bluuebunny/crossref_metadata_2025 huggingface dataset:
Is there a role for a diabetes specialist on the AMU?
Authors:   Portsmouth Hospitals NHS Trust, Kar Partha
Published: June 2021

Many specialists have taken time to adjust to the development of acute medicine and Acute Medical Units (AMUs). As these concepts have evolved, so has the understanding of how specialists can better interact with their new acute medicine colleagues and how they help to ensure the smooth running of one of the most vital cogs of the hospital ‘machine’. For some specialties (Cardiology , Respiratory Medicine etc), it has been relatively straightforward to integrate into the new model – perhaps due to the sheer numbers of acute patients relevant to those specialties. However, for the chronic disease specialties such as diabetes, it has been less easy to understand how to optimize the interface with acute medicine.
Journal Watch: October 2012-January 2013
Authors:   University Hospital of North Durham, Taranu R , Atkinson J ,   City Hospitals Sunderland Foundation Trust
Published: June 2021

In this article we are presenting 4 articles of interest to acute physicians. We reviewed literature covering the period August to October 2012 in The New England Journal of Medicine, BMJ, JAMA and the Lancet.
Correspondence
Authors:   Royal Liverpool University Hospital Prescot Sreet Liverpool L7 8XP, Renton Bryan
Published: June 2021

Dear Sir, I read with interest the article by Langford et al in the recent edition of Acute Medicine, summarising the NICE guidance for the management of venous thromboembolic diseases.1 This highlights the recommendation that CTPA should be the investigation of choice for patients with suspected pulmonary embolism (PE), in view of its clinical and cost effectiveness.
The NICE Guideline on chest pain of recent onset: What does it mean for the Acute Physician?
Authors:   Swindon Great Western Hospital, Cannon Charlotte
Published: June 2021

The long-awaited guideline from the National Institute for Health and Clinical Excellence (NICE) for the management of chest pain of recent onset has now been published. This provides detailed recommendations for the management of patients with chest pain of possible or likely cardiac origin. This clarity should be welcomed by Acute Physicians who have seen a significant increase in emergency referrals to hospital, of which up to 25% in our practice are patients with chest pain. The guidance aims to help and support healthcare professionals to direct their patients into the appropriate referral stream.
Editorial
Authors:   Acute Medicine University Hospital Southampton Foundation Trust Tremona Road Mail Point 520 Southampton SO16 6YD UK, Roseveare Chris
Published: June 2021

Welcome to this special 10th anniversary edition of the Acute Medicine journal. Yes – there really have been 30 editions since Vol 1 issue 1, then the ‘CPD Journal of Acute Medicine’ rolled off the press. The journal has clearly evolved and expanded since then – both in terms of circulation and page count; submissions continue to rise in number and quality, ref lecting increased readership and developing interest in acute medicine as a speciality. We are marking the anniversary with a series of guest editorials, from inf luential figures in the development of the speciality over the past decade. I am delighted that Sir George Alberti agreed to write the first of these. George was the President of the Royal College of Physicians of London at the time of this journal’s first edition, and was instrumental in the developments leading up to the creation of the speciality of Acute Internal Medicine. After describing the challenges which the speciality has faced in its ‘gestation and birth’, he concludes that Acute Medicine has now reached its ‘rumbustious’ infancy with a bright future. ‘Overly exuberant or uncontrollably boisterous’, its definition, according to my Google dictionary are terms reminiscent of the past few weeks on our AMU. Hopefully, by the time this reaches printing, spring will be in the air and the dark days of winter, f lu and norovirus will be a distant memory. Optimism is as important as exuberance when working at the front line! As I mentioned in my last editorial, this year will see an increase from three to four issues, with the addition of a ‘trainee section’ containing a variety of new features. I hope that these will be of general interest, not just for the trainees. We have included a number of research-based articles this time, ref lecting some of the excellent work being done on acute medical units around the country. We still need to attract more research submissions if we are going to maintain the quality of the journal and develop into the high impact publication which the speciality so badly needs. Case reports continue to f lood in to the publishers and I am pleased that we are able to include a selection of these. The correspondence section is empty this time, after none was received in time for the publication deadline, but I hope this will return in the next edition. Finally, a word of thanks to the editorial committee, our external referees and, of course, the readers, for all the support over the past decade. The editorial team have worked tirelessly filtering, refereeing and selecting suitable articles for publication. Additional offers of help are always welcomed – please email me with details of any special areas of interest or expertise which you may be able to offer. In the meantime, I hope you enjoy reading this edition, and look forward to meeting some of you at the SAM meeting in May.
An Unusual Cause of Septicaemia
Authors:   Department of Acute Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Nadarajah Channa Vasanth , Asghar Syed Ali ,   Department of Acute Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Saif Imran ,   Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust
Published: June 2021

