The Journey of Insulin: Leaving a Legacy as a Medical Student

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Sustained Improvement of Negative Self-Schema After a Single Ketamine Infusion: An Open-Label Study

Conventional antidepressants have several important limitations, including a lack of direct effects on negative self-schema, which is at the core of Beck’s cognitive theory of depression. Based on previous studies showing a positive effect of ketamine on negative cognition, we compared reductions in negative self-schema between responders and non-responders to a single infusion of ketamine. In an open-label study, 26 participants with treatment-resistant depression received 0.5 mg/kg ketamine via infusion. Depression symptoms were assessed at baseline, 24 h, and 7 days after treatment with Montgomery-Åsberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI-II). Nine of the 26 participants fulfilled response criteria after 24 h. Of these, eight still fulfilled response criteria after 7 days. Response was defined as a reduction in MADRS total score of 50% or more. Responders improved significantly more than non-responders both 24 h and 7 days after ketamine treatment on the following BDI-II items: item 1 (“Sadness”), item 7 (“Self-Dislike”), and item 8 (“Self- Criticalness”). These results suggest an important therapeutic effect of ketamine on negative self-schema, which is a fundamental cognitive aspect of depression. This effect is unique and might be associated with ketamine’s profound effects on neuroplasticity. Small sample size and lack of a placebo control group are the major limitations of this study

The Effect Of The Case Of Covid-19 On Sport Activities Of The Village Of Suka Negeri Village Lebong District

This research aims to know the effect of the Covid-19 pandemic on sports activities of village residents of Suka Negeri at the age of 17-25 years. This research was conducted in Suka Negeri village in Lebong district. With this the type of research used is qualitative and the design used is a narrative design to describe the lives of individuals, collect and tell information about the lives of individuals, and report narrative about their experiences. The population in this study amounted to 60 people, the sampling in this study was carried out by purposive sampling technique, which is a sampling technique based on certain criteria or with certain judgments. The data collection technique in this study is to use a questionnaire. The questionnaire was used to obtain data about the effect of Covid 19 on sports activities among residents of the Village of Suka Negeri, Lebong Regency, ages 17 to 25 years. In the analysis of the questionnaire data, the calculation results obtained show that the number of residents who carry out sports activities with high intensity is 36 people or 60%, while the number of residents who carry out sports activities with moderate intensity is 17 people or 28%, while the number of residents who carry out activities low exercise is as much as 7 people or 12%. Then the analysis of the questionnaire data shows that there is an influence of Covid 19 on sports activities in Suka Negeri Village residents, this can be seen from the number of Suka Negeri villagers who do the most sports activities, namely at very high intervals

Locally Advanced Pancreatic Cancer: Beyond the borders

Staging and treatment of locally advanced pancreatic cancer.The staging of locally advanced pancreatic cancer (LAPC) remains essential, especially in the current expansion of local therapies.[20] As proper staging of LAPC allows for better understanding of new treatment protocols, since patients with understaged disease are excluded before diluting true outcomes. Furthermore, there are no definitive answers on which regimens should be used as treatment for LAPC. The role of FOLFIRINOX and radiotherapy in the treatment of LAPC is of interest, as they have shown promising results lately. This thesis is divided in two parts. The first part focuses on the staging of LAPC. The second part focuses on the treatment of patients with LAPC

Management by Values and its Relationship to Organizational Loyalty Through the Trend Toward Practiced Values as an Intermediate Variable

هدفت الدراسة إلى التعرف على درجة ممارسة مديري مدارس منطقة شرق غزة التعليمية للإدارة بالقيم، ومستوى الاتجاه نحوها، وكذلك مستوى الولاء التنظيمي لدى المعلمين في تلك المدارس، كما هدفت إلى فحص ما إذا كانت هناك علاقة ارتباطية بين كل من درجة ممارسة الإدارة بالقيم ومستوى كل من الاتجاه نحو القيم الممارسة والولاء التنظيمي، وكذلك فحص ما إذا هناك تأثير لمستوى الاتجاه نحو القيم الممارسة على العلاقة بين درجة ممارسة الإدارة بالقيم، ومستوى الولاء التنظيمي، ولتحقيق ذلك تم استعمال المنهج الوصفي، كما تم توزيع أدوات الدراسة على عينة من 266 معلمًا ومعلمةً، وتوصلت الدراسة إلى أنَّ درجة ممارسة الإدارة بالقيم جاءت مرتفعة، وكذلك كان مستوى كل من اتجاه المعلمين نحو القيم الممارسة، وولائهم التنظيمي، كما بينت الدراسة أنَّ هناك علاقة ارتباطية موجبة بين كل من درجة ممارسة الإدارة بالقيم ومستوى كل من الاتجاه نحو القيم الممارسة والولاء التنظيمي، كما أوضحت الدراسة أنَّ هناك تأثيراً واضحاً لمستوى الاتجاه نحو القيم كمتغير وسيط على العلاقة بين درجة ممارسة الإدارة بالقيم، ومستوى الولاء التنظيمي.The study aimed to identify the degree of practice of the principals of the East Gaza Educational District to manage by values, as well as the level of organizational loyalty of teachers in these schools. The study also examined whether there is a correlation between the degree of management by values practice ​​and the level of the organizational loyalty. It also examined whether there is an impact of the level of trend towards values practiced on the relationship between the degree of management by values practice and the level of organizational loyalty. To achieve this, the descriptive approach was used. The study tools were distributed to a sample of 266 teachers. The study showed that there is a positive correlation between the degree of management by values practice and the level of both of  the values ​​practiced and the organizational loyalty. The study showed that there is a clear effect on the level of values ​​as an intermediate variable on the relationship between the degree of management by values practice ​​and the level of organizational loyalty

