bluuebunny/crossref_metadata_2025 huggingface dataset:
Les problèmes de l'énergie et le rapport de la Commission des Sages
Authors: Cyprès René
Published: July 2021

The author discusses the position of coat in the energetic future of Belgium.The report of the «Commission des Sages» has carefully studied only the problem of the applications of nuclear energy.During the next century, the energy of all origins wilt be used.  The future must not be mortgaged by putting forward solutions which bring only marginal contributions.The actual reserves of coat in Belgium and in the world are enormous. In 2000, only 2 % of these reserves wilt be consumed.There is enough coat in the world to cover the energetic needs during several centuries.The use of Belgian or imported coat to produce electricity induces to study simultaneously the development of a modern carbochemistry which will progressively replace petroleum and gas by the manufacture of substituted gas and motor fuel.Methanol is the car motor-fuel for the future. Coat underground pressurised gasification shows interesting views for the upgrading of deep seams and of those who are not exploitable because of their small thickness.A sequence based on the production of electricity from high volatile coat, previously distilled at low temperature is proposed. This sequence allows a progressive and immediate development of a carbochemical industry in Belgium without important investments.
Les groupements européens de partis politiques
Authors: Claeys Paul , Loeb-Mayer Nicole
Published: July 2021

The prospect of European elections has begun to alter the conditions under which national poli tical parties exercise their functions. It has brought parties to negociate common platforms and to strengthen transnational organizations. How these organizations wilt be structured, what functions they wilt assume, will be determined largely by the issue of a conflict-solving process between existing national structures, by the ability of national parties to accomplish new functions in a European system, and by the demands of that system.This study presents a tentative framework of analysis for the examination of European groupings of political parties. It may help to interpret current negotiations and future actions of these organizations with reference to the criteria, structures and functions that are classically those of political parties. It suggests how new situations in the European field may be met by existing organizations or give rise to original political answers.
L'opinion et le Roi : 1940-1944
Authors: Gotovitch José
Published: July 2021

This present study tries to encircle the image of King Leopold III as it was fashioned by public opinion during the occupation. It excludes the collaborationist movements and the exiled Belgians in London.  Different sources have been interrogated : reports on public opinion destinated to the Cabinet-in-exile in London, available diaries and most of all underground leafl,ets and newspapers.The public opinion underwent a strong evolution from 1940 till 1944 and changed according to social classes. The author particularly describes some significant moments: the surrender of the army, the King's marriage, the forced labour. After a highly pronounced admiration during 1940, a very clear turn is already palpable at the end of 1941. This reverse is due to regained confidence in democracy. It translates the refusalof dictatorial projects formulated in certain circles, intending to invest the King with absolute power in a corporative society, which should be rid of parliament and political parties. The image of the Royal prisoner of war received a decisive blow by his marriage. This deconsacration was reinforced by the germanophile sentiments, imputed to His court,and by the royal silence kept about some methods of the occupational power.The Church however proved to be a resolute defender of the King.  On the other hand, Flanders and Wallonia react differently. At Liège, the hostility even spreads among some christian-democratic circles.Gradually the Royal Question, which has agitated the opinion from 1940-1942, fades away, and the deportation of Leopold III took place in a climate of indifference.However, not a single authorized voice of the underground movement demands the retirement of the King at the moment of the liberation.  For all groups and parties it remains an open question, their only wish being to obtain explanations.Thus, the Royal Question, based on the positions adopted during the occupation, can only be explained by the circumstances which happened after the war.
Van Stuyvenberg naar de Wetstraat 16 : Een derde onderhandelingsronde over het Gemeenschapsakkoord
Authors: Platel Marc
Published: July 2021

The talks from mid-februari 1978 on the regionalization pact in Belgium were more than a mere format approval of the Stuyvenbergprotocol. This becomes very clear when one compares the unpublished draft-Stuyvenbergprotocol and the official agreement. History will learn that the third round of negotiation wilt not be the last one.
La crise constitutionnelie australienne
Authors: Lauvaux Philippe
Published: July 2021

The crisis which arose in Australia in October-November 1975 led to the dismissal of the Labour Prime Minister Gough Whitlam by the Governor-General Sir John Kerr, the formation of a caretaker Government by the opposition leader Malcolm Fraser and the simultaneous dissolution of the Houses of the Federal Parliament.The constitutional issues involved in that crisis are studied. The opinion is maintained that the rational coherence of the parliamentary system require an effective head of State with the responsibility of acting personally in unusual circumstances, rather than the strict law definitely lapsed and the issue even then ruled by the «constitutional conventions» of Cabinet government.
De partijpolitisering als instrument van particratie : Een overzicht van de ontwikkeling sinds de Tweede Wereldoorlog
Authors: De Winter Lieven
Published: July 2021

