bluuebunny/crossref_metadata_2025 huggingface dataset:
PENERAPAN BENFORD'S LAW UNTUK MENDETEKSI DUGAAN KETIDAKPATUHAN MATERIAL PADA SPT TAHUNAN PPH ORANG PRIBADI
Authors: Adetya Candra Yuwana Putra  , Maryadi
Published: May 2021

This study aims to examine whether the Individual Income Tax Return data set conforms to the Benford's Law pattern and to examine whether there are indications of material noncompliance in that data set based on the application of Benford's Law. This research is a quantitative research. The data source in this study is the taxation database owned by the Directorate General of Taxes (DGT), Ministry of Finance. The results of this study indicate that most of the Individual Income Tax Return data set variables conform to Benford's Law pattern and there are indications of material noncompliance in that data set. Tax officer, in this case account representatives and tax auditors are expected to be able to use the results of this study to carry out further analysis of the numerical class in the Individual Income Tax Return data set that is not appropriate and deviates from Benford's Law pattern. DGT, as a tax institution, is expected to consider the use of Benford's Law to assist the taxpayer supervision and inspection process.
Effect of COVID-19 pandemic on Dental Training of Students and Residents in USA
Authors: Akhtar Taha M. , Bendayan Alexander , Swann Brian J. , Dunham Larry G.
Published: May 2021

The turn of this decade has seen the start of a pandemic originated in Wuhan, China that inundated the world by the emergence of the coronavirus disease 2019 (COVID-19) crisis. This may result in dental and training taking a back seat, as critical resources are channeled toward frontline efforts to combat outbreaks. In dental education, patient care and service is an important a mandate within the healthcare system. There must be some contingency plans to minimize the disruption of the education and training. Advance in the physical structure and protocol of the dental practice on live patients will become the new normal in dentistry. This gap in time created by the pandemic is an opportunity to expand the horizon of the dental professional into the scope of the oral physician with a broader focus of the responsibility of the dentists as the scientist, the artist, the engineer and the doctor must be adopted in practice.
Centro da cidade do Rio de Janeiro: proposta de enquadramento como Bem Cultural Nacional da Primeira República (1889-1930)
Authors:   Universidade Federal Rural do Rio de Janeiro, Cesar Ribeiro Sampaio Julio
Published: May 2021

Neste trabalho, objetivamos avaliar a condição do Centro da Cidade do Rio de Janeiro como Patrimônio Cultural Nacional e também como parte do Patrimônio Mundial, enquadrado, especificamente, no conceito de Paisagem Cultural. Em especial, pretendemos aqui rever "valores universais excepcionais" e a ideia de "patrimônio nacional" do caso brasileiro, sobretudo em relação à categoria das cidades ditas "históricas."
Genetics in Dentistry – A Review Article
Authors: Kulshrestha Rohit
Published: May 2021

Most genetic disorders present in early childhood, some even in utero. The diagnosis and management of genetic disorders is, therefore, an important part of fetal medicine and pediatrics, including pediatric dentistry. Clinical genetics, which traditionally is responsible for genetic counseling, is an important collaborator. This article summarises the recent findings in genetics and elaborates on its benefits as well.
Competencia argumentativa: un factor clave en la formación de docentes
Authors: Ruiz-Ortega Francisco Javier , Dussan Luberth Carmen
Published: May 2021

El artículo aporta elementos que evidencien la necesidad de intervenir y proponer la argumentación como un contenido explícito en la formación de profesores de educación media. Para ello, se desarrolló una investigación de tipo descriptivo-correlacional, de carácter transversal, cuya población estuvo constituida por 314 estudiantes del programa de Licenciatura en Biología y Química, de la Universidad de Caldas, Colombia. Un muestreo estratificado aleatorio simple permitió determinar el tamaño de la muestra, que fue de 121 sujetos. El estudio concluye que la poca claridad para asumir la argumentación como posibilidad de aprendizaje y coconstrucción de conocimiento escolar, sumada al poco trabajo en el aula centrado en procesos argumentativos conscientes e intencionados que aporten al desarrollo de aprendizajes en profundidad, hacen indispensable en las estructuras curriculares la presencia explícita de la argumentación como objeto de enseñanza y aprendizaje.
Reporting and Analyzing Race and Ethnicity in Orthopaedic Clinical Trials: A Systematic Review
Authors: Paul Ryan W. , Lee Donghoon , Brutico Joseph , Tjoumakaris Fotios P. , Ciccotti Michael G. , Freedman Kevin B.
Published: May 2021

Background:

The distinction between race and ethnicity should be carefully understood and described for demographic data collection. Racial healthcare differences have been observed across many orthopaedic subspecialties. However, the frequency of reporting and analyzing race and ethnicity in orthopaedic clinical trials has not been determined. Therefore, the primary purpose of this systematic review was to determine how frequently race and ethnicity are reported and analyzed in orthopaedic clinical trials.

Methods:

The top 10 journals by impact factor in the field of orthopaedics were manually screened from 2015 to 2019. All randomized controlled trials related to orthopaedics and assessing clinical outcomes were included. Eligible studies were evaluated for bias using the Cochrane risk-of-bias tool and for whether the trial reported and analyzed several demographics, including age, sex, height, weight, race, and ethnicity. The frequency of reporting and analyzing by each demographic was accessed. In addition, comparisons of reporting and analyzing race/ethnicity were made based on orthopaedic subspecialty and journal of publication.