Splenic infarction occurs when occlusion of splenic vasculature leads to ischemia, and subsequent tissue necrosis. It is a rare condition. Most patients have an underlying haematological or malignant process or a potential source of embolism. This article describes a patient who presented with unexplained sepsis to the acute medical unit; investigation revealed a splenic abscess and primary hyperparathyroidism, but no evidence of an underlying cause.
Severe recurrent hypoglycaemia following discontinuation of olanzapine
Authors:   Diabetes and Endocrinology Sunderland Royal Hospital, Sunderland, Steven Sarah , Nayar Rahul ,   Diabetes and Endocrinology Sunderland Royal Hospital, Sunderland
Published: June 2021

Severe hypoglycaemia is a diagnostic challenge.1 It is often explained by mismatch between insulin doses, food ingestion and exercise. Recurrent hypoglycaemia can indicate underlying medical problems. Drug related events usually concern insulin or sulphonylureas. However, withdrawal of drugs which can cause insulin resistance can be causative if insulin or sulphonylureas continue.2We report the case of an insulin-treated patient who presented with severe recurrent hypoglycaemia. After exclusion of secondary causes of hypoglycaemia it was established that at the time of diagnosis of diabetes he had been taking olanzapine. This had subsequently been discontinued. Olanzapine is recognised to cause diabetes and diabetic ketoacidosis. Our patient was able to discontinue insulin therapy.
Trainee Update
Authors: Miller Alice , Bonnici Tim
Published: June 2021

The new trainee section of the Acute Medicine journal gives us an excellent opportunity to keep trainees up-to-date with the latest news. We will provide you with a summary of relevant information coming directly from both the Society for Acute Medicine and the Acute Medicine Specialty Advisory Committee (SAC).
The patient with haematemesis and melaena
Authors:   Gastroenterology, John Radcliffe Hospital, Oxford OX3 9DU, Kent A J , O’Beirne J ,   Royal Free Hospital, London, Negus Rupert ,   Acute Medical Service, The Royal Free Hospital, The Royal Free London NHS Foundation Trust, Pond Street Hampstead, London NW3 2QG
Published: June 2021

Bleeding from the upper gastrointestinal (GI) tract is a common medical emergency, with an incidence of between 50-150 cases per 100,000 per year.1 A recent audit by the British Society of Gastroenterology showed the mortality rate from upper GI bleeds has fallen from 14%2 in 1993 to 10% in 2007.3 However, despite the use of proton pump inhibitors (ppis), admission rates for peptic ulcer haemorrhage have increased in older age groups,4 probably related to increased use of antiplatelet agents such as aspirin and clopidogrel and anticoagulants in acute coronary syndromes, stroke and atrial fibrillation. The rising age of the population may also have offset further reductions in mortality and morbidity that may have otherwise come about through improved supportive and endoscopic care.
Picture Quiz: A Red Man on the AMU
Authors:   25 Bernard Ireland House, Royal United Hospital, Bath, BA1 3NG, Kamour Ashraf , Thompson Andrew ,   Musgrove Park Hospital, Parkfield Drive, Taunton, Somerset.
Published: June 2021

A fifty-eight year old man was referred to the Acute Medical Unit by his general practitioner with a generalised erythematous rash. The rash had appeared 3 weeks earlier, initially affecting his back, but had not responded to topical emollient treatment, nor the subsequent addition of an antibiotic.
Acute and General Medicine on Opposite Sides of the World
Authors:   Internal Medicine Society of Australia and New Zealand & Royal Australasian College of Physicians, MacDonald Alasdair B
Published: June 2021

