bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitigation of PQ issues in EV charging station connected distribution system using novel RSMLI-based shunt APF
Authors: Mogilicharla Veera Narasimha Murthy , Rao Lingineni Shanmukha , Moparthi Ranjit Kumar , Chowdary Tarigopula Jyothika
Published: December 2023

In the present scenario, the significant use of electric vehicles (EVs) is growing rapidly in the automotive industry due to cheaper transportation, no fossil fuel required, low maintenance, no fuel cost, and low impacts on the environment over the formal internal combustion engine (ICE) vehicles. In actuality, these EVs are powered by batteries that are charged by a utility-grid-based charging facility. A power-electronic conversion-based charging device is used in this charging station to charge the battery packs in the EV system. The problem statement of this work is identified, these conversion devices in charging units proliferate the power quality of the utility grid. To overcome these problems, a classical square-wave inverter-based active power filter (APF) is employed. The major problems in classical inverters are high common-mode voltage, more harmonic profile, high dV/dt stress, high switching stress, and low efficiency. The contribution of this work is proposing the multilevel inverter (MLI) based APF for better compensation over classical inverters. In this approach, a novel reduced-switch MLI-based APF has been proposed for the mitigation of harmonic currents and also enhances the power factor in utility-grid-connected distribution systems. The effectiveness of the proposed reduced-switch multilevel inverter (RSMLI)-APF is validated by integrating the number of charging units with the MATLAB/Simulink tool, and simulation outcomes are shown along with comparisons.
Analysis of pulmonary function in post-Covid-19 patients at a university hospital
Authors: Sousa Pedro Henrique Borges , Targino Hugo Alexandre Sousa , Lima Júnior Fábio Antônio Serra de , Costa Camila Melo de Oliveira , Sousa Thiago Lins Fagundes de , Braga Ijanileide Gabriel de Araújo
Published: December 2023

Objective: Evaluate the spirometry pattern of patients who persisted with respiratory symptoms after infection with SARS-Cov-2. Methods: Cross-sectional, observational, retrospective study in a single center, approved by the local Ethics Committee (registration number: 5,120,720). Patients who underwent spirometry due to Post-Covid Syndrome were evaluated to analyze the spirometric pattern presented. The following were collected: exam identification data, sex, age, symptom time, the need for mechanical ventilation, and quality of spirometry, in addition to the following exam parameters: FVC, FEV1, FEV1/FVC, FEV 25-75/FVC, and FEV 75, evaluating the Lower Limit of Normality, pre-bronchodilator and post-bronchodilator values. Results: Data from 72 patients were collected.Of these, 55.5% of patients had spirometry results within normal limits. The most frequent respiratory alteration was obstructive respiratory disorder, present in 29.2% of the patients. Conclusions: The presence of dyspnea in patients with normal spirometry may indicate further evaluation of lung function and other etiologies for dyspnea.
Série temporal da dinâmica do sistema de saúde para o diagnóstico de tuberculose em uma região metropolitana do nordeste brasileiro (2010-2020)
Authors: Aragão Francisca Bruna Arruda , Berra Thais Zamboni , Fiorati Regina Célia , Arcêncio Ricardo Alexandre , Cunha José Henrique da Silva , Rodrigues Vandilson Pinheiro , Mota e Silva Carolina Guerra da , Santos Neto Marcelino , Calori Mellina Yamamura
Published: December 2023

Objetivo: Analisar a dinâmica do sistema de saúde para o diagnóstico de tuberculose em região metropolitana de um estado do nordeste brasileiro. Métodos: Estudo ecológico de série temporal realizado em São Luís, no Estado do Maranhão, região Nordeste do Brasil. A população do estudo foi composta casos de tuberculose notificados noSistema de Informação de Agravos de Notificação (SINAN) no período de 2010 a 2020. A estatística descritiva dos casos foi realizada utilizando medidas de frequência absoluta e relativa e o teste Qui–quadrado de Pearson foi utilizado para comparar as frequências entre os casos notificados em unidades de Atenção Primária a Saúde (APS) e hospitalares e a caracterização sociodemográfica e clínica. Para análise da série temporal, recorreu-se ao modelo deautorregressão Prais–Winsten, seguido do método de decomposição denominado Seasonal–Trend using Loess (STL), finalizando com a previsão da tendência temporal para os próximos anos. Os dados foram analisados utilizando os recursos do software Stata versão 17 (StataCorp, College Station, TX, USA) e R versão 3.5.2 (R Core Team, 2020). Resultados: Foram notificados 7.948 casos com diagnóstico de tuberculose, sendo 1.608 notificados em unidadesde Atenção Primária e 6.340 em unidades Hospitalares. O teste Qui–quadrado resultou na frequência relativa calculada considerando o total de paciente que possuíam resultados de cada exame com diferenças estatisticamente significantes (p < 0,05). Conclusão: Foi possível observar tendência temporal diferenciada entre o diagnóstico realizado pela APS e hospitais. Na análise e modelagem temporal houve aumento nos casos notificados na APS e estacionário nos hospitais, entretanto, na modelagem temporal houve redução do número de casos nos hospitais.
O pulsar da escritura: uma análise de Lins sobre as temáticas de Lima
Authors: Ramos Darcy Attanasio Taboada
Published: December 2023

