bluuebunny/crossref_metadata_2025 huggingface dataset:
High Diagnostic Accuracy of Transbronchial Cryobiopsy in Fibrotic Interstitial Lung Diseases Compared to Final Explant Diagnosis
Authors: Unterman Avraham , Wand Ori , Fridel Ludmila , Edelstein Evgeny , Pertzov Barak , Kramer Mordechai R.
Published: September 2019

Background: A diagnostic lung biopsy may be required in some cases of fibrotic interstitial lung diseases (ILD). Transbronchial cryobiopsy has been suggested as a possible alternative to surgical lung biopsy. However, previous estimates of its diagnostic yield were not validated compared to the definitive diagnosis in explanted lungs. Objectives: We aimed to assess the diagnostic accuracy of cryobiopsy in fibrotic ILD patients who subsequently had lung transplantation. Methods: All 197 patients who underwent lung transplantation at our Center due to fibrotic ILD from January 2010 to May 2018, were screened for the presence of a pre-transplant cryobiopsy. Fourteen patients who underwent cryobiopsy before transplantation were identified. Two expert lung pathologists blindedto the explant diagnoses, independently examined these cryobiopsy specimens to decide if they match guideline criteria for usual interstitial pneumonia (UIP) pattern or an alternative diagnosis. The primary measure was the diagnostic accuracy of cryobiopsy to detect or refute a UIP pattern, as compared to the final explant diagnosis. Results: Median time between cryobiopsy and transplantation was 1.4 years. All 14 cryobiopsy samples contained adequate alveolar tissue. The explant diagnosis of 13/14 patients was UIP. The two pathologists correctly diagnosed or refuted UIP in the cryobiopsy specimen in 12/14 cases (85.7%) and 11/14 cases (78.6%), respectively. The level of diagnostic agreement between pathologists was good (kappa 0.59, p = 0.016). Conclusions: Compared to the final explant diagnosis, transbronchial cryobiopsy had high diagnostic accuracy and good inter-observer agreement for UIP pattern. These findings support a potential diagnostic role for cryobiopsy in experienced centers.
Extensive Refractory Perineal Pyoderma Gangrenosum Treated with Infliximab, Fecal Diversion, and Negative-Pressure Wound Therapy
Authors: Sousa Mafalda , Campos Manuel António , Sousa Ana Cristina , Lopes Jorge , Rodrigues Adélia , Carvalho João
Published: September 2019

Background: Pyoderma gangrenosum (PG) is a rare and difficult-to-diagnose disease that often associates with inflammatory bowel disease. Case: We present a case of a 57-year-old female with ulcerative colitis receiving 5-ASA who presented with rapidly progressive ulcers in the right foot and on the inside of the thigh, extending from the left large vaginal lip to the perianal area, compatible with PG. She was initially treated with corticosteroids with no response. After multidisciplinary consultation, it was decided to initiate in­fliximab 5 mg/kg, and to perform ileostomy for fecal diversion and negative-pressure wound therapy. The patient presented with marked improvement of the lesions, being discharged after 2 months and demonstrating almost complete resolution of the lesions within 4 months. Conclusion: Due to the rarity of PG, there is no evidence of the optimal management. The role of surgery is controversial as PG lesions can demonstrate pathergy and theoretically could worsen with surgical intervention. In this case it was decided based on the extent of the lesions and the experience in other septic/ulcerative perianal conditions.
Active Surveillance of Papillary Thyroid Microcarcinoma: Where Do We Stand?
Authors: Jeon Min Ji , Kim Won Gu , Chung Ki-Wook , Baek Jung Hwan , Kim Won Bae , Shong Young Kee
Published: September 2019

The recent sharp increase in thyroid cancer incidence is mainly due to increased detection of small papillary thyroid microcarcinoma (PTMC). Due to the indolent nature of the disease, active surveillance (AS) of low-risk PTMCs is suggested as an alternative to immediate surgery to reduce morbidity from surgery. For appropriately selected PTMC patients, AS can be a good management option and surgical intervention can be safely delayed until progression occurs. Many considerations must be taken into account at the time of initiation of AS, including radiological tumor characteristics and clinical characteristics of the patient. A specialized medical team should be assembled to monitor patients during AS with an appropriate follow-up protocol. The fact that some patients require surgery for disease progression after long-term follow-up is a major drawback of the current AS protocol. Evaluation of tumor kinetics by three-dimensional tumor volume measurement during the initial 2–3 years of AS may be helpful for discrimination of PTMCs that need early surgical intervention. In this review, we will discuss the clinical outcomes of surgical intervention and AS, considerations during AS, and unresolved questions about AS.
The Epidemiologic Burden of Tacrolimus Variability among Kidney Transplant Recipients in the United States
Authors: Shah Pratik B. , Ennis Jennifer L. , Cunningham Patrick N. , Josephson Michelle A. , McGill Rita L.
Published: September 2019