The environments in which General, Acute and Emergency Medicine have evolved in Australia, New Zealand and the United Kingdom have differed significantly. As a result of this, the development and the role of Acute Medicine have also had significant contrasts but there are also many similarities and opportunities for shared learning. We are now in a position to look maturely at our services and allow a little constructive ‘compare and contrast’. Confidence in our own models means now we can each embrace diversity rather than believe one size fits all – not just across the world but also in our own backyards.
Preventing deaths in Ambulatory Care from Isolated Pelvic Vein Deep Vein Thrombosis: Mortality and Mortality Meetings have a key role
Authors:   Acute Medicine, Queen Alexandra Hospital, Cosham, Portsmouth, Wileman Joe
Published: June 2021

Isolated Pelvic vein Deep Venous Thrombosis (DVT) is a relatively rare phenomenon, but is usually not identified by conventional lower limb duplex Ultrasound scanning. We present two cases of isolated iliac vein thrombosis; the first resulting in the patient’s death from Pulmonary Embolism (PE) after normal lower limb duplex scan. The second case was identified and successfully treated after introduction of a revised investigation algorithm following the first case. The literature supports the use of magnetic resonance imaging, CT venography, or ascending venography, to diagnose this condition.
Acute Medicine Trainee Update
Authors:   Society for Acute Medicine, Daniel Amy , Miller Alice ,   Society for Acute Medicine
Published: June 2021

Amy Daniel replaces Tim Bonnici as one of the SAM trainee representatives. Tim’s term of office came to an end in May 2011, and Amy took over just after the Spring meeting in Bristol. Amy is an ST5 in the Oxford Deanery, and brings lots of enthusiasm and new ideas. Media and Communications updates SAM is working hard to keep us all updated on relevant stories from the national and international media. In addition...
Journal Watch
Authors:   Acute Medicine, Royal Hampshire County Hospital, Winchester, Cockrell Phillip
Published: June 2021

Journals were reviewed between January and April 2011. The journals reviewed include: American Journal of Medicine, Annals of Internal Medicine, Archives of Internal Medicine, British Medical Journal, Gut, Heart, Journal of Hospital Infection, Journal of the American Medical Association (JAMA), The Lancet, Lancet Neurology, New England Journal of Medicine and Thorax. The articles chosen are those which were felt to have particular relevance to Acute Physicians.
Hypokalaemia, Drugs and the QT interval – A Recipe for Disaster
Authors:   Acute Medicine, Pennine Acute Hospitals NHS Trust, Fairfield Hospital, Rochadale Road, Bury, Gtr Manchester, Gulliford Stephen R , Mushahwar Shukri S ,   Cardiology, Pennine Acute Hospitals NHS Trust, Fairfield Hospital, Rochadale Road, Bury, Gtr Manchester
Published: June 2021

We enjoyed the recent article by Heaps and Gormley.1 It highlights both the importance of electrolyte disturbance and the QT interval, in the context of acute drug overdose or substance misuse. We recently managed a 40 year old gentleman who was admitted to our intensive care unit after resuscitation from an outof- hospital ventricular fibrillation (VF) cardiac arrest. He had a long history of smoking heroin, and occasional cannabis use. There was no other relevant past medical history and he had not reported any preceding illness. He was on an established methadone drug rehabilitation programme, taking 120mls/day, but took no other regular medications. There was no known family history of sudden cardiac death.
Acute Care Fellow: a brief introduction
Authors: Temple Mark
Published: June 2021