The Belgian political system is of ten qualified as a particracy, this is a variation of the classical parliamentary democracy, in which political parties dominate the political  decision-making process more than the other subsystems, such as parliament, the government, the public administration, the judiciary power, the broadcasting institutions, the written press etc. This preponderancy is achieved by the partypolitisation of the positions in and the functio ning of these subsystems.Partyleaders exert nowadays a major influence on the constellation of a new government and the designation of its ministers. Through the governmental program and special extraparliamentary pacts they map out more and more government's future policies. The ministerial cabinets execute the control over the public administration on behalf of the parties of the majority and aften take over some of its peculiar functions. The recruitment of public servants and their promotion depend highly upon the institutionalized patronage of the governmental parties.The power to select the candidates for the general elections has shifted away from the rank-and-file member to the local and national partyleaders.Partydiscipline is one of the major causes of the shift of the government making function, the legislative and controlling functions of parliament to the party headquaters.The recruitment and the promotions of magistrates was already before World War II largely politicized.Although the structural integration between the newspapers and parties has decreased since 1945, the political parties have strengthened their control over the designation of the diree:tors and administrators of the Belgian broadcasting institutions.
Souveraineté régionale et finances publiques : Approche par les recettes et les masses budgétaires
Authors: Dersin Arthur
Published: July 2021

1. A short analysis of the institutional reform legislation of August 1980 allows the ascertainment that the competences «granted» by the central power to the regions are truncated.2. Financial means are also «granted». They consist in merely listing sources of revenues : receipts other then tax, black grants, tax shares, limited tax entitlement and borrowing power. Those financial means are arbitrary chosen, they are not related to the competences granted, they are insufficient.3. Anyway, the existing budgeting system (functional and economic classification) does not allow connecting policies and financial means. A new classification (program budgeting) should be of more adequacy to achieve this end.4. Actual regional sovereignty implies that all competences explicitely attributed to the federal level should belong to the regions. In the countries where such a system exists, the regions are mastering 40 to 60 % of the revenues. The kind of  regionalisation implemented in Belgium only grants about 8 % to the regions.It is pointed out that 65 % of the current revenues and 46 % of the expenditures could technically be subject to federalisation. Should also the financial system of social security be federalized, then should the part of both ressources and expenditures belonging to the regions increase to 7 5 % .On the long way to federalism in Belgium, the new legislation is just a step, not an arrival. The forthcoming years will probably confirm it.
De standenvertegenwoordiging in de Christelijke Volkspartij en de Parti Social Chrétien
Authors: Smits Jozef
Published: July 2021

The in 1945 established Christian Social Party (The Flemish CVP and the French speaking PSC) showed some important differences in comparison with the prewar Catholic Party. The structure of the CVP-PSC was unitary, based upon individual membership instead of the prewar federation of « estates » (standen) . With this unitary structure, the founding fathers of the CVP-PSC tried to avoid the conflicts between the estates, a permanent cause of criticism and disurtity in the Catholic Partyduring the interwar period. In spite of the new organizational structure of the CVP-PSC, new methods of informal recognition of the estates were introduced for the aggregation of their claims and their representation within the party.The way this informal recognition of the estates in the CVP-PSC was solved, is briefly described in the first part of this article. Subsequent to the survey of the evolution of the political position of the estates and their relation to the CVP-PSC, the composition of the lists of candidates in the CVP-PSC for the general elections of 8 november 1981 is discussed.  Special attention is paid to the balancing in number and the ranking ofcandidates from the estates. Finally, the representation of the estates in the parliamentary group of the CVP-PSC is calculated for the general elections of 1974, 1977, 1978 and 1981.
Martens IV - Eyskens I - Martens V
Authors: Platel Marc
Published: July 2021

It is striking to note that the political unrest and instability in 1981 coincided with continual and serious unrest on the national money market. On the political party level, one notes that the Christian Democratic Parties and the Socialist Parties had more and more difficulties in getting along with each other. This probably is related to the policyof the new chairman of the French-speaking Socialist Party, who has resolutely chosen to back Wallonia. The Flemish Christian Democratic Party, has still difficulties in seeing itself as the largest party in Flanders and to act appropriately. In addition, the French-speaking Socialist Party feels confident in the conviction that influential circles, including the Court, prefer not to see the Socialists in the opposition. This has motivated some to cling as long as possible to the formation of a three -party cabinet. The actual political situation, however, has clearly demonstrated that such a three-party cabine! cannot fu nction for a long time. The question remains why the Christian Democratic Party has not pursued elections with the same energy as it did in September af ter the resignationof the Martens IV government.  In the meantime, it has become evident that the state reform of August 1980 is certainly not «completed», that is should best be redone, andthat the consequences of this reorganization can be gauged only with difficulty.
Integratie van kernen in de gefusioneerde gemeenten
Authors: Reynders Marcel
Published: July 2021

The integration factor can mean, on the one hand, absorption of the sub-municipalities into the amalgamated municipality and, on the other hand, greater autonomy for the sub-municipalities. Complete integration in all policy areas is not possible nor desirable. Integration of centres can only be considered primarily in function of better organised service provision and also in function of supporting typical village life. Economic yields and an administration that is close to the people must be increasinglycoupled in an optimal balance. The increase of developmental opportunities of municipalities must take place more and more via preservation and reinforcement of the viability of the villages. Concerns for local interests must be lifted partially toward a functional integration in the broader amalgamated whole. The national and Flemish regional governments must make more funds available to this end so that the effects of such integration wilt not remain limited to an equalisation policy on the level of a few basic infrastructural elements.
Beleidsvisie van het Vlaamse Gewest inzake de financiële middelen der gemeenten
Authors: Delanghe Johan
Published: July 2021