Background: Within-patient tacrolimus level variability >30% has been shown to be a risk factor for de novo donor-specific antibody formation and death-censored graft failure among kidney transplant recipients. The burden of tacrolimus variability and the correlation between variability and subtherapeutic tacrolimus levels were examined in a large national data set. Methods: All tacrolimus levels drawn at LabCorp® facilities in the United States with a diagnosis code for kidney transplant between November 2011 and September 2017 were examined, excluding values that could represent new allografts. Tacrolimus variability was calculated if at least 3 levels were available. The percentage of subtherapeutic (<4.0 ng/dL) tacrolimus levels (%subT) was also calculated. Interdependence between %subT and tacrolimus variability was assessed with correlation analysis and linear regression. Results: There were 410,257 tacrolimus levels among 27,375 patients, who had 11 (interquartile range [IQR] 6–20) tacrolimus levels over a median follow-up of 26.5 (IQR 12.8–46.1) months. Median tacrolimus variability was 30.6%, and 51.6% of patients exceeded 30% variability. Median %subT was 11.1% (IQR 0–30.8%), and 34.3% of patients had no subtherapeutic levels. The correlation coefficient between tacrolimus variability and %subT was 0.253 (p< 0.001). In linear regression, tacrolimus variability increased 1.86% for each 10% increase in %subT (p < 0.001), but R-squared for this model was only 0.06. Conclusion: More than half of established kidney transplant patients from a large national sample exhibited levels of tacrolimus variability that have been associated with inferior transplant outcomes. Tacrolimus variability has a weak association with subtherapeutic levels, but represents a more complicated constellation of clinical factors.
Crohn’s Disease Presenting as Granulomatous Appendicitis
Authors: Otsuka Ryota , Shinoto Koichi , Okazaki Yasushi , Sato Kota , Hirano Atsushi , Isozaki Tetsuro , Tamachi Tomohide , Hirai Tomoya , Yonemoto Shohei , Matsubara Hisahiro
Published: September 2019

Granulomatous appendicitis is uncommon. It can be caused by infectious or systemic disorders, such as Crohn’s disease (CD) and sarcoidosis. It is therefore essential to investigate systematic causes of granulomatous appendicitis after surgery by appropriate examinations. It is also rare for acute appendiceal inflammation to develop due to active CD. We herein report a case of CD presenting as granulomatous appendicitis. The patient was a 28-year-old man who arrived at the emergency room with right lower abdominal pain. Computed tomography showed a low-density lesion with a clear boundary and a small high-density spot in its center behind the cecum. Acute appendicitis with abscess formation was suspected and conservative treatment was started. After 3 consecutive days of conservative treatment there was no improvement in his condition. We therefore performed open appendectomy. Histopathological examination showed numerous noncaseous epithelioid granulomas in the wall of the appendix. Specific staining revealed no evidence of acid-fast bacilli or fungi. During follow-up after discharge, colonoscopy demonstrated erosion from the cecum to the transverse colon. A colon biopsy showed severe inflammation with cryptitis, Paneth cells, and a granulomatous lesion. The patient was therefore diagnosed with CD and treatment with mesalazine was started. Careful examination is necessary to diagnose and properly treat patients with granulomatous inflammation of the appendix.
Low Recurrence Rate and Risk of Distant Metastases following Marginal Surgery of Intramuscular Lipoma and Atypical Lipomatous Tumors of the Extremities and Trunk Wall
Authors: Presman Benjamin , Jauffred Sune Frederik , Kornø Maj Raundrup , Petersen Michael Mørk
Published: September 2019

Objective:The purpose of the present study was to determine the local recurrence rate, risk of dedifferentiation, and distant metastasis after surgical excision of intramuscular lipomas (IML) and atypical lipomatous tumors (ALT). Subjects and Methods: We retrospectively assessed all IML and ALT surgically removed from the extremities or trunk wall in our clinic between 1997 and 2006. Data from 141 patients with IML and 35 patients with ALT were extracted from the National Pathology Registry and patient files. Results: IML and ALT recurred in 10 and 6 tumors, respectively. No metastases were observed in either group. The 5- and 10-year local recurrence-free survival rates were 97.1% (94.3–99.9) and 94.8% (CI: 91.1–98.6) for IML and 84.6% (CI: 72.1–97.1) and 81.1% (CI: 67.6–94.8) for ALT, respectively. ALT were found to dedifferentiate in 2/35 cases. Conclusion: Both IML and ALT showed a low recurrence rate when removed surgically from the extremities or trunk wall with intended marginal resection. No distant metastases were observed in any of the groups. It, therefore, seems safe to treat these tumors with marginal resection.
A estruturação do saber relacionado a geometria complexa e a modelagem paramétrica de estruturas regenerativas na arquitetura
Authors: Pires Janice de Freitas , Pereira Alice Theresinha Cybis
Published: September 2019

A arquitetura regenerativa surge com uma abordagem que vai além da sustentabilidade dos edifícios, buscando ampliar a relação com o meio ambiente, de modo a promover a regeneração dos sistemas vivos, através de uma compreensão completa do lugar no projeto de arquitetura. Neste trabalho, com objetivo didático, é realizado um estudo sobre os princípios da arquitetura regenerativa em associação com a explicitação das estruturas de saber que envolvem as geometrias complexas recorrentes na natureza, a qual desenvolve suas estruturas em estrita relação com as dinâmicas que são processadas no ambiente natural. Visando estudos de transposição didática para arquitetura, estruturam-se processos de modelagem paramétrica de tais geometrias com o propósito de disponibilizá-las em uma rede de conceitos com foco no estudo das superfícies matemáticas empregadas na arquitetura contemporânea recente.
Pavilhão FAB!t: proposta portátil para inserção da cultura maker no ensino tradicional
Authors: Pacini Giordana Dileta , Passaro Andrés Martín , Henriques Gonçalo Castro
Published: September 2019