Results:

A total of 15,488 publications were screened and 482 met inclusion criteria. Of these 482 trials, 460 (95.4%) reported age and 456 (94.6%) reported sex, whereas 35 (7.3%) reported race and 15 (3.1%) reported ethnicity for the randomized groups; 79 studies (16.4%) analyzed age and 72 studies (14.9%) analyzed sex, whereas 6 studies (1.2%) analyzed race and 1 study (0.2%) analyzed ethnicity. The orthopaedic subspecialty of spine was found to report race (23.5%) and ethnicity (17.6%) more frequently than all the other subspecialties, whereas sports medicine reported race and/or ethnicity in only 3 of 150 trials (2.0%).

Conclusions:

Race and ethnicity are not frequently reported or analyzed in orthopaedic randomized controlled trials. Social context, personal challenges, and economic challenges should be considered while analyzing the effect of race and ethnicity on outcomes.
The effect of lipopolysaccharide from uropathogenic Escherichia coli on the immune system, testis tissue, and spermatozoa of BALB/c mice
Authors: Khanmohammad Khadije Rezai , Khalili Mohammad Bagher , Sadeh Maryam , Talebi Ali Reza , Astani Akram , Shams Ali , Zare Fateme
Published: May 2021

Objective: Uropathogenic Escherichia coli is known to cause urinary tract infections, and the endotoxin (lipopolysaccharide [LPS]) of this bacterium may cause deficiencies of sperm quality and morphology. In the present study, the effects of LPS on mouse sperm were studied, and the levels of interleukin (IL)-17A and possible changes in testis tissue were evaluated.Methods: LPS of uropathogenic E. coli was extracted using the methanol-chloroform method, followed confirmation using sodium dodecyl sulfate-polyacrylamide electrophoresis. Purified LPS (100 µg/kg) or phosphate-buffered saline was injected intraperitoneally into BALB/c mice for 7 days consecutively in the test and control groups, Mice were sacrificed on days 3, 7, and 42 after the first injection. Blood was tested for levels of IL-17A using the enzyme-linked immunosorbent assay method. Testis tissue and sperm were collected from each mouse and were studied according to standard protocols. Results: The mean sperm count and motility significantly decreased (p=0.03) at 3, 7, and 42 days after the injections. The level of IL-17A in the test groups increased, but not significantly (p=0.8, p=0.11, and p=0.15, respectively). Microscopic studies showed no obvious changes in the morphology of the testis tissue; however, significant changes were observed in the cellular parenchyma on day 42. Conclusion: LPS can stimulate the immune system to produce pro-inflammatory cytokines, resulting in an immune response in the testis and ultimately leading to deficiency in sperm parameters and testis tissue damage. In addition, the presence of LPS could significantly impair sperm parameters, as shown by the finding of decreased motility.
Implicações hidrogeomorfológicas do rompimento da barragem de rejeito da Mina do Córrego do Feijão – MG
Authors: Carvalho Regina Paula Benedetto de , Magalhães Júnior Antônio Pereira , Barros Luiz Fernando de Paula
Published: May 2021

O artigo busca identificar e analisar alterações hidrogeomorfológicas nos fundos dos vales do ribeirão Ferro-Carvão e do rio Paraopeba decorrentes do rompimento da barragem de rejeito B1 da Mina do Córrego do Feijão (Brumadinho-MG).  A pesquisa se baseou no uso de imagens de satélite e de dados quali-quantitativos da primeira estação chuvosa pós-rompimento. O conjunto das alterações identificadas permitiu a definição de cinco trechos fluviais, estando a abrangência dos impactos morfológicos diretamente relacionada à proximidade com o local do rompimento, fato que não se verifica, necessariamente, com relação aos aspectos hidrossedimentológicos. Enquanto o Trecho 1 foi marcado pelo completo soterramento do fundo do vale, nos demais a formação de depósitos de rejeito nas margens, o surgimento de barras de canal na calha do Paraopeba e o entulhamento de áreas de confluência até o reservatório de Retiro Baixo são indicativos de consequências importantes do desastre. O trabalho ilustra como os eventos de rompimento de barragens de rejeito tendem a comprometer a configuração e a dinâmica hidrogeomorfológica de sistemas fluviais, além dos conhecidos impactos socioambientais.
Do protagonismo à invisibilidade: Geografia Histórica do córrego do Acaba Mundo e a sua relação com o sítio de Belo Horizonte-MG (1716/1973)
Authors: Borsagli Alessandro , Castro José Flávio Morais
Published: May 2021

O artigo tem como objetivo analisar a relação do córrego do Acaba Mundo com o sítio ocupado pela cidade de Belo Horizonte. Correndo atualmente sob diversas vias da região centro-sul da capital mineira, o curso d’água possui grande importância não só para os estudos sobre a ocupação do sítio do arraial do Curral del Rey, mas também para a reconstrução das paisagens profundamente modificadas a partir do processo de evolução urbana de Belo Horizonte, onde a geografia histórica se encontra intrinsecamente ligada à paisagem. A abordagem da pesquisa foi trabalhada através da Geografia Histórica, possibilitando dessa forma a realização de uma contextualização geohistórica da ocupação do sítio que veio a receber a nova capital de Minas Gerais. Nesse contexto, observa-se que o curso d’água foi de grande importância para o abastecimento e para a forma do arraial, perdendo gradativamente importância ao longo do processo de evolução urbana de Belo Horizonte.
LAZE - Um poderoso analisador de logs do Squid
Authors: Knob Natália , Knob Luis , Da Silva Eduardo Germano , Machado Cristian Cleder , Lusa Diego
Published: May 2021

