediatric patients in whom they performed 9 resections for lesions within or close (≤ 10 mm) to M1 and/or the CST. Monopolar high-frequency motor mapping with train-of-five stimuli (pulse duration 500 μsec, interstimulus interval 4.0 msec, frequency 250 Hz) was used. The motor threshold was defined as the minimal stimulation intensity that elicited motor evoked potentials (MEPs) from target muscles (amplitude > 30 μV). Resection was performed toward M1 and the CST at sites negative to 1- to 3-mA high-frequency train-of-five stimulation.

Results

The M1 was identified through high-frequency train-of-five via application of varying low intensities. The lowest motor thresholds after final resection ranged from 1 to 9 mA in 8 cases and up to 18 mA in 1 case, indicating proximity to motor neurons. Intraoperative electroencephalography documented an absence of seizures during all surgeries. Two transient neurological deficits were observed, but there were no permanent deficits. Postoperative imaging revealed complete resection in 8 patients and a very small remnant (< 0.175 cm3) in 1 patient.

Conclusions

High-frequency train-of-five with a minimal threshold of 1–3 mA is a feasible and safe procedure for resections in the proximity of the CST. Thus, low-threshold motor mapping might help to expand the area for safe resection in pediatric patients with lesions located within the precentral gyrus and close to the CST, and may be regarded as a functional navigational tool. The additional use of continuous MEP monitoring serves as a safety feedback for the functional integrity of the CST, especially because the true excitability threshold in children is unknown.
Clinical course of untreated pediatric brainstem cavernous malformations: hemorrhage risk and functional recovery
Authors: Li Da , Hao Shu-Yu , Tang Jie , Xiao Xin-Ru , Jia Gui-Jun , Wu Zhen , Zhang Li-Wei , Zhang Jun-Ting
Published: March 2014

Object

The aim of this study was to investigate the clinical appearance of untreated pediatric brainstem cavernous malformations (CMs) and to identify the hemorrhage risks and functional outcomes.

Methods

All pediatric patients with a diagnosis of brainstem CM between 1985 and 2012 were registered. The clinical chart and radiographs were recorded, and follow-up evaluations were obtained prospectively.

Results

A total of 85 patients (69.4% male) were included with a mean age of 12.7 years. Sixty-seven patients (78.8%) had prior hemorrhage, and 6 patients (7.1%) were asymptomatic. There were 15 midbrain lesions, 53 pons lesions, and 17 medulla lesions. The mean lesion size was 1.9 cm. During a total of 401.6 patient-years of follow-up, 47 hemorrhages occurred in 37 patients, and the annual hemorrhage rate was 11.7% per patient-year. The mean hemorrhage interval was 47.8 months. The hemorrhage risk declined over time, especially after the first 2 years. Both a lesion size ≥ 2 cm (hazard ratio [HR] 2.122, p = 0.037) and the presence of perilesional edema (HR 2.192, p = 0.039) predicted future hemorrhage and were associated with a high annual hemorrhage rate. The hemorrhage-free survival at 6 months was 85.7%, and at 1, 5, 10, and 15 years was 71.5%, 49.4%, 27.5%, and 13.7%, respectively. At the most recent functional evaluation, 33 patients (38.8%) had improved, 32 (37.6%) had stabilized, and 20 (23.5%) had worsened, without any deaths. Twenty-two patients (25.9%) obtained a full recovery. Prospective hemorrhage (HR 0.191, p = 0.003) was the adverse predictor for full recovery. Full recovery primarily occurred within the first 12 months, after which the chance of full recovery decreased. The cumulative percentage of complete recovery at 6 months was 32.7%, and at 1, 3, and 5 years was 40.8%, 43.6%, and 49.2%, respectively.

Conclusions

In this study the hemorrhage rate was relatively high in pediatric brainstem CMs, although the functional outcome was acceptable. The decline in hemorrhage risk and the identified adverse predictors in this study were helpful for clinicians and patients when deciding on treatment. Referral bias and the insufficient follow-up period of the study were highlighted as limitations.
Unilateral coronal craniosynostosis and Down syndrome
Authors: Siu Alan , Rogers Gary F. , Myseros John S. , Khalsa Siri S. , Keating Robert F. , Magge Suresh N.
Published: March 2014

There is no known correlation between Down syndrome and craniosynostosis. The authors report 2 infants with trisomy 21 and right unilateral coronal craniosynostosis. Both patients were clinically asymptomatic but displayed characteristic craniofacial features associated with each disorder. One patient underwent a bilateral fronto-orbital advancement and the other underwent an endoscopically assisted strip craniectomy with postoperative helmet therapy. Both patients demonstrated good cosmesis at follow-up.
Mathematical Analysis of Side effects of HIV/AIDS Medication
Authors: Tirmizi Syed Rizwan , Khan Nasiruddin
Published: March 2014