O Pavilhão FAB!t é um pavilhão portátil que pretende promover a inclusão da cultura maker na educação tradicional, introduzindo o conceito de indústria 4.0 nos programas da escola elementar, justificados pela mudança dos sistemas produtivos, especialmente relativamente à manufatura e à nova relação produto-consumidor. Neste contexto, dissemina através da cultura maker os avanços tecnológicos e democratiza o seu acesso na educação tradicional. Esta pesquisa contribui para atualizar o ensino de tecnologia nas escolas, introduzindo fundamentos da cultura maker, de maneira rápida, barata e igualitária. Como metodologia analisamos vários laboratórios existentes, designados como Fab Labs, identificando as atividades e ferramentas utilizadas em seus espaços. Com base neste estudo, desenvolvemos um sistema modular que permite criar espaços personalizados adaptáveis aos requisitos funcionais dos equipamentos e às atividades com eles associadas. Propomos uma plataforma de construção montável e desmontável com base num sistema que permita a expansão e retração da estrutura, que assim se adapta aos futuros desejos e necessidades da comunidade.
Formwork fabrication freedom for a concrete canoe
Authors: Jipa Andrei , Bernhard Mathias , Ruffray Nicolas , Wangler Timothy , Flatt Robert , Dillenburger Benjamin
Published: September 2019

The pursuit for complex geometries in contemporary architecture is driving innovation towards an unconstrained fabrication freedom for building components. Concrete is a building material with excellent structural and architectural qualities, which has the theoretical capacity of being cast into any shape. However, in practice, concrete is generally limited by the formwork manufacturing industry to simple, planar shapes. To overcome this fabrication limitation, this research investigates the use of large-scale 3D-printed plastic formworks for concrete components. This novel construction method takes advantage of the load-bearing capacity of concrete and relies on the fabrication-freedom inherited from the 3D printed formwork, thus making complex topologies and precise details possible for concrete structures. To demonstrate the potential applications of this method, skelETHon —a functional four-meter-long concrete canoe— was designed, built and raced in a regatta on the Rhine river. The research focused on the optimization of the 3D printing process for large-scale plastic formworks and on improving the stability of the thin formwork shells during casting.
Imagens em espiral
Authors: Rosa Ana Paula da
Published: September 2019

No cenário da midiatização verifica-se a complexificação das relações sociais, atravessadas por lógicas midiáticas que convocam memórias e transformam a noção de referência, potencializando a fixação de imagens-sombra. Em nossa visada, as imagens midiatizadas apresentam uma tripla condição: a) afetam o coletivo e a consolidação ou não de imaginários sociais; b) emergem de uma disputa pela atribuição de valor ao visível e c) implicam no desenvolvimento de domínios técnicos e apropriações. Neste artigo discute-se a circulação do que transita no imaginário midiático vinculado ao atentado à revista Charlie Hebdo desde as coberturas de 2015e seus intervalos até 2018. Como aportes teóricos mobilizamos Warburg e Didi-huberman, bem como os contributos específicos da midiatização, em especial a circulação e seus movimentos fágicos.
Extension of the television domain to the digital age
Authors: Jost François
Published: September 2019

The term digital applied to television did not appear until we began talking about digital terrestrial TV (DTTV), that is, long after this information coding system had appeared in the world of television. This paper, therefore, examines the various changes performed in the television production by computer-generated images and special effects in the 1990s, the broadcasting with DTTV in the early 21st century, and channel delineation in the last decade. Based on practices and uses, it highlights the gaps which sometimes exist between technical possibilities and user ownership, particularly according to television genres. Then, television borrowing from social sharing sites and eventual relinearization are discussed before examining what platforms change in content consumption.
Do feminismo ao gênero: uma nova Inquisição?
Authors: Blay Eva Alterman
Published: September 2019

As análises relativas a sexo e gênero têm se espalhado por todas as ciências. Esse tema se vincula aos processos de implementação dos direitos à plena cidadania das mulheres. No Brasil atravessamos uma guerra ao gênero por parte de segmentos conservadores, machistas e racistas. Será que vamos voltar à fogueira da Inquisição e queimar as inovações decorrentes da inclusão de gênero no saber?
Peripheral Vasoconstriction During Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease
Authors: Kim Jeong Hwan , Almuwaqqat Zakaria , Hammadah Muhammad , Liu Chang , Ko Yi-An , Lima Bruno , Sullivan Samaah , Alkhoder Ayman , Abdulbaki Rami , Ward Laura , Bremner J. Douglas , Sheps David S. , Raggi Paolo , Sun Yan V. , Shah Amit J. , Vaccarino Viola , Quyyumi Arshed A.
Published: September 2019

Rationale:

Excessive vasoconstriction in response to mental stress may be a potential mechanism by which acute psychological stress leads to adverse cardiac events.