Este artigo descreve o desenvolvimento de uma ferramenta de análise de logs gerados através do software Squid, chamada LAZE, que busca apresentar informações úteis, a partir de relatórios e gráficos, aos gestores de redes em ambiente empresarial ou organizacional. Ainda, procurou-se identificar limitações e ausência de recursos em ferramentas similares, procurando-se suprir limitações advindas da necessidade de controle de requisições web realizadas pelos usuários. Este artigo também busca descrever os problemas encontrados para a obtenção e gerência de uma grande quantidade de logs e seu tratamento em um banco de dados relacional.
Avaliação de Desempenho de Heavy Hitters utilizando P4 e XDP
Authors: Machado Douglas , De Castro Ariel Góes , Vogt Francisco , Luizelli Marcelo Caggiani
Published: May 2021

A ser definido.
Pesquisa experimental sobre Ataques Cibernéticos em serviços de infraestruturas de nuvens públicas baseadas em Microsoft Azure
Authors: Santos Mateus , Marcon Daniel
Published: May 2021

Para manter a perpetuidade de seus negócios, as corporações estão transformando-os para o modelo digital. Como consequência dessas mudanças, a infraestrutura de tecnologia da informação (TI) precisa mudar os paradigmas obsoletos e adotar soluções que assegurem elasticidade para crescimento, alta disponibilidade e segurança para suportar os novos modelos de negócios. Dentro desse contexto, a infraestrutura em nuvem se tornou um modelo primordial para atender às necessidades do negócio e também da TI. Assim como outras tecnologias disruptivas, a infraestrutura em nuvem também possui considerações importantes referente à segurança da informação. Neste cenário, o presente artigo realiza uma pesquisa experimental das soluções de segurança disponíveis no ambiente de infraestrutura pública da Microsoft Azure e apresenta uma avaliação da eficiência e da efetividade dos controles disponíveis através de simulações de ataques cibernéticos. Os resultados obtidos apresentam a baixa efetividade dos mecanismos de segurança oferecidos pela Microsoft Azure e demonstram os acréscimos relacionados ao desempenho da solução.
SAAS: Uma Solução de Autenticação para Aplicativos de Smartphones
Authors: Fernandes Rafael , Kreutz Diego , Paz Giulliano , Mansilha Rodrigo , Immich Roger
Published: May 2021

A crescente utilização de aplicativos em dispositivos móveis como forma de autenticação de usuários está trazendo à tona diferentes oportunidades e desafios de segurança. Por exemplo, o cartão virtual do SESC-RS utiliza um QR Code estático, contendo apenas o CPF do associado, como forma de autenticação, o que representa uma vulnerabilidade crítica sob a ótica da segurança. Neste trabalho é proposta uma solução de autenticação para aplicativos de dispositivos móveis, denominada SAAS, composta de dois protocolos principais, um de vinculação de credenciais do usuário (i.e. identificação) ao dispositivo móvel e outro para a geração de códigos de autenticação descartáveis, denominados OTACs. Como forma de demonstrar o funcionamento e a viabilidade da solução, foi implementado um protótipo que simula o controle de acesso utilizando catracas eletrônicas, uma das finalidades para as quais o cartão virtual do SESC-RS é utilizado.
Análise de vulnerabilidades na implementação de dispositivo de Internet das Coisas como fechadura eletrônica
Authors: M. Migotto Sander , B. Voss Gleizer
Published: May 2021

Com a popularização da IoT aumentam os desafios relacionados à segurança. Neste trabalho foi simulado um ambiente com uma fechadura eletrônica utilizando um microcontrolador Arduino e um leitor RFID para controle de acesso. Foram realizados testes de segurança que permitiram analisar a quais tipos de ataque o sistema é mais suscetível a falhas, demonstrando que a sua instalação padrão é insegura e a necessidade de usar rede segregada.
Sliding Window: The Impact of Trace Size in Anomaly Detection System for Containers Through Machine Learning
Authors: Castanhel Gabriel Ruschel , Heinrich Tiago , Ceschin Fabrício , A. Maziero Carlos
Published: May 2021

Anomaly intrusion detection in Host-based Intrusion Detection System (HIDS) is a process intended to monitor operations on a host to identify behaviors that differ from a “normal ” system behavior. System call based HIDS uses traces of calls to represent the behavior of a system. Due to the volume of data generated by applications and the operating system, sliding windows are applied in order to asses an online environment, allowing intrusions to be detected in real time while being still executed. The respective study explores the impact that the size of the observation window has on Machine Learning (ML) one-class algorithms.
Infraestrutura de acesso em redes sem fio obstruídas: da Intratabilidade à Conectividade
Authors: Ferreira Neto Manassés , Goussevskaia Olga , Dos Santos Vinicius
Published: May 2021

