bluuebunny/crossref_metadata_2025_split huggingface dataset:
تشكيلية القصيدة البصرية في شعر فاضل العزاوي صاعدا حتى الينبوع انموذجا
Authors: الهاشمي شاكر عجيل 
Published: April 2019

تسعى هذه الدراسة إلى معرفة السبل البصرية التي تجسد هوية الخطاب الشعري لدى الشاعر فاضل العزاوي، فلا يخفى على المتخصصين بالأدب ونقده، ان ما يميز الصورة البصرية بوصفها تقانة خطابية، هو طواعيتها وسرعة الاستجابة في تلقيها، الأمر الذي جعلها متعددة الوسائل سريعة التأثير، فهي تقانة تتقدم على الأدوات الشعرية الأخرى التي تعالج موضوعات الشعر؛ فبفضلها يمكن تحويل مجالات الرؤية البصرية إلى قيم تعبيرية خطابية ويتم بوساطتها تحديد جماليات الأدب عموما، كما أنها تمثل بحكم طبيعتها السابقة صوغ لساني مخصوص تصاغ فيه الملفوظات على وفق أعراف بنائية جديدة تتشكل المعاني فيه تشكلا مختلفا يفضي بها إلى تشكيل مرئي مغاير(1) تكشف عن عائدات قرائية على مستوى الدلالة والفن، بفضل ما تعكسه الطبيعة التفاعلية التي تنتج من امتزاجها بالنص وحلولها فيه، وتصبح الهيأة علامة إيحائية فارقة في النص تضاف إلى أبعاده الأيديولوجية، فالصورة بعدها دالّاً على فرادة الشاعر وتميّزه، تكون بحاجة إلى صوغ مخصوص يمنحها مساحة ملائمة للتشكل الانزياحي والمغاير لأعراف التلقي، إذ تمثل الصورة الشعرية البصرية أسلوب الشاعر في الخلق والتشكيل المتحقق بالاعتماد على انعكاسات الخبرة الفنية لديه في الصياغة وفي نظام التفكير الناتج عن وعي التجربة بأبعادها المختلفة، وما يرصده من خبرات متميزة يستوحيها من الحياة، ومن المعرفة الثقافية محتوىً ومضموناً، لذا أخذت الصورة في الشعر تبحث عن مستويات تعبير مختلفة، فكانت الصورة المرئية احد هذه المستويات التي تميزت بمستوى أبعدَ في المدى التأويلي مما جعلها تتسم بفاعليتها المميزة في إسناد أدواته الإجرائية وتمكِّنهُ من الإفادة من هذه التقانات في تجسيد خطابِه الشعريِ على وفق البناء التركيبي الجديد الذي يجسد له التعادلية في مستوياته المختلفة، لتتكشف المسافة التصويرية ببعديها الفني والايحائي(2).

(1) ينظر: الصورة الشعرية في النقد العربي الحديث، د. بشرى موسى صالح:3.
(2) ينظر :المصدر نفسه:7.
أثر انموذج زاهوريك في تحصيل مادة التاريخ والتفضيل المعرفي عند طلاب الصف الرايع الادبي
Authors: مظلوم حسين جدوع , محمد محمد هاشم 
Published: April 2019

نظراً لندرة الدراسات التي تناولت انموذج زاهوريك على المستوى المحلي ( على حد علم الباحث ) ولاسيما في تدريس مادة التاريخ ، وايضاً كما أنها تُسهم في تحسين التخصيل والتعلم . لذا ارتأى الباحث تجريب انموذج (زاهوريك .لمعرفة اثرهما في تحصيل طلاب الصف الرايع الاعدادي. وتتحدد مشكلة البحث بالإجابة عن السؤال الآتي:
الابعاد الاجتماعية والنفسية للتهجير القسري على الاطفال في العراق
Authors: محمد هديل تومان , كاظم حيدر جواد 
Published: April 2019