O intento deste artigo é pôr em evidência a leitura de Osman Lins acerca de questões vitais da escrita de Lima Barreto, muitas referidas na sua tese Lima Barreto e o espaço romanesco; destacar que o pulsar da escritura limeana encontra ressonância no espírito de Lins em temáticas como o amor à literatura e as carências e os preconceitos estruturais que estão na nossa formação cultural e atingem não só os leitores, mas também escritores e editores. Com frequentes dificuldades financeiras, vivendo as dores e os estigmas da privação de saúde mental familiar e pessoal, com a consciência do racismo estrutural na sociedade brasileira, Lima Barreto alavancou forças para enfrentar tal contexto com verdadeira obsessão, sem timidez. Osman Lins, igualmente, com a publicação de Guerra sem testemunhas: o escritor, sua condição e a realidade social, um ensaio literário de 1969, dedicou-se a apontar muitos desses entraves e a dar mostras do próprio embate com o poder. Desse modo, o artigo se propõe a confirmar que, mesmo com peculiaridades em seu processo de criação literária, as análises de Lins a respeito de Lima demonstram a atitude combativa de ambos, cada qual focalizado sobre o próprio tempo.
O ensaio irrompe no romance – uma leitura dos fêneros em Lima Barreto e o espaço romanesco
Authors: Cariello Graciela
Published: December 2023

Esta comunicação é o aprofundamento da análise de Lima Barreto e o espaço romanesco, que incluí no meu livro Jorge Luis Borges y Osman Lins. Poética de la lectura (Rosario: Laborde Editor, 2007). No capítulo a ele dedicado, estudava a hibridação genérica e o traço ficcional nesse ensaio osmaniano, que designei na ocasião como “el ensayo de um novelista” (o ensaio de um romancista). Nesta nova proposta, me foco no Capítulo I “Lima Barreto: o escritor”, do livro de Osman Lins, realizando uma leitura pormenorizada dos recursos literários dos gêneros que nele se atualizam, na trilha do que o próprio autor indicava no prólogo: “essa pequena intromissão do romance no âmbito do ensaio”. Só que, na minha presente argumentação, leio a fórmula ao contrário: o ensaio é que irrompe, nesse capítulo, na escrita romanesca. O livro, designado pelo autor como ensaio múltiplas vezes no texto, sabemos, foi na origem uma tese acadêmica. Como ele respondeu a essa exigência, com qual criatividade romanesca (e ensaística), é o que tento apresentar. Nesse caminho, aliás, desvenda-se o jogo com o leitor, que devém assim um pesquisador que acompanha a descoberta do escritor por trás (ou dentro) da obra.
Lido depois, para ser repensado hoje: O nexo profundo entre Lima Barreto e Osman Lins
Authors: Barreto Francismar Ramírez
Published: December 2023

Os cem anos da morte de Lima Barreto (1922-2022) e os quarenta da escrita de Lima Barreto e o ensaio romanesco, de Osman Lins (1973-2023), é um bom momento para repensar a relação entre esses dois autores e, especificamente, a conexão entre os romances Vida e morte de M. J. Gonzaga de Sá e A rainha dos cárceres da Grécia. Textos críticos existem de muitas naturezas, mas não abundam os que, pensados por romancistas, se detenham a refletir por extenso na arquitetura ficcional da obra de algum grande nome literário do passado (também não é comum na atualidade). Redigido em um tempo breve (em torno de oito meses, segundo noticia Sandra Nitrini), o trabalho de doutoramento de Lins foi publicado em 1976 e por muito tempo ficou de lado. Contabilizado entre os primeiros aportes acadêmicos brasileiros a respeito do tema do espaço literário, e visto o progressivo crescimento da fortuna crítica do escritor pernambucano, era hora de dar sustento a essas relações. Este trabalho tenta estabelecer uma ponte teórica entre o romance de Lima Barreto, o capítulo VII do ensaio de Lins e alguns fragmentos de seu último romance publicado em 1976. São histórias com personagens isoladas; delirantes (a loucura incipiente em um deles, mais radical no do autor mais recente); que se relacionam de um modo particular com o seu espaço; que se desenvolvem em meio a fortes oposições temáticas (vida e morte; juventude e velhice; luta e capitulação; espiritualidade e materialidade; barbárie e beleza); que se veem diante de superposições (figuras e incidentes sobre cenários) e animizações; e também diante de tensões temporais. O tema é longo, mas em desdobramentos futuros será possível ampliar algumas destas notas.
Hospitalizações no Brasil pelas estimativas da Pesquisa Nacional de Saúde, 2013 e 2019
Authors: Andrade André Oliveira , Jesus Sandra Rêgo de , Mistro Sostenes
Published: December 2023