Neste trabalho é considerada uma rede sem ﬁo ad hoc realizada em uma grade regular quadrada, na qual a comunicação entre os dispositivos é inﬂuenciada por obstáculos regularmente espaçados. O raio crítico de transmissão para obter conectividade nesse tipo de rede cresce com o tamanho da grade, o que pode prejudicar a viabilidade em larga escala de tecnologias sem ﬁo de baixa potência. Avalia-se portanto como introduzir eﬁcientemente uma infraestrutura conectada de pontos de acesso em cenários subcríticos, nos quais o raio de transmissão é insuﬁciente para estabelecer a conectividade. Formula-se o problema de posicionar o menor número de pontos de acesso, de tal modo que todo componente conectado seja coberto por pelo menos um ponto de acesso, e denomina-se esse problema de Obstructed Wireless Network Backbone Cover Problem (OWN-BC). Prova-se que OWN-BC é NP-Completo e propõe-se um algoritmo 2-aproximativo para obter soluções com garantia de qualidade. Realiza-se simulações para ilustrar o desempenho do algoritmo em diferentes cenários. Além disso, é feita uma caracterização de cenários para os quais o algoritmo proposto obtêm soluções ótimas em tempo polinomial com alta probabilidade.
MARS: uma arquitetura para análise de malwares utilizando SDN
Authors: Ceron João , Margi Cíntia , Granville Lisandro
Published: May 2021

Investigar características de códigos maliciosos é um processo essencial para aprimorar os sistemas de segurança. No entanto, malwares modernos requerem condições específicas no ambiente em que são executados para revelar seu comportamento malicioso. Esta tese propõe arquitetura flexível para analisar códigos maliciosos controlando de maneira unificada o ambiente de análise, incluindo o sandbox e os elementos que o circundam. Dessa maneira, é possível gerenciar regras de contenção, configuração dinâmica de recursos, e manipular o tráfego de rede gerado pelos malwares. Os resultados experimentais demonstraram que a arquitetura pode revelar comportamentos de malwares que não são exibidos em soluções tradicionais de análise.
Scalable Cost-Efficient Placement and Chaining of Virtual Network Functions
Authors: Luizelli Marcelo , Buriol Luciana , Gaspary Luciano
Published: May 2021

While Network Function Virtualization (NFV) is increasingly gaining momentum, with promising beneﬁts of ﬂexible service function deployment and reduced operations and management costs, there are several challenges that remain to be properly tackled, so that it can realize its full potential. One of these challenges, which has a signiﬁcant impact on the NFV production chain, is effectively and (cost) efﬁciently deploying service functions, while ensuring that service level agreements are satisﬁed and making wise allocations of network resources. Despite recent research activity in the ﬁeld, little has been done towards scalable and cost-efﬁcient placement & chaining of virtual network functions (VNFs) – a key feature for the effective success of NFV. In this thesis, we approach VNF placement and chaining as an optimization problem in the context of Interand Intra-datacenter. We formalize the Virtual Network Function Placement and Chaining (VNFPC) problem and propose a mathematical model to solve it. Our model has established one of the ﬁrst baseline comparison in the ﬁeld of resource management in NFV and has been widely used in the recent literature. We also address scalability of VNFPC problem to solve large instances by proposing a novel ﬁx-and-optimize-based heuristic algorithm for tackling it. Further, we extensively measure the performance limitations of realistic NFV deployments. Based on that, we propose an analytical model that accurately predict incurred operational costs. Then, we develop an optimal Intra-datacenter service chain deployment mechanism based on our cost model. Finally, we tackle the problem of monitoring service chains in NFV-based environments efﬁciently.
Anpassung nach unten? Versuch über Vulgarität
Authors: Koschorke Albrecht
Published: May 2021

Nach einer gängigen Vorstellung integrieren sich moderne Gesellschaften über ihre soziokulturelle Aufwärtsdynamik, während Abwärtsmobilität mit kultureller Regression und sozialer Auflösung einhergeht. Die aktuell beobachtbare Vulga­ri­sie­rung des öffent­lichen Diskurses scheint dem zu entsprechen. In dem Beitrag wird danach gefragt, ob und wie sich dieser Befund mit der Moral Economy von Protestbewegungen und ihrem An­spruch auf sozialmoralische Erneuerung vereinbaren lässt.
Neue Frauen – neuer Alltag. Die kleinen Folgen einer großen Revolution
Authors: Schlaffer Hannelore
Published: May 2021

Just how far gender equality has progressed cannot be traced in politics and in professional life alone. A style change has also taken place in everyday life, the reason for which must be seen as emancipation. In the centre of the cities and in their residential quarters, manners, one could even say: rituals have emerged - for example a separate breakfast culture - in which the new relationship between women and their environment becomes visible and can be more vividly grasped than through any statistical analysis.
Zivilgesellschaftliches Engagement der Jugendbewegung »Fridays for Future« – ein kritischer Seismograph demokratischer Verhältnisse
Authors: Cazzini Christina
Published: May 2021

Das zivilgesellschaftliche Engagement der Jugendbewegung Fridays for Future problematisiert die Ressourcenverschwendung und den Raubbau der neoliberalen Lebens- und Wirtschaftsweise als Ursache des Klimawandels und der damit verwobenen sozialen Konflikte. Ihr Engagement und ihre Forderung nach Klimagerechtigkeit werfen Fragen nach demokratischen Möglichkeitsräumen auf - auch für die Soziale Arbeit.
Theorien für die Soziale Arbeit
Authors: May Michael , Schäfer Arne
Published: May 2021

he now second, updated and expanded edition of the textbook first establishes the importance of theory for social work research and practice After offering an outline of the historical development of theory in this field, it presents the most important theories used in social work at the moment. The book presents approaches related to systems theory, power and discourse analysis, and psychoanalysis, plus lifeworld-oriented and feminist approaches as well as those related to coping strategies and to a materialistic–dialectical theory of critical social work, including elements provided by the capability approach. It is rounded off by a systematic comparison of the theoretical approaches and an outlook on theory development in social work.

