bluuebunny/crossref_metadata_2025 huggingface dataset:
Qualia, categorias semióticas, verdade sentida: remática, pragmática, simbólica
Authors: Harkness Nicholas
Published: August 2022

É um truísmo sócio-científico, e também um problema, que as verdades sentidas “imediatas” dos indivíduos façam parte de uma semiótica “dinâmica” dos grupos sociais e, portanto, devem ser investigadas como tais. Qualia, cuidadosamente formulados como fatos de primeiridade, disagregam e esclarecem partes desse problema. Os fatos de primeiridade se tornam uma categoria semiótica metodologicamente viável a partir da reformulação, feita de acordo com o interpretante, do Triângulo de Peirce de 1903 referente aos dez tipos de signos. Este rearranjo diagramático revela o domínio da remática, estendendo-se continuamente dos sinais remáticos simbólicos mais familiares, que são os legissignos, aos qualia entendidos como casos limite de semiose nos quais a própria mediação semiótica parece estar suspensa no (e pelo) imediato estético. O rearranjo diagramático também acentua os qualia como culturalmente emergentes: sedimentos de vasta escala e operações de semiose que enganosamente guardam pouca semelhança com o seu processo de produção. Um exemplo de calibração sônica, cinestésica e visual dá respaldo à discussão.
Retórica negacionista e figuras da pós-verdade. Uma pesquisa transversal nas mídias sociais na era da Covid-19
Authors: Pezzini Isabella , Terracciano Bianca
Published: August 2022

A hipótese de investigação deste artigo postula a existência de isotopias dominantes e imagens-símbolos que cruzam todas as teorias de conspiração, independentemente de sua especificidade ideológica ou contextual. Assim, para detectar um núcleo duro ideal do universo semântico dos discursos conspiratórios, no qual convergem as várias vertentes das teorias de conspiração, assumimos que o seu denominador comum poderia ser encontrado no raciocínio figurativo, o que implica partilhar as mesmas imagens para explicar os acontecimentos actuais. O melhor campo para validar a nossa hipótese é constituído pela representação visual da pandemia de Covid-19 que circula nas redes sociais. O corpus a partir do qual a análise foi realizada cobre o período de 15 de Fevereiro de 2020 a 15 de Dezembro de 2021, e conta com milhares de publicações online. Dentro do corpus foram selecionados os posts sobre a pandemia de Covid-19 e aqueles sobre o lockdown de Março de 2020, feitos pelos principais jornais italianos, figuras institucionais e influenciadores digitais, relatados pela OMS como pontos cruciais de disseminação de desinformação, ao lado das facções conspiratórias italianas que costumam divulgar fake news no Facebook, Instagram, Telegram e Twitter.
Como estaremos em 2022
Authors: Possenti Sírio
Published: August 2022

O texto retoma alguns indícios históricos que, vistos a posteriori, parecem deixar claro que não há nenhuma novidade no que está acontecendo no Brasil hoje. No entanto, quando ocorreram, não se imaginou que eram signos de algo relativamente terrível . O caso mais grave parece ser a circulação de “polit icamente correto”, expressão ao qual se deram sentidos inimagináveis. O texto cita e comenta os casos mais escabrosos.
Bolsonarismo sem Bolsonaro? Públicos antiestruturais na nova fronteira cibernética
Authors: Cesarino Letícia
Published: August 2022

Este ensaio propõe pensar o bolsonarismo enquanto fenômeno sociotécnico, definido menos por um conteúdo ou base social fixado que por uma dinâmica circular de mobilização performativa de demandas latentes , orientada por métricas em tempo real . Sob essa perspectiva, agência e processo decisório não pertencem a atores específicos, mas são propriedades emergentes do sistema sociotécnico global por e le s formado. Sugiro que os múltiplos segmentos que entram em ressonância para formar o bolsonarismo compartilham uma dinâmica cibernética comum, que se caracteriza por introduzir, na esfera pública, bifurcações de viés antiestrutural.
Tradução e adaptação transcultural para a língua portuguesa do Brasil dos questionários "Quality of Life in Swallowing Disorders (SWAL-QOL)" e "Quality of Care in Swallowing Disorders (SWAL-CARE)" para idosos com disfagia neurogênica
Authors: Felipini Leila Maria Gumushian , Silva Nayara Ribeiro da , Berretin-Felix Giédre , Santos Carlos Ferreira dos
Published: August 2022

No Brasil, na área da Disfagia, a escassez de instrumentos clínicos é significativa. Traduzir e adaptar instrumentos disponíveis em idiomas estrangeiros é uma forma de amenizar esse problema. Assim, este estudo buscou traduzir e adaptar transculturalmente os questionários SWAL-QOL e SWAL-CARE da língua inglesa para a língua portuguesa do Brasil, considerando diretrizes e casuística específicas. O SWAL-QOL e o SWAL-CARE são instrumentos clínicos desenvolvidos para avaliar a qualidade de vida de idosos com disfagia neurogênica. Seis etapas metodológicas foram conduzidas: tradução, síntese das traduções, retrotradução, banca de especialistas, pré-teste e submissão da documentação ao comitê. Conceitos das áreas de Tradução e de Saúde foram discutidos. A versão final dos questionários em língua portuguesa foi estabelecida e considerada equivalente à original.
Differentiation of Fibroblasts Into Myofibroblasts in the Arachnoid Membrane of Moyamoya Disease
Authors: Yamamoto Shusuke , Yamamoto Seiji , Akai Takuya , Sasahara Masakiyo , Kuroda Satoshi
Published: August 2022

Background:

Moyamoya disease (MMD) is a very specific disorder in terms of spontaneous development of extracranial-to-intracranial collateral circulation through the dura mater, but the underlying mechanisms are unclear. This study aimed to investigate the role of the arachnoid membrane in this unique angiogenesis in MMD.