Chris Roseveare has kindly invited me to introduce myself through this ‘Guest Editorial’ page of Acute Medicine. I was appointed to the new post of Acute Care Fellow at the Royal College of Physicians of London in July of this year. This is a new post, created by the College in recognition of the immense pressures currently being experienced by acute medical services. The remit includes identifying the difficulties faced by physicians in delivering high quality care and seeking out and sharing examples of good practice. I will chair the new acute medical care committee at the College which will have wide representation from all medical specialties involved in the provision of acute medical care. Acute medical units are the hub of the acute medical take and acute medicine will be well represented on the new committee with SAM consultant, trainee and nursing representatives. One practical work stream that is underway is a series of acute care toolkits commissioned by the College. The first on “Handover” was published in May 2011. The second, “High quality acute care”, has just been launched and is available on the Royal College of Physicians’ website: http://www.rcplondon.ac.uk/press-releases/new-toolkit-support-high-quality-care-acutely-ill-patients The toolkits focus on problem areas in acute care and provide practical advice, examples of best practice and recommendations. “High quality acute care” lists 14 key principles of acute care, drafted in close consultation with SAM. One particular concern is the evidence that the outcomes for patients admitted as medical emergencies at week-ends are inferior to those admitted on weekdays. In November 2010 the RCP issued a statement that “Hospitals undertaking admission of acutely ill medical patients should have a consultant physician on site for at least 12 hours per day, seven days per week”. Most acute hospitals are well on the way to providing this level of cover on weekdays – but weekends and bank holidays continue to present a major challenge. The RCP will be working closely with SAM to look at ways in which changes to staffing patterns at weekends can be realised, including reorganisation of rota patterns. Recommendations will be incorporated into a later toolkit.
Acute Medicine Trainee Update
Authors:   Society for Acute Medicine, Daniel Amy , Freeman Kirk ,   Society for Acute Medicine, Miller Alice ,   Society for Acute Medicine
Published: June 2021

In the recent SAM elections, there were three nominations for trainee representative, and we are pleased to announce that Kirk Freeman was the successful candidate. Kirk is an ST6 trainee in the Wales Deanery, and will be taking over from Alice when her term ends in May 2012. He will also be helping out over the next few months while Amy is on maternity leave.
Investigation of Pleural Effusions
Authors:   Respiratory Department, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Idris Luaie , Ranaweera Nilushi ,   Respiratory Department, Poole Hospital, Longfleet Road, Poole, Dorset, Laws Diane ,   Department of Thoracic Medicine, Royal Bournemouth Hospital, Castle Lane, East Bournemouth, Dorset
Published: June 2021

Pleural effusion is a common medical condition which often presents on the AMU. There are more than 50 recognised causes of pleural effusion which include diseases local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs.1 The normal pleural space contains approximately 1mL of fluid. The balance between hydrostatic and oncotic pressures in the visceral and parietal pleural vessels maintains this environment; any disorder affecting this balance will result in a pleural effusion.
Training in Intensive Care Medicine
Authors:   Acute Medicine and Intensive Care Medicine, Yorkshire and Humber Deanery, Whiteside Anne , Booth Chris ,   Anaesthetics and Intensive Care Medicine, North Western Deanery
Published: June 2021

Training in Intensive Care Medicine is currently undergoing extensive changes, with the introduction of a new curriculum and new examinations. This article explains the new pathways for training in Intensive Care, with specific reference to trainees in Acute Medicine.
A young patient with heart failure – picture Quiz Question
Authors:   Eastbourne District General Hospital Eastbourne BN22 2UD, Patel H , Dhillon G ,   Eastbourne District General Hospital Eastbourne BN22 2UD, Bandali A ,   Eastbourne District General Hospital Eastbourne BN22 2UD, Patel Neil ,   Society for Acute Medicine
Published: June 2021

Case report A 28 year old gentleman presented after an episode of collapse with loss of consciousness. He gave a history of non-specific malaise and myalgia over the previous 7 days, with fever, a generalised rash and a non productive cough. He developed progressive shortness of breath with sharp, pleuritic chest pain that was unresponsive to antibiotics in the community.
Application of an age-adjusted D-dimer threshold for exclusion of pulmonary thromboembolism (PTE) in older patients: a retrospective study
Authors:   Southern General Hospital, NHS Greater Glasgow and Clyde, Leng Owain , Sitaraaman Hemalatha Bhuvanai ,   Wishaw General Hospital, NHS Lanarkshire
Published: June 2021