Objectives:

We investigated whether excessive digital vasoconstriction during acute mental stress predicts adverse cardiovascular outcomes among patients with coronary artery disease.

Methods and Results:

Five hundred forty-nine patients with stable coronary artery disease (age 63±9, 76% male, 29% black) underwent mental stress testing with a standardized public speaking stressor and followed prospectively for cardiovascular end points. Digital pulse wave amplitude was continuously measured using peripheral artery tonometry (PAT, Itamar Inc). Stress/rest PAT ratio (sPAT) of pulse wave amplitude during mental stress/baseline was calculated and dichotomized by the median value into low and high sPAT ratio groups. Upon 3-year follow-up, Fine and Gray’s subdistribution hazard ratios were used to examine the association between sPAT ratio and the composite end point of cardiovascular death, myocardial infarction, revascularization, and hospitalization for heart failure. The median sPAT ratio was 0.68 (interquartile range, 0.48–0.88), indicating 32% vasoconstriction with mental stress. Men were more likely to have low sPAT ratio than women (odds ratio, 1.79;
P
=0.007) while those on β-blockers were less likely to have low sPAT ratio (odds ratio, 0.52;
P
=0.003). After adjusting for demographic and cardiovascular risk factors, medications, and rate-pressure product change during mental stress, those with low sPAT ratio were at significantly higher risk of adverse outcomes (subdistribution hazard ratio, 1.77 [95% CI, 1.12–2.80]).

Conclusions:

Greater peripheral vasoconstriction with mental stress, denoted by a low sPAT ratio, is associated with a higher risk of adverse cardiovascular outcomes in patients with coronary artery disease.
Outcome of Normal‐Flow Low‐Gradient Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction: A Propensity‐Matched Study
Authors: Chadha Gagandeep , Bohbot Yohann , Rusinaru Dan , Maréchaux Sylvestre , Tribouilloy Christophe
Published: September 2019

Background

Normal‐flow, low‐gradient severe aortic stenosis (
NF
‐
LG
‐
SAS
), defined by aortic valve area <1 cm
2
, mean gradient <40 mm Hg, and indexed stroke volume >35 mL/m
2
, is the most prevalent form of low‐gradient aortic stenosis (
AS
). However, the true severity of
AS
and the management of
NF
‐
LG
‐
SAS
are controversial. The aim of this study was to evaluate the outcome of patients with
NF
‐
LG
‐
SAS
compared with moderate
AS
(
MAS
) and with high‐gradient severe‐AS (HG‐SAS).

Methods and Results

A total of 154 patients with
NF
‐
LG
‐
SAS
, 366 with
MAS
(aortic valve area between 1.0 and 1.3 cm
2
), and 1055 with HG‐SAS were included. On multivariate analysis, after adjustment for covariates of prognostic importance,
NF
‐
LG
‐
SAS
patients did not exhibit an excess risk of mortality compared with
MAS
patients under medical management (hazard ratio=1.13 [95% CI, 0.82‐1.56];
P
=0.45) and under medical and surgical management (hazard ratio 1.06 [95% CI, 0.79‐1.43];
P
=0.70), even after further adjustment for aortic valve replacement (hazard ratio=1.09 [95% CI, 0.81‐1.48];
P
=0.56). The 6‐year cumulative incidence of aortic valve replacement (performed in accordance with guidelines) was comparable between the 2 groups (39±4% for
NF
‐
LG
‐
SAS
and 35±3% for
MAS
,
P
=0.10). After propensity score matching (n=226),
NF
‐
LG
‐
SAS
and
MAS
patients also had comparable outcomes under medical (
P
=0.41) and under medical and surgical management (
P
=0.52).
NF
‐
LG
‐
SAS
had better outcomes than HG‐SAS patients (adjusted hazard ratio 1.84 [95% CI, 1.18‐2.88];
P
<0.001).

Conclusions

This study shows that patients with
NF
‐
LG
‐
SAS
have a comparable outcome to those with
MAS
when aortic valve replacement is performed during follow‐up according to guidelines, mostly at the stage of HG‐SAS. Rigorous echocardiographic assessment to rule out measurement errors and close follow‐up are essential to detect progression to true severe AS
in NF
‐
LG
‐
SAS
.
On the Need for Mapping Design Inequalities
Authors: Sloane Mona
Published: September 2019

This article introduces the special issue “Design Inequalities” and the articles contained within it. It provides a new conceptual framework by looking at design as a way of “making society” and exploring how design is entangled with social inequalities across a wide spectrum of domains. The ontological point of departure is to view “design” and “inequalities” as both superstructures and micro-practices of creativity, power, and expertise that can simultaneously sustain and challenge privilege and exclusion, regardless of what is being designed.
Historicizing the Apostolic Faith Mission in the United Kingdom
Authors: Sande Nomatter
Published: September 2019

