bluuebunny/crossref_metadata_2025 huggingface dataset:
The Four Power Status of West Berlin. One-Sided German Regulation
Authors:   Institute of Europe, Russian Academy of Sciences, Maksimychev Igor
Published: February 2021

Modern system of international relations established a special responsibility of the Security Council’s permanent members for sustaining of universal peace and searching for solutions to the greatest global issues. Building a safer world depends on their successful communication. Therefore, it is of utmost importance to look back at the failures of global communication in order to draw lessons. One of them is the process of four-way regulation of the West Berlin Status, which led to the first “color” revolution in Europe – disintegration of the German Democratic Republic. The article provides insight into the analysis of the negotiations on the issue between USSR, USA, Britain and France.
UK’s New Strategy for Africa in Light of Russia’s Interests
Authors:   Institute for African Studies, RAS, Fituni Leonid , Abramova Irina ,   Institute for African Studies, RAS
Published: February 2021

. In the past two years, a certain number of world powers have announced the development or update of their African strategies, which is directly related both to the profound changes taking place in the world, and to the general recognition of the African region increased importance in the world economy and international relations. Due to Brexit and in light of the concept of Global Britain, London considers the development of strategies in order to explore alternative markets with the aim to compensate the loss of the state and private business revenues by activating the African vector of its policy. The article summarizes and analyzes the content of the UK strategic documents adopted in the last two years by various state bodies and departments in the African direction ‒ political, military, economic, etc. They are scrutinized from the angle of current Russian interests and strategies. The authors come to the conclusion that despite of the similarities of the official content of the African strategies of Russia and the UK, the possibilities of real UK-Russia cooperation in the region in the interests of its peoples or in their own national interests are low.
The Problem of Gibraltar in British-Spanish Relations in the Context of Brexi
Authors:   MGIMO University, Anikeeva Natalia , Kapitonova Natalia ,   MGIMO University
Published: February 2021

The article deals with the problem of Gibraltar in British-Spanish relations in light of Brexit. The provisions of the Treaty of Utrecht in 1713 do not allow the UK and Spain to reach a compromise and move forward in resolving the dispute over Gibraltar. From Britain’s perspective, the Gibraltar issue appears to be a permanent and irritating element in relations with Spain. Gibraltar does not seek to return to the jurisdiction of Spain, as indicated by the results of referendums held in Gibraltar in 1967 and 2002. During the negotiations on regional cooperation in 2004, the parties announced the creation of the Forum "Dialogue on Gibraltar". In 2006, within the framework of the first ministerial meeting of the Forum, the Cordoba agreement was signed, which does not mention the problem of sovereignty, as well as other controversial issues of the Gibraltar problem, but specifically settles inter alia the problem of freedom of movement according to one of the fundamental principles of the EU. Spain considered Brexit as an opportunity to resolve a long-running historic dispute with London. According to Madrid, all parties lose from Brexit. At the same time, Spain managed to strengthen its position on the Gibraltar issue, having enlisted the support of the European Commission and the European Council. The UK as a whole voted to leave the European Union. This puts the Gibraltar in a difficult position: they do not want to leave the EU, but at the same time intend to keep belonging to the British crown.
European Donors in the Arab World: Redistribution of Resources and Roles
Authors:   Institute of Oriental Studies RAS, Bartenev Vladimir
Published: February 2021

The article explores official development assistance flows from European countries to the Middle East and North Africa (MENA) and highlights certain specifics and the logic of redistribution of resources and roles between the largest European donors throughout the 2010s – since the Arab Spring, which transformed the political landscape of the entire region. This trend is explained by uneven dynamics of the donor activities of three states with a direct access to the Mediterranean – France, Italy and Spain ‒ and other countries. This dynamic seems to be caused by differences in domestic economic and political environment and dissimilarities in motivation and strategy which manifested themselves in allocation of resources between MENA and other regions, humanitarian and non-humanitarian assistance, various sectors, sub-regions and recipient countries. The Arab Spring made these dissimilarities even more acute and created an illusion of a conscious 'division of labour'. However, leading European powers – Germany, France and the United Kingdom – compete actively with each other as well as with non-European actors. A wide range of new and unexpected challenges such as a recent destabilization in the countries to a lesser extent affected by the Arab Spring (Algeria, Sudan, Lebanon and Iraq), escalation of tensions in the Eastern Mediterranean, a devastating explosion in the Beirut port etc., notwithstanding mid- and long-term consequences of the COVID-19 pandemic, might make this competition even more dynamic.
Škola a sociální pomoc ve druhé polovině 19. století
Authors: Halířová Martina
Published: February 2021

The paper deals with the forms of social assistance provided to poor children and youth in schools. The specific examples are illustrated by the example of Pardubice town. The article mainly deals with the second half of the 19th century, when under the influence of social changes the charitable activities aimed at children and young people were developed. The article mentions also the end of the 18th century, when education and social care reforms took place, and influenced the development of social assistance in the following century. Two types of institutions were established at schools; on one hand, associations providing financial or material support, on the other, groups providing out-of-school activities for children and youth. These organizations had the same goal – the discipline of the poor in society.
Visual Music and Kinetic Ornaments
Authors: Rochester Katherine
Published: February 2021