ان تعرض المجتمع العراقي الى ازمات عديدة نتيجة الحصار الاقتصادي لحوالي ( 12سنة ) وما لحق ذلك من ممارسات العنف الطائفي والقومي بعد عمليات الاحتلال الامريكي وما تبع ذلك من العمليات الاجرامية للمليشيات المسلحة وما يسمى بتنظيم (داعش) جعل العراق في حالة من عدم الاستقرار والتوازن وتعد حالة التهجير القسري الفردي والجماعي الخارجي والداخلي هي من اهم مظاهر عدم التوازن التي مر بها المجتمع العراقي خصوصا وان هذه الهجرة من النوع الكارثي التي يصعب تصورها، اذ سببت اثار اجتماعية ونفسية وصحية مؤلمة للمجتمع ككل وللمهجرين بصورة خاصة. وقد تناول هذا البحث مشكلة التهجير القسري في العراق وانعكاس هذه المشكلة على الحالة الاجتماعية والنفسية للطفل اذ تناول المبحث الاول العناصر المنهجية للبحث وقد تناول المبحث الثاني مفهوم التهجير القسري وواقعه في العراق ، فيما تناول المبحث الثالث ، اهم الانتهاكات التي قد يتعرض لها الاطفال نتيجة التهجير القسري ، في حين تناول المبحث الرابع أهم الاثار الاجتماعية والنفسية التي تركها التهجير القسري على الاطفال المهجرين ، وقد استعان الباحثان بالمنهج الوصفي للأحاطة بمشكلة البحث والتوصل للنتائج المرجوه ، وقد اتضح من خلال البحث اهم و اخطر الاضطرابات الاجتماعية والنفسية وصعوبات العيش التي يعانيها الاطفال المهجرين وما يمكن ان تؤل اليه من تبعات تقع على المجتمع
Prevalence of vitamin D deficiency in patients attending outpatient clinic with thyroid disorders in Chitwan Medical College Teaching Hospital
Authors: Shrestha Bidhan , Adhikari Shital , Piryani Rano Mal , Sedhain Arun , Deep Suresh , Sedhai Sabina , Dhakal Harikrishna 
Published: April 2019

Objectives: Vitamin D deficiency is being studied all over the world and is a global health problem. Recent studies haveshown that Vitamin D may have a significant role in reducing the incidence of autoimmune diseases. This study was conducted to find out the level of Vitamin D in patients with thyroid disorders and compare Vitamin D levels in Anti Tpo positive and negative patients.
Subject and Methodology: 60 patients from Chitwan Medical College outpatient clinic were included in the study from February to May 2016. A brief history and clinical examinations were taken from all patients along with laboratory tests for thyroid functions, TPO antibody level of 25(OH) Vitamin D3 level and Serum Calcium level.
Results: Both patients of hypothyroidism (autoimmune and nonautoimmune) had severe Vitamin D deficiency. Most of the hyperthyroid cases had Vitamin D insufficiency. Anti TPO positive and negative patients both had Vitamin D deficiency.
Conclusion: Our study shows there is significant Vitamin D deficiency in hypothyroidism and hyperthyroidism irrespective of its autoimmunity. This study certainly encourages us to screen Vitamin D and supplement Vitamin D to all thyroid disorders patients.
Exfoliative cytology analysis from different sites of the body
Authors: Maharjan Sushana , Ranabhat Sabin , Tiwari Mamata , Bhandari Anita , Osti Bidur Prasad , Neopane Puja 
Published: April 2019