Acquired Immune deficiency syndrome (AIDS) is caused by Human immunodeficiency virus (HIV); More than 40 Million people live with HIV worldwide. Various antiretroviral classes of drugs are used to treat HIV infection and the prolonged treatment has to be taken for the rest of life. It is very difficult to continue prolonged treatment because of problem of adherence and side effects. The basic purpose of antiretroviral treatment is to maintain the quality of life of a patient. However, these side effects vary from drug to drug and patient to patient. The objective of this research is to be modeled some major drug induced side effects by using fuzzy matrix theory which is one of the best tools to analyze unsupervised data involving imprecision. This study is of interest for HIV Specialist and physician who care for HIV/AIDS patients with an aim to concentrate more on safety profile of HIV/AIDS drugs. DOI: http://dx.doi.org/10.3329/bjms.v13i2.13884 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.119-123
Menstrual Hygiene and Reproductive Morbidity in Adolescent Girls in Dehradun, India
Authors: Juyal Ruchi , Kandpal S. D. , Semwal Jayanti
Published: March 2014

Context: In India, adolescent girls face serious health problem due to socio-economic, environmental and cultural conditions as well as gender discrimination. A vast majority of girls in India are suffering from either general or reproductive morbidities. Unhygienic practices during menstruation expose them for Reproductive Tract Infections (RTI). If not treated early, it could lead to various disabilities and consequently affect their valuable lives. This study was done with the aim of estimating the magnitude of gynaecological morbidities among unmarried adolescent girls as well as to find out the relation between menstrual hygiene and RTI. Settings and Design: Cross-Sectional Observational study conducted in two randomly selected Inter colleges (one rural and one urban) of district Dehradun, Uttarakhand state. Methods and Material: A cross-sectional study was undertaken in school going unmarried adolescent girls to know their menstrual hygiene practices as well as reproductive morbidity. Data was collected by interview method using a pretested, prestructured questionnaire after taking consent. Statistical analysis used: percentages and Chi-square test. Results: Approximately 65 % of the girls reported having dysmenorrhoea and 19 % of the girls had given the history of excessive vaginal discharge with or without low backache/lower abdominal pain. Strong association was found between Reproductive Tract Infections and poor menstrual hygiene. Conclusions: Girls should be made aware of the process of menstruation and importance of maintaining its hygiene before attaining menarche. They should also be made aware about its linkages with their forthcoming reproductive health. DOI: http://dx.doi.org/10.3329/bjms.v13i2.14257 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.170-174
Collision tumor of ovary: a rare combination of dysgerminoma and serous cystadenocarcinoma
Authors: Sengupta Sanjay , Pal Subrata , Biswas Biplab Kr , Chakrabarti Srabani , Bose Kingshuk , Jana Sritanu
Published: March 2014

Collision tumors of ovary are rare neoplasms and most commonly consist of a teratoma with mucinous tumor. Combination of papillary serous cystadenocarcinoma and dysgerminoma was yet to be reported. A twenty years female patient presented with a large tumor of right ovary. Microscopically it was diagnosed as a collision tumor of ovary composed of dysgerminoma and serous cystadenocarcinoma. Mixed tumour can arise from divergent differentiation of a single type of stem cell. But components of collision tumor must arise from separate clones. Possibility of collision tumour should always kept in mind during assessment of difficult ovarian tumors to avoid diagnostic error. DOI: http://dx.doi.org/10.3329/bjms.v13i2.14955 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.224-227
Evaluation the frequency of computerized tomography (CT) scan indication in children under two years old with mild trauma
Authors: Masoumi Babak , Omraninava Ali , Nasr-Esfahani Mohammad , Hashemian AmirMasoud
Published: March 2014

Objective: Head traumas are prevalent in children with mild severity and without commitment of delayed brain injuries. The aim of present study was to detect the mild head trauma (MHT) children with high risk of brain injuries for avoidance of unnecessary interventions. Methods: This cross-sectional study considered 100 children under 2 years old with MHT in Kashani and Alzahra Hospitals between March 2011 and August 2011, Isfahan, Iran. Data was gathered by these project executives including the radiologist reports and the patients past medical history. The patients were divided into normal and abnormal CT scan and reduction of consciousness level, vomiting and the other variables were considered. Results: The results were obtained from evaluation of 100 files from the patients with mean age 18±7.1 month. CT scan findings showed that 55 percent of the patients were abnormal and had burn injuries including skull fracture, epidural hemorrhage, skull contusion, and arachnoids hemorrhage. The incidence of repeated vomiting and reduction of consciousness level in patients with non-normal CT scan was more than normal group while this difference was not significantly different. Also according to CT scan findings there was no statistically significant difference between patients with repeated vomiting or reduced consciousness level (P>0.05). Conclusions: This study results showed that there is not significantly difference between vomiting incidence, deceased level of consciousness and CT scan results. These criteria were not considered separately as only factors for burn trauma of performing CT scan in MHT patients. DOI: http://dx.doi.org/10.3329/bjms.v13i2.15053 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.140-144
A Rare case of Subcutaneous Mycosis due to Rhizoctonia solani
Authors: Sahu Susmita Kumari , Padhy S , Dash M , Mohanty I , Pattnaik S
Published: March 2014