The D-dimer assay’s ability to exclude pulmonary thromboembolism (PTE) falls with age.1,2 Douma et al. have proposed an age-adjusted D-dimer threshold ([threshold, μg/l] = [age, years] x 10) for patients aged >50 years with low clinical risk of PTE.3 We retrospectively applied this threshold to patients who underwent computer tomographic pulmonary angiogram (CTPA) for suspected PTE during a 13 month period at a busy District General Hospital. Of the 423 patients >50 years old who underwent CTPA, 22 (5.2%) had D-dimer concentrations higher than the traditional threshold but lower than the age-adjust threshold, none of whom had evidence of PTE on CTPA. This suggests that use of the age-adjusted D-dimer threshold may reduce necessity for CTPA concept patients aged >50 years.
An unusual cause of confusion and hyponatraemia in an elderly patient
Authors:   Severn Deanery Frenchay Hospital Frenchay Park Road Bristol BS16 1LE, Greer Ruth , Rahman Jonathan ,   Severn Deanery Frenchay Hospital Frenchay Park Road Bristol BS16 1LE, Parfitt Vernon ,   North Bristol NHS Trust
Published: June 2021

A large proportion of patients presenting on the acute medical take are frail and elderly and a significant proportion of these will have symptoms such as confusion, reduced mobility and electrolyte disturbances. These symptoms are typically attributed either to the iatrogenic effects of prescribed medications, disturbances in fluid balance and possible infective causes. We describe the case of a gentleman who presented with delirium, reduced mobility and hyponatraemia who was subsequently found to have pituitary failure secondary to pituitary apoplexy.
Clinically Lean – “Cutting the Crap”
Authors:   Worthing Hospital Western Sussex Hospitals NHS Foundation Trust Worthing BN11 2DH, Caldwell Gordon
Published: June 2021

Proponents of Lean Philosophy believe that successful businesses must reduce waste in working time and resources to a minimum, and maximise their use in productive work. The productive work of the Acute Medical Unit is to provide effective clinical management to a daily cohort of acutely ill patients. Many Clinicians are cynical about Lean. In this article, Dr Caldwell discusses how many clinicians complain of too much crap in the workplace, which gets in the way of swift, safe high quality clinical care. He argues that “Cutting the Crap” in the Acute Medical Unit is entirely consistent with Lean approaches to management of complex systems.
Shared Experiences of Consultant Delivered Care – A toolkit for those responsible for configuring consultant delivered care in Acute Medicine
Authors:   Acute Medicine, Queen Elizabeth Hospital, Woolwich, Ward David , Skene Hannah ,   Chelsea & Westminster Hospital, 369 Fulham Road, London
Published: June 2021

Background: NHS London released commissioning standards for Adult emergency services in September 2011. The Pan-London Acute Medicine Network (PLAN) agreed to survey its members regarding these standards. Method: A web-based survey asked PLAN members to comment on the standards which were most relevant to Consultant-delivered care in Acute Medicine. The self-reported rate of compliance with each standard was calculated. The free text comments were grouped by thematic analysis. Results: 23 responses were received. The compliance with each standard was variable between 9% and 91%. Discussion: A series of themes are discussed and presented as tips to be considered by those responsible for providing Consultant-delivered care to patients on an AMU. Conclusion: There is still enormous variation between trusts in how acute medical services are supported by Consultant physicians. The demands on each service and the resources available to trusts differ hugely, therefore the solutions to providing a Consultant-led service need to be tailor made for each AMU.
An Effective System to Measure and Report Quality Indicators in Acute Medical Units
Authors:   Acute Medicine, City Hospitals Sunderland Foundation Trust, Atkinson J , Barton Lorna ,   Acute Medicine and Intensive Care, Royal Victoria Hospital, Newcastle, Harrison Andrew ,   North Tees Hospital, Roper Nick ,   Acute Medicine, North Tees Hospital
Published: June 2021

The Society for Acute Medicine has developed a number of clinical quality indicators by which all UK Acute Medicine Units can bench mark their activity. These will help to ensure high quality care for patients, inform the continuing development of acute medical services and demonstrate the positive impact of this new speciality. Prospective collection of these data may be a challenge for many busy units. This paper describes a local solution developed in house in a North East hospital. It demonstrates how the data collected can be analysed to assess the effect of changes in consultant presence on the unit and also time taken for patients to be seen by a doctor. The limitations of the system and potential for future development are considered.
Sepsis- what is the role for acute medicine?
Authors:   Anaesthesia and Critical Care, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, Daniels Ron
Published: June 2021