OBJETIVO: Comparar o perfil e a prevalência das hospitalizações no Brasil com base nas estimativas da Pesquisa Nacional de Saúde (PNS), 2013 e 2019. MÉTODOS: Estudo transversal seriado que utilizou os dados das PNS 2013 e PNS 2019. O desfecho foi ter ficado internado por 24 horas ou mais nos últimos 12 meses. Calculamos a proporção da população nas diversas categorias de faixa etária, de presença ou ausência de doenças crônicas e de percepção do estado de saúde. Estimamos o número total de hospitalizações e a proporção correspondente a cada categoria de faixa etária, de doença crônica e de percepção do estado de saúde. Calculamos a prevalência de internação segundo fatores geográficos, socioeconômicos e condições de saúde. Comparamos as estimativas das duas edições da PNS utilizando o teste t de Student para amostras independentes. Consideramos as diferenças significativas quando o valor de p foi menor que 0,01. E finalmente comparamos as estimativas de hospitalização com os dados administrativos para avaliar a consistência dos dados. RESULTADOS: Observamos que a proporção de doentes crônicos na população passou de 15,04% para 31,48%. Este grupo foi responsável por 36,76% do total de internações em 2013 e de 57,61% em 2019. A prevalência de hospitalizações aumentou significativamente entre os dois inquéritos e os incrementos foram maiores na região Sudeste e entre pessoas que possuem plano de saúde privado. Foi encontrada uma discrepância entre os dados administrativos e as estimativas dos inquéritos. As internações obstétricas e as internações por plano de saúde foram subestimadas. CONCLUSÃO: Houve um aumento nas taxas globais de hospitalização no período compreendido entre as PNS 2013 e 2019, especialmente entre as pessoas com melhor acesso aos serviços de saúde. O perfil de hospitalização também mudou – na PNS 2013 predominaram internações de pessoas sem doenças crônicas. Isto se inverteu na PNS 2019.
Internal consistency of the Strengths and Difficulties Questionnaire in Amazonian children
Authors: Giacomini Isabel , Martins Maria Rosário O. , Matijasevich Alicia , Cardoso Marly A.
Published: December 2023

OBJECTIVE: To describe the frequency of behavioral problems and the internal consistency of the parent version of the Strengths and Difficulties Questionnaire (SDQ-P) in Amazonian preschool children during the covid-19 pandemic. METHODS: Data from the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) study, a population-based birth cohort in the Western Brazilian Amazon, were used. The SDQ-P was applied in 2021 at the five-year follow-up visit to parents or caregivers of 695 children (49.4% of which were girls). This instrument is a short behavioral screening questionnaire composed of 25 items reorganized into five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Cases of behavioral problems were defined according to the original SDQ cut-offs based on United Kingdom norms. Moreover, cut off points were estimated based on the SDQ-P percentile results of our study sample. Internal consistency was assessed by calculating Cronbach’s alpha coefficient and McDonald’s omega for each scale. RESULTS: According to the cut-offs based on our studied population distribution, 10% of all children had high or very high total difficulty scores, whereas it was almost twice when the original SDQ cut-offs based on United Kingdom norms, were applied (18%). Differences were also observed in the other scales. Compared to girls, boys showed higher means of externalizing problem and lower means of prosocial behavior. The five-factor model showed a moderate internal consistency of the items for all scales (0.60 ≤ α ≤ 0.40), except for total difficulty scores, which it considered substantial (α > 0.61). CONCLUSIONS: Our results support the usefulness of SDQ in our study population and reinforce the need for strategies and policy development for mental health care in early life in the Amazon.
L’authenticité des généalogies des immigrés andalous au Maroc et dans les régences ottomanes à l’époque moderne entre revendications et refus
Authors: Ben el Haj Soulami Jaafar
Published: December 2023

Although al-Andalus was historically the territory of the Umayyads par excellence, certain branches of the Alid families (enemies of the Umayyads) settled there, especially in the 4th / 10th century. Over the centuries, other non-Idrisid branches also settled in al-Andalus, where the presence of these ašrāf branches was noted until the end of the Middle Ages. With the forced Christianization of all Andalusians from around 1500 in the Kingdom of Granada, and from 1523 in the Kingdom of Valencia, these branches suffered the systematic loss of family documents justifying their membership of the Prophet’s family, especially with the ransacking of Arab heritage papers. Forced into exile in 1609, in a mass exodus ordered by the Hispanic monarchy, the Andalusians found themselves exiled in the Muslim countries of North Africa, bereft of any written genealogical justification. Oral tradition was all that remained to justify their claim. They claimed the noble genealogy of the Prophet, but often to no avail, as the indigenous North African Muslims generally denied them this claim for lack of convincing justification.
Le pouvoir du chérif : perspectives sahariennes (XVIIIe/XIXe siècles)
Authors: Warscheid Ismail
Published: December 2023

This article studies the integration of Cherifian lineage groups into the social fabric of two oasis societies in western Sahara, Touat in southern Algeria and Oualata in Mauritania, during the 18th and 19th centuries. The aim is to consider the šarīf as a social actor distinct from “maraboutic” groups. We argue that Saharan šurafāʾ have a power that, although legitimized by the prestige of the genealogical link with the Prophet, can be articulated independently of the authority conferred by the status of scholar or “saint” (walī). Their power seems to rest primarily on their commitment as community leaders and, above all, on their ability to impose themselves in power relations between lineage groups, including through use of force of arms.
Eschatology, Divination, and Gassendi’s Encounter with Spanish-Netherlandish Natural Philosophy (1629)
Authors: Broecke Steven Vanden
Published: December 2023

Scholars have tended to focus on Gassendi’s relations with the mathematical, natural-philosophical, and erudite interlocutors he encountered in the Republic. This sits uneasily with the fact that Gassendi’s time in the Spanish Netherlands was about three times as long as his stay in the Republic (i.e., six weeks vs. two weeks). Drawing on the deep engagement with eschatology and divination of Gassendi’s close friend Govaert Wendelen (1580–1667) in the period between 1626 and 1632, this paper raises two questions. First, which natural-philosophical culture did Gassendi encounter in the Spanish Netherlands? Second, which similarities and divergences between Gassendi and his interlocutors does this encounter allow us to discern more clearly?
Zoonoses in Unconventional Companion Animals
Authors: Bursee Lukas J.
Published: December 2023