An adaptation of the Municipal Law to the present-day requirements of modern management and the discharge of the centra! government of its financial duties vis-à-vis the municipalities are preliminary conditions for the Flemish Community to reinforce municipal autonomy. This reinforcement will go together with a granting of greater financial responsibility to the municipality. The resolution of the financial situation of the municipalities is a pressing issue for the Flemish Executive Body. In addition to the need for a new method of distributing the Municipal Fund correctly over each region, the redress of the budgetary balance, leaving the municipal autonomy unaffected, is of primary importance.
Een regionale stad met langere fusie-ervaring : Brugge
Authors: Reynaert Raymond
Published: July 2021

The city of Bruges went through an amalgamation operation already in 1971. The number of personnel increased considerably, though there was no question of a surplus. This increase is only partially to be ascribed to the amalgamation. The integration of the personnel from the formel municipalities proceeded quite well, although the coordination had to be improved on some points. On the political level, all of the former municipalities are represented with a predominance of the outskirts. For the provision of services, a decentralised approach was chosen. Except for centralisation of the Registry for Births, Deaths, and Marriages, the ordinary administrative services were decentralised to the former municipal halls. The financial capacity increased steadily, which was necessary to cover the greater financial needs, which can be reduced to the supplementary expenses resulting from the amalgamation, which brought with it an expansion of the task package. On the level of the input and participation facilities, functional and territorial advisory councils were created, which function quite satisfactorily. Neighbourhood meetings are organised on the occasion of large projects. Globally, the Bruges amalgamation succeeded. A more flexible supervisory authority would be able to give more efficiency and effectiveness to the policy.
Profiel van een kleine fusiegemeente
Authors: Baldewijns Eddy
Published: July 2021

While the population expected a quantitative improvement in municipal management, there was, from the outset, a fear of greater centralisation. The policy makers aften did not seem up to their tasks through the lack of experience and because of favouritism. This often led to dissension between the sub-municipalities. Centralisation did not improve the services, unless the council produced the necessary creativity. Difficult problems in the amalgamation concerned the shifting of the financial repercussions ofthe amalgamation onto the population, the further construction of the road system and the infrastructure policy, the restructuring of education, the giving of new stimuli to the social policy, and the involvement of the organisational life in policy formation. The balance can turn positive if the municipal administrations are better assisted, if the demographic decline is halted, if more financial support appears, if the participation of the population is increased, and if more pluralism is achieved in socio-cultural and educational matters.
La fusion des communes bruxelloises
Authors: Herremans Maurice-Pierre
Published: July 2021

The idea of amalgamation for the Brussels municipalities is already an old one. In addition to the numerous parliamentary attempts to return to the situation of before 1795, when eight Brussels municipalities formed an administrative unit, there were also the Holvoet Report of 1936 and the establishment of the State Commissariat for the Large Agglomerations during the Second World War. In 1942, «Gross Brüssel» was created, but it was dissolved after the liberation. Except for the proposals of the Union of Cities, things remained rather quiet until the first amalgamation operation of 1971. Brussels was not involved in these amalgamation operations primarily because of the complexity of the Brussels problem over which the Flemish and the French speaking groups could not come to an agreement. The recent proposals can be placed into three categories : a complete amalgamation of the 19 municipalities into one entity, a partial amalgamation of 3 to 10 entities, the status quo. Since the amalgamation means an increase in the municipal expenses because of equalisation of the services in the sub-municipalities at a higher level, integral amalgamation of the present 19 municipalities offers no solution for the financial difficulties besetting these municipalities. In addition,this integral amalgamation solution generales negative reactions from the people of Brussel, who see in it a demand of the Flemish Movement.
Eenpartijstaten in Zwart Afrika : Evolutie, recente ontwikkelingen, perspectieven
Authors: Reyntjens Filip
Published: July 2021

Together with the emergence of strong executive presidencies and the frequency of coups d'Etat, the single party is one of the striking features of the political development in Africa South of the Sahara since 1960.More than half the countries of the continent are presently under one-party rule. This article attempts to analyse the origins, recent developments, and perspectives in the field of African single-party states. Sameelements favourable to the emergence of this phenomenon were the colonial heritage, the precolonial tradition, and the aura of legitimacy of the national liberation movements. Several techniques were usedby African leaders to impose rule by one party; distinction is made between political, legal and institutional, and authoritarian means. African leaders have relied on several justifications to rationalise the introduction of such regimes : economie development, national unity and nation-building, the absence of class-differentiation, the unanimitarian tradition, and the need to give constitutional recognition to a de facto situation. A critical  analysis shows that these arguments do not, in general, withstand closer examination. The conclusion is that the single-party «ideology» serves mainly to protect the hegemony of a small and privileged political class of rulers against challenge of its position. As far as perspectives are concerned, three possibilities seem to be developing simultaneously : the Party-State, the no-party state, and the multi-party state. It is argued in a conclusion that the single-party state need not be undemocratic ; some conditions for a democratic one-party system are set forth.
Démocratie représentative et démocratie directe : le cas italien
Authors: Ryngaert Johan
Published: July 2021