Sepsis- the life-threatening response of the body to an infection- is one of the more common reasons for presentation to an Acute Medical Unit, and a major health and economic burden to our healthcare system, with an estimated 37,000 deaths occurring annually in the U.K. In the United States, recent evidence suggests that the incidence of sepsis has been rising by between 8 and 13% per annum over the last decade, and that it is now higher than that of Acute Coronary Syndrome.1 Across Europe, the cost of a hospital admission for sepsis (due to the frequent need for prolonged Critical Care admission) has been estimated at between 25,000 and 55,000 Euros.2 For the NHS, this means an estimated expenditure of £2.5 billion per year.
Problem based review: the patient with dizziness on the AMU
Authors:   Tauranga Hospital, New Zealand, Kennedy Adrian , Cooper Nicola ,   Acute Medicine, Leeds Teaching Hospitals
Published: June 2021

Unsteadiness, balance disturbance, and ‘dizziness’ are common presenting complaints on the Acute Medical Unit. This article outlines key components in the evaluation of these problems and describes the most common clinical patterns of dizziness. A case history is used to highlight some key learning points.
The Febrile Patient with Neutropenia
Authors:   Department of Acute Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, Cooksley Timothy , Holland Mark ,   Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, United Kingdom
Published: June 2021

Fever in a neutropenic patient is an acute medical emergency. This article considers the diagnosis, investigation and management of neutropenic sepsis, along with the clinical challenges that an acute physician may face when treating patients presenting with this condition.
Healing and Spirituality: Psychotherapeutic Case
Authors: Matei Antonella
Published: June 2021

This article is an invitation to reflect on how we can handle the spiritual, existential aspects described by Nossrat Peseschkian in his method of Positive and Transcultural Psychotherapy. The existential aspect was analyzed during the process of therapy and used as a strong resource. According to the Role model, and related with Basic Conflict, author looks at the patient’s relationship with God. The resources offered by religion in psychotherapy can be: hope, acceptance, the meaning of life (useful in depression, death), prayer (which reduces anxiety), meditation exercises and rituals. It is determined that where the patient is facing existential problems, the resources offered by religion are indisputable
Health – Illness from the Perspective of Positive Psychotherapy
Authors: Huebner Gunther
Published: June 2021

Health and illness are to be understood as two sides of the same coin. The human being is neither healthy nor sick, rather there is a constant effort for a balance, only then can one speak of an approach to health. In this context, symptoms take on an informative character and indicate longings (needs) that have not been fulfilled.
Diferentes montações e performances de drag queens e pessoas gênero-dissidentes: mimese de um ideal feminino ou revolução de gênero?
Authors: Barreto Rafaela Gomes Paes , Lima Aluísio Ferreira de , Lima Stephanie Caroline Ferreira de
Published: June 2021

Neste artigo, discutimos as vicissitudes das diferentes montações e performances drag e de pessoas gênero-dissidentes. Fazendo uso do termo “performance trans”, na perspectiva de Juliana Frota da Justa Coelho, pretendemos refletir sobre diferentes formatos e efeitos suscitados por performances de gênero. O objetivo é, sem intenção de constituir uma trajetória histórica supostamente única, compreender as potencialidades e os desafios destas performances e promover uma reflexão sobre os efeitos dessas manifestações em nossa sociedade e o contexto social dos lugares onde ocorreram e ocorrem. A partir da teoria queer, que se apresenta como crítica à cisheteronormatividade, voltamos a nossa atenção para a análise de performatividades não hegemônicas que tensionam tais normas. Assim, o artigo foi dividido metodologicamente em três partes: 1) discussão teórica sobre a normatividade envolvendo os usos do corpo generificado; 2) contextualização das performances drag queen; e 3) análise acerca de alguns dos múltiplos significados e formatos que foram sendo adotados nas últimas