The keeping of unconventional companion animals represents a special area of animal husbandry. While formerly reserved for zoological institutions, nowadays more and more unconventional companion animals can be found in the care of private owners. Due to the special nature and requirements of these animals, there are people who demand legal restrictions of these husbandries. One point often mentioned in this regard is the risks of zoonoses, which are said to be higher than with classical companion animals. Considering this argument, a conflict emerges between private rights of companion animal owners and the interests of public safety. With the help of a balancing of interests, this conflict can be examined more closely and an initial assessment of the justification for restrictions can be made.
Indian Development and Its Discontents
Authors: Oommen M. A.
Published: December 2023

This monograph approaches Indian development as a pursuit to realise the idea of India as crystallised in the Indian Constitution, which left it to the Indian democratic system tasked with developing citizenship to its fullness. This great experiment in a constitutional democracy is in significant contrast to the emphasis on economic growth projected as a panacea to solve India’s problems of poverty and deprivation by economists in general. Jobless growth in the context of the unprecedented demographic dividend and growing inequality is a negation of human development, building capabilities, and social justice. The study outlines how crony capitalism and corruption undermine the pursuit of equality of opportunity, freedom, and democratic practice.
Book review: Detlef Siegfried and David Templin (Eds.), Lebensreform um 1900 und Alternativmilieu um 1980. Kontinuitäten und Brüche in Milieus der gesellschaftlichen Selbstreflexion im frühen und späten 20. Jahrhundert [Life Reform Around 1900 and Alternative Milieu Around 1980. Continuities and Discontinuities in Milieus of Social Self-Reflection in the Early and Late 20th Century] (German)
Authors: Homberg Michael
Published: December 2023

Detlef Siegfried and David Templin (Eds.), Lebensreform um 1900 und Alternativmilieu um 1980. Kontinuitäten und Brüche in Milieus der gesellschaftlichen Selbstreflexion im frühen und späten 20. Jahrhundert [Life Reform Around 1900 and Alternative Milieu Around 1980. Continuities and Discontinuities in Milieus of Social Self-Reflection in the Early and Late 20th Century] (German), V&R unipress, 2019, 429 pp., €40, ISBN 978-3-8471-1012-8 (E-book).
Surfactant for the treatment of respiratory distress syndrome in very low birth weight infants at a level 2 hospital: A descriptive retrospective cohort study – safety and efficacy
Authors: Nxumalo M , Els-Goussard I , Sprenger K , Joolay Y
Published: December 2023

Respiratory distress syndrome (RDS) is common and is a leading cause of death in pre-term infants. The purpose of our study is to describe the demographics and incidence of adverse events in very low birth weight (VLBW) pre-term infants with RDS treated with surfactant at George, a level 2 Hospital in the Western Cape Province of South Africa. This was a retrospective observational study. We conducted an electronic folder review of infants with a birth weight of 800–1200 g treated during the study period 2017–2019 at George Regional Hospital. Outborn infants and those with congenital abnormalities were excluded. The total number of patients included in the study was 66. The mortality rate was 25.8% (17/66). The incidence of bronchopulmonary dysplasia was 6% (4/66). Our study showed that the outcomes of VLBW infants treated with surfactant at level 2 hospitals are comparable to South African central hospitals.
The association between divergent thinking, personality, and listening to classical music
Authors: Hooi LY , Tan KW
Published: December 2023

Divergent thinking (DT) enables flexible thinking and the generation of a wider range of original ideas that form the basis of creativity. Although personality traits and music listening have been found to be positively correlated with DT performance, the association remains inconclusive. Furthermore, there is a debate regarding whether originality should be included as an index to measure DT. The present study examines the association between DT, personality, and classical music listening. There were 162 Malaysian adults who participated in this experiment. Participants were randomly allocated to either happy, sad classical music (i.e., listen to a repeated clip of happy or sad music), or silent conditions (i.e., no music was played). DT and personality were assessed with Figural and Realistic DT Tests and 44-item personality model with five broad factors, respectively. Positive intercorrelations were found between fluency, flexibility, originality, and DT total score. A weak positive correlation was revealed between DT total score and openness trait. However, there was no significant difference between happy, sad music, and silent conditions on DT performance. The findings support the notion that fluency, flexibility, and originality are the essential indices in measuring DT performance. The results suggest that open-minded people have better DT performance.
From Gender Re-Traditionalizations to Anti-Gender Mobilizations: Care for Family in Serbia and Croatia
Authors: Ćeriman Jelena , Vučković Juroš Tanja
Published: December 2023

This article focuses on the cases of Croatia and Serbia to demonstrate how the heteronormative model of family and the constructs of “protection of family and children”—which are central to anti-gender mobilizations—can be traced to the 1990s heteronationalist discourses of family in both countries. The authors argue that the crucial link between these two discourses is that they both increasingly problematize diverse family forms and imbue “traditional family” with special value as the structure that is “best for children” and therefore merits special legal and policy protection, with a view to its restoration as society’s unquestionable cornerstone. The analysis of narrative content in parliamentary and public debates about family-related laws and policies in Serbia and Croatia between the 1990s and the 2020s is guided by the following questions: What are the continuities in the legal framework and narratives on the family in post-socialist Croatia and Serbia compared with the period of socialist Yugoslavia? Who are the actors who create narratives of return to a traditional family in post-socialist Croatia and Serbia, and how do these actors define family and care for the family? The article calls attention to how what is “old”—narratives of return to the traditional family—forms the backbone of religious-conservative oppositions to gender and sexuality rights, including the most recent wave of anti-gender mobilizations.
Families in Times of Crisis: Narratives of Family and Care during the COVID-19 Pandemic in Slovakia
Authors: Lutherová Soňa G. , Voľanská Ľubica
Published: December 2023