This essay traces the theorization of interwar animation through period analogies with painting and dance, paying special attention to the valorization of concepts such as dematerialization and embodiment, which metaphors of visual music and physical kinesthesis were used to promote. Beginning in 1919, and exemplified by her feature-length film Die Abenteuer des Prinzen Achmed (1926), Lotte Reiniger directed numerous silhouette films animated in an ornate style that embraced decorative materiality. This aesthetic set her in uneasy relation to the avant-garde, whose strenuous attempts to distance abstraction from ornament took the form of absolute film, and were screened together at the Absolute film Matinee of 1925. However, their claims for aesthetic integrity were staked on territory these artists largely had in common. By adopting a feminist approach that examines networks of collaboration, publication, and artistic production in Weimar Berlin, this essay reveals Reiniger as an early proponent of haptic cinema in interwar Europe and one of animation's earliest and most perceptive theorists.
“We’d like to see trans people at the very top”
Authors: Horak Laura
Published: February 2021

Queer film scholar Laura Horak interviews Ann Thomas, founder and president of Transgender Talent, one of the first management companies devoted to managing openly trans performers. Thomas discusses how the various parts of Hollywood that work in the background—from managers and agents to casting directors and breakdown writers—are changing or resisting change. She states her vision for trans people in Hollywood, an industry admittedly devoted to profit, not social justice.
Current Paradigm of Treatment for Pancreatic Neuroendocrine Tumor
Authors: Sung Min Je , Chung Moon Jae
Published: February 2021

Pancreatic neuroendocrine tumor (PNET) refer to tumors originating from the islet of Langerhans and shows various prognosis based on the presence or absence of symptoms due to hormone secretion, the Ki-67 cell proliferation index, and the histologic grade, and according to the degree of disease progression defined by the tumor-node-metastasis (TNM) stage classification. The purpose of medical treatment for PNET is to control symptoms or inhibit tumor growth. Somatostatin analogues can be administered for the purpose of controlling symptoms caused by the secretion of specific hormones, and are accepted as effective drugs for inhibiting the progression of G1/G2 tumors based on World Health Organization (WHO) classification with a Ki-67 cell proliferation index less than 20%. Among the molecularly targeted agents, everolimus and sunitinib can be considered in patients with WHO G1/G2 PNET showing progression after somatostatin analog therapy. Cytotoxic chemotherapy is generally administered to patients with large tumor volume and rapidly progressing metastatic NET, and etoposide/cisplatin combination therapy has been considered as a standard treatment. For the patient group of Grade 3 PNET (well differentiated) newly classified by the WHO 2017 classification, guidelines for standard treatment have not yet been established. As it has been reported, studies are needed to evaluate the treatment response rate of somatostatin analogues or molecularly targeted therapies for the patient with Grade 3 PNET. It is important to consider a multidisciplinary approach with all possible treatment options including medical treatment, radical resection of primary or metastatic lesions, liver-directed therapies, and peptide receptor radionuclide therapy for the patients with PNET.
Intrahepatic Cholangiocarcinoma: Evolving Concepts and Medical Treatment
Authors: Kim Hong Ja
Published: February 2021

Cholangiocarcinoma (bile duct cancer) is classified into intrahepatic and extrahepatic cholangiocarcinoma (perihilar and distal cholangiocarcinoma) according to the anatomical location of the lesion. The incidence of extrahepatic cholangiocarcinoma has been relatively stagnant in recent decades, but intrahepatic cholangiocarcinoma is steadily increasing worldwide, requiring attention. Various classification systems based on gross growth patterns, histological findings, and tumor-derived cells, as well as classification based on existing anatomical location, have been proposed, however, the consensus has not been established yet. Intrahepatic cholangiocarcinoma is a carcinoma with an extremely poor prognosis. Complete tumor resection is the only curative treatment. The overall survival rate for 5 years after surgery is 15% to 40%, but recurrence after surgery is observed in 2/3 patients. Therefore, determining the right stage before surgery and selecting an appropriate treatment method through a multidisciplinary approach is a very important process in determining proper treatment. Systemic therapy may be used for locally advanced biliary tract cancer or metastatic biliary tract cancer where surgery is not possible. However, the effectiveness of traditional anticancer chemotherapeutic agents is rather pessimistic, therefore treatments using molecular biological properties have recently been attempted. Finding a way to increase the number of resectable cases through early diagnosis is one of the main challenges. In addition, it is also hoped that the selection of new therapeutic targets and therapeutics will be possible as a result of advanced research on gene expression profiles and mutations in cholangiocarcinoma.
New-onset diabetes after kidney transplantation revealing HNF1B-associated disease
Authors: Lopes Ana M , Teixeira Sofia
Published: February 2021