Although the popular referendum is part of Italy's 1948 constitution, the political parties in power delayed for more than 20 years putting it info practice. It was finally institutionalized in 1970 and has met on various occasions with caution or hostility from the political parties.Succeeding in mobilizing public opinion, shaking the political parties and speeding up the legislative process, the referendum disappointed in several respects. Especially the permanent conflict with parliament through the action of the radical party led to negativism on its behalf.
Omroep en objectiviteit : De politieke agenda-setting functie van de externe kritiek op de omroep (radio) berichtgeving (periode 1970-1977)
Authors: Burgelman Jean-Claude
Published: July 2021

Analysing the debate in the press concerning the most crucial and sensible point of Public Service Broadcasting in Belgium, i.e. an objective and nationwide representative news service, shows clearly that this critizing of the news has primarily a political function because its aim is not to demonstrate how subjectivc or so the news is supposed to be.Accepting and demonstrating the point that a public service organization of broadcasting is no worse for objective newsreporting than a commercial or a Dutch one; it follows from this that these critics must 'hide' other interests ( namely pressure to political conformity and financial motives).Strong correlations are found between this press debate and the political debate on the nature of this system and the wish to change it.  Thus the press, being part of the party system in Belgium, reveals itself as (literally) an agenda-setter of political action.These results do not suggest that the press bas an ultimate influence in political matters but it certainly demonstrates that the press indicates how the debate wilt develop.Showing up the agenda-setting concept in the dynamics of politics could be a more fruitfull way to define the political functions of the mass media.
Denmark, a limited monarchy
Authors: Kaarsted Tage
Published: July 2021

The article describes the history of Danish constitutional monarchy (since 1849). It analyzes the complicated procedure in connection with government formation. The Queen must avoid being implied in party polities. She will always act on the responsibility of the Prime Minister, but the role of the Private Secretary is important. The Queen does not take part in policy-making at all. Her functions, be they only formal, are of great symbolic significance. Gallup polls indicate the popularity of monarchy. The Queen is considered the impartial head of state. She is respected as a talented artist. The Queen does not take part in business life.
Analyse discriminante et vocabulaire politique : Essai méthodologique
Authors: Chapelle Jacqueline , Couvreur Pierre , Pagano Giuseppe
Published: July 2021

This paper aims at testing the hypothesis of growing ideological uniformity of political speeches. If political speeches lack ideological differences, it should be difficult to re-classify them only by analyzing the presence or absence of lexical items. We first worked out a method to classify political speeches and then carried a test on two speeches by leading Belgian French-speaking politicians.  The method is based on discriminant analysis. It utilizes the words most encountered in one speech and not in the other as discriminant factors. Statistical softwares then assess a discriminant function used to re-classify short parts of each speech called blocks. The most discriminating 10 factors re-classify correctly 89% of the blocks. The percentage increases to 93% with 20 factors and to 98% with 30 factors.However the results should be taken with caution because of the limited sample, the test tends to question the growing uniformity of political speeches. The sampled ones had enough specific features for allowing a rather simpte method to re-classify most parts of them correctly, even if some typically ideological items are not to be found.
Prediction of remodeling of arteries of kidneys of small diameter in patients with chronic glomerulonephritis
Authors: Levickaja E. S. , Batiushin M. M. , Sinel’nik E. A. , Bagmet A. D. , Mokrushin A. A. , Cherkashina M D. , Chumakova I. E. , Gaponenko N. I. , Nazheva M. I.
Published: July 2021

Objective: to determine the significance of clinical, laboratory and morphometric indicators of structural restructuring of kidney tissue in the prognosis of remodeling of small-diameter kidney arteries in patients with primary chronic glomerulonephritis. Materials and methods: the study included 97 patients with primary chronic glomerulonephritis and indications for puncture nephrobiopsy. In all patients, anamnestic and clinical and laboratory risk factors were recorded, and nephrobiopsy was performed. When performing morphometric analysis of nephrobiopsy, the state of the tissue and vessels of the kidneys of small diameter was studied. To achieve this goal, all patients were divided into two groups, the ranking of which was carried out according to the median wall thickness of the interlobular artery. Results: Among all the risk factors studied, a statistically significant effect of an increase in the stages of hypertension (χ2 criterion = 4.24, p = 0.03) and a decrease in GFR (χ2 criterion = 5.92, p = 0.015) on the risk of increasing the thickness of the interlobular artery was found. The indicators of structural reconstruction of the renal tissue did not have a statistically significant effect on the likelihood of remodeling of the arterial wall. However, a direct correlation of weak strength was found between the severity of tubulointerstitial inflammation and the thickness of the wall of the interlobular artery (r = 0.23, p = 0.02). Conclusions: this work shows the paramount importance of hypertension, accompanied by damage to target organs, as a marker of remodeling of the vascular wall of the interlobular artery in patients with chronic glomerulonephritis.
Idiopathic inflammatory demyelining diseases: optimization of early diagnosis, predictors of the course
Authors: Goncharova Z A. , Pogrebnova Y. Y.
Published: July 2021