Background: Cytological study of body fluids a non-invasive, simple procedure, relatively inexpensive, and helps in faster reporting that has high population acceptance. The present study aims to determine the proportion of malignant and non malignant lesions.
Methods: A total of 1129 specimens of exfoliative cytology were examined during the period over five years from year January 2011 to December 2016 at Department of Pathology at Chitwan Medical College Teaching Hospital, Nepal. The fluid received was centrifuged at 3000 revolutions per minute for five minutes. Smears were made from the sediment. Two to three slides were air dried and stained with Giemsa stain. One slide was immediately fixed in 95% alcohol and stained with Papanicolaou (Pap) stain for cytological evaluation.
Results: Pleural fluid was most common specimen (49.3%) with peritoneal fluid (32%), pericardial fluid (1%), BAL (7.8%), CSF (4%), sputum (3.4%), synovial fluid (2%) and urine (0.5%) specimens. Male to female ratio was 1.33:1. Maximum cases belonged to age group of 50-69 years. Only (5.8%) 67 cases were neoplastic. The maximum cases of malignant neoplasm were detected in pericardial fluid and pleural fluid, each 21 (1.8%) cases, and 20 (1.7%) cases BAL. Malignant effusions were detected in 46 (4%) cases. Maximum malignant cases were adenocarcinoma (71.6%), followed by squamous cell carcinoma (20.8%).
Conclusion: Exfoliative cytology should be suggested in all cases of effusion and suspected malignancies which helps in reaching at a particular diagnosis and aids in further management.
A three-month longitudinal study for diagnostic stability of acute and transient psychotic disorder
Authors: Joshi Devavrat , Adhikari Ananta Prasad , Bhattarai Praveen , Sharma Pawan 
Published: April 2019

Background: The diagnostic category of “acute and transient psychotic disorders” (ATPD) comprises of psychotic disorders with features of acute onset (within 2 weeks), presence of typical syndromes that are either polymorphic or schizophrenic or persistently delusional, evidence for associated acute stress and complete recovery in most cases within 2–3 months. Studies of diagnostic stability among patients with the initial diagnosis of ATPD at their first admission have reported modest stabilities spanning over different periods of time, with higher levels of stability reported in samples from the developing countries. This study aimed at investigating the diagnostic stability of cases of ATPD at the Mental Hospital, Lagankhel over a period of 3 months from the first diagnosis.
Methods: ASeventy-five drug naïve patients with the initial diagnosis of first episode ATPD admitted at the in-patient unit of Mental Hospital, Lagankhel were followed up longitudinally and their diagnosis was assessed independently by two consultant psychiatrists over a period of 3 months.
Results: Average age of the sample was 30.71 years. 66.7% of the cases retained their index diagnosis of ATPD at 3 months, while the remaining required diagnostic revision. A higher number of patients had their diagnosis revised to Affective Disorders including Mania and Severe depression with psychotic features (13.88%) when compared to Schizophrenia (6.94%).
Conclusion: ATPD is a relatively stable diagnostic category in the Nepalese Scenario as well with more than two third of the patients retaining the initial diagnosis at 3 months.
Study of association between characteristics of patient and likelihood of benzodiazepine use in psychiatry outpatient department at tertiary care hospital of Kathmandu
Authors: Raut Binod , Khadka Anjan , Manandhar Pradeep , Kandel Kamal 
Published: April 2019

Introduction: Benzodiazepines exert their pharmacological properties as hypnotics, anxiolytics, anticonvulsants and muscle relaxants. Benzodiazepines are clinically effective for a number of indication including the reduction of anxiety, the induction and maintenance of sleep, muscle relaxation. They have a range of well documented adverse effects that may outweigh the benefits in certain patient population including psychomotor impairment, development of tolerance and dependence, potential for abuse.
Methods: It is a hospital based prospective cross-sectional study conducted in a psychiatry outpatient department of tertiary care hospital. All the patients attended to the outpatient department of psychiatry and prescribed with benzodiazepine were selected for study. Drug therapy details in medication chart review and clinical review in patients treated with benzodiazepines was analyzed to measure the utilization pattern of benzodiazepines in terms of patient characteristics (e.g. age, gender and marital status), occupation, education and diagnosis, number of prescription of benzodiazepines, their doses, frequency, routes of administration and duration of use in each patient.
Results: Out of a total of 384 patients, 246 of the patients had been currently using at least one benzodiazepine. Prevalence of benzodiazepine use was 64%. There was statistically significant association between benzodiazepines use with gender distribution, occupation and education. The prevalence of benzodiazepines use is relatively higher than that reported in the developed countries. Clonazepam was the most widely used benzodiazepine followed by lorazepam.
Conclusion: The study evaluated the association between characteristics of patient and likelihood of benzodiazepines use. This will definitely help to optimize the drug therapy, improve the quality of care and reduce the negative outcomes in the usage of benzodiazepines.
Current pattern of secondary glaucoma
Authors: Sherpa Dakki , Pokhrel Suprada 
Published: April 2019