Rhizoctonia solani is a very common soil borne pathogen with a great diversity of host plants. A 52 year old lady presented with sole manifestation of subcutaneous swelling over the left leg for 3 months Pus was collected by aspiration revealed septate fungal hyphae. After culture on SDA at 25 C showed white cottony growth initially, progressed to buff colored to black colonies on further incubation. On LPCB mount we found septate hyphae with acute and right angled branching without any conidia and hyphal anastomosis which resembled features of Rhizoctonia solani. Patient was put on Fluconazole and responded well to the treatment. DOI: http://dx.doi.org/10.3329/bjms.v13i2.15060 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.228-230
2 Handfuls of Medication in 2 Hours Just to Let Him Talk
Authors: Kamaluddin Azlan , Fauzi Mohd Hashairi , Hussein SA Syed , Hussein Hardawani Mohd , Mohamed Fatahul Laham , Abu Bakar Norzuraini
Published: March 2014

Repeated dose of adrenaline in anaphylaxis is limited evidence in clinical setting. Hence, the usage is depending on physician best interest and knowledge. We reported a case of repeated doses of adrenalin was given through nebulizer and intravenous in anaphylaxis. We believed the unusual circumstances of this case was likely to be repeated on some readers' clinical practice and this mode of treatment is an adjunct to consider in such cases especially in Emergency Department (ED). DOI: http://dx.doi.org/10.3329/bjms.v13i2.16100 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.209-211
Non invasive Management of Post Dural Puncture Headache - A Comparison
Authors: Sen Jayashree , Sen Bitan
Published: March 2014

Aim: To evaluate the efficacy of oral Theophylline for the management of post dural puncture headache (PDPH). Material and Method: Forty patients with PDPH, whose surgeries were done under spinal anaesthesia, were selected randomly and divided into two groups of 20 each. One group to receive conservative treatment and the other group Theophylline (400 mg) only orally. Intensity of headache was analysed using a visual analogue scale (VAS) of pain. Assessment was done immediately before (0 h) and at 8, 16 and 24th hr of drug administration. Result: Significantly better relief of PDPH was found in Theophylline (9.3±5.7) than the conservative group (56.7 ±10.2) (p<0.001). Recurrence of headache was found in 2 patients (10 %) at 16th hr and 2 (10%) at 24th hr in the Theophylline group compared to 12 (60%) and 14 (70%) patients respectively in the other group. Conclusion: The study concludes that Theophylline in the management of post dural puncture headache may be considered the best choice over the conventional approach. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18292 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.114-118
Abnormal Uterine Bleeding in Perimenopausal Age: Different causes and its relation with histopathology
Authors: Nargis Nazlima , Karim Iqbal , Sarwar Khondaker Bulbul
Published: March 2014

Background: Abnormal uterine bleeding (AUB) is the most common reason for gynecological visits for perimenopausal bleeding and may account for more than 25% of all hysterectomies. Objective: This study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with ultrasonographic and histopathological examinations. Study Method: This descriptive study was conducted in the department of gynecology and obstetrics, Ibn Sina Medical College, Dhaka during January to December 2012. Two hundred and eleven women were selected for this study, who admitted into the hospital with abnormal uterine bleeding in perimenopausal age. The clinical, ultrasonographic and histopathological findings of these women were evaluated in this study. Results: Menorrhagia was the major symptom (52.6%) irrespective of age and parity. All these women underwent D&C followed by either medical management or hysterectomy depending upon the diagnosis. The histopathological findings of endometrium were analyzed and confirmed as fibroid uterus (58.28%) and DUB (17.58%) correlated well with transvaginal sonography (TVS) and histopathological examination. Hysterectomy conferred other uterine lesions as adenomyosis (18.71%), endometrial polyp (4.81%) and malignancy (1.06%). Conclusion: Abnormal uterine bleeding in perimenopausal age group is a common but ill-defined entity which needs proper evaluation. Accurate diagnosis of the causative factors of AUB in this age group is of utmost importance so that appropriate management can be established early that leads the minimization of the patients sufferings. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18295 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.135-139
Knowledge, Awareness and Perception about HIV/AIDS among Primary School Teachers in Bangladesh
Authors: Choudhary Md. Shahidur Rahman , Rahman Md. Mahfuzar
Published: March 2014

Objective: Information is very important to have accurate understanding of people about the modes of HIV/AIDS transmission and its prevention strategies. Teachers at all levels are always expected to play a foremost role in the provision of information to promote awareness leading to behavioral change among students. Therefore, this article is aimed to evaluate the knowledge, awareness and perception about the deadly disease HIV/AIDS among primary school teachers in Bangladesh. Materials and methods: To do so, about 120 teachers from 28 primary schools, out of 68, in Rajshahi City Corporation (RCC) areas were interviewed purposively for this study using a self-administered questionnaire. Results and discussion: The results showed that the teachers serving at primary schools level were not too sure of their own knowledge about the issue. They had much misperception about the knowledge of facts, modes of transmission to reduce contamination and the modes of transmission from one person to another of HIV/AIDS. Conclusion: Government should provide adequate funding to organize and sponsor teachers to attend in training workshops, seminars and conferences related to HIV/AIDS and that the pandemic should be discussed with other for the purpose of awareness. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18297 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.145-149