Objective: to describe the clinical and epidemiological features of idiopathic inflammatory demyelinating diseases and to determine the factors influencing their course. Materials and methods: the study included 803 patients with idiopathic inflammatory demyelinating diseases using patient questionnaires and scales, laboratory and instrumental research methods. Statistical processing of the results was carried out using a point biserial coefficient and programs for analyzing large data arrays and machine learning. Results: a dynamic increase in the prevalence of some forms of idiopathic inflammatory demyelinating diseases was revealed, the difficulties of differential diagnosis of rare forms of demyelination and the need to create a unified version of their classification are reflected. In the studied population, the effectiveness of liquorological examination in the diagnosis of multiple sclerosis in the early stages of the disease was shown. It has been shown that the likelihood of developing highly active multiple sclerosis is influenced by both a genetic factor and concomitant inflammatory, allergic and autoimmune diseases, surgical interventions, dietary habits, childhood infections, and a history of pregnancy. Conclusions: given the complexity of the differential diagnosis of idiopathic inflammatory demyelinating diseases and the appointment of modifying therapy in multiple sclerosis in the early stages, it is necessary to create a combined classification and maintain a common register.
Acceptance of a Smartphone-Based Visual Field Screening Platform for Glaucoma: Pre-Post Study
Authors: Nida Esmael Kedir , Bekele Sisay , Geurts Luc , Vanden Abeele Vero
Published: July 2021

Background

Glaucoma, the silent thief of sight, is a major cause of blindness worldwide. It is a burden for people in low-income countries, specifically countries where glaucoma-induced blindness accounts for 15% of the total incidence of blindness. More than half the people living with glaucoma in low-income countries are unaware of the disease until it progresses to an advanced stage, resulting in permanent visual impairment.

Objective

This study aims to evaluate the acceptability of the Glaucoma Easy Screener (GES), a low-cost and portable visual field screening platform comprising a smartphone, a stereoscopic virtual reality headset, and a gaming joystick.

Methods

A mixed methods study that included 24 eye care professionals from 4 hospitals in Southwest Ethiopia was conducted to evaluate the acceptability of GES. A pre-post design was used to collect perspectives before and after using the GES by using questionnaires and semistructured interviews. A Wilcoxon signed-rank test was used to determine the significance of any change in the scores of the questionnaire items (two-tailed, 95% CI; α=.05). The questionnaire and interview questions were guided by the Unified Theory of Acceptance and Use of Technology.

Results

Positive results were obtained both before and after use, suggesting the acceptance of mobile health solutions for conducting glaucoma screening by using a low-cost headset with a smartphone and a game controller. There was a significant increase (two-tailed, 95% CI; α=.05) in the average scores of 86% (19/22) of postuse questionnaire items compared with those of preuse questionnaire items. Ophthalmic professionals perceived GES as easy to use and as a tool that enabled the conduct of glaucoma screening tests, especially during outreach to rural areas. However, positive evaluations are contingent on the accuracy of the tool. Moreover, ophthalmologists voiced the need to limit the tool to screening only (ie, not for making diagnoses).

Conclusions

This study supports the feasibility of using a mobile device in combination with a low-cost virtual reality headset and classic controller for glaucoma screening in rural areas. GES has the potential to reduce the burden of irreversible blindness caused by glaucoma. However, further assessment of its sensitivity and specificity is required.
Determining the Evolution of Headache Among Regular Users of a Daily Electronic Diary via a Smartphone App: Observational Study (Preprint)
Authors: Raffaelli Bianca , Mecklenburg Jasper , Overeem Lucas Hendrik , Scholler Simon , Dahlem Markus A , Kurth Tobias , Oliveira Gonçalves Ana Sofia , Reuter Uwe , Neeb Lars
Published: July 2021

BACKGROUND

Smartphone-based apps represent a major development in health care management. Specifically in headache care, the use of electronic headache diaries via apps has become increasingly popular. In contrast to the soaring volume of available data, scientific use of these data resources is sparse.

OBJECTIVE

In this analysis, we aimed to assess changes in headache and migraine frequency, headache and migraine intensity, and use of acute medication among people who showed daily use of the headache diary as implemented in the freely available basic version of the German commercial app, M-sense.

METHODS

The basic version of M-sense comprises an electronic headache diary, documentation of lifestyle factors with a possible impact on headaches, and evaluation of headache patterns. This analysis included all M-sense users who had entered data into the app on a daily basis for at least 7 months.

RESULTS

We analyzed data from 1545 users. Mean MHD decreased from 9.42 (SD 5.81) at baseline to 6.39 (SD 5.09) after 6 months (P<.001; 95% CI 2.80-3.25). MMD, AMD, and migraine intensity were also significantly reduced. Similar results were found in 985 users with episodic migraine and in 126 users with chronic migraine.

CONCLUSIONS

Among regular users of an electronic headache diary, headache and migraine frequency, in addition to other headache characteristics, improved over time. The use of an electronic headache diary may support standard headache care.
Predicting and Responding to Clinical Deterioration in Hospitalized Patients by Using Artificial Intelligence: Protocol for a Mixed Methods, Stepped Wedge Study (Preprint)
Authors: Holdsworth Laura M , Kling Samantha M R , Smith Margaret , Safaeinili Nadia , Shieh Lisa , Vilendrer Stacie , Garvert Donn W , Winget Marcy , Asch Steven M , Li Ron C
Published: July 2021

BACKGROUND

The early identification of clinical deterioration in patients in hospital units can decrease mortality rates and improve other patient outcomes; yet, this remains a challenge in busy hospital settings. Artificial intelligence (AI), in the form of predictive models, is increasingly being explored for its potential to assist clinicians in predicting clinical deterioration.