This article presents a history of the Apostolic Faith Mission in the United Kingdom from an academic perspective. More specifically, the article discusses the emergence of the Apostolic Faith International Ministries UK (afmimuk). Arguably, the afmimuk is regarded as a missionary field of the Apostolic Faith Mission of Zimbabwe. So, the article discusses the early 20 years of the Apostolic Faith Mission in the United Kingdom. The lack of previous documentation presents a challenge to the writing of the denomination’s history. The article uses historiography by objective (hbo) as a theoretical framework and concludes that the afmimuk is an example of the spread of Pentecostal Christianity in Europe.
What Is Expressed When Emotions Are Expressed in Art?
Authors: Döring Sabine A.
Published: September 2019

The author argues for a Collingwoodian claim: if an emotion is expressed in art, it is not a content which exists prior to, and independent of, its expression. Artistic emotion expressions rather clarify and complete emotions. The autor backs up this claim by Musil’s Lewinian theory of emotion which displays significant parallels to recent Enactivist Theories of Emotion: it states that embodiment in action (in a broad sense) is necessary in any case in order for nonspecific dispositions to emotions to shape and consolidate into specific fully fledged, genuine emotions. Two ways of shaping and consolidating are distinguished. One way is to categorise emotions in terms of their so-called “formal objects” by associating nonspecific dispositions to emotions via action with specific paradigm scenarios. Another way is to put these categories to the test by expressing exemplary individual experiences which go beyond the existing repertoire of paradigm scenarios. Art, when it expresses emotions, shapes and consolidates in the second way. Art challenges the existing system of emotion types which is at the same time to challenge the corresponding system of evaluations and values. The presented argument draws upon the notions of expressing developed by Dorit Bar-On and Philipp J. Koch.
The Expressive Dimension and Score-changing Function of Speech Acts from the Evolutionist Point of View
Authors: Witek Maciej
Published: September 2019

The aim of this paper is twofold. First, the author examines Mitchell Green’s (2009) account of the expressive power and score-changing function of speech acts; second, he develops an alternative, though also evolutionist approach to explaining these two hallmarks of verbal interaction. After discussing the central tenets of Green’s model, the author draws two distinctions – between externalist and internalist aspects of veracity, and between perlocutionary and illocutionary credibility – and argues that they constitute a natural refinement of Green’s original conceptual framework. Finally, the author uses the refined framework to develop an alternative account of expressing thoughts with words. In particular, he argues that in theorising about expressing thoughts with words – as well as about using language to change context – we should adopt a Millikanian view on what can be called, following Green, acts of communication and an Austinian approach to speech or illocutionary acts.
Clinical or gimmickal: The use and effectiveness of mobile mental health apps for treating anxiety and depression
Authors: Marshall Jamie M , Dunstan Debra A , Bartik Warren
Published: September 2019

Objectives:

The increase in ownership of smartphones and tablet devices has seen a worldwide government push, championed by the World Health Organization, towards digital healthcare services generally. Mental health has been a strong presence in the digitisation of healthcare because of the potential to solve some of the difficulties in accessing face-to-face services. This review summarises the recent history of e-mental health services and illuminates two very different paths. The first is the considerable amount of research that has proven the effectiveness of many online mental health programmes for personal computers and laptops, resulting in widespread acceptance of their ability to make a contribution in an individual’s recovery from anxiety and depression. The second is associated with the more recent development of apps for smartphones and tablet devices and the contrasting paucity of research that has accompanied this burgeoning area of e-mental health. This review also outlines the current state of play for research into the effectiveness of mobile mental health apps for anxiety and depression, including issues associated with methodology, and offers sources of practical advice for clinicians wanting more information about these new digital tools.

Conclusion:

Research into the effectiveness of mental health apps is lacking, and the majority have no evidence of efficacy. Clinicians need to be aware of what apps have such evidence and should exercise caution when recommending apps to patients. Suggestions are offered on the direction of future research, including an appeal to further include clinicians in the development and efficacy testing of mental health apps.
The locative imaginary: Classification, context and relevance in location analytics
Authors: Smith Harrison
Published: September 2019

The location analytics industry has the potential to stimulate critical sociological discussions concerning the credibility of data analytics to enact new spatial classifications and metrics of socio-economic phenomena. Key debates in the sociology of geodemographics are revisited in this article in light of recent developments in algorithmic culture to understand how location analytics impacts the structural contexts of classification and relevance in digital marketing. It situates this within a locative imaginary, where marketers are experimenting with consolidating the epistemes of behavioural targeting, classification and performance evaluation in urban environments through spatial analytics of movement. This opens up future research into the political and cultural economies of relevance in media landscapes and the social shaping of valuable subjects by third-party data brokers and analytics platforms that have become matters of public and regulatory concern.
Enacting Alcohol and Other Drug (Testing)-Related Harms in an Australian Drug Court
Authors: Sarmiento Eliana , Seear Kate , Fraser Suzanne
Published: September 2019