Molecular alterations of the transcription factor hepatocyte nuclear factor 1B (HNF1B) are associated with systemic disease, with kidney disease and maturity-onset diabetes of the young (MODY) as the most characteristic manifestations. Other features comprise pancreatic exocrine insufficiency, liver and biliary anomalies, and genital tract malformations. HNF1B-associated disease is clinically heterogeneous, and therefore the diagnosis is challenging. The authors describe the case of a 19-year-old man with new-onset diabetes after kidney transplantation (NODAT). The kidney disease presented during fetal life as bilateral hyperechogenic kidneys. Renal function progressively deteriorated during childhood, and at the age of 19, the patient was submitted to a living-kidney transplant. Two weeks after transplant, NODAT developed. Given the young age and normal body weight, NODAT was unexpected, and the possibility of HNF1B-associated disease was considered. Screening for mutations in HNF1B was undertaken, and a known mutation was found. As this case highlights, HNF1B-associated disease should be considered when NODAT unexpectedly develops in young kidney transplant recipients with a suggestive renal disease.

Learning points:

HNF1B anomalies are associated with systemic disease, including kidney disease, diabetes mellitus, pancreatic exocrine insufficiency, liver test abnormalities and genital tract malformations.

Phenotype is variable and there are no pathognomonic manifestations, but kidney disease appears to be the most common feature and diabetes the most frequent extra-renal phenotype.

Spontaneous gene alterations are common, and the lack of family history should not exclude the diagnosis.

HNF1B defects should be considered when NODAT develops in a young adult kidney transplant recipient with a suggestive kidney disease and without extensive risk factors for diabetes.

The most appropriate treatment for HNF1B-associated diabetes is not established, but immunosuppressive therapy superimposed on a beta-cell dysfunction seems to determine the need for insulin therapy after a variable period.

Immunosupressive regimens free of calcineurin inhibitors should be considered in patients with HNF1B-associated disease to minimize the risk of developing NODAT.
Transcriptome wide association studies: general framework and methods
Authors: Xie Yuhan , Shan Nayang , Zhao Hongyu , Hou Lin
Published: February 2021

Background

Genome‐wide association studies (GWAS) have succeeded in identifying tens of thousands of genetic variants associated with complex human traits during the past decade, however, they are still hampered by limited statistical power and difficulties in biological interpretation. With the recent progress in expression quantitative trait loci (eQTL) studies, transcriptome‐wide association studies (TWAS) provide a framework to test for gene‐trait associations by integrating information from GWAS and eQTL studies.

Results

In this review, we will introduce the general framework of TWAS, the relevant resources, and the computational tools. Extensions of the original TWAS methods will also be discussed. Furthermore, we will briefly introduce methods that are closely related to TWAS, including MR‐based methods and colocalization approaches. Connection and difference between these approaches will be discussed.

Conclusion

Finally, we will summarize strengths, limitations, and potential directions for TWAS.
Mathematical modeling and optimal intervention of COVID‐19 outbreak
Authors: Biswas Saroj K , Ahmed Nasir U
Published: February 2021

Background

The COVID‐19 pandemic has become a formidable threat to global health and economy. The coronavirus SARS‐CoV‐2 that causes COVID‐19 is known to spread by human‐to‐human transmission, and in about 40% cases, the exposed individuals are asymptomatic which makes it difficult to contain the virus.

Methods

This paper presents a modified SEIR epidemiological model and uses concepts of optimal control theory for analysis of the effects of intervention methods of the COVID19. Fundamentally the pandemic intervention problem can be viewed as a mathematical optimization problem as there are contradictory outcomes in terms of reduced infection and fatalities but with serious economic downturns.

Results

Concepts of optimal control theory have been used to determine the optimal control (intervention) levels of i) social contact mitigation and suppression, and ii) pharmaceutical intervention modalities, with minimum impacts on the economy. Numerical results show that with optimal intervention policies, there is a significant reduction in the number of infections and fatalities. The computed optimum intervention policy also provides a timeline of systematic enforcement and relaxation of stay‐at‐home regulations, and an estimate of the peak time and number of hospitalized critical care patients.

Conclusion

The proposed method could be used by local and state governments in planning effective strategies in combating the pandemic. The optimum intervention policy provides the necessary lead time to establish necessary field hospitals before getting overwhelmed by new patient arrivals. Our results also allow the local and state governments to relax social contact suppression guidelines in an orderly manner without triggering a second wave.
Testing the leanocentric locking‐point theory by in silico partial lipectomy
Authors: Wang Guanyu
Published: February 2021

Background

The lipostatic set‐point theory, ascribing fat mass homeostasis to leptin mediated central feedback regulation targeting the body’s fat storage, has caused a variety of conundrums. We recently proposed a leanocentric locking‐point theory and the corresponding mathematical model, which not only resolve these conundrums but also provide valuable insights into weight control and health assessment. This paper aims to further test the leanocentric theory.

Methods

Partial lipectomy is a touchstone to test both the leanocentric and lipostatic theories. Here we perform in silico lipectomy by using a mathematical model embodying the leanocentric theory to simulate the long‐term body fat change after removing some fat cells in the body.