OBJECTIVE

Using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, this study aims to assess whether an AI-enabled work system improves clinical outcomes, describe how the clinical deterioration index (CDI) predictive model and associated work processes are implemented, and define the emergent properties of the AI-enabled work system that mediate the observed clinical outcomes.

METHODS

This study will use a mixed methods approach that is informed by the SEIPS 2.0 model to assess both processes and outcomes and focus on how physician-nurse clinical teams are affected by the presence of AI. The intervention will be implemented in hospital medicine units based on a modified stepped wedge design featuring three stages over 11 months—stage 0 represents a baseline period 10 months before the implementation of the intervention; stage 1 introduces the CDI predictions to physicians only and triggers a physician-driven workflow; and stage 2 introduces the CDI predictions to the multidisciplinary team, which includes physicians and nurses, and triggers a nurse-driven workflow. Quantitative data will be collected from the electronic health record for the clinical processes and outcomes. Interviews will be conducted with members of the multidisciplinary team to understand how the intervention changes the existing work system and processes. The SEIPS 2.0 model will provide an analytic framework for a mixed methods analysis.

RESULTS

A pilot period for the study began in December 2020, and the results are expected in mid-2022.

CONCLUSIONS

This protocol paper proposes an approach to evaluation that recognizes the importance of assessing both processes and outcomes to understand how a multifaceted AI-enabled intervention affects the complex team-based work of identifying and managing clinical deterioration.

CLINICALTRIAL

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/27532
Politics of Race: Diskriminasi Rasial Etnis Tionghoa dalam Kebijakan Pertanahan di Daerah Istimewa Yogyakarta
Authors: Friska Dianing Puspa Felisitas , Salzabilla Puspita Sari Fira , Azarine Lathifah Finna , Nadimjethro Johanes , Wahyu Nugroho Agus , Wahyu Nugroho Agus , Nurcholis Ahmad
Published: July 2021

Tulisan ini berusaha memberikan elaborasi mengenai faktor-faktor apa saja yang berperan dalam melanggengkan diskriminasi hak kepemilikan tanah terhadap penduduk etnis Tionghoa di wilayah Yogyakarta. Terdapat keunikan dalam implementasi Undang-Undang Pokok Agraria, di Kota Yogyakarta dengan Sultan sebagai pusat kekuasaannya. Dari penelusuran historis terdapat serangkaian tindakan diskriminatif terhadap penduduk etnis Tionghoa berkaitan dengan hak kepemilikan tanah. Mulai dari kesulitan mendapatkan pengakuan sebagai warga negara Indonesia, penetapan status yang didasarkan pada ciri-ciri rasial, hingga penolakan kepemilikan tanah dari aturan formal yang berlaku beserta birokrasi yang berkuasa. Berbeda dengan wilayah lainnya di Indonesia, Yogyakarta dengan segala tradisinya masih mempertahankan diskriminasi rasial tersebut. Dalam praktiknya di masa kini, diskriminasi tersebut, selain tercantum dalam aturan formal, juga terinstitusionalisasi pada pemahaman masyarakat Yogyakarta, sehingga menjadi sesuatu yang normal. Proses institusionalisasi tersebut dapat dikaitkan dengan pengaruh politik kekuasaan yang dimiliki oleh Sultan terhadap seluruh lapisan masyarakat Yogyakarta, berikut lembaga-lembaga formal terkait. Melalui studi lapangan serta sumber-sumber sekunder, tulisan ini menjelaskan apa yang menyebabkan diskriminasi tersebut dapat bertahan dari waktu ke waktu, baik dari sisi aturan formal, historis serta pemahaman sosiokultural yang memperkuatnya.
Belatacept for Simultaneous Calcineurin Inhibitor and Chronic Corticosteroid Immunosuppression Avoidance
Authors: Kaufman Dixon B. , Woodle E. Steve , Shields Adele Rike , Leone John , Matas Arthur , Wiseman Alexander , West-Thielke Patricia , Sa Ting , King Eileen C. , Alloway Rita R. ,   for the BEST Study Group
Published: July 2021

Background and objectives

Immunosuppressive therapy in kidney transplantation is associated with numerous toxicities. CD28-mediated T-cell costimulation blockade using belatacept may reduce long-term nephrotoxicity, compared with calcineurin inhibitor–based immunosuppression. The efficacy and safety of simultaneous calcineurin inhibitor avoidance and rapid steroid withdrawal were tested in a randomized, prospective, multicenter study.

Design, setting, participants, & measurements

This study reports the 2-year results of a randomized clinical trial of 316 recipients of a new kidney transplant. All kidney transplants were performed using rapid steroid withdrawal immunosuppression. Recipients were randomized in a 1:1:1 ratio to receive belatacept with alemtuzumab induction, belatacept with rabbit anti-thymocyte globulin (rATG) induction, or tacrolimus with rATG induction. The composite end point consisted of death, kidney allograft loss, or an eGFR of <45 ml/min per 1.73 m2 at 2 years.