Societal narratives about families, ranging from individual discourses to public discourse, do not always reflect the reality of family lives. This is also valid for Narratives of Return (NoR), which propose a return to a “natural” family order and lean on conservative ideological values. However, such a notion does not rely on actual past and present social practice but tries to reshape it. It deliberately omits the variety of existing forms and relationships present among families. During the COVID-19 pandemic in Slovakia, many processes, patterns, and problems in society became more visible. The crisis put particular pressure on families and intergenerational relationships, mainly regarding care. This paper analyses micro-narratives about families, relationships, and care, juxtaposed to actual practice, during the pandemic. We rely on data from a two-year-long ethnographic research project using online surveys, ethnographic interviews, and autobiographical texts. We compare these data with political discourse and its presentation in media, where we looked for aspects of NoR. It seems that the political discourse was primarily focused on securing public health but was at the same time oriented towards particular problems (such as natality or abortions), constructing an ideological narrative with specific family structures in mind (in accordance with NoR). Simultaneously, it put older adults at the forefront as a uniform social group that was vulnerable and dependent on others, omitting their function as caregivers of the youngest generation in the family.
Teaching Christian Ethics Beyond Europe and North America: From a Postgraduate Research Seminar to a Theology of Listening
Authors: Heimburger Robert W. , Murillo Torres Samuel Efraín , Sam James Wesly
Published: December 2023

This article explores the process of teaching Christian theological ethics beyond the common focus on European and North American sources. In conversation with moves to decolonise university curricula, the article proposes a theology of listening, an example of a research seminar for master’s and doctoral students at the University of Aberdeen on Christian ethics beyond Europe and North America, and an exploration of broader challenges for the formation of the theologian. The article asks, what can we learn when we give up power and control when teaching and learning theology? How can we shift our methods of knowing and practising theology? We write as theologians from India, Mexico, and the United States living in the United Kingdom. We reflect on forms of exclusion in theological method and formation that arise from colonising, systemic violence, and inequalities. The article considers intercultural challenges when encountering different methods of reflection on the Christian experience. In a search for a more profoundly theological approach, we propose listening to the other as integral to doing theology. In an intercultural move, we draw on Dietrich Bonhoeffer's theology of listening, proposing that theology must be an advent of voices from beyond our usual places and methods.
Assessment of safety risk in airline operations based on constant-sum game
Authors: Peng Chong , Sun Youchao , Guo Yuanyuan , Su Siyu , Chen Nongtian
Published: December 2023

Safety is the key to airline operations. The premise for ensuring safety is valid classification and scientific assessment of hazardous sources. The airlines, however, are deficient in an overall mastery and effective analysis of the hazardous sources currently. Here, we propose a model for a safety risk assessment in airline operations based on constant-sum games, with a comprehensive analysis of hazardous sources identified by airlines. The subjective and objective weights of the hazardous source indicators are balanced depending on the optimal coefficients, which are determined by deriving the countermeasure model through the constant-sum game theory. The comparative analysis of safety risks and weaknesses in management for airlines or secondary departments is then conducted. Meanwhile, a long-term reward mechanism is introduced into the model to eliminate the negative effect of a sudden increase in safety risk indices caused by the newly added hazardous sources. This method provides airlines with an accurate assessment of the safety status and an estimation of safety development which trends to make targeted decisions and realize prevention beforehand.
Acquired brown syndrome in a child with acute rheumatic fever
Authors: Assayag Elishai , Totah Hashem , Drabkin Elena , Reich Ehud , Rabinovich Ronen , Rappoport Daniel
Published: December 2023

Purpose

To describe a rare case of acquired Brown syndrome (ABS) associated with acute rheumatic fever (ARF).

Case Report

a healthy 9-year-old girl developed polyarthritis, carditis, and elevated inflammatory markers 10 days after suffering from a sore throat. She was diagnosed with ARF and was treated with systemic antibiotics and high-dose non-steroidal anti-inflammatory drug (NSAID). After 2 weeks, despite improvement of ARF symptoms, the patient presented with binocular vertical diplopia, periorbital pain, and limited elevation in adduction of the left eye. Imaging revealed a thickened trochlea-superior oblique tendon complex, and ABS due to trochleitis was diagnosed. The patient underwent a successful regional corticosteroid injection as a second-line treatment, and within a month, all signs and symptoms of ABS resolved.