Methods:

A piece of arachnoid membrane and 1- to 2-mL cerebrospinal fluid were simultaneously harvested during surgery from 26 patients with MMD. The specimens were also collected during surgery as the controls from 6 patients with atherosclerotic carotid artery diseases. The arachnoid membrane was subjected to immunohistochemistry and the cerebrospinal fluid was used to measure the concentration of cytokines using ELISA.

Results:

The number of cells positive for PDGFR (platelet-derived growth factor receptor) α was significantly higher in MMD than in the controls (5.4±3.1 versus 2.3±2.1 cells/field;
P
=0.02). The results were same in PDGFRβ-positive cells (10.1±4.6 versus 4.8±2.8; P=0.01) and α-SMA (alpha-smooth muscle actin)–positive cells (8.8±3.1 versus 2.0±2.5; P<0.01). On multicolor immunofluorescence, 80.5±15.6% of cells positive for PDGFRα in MMD also expressed α-SMA, being significantly higher than 14.6±7.2% in the controls (
P
<0.01). The density of collagen in the arachnoid membrane was significantly higher in MMD than in the controls (60.3±15.0% versus 40.1±15.3%;
P
<0.01). In MMD, advanced disease stage was significantly associated with a larger number of α-SMA–positive cells in the arachnoid membrane (
P
=0.04). On ELISA, the cerebrospinal fluid concentrations of bFGF (basic fibroblast growth factor), HGF (hepatocyte growth factor), and TGF (transforming growth factor)-β1 were significantly higher in MMD than in the controls.

Conclusions:

Based on these findings, MMD may elevate the concentrations of angiogenic factors in the cerebrospinal fluid and then promote the proliferation of fibroblasts in the arachnoid membrane and their differentiation into myofibroblasts, which may, in turn, enhance the production of collagen essential for spontaneous collateral formation across the arachnoid membrane.
Forgetting to Remember: Theorizing the Role of the Forgotten In the Production of Biblical Text and Tradition
Authors: Kemp Jenna
Published: August 2022

This article examines Exod 34:11–17 by utilizing theory of cultural memory, enriched with theory of metaphor and allusion. As the author of a late text, the scribe responsible for this insertion remembers other various biblical texts via allusion, creating synthetic categories that are useful for carrying the texts forward in time. The synthesis occurs, however, not just by remembering but also by forgetting parts of the evoked texts. The fact that they can be read together strengthens the idea that multiple texts could be considered a conceptual whole. Forgetting is therefore not just about loss; it is as a result of loss extremely productive in creating and maintaining conceptual links between texts within the tradition.
“For 2300 Evenings and Mornings” (Dan 8:14): Recalculating the Cessation of the Daily Offering
Authors: Segal Michael , Wadler Shlomo
Published: August 2022

A previous study (M. Segal, “Calculating the End: Inner-Danielic Chronological Developments,” VT 68 [2018] 272–96), analyzed chronological aspects in Daniel 7–12, and suggested that they offer a key for tracing the literary development of this section. This article offers a new interpretation of the expression “2300 evenings and mornings” (8:14), generally understood as a period of time shorter than the 3.5-year tradition expressed in 9:27 and 12:11–12. In contrast, it is suggested that 2300 refers to the number of daily offerings which were to be missed due to the desecration of the Temple. This calculation was performed according to an early, pre-sectarian halakhic interpretive tradition of Leviticus 23:37–38, reconstructed based upon a Sabbath prohibition in Damascus Document XI, 17–18. When calculated according to this method, “2300 evenings and mornings” maps precisely onto 3.5 years.
Evaluating the Evidence by the UN International Investigative Mechanisms: a New Challenge for the International Criminal Court?
Authors: Micha Eleni
Published: August 2022

International criminal courts and tribunals have faced a number of challenges with respect to the assessment of evidence. For the International Criminal Court (icc) there are pressing questions regarding the best interpretation of the relevant provisions in the Rome Statute (rs). To this point, the assessment of documentary evidence conveyed by the UN Independent Investigative Mechanisms (iims) constitutes a rather unexplored area. Accordingly, the present study will reflect upon the challenges posed for the icc, in case the Court proceeds to evaluate the evidence collected by those mechanisms. Special focus will be upon the working methodology of the IIM on Syria and Myanmar. Based on the Court’s recent case-law and, in particular on the Ongwen judgment, the study will further analyze the applicability of the three-prong test of Article 69(4)rs with a view to clarifying the evidentiary standard-setting of the Court.
“Her Parents Are Exhausted and Unable to Ensure her Safety” – Families, Institutions, and Psychiatric Care in France in the Second Half of the Nineteenth Century
Authors: Le Bras Anatole
Published: August 2022