Alcohol and other drug testing is used in a range of environments including workplaces, schools, sporting tournaments, substance treatment and criminal justice system settings. It is also the cornerstone of the drug court model. Despite its centrality, it has received little scholarly attention. In this article, we address this gap through a study of how the drug-testing regime unfolds at one Australian drug court. Based on ethnographic observation, qualitative interviews with drug court participants, and analysis of drug court documents, this article examines how participants experience drug testing. Drawing on Carol Bacchi’s poststructuralist policy analysis framework, we examine how the “problem” of substance “dependence” is conceptualized in one drug court’s approach to drug testing, and we consider some of the effects of the policy. We argue that the everyday and seemingly mundane ritual of urination becomes a core technique for the governance of drug court subjects and note that the testing regime is onerous, regimented, and invasive. We also trace some of the effects of this policy and its implementation for participants. We suggest that the urine-testing regimen might operate counterproductively, intensifying participants’ involvement with the criminal justice system. Its reliance on an abstinence model may heighten exposure to substance-related harms and segregate drug court participants from the “rest of society,” inhibiting other aspects of their lives, including their relationships and employment prospects. Overall, we argue that these effects are at odds with the stated purposes of the drug court. We conclude with some reflections on claims about the therapeutic value and potential of drug courts and suggest opportunities for reform.
Evaluating Didactic and Exemplar Information: Noninvasive Brain Stimulation Reveals Message-Processing Mechanisms
Authors: Coronel Jason C. , O’Donnell Matthew B. , Beard Elizabeth C. , Hamilton Roy H. , Falk Emily B.
Published: September 2019

People in their everyday lives encounter claims about various health, political, and economic issues. These claims are often supported by evidence based on didactic or exemplar information. In the research reported here, we use a noninvasive brain stimulation technique (transcranial Direct Current Stimulation [tDCS]) to examine the cognitive mechanisms underlying people’s ability to support or refute claims conveyed by messages that contain didactic or exemplar information. Our results are consistent with the notion that the evaluation of didactic-based evidence engages more deliberative cognitive processes than the evaluation of exemplar information. Our study highlights the utility of tDCS in the study of message processing by demonstrating how it can be used to test the assumptions of message-processing theories.
Bridging Levels of Public Administration: How Macro Shapes Meso and Micro
Authors: Roberts Alasdair
Published: September 2019

Scholars in public administration now recognize three levels of analysis: macro, meso, and micro. But there is uncertainty about the relationship between levels and concern about a “schism” in research. However, linkages between levels can be demonstrated easily. At the macro-level, leaders develop an overall strategy for pursuing national priorities, which determines the broad architecture of the state. Institutions must be built, renovated, or managed to give effect to these strategies: This is the meso-level of public administration. Overall, strategies also shape the micro-level relationship between people who rule and people who are ruled. This is done by categorizing people—as subjects or citizens, for example—and by redefining categories. Macro-level strategies evolve, with consequences for the agenda at the meso- and micro-levels. Experience at lower levels also shapes strategy at the macro-level. The interaction among levels is illustrated by comparison of three eras in modern American history.
The Cyclical Nature of the Territorial Development of Large Cities: A Case Study of Wrocław (Poland)
Authors: Szmytkie Robert
Published: September 2019

The primary aim of the study was to identify the process of territorial development of large cities in Central and Eastern Europe based on the example of Wrocław. The analysis of the administrative boundaries changes; population density and land development revealed specific features of the territorial growth of large cities, which due to their repeatability indicate the cyclical nature of the processes. The specific pattern of territorial development in large cities can be described as follows: each period of socioeconomic development of the city contributes to an increase in population density within urban boundaries, and then to the sprawl of the city into its nearest neighborhood. The suburban area is an extension of the city and over time is incorporated into administrative boundaries of the city. Extension of the city usually reduces the population density within its new boundaries. Each subsequent period of prosperity in the city initiates another cycle of spatial development.
Evaluating the Open and Engaged Components of Acceptance and Commitment Therapy in an Online Self-Guided Website: Results from a Pilot Trial
Authors: Petersen Julie M. , Krafft Jennifer , Twohig Michael P. , Levin Michael E.
Published: September 2019

Online acceptance and commitment therapy (ACT) is promising for treating a range of psychological problems. Component research can further clarify which components are needed for optimal outcomes in what contexts. Online platforms provide a highly controlled format for such research. In this pilot trial, 55 adults were randomized to: ACT-Open (i.e., acceptance, defusion components), ACT-Engaged (i.e., values, committed action), or ACT-Combined (i.e., acceptance, defusion, values, committed action). Each condition was 12 sessions over 6 weeks, with assessments at baseline, post-treatment, and 4-week follow-up. ACT-Open, ACT-Engaged, and ACT-Combined all significantly improved from pre- to post-treatment on mental health, psychosocial functioning, and components of psychological flexibility. Compared to ACT-Combined, ACT-Open improved less on psychosocial functioning at post-treatment, and ACT-Engaged worsened on functioning at follow-up. The platform was acceptable with high satisfaction ratings. Results support the feasibility of conducting online ACT component research, which will be tested in a fully powered non-inferiority trial.
Comparing GAAP With NIPA Earnings
Authors: Dichev Ilia D. , Zhao Jingran
Published: September 2019