Conclusions

ABS is an infrequent yet possible manifestation of ARF.
Precarious work and precarious urban spaces: Divergent experiences of pandemic creativity
Authors: Wolifson Peta , Gibson Chris , Brennan-Horley Chris , Cook Nicole ,   Pauline MGuirk, Warren Andrew
Published: December 2023

How does the precarity of creative work iterate with the precarity of creative spaces? In answer, we examine Covid-19 pandemic experiences of workers across diverse creative sectors in Sydney, Australia, drawing upon qualitative mapping research. Our findings highlight divergent experiences of precarity before and during the pandemic: many suffered, others adapted, some even thrived, depending upon the nature of their work, access to socialisation and networking opportunities, plus whether livelihood precariousness was worsened and overlaid with additional geographic factors, including venue loss, tenure vulnerability, housing insecurity, and access to production spaces. Using conceptual insights from labour and feminist geography, we argue that for the creative sectors to flourish and support diverse, well-remunerated and satisfying work, there must also be discussions of the post-pandemic geography of creative work. Space and social relations within and beyond the work sphere are co-constitutive of precarity.
Current Situation and Prospect of Adoptive Cellular Immunotherapy for Malignancies
Authors: Zhao Dong , Zhu Dantong , Cai Fei , Jiang Mingzhe , Liu Xuefei , Li Tingting , Zheng Zhendong
Published: December 2023

Adoptive cell immunotherapy (ACT) is an innovative promising treatment for tumors. ACT is characterized by the infusion of active anti-tumor immune cells (specific and non-specific) into patients to kill tumor cells either directly or indirectly by stimulating the body's immune system. The patient's (autologous) or a donor's (allogeneic) immune cells are used to improve immune function. Chimeric antigen receptor (CAR) T cells (CAR-T) is a type of ACT that has gained attention. T cells from the peripheral blood are genetically engineered to express CARs that rapidly proliferate and specifically recognize target antigens to exert its anti-tumor effects. Clinical application of CAR-T therapy for hematological tumors has shown good results, but adverse reactions and recurrence limit its applicability. Tumor infiltrating lymphocyte (TIL) therapy is effective for solid tumors. TIL therapy exhibits T cell receptor (TCR) clonality, superior tumor homing ability, and low targeted toxicity, but its successful application is limited to a number of tumors. Regardless, TIL and CAR-T therapies are effective for treating cancer. Additionally, CAR-natural killer (NK), CAR-macrophages (M), and TCR-T therapies are currently being researched. In this review, we highlight the current developments and limitations of several types of ACT.
Deterritorialisation of Korean TV dramas in “Netflix Originals”: “We are living in the Squid Game world”
Authors: Ju Hyejung
Published: December 2023

Squid Game’s phenomenal success calls attention to the local specificity of Netflix’s global expansion as it commissions original K-dramas. This practice has rich implications, both positive and negative, for Netflix’s production and distribution of Korean content. K-dramas classified as Netflix Originals have been riding its international market power to a wide range of transnational audiences, enabling national television creators to reimagine cultural spheres for both production and distribution that transgress the uneven circuit of transnational media. At the same time, the deterritorialisation of Netflix’s K-dramas raises concerns about its deep interpenetration of the Korean TV industry.
Predicting Mortality Following Odontoid Fracture Fixation in Elderly Patients: CAADS-16 Score
Authors: ElNemer William , Solomon Eric , Raad Micheal , Jain Amit , Lee Sang Hun
Published: December 2023

Study Design

Retrospective Review of a National Database.

Introduction

By utilizing a national database, this study aims to quantify the predictors of 30-day mortality after odontoid fixation and guide appropriate management for patients in whom the choice between operative and non-operative management is unclear.

Methods

The American College of Surgeons National Surgical Quality Improvement Database was queried using Current Procedural Terminology (CPT) codes and International Classification of Disease (ICD) codes to identify patients 60 or older who underwent surgical fixation of an odontoid fracture from 2005 to 2020. Risk factors for mortality significant in univariate and subsequent multivariate analysis were used to develop a scoring system to predict post-operative mortality.

Results

608 patients were identified. Patients were split into a non-mortality 30 days post-op group, and into a mortality 30 days post-op group. The following risk factors were included in the scoring system: functional dependency, disseminated cancer, albumin less than 3.5, WBC count greater than 16 k, anterior surgical approach, and pre-op SIRS. Using a cutoff value of 2, the CAAD-16 score had a sensitivity and specificity of 82% and 81%, respectively. The ASA score, cutoff at 4, showed a sensitivity and specificity of 64% and 75% respectively.

Conclusions

This sample of 294 patients represents one of the largest samples of odontoid fracture fixation patients available in the literature and comes from a nationally representative database. We structure relevant risk factors into the CAADS-16 score, which has the potential to be a clinically relevant tool to prevent short-term postoperative mortality.
Establishment of a PML-RARa Copy Number Estimator for Prototype Xpert ® PML-RARa Assay
Authors: Liu Mengying(Mona) , Zhao Yan (Amber) , Liu Yuanyuan , Wei Huilin , Goldman Dylan , Tran Tran , Yuan Lin , Day Gwo-Jen
Published: December 2023