The significant increase in the number of internees in French asylums after the “Law on the insane” of 1838 raised the question of the place of the family in the system of psychiatric care. Drawing from medical and administrative literature, as well as from admission registers and patient files from four French public asylums located in the Seine and Finistère departments, this article aims at understanding how the responsibilities for care were delineated before, during, and after internment. It sheds light on the evolutions of psychiatric practices in the last third of the nineteenth century. Prompted by practical constraints as well as by new conceptions of care, these practices allowed for a more sustained cooperation between families and doctors in the processes of commitment and discharge. While the overall role of the family in the sharing of the responsibility for care was increasingly recognized, the article shows that its involvement depended on local arrangements, and on factors such as gender and class.
Ain Zhalta: A new early Barremian fossiliferous amber outcrops from central Lebanon
Authors: MAKSOUD SIBELLE , GÈZE RAYMOND , AZAR DANY
Published: August 2022

Lebanon has an extraordinarily high proportion of Mesozoic amber outcrops, some (19 outcrops) from the Kimmeridgian, Upper Jurassic (Azar et al., 2010b; Nohra et al., 2013; Maksoud & Azar, 2020); and others (more than 450 outcrops) from the lower Barremian (Granier et al., 2016; Maksoud et al., 2017; Maksoud et al., 2022), Lower Cretaceous (Maksoud & Azar, 2020). The latter number is still endlessly growing (for a very small country with a total surface of 10,452 km2). To date 28 outcrops yielding biological inclusions are known (Maksoud et al., 2019, 2020, 2021a, b, c; Maksoud & Azar, 2022).
Revealing the Odonatofauna of Northeastern Brazil: new Heteragrion Selys, 1862 (Odonata: Heteragrionidae) species from Bahia state
Authors: VILELA DIOGO SILVA , RODRIGUES MARCIEL ELIO , LENCIONI FREDERICO A. A.
Published: August 2022

Heteragrion roquei sp. nov. (Brazil, Bahia state, Municipality of Una, Fazenda Araruna, (-15.3146, -39.1621), 40 m, 19.ix.2019, M.E. Rodrigues leg., UESC) is described based on two males recently collected in Bahia state, Brazil. The new species is illustrated, diagnosed and compared with morphologically close congeners, being separated from them mainly by cercus characters, such as the medial portion and both ventrobasal / dorsobasal expansions.
Hailstone Characteristics in Northeast Italy from 29 Years of Hailpad Data
Authors: Manzato Agostino , Cicogna Andrea , Centore Massimo , Battistutta Paolo , Trevisan Mauro
Published: August 2022

Although hail is a well-known meteorological hazard, it is hard to find long records of hail observed at the ground with high spatial resolution. Most hail climatologies are based on remote sensing observations or inhomogeneous networks of human observers. In the plain of Friuli Venezia Giulia (northeast Italy), a hailpad network of 367 stations has operated since 1988. During the 1988–2016 warm seasons, 7782 hailpads were impacted by hailstones and more than one million dents were observed and automatically analyzed, even though only 63% of them were associated with valid hailstone dents. In this work, this large quantity of direct hail observations is used to build a hail climatology in terms of hailstone size, areal density, and flux of kinetic energy. From the empirical distributions of data collected, it is possible to fit statistical distributions to the different hailstone/hailpad behaviors. In particular, it is also possible to find an approximate estimation of the flux of kinetic energy based only on the largest hail diameter observed on the hailpad. Last, temporal and spatial distributions of these characteristics are investigated. Hailstones are larger along a southwestern-to-northeastern alley, which is parallel to the main pre-Alpine crest, with the very largest sizes being more frequent on the southwestern corner. The only hail climate change signal that one can infer from the analysis of these multidecadal trends is that, in more recent years, hailstorms seem to produce fewer and larger hailstones, on average.
Use of a Vacuum-Assisted Device to Facilitate Abdominal Closure
Authors: Stonerock Charles E. , Bynoe Raymond P. , Yost Michael J. , Nottingham James M.
Published: August 2022

The inability for abdominal closure in critically ill surgical patients provides a complex problem. Often, these patients are left with a large ventral hernia, which requires readmission for abdominal wall repair. We are reporting on the use of a vacuum-assisted device (VAD) to facilitate abdominal wall closure. Fifteen patients were enrolled for placement of a VAD. Selection was based on the diagnosis of abdominal compartment syndrome, the inability for abdominal closure at the initial operation, or the inability to close the abdomen upon re-exploration. Ten (67%) patients were successfully closed within 11 days using the VAD. Predictors of successful closure were the duration of VAD placement (<12 days, P < 0.001), the total amount of VAD output (<3 L, P < 0.04), the patient's cumulative fluid balance within the first 2 weeks (<2 L, P < 0.002), or the presence of a systemic infection at the time of attempted closure (P < 0.001). After 6 months, there have been no complications in patients successfully closed with this device. There have been a few recent reports describing VAD abdominal closures. While not successful for every case, the majority of our patients were able to have their abdominal wall closed primarily. We plan to use this technique to help shorten hospital stay and prevent readmission for hernia repair.
Hand-Assisted Surgery Improves Outcomes for Laparoscopic Nephrectomy
Authors: Kercher Kent W. , Joels Charles S. , Matthews Brent D. , Lincourt Amy E. , Smith Trina I. , Heniford B. Todd
Published: August 2022