Objective: To determine the pattern of secondary glaucoma in Nepal Eye Hospital.
Material and Methods: A retrospective hospital based analysis of medical records of patients attending Nepal Eye Hospital Glaucoma clinic over a period of 1 years (Jan 2013 - Jan 2014) was done in order to know the pattern of secondary glaucoma to launch a preventive measure to decrease the burden of glaucoma blindness.
Results: A total of 59 patients with secondary glaucoma were seen during a period of one year. Out of 59 patients of secondary glaucoma 35 (59.28%) were male and 24 (40.66%) were female with male and female ratio to be 1.46:1. Neovascular glaucoma comprised of 52.54%, Lens induced glaucoma 20.34%, Uveitic glaucoma 8.4%, Pseudoexfoliation syndrome 6.75%, Angle recession glaucoma 3.39%, Steroid induced glaucoma 3.39%, Pigmentary glaucoma 1.69%, Pseudophakic glaucoma 1.69% and Glaucomatoiridocyclitic crisis 1.69%. A large number of patients had profound loss of vision and 81.35% patients had presenting visual acuity of less than 3/60.
Conclusion: Secondary glaucoma is a significant problem due to its impact on visual acuity. Identification of etiology of secondary glaucoma along with preventive measures must be undertaken to decrease this burden of blindness in Nepal.
Dosimetric effects of Onyx embolization on Gamma Knife arteriovenous malformation dose distributions
Authors: Schlesinger David J. , Nordström Håkan , Lundin Anders , Xu Zhiyuan , Sheehan Jason P. 
Published: April 2019

OBJECTIVEPatients with arteriovenous malformations (AVMs) treated with Gamma Knife radiosurgery (GKRS) subsequent to embolization suffer from elevated local failure rates and differences in adverse radiation effects. Onyx is a common embolic material for AVMs. Onyx is formulated with tantalum, a high atomic number (Z = 73) element that has been investigated as a source of dosimetric uncertainty contributing to the less favorable clinical results. However, prior studies have not modeled the complicated anatomical and beam geometries characteristic of GKRS. This study investigated the magnitude of dose perturbation that can occur due to Onyx embolization using clinically realistic anatomical and Gamma Knife beam models.METHODSLeksell GammaPlan (LGP) was used to segment the AVM nidus and areas of Onyx from postcontrast stereotactic MRI for 7 patients treated with GKRS postembolization. The resulting contours, skull surface, and clinically selected dose distributions were exported from LGP in DICOM-RT (Digital Imaging and Communications in Medicine–radiotherapy) format. Isocenter locations and dwell times were recorded from the LGP database. Contours were converted into 3D mesh representations using commercial and in-house mesh-editing software. The resulting data were imported into a Monte Carlo (MC) dose calculation engine (Pegasos, Elekta Instruments AB) with a beam geometry for the Gamma Knife Perfexion. The MC-predicted dose distributions were calculated with Onyx assigned manufacturer-reported physical constants (MC-Onyx), and then compared with corresponding distributions in which Onyx was reassigned constants for water (MC-water). Differences in dose metrics were determined, including minimum, maximum, and mean dose to the AVM nidus; selectivity index; and target coverage. Combined differences in dose magnitude and distance to agreement were calculated as 3D Gamma analysis passing rates using tolerance criteria of 0.5%/0.5 mm, 1.0%/1.0 mm, and 3.0%/3.0 mm.RESULTSOverall, the mean percentage differences in dose metrics for MC-Onyx relative to MC-water were as follows; all data are reported as mean (SD): minimum dose to AVM = −0.7% (1.4%), mean dose to AVM = 0.1% (0.2%), maximum dose to AVM = 2.9% (5.0%), selectivity = 0.1% (0.2%), and coverage = −0.0% (0.2%). The mean percentage of voxels passing at each Gamma tolerance were as follows: 99.7% (0.1%) for 3.0%/3.0 mm, 98.2% (0.7%) for 1.0%/1.0 mm, and 52.1% (4.4%) for 0.5%/0.5 mm.CONCLUSIONSOnyx embolization appears to have a detectable effect on the delivered dose distribution. However, the small changes in dose metrics and high Gamma passing rates at 1.0%/1.0 mm tolerance suggest that these changes are unlikely to be clinically significant. Additional sources of delivery and biological uncertainty should be investigated to determine the root cause of the observed less favorable postembolization GKRS outcomes.
Worldwide variance in the potential utilization of Gamma Knife radiosurgery
Authors: Hamilton Travis , Dade Lunsford L. 
Published: April 2019