Results

The composite end point was observed for 11 of 107 (10%) participants assigned to belatacept/alemtuzumab, 13 of 104 (13%) participants assigned to belatacept/rATG, and 21 of 105 (21%) participants assigned to tacrolimus/rATG (for belatacept/alemtuzumab versus tacrolimus/rATG, P=0.99; for belatacept/rATG versus tacrolimus/rATG, P=0.66). Patient and graft survival rates were similar between all groups. An eGFR of <45 ml/min per 1.73 m2 was observed for nine of 107 (8%) participants assigned to belatacept/alemtuzuab, eight of 104 (8%) participants assigned to belatacept/rATG, and 20 of 105 (19%) participants assigned to tacrolimus/rATG (P<0.05 for each belatacept group versus tacrolimus/rATG). Biopsy sample–proven acute rejection was observed for 20 of 107 (19%) participants assigned to belatacept/alemtuzuab, 26 of 104 (25%) participants assigned to belatacept/rATG, and seven of 105 (7%) participants assigned to tacrolimus/rATG (for belatacept/alemtuzumab versus tacrolimus/rATG, P=0.006; for belatacept/rATG versus tacrolimus/rATG, P<0.001). Gastrointestinal and neurologic adverse events were less frequent with belatacept versus calcineurin-based immunosuppression.

Conclusions

Overall 2-year outcomes were similar when comparing maintenance immunosuppression using belatacept versus tacrolimus, and each protocol involved rapid steroid withdrawal. The incidence of an eGFR of <45 ml/min per 1.73 m2 was significantly lower with belatacept compared with tacrolimus, but the incidence of biopsy sample–proven acute rejection significantly higher.

Clinical Trial registry name and registration number:

Belatacept Early Steroid Withdrawal Trial, NCT01729494
Effect of Hemodiafiltration on the Progression of Neuropathy with Kidney Failure
Authors: Kang Amy , Arnold Ria , Gallagher Martin , Snelling Paul , Green Julianne , Fernando Mangalee , Kiernan Matthew C. , Hand Samantha , Grimley Kim , Burman Jenny , Heath Anne , Rogers Kris , Bhattacharya Amritendu , Smyth Brendan , Bradbury Thomas , Hawley Carmel , Perkovic Vlado , Krishnan Arun V. , Jardine Meg J.
Published: July 2021

Background and objectives

Neuropathy is a common complication of kidney disease that lacks proven disease-modifying treatments. Hemodiafiltration improves clearance of uremic toxins and is associated with better nerve function than hemodialysis. We aimed to determine whether hemodiafiltration reduces the progression of neuropathy in people receiving hemodialysis.

Design, setting, participants, & measurements

The Filtration in the Neuropathy of End-Stage Kidney Disease Symptom Evolution (FINESSE) study was an open-label, blinded end point assessment, controlled trial that randomized maintenance hemodialysis recipients to hemodiafiltration or high-flux hemodialysis for 48 months or until death or cessation of dialysis at four study centers. The primary outcome was the mean change in the yearly modified total neuropathy score from baseline, with time points weighted equally.

Results

A total of 124 participants were randomized and followed for a mean of 41 months. At baseline, neuropathy was present in 91 (73%) participants (modified total neuropathy score greater than or equal to two), and 38 (31%) had moderate to severe neuropathy (modified total neuropathy score 9–28). Convection volume in the hemodiafiltration arm was a median of 24.7 (interquartile range, 22.4–26.5) L. The mean modified total neuropathy score (SEM) worsened by 1.7 (0.4)/28 and 1.2 (0.4)/28 in the hemodiafiltration and hemodialysis groups, respectively, with a mean difference of 0.5 (95% confidence interval, −0.7 to 1.7; P=0.37). There was no difference in survival (hazard ratio, 1.24; 95% confidence interval, 0.61 to 2.51; log rank P=0.55) or any of the prespecified adverse events. There was no difference between groups in the number of participants who suffered an adverse event adjusted by follow-up time (relative risk, 1.05; 95% confidence interval, 0.83 to 1.32; P=0.68).

Conclusions

Neuropathy is still a common complication of kidney disease without disease-altering therapy. Hemodiafiltration did not affect neuropathy progression compared with hemodialysis.

Clinical Trial registry name and registration number:

Filtration in the Neuropathy of End-Stage Kidney Disease Symptom Evolution (FINESSE), ACTRN12609000615280
Preguntas, indeterminaciones y conjeturas
Authors: Carranco Arenas Morgana
Published: July 2021

El camino del conocimiento no es lineal y, además del obvio esfuerzo que conlleva, está poblado de tropiezos, hipótesis equivocadas y coincidencias. El conocimiento, en todos sus ámbitos, es algo que perseguimos y perseguimos, pero que no es fijo. Por ello, este numero de la Revista Digital Universitaria sintetiza las diferentes formas de explorar el conocimiento, su empleo e implicaciones para la sociedad.
El enemigo de mi enemigo es… Un virus que ataca a las bacterias: los bacteriófagos
Authors: Fuentes Valencia María Anel , Gil Correa Adriana Carolina , Martínez Palacios Carlos Antonio , Baizabal Aguirre Víctor Manuel , Valdez Alarcón Juan José
Published: July 2021