Results

The mathematical modeling uncovers a phenomenon called post‐surgical fat loss, which was well‐documented in real partial lipectomy surgeries; thus, the phenomenon can serve as an empirical support to the leanocentric theory. On the other hand, the leanocentric theory, but not the lipostatic theory, can well explain the post‐surgical fat loss.

Conclusions

The leanocentric locking‐point theory is a promising theory and deserves further testing. Partial lipectomy surgeries are beneficial to obese patients for quite a long period.
Tecnología FiMe con coagulantes naturales para el tratamiento de aguas en zonas rurales de Colombia
Authors: Jhon Jairo Feria Díaz
Published: February 2021

El principal objetivo de este trabajo fue determinar la eficiencia de remoción de la turbidez de muestras de agua cruda, utilizando la tecnología de Filtración en Múltiples Etapas, complementada con coagulantes naturales. Las muestras de agua fueron tomadas del río Sinú. En laboratorio, se montó una planta piloto y se realizaron ensayos de tratabilidad de las muestras con diferentes escenarios. El mejor tratamiento para el agua cruda, se obtuvo cuando se aplicaron tasas de 240 m3m-2d-1 para turbiedades iniciales de 200 NTU. No se evidenció alteraciones en el pH y en la alcalinidad del agua luego de los ensayos de tratabilidad. Esta tecnología de tratamiento de agua cruda es muy útil y apropiada para ser aplicada en zonas rurales de difícil acceso y con escasos recursos económicos, ya que por su simplicidad no requiere de insumos ni de mantenimientos costosos.
Presentación Signo Distintivo Semillero Oropéndolas
Authors: Miguel Andrés Riveros Romero , Diana Lorena Galeano Rodríguez , Amable José Pérez , Mario Fernando Prieto Delgadillo , Oscar Orlando Berrío Flórez
Published: February 2021

El documento da cuenta de la presentación del Signo Distintivo del semillero Oropéndolas
Presentación de Signo Distintivo Semillero Teiorinoco
Authors: Miguel Andrés Riveros Romero , Diana Lorena Galeano Rodríguez , Amable José Pérez , Mario Fernando Prieto Delgadillo
Published: February 2021

El documento da cuenta de la presentación del signo distintivo del Semillero Teiorinoco
Zonificación Ecológica y Socioeconómica como aporte al proceso de planificación y gestión, en el marco del proceso de Ordenamiento, de la Cuenca Grande del Municipio de San Antonio del Tequendama, Departamento de Cundinamarca
Authors: Jorge Alberto Sánchez Espinosa , Yenny Beatriz Mendoza Plazas , Paulo Germán García Murillo
Published: February 2021

Con el fin de crear una visión integral y así generar información confiable y útil para la toma de decisiones específicas y de conjunto sobre el desarrollo natural del uso del espacio a nivel de la cuenca de la quebrada Grande, la Vicerrectoría de Educación a Abierta y a Distancia de La Universidad Santo Tomas, mediante estudios de tipo biofísico y socioeconómico que aportan la información básica para el diseño de políticas de planificación y regulación del uso de la tierra y protección del recurso, como aporte a los procesos de ordenamiento territorial de las cuencas hidrográficas, investigación enmarcada bajo un enfoque sistémico aplicado a las cuencas hidrográficas donde la integración interdisciplinaria, facilita un mejor conocimiento de su estructura y función en términos que puede definir elementos y relaciones. Además permite analizar y evaluar factores involucrados dentro de contextos mayores o menores desde diversos escenarios (técnicos- científicos, administrativos, económicos, naturales, socio-culturales, etc.). Se encontró que las tierras de ladera con pendientes superiores al 50%, son la característica dominante en la zona de la microcuenca de la Quebrada Grande, presentan conflictos de uso por cuanto la tendencia es a someterlas al desarrollo de actividades ganaderas o agrícolas, sin medir las consecuencias negativas que traen estas acciones.
Ponencia - Julio Cesar Rueda Cantor - Villavicencio, Colombia
Authors: Julio Cesar Rueda Cantor
Published: February 2021

Informe de movilidad académica.
Ponencia - Oscar David Torres Pérez - Cali, Colombia
Authors: Oscar David Torres Pérez
Published: February 2021

Informe de movilidad académica. PRESENTACIÓN DE PONENCIA EN EL MARCO DEL IV CONGRESO DE REDINTERCOL, Cali, Colombia.
We Look Forward to the Future in the Difficult Days
Authors: Yao Jijun
Published: February 2021

No matter from which point of view, 2020 is an unimaginable year. The sudden outbreak and rapid spread of the COVID-19 pandemic have caused the world to face unprecedented challenges. Schools were closed, and how to make the education system work effectively in this context has become a common topic among educators around the world.
Efficiency and prospects for the implementation of measures for qualification of equipment important for safety in domestic nuclear energetics
Authors:   Institute for Nuclear Research, National Academy of Sciences of Ukraine, Kyiv, Ukraine, Khomych I.A. , Kovalinska T.V. , Sakhno V.I. , Ivanov Yu.V.
Published: February 2021