With contributions by
Maria Bitzan, Margret Dörr, Cornelia Füssenhäuser, Fabian Kessl, Michael Klassen, Michael May, Arne Schäfer, Silvia Staub-Bernasconi, Michael Winkler and Holger Ziegler.
Die Rechtsstellung des angemeldeten Verbrauchers in der Musterfeststellungsklage
Authors: Oehmig Adrian E.
Published: May 2021

Subject of the thesis is primarily the constitutional admissibility of the binding effect pursuant to Section 613 of the German Code of Civil Procedure (ZPO), in particular with regard to the legal hearing of registered consumers. Under this aspect the applicability of the procedural institutes of the change of action and the counterclaim in the model declaratory action (Musterfeststellungsklage) is examined in the further course, which according to the opinion of the author require a very restrictive application in the proceedings of the qualified institution. Lastly, the highly sensitive issue of the liability of the qualified institution for inadequate conduct of proceedings in the model declaratory action is addressed.
The Authorship of Place
Authors: Lo Dennis
Published: May 2021

The Authorship of Place is the first monograph dedicated to the study of the politics, history, aesthetics, and practices of location shooting for Taiwanese, Mainland Chinese, and coproduced art cinemas shot in rural communities since the late 1970s. Lo argues that rural location shooting, beyond serving aesthetic and technical needs, constitutes practices of cultural survival in a region beset with disruptive social changes, including rapid urbanization, geopolitical shifts, and ecological crises. In response to these social changes, auteurs like Hou Xiaoxian, Jia Zhangke, Chen Kaige, and Li Xing transformed sites of film production into symbolically meaningful places of collective memories and aspirations. These production practices ultimately enabled auteurs to experiment with imagining communities in novel and contentious ways.
Guiding readers on a cross-strait tour of prominent shooting locations for the New Chinese Cinemas, this book shows how auteurs sought out their disappearing cultural heritage by reenacting lived experiences of nation building, homecoming, and cultural salvage while shooting on-location. This was an especially daunting task when auteurs encountered the shooting locations as spaces of unresolved historical, social, and geopolitical contestations, tensions which were only intensified by the impact of filmmaking on rural communities. This book demonstrates how complex circumstances surrounding location shooting were pivotal in shaping representations of the rural on-screen, as well as the production communities, institutions, and industries off-screen. Bringing together cutting-edge perspectives in cultural geography and media anthropology, this work revises Chinese film history and theorizes ground-breaking approaches for investigating the cultural politics of film authorship and production.
Angioedema Secondary to tPA Use in Acute Ischemic Stroke Patient with Hypertension: A Case Report
Authors: Kim Chris , Hladik Andrea
Published: May 2021

Introduction: A well-documented complication of administering tissue plasminogen activator (tPA) in stroke patients is acute intracranial bleeding. A lesser known but still significant complication is angioedema secondary to tPA administration, which can develop in certain individuals with risk factors such as angiotensin converting enzyme (ACE) inhibitor use and location of the stroke. Knowing the potential for this life-threatening complication and being prepared for its proper management is vital for emergency physicians.

Case Report: We report a 53-year-old Black female who presented to the emergency department with sudden onset of slurred speech and a facial droop. She was found to have an acute ischemic stroke and tPA was administered. She subsequently developed angioedema. Retrospectively, the patient was found to have risk factors that are thought to predispose patients to tPA-induced angioedema.

Conclusion: Risk factors associated with angioedema secondary to tPA administration have been documented in patients taking ACE inhibitors, as well as patients who develop strokes in the frontal lobe. While many cases may be mild, some patients may develop life-threatening angioedema. Although this complication does not necessarily contraindicate tPA use, it is prudent for the emergency physician to be vigilant for its development, prepared for its treatment, and to be diligent in assessing the need for control of the patient’s airway.
Legionella Pneumonia on Point-of-care Ultrasound in the Emergency Department: A Case Report
Authors: Lopez Robert , Hysell Matthew , Long Jereme , Longobardi Joseph
Published: May 2021

Introduction: Legionella is an uncommon, atypical organism that can cause community-acquired pneumonia. Commonly associated with high fevers, gastrointestinal symptoms, and hyponatremia, it can be easily overlooked, especially during the coronavirus disease of 2019 (COVID-19) pandemic. Legionella has specific antibiotic treatment that will improve outcome; thus, its recognition is important.

Case Report: We present a case of Legionella pneumonia in a man presenting with shortness of breath and fever. The patient’s initial chest radiography was negative. With the use of point-of-care ultrasound (POCUS) the changes of atypical pneumonia could be seen. Ultimately Legionella was confirmed with urine antigen testing, and appropriate antibiotic treatment was started.

Discussion: Given the increased awareness of COVID-19 it is important to consider a broad differential with respiratory illness. Legionella pneumonia on POCUS is consistent with atypical pneumonia descriptions on ultrasound. Point-of-care ultrasound can be used to diagnose atypical pneumonia, specifically caused by Legionella in our case.
Conclusion: Legionella is evident on POCUS but is difficult to distinguish from other infections with POCUS alone. One should consider Legionella if POCUS is positive for signs of atypical infection.
Case of Displaced Glenoid Fracture After Fall: Subtle Findings with Significant Implications for Trauma Patients
Authors: Sebt Solomon , Barden Mathias , Leroux Eric
Published: May 2021

Case Presentation: A 64-year-old man presented to the emergency department with a chief complaint of left shoulder pain after a mechanical fall from standing. Plain radiography revealed a displaced fracture of the inferior glenoid rim. A computed tomography further characterized the fracture and the patient was taken emergently by an orthopedic surgeon for open reduction and internal fixation.