The U.S. Bureau of Economic Analysis produces a measure of aggregate corporate profits (national income and product accounts [NIPA] earnings), which is an integral component of the accounting for gross domestic product (GDP). Interesting features of NIPA earnings include consistent accounting rules over time and determination with little or no managerial discretion. Thus, NIPA earnings provide a useful benchmark for generally accepted accounting principles (GAAP) earnings, especially in parsing out the effects of real-economy versus the accounting in explaining the documented temporal increase in volatility and decline in persistence of GAAP earnings. We find that GAAP and NIPA earnings are closely related in the early years, with similar means and standard deviations, and with earnings changes correlating at .90 during 1950-1983. This close relation substantially deteriorates, however, during the second half of the sample period, 1984-2016. Although the behavior of NIPA earnings remains roughly the same, the volatility of GAAP earnings increases 10-fold, and the correlation between GAAP and NIPA earnings changes falls to .39. Additional tests reveal that the increase in the volatility of GAAP earnings is mostly due to rapid earnings reversals, especially the effect of large transient items during economic downturns. The frequency and severity of such downturns, however, are roughly the same across the two periods. In addition, there is little change in the properties of aggregate cash flow from operations and revenue over time. Overall, this evidence suggests that in addition to changes in the real economy, changing GAAP rules and their application are significant factors in the changing properties of GAAP earnings.
Exercise training for adults hospitalized with an acute respiratory condition: a systematic scoping review
Authors: Rice Hayley , Harrold Megan , Fowler Robin , Watson Carol , Waterer Grant , Hill Kylie
Published: September 2019

Objective:

In adults hospitalized with an acute or chronic respiratory condition, to determine what has been reported regarding exercise programmes in terms of content, tolerability, evaluation and adverse events.

Data sources:

A systematic search was conducted of electronic databases (PubMed, EMBASE, CINAHL, PEDro, The Cochrane Library), trial registries and conference abstracts (Thoracic Society of Australia and New Zealand Annual Scientific Meeting, the European Respiratory Society Congress, the American Thoracic Society International Conference).

Review methods:

Studies were included if they (1) recruited adults hospitalized with an acute or chronic respiratory condition, (2) described an exercise programme that targeted peripheral muscles and (3) reported that ⩾80% of the sample had initiated training within 72 hours of hospitalization.

Results:

The last search was conducted on 2 June 2019. Of the 6282 records identified, 20 met the study criteria. These described 18 separate studies (2018 participants). Studies were conducted in adults hospitalized with an exacerbation of chronic obstructive pulmonary disease or with community-acquired pneumonia. The content of exercise programmes included aerobic and/or resistance training, neuromuscular electrical stimulation, whole-body vibration or movement out of bed. In eight studies (44%), the initial session was prescribed using objective measures of exercise capacity, peripheral muscle force and the ability to undertake activities of daily living. Across 7420 training sessions, seven adverse events were reported.

Conclusion:

Methods used to prescribe and titrate exercise programmes in adults hospitalized with an acute or an exacerbation of a chronic respiratory condition were disparate. When reported, programmes were well tolerated and adverse events were infrequent.
A case of multiple system atrophy
Authors: Guo Jing , Liu Fuying , Liu Tingting , Zhang Xin , Luo Yong
Published: September 2019

Multiple system atrophy (MSA) is the most rapidly progressive neurodegenerative disorder among the various types of synucleinopathies. The cause of MSA remains unknown, but it can involve the extrapyramidal system, the pyramidal system, the autonomic nerves and the cerebellum. The main clinical manifestations are Parkinson's symptoms, cerebellar ataxia, pyramidal tract signs and autonomic nervous system disorders. Depending on the initial predominant motor deficits, MSA is subclassified into either Parkinsonian type (MSA-P) or cerebellar type (MSA-C). MSA is rare in the Zunyi area of Guizhou Province, so when it is observed for the first time it often results in a convoluted diagnosis and treatment process, which takes a lot of time, money, manpower and material resources, which can also have a psychological impact on the patient. This report describes the case of a 60-year-old woman who presented with syncope for 1 year combined with dizziness for 1 day. She had been diagnosed twice with transient ischaemic attack in the previous 6 months. Cranial magnetic resonance imaging suggested widening of the cerebellar sulcus and mild cerebellar atrophy. Based on the patient’s medical history, physical signs and auxiliary examinations, she was diagnosed with MSA-C.
Effect of vitiligo treatment using compound glycyrrhizin combined with fractional carbon dioxide laser and topical triamcinolone acetonide on serum interleukin-17 and tissue growth factor-β levels
Authors: Li Ling , Ma Qiushuang , Li Haiyan
Published: September 2019

Objective

Vitiligo is a common pigmentation disorder of the skin, and its pathogenesis remains unclear. We evaluated the effectiveness of compound glycyrrhizin combined with fractional carbon dioxide (CO2) laser and triamcinolone acetonide solution in patients with vitiligo.

Methods

Patients with stable vitiligo treated at our hospital between May 2016 and August 2017 were randomized to a control group or an observation group. Both groups were treated with fractional CO2 laser and triamcinolone acetonide solution, while the observation group also received compound glycyrrhizin. Clinical effectiveness, serum IL-17 and TGF-β levels, and adverse drug reactions were compared between the groups.

Results

Following treatment, the clinical effective rate was significantly higher in the observation group than in the control group (75.00% vs. 52.50%). Furthermore, IL-17 decreased in both groups but was significantly lower in the observation group, while TGF-β increased in both groups but was significantly higher in the observation group. The incidence of adverse drug reactions was not significantly different between the groups.