The results of implementing equipment qualification are analyzed. Such equipment is critical for the nuclear and technical safety of domestic nuclear power plants that are especially important for the implementation of the Program for extending the terms of out-of-project operation of power reactors that are capable of being used as powerful sources of electricity. Based on the comparison of published reliability indicators of domestic nuclear power plants before and after implementing the qualification, it is shown that still there are problems to be solved. The perspective of further enhancing the reliability of the operation of domestic nuclear energetics is considered, by implementing radiation functional testing methods that are been developed at the INR NAS of Ukraine for a long period. The basis of this method is detailed research and operational control of all processes that occur in critical equipment in any operating modes of nuclear reactors to form a resource history of the equipment and to provide operational information about the remaining resource and the expected time of its failure to an on-line object operator.
Evaluation of renal cyst treatment using retroperitoneal laparoscopic decortication
Authors: Ho Ut Thanh , Dam Cuong Van , Le Nghiep Ke
Published: February 2021

Introduction: Renal cyst is a common disease of the renal parenchyma. The management options include percutaneous aspiration with or without sclerotherapy, open surgery, and laparoscopic decortication of renal cyst. Laparoscopic renal cyst decortication is a safe and effective alternative with a high success rate. Objectives: Evaluation of renal cyst treatment by retroperitoneal laparoscopic decortication.

Methods: This was a prospective study of patients with asymptomatic renal cyst size greater than 60 mm or symptomatic renal cyst size less than 60 mm in their greatest dimension. These patients underwent retroperitoneal laparoscopic decortication and were admitted at the University Hospital, Can Tho General Hospital (Viet Nam), and Can Tho Central General Hospital (Viet Nam), from September 2018 to May 2020. Renal cysts were localized and characterized by ultrasonography and computed tomography (CT). Symptomatic success rate, radiologic success rate, and complication of procedure were noted. Each patient was reassessed with clinical and ultrasonography examinations at 3 months postoperatively.

Results: 33 patients underwent retroperitoneal laparoscopic cyst decortication; this included 11 males (33.3%) and 22 females (66.7%). The mean age of patients was 58.48 ± 9.36 years. Flank pain was a common clinical symptom at presentation in all patients. Most of the cysts were located in the left kidney (39.4%), in the lower pole (54.6%), and in a single cyst (87.9%). The mean cyst diameter was 80.09 ± 27.03 mm. Cysts were classified I with the Bosniak classification. The mean operative time was 69.39 ± 16.94 minutes. Operative time in patients with cyst diameter ≥ 60 mm was statistically significantly longer than in patients with cyst diameter < 60 mm (p = 0.004). The mean hospital stay time was 8.24 ± 2.84 days. Symptomatic success was achieved in 90.1% of patients and radiographic success on ultrasonography was achieved in 84.8%. The operation was successfully completed by laparoscopy in all cases.

Conclusion: Retroperitoneal laparoscopic cyst decortication is effective for the treatment of renal cysts. The operation was successfully completed via laparoscopy in all cases.
The Secondary Consequences of the COVID-19 Pandemic in Hospital Pediatrics
Authors: Diskin Catherine , Orkin Julia , Agarwal Tanvi , Parmar Arpita , Friedman Jeremy N.
Published: February 2021

BACKGROUND AND OBJECTIVES:

The coronavirus disease (COVID-19) pandemic has broad implications for children and families. Particular attention has been paid to delays in accessing timely pediatric care leading to unintended morbidity. In this study, we aim to describe the broader spectrum of unintended negative consequences for pediatric patients and families due to recent health care and societal changes.

METHODS:

All full-time doctors, dentists, and nurse practitioners working at a tertiary care children’s hospital in Canada were surveyed every 2 weeks throughout the initial phase of the COVID-19 pandemic to identify clinical cases in which they perceived a negative outcome associated with hospital or societal changes as a result of the COVID-19 pandemic. Analysis followed a qualitative case series methodology using a narrative synthesis approach to determine similarities and associated themes.

RESULTS:

One hundred and forty-one clinicians, representing 26 hospital divisions, reported 57 unique cases in the first 6 weeks of the study. Thematic analysis of the first 50 reported cases was used to identify 6 primary themes focusing on health care quality domains as described by the Agency for Healthcare Research and Quality (safe, effective, patient-centered, timely, efficient, and equitable care).

CONCLUSIONS:

In this preliminary case analysis, we describe the broad social and clinical impact of COVID-19 on hospitalized pediatric patients and their families. These themes highlight the unintended consequence on families, siblings, disease diagnosis, and hospital-based care provision. Recognition and understanding of the broad implications of the COVID-19 pandemic are necessary as we strive to deliver safe, high-quality, family-centered pediatric care in this new era.
A Changing Landscape: Exploring Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships
Authors: Chandrasekar Hamsika , White Yasmine N. , Ribeiro Claudio , Landrigan Christopher P. , Marcus Carolyn H.
Published: February 2021

BACKGROUND:

Pediatric Hospital Medicine (PHM) was approved as a subspecialty in 2016. Perspectives of pediatric and combined pediatric residents regarding barriers and facilitators to pursuing PHM fellowships have not previously been assessed.