Discussion: Scapula fractures, especially isolated glenoid rim fractures, are rare and most typical of high-energy mechanism traumas. A missed or delayed diagnosis can result in long-term suffering and disability. Awareness of radiographic as well as physical findings and the subsequent classification system described below can optimize outcomes for trauma patients with glenoid fractures.
Rare but Foreseeable: Rapidly Expanding Retropharyngeal Hematoma After Fall from Height
Authors: Bracey Alexander , Ahn Christine , Barnicle Ryan , Frost Michael , Leonard Marshall , Wright Brian
Published: May 2021

Case Presentation: An elderly man presented to the emergency department after a fall from a 15-foot height. Initial examination revealed signs of head and neck trauma without airway compromise. Computed tomography imaging identified cervical fractures at the first and second level with a retropharyngeal hematoma. In discussion with the trauma service, the patient was admitted to the hospital for airway monitoring. After 10 hours he clinically deteriorated, resulting in acute respiratory failure, and ultimately required intubation. The patient was intubated with a hyperangulated video laryngoscopy, and a surgical set-up was also prepared. The intubation was uncomplicated and resulted in clinical improvement. The patient was extubated after three days without difficulty and was ultimately discharged following an uncomplicated hospital course. Discussion: Retropharyngeal hematoma is a rare but significant clinical condition. Rapid decline and airway compromise have been described. Patients often require intubation and mechanical ventilation to avoid airway obstruction and respiratory failure. Coagulopathies should be reversed, if present. Prompt recognition and treatment of this condition is crucial to successful management.
Arterial-embolic Strokes and Painless Vision Loss Due to Phase II Aortitis and Giant Cell Arteritis: A Case Report
Authors: Endres Kaitlin , Anjum Omar , Costain Nicholas
Published: May 2021

Introduction: Aortitis refers to abnormal inflammation of the aorta, most commonly caused by giant cell arteritis (GCA). Herein, we present a 57-year-old female with aortitis and arterial-embolic strokes secondary to GCA.

Case Report: Our patient presented to the emergency department following an episode of transient, monocular, painless vision loss. Computed tomography angiogram head and neck demonstrated phase II aortitis, and magnetic resonance imaging revealed evidence of arterial-embolic strokes.

Conclusion: Cerebrovascular accident is a rare complication of large-vessel vasculitis and can occur due to multiple underlying etiologies including intracranial vasculitis, aortic branch proximal occlusion, or arterial-embolic stroke.
Atezolizumab-induced Autoimmune Diabetes in a Patient with Metastatic Breast Cancer: A Case Report
Authors: Clontz Robert , Dang Duc , Hieger Michelle , Becker Brent
Published: May 2021

Introduction: Immune checkpoint inhibitors (ICI) are a class of immunotherapy drugs used increasingly in the treatment of multiple types of cancer. Major side effects include immune-related adverse effects, potentially resulting in damage to normal tissue across multiple different organ systems.

Case Report: A 74-year-old woman with a history of triple negative metastatic breast cancer treated with the ICI atezolizumab presented with new-onset autoimmune diabetes in diabetic ketoacidosis. She required fluid resuscitation, insulin infusion, vasopressors, and initial hospitalization in the intensive care unit. The patient was subsequently discharged on bolus dose insulin and remained an insulin-dependent diabetic at three-month follow-up.

Conclusion: Autoimmune diabetes is a rare, but life-threatening, adverse event associated with ICIs such as atezolizumab. To our knowledge this is the only case report of atezolizumab causing autoimmune diabetes in the setting of metastatic breast cancer. As ICIs become more common in the treatment of cancer, emergency physicians should remain vigilant for the various immune-mediated complications associated with this class of immunotherapy drugs.
A Traumatic Tick Bite: A Case Report
Authors: Finnin Daniel , Hanowitz Christopher
Published: May 2021

Introduction: Human granulocytic anaplasmosis is a tick-borne disease with an increasing incidence associated with morbidity and mortality. Uncertainty remains whether a prophylactic dose of doxycycline is effective in prevention.

Case Report: We present a case of an 80-year-old female with syncope, resultant facial trauma, and fever two weeks after a tick bite for which she received prophylaxis. Workup revealed anaplasmosis, and treatment led to symptomatic improvement.

Conclusion: We review the presenting symptoms, laboratory findings, and treatment of anaplasmosis, as well as give caution about the limitations in prescribing a prophylactic dose of doxycycline following a tick bite.
A Case Report of Cardiogenic Syncope Due to Loperamide Abuse: Acute Presentation and Novel Use of Buprenorphine
Authors: Betting David , Chenoweth James , Jarman Angela
Published: May 2021

Introduction: Loperamide is a non-prescription anti-diarrheal agent targeting µ-opioid receptors in the intestinal tract. At high doses it crosses the blood-brain barrier, where µ-opioid agonism can cause euphoric effects. Misuse has been increasing for both the euphoric effects and as an alternative treatment for opioid dependence and withdrawal.