Laparoscopy has become the preferred method for nephrectomy in many medical centers. We compared our experience with hand-assisted laparoscopic nephrectomy (HALN) and standard laparoscopic nephrectomy (LN). Data were prospectively collected on 119 consecutive patients undergoing laparoscopic nephrectomy between August 2000 and November 2002. Outcomes were compared for LN versus HALN using Wilcoxon rank sum test for quantitative outcomes and Fisher exact test and x2 for qualitative outcomes. Thirty-nine patients underwent LN: 16 live donor, 16 radical, and 7 simple nephrectomies. Eighty patients were treated with HALN: 47 live donor, 32 radical, and 1 simple nephrectomy. There were no differences in mean age (49.2 years LN vs. 47.7 years HALN, P = 0.60) or weight (192.2 lb LN, 179.2 lb HALN, P = 0.12). Mean tumor size (4.77 cm LN vs. 7.12 cm HALN, P = 0.07) and length of extraction incision (8.37 cm LN vs. 7.87 cm HALN, P = 0.08) were similar. Total hospital charges ($19,352 vs. $18,505, P = 0.29) and length of stay (3.68 days vs. 3.72 days, P = 0.15) were equivalent for LN and HALN. Average operative time for HALN was significantly shorter (202 minutes vs. 258 minutes, P = 0.0001), and blood loss was less for HALN (71.7 cc vs. 113.1 cc, P = 0.007). Wound complications rates were similar (6.5% HALN vs. 13% LN, P = 0.34), but overall morbidity rates were higher after LN (28.2% vs. 6.3%, P = 0.001). Compared with pure laparoscopic nephrectomy, the hand-assisted approach reduces operative time and blood loss without increasing total hospital charges or length of stay. In our patients, HALN was also associated with fewer postoperative complications than standard laparoscopic nephrectomy. Hand-assisted laparoscopy may allow for the performance of increasingly complex procedures while maintaining the benefits of minimally invasive surgery.
Radio-Frequency Ablation in Cirrhotic Patients with Hepatocellular Carcinoma
Authors: Arch-Ferrer J.E. , Smith J.K. , Bynon S. , Eckhoff D.E. , Sellers M.T. , Bland K.I. , Heslin M.J.
Published: August 2022

Current surgical treatments for hepatocellular carcinoma (HCC) include radio-frequency ablation (RFA), resection, and orthotropic liver transplant (OLT). RFA is particularly attractive in these high-risk patients because surgery is associated with high mortality and there is a relative scarcity of organs available for those in need of transplants. This study was performed to evaluate the management of cirrhotic patients with HCC undergoing RFA at a single Western institution. A retrospective study from March 1999 to June 2002 was performed to evaluate the clinicopathologic and treatment-related variables in cirrhotic patients with HCC. Forty-nine lesions in 26 patients with HCC and cirrhosis underwent RFA. Data was analyzed for safety and overall survival as the main endpoints. The mean age was 60.4 ± 11 years, 19 patients were male, 5 had hepatitis B virus, and 19 had hepatitis C virus. The Child classification was 26 per cent, 39 per cent, and 35 per cent for A, B, and C; the number of lesions was 1 in 62 per cent, 2 in 23 per cent, and more than 2 in 15 per cent. The approach was laparoscopic in 58 per cent, percutaneous in 15 per cent, and open in 27 per cent. There were no mortalities and only 1 complication. Average hospital stay was 2.7 ± 2 days. Subsequent to RFA, 9 patients underwent an OLT within a median of 4.1 months. The median follow-up of the whole group was 13 months and the disease-free survival 9.3 months. Tumor recurrence was identified in 3 previously ablated lesions, nonablated liver in 11, and as pulmonary metastases in 3. Overall survival (P = 0.03) was prolonged for those treated with RFA + OLT over RFA alone. We conclude that RFA is a safe ablative technique in high-risk cirrhotic patients with HCC. This technique may provide a bridge to OLT; however, it remains to be proven whether it prolongs survival in those who do not undergo OLT.
Malignant Duodenal Somatostatinoma Presenting in Association with von Recklinghausen Disease
Authors: Patel Vijaykumar G. , Henderson Vernon J. , Fairweather David A. , Fortson James K. , Weaver William L. , Martin David M. , Lyons Ralph , Hamami Amir
Published: August 2022

Somatostatinomas are extremely rare periampullary malignant neuroendocrine tumors that may be associated with von Recklinghausen disease or type-I neurofibromatosis. Duodenal somatostatinomas are distinguished from pancreatic somatostatinomas by their frequent association with type-I neurofibromatosis and typically absence of somatostatinoma syndrome. We report a very rare and atypical case of malignant duodenal somatostatinoma presenting with somatostatinoma syndrome in association with type-I neurofibromatosis.
Minimally Invasive Parathyroidectomy: How Effective is Preoperative Sestamibi Scanning?
Authors: Vassy W. Matthew , Nelson Henry S. , Mancini Matthew L. , Timaran Carlos H. , Hall Nathan C. , Smith Gary T.
Published: August 2022

Minimally invasive parathyroidectomy (MIP) guided by preoperative sestamibi scanning has been shown to reduce operative time, hospital stay, and cost in treating primary hyperparathy-roidism. However, controversy exists over routine preoperative sestamibi scanning. The purpose of this study was to determine the utility of sestamibi scanning at our institution as part of the MIP protocol and to analyze calcium and parathyroid hormone levels as possible predictors of successful sestamibi scanning. Charts of 37 consecutive patients undergoing MIP at our institution were reviewed, and age, sex, preoperative calcium, and parathyroid (PTH) levels, invasiveness of procedure, and pathologic diagnosis were recorded. Sestamibi scans were reviewed and scored by 4 nuclear medicine faculty based on the level of suspicion for parathyroid adenoma. Neither calcium nor PTH correlated significantly with sestamibi scan score (Spearman coefficient, r = 0.075, P = 0.67 and r = 0.277, P = 0.10, respectively). Receiver-operating-characteristic (ROC) analysis showed sestamibi scanning to have sensitivity and specificity in predicting MIP completion (87% and 68%). Logistic regression showed only sestamibi scan (P = 0.038), not calcium or PTH (P = 0.977 and P = 0.767) to be predictive of MIP completion. In conclusion, sestamibi scanning effectively predicted the ability to perform MIP. However, preoperative calcium and PTH predicted neither sestamibi scan results nor completion of MIP.
Injuries in Pediatric Patients with Seatbelt Contusions
Authors: Campbell D.J. , Sprouse L. Richard , Smith Lisa A. , Kelley Joseph E. , Carr Michael G.
Published: August 2022