METHODS:

A survey to explore residents’ perspectives on PHM fellowships, with questions regarding demographics, likelihood of pursuing PHM after fellowship introduction, and influencing factors was distributed to pediatric and combined pediatric residents via program directors.

RESULTS:

The survey was distributed to an estimated 2657 residents. A total of 855 (32.2%) residents completed the survey; 89% of respondents had at least considered a career in PHM, and 79.4% reported that the introduction of the PHM fellowship requirement for subspecialty certification made them less likely to pursue PHM. Intent to practice in a community setting or only temporarily practice PHM, Combined Internal Medicine and Pediatric trainee status, and high student loan burden were associated with decreased likelihood of pursuing PHM (P < .05). Most respondents reported that forfeited earnings during fellowship, family and student loan obligations, and perceived sufficiency of residency training discouraged them from pursuing PHM fellowship. Half of respondents valued additional training in medical education, quality improvement, hospital administration, research, and clinical medicine.

CONCLUSIONS:

Many survey respondents expressed interest in the opportunity to acquire new skills through PHM fellowship. However, the majority of respondents reported being less likely to pursue PHM after the introduction of fellowship requirement for board certification, citing financial and personal opportunity costs. Understanding factors that residents value and those that discourage residents from pursuing PHM fellowship training may help guide future iterations of fellowship design.
The Association of Seasonality With Resource Use in a Large National Cohort of Infants With Bronchiolitis
Authors: Andrews Christine , L. Maxwell Sarah , Kerns Ellen , McCulloh Russell , Alverson Brian
Published: February 2021

OBJECTIVES:

Examine the degree of seasonal variation in nonrecommended resource use for bronchiolitis management subsequent to publication of the American Academy of Pediatrics (AAP) 2014 guidelines.

METHODS:

We performed a multicenter retrospective cohort study using the Pediatric Health Information System database, examining patients aged 1 to 24 months, diagnosed with bronchiolitis between November 2015 and November 2018. Exclusions included presence of a complex chronic condition, admission to the PICU, hospital stay >10 days, or readmission. Primary outcomes were use rates of viral testing, complete blood count, blood culture, chest radiography, antibiotics, albuterol, and systemic steroids. Each hospital’s monthly bronchiolitis census was aggregated into hospital bronchiolitis census quartiles. Mixed-effect logistic regression was performed, comparing the primary outcomes between bronchiolitis census quartiles, adjusting for patient age, race, insurance, hospitalization status, bacterial coinfection, time since publication of latest AAP bronchiolitis guidelines, and clustering by site.

RESULTS:

In total, 196 902 bronchiolitis patient encounters across 50 US hospitals were analyzed. All hospitals followed a similar census pattern, with peaks during winter months and nadirs during summer months. Chest radiography, albuterol, and systemic steroid use were found to significantly increase in lower bronchiolitis census quartiles, whereas rates of viral testing significantly decreased. No significant variation was found for complete blood count testing, blood culture testing, or antibiotic use. Overall adherence with AAP guidelines increased over time.

CONCLUSIONS:

Resource use for patients with bronchiolitis varied significantly across hospital bronchiolitis census quartiles despite adjusting for potential known confounders. There remains a need for greater standardization of bronchiolitis management.
Is Unplanned PICU Readmission a Proper Quality Indicator? A Systematic Review and Meta-analysis
Authors: Prutsky Gabriela J. , Padhya Dipti , Ahmed Ahmed T. , Almasri Jehad , Farah Wigdan H. , Prokop Larry J. , Murad M. Hassan , Alsawas Mouaz
Published: February 2021

CONTEXT:

Unplanned PICU readmissions within 48 hours of discharge (to home or a different hospital setting) are considered a quality metric of critical care.

OBJECTIVE:

We sought to determine identifiable risk factors associated with early unplanned PICU readmissions.

DATA SOURCES:

A comprehensive search of Medline, Embase, the Cochrane Database of Systematic Reviews, and Scopus was conducted from each database’s inception to July 16, 2018.

STUDY SELECTION:

Observational studies of early unplanned PICU readmissions (<48 hours) in children (<18 years of age) published in any language were included.

DATA EXTRACTION:

Two reviewers selected and appraised studies independently and abstracted data. A meta-analysis was performed by using the random-effects model.

RESULTS:

We included 11 observational studies in which 128 974 children (mean age: 5 years) were evaluated. The presence of complex chronic diseases (odds ratio 2.42; 95% confidence interval 1.06 to 5.55; I2 79.90%) and moderate to severe disability (odds ratio 2.85; 95% confidence interval 2.40 to 3.40; I2 11.20%) had the highest odds of early unplanned PICU readmission. Other significant risk factors included an unplanned index admission, initial admission to a general medical ward, spring season, respiratory diagnoses, and longer initial PICU stay. Readmission was less likely after trauma- and surgery-related index admissions, after direct admission from home, or during the summer season. Modifiable risk factors, such as evening or weekend discharge, revealed no statistically significant association. Included studies were retrospective, which limited our ability to account for all potential confounders and establish causality.