Case Report: Here we report the case of a 30-year-old woman presenting with syncope, who was found to have severe myocardial conduction delays in the setting of chronic loperamide abuse.

Conclusion: Treatment with sodium bicarbonate and hypertonic sodium resulted in improvement of her conduction abnormalities. Prior to discharge she was initiated on buprenorphine for her opioid use disorder.
Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report
Authors: Starrs Mary , Yenigun Onur
Published: May 2021

Introduction: Metronidazole, a nitroimidazole antibiotic, is a well-known antibacterial and antiprotozoal agent that is generally well tolerated without many serious side effects. Most adverse reactions affect the gastrointestinal or genitourinary system, but the central nervous system may also be afflicted. In addition to headache and dizziness, cerebellar dysfunction can occur with metronidazole use.

Case Report: We discuss the clinical presentation and imaging findings of metronidazole-induced encephalopathy in a 12-year-old male. The patient had a history of Crohn’s disease and chronic Clostridium difficile infection for which he had received metronidazole for approximately 75 days prior to arrival to a local emergency department (ED). He presented with five days of progressive vertigo, nausea, vomiting, and ataxia. Subsequent magnetic resonance imaging showed symmetric hyperintense dentate nuclei lesions, characteristic of metronidazole-induced encephalopathy. The patient’s symptoms improved rapidly after cessation of metronidazole, and his symptoms had completely resolved by discharge on hospital day two.

Conclusion: Metronidazole-induced encephalopathy is a rare cause of vertigo and ataxia that can lead to permanent sequela if not identified and treated promptly. Thus, it is important for physicians to keep this diagnosis in mind when evaluating patients on metronidazole who present to the ED with new neurologic complaints.
Disclosing an Experience of Sexual Assault: Ethics and the Role of the Confidant
Authors: Cahill Ann J.
Published: May 2021

This chapter explores the ethical dimensions of a fraught and promising moment: the moment when a survivor of sexual assault discloses their experience to a trusted person (a confidant). I argue that this moment entails and produces multiple forms of vulnerability, and that the ways in which vulnerability is in play can remind us that vulnerability is not only the openness to harm or injury, but is a necessary condition of world-making and subject-making. The harmful or beneficial possibilities inherent in this moment of disclosure should therefore be understood not as different responses to vulnerability, but as different deployments of it. In creating better policies and practices about sexual harassment and violence, then, we must remain aware – and even protective – of the vulnerability of vulnerability. The chapter addresses not only the risks that a survivor takes in disclosing to a confidant, but also the risks and possibilities that the moment holds for the confidant. Legal or institutional encroachments upon this moment of disclosure, such as those now common in higher education in the US, undermine its potential for intersubjective meaning-making while simultaneously rendering survivors even more vulnerable to invasive bureaucratic procedures that rarely result in justice.
O PROCESSO COOPERATIVO COMO PARADIGMA PARA O REDIMENSIONAMENTO DA ATIVIDADE DO JULGADOR E SUPERAÇÃO DO ATIVISMO JUDICIAL: APLICAÇÃO DO NOVO ARQUÉTIPO DECISÓRIO PELO SUPERIOR TRIBUNAL DE JUSTIÇA
Authors: Costa Rosalina Moitta Pinto da
Published: May 2021

O trabalho analisa as mudanças estruturais no estudo e no dimensionamento da ciência processual civil, para salientar os desvios ocorridos em nosso país que levaram ao incremento do protagonismo judicial e à necessidade de construção de um novo paradigma de processo para superar as práticas nocivas do ativismo judicial. Utilizando-se como opção metodológica a pesquisa bibliográfica e a jurisprudência do Superior Tribunal de Justiça, parte-se do estudo do neoconstitucionalismo como marco teórico decisivo para as mudanças estruturais da ciência processual, o qual, em nosso país, acabou gerando um protagonismo judicial. A seguir, analisa-se a busca de um novo modelo processual capaz de superar o ativismo judicial. Conclui-se, com suporte nos julgamentos mais recentes do Superior Tribunal de Justiça, que o modelo cooperativo de processo, provocando uma mudança de paradigma e um redimensionamento no papel do juiz, tem-se mostrado eficaz para a combater as práticas nocivas do ativismo praticado por alguns juízes.
A NECESSIDADE DA JUSTIFICAÇÃO POR DEDUÇÃO NA CONSTRUÇÃO DA RATIO DECIDENDI DE CASOS FÁCEIS A PARTIR DA TEORIA DE NEIL MACCORMICK: UMA ANÁLISE DO RESP 1.745.333/RS
Authors: Dias Eduardo Rocha , Pereira Marynna Laís Quirino
Published: May 2021

O objetivo deste artigo é analisar o Recurso Especial n. 1.745.333/RS a partir da argumentação justificada exclusivamente pela dedução. Neil MacCormick propõe uma teoria integradora para argumentar por justificação as decisões jurídicas, nesse sentido, ele apresenta um método para casos fáceis e difíceis. A partir do método defendido por ele para justificar casos fáceis é que o presente artigo se fundamenta. Desse modo, para construir este artigo é utilizado o método hipotético-dedutivo, por meio de análise bibliográfica e documental, assim, possui abordagem qualitativa, do tipo básica e exploratória. Inicialmente, são expostos os pressupostos teóricos dessa abordagem, como o silogismo aristotélico. Depois, apresenta-se a justificação por dedução proposta por Neil MacCormick, para então analisar o referido acórdão. Ao final são apresentados os pressupostos e limites dessa teoria. A partir dessa análise, foi possível chegar à conclusão de que a justificação por dedução é possível, mas única e exclusivamente nos casos fáceis, o que confirma a teoria de MacCormick.
NÍVEL DE ESTRESSE PERCEBIDO EM ESTUDANTES DE ENFERMAGEM EM UMA UNIVERSIDADE PÚBLICA DO BRASIL
Authors: Raulino Maria Eduarda Ferreira Goulart , Lino Monica Motta , Sanes Marina da Silva , Amadigi Felipa Rafaela , Willemann Maria Cristina , Maffissoni André Lucas
Published: May 2021