Statement of the Problem: Acute Promyelocytic Leukemia (APL) represents 10-15% of Acute Myeloid Leukemia (AML). The PML-RARa fusion transcript is expressed in more than 95% of APL patients. Three PML-RARa isoforms (bcr1, bcr2, and bcr3) are identified in 90-95% of PML-RARa positive cases. Prototype Xpert ® PML-RARa, an automated cartridge-based assay for measuring PML-RARa fusion transcript levels (bcr1, bcr2, and bcr3), is standardized to quantify the amount of PML-RARA relative to ABL1 control gene based on delta Ct in peripheral blood. Since PML-RARa level is crucial for diagnosis and ongoing therapeutic monitoring in APL, it can be useful to obtain the PML-RARa copy number (CN). The aim of this work is to develop PML-RARa CN estimator and to compare %PML-RARa/ABL1 reporting between delta Ct-based and CN-based methods. Methodology & Theoretical Orientation: Four levels of PML-RARa (bcr1, bcr2, and bcr3) and ABL1 IVT-RNA panels as well as two lots of prototype Xpert ® PML-RARa assay were used to generate standard curves for CN and %CN reporting. The samples with spiked-in bcr1 IVT-RNA and APL clinical samples containing PML-RARa fusion transcript were examined to evaluate the CN and %CN between two lots of the prototype Xpert ® PML-RARa assay and to compare the delta Ct-based and CN-based methods for reporting %PML-RARa/ABL1. Findings: Linearity was demonstrated in Ct vs CN input for PML-RARa (R 2>0.98) and ABL1 (R 2>0.97). Less than 2-fold difference was exhibited for CN and %CN across two different lots. Less than 2-fold difference was observed in %PML-RARa/ABL1 reporting between delta Ct-based and CN-based approaches. Conclusion & Significance: A PML-RARa copy number estimator for prototype Xpert® PML-RARa assay was established, which will provide helpful information for diagnosis and prognosis of APL. (Product in development. Not for use in diagnostic procedures. Not reviewed by any regulatory body.)
Exclusive Benefits of Sustained MRD-Negative in High-Risk Multiple Myeloma
Authors: Ren Liang , Xu Tianhong , Wang Wenjing , Yang Yang , Wang Yawen , Maihemaiti Aziguli , Lan Tianwei , Li Panpan , Zhou Chi , Wang Pu , Liu Peng
Published: December 2023

Introduction: Achievement of minimal residual disease (MRD) negativity is now recognized as a strong prognostic indicator for favorable clinical outcomes in multiple myeloma (MM) patients. Nonetheless, the optimal duration of MRD-negativity as a surrogate endpoint across different levels of sensitivity remains unclear. Additionally, it is imperative to explore whether sustained MRD-negativity holds the same prognostic value for MM patients with varying risk stratifications.

Methods: In this study, 587 newly diagnosed MM patients were assessed for MRD using multiparameter flow cytometry (sensitivity of 10^-5 or 10^-6) at Zhongshan Hospital Fudan University between January 2014 and Janyary 2022. Patients were categorized as MRD-negativity not obtained (NON-MRD), obtained and sustained (SUS-MRD), or obtained and lost (LOS-MRD) based on their MRD status at given landmark point(4, 6, 12, 18, 24, and 36 months) after initiation of anti-myeloma treatment. The impact of MRD-negativity on survival outcomes was analyzed at increasing landmark times. Univariate and multivariate regression analyses were performed to examine the prognostic implications of time-dependent MRD status on overall survival in the context of different risk-stratification systems which were identified by versions of International Staging System (ISS).

Results: A total of1718 MRD tests were performed on MM patients, the median number was 3. Among survival analyses at differnet landmark time, MM patients at 12 months showed greatest separation in subsequent survival between 3 groups no matter the sensitivity of 10^-5 or 10^-6 ( p=0.032, p=0.03). Pooled analysis indicated that patients who were in SUS-MRD category with a sensitivity ≥10^-5 had superior overall survival (OS) at 12 months landmark point ( p<0.001), with comparable survival between patients in Non-MRD and LOS-MRD category ( p=0.096, Figure 1). SUS-MRD group of MM patients at 12 months did not show better OS than the rest part patients in low-risk subgroup(ISS/R-ISS/R2-ISS=I, p=0.73, p=0.28, p=0.41,respectively). Among high-risk subgroup (ISS/R-ISS=III, R2-ISS=IV), landmark survival analyses at 12 months indicated that SUS-MRD benefited patients most, as shown the greatest OS in the SUS-MRD part ( p=0.013, p=0.011, p=0.056,respectively). Multivariate cox regression analysis showed that SUS-MRD was an independent favorable variable for patients in the ISS/R-ISS=III group ( p=0.021, HR:0.429; p=0.002, HR: 0.161).

Conclusions: No matter the sensitivity of 10^-5 or 10^-6, the sustained of MRD negative lasts for 12 months is a robust marker of superior survival outcomes. MM patients who lost MRD negative has similar OS with those constant MRD positive in the long term. Benefit of Sustained MRD negative in MM limited to high risk subgroup MM patients.
Acute Myeloid and Lymphoblastic Leukemias: A NPM1 Targeting Strategy
Authors: Bento Marta Leal , Carvalho Luís , Chen Zhewei , Coelho Ana , Tang Cong , Bernardes Gonçalo
Published: December 2023

Leukemia, a wide spectrum of diseases with altered proliferation and differentiation capacity of myeloid and lymphoid blood progenitors, is the most frequent type of cancer in children and one of the most common in adults. We discovered a covalent small-molecule “probe” for the treatment of acute myeloid and lymphoblastic leukemias that allows for post-translational modulation of the proteome in these leukemia cells. The probe dramatically induces apoptosis of leukemic cells at sub-toxic doses and consistently reduces proliferation, impairs cellular metabolism and promotes chemosensitization to “standard-of-care” chemotherapy regimens. Our proteomic analysis found specific targets that are critical to the leukemia cell survival, namely Nucleophosmin (NPM1) protein, which is a nucleolar phosphoprotein that performs diverse biological functions including molecular chaperoning, ribosome biogenesis, DNA repair, and genome stability. NPM1 gene mutations represent the most common genetic lesion in adult acute myeloid leukemia and their prognostic relevance earned them recognition as a distinct entity in the 2017 World Health Organization (WHO) classification of hematopoietic neoplasms. Our findings suggest a critical role of covalent inhibition of NPM1 in maintaining acute myeloid and lymphoblastic leukemia cells survival. This finding provides a rationale for therapeutic NPM1 modulation in acute leukemias.
Reducing Preventable Bleeding Visits and Institutional Factor Costs for Patients with Bleeding Disorders with a Prospective Quality Improvement Project
Authors: Merrill Sam , Webber Sylvia , Merrill Laura , Varvoutis Megan , Shmookler Aaron Daniel
Published: December 2023