CONCLUSIONS:

Many risk factors for early unplanned PICU readmission are not modifiable, which brings into question the usefulness of this quality measure.
Evaluation of MPV and PDW levels by using antihyperglycemic drugs in type 2 DM patients
Authors: Dinçoğlu Hacer , Eray İrep
Published: February 2021

Objectives: MPV and PDW are vascular complications markers and improved glycemic control levels are correlated those indicators in patients with type 2 Diabetes Mellitus. The aim of in this study, MPV and PDW levels were compared type 2 diabetic patients treated with oral antihyperglycemic agent and insulin. Methods: This study was performed retrospectively on type 2 DM patients who were admitted to Ankara Atatürk Training and Research Hospital. 118 randomly selected patients were divided into 3 groups that were non-diabetic (Group 1), who received OAD therapy (Group 2), and those who received insulin therapy (Group 3). HbA1c, MPV, PDW levels were collected, analyzed and compared with each other. Results: MPV and PDW values were increased in type 2 DM patients compared to the control group (Group 2; p <0.001 and Group 3 p <0.001, respectively). There was no statistically significant difference between MPV and PDW values in patients treated OAD and insulin therapy (p=0.736 ve p=0.360 respectively). A statistically significant positive correlation was found between HbA1c values and MPV (p <0.001) and PDW (p <0.001) values. Conclusions: In our study, no significant difference was found between MPV and PDW values of patients using insulin and oad. Early initiation of conventional insulin therapy in patients with type 2 diabetes provides good glycemic control. Rational drug use in accordance with the guidelines; gains importance in treatment success. Skipping this factor may reduce the efficiency of other efforts in relation to rational treatment.
Lymphadenopathy of Systemic Lupus Erythematosus: A Case Presentation
Authors: Küçük Şirin , Küçük İzzet Göker
Published: February 2021

Systemic lupus erythematosus (SLE) is an autoimmune disease that might be seen at any period of life regardless of age, gender, or race, but it most frequently affects young female patients. SLE might be observed to be together with the involvement of multiple organs coursing with skin, kidney, hematologic, and musculoskeletal involvement and responds well to the corticosteroids. Several symptoms and findings during the course of the disease might be dependent on the involvement of disease and they might also develop secondarily to the therapies applied. SLE is rarely seen together with lymphadenopathy (LAP) and this situation causes difficulties in diagnosis and treatment. The present case was a 32-year-old female patient, who has been diagnosed 13 years before, had no follow-up during the last 1.5 years, and presented to the family health center with the complaint of disease activation and swelling on the left side of neck. In medical examination, soft, mobile, and painless LAPs with approx. 2x1cm size were observed in both cervical regions. The one located on the right side was more remarkable. The patient stated that the swellings were there for 1.5 months and no reduction was observed in LAPs although she has taken various antibiotics. The patient was referred to Uşak Education and Research Hospital General Surgery Clinic with a referral note containing the necessary information with the preliminary diagnosis of SLE lymphadenopathy as a result of Anamnesis and physical examination taken by the patient who was admitted to the Family Health Center. All the procedures were followed by contacting the relevant branch physicians and patients at the hospital where the patient was admitted and treated. We had the opportunity to learn about the diagnostic procedures and treatments applied to the patient. The histopathologic diagnosis of LAP excision specimen was lupus lymphadenitis. The early diagnosis might be very difficult in these cases since the autoantibodies and low levels of complements cannot be detected. The present case is discussed here in the literature in order to emphasize that SLE is a pathology that should be considered in the differential diagnosis for the patients presenting with LAP.
Self Transcendence In Family Practice
Authors: Yayla Muhteşem Erol
Published: February 2021

Family practice’s contextual, scientific, and comprehensive core competencies need having an altruistic consciousness. As self transcendence stands on the top of modified maslow’s hierarchy of needs, primary care also need to be altrustic.
The Quality of life and aging perceptions in the elderly: Baskent University example
Authors: Sözen Fisun , Yavuz Çolak Meriç
Published: February 2021