RESUMO Objetivo: identificar os níveis de estresse percebido em estudantes de graduação em Enfermagem em uma universidade pública no Sul do Brasil. Método: estudo descritivo, transversal, de abordagem quantitativa. Os dados foram coletados entre dezembro de 2018 e março de 2019, por meio de escala tipo Likert. Resultados: participaram do estudo 164 estudantes de Enfermagem de diferentes fases da graduação de uma instituição pública do Sul do país. Projetaram-se domínios a partir das questões da PSS-10, confluindo sentimentos positivos e negativos. Os estudantes, em geral, alcançaram nível médio de estresse percebido (25,4). Nos domínios positivos a média estabelecida foi de 1,8 e nos negativos foi de três. Os estudantes da segunda, quarta e sexta fases alcançaram níveis mais elevados na comparação com a média geral. Já os estudantes da nona fase obtiveram a menor média de estresse. Conclusão: a universidade não é a única fonte de estresse para os acadêmicos de Enfermagem, porém há de se considerar que os estressores estão presentes durante a formação. O nível de estresse é um indicador importante de saúde mental entre os acadêmicos.
TECNOLOGIAS DA INFORMAÇÃO E COMUNICAÇÃO NO ENSINO DE PÓS-GRADUAÇÃO EM ENFERMAGEM NA PANDEMIA DE COVID-19
Authors: Silva Mônica Maria de Jesus , Panobianco Marislei Sanches , Clapis Maria José
Published: May 2021

RESUMO Objetivo: relatar a experiência do uso das tecnologias da informação e comunicação no ensino remoto emergencial de pós-graduação em Enfermagem durante a pandemia de COVID-19. Método: relato de experiência no ensino de pós-graduação stricto sensu em disciplina de um Programa de Enfermagem de uma universidade pública do interior de São Paulo. Foram utilizados dados secundários do processo de avaliação da disciplina, discutidos conforme referencial sobre o ensino mediado pelas tecnologias da informação e comunicação. Resultados: a experiência na modalidade de ensino remoto emergencial envolveu o desenvolvimento do ambiente virtual de aprendizagem e seleção das estratégias de ensino, planejamento, operacionalização e avaliação da disciplina. Foram utilizadas as plataformas Moodle® e Hangouts Meet® e o aplicativo Google Forms®. Considerações finais: o uso de estratégias de ensino não presenciais mediadas pelas tecnologias da informação e comunicação, com a utilização de plataformas e ferramentas online, demonstrou ser uma experiência desafiadora e bastante satisfatória no ensino remoto emergencial de pós-graduação de Enfermagem.
Conscious attention: Mindfulness as a factor in improving the learning context in 21. century
Authors: Marković Bojana
Published: May 2021

In the time when we are overwhelmed with information, important things often elude us. Conscious attention allows us not to let that happen, to really feel, hear and see. The paper presents the importance of practicing conscious attention, both in teaching and extracurricular activities. It contributes to making students feel more comfortable, more relaxed, more aware of the world around them and, more importantly, themselves and their senses in that world. Conscious attention can be a framework for stimulating learning because it has a lot in common with the project approach in teaching, which expects students to discover, research, and be as active as possible. The teacher is an associate and a coach, but the students themselves determine their path of acquiring knowledge, experience and awareness. Examples are given of how we can practice and develop awareness and attention in different school activities.
Educational computer games in primary school
Authors: Radaković Tijana , Glumičić Teodora , Rastovac Dragan , Mandić Milinko
Published: May 2021

We are witnesses of the time when technology is developing fast and finds its way in all spheres of life. The use of computers at school has many advantages and can be used in many ways in teaching. Some of the possibilities are application for practice, motivation of children for new areas of learning, research work, making various multimedia presentations to show their independent work, etc. There are also negative attitudes related to this topic. Through the research in this paper, we want to check whether the presence of technology in our schools is an advantage or not. By applying educational computer games, greater interest can be achieved in children, but on the other hand, we have teaching staff who are afraid of unfamiliarity and changes in the teaching process. As for the subject of this research we can ask the following question: Whether and how often teachers use educational computer games in teaching, as well as what are their views on the application of educational computer games and whether they have enough knowledge to create an educational computer game. The theoretical goal of this research is to increase knowledge about the application of educational computer games in teaching in primary schools. The practical aim is to determine, on the basis of the textbook, the opinions and attitudes of teachers on the use of educational computer games in teaching. The results of the research show that teachers still have negative attitudes towards the use of computers and educational computer games in teaching, while the other part thinks that they would like computers to be used more in teaching but that is not possible because schools are not technically equipped. During the research and analysis, we come to the conclusion that teachers have great aversion towards technology and its application in teaching, although some schools have organized the training of their staff to use some programming languages, they are still very poorly used in teaching.