OBJECTIVEThe role of Gamma Knife radiosurgery (GKRS) has expanded worldwide during the past 3 decades. The authors sought to evaluate whether experienced users vary in their estimate of its potential use.METHODSSixty-six current Gamma Knife users from 24 countries responded to an electronic survey. They estimated the potential role of GKRS for benign and malignant tumors, vascular malformations, and functional disorders. These estimates were compared with published disease epidemiological statistics and the 2014 use reports provided by the Leksell Gamma Knife Society (16,750 cases).RESULTSRespondents reported no significant variation in the estimated use in many conditions for which GKRS is performed: meningiomas, vestibular schwannomas, and arteriovenous malformations. Significant variance in the estimated use of GKRS was noted for pituitary tumors, craniopharyngiomas, and cavernous malformations. For many current indications, the authors found significant variance in GKRS users based in the Americas, Europe, and Asia. Experts estimated that GKRS was used in only 8.5% of the 196,000 eligible cases in 2014.CONCLUSIONSAlthough there was a general worldwide consensus regarding many major indications for GKRS, significant variability was noted for several more controversial roles. This expert opinion survey also suggested that GKRS is significantly underutilized for many current diagnoses, especially in the Americas. Future studies should be conducted to investigate health care barriers to GKRS for many patients.
Prognostic value of diffusion tensor imaging parameters for Gamma Knife radiosurgery in meningiomas
Authors: Speckter Herwin , Bido Jose , Hernandez Giancarlo , Mejía Diones Rivera , Suazo Luis , Valenzuela Santiago , Perez-Then Eddy , Stoeter Peter 
Published: April 2019

OBJECTIVEDiffusion tensor imaging (DTI) parameters are able to differentiate between meningioma subtypes. The hypothesis that there is a correlation between DTI parameters and the change in tumor size after Gamma Knife radiosurgery (GKRS) was analyzed.METHODSDTI parameters were measured using MRI before GKRS in 26 patients with meningiomas. The findings were correlated with the change in tumor size after treatment as measured at the last follow-up (range 12.5–45 months).RESULTSOnly those meningiomas that showed the highest fractional anisotropy (FA), the lowest spherical index of the tensor ellipsoid (Cs), and the lowest radial diffusivity (RD) either increased or remained stable in terms of volume, whereas all other meningiomas decreased in volume. The correlation between the DTI parameters (correlation values of −0.81 for FA, 0.75 for Cs, 0.66 for RD, and 0.66 for mean diffusivity) and the rate of volume change per month was significant (p ≤ 0.001). Other factors, including original tumor size, prescription dose, and patient age, did not correlate significantly.CONCLUSIONSMeningiomas that show high FA values—as well as low Cs, low RD, and low mean diffusivity values—do not respond as well to GKRS in comparison with meningiomas with low FA values. This finding might be due to their higher content level of fibrous tissue. In particular, the meningioma with the highest FA value (0.444) considerably increased in volume (by 32.3% after 37 months), whereas the meningioma with the lowest FA value (0.151) showed the highest rate of reduction (3.3% per month) in this study.
Cost-effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for up to 10 brain metastases
Authors: Lester-Coll Nataniel H. , Dosoretz Arie P. , Magnuson William J. , Laurans Maxwell S. , Chiang Veronica L. , Yu James B. 
Published: April 2019