Providing optimal care to patients with bleeding disorders requires specialized physician, laboratory, pharmacy, nursing, and institutional resources best achieved at Hemophilia Treatment Centers (HTCs). Current systems for managing the care of a resource intensive patient population may be suboptimal. We observed frequent bleeding related hospitalizations and emergency room (ER) visits in patients with bleeding disorders treated at our HTC that could have been potentially prevented by changes in outpatient care delivery.

We initiated a prospective quality improvement (QI) project to improve care delivery and to reduce preventable bleeding related hospitalizations and ER visits for adult patients treated at our HTC. The interventions targeted patient-level and systems-level factors contributing to preventable visits, and barriers to care in our patient population. We compared preventable bleeding related hospitalizations and ER visits, institutional factor cost, use of prophylaxis in severe hemophilia, primary care physician attainment, and patient electronic portal enrollment before and after the QI intervention.

In our population of adult patients with bleeding disorders (N=88), the intervention significantly reduced the primary outcome of preventable bleeding hospitalization or ER visit (P=0.0082, Figure), and reduced such visits by 85.4%, meeting the pre-specified criteria for success. Institutional factor acquisition costs to treat preventable bleeding were reduced by 94.5%, from $11,800 to $640 per patient per year; a projected savings of $982,088 yearly. Use of factor prophylaxis in patients with severe hemophilia increased from 58.8% to 100%, attainment of a primary care physician increased from 69.4% to 86.4%, and use of the electronic patient portal increased from 53.2% to 83%; all secondary outcomes met pre-specified criteria of success and were statistically significant. HTC clinic visit attendance was low at 55.2%. The majority of patients (71.6%) had at least one outpatient urgent episode (mean 0.72 episode per year), and 93% had non-urgent management (mean 9.3 episodes per year) occurring outside of a clinic visit.

These data demonstrate that concerted outpatient management of patients with bleeding disorders with a quality improvement framework can reduce preventable hospitalization and ER visits. Decreased inpatient utilization resulted in substantial reductions in factor costs at the health system level. The clinical effort required to achieve these results was substantial, and required frequent provider engagement outside of regular clinic visits. The HTC can improve patient outcomes and reduce institutional costs from preventable bleeding episodes by supporting a collaborative quality improvement process led by physician, nursing, and laboratory coagulation experts.
Establishment of a BCR-ABL p190 Copy Number Estimator for Xpert ® BCR-ABL Ultra p190 Test
Authors: Liu Mengying(Mona) , Zhao Yan (Amber) , Liu Yuanyuan , Wei Huilin , Tran Tran , Yuan Lin , Day Gwo-Jen
Published: December 2023

Statement of the Problem: BCR-ABL p190 (e1a2) is expressed in 20-30% of Acute Lymphoblastic Leukemia (ALL) and 1-2% of Chronic Myeloid Leukemia (CML). The co-expression of p190 and p210 is rare in both CML and ALL. Xpert ® BCR-ABL Ultra p190, an automated cartridge-based test for measuring BCR-ABL p190 transcript level, is standardized to quantify the amount of BCR-ABL p190 relative to ABL1 control gene based on delta Ct in peripheral blood of patients. Since BCR-ABL p190 level is crucial for risk stratification and treatment decisions in ALL as well as diagnosis and continuous therapeutic monitoring in CML, it can be useful to obtain the copy number (CN) of BCR-ABL p190. The purpose of this study is to establish a BCR-ABL p190 CN estimator with known CN of e1a2-ABL IVT-RNA as well as to compare %BCR-ABL p190/ABL1 reporting between delta Ct-based and CN-based methods. Methodology & Theoretical Orientation: Nine levels of e1a2-ABL IVT-RNA as well as two lots of Xpert ® BCR-ABL Ultra p190 tests were used to generate standard curves for CN and %CN reporting. BCR-ABL p190 contrived samples and ALL clinical samples containing the BCR-ABL p190 transcript were examined to evaluate the CN and %CN between two lots of the Xpert ® BCR-ABL Ultra p190 tests and to compare the delta Ct-based and CN-based methods for reporting %BCR-ABL p190/ABL1. Findings: Linearity was demonstrated in Ct vs CN input for BCR-ABL p190 (R 2>0.99) and ABL1 (R 2>0.98). Less than 1.4-fold difference was exhibited for CN and %CN across two different lots. Less than 2-fold difference was observed in %BCR-ABL p190/ABL1 reporting between delta Ct-based and CN-based approaches. Conclusion & Significance: A BCR-ABL p190 copy number estimator for Xpert ® BCR-ABL Ultra p190 test was established, which will provide helpful information for diagnosis and prognosis of diseases relating to BCR-ABL p190.