Los virus son partículas que infectan a todas las formas de vida. Los virus bacteriófagos, que infectan bacterias, fueron descubiertos antes que los antibióticos. A pesar de su tamaño pequeño, han contribuido al desarrollo científico desde hace décadas, como en el descubrimiento de numerosas enzimas con aplicaciones en la biología molecular1. En este trabajo se analizarán aspectos generales de la biología de los virus bacteriófagos, su contribución a la salud y se presentarán algunos casos exitosos de la terapia antimicrobiana usando bacteriófagos en humanos y animales. Aunque la terapia con bacteriófagos no cuenta con autorización para su uso global, ya existen formulaciones comerciales de bacteriófagos para la industria alimentaria. Se describirá el arma principal de los bacteriófagos, la endolisina, enzima que “revienta” a las bacterias. Las endolisinas se consideran una alternativa más segura que los bacteriófagos, al carecer de material genético. Los bacteriófagos y las endolisinas tienen aplicaciones revolucionarias en la medicina, como vehículos de transporte de moléculas y generación de vacunas, de fantasmas bacterianos, o en la detección diagnóstica de bacterias patógenas.
La educación sexual escolar… ¿Funciona?
Authors: Heredia Espinosa Ana Lis , Rodíguez Barraza Adriana
Published: July 2021

A lo largo de nuestra vida, adquirimos conocimientos sobre la sexualidad en distintos contextos: en el familiar, el escolar y el social. En este artículo, haremos un análisis sobre la educación sexual impartida, específicamente, en el contexto escolar. Cada país tiene sus modos y políticas para impartir la educación sexual, por lo que resulta interesante conocer las formas de llevarla a cabo. En ese sentido, el objetivo de este texto es hacer una comparación de cómo se imparte la educación sexual en México y en otros países, en especial, en las últimas décadas. Por consiguiente, se hablará de su manejo en países donde la educación sexual integral ha dado resultados favorables, con la finalidad de reflexionar acerca de cómo, a falta de un abordaje integral de la educación sexual, en México se continúa con prácticas de riesgo y se sigue recurriendo a fuentes de información inadecuadas que mantienen los roles de género, los estereotipos y la violencia.
Bacterias del maíz como aliadas en la producción agroecológica de alimentos
Authors: Maldonado Mendoza Ignacio Eduardo , Morales Ruiz Estefanía
Published: July 2021

El control biológico de plagas, o biocontrol, consiste en utilizar componentes de origen biológico, como insectos, hongos y bacterias, capaces de antagonizar el crecimiento de otros insectos, hongos y bacterias que dañan cultivos. El biocontrol es una estrategia para disminuir las pérdidas en cultivos derivadas del ataque de plagas, con el propósito de asegurar la producción agrícola sostenible desde un enfoque agroecológico, es decir, amigable con el ambiente. El objetivo de este artículo es presentar un ejemplo de control biológico de una enfermedad en el maíz, la fusariosis —causada por el hongo infeccioso Fusarium verticillioides—, mediante el uso de la bacteria de la rizósfera del maíz Bacillus cereus B25. Asimismo, se discutirá del trabajo realizado para entender los posibles mecanismos que usa esta bacteria para inhibir el crecimiento del hongo fitopatógeno, en específico de las enzimas llamadas quitinasas, capaces de degradar la molécula de quitina que forma la pared celular del hongo y que, en consecuencia, detienen su crecimiento. Finalmente, se plantean las posibles aplicaciones biotecnológicas de los resultados encontrados.
Los últimos serán los primeros: la importancia de los hablantes de herencia
Authors: Ibáñez Bravo María Elena
Published: July 2021

La diversidad lingüística se encuentra en grave riesgo ante el desplazamiento de 96% de lenguas que se hablan a nivel mundial a favor de sólo 3% de lenguas dominantes. Ante esta pérdida, las acciones de revitalización, fortalecimiento y promoción de lenguas se vuelven fundamentales para intentar revertir dicha situación. En este escenario, los hablantes de herencia, un tipo de bilingüismo recientemente reconocido, se consideran figuras fundamentales para ampliar el panorama de estrategias de planificación lingüística, ya que por las características que presentan es posible aumentar las opciones de espacios de uso y de enseñanza de lenguas a favor de las comunidades de habla que se encuentran en contextos de desplazamiento lingüístico.
Food And Mood: A Dietary Approach to Treating Depression
Authors: Cranford Kimberly
Published: July 2021

Providing dietary advice that targets specific health outcomes can be a daunting task given the plethora of often-conflicting advice available in the mainstream and even medical literature. As a psychiatrist, I am specifically interested in how dietary interventions might target mood, particularly depression, a leading cause of disability worldwide. Presented herein is the available research targeting depression with dietary interventions. I will provide a brief introduction on what led me toward an interest in diet and nutrition, discuss the evidence base demonstrating improvements in depression with specific dietary interventions, and provide a discussion on the subset of patients suffering from a type of depression that appears to be in large part a systemic inflammatory condition and the dietary implications for treatment in this group.