Valoración de diferentes propuestas de diagnóstico de anemia ferropénica en gestantes de Cusco, 2020

El propósito de estudio del presente trabajo fue evaluar la capacidad diagnóstica de diferentes propuestas de diagnóstico para identificar anemia ferropénica en mujeres gestantes de Cusco. Métodos utilizados para el análisis secundario con base de un estudio observacional de corte transversal, y analítico. Se determinó parámetros laboratoriales de muestras sanguíneas mediante el hemograma automatizado para obtener valores de hemoglobina e índices eritrocitarios. Se usó kits de ELISA para determinar valores de los biomarcadores del estado de hierro. El análisis descriptivo y bivariado fue realizado con el programa Stata, y la capacidad diagnostica evaluada mediante modelos crudos y ajustados en términos de curvas ROC con el programa R v3.6.1. Resultados: La prevalencia de anemia fue diferente según cinco propuestas diagnosticas usando hemoglobina sin corregir fue 2%, corregida por el método OMS fue 13,2%, por Dirren 17,1%, por Dallman 2,9% y Bartolo 11,7%, durante la gestación la hemoglobina tiene un descenso más marcado en el segundo trimestre que correlaciona con la hemodilución fisiológica; la estrategia propuesta por Dallman y la de hemoglobina sin corregir además de los índices eritrocitarios tuvieron valores altos de Área Bajo la Curva en los modelos crudos y ajustados. Se encontró cifras considerables de eritrocitosis en gestantes mediante la estrategia de hemoglobina sin corregir. Conclusiones: La estrategia de corrección de Dallman y de hemoglobina sin corregir además de los índices eritrocitarios tuvieron buen rendimiento diagnóstico respecto a otras estrategias.Financiada por la UNSAA

Studying the Effect of Cutting Conditions in Turning Process on Surface Roughness for Different Materials

Surfaces quality is one of the most specified customer requirements for machine parts. The major indication of surfaces quality on machined parts is surface roughness. The research aim is to study the cutting conditions and their effects on the surface roughness. This research will use regression models and neuro-fuzzy to predict surface roughness over the machining time for variety of cutting conditions in turning. In the experimental part for turning, different types of materials (Aluminum alloy, brass alloy, and low carbon steel) were considered with different cutting speed, and feed rate. A linear regression and neuro-fuzzy model depending on statistical-mathematical method between surface roughness, Ra, and cutting condition will be derived, for the three materials. The effect of cutting parameters on surface roughness is evaluated and the optimum cutting condition for minimizing the surface roughness will be determined. The model will be established between the cutting conditions and surface roughness using regression and neuro-fuzzy model. As the results of this work, the linear regression and neuro-fuzzy model will be used in predicting surface roughness, can be used in manufacturing systems, this modeling helps engineer to reduce the efforts and improve the quality

Botulinumtoxin als neue Option in der Behandlung der Depression

Despite effective pharmacological and psychotherapeutic treatment ­options for depression, about one third of patients affected by depression prove resistant to therapy. The injection of botulinum toxin A (BTA) into the glabellar muscles of the forehead constitutes a new approach to treating depression. Such treatment exhibits relatively significant effectiveness and demonstrates considerably different properties than conventional ­antidepressants. BTA injections into the glabella are associated with an ­antidepressant effect lasting several months, which sets them apart from other pharmacological antidepressant interventions thus far. The local ­injection of BTA entails no ­expected pharmacological interactions with other medications. Such properties may make BTA injections a potentially cost-effective alternative to standard antidepressant treatments, exhibiting only very few undesirable events. Three randomized, placebo-controlled clinical studies have demonstrated the effectiveness of BTA treatment for patients affected by unipolar depressive disorder. Studies conducted to date display a few ­methodological weaknesses. The sample size in the individual studies ­tended to be small, with blinding methods for BTA treatment being not ideal. Currently, several hypotheses are under discussion concerning the mechanism of action of BTA treatment, namely the information-processing hypothesis, the aesthetic hypothesis, as well as the social hypothesis

The yield of chest computed tomography in patients with locally advanced pancreatic cancer

Objective: To evaluate the incidence of pulmonary metastases on chest computed tomography (CT) in patients with locally advanced pancreatic cancer (LAPC). Methods: All patients diagnosed with LAPC in a single tertiary center (Erasmus MC) between October 2011 and December 2017 were reviewed. The staging chest CT scan and follow-up chest CT scans were evaluated. Pulmonary nodules were divided into three categories: apparent benign, too small to characterize, and apparent malignant. Results: In 124 consecutive patients diagnosed with LAPC, 119 (96%) patients underwent a staging chest CT scan at the initial presentation. In 88 (74%) patients no pulmonary nodules were found; in 16 (13%) patients an apparent benign pulmonary nodule was found, and in 15 (13%) patients a pulmonary nodule too small to characterize was found. Follow-up chest CT scan(s) were performed in 111 (93%) patients. In one patient with either no pulmonary nodule or an apparent benign pulmonary nodule at initial staging, an apparent malignant pulmonary nodule was found on a follow-up chest CT scan. However, a biopsy of the nodule was inconclusive. Of 15 patients in whom a pulmonary nodule too small to characterize was found at staging, 12 (80%) patients underwent a follow-up CT scan; in 4 (33%) of these patients, an apparent malignant pulmonary nodule was found. Conclusion: In patients with LAPC in whom at diagnosis a chest CT scan revealed either no pulmonary nodules or apparent benign pulmonary nodules, routine follow-up chest CT scans is not recommended. Patients with pulmonary nodules too small to characterize are at risk to develop apparent malignant pulmonary nodules during follow-up