Aging is a continuous and universal process that is seen in every living thing without privilege and causes a decrease in all our functions. In the past 40-50 years, the most important concept that has developed with the increase of the elderly population in the world, especially in developed countries, is the aging of societies. Quality oflife (QOL) was defined by the World Health Organization Quality of Life (WHOQOL) Group as “individuals’ perception of their position in life in the context of culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns” In this study, it was aimed to evaluate the quality of life perception and aging perception of elderly patients who applied to family medicine outpatient clinics of a university hospital. The data of this descriptive and cross-sectional study, the questionnaire containing socio-demographic information, and the Turkish version of WHO’s Quality of Life Instrument Older Adults Module (WHOQOL-OLD)-TR and WHO’s Europe Attitudes to Aging questionnaire. (EAAQ)-TR were created. The questionnaires were applied to Baskent University Hospital Family Medicine outpatient clinics and 200 randomly selected volunteers over the age of 65.All scale dimension scores were compared according to demographic characteristics by statistical t-test and variance analysis. As a result, significant positive correlations among the dimensions of QOL and aging attitude (AA) were obtained. Also total scores of QOL and AA were significantly correlated.Moreover QOL dimension scores were significantly correlated to AA dimension scores. Whereas age and gender were significantly related to psychosocial loss dimension, education was significantly related to psychosocial growth, physical change and total aging attitude scores. Additionally higher educated subjects (university degree) had higher mean scores. The presence of a disease was significantly related to physical change and total aging attitude scores. (p< 0.005) Changes in living environments were significantly correlated to physical change dimension. There is a significant positive correlation between WHOQOL-OLD-TR total scores and AYTA-TR total scores. Increasing the quality of life of the rapidly increasing elderly population will be one of the most important goals in the field of health both today and in the future. Family physicians can provide a better primary health care service by evaluating the quality of life and aging perceptions of the elderly and contribute to the development of new policies in this difficult issue.
Prevalence of Dental Caries Among Costa Rican Male Students Aged 12-22 Years Using ICDAS-II
Authors: Gudiño-Fernández Sylvia , Gómez-Fernández Adrián , Molina-Chaves Katherine , Barahona-Cubillo Juan , Fantin Romain , Barboza-Solís Cristina
Published: February 2021

Objective: Dental decay is a public health challenge in Low- and Middle-Income Countries, particularly for young people, often confronted to healthcare access barriers. The aim of this study was to determine the prevalence and severity of dental caries among young male students in Costa Rica. Study design: A cross-sectional study was performed in 428 Costa Rican male students aged 12-22 years, who attended a nonprofit social welfare boarding school in 2019. A clinical examination was ran by three calibrated examiners following the International Caries Detection and Assessment System (ICDAS-II). Results: Caries prevalence was estimated at 83%, 15% have lost a tooth due to dental decay, 61% have at least one filled tooth, 36% have at least one filled and decayed tooth. The most frequent caries lesions were codes 2-Inactive (46.7%), and code 1-Inactive (23.8%). DMFT indicated a mean index using ICDAS-II 1-6>0 codes of 7.89. Using ICDAS-II 3-6>0 as threshold, the index decreases to 3.94. Finally, the lower and upper first permanent molars were found to be the most affected teeth. Conclusions: Dental caries experience represents a significant public health burden in young people, requiring better access to public dental healthcare.
Dati iniziali sulla reduplicazione linguistica nella lingua letteraria vigatese: la reduplicazione degli aggettivi tra diegesi e mimesi
Authors:   Università degli Studi di Modena e Reggio Emilia, Italia, Mazzarisi Pietro
Published: February 2021

The article presents the results of research on linguistic reduplication in Vigatese, the literary language invented by writer Andrea Camilleri. This is an aspect of Camilleri’s storytelling that is often noted by scholars but that has not yet received a dedicated study. The research is conducted on the corpus of 101 texts starring Salvo Montalbano—composed of 29 novels and 72 short stories published between 1994 and 2020—within which about 300 different reduplication forms and more than 2,200 total occurrences have been recorded. Here, the data on the expressive reduplication with adjectives are given: 64 forms with 379 total occurrences analysed for different literary scales, at sentence level and paragraph level. The collocations within the corpus, the possible spelling variations, and whether the use is in mimesis or diegesis are restored. The methodological approach is of a mixed-methods nature: a digitally assisted text analysis (DATA) following the concept of scalable reading (Mueller, 2014) follows the traditional close-reading analysis. A second analysis of the data on the diegetic and mimetic axis was carried out. The results obtained were then used for a data-driven comparison conducted on the corpus of all of Giovanni Verga’s narrative works. These initial results show that three out of every four reduplications are a diegetic recurrence. Despite the extensive use of mimesis in the texts, the true orality of Camillerian storytelling seems to reside elsewhere. This research is part of a broader study of all narrative texts under the general hypothesis that the formal equivalents of the writer’s popularity are to be found in the repetitiveness that was originally, and perhaps too hastily, criticised.
Ironia e sarcasmo in Un filo di fumo di Andrea Camilleri
Authors:   Università degli Studi di Cagliari, Italia, Caocci Duilio
Published: February 2021

This article examines the representational modes of the relationships in Andrea Camilleri’s Vigata community and, in particular, those presented in Un filo di fumo. Our initial consideration is that only by combining a semantic perspective with a pragmatic one, the measurement of Sicilianisms and the evaluation of the quality of the Sicilian-Italian language can provide useful information. We need to analyse the relationship that exists between the extra-linguistic hints provided by the narrator and by the characters and the dialogues interspersed in the novel to realise that one needs to be wary of the literal sense of the text in order to fully grasp the significance of many statements. In other words, speakers make constant use of oblique strategies of communication, amongst which, this article argues, irony and sarcasm (in the current interpretation offered by the philosophy of language) emerge as prevailing. As irony is seldom presented as dislocated from an environmental, relational, and historical context, both the narrator and the characters are charged with the duty of providing indispensable information. The Sicilian-Vigatese world arising from some of Camilleri’s novels takes on a semiotic specificity, then, that can be deciphered only with adequate linguistic and cultural competence.