Children restrained with lap belts may sustain severe injuries. We investigated the frequency of each type of injury associated with seatbelt contusions. The medical records of all trauma patients with ICD-9 codes for abdominal wall contusions from January 1,1999, to December 31, 2001, were reviewed. All patients with seatbelt contusions were included in the study. Age, seat position, weight, restraint-type, sex, and mechanism of injury were noted. There were 1447 admissions for trauma over the 3-year period. Forty-six patients (ages 4-13) had a seatbelt contusion. Thirty-three wore lap belts, and 13 wore lap and shoulder harnesses. Twenty-two children required abdominal exploration. Small bowel injuries were the most common intra-abdominal injuries. Facial injuries were the most common associated injuries. Forty-eight per cent of children with seatbelt contusions in our institution required surgery. The smaller patients tend to have higher frequency of abdominal injuries. The presence of seatbelt contusion indicates the possibility of severe internal injuries.
Her2 Expression in Thyroid Tumors
Authors: Mondi Matthew M. , Rich Ryan , Ituarte Phillip , Wong Mariwil , Bergman Simon , Clark Orlo H. , Perrier Nancy D.
Published: August 2022

Similarities exist in hormone receptors of breast, prostate, and thyroid tumors. HER2 oncogene expression is known to be present in breast and prostate tumors, but conflicting data have been published about its presence in thyroid tumors. This uncertainty prompted us to examine the incidence of HER2 overexpression in normal and malignant thyroid tissue. Normal and neoplastic thyroid tissue samples from 46 female and 9 male patients were assayed for HER2 expression by immunohistochemical assay. Of the 55 total samples, 36 were from neoplasms and 19 were from benign tissues. Significant HER2 overexpression was not found in any benign or malignant thyroid tissue. Two of 6 thyroid carcinomas from male patients showed 1+ reactivity for HER2 expression on immunohistochemistry assay, but remained negative on fluorescene in sito hybridization confirmatory testing. No significant expression of HER2 was noted in benign or malignant thyroid tissue. These results cast doubt on the value of HER2 as a prognostic factor or possible target for specific antitumor therapy for thyroid cancer.
Thoracotomy for Blunt Trauma: Traditional Indications May Not Apply
Authors: Hoth Jason J. , Scott Melanie J. , Bullock Timothy K. , Stassen Nicole A. , Franklin Glen A. , Richardson J. David
Published: August 2022

The indications for performing as urgent thoractomy after trauma are based on the criteria used for penetrating injuries. However, few data are available on the use of these indications for patients with blunt injuries. In a retrospective study (June 1996 to July 2001), we compared the indications of urgent thoracotomy after blunt injury and penetrating injury in patients who underwent thoracotomy within 24 hours of hospital admission at our institution. Patients with blunt aortic injuries or emergency department thoracotomies were excluded from evaluation. Fifty-nine patients were identified (37 penetrating injuries, 22 blunt injuries). Blunt trauma victims had a higher mortality rate than penetrating trauma victims (73% vs. 22%). Chest tube output was the indication for nontherapuetic thoracotomy in 5 patients with blunt injuries whereas this occurred in only 1 penetrating injury victim (P = 0.04). All 5 blunt injury patients underwent a prior procedure and were coagulopathic when thoracotomy was performed. In conclusion, tho-racotomy following blunt trauma is associated with a high rate of mortality. The rate of non-therapeutic exploration is increased when chest tube output is the indication for thoracotomy after blunt trauma. Since the majority of such patients have multicavitary injuries that require prior operation and are commonly coagulopathic, caution should be exercised when deciding whether to proceed with thoracotomy based solely on chest tube output.
Assessment of Individual Hand Performance in Box Trainers Compared to Virtual Reality Trainers
Authors: Madan Atul K. , Frantzides Constantine T. , Shervin Nina , Tebbit Christopher L.
Published: August 2022

Training residents in laparoscopic skills is ideally initiated in an inanimate laboratory with both box trainers and virtual reality trainers. Virtual reality trainers have the ability to score individual hand performance although they are expensive. Here we compared the ability to assess dominant and nondominant hand performance in box.trainers with virtual reality trainers. Medical students without laparoscopic experience were utilized in this study (n = 16). Each student performed tasks on the LTS 2000, an inanimate box trainer (placing pegs with both hands and transferring pegs from one hand to another), as well as a task on the MIST-VR, a virtual reality trainer (grasping a virtual object and placing it in a virtual receptable with alternating hands). A surgeon scored students for the inanimate box trainer exercises (time and errors) while the MIST-VR scored students (time, economy of movements, and errors for each hand). Statistical analysis included Pearson correlations. Errors and time for the one-handed tasks on the box trainer did not correlate with errors, time, or economy measured for each hand by the MIST-VR (r = 0.01 to 0.30; P = NS). Total errors on the virtual reality trainer did correlate with errors on transferring pege (r = 0.61; P < 0.05). Economy and time of both dominant and nondominant hand from the MIST-VR correlated with time of transferring pegs in the box trainer (r = 0.53 to 0.77; P < 0.05). While individual hand assessment by the box trainer during 2-handed tasks was related to assessment by the virtual reality trainer, individual hand assessment during 1-handed tasks did not correlate with the virtual reality trainer. Virtual reality trainers, such as the MIST-VR, allow assessment of individual hand skills which may lead to improved laparoscopic skill acquisition. It is difficult to assess individual hand performance with box trainers alone.
The Effect of Antiplatelet Agents on Thromboelastography
Authors: Westfall Kristen M. , Ramcharan Roger N. , Shulkosky Megan M. , Wahl Wendy L. , Hecht Jason P.
Published: August 2022