Conclusion

Compound glycyrrhizin in combination with fractional CO2 laser and triamcinolone acetonide solution can be used to treat vitiligo and appears to modulate cytokine levels. Trial registration: Hebei Provincial Administration of Traditional Chinese Medicine (no. 2019366; http://www.hebwst.gov.cn/index.do?templet=cs_zyj )
Management of intraoperative acute pulmonary embolism in a patient with subarachnoid haemorrhage undergoing femoral fracture repair
Authors: Aiping Yang , Shuangyin Zhang , Yanhong Xing , Rongzhi Zhang
Published: September 2019

Acute pulmonary embolism (APE) during surgery can be life-threatening. We herein report a case of a 56-year-old man with subarachnoid haemorrhage who underwent surgical repair of a femoral fracture. During surgery with the patient under general anaesthesia, his oxygen saturation and end-tidal carbon dioxide decreased dramatically. An emergency transoesophageal echocardiogram demonstrated mobile echogenic densities in the right pulmonary artery and enlargement of the right atrium, and these findings were suggestive of APE. Considering the patient’s history of subarachnoid haemorrhage, anticoagulation with heparin or thrombolysis therapy for APE was contraindicated. We recommended inferior vena cava filter placement to prevent recurrence of the APE. Unfortunately, the patient and his family members refused the filter implantation, and the patient was discharged.
Dissecting basilar artery aneurysm manifesting as sudden sensorineural hearing loss: a case report and literature review
Authors: Zhang Yi-zhi , Chen Qiu-hui , Liu Zhan-chuan , Zhang Ying , Han Yan-qiu , Nan Shan-ji
Published: September 2019

Highlights

• Dissecting basilar artery aneurysm (DBAA) is relatively rare.

• We report the first case of a DBAA manifesting as sudden sensorineural hearing loss.

• This case report adds to the symptom spectrum of DBAA.
Underinsurance as adaptation: Household agency in places of marketisation and financialisation
Authors: Booth Kate , Kendal Dave
Published: September 2019

The underinsurance of property is pervasively and persuasively promoted as an indicator of risk and riskiness and, in Western nations, is assumed to be aligned with socio-economic disadvantage. Yet, the solution – in its most simple form, buying more insurance – lacks critical interrogation of what the problem actually is. To understand underinsurance better, we map house and contents underinsurance across two municipalities in Australia’s island state of Tasmania, and observe that the existing delineation of disadvantage and advantage between these two places is muted in relation to insurance – underinsurance does not straightforwardly map onto disadvantage. We provide an alternative explanation: that underinsurance is not a risk for households per se and does not represent riskiness on behalf of these households. Rather, it is indicative of household agency that produces place-specified responses within the processes of financialisation and marketisation. We observe that the growth in renting, driven in part by housing financialisation, is associated with property underinsurance. The history of renting as temporary and marginal informs renter decision making not to insure, and thus current financialised changes in housing co-produce rather than ameliorate underinsurance. We also conclude that in negating or resisting insurance marketisation, households garner everyday financial and material adaptative capacity by underinsuring.
Artificial intelligence in healthcare: An essential guide for health leaders
Authors: Chen Mei , Decary Michel
Published: September 2019

Artificial Intelligence (AI) is evolving rapidly in healthcare, and various AI applications have been developed to solve some of the most pressing problems that health organizations currently face. It is crucial for health leaders to understand the state of AI technologies and the ways that such technologies can be used to improve the efficiency, safety, and access of health services, achieving value-based care. This article provides a guide to understand the fundamentals of AI technologies (ie, machine learning, natural language processing, and AI voice assistants) as well as their proper use in healthcare. It also provides practical recommendations to help decision-makers develop an AI strategy that can support their digital healthcare transformation.
“I’m Already Seen as a Sexual Predator From Saying Hello”: Black Men’s Perception of Sexual Violence
Authors: Zounlome Nelson O. O. , Wong Y. Joel , Klann Elyssa M. , David Jessica L.
Published: September 2019

Sexual violence is a severe and rampant issue plaguing college campuses. However, the lack of research pertaining to underrepresented students calls into question the generalizability of university education and prevention efforts. Consequently, there is a gap in the literature regarding African American men’s understanding of sexual violence. This study seeks to address this gap by examining African American university men’s conceptualization of sexual violence from their own racial and cultural perspectives. Ninety-minute semi-structured interviews were conducted with eight male African American students attending predominantly White institutions. Data were analyzed by three coders using an interpretative phenomenological approach and intersectional framework. Data were then presented to an auditor and the coders revised the themes based on the auditor’s feedback. Four themes emerged from this analysis: aggressive and violent stereotypes of Black men, othering of male survivors, racial considerations when responding to survivors, and awareness of racial injustices. These results provide evidence supporting the need for culturally grounded sexual violence education and prevention efforts to effectively reach African American men on university campuses. For example, universities may consider having African American confidential advocates and a committee of racially diverse members to run reported instances of sexual violence to reduce bias. In addition, universities may benefit from partnering with Black fraternities to empower men to be allies for social change against rape culture within their communities. For clinical work, such efforts could include incorporating explicit discussions of the impact of gendered racism on Black male survivors into session. Also, clinicians could aim to combat the internalization of the gender racist stereotypes with clients.