OBJECTIVEThe JLGK0901 study found that stereotactic radiosurgery (SRS) is a safe and effective treatment option for treating up to 10 brain metastases. The purpose of this study is to determine the cost-effectiveness of treating up to 10 brain metastases with SRS, whole-brain radiation therapy (WBRT), or SRS and immediate WBRT (SRS+WBRT).METHODSA Markov model was developed to evaluate the cost effectiveness of SRS, WBRT, and SRS+WBRT in patients with 1 or 2–10 brain metastases. Transition probabilities were derived from the JLGK0901 study and modified according to the recurrence rates observed in the Radiation Therapy Oncology Group (RTOG) 9508 and European Organization for Research and Treatment of Cancer (EORTC) 22952–26001 studies to simulate the outcomes for patients who receive WBRT. Costs are based on 2015 Medicare reimbursements. Health state utilities were prospectively collected using the Standard Gamble method. End points included cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was $100,000 per QALY. One-way and probabilistic sensitivity analyses explored uncertainty with regard to the model assumptions.RESULTSIn patients with 1 brain metastasis, the ICERs for SRS versus WBRT, SRS versus SRS+WBRT, and SRS+WBRT versus WBRT were $117,418, $51,348, and $746,997 per QALY gained, respectively. In patients with 2–10 brain metastases, the ICERs were $123,256, $58,903, and $821,042 per QALY gained, respectively. On the sensitivity analyses, the model was sensitive to the cost of SRS and the utilities associated with stable post-SRS and post-WBRT states. In patients with 2–10 brain metastases, SRS versus WBRT becomes cost-effective if the cost of SRS is reduced by $3512. SRS versus WBRT was also cost effective at a WTP of $200,000 per QALY on the probabilistic sensitivity analysis.CONCLUSIONSThe most cost-effective strategy for patients with up to 10 brain metastases is SRS alone relative to SRS+WBRT. SRS alone may also be cost-effective relative to WBRT alone, but this depends on WTP, the cost of SRS, and patient preferences.
Clinical outcomes in patients with brain metastases from breast cancer treated with single-session radiosurgery or whole brain radiotherapy
Authors: Mix Michael , Elmarzouky Rania , O'Connor Tracey , Plunkett Robert , Prasad Dheerendra 
Published: April 2019

OBJECTIVEGamma Knife radiosurgery (GKRS) is used to treat brain metastases from breast cancer (BMB) as the sole treatment or in conjunction with tumor resection and/or whole brain radiotherapy (WBRT). This study evaluates outcomes in BMB based on treatment techniques and tumor biological features.METHODSThe authors reviewed all patients treated with BMB between 2004 and 2014. Patients were identified from a prospectively collected radiosurgery database and institutional tumor registry; 214 patients were identified. Data were collected from aforementioned sources and supplemented with chart review where needed. Independent radiological review was performed for all available brain imaging in those treated with GKRS. Survival analyses are reported using Kaplan-Meier estimates.RESULTSDuring the 10-year study period, 214 patients with BMB were treated; 23% underwent GKRS alone, 46% underwent a combination of GKRS and WBRT, and 31% underwent WBRT alone. Median survival after diagnosis of BMB in those treated with GKRS alone was 21 months, and in those who received WBRT alone it was 3 months. In those treated with GKRS plus WBRT, no significant difference in median survival was observed between those receiving WBRT upfront or in a salvage setting following GKRS (19 months vs 14 months, p = 0.63). The median survival of patients with total metastatic tumor volume of ≤ 7 cm3 versus > 7 cm3 was 20 months vs 7 months (p < 0.001). Human epidermal growth factor receptor-2 (Her-2) positively impacted survival after diagnosis of BMB (19 months vs 12 months, p = 0.03). Estrogen receptor status did not influence survival after diagnosis of BMB. No difference was observed in survival after diagnosis of BMB based on receptor status in those who received WBRT alone.CONCLUSIONSIn this single-institution series of BMB, the addition of WBRT to GKRS did not significantly influence survival, nor did the number of lesions treated with GKRS. Survival after the diagnosis of BMB was most strongly affected by Her-2 positivity and total metastatic tumor volume.