Background

Thomboelastography (TEG) is a point of care viscoelastic test that provides an assessment of clot formation and kinetics. Antiplatelet agents are commonly used but there is limited literature evaluating their possible effects on overall clot kinetics. We aimed to evaluate the relationship between antiplatelet agents and clot kinetics as defined by TEG.

Methods

This is a retrospective study of adult patients who underwent TEG from February 2018 to July 2020. Patients who received anticoagulants or blood transfusions within 72 hours, had an incomplete TEG, were diagnosed with COVID-19, or had liver failure were excluded. Patients were stratified based on antiplatelet status.

Results

Of 1060 patients, 119 were included (50 controls, 69 antiplatelet agents—37 aspirin monotherapy, 26 dual antiplatelet therapy). Between the control and antiplatelet therapy groups, there was no significant difference in clot time, maximal clot strength, or fibrinogen level. When compared to control patients, patients on dual antiplatelets had significantly higher fibrinogen levels (408.1 mg/dL vs 481.5 mg/dL, P = .013) but no significant differences in clot time or maximal clot strength. In our subgroup analysis, patients on dual antiplatelets had increased maximal clot strength (58.8° vs 63°, P = .005) and fibrinogen levels (384.1 mg/dL vs 481.5 mg/dL, P = .005) compared to those on aspirin alone.

Discussion

Compared to control patients and those on aspirin alone, patients on dual antiplatelets have increased maximal clot strength and increased fibrinogen levels. These results can help physicians better target product resuscitation in patients who are on antiplatelet agents.
Comparison Between Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Unstable Angina with Preserved Left Ventricular Systolic Function
Authors: Xiao Jiong , Liu Linze , Lin Wenhua
Published: August 2022

The present study evaluated the clinical results of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) treatment in patients with unstable angina (UA) with preserved left ventricular systolic function who underwent percutaneous coronary intervention (PCI) due to uncertainty regarding the long-term prognosis using ACEI or ARB. A total of 1627 UA patients with preserved left ventricular systolic function after PCI were enrolled. After propensity score matching, there were no differences in major adverse cardiovascular and cerebrovascular events (MACCEs) (hazard ratio (HR) = .860, 95% confidence interval (CI): .465–1.590, P = .630), all-cause death (HR = .334, 95% CI: .090–1.238, P = .101), nonfatal myocardial infarction (HR = 4.929, 95% CI: .576–42.195, P = .145), stroke (HR = 1.049, 95% CI: .208–5.290, P = .954) and target vessel revascularization (TVR) (HR = 1.276, 95% CI: .537–3.031, P = .581) between the ACEI and ARB groups. In conclusion, prognoses were comparable between ACEI or ARB treatment in UA patients who had preserved left ventricular systolic function after PCI.
Short-Term Efficacy of the Transnasal-Transoral Approach to Endoscopic Nasopharyngectomy for Nasopharyngeal Adenocarcinoma
Authors: Tan Qingjian , Yang Qing , Li Hao , Li Mingtian , Chen Wenkuan , Liang Zicong , Yang Zhongyuan , Li Yin , Ning Li , Zhao Chong , Guo Xiang , Yang Ankui , Shan Hongbo , Ouyang Dian
Published: August 2022

Objectives:

Nasopharyngeal adenocarcinomas (NPACs) are rare malignant tumors. The treatment of NPACs is usually surgery with resection of normal nasal passage tissues.We introduced an innovative double endoscopic surgery for NPACs patients and evaluated the clinical efficacy of this approach.

Methods:

The clinical data of 4 NPACs patients who underwent radical endoscopic nasopharyngectomy using a combined transnasal and transoral approach were analyzed to determine the efficacy of this surgery. The endpoints were en bloc resection and relief of clinical symptoms.

Results:

All surgeries were successfully performed without any severe postoperative complications or death. Postoperative MRI revealed that en bloc resection was achieved for all patients with NPACs, and they had high quality of life without postoperative complications.

Conclusions:

The transnasal-transoral approach to endoscopic nasopharyngectomy for nasopharyngeal adenocarcinoma is safe and effective.
Impact of the COVID-19 Pandemic on Children and Adolescents Presenting With a Psychiatric Emergency
Authors: Erjavac Benjamin W. , Rolin Alicia I. , Gondy Keerthi , Cranford James A. , Shobassy Ahmad , Biermann Bernard J. , Rogers Alexander J. , Hong Victor
Published: August 2022

This mixed-methods survey study aims to describe the effects of the COVID-19 pandemic on the mental health of a sample of 571 children and adolescent seeking psychiatric emergency care. The study was conducted from July to October 2020 at a large Midwestern academic center. Among the respondents, there were significant increases in mental health symptoms attributed to the COVID-19 pandemic, including anxiety (71% of respondents), depression (66%), suicidal thoughts or behaviors (45%), and aggression (31%). There were significant differences in reported increases in symptoms by age and gender. In addition, 38% of participants reported that the pandemic led to a change or closure of their health care treatment, including mental health providers, with 22% reporting that reduced treatment access led to their emergency visit. Further research is indicated to assess other, more diverse populations, as well as the longer-term mental health impacts of the pandemic.
Expanding Neuroprotective Care: A Trauma-Informed Approach to Delivery of Services within Pediatric Inpatient Units
Authors: Agoston A. Monica
Published: August 2022

Children with a history of trauma or adverse childhood experiences may be at higher risk for poor psychological and physical responses to medical experiences aimed at enhancing their well-being. Health care institutions are aware of the need for integration of trauma-informed care (TIC) practices yet struggle to find frameworks that promote resiliency to medical stress. An approach called neuroprotective care buffers the effects of toxic stress negatively affecting child health and well-being. Although often used in neonatal and cardiac intensive care units, the development and broad implementation of universal neuroprotective care measures across age groups and hospital settings has not been previously explored. An expanded neuroprotective care protocol takes a prevention approach to TIC. It fits a TIC framework, accounts for children’s ecological, biological, and developmental needs, protects them against medical traumatic stress and retraumatization, and provides a tailored, measurable approach that systematically preserves child well-being within hospital settings.
A qualitative evaluation of a campus wide COVID-19 health education campaign: Intent, impact, and ideas for the future
Authors: Teti Michelle , David Ifeolu , Myroniuk Tyler W , Schatz Enid
Published: August 2022

Background:

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the diseases it causes remain a public health threat. Data describing health education campaigns for COVID-19 on university and college campuses are lacking, however.

Purpose:

This study explored college students’ experiences of a USA campus COVID-19 campaign encouraging masking, social distancing and handwashing.

Methods:

We conducted in-depth interviews with 33 demographically diverse students. Questions focused on students’ experiences during COVID-19, actions and beliefs, and reactions to the university’s COVID-19 prevention campaign. Thematic analysis was used to evaluate responses to the campaign and identify suggestions for future interventions.

Results:

Students identified three areas of concern – lack of enforcement for nonadherence, inequities and inconsistencies in messaging and failure to connect messages to students’ daily experiences – as problematic. Participants also said the campaign did not address their primary COVID-19 concerns, outlining four thematic content areas needing more attention – learning in quarantine, missing the ‘college experience’, difficult social relationships and chaos and uncertainty.

Discussion:

COVID-19 prevention campaigns on campus may be best served by a holistic ecological model engaging with needed forms of support on multiple levels.

Conclusion:

Health education and promotion campaigns that speak to individual, relational, community and policy aspects of disease such as COVID-19 are more promising than campaigns that promote single prevention actions.
Freedom, work and organizations in the 21st century: Freedom for whom and for whose purpose?
Authors: Lindebaum Dirk , den Hond Frank , Greenwood Michelle , Chamberlain James A , Andersson Lynne
Published: August 2022

This article critically interrogates the meaning of freedom and its current and potential relationship with social relations in and around work as introduction to this special issue. This interrogation is vital given neoliberalism’s evaluative promise for more individual and corporate freedom, while concurrently limiting the conditions for the experience/expression of freedom of workers. Consequently, there are concerns about working for “private governments”, workers being subject to electronic surveillance, and workers increasingly caught up in structural disadvantages (i.e. precarious work) that contribute to growing unfreedom. Rather than reproducing abstract principles around freedom, this article and special issue advance a contextually sensitive emergence of freedom. We explicate this emergence as (i) alternative experiences of freedom, (ii) alternative conceptions of freedom, and (iii) alternative modes of organizing. To inspire future research, we extend these themes to suggest that treating freedom (i) as pluralist/relational and (ii) as having the capacity for world-making has meaningful implications for how work is organized and for whose benefit. We advocate an explicit turn to non-neoliberal values (e.g. collectivism, solidarity, human dignity, respect, and recognition) to enable more relational versions of freedom that can serve as a basis for freedom as world-making at work and in society.
An on-site temperature prediction method for passive thermal management of high-temperature logging apparatus
Authors: Xue Zhibo , Zhang Cheng , Li Zhaopu , Cheng Jingjing
Published: August 2022

In the downhole oil and gas industry, temperature prediction is an important means to avoid the hazards brought by the high-temperature environment to electronic devices. An improved adaptive Kalman filter (IAKF) temperature prediction method, used here as a virtual sensor, can predict the instrument temperature in real time. It uses the temperature state transfer matrix as a system adaptive discriminant parameter to improve the prediction accuracy of the model. This approach is a data-driven prediction method for practical, field-deployable application, it does not require modeling of heat transfer mechanisms and does not require data sets. Experiments results show that the IAKF model can effectively predict the changing trend of the apparatus in the next 30 min, and the maximum temperature prediction error is within 6.5°C. Its predictions are more stable and accurate than the extended Kalman filter, and it consumes very little CPU resources to run in embedded devices.
Robust self-adaptive Kalman filter with application in target tracking
Authors: Chen Yi-Wei , Tu Ken-Ming
Published: August 2022

Kalman filter has been applied extensively to the target tracking. The estimation performance of Kalman filter is closely resulted by the quality of prior information about the process noise covariance (Q) and the measurement noise covariance (R). Therefore, the development of adaptive Kalman filter is mainly to reduce the estimation errors produced by the uncertainty of Q and R. In this paper, the proposed self-adaptive Kalman filter algorithm has solved the problems of covariance-matching method about the determination of the width of the window and the addition of storage burden and that can update Q and R simultaneously. Simulation results confirm that the proposed method outperforms the traditional Kalman filter and has the better estimation performance than the other two adaptive Kalman filters in the target tracking. The developed filtering algorithm has the following characteristics: high robustness, low computing load, easy operation and tuning Q, R simultaneously.
Digital Tools Adopted by Public Health Agencies to Support COVID-19 Case Investigation and Contact Tracing, United States, 2020-2021
Authors: Surio Priyanka , McLean Jody E. , Jain Ankur , Chughtai Zeeshawn , Ruebush Elizabeth , Lane J.T. , Ali Hammad , Pina Jamie
Published: August 2022

During the COVID-19 pandemic, public health agencies implemented an array of technologies and digital tools to support case investigation and contact tracing. Beginning in May 2020, the Association of State and Territorial Health Officials compiled information on digital tools used by its membership, which comprises 59 chief health officials from each of the 50 states, 5 US territories, 3 freely associated states, and the District of Columbia. This information was presented online through a publicly available technology and digital tools inventory. We describe the national landscape of digital tools implemented by public health agencies to support functions of the COVID-19 response from May 2020 through May 2021. We also discuss how public health officials and their informatics leadership referenced the information about the digital tools implemented by their peers to guide and refine their own implementation plans. We used a consensus-based approach through monthly discussions with partners to group digital tools into 5 categories: surveillance systems, case investigation, proximity technology/exposure notification, contact tracing, and symptom tracking/monitoring. The most commonly used tools included the National Electronic Disease Surveillance System Base System (NBS), Sara Alert, REDCap, and Maven. Some tools such as NBS, Sara Alert, REDCap, Salesforce, and Microsoft Dynamics were repurposed or adapted for >1 category. Having access to the publicly available technology and digital tools inventory provided public health officials and their informatics leadership with information on what tools other public health agencies were using and aided in decision making as they considered repurposing existing tools or adopting new ones.
Evaluating COVID-19 Exposure Notification Effectiveness With SimAEN: A Simulation Tool Designed for Public Health Decision Making
Authors: Streilein William , Finklea Lauren , Schuldt Dieter , Schiefelbein M. Curran , Yahalom Raphael , Ali Hammad , Norige Adam
Published: August 2022

Objectives:

Exposure notification (EN) supplements traditional contact tracing by using proximity sensors in smartphones to record close contact between persons. This ledger is used to alert persons of potential SARS-CoV-2 exposure, so they can quarantine until their infection status is determined. We describe a model that estimates the impact of EN implementation on reducing the spread of SARS-CoV-2 and on the workload of public health officials, in combination with other key public health interventions such as traditional contact tracing, face mask wearing, and testing.

Methods:

We created an agent-based model, Simulated Automated Exposure Notification (SimAEN), to explore the effectiveness of EN to slow the spread of SARS-CoV-2. We varied selected simulation variables, such as population adoption of EN and EN detector sensitivity configurations, to illustrate the potential effects of EN. We executed 20 simulations with SimAEN for each scenario and derived results for each simulation.

Results:

When more sensitive versus more specific EN configurations were compared, the effective reproductive number, RE, was minimally affected (a decrease <0.03). For scenarios with increasing levels of EN adoption, an increasing number of additional infected persons were identified through EN, and total infection counts in the simulated population decreased; RE values for this scenario decreased with increasing EN adoption (a decrease of 0.1 to 0.2 depending on the scenario).

Conclusions:

Estimates from SimAEN can help public health officials determine which levels of EN adoption in combination with other public health interventions can maximize prevention of COVID-19 while minimizing unnecessary quarantine in their jurisdiction.
Robustification of the state-space MRAC law for under-actuated systems via fuzzy-immunological computations
Authors: Saleem Omer , Rizwan Mohsin , Awan Fahim Gohar
Published: August 2022

This paper formulates an enhanced Model-Reference-Adaptive-Controller (MRAC) that is augmented with a fuzzy-immune adaptive regulator to strengthen the disturbance-attenuation capability of closed-loop under-actuated systems. The proposed scheme employs the conventional state-space MRAC and augments it with a pre-configured fuzzy-immune mechanism that acts as a superior regulator to dynamically modulate the adaptation gains of the Lyapunov gain-adjustment law. The immunological computations increase the controller's adaptability to flexibly manipulate the damping control effort under exogenous disturbances. The efficacy of the proposed Immune-MRAC law is comparatively analyzed under practical disturbance conditions by conducting real-time hardware experiments on the QNET rotary pendulum. The experimental outcomes validate the faster transient-recovery behavior and stronger damping effort of the proposed control law against the exogenous disturbances while preserving the system's asymptotic stability and control energy efficiency.
Foot notes: Retracing the steps towards diagnosis
Authors: Engle Karen
Published: August 2022

In this article, I describe the experience of a chronic pain diagnosis. Combining memoir, medical history, and literary precedents, I begin with a reflection on my own history with walking. Walking leads to foot pain which eventually leads to diagnosis of a full-body chronic condition: fibromyalgia. Through an exploration of the history of hysteria, one of fibromyalgia’s ancestors, I consider some of the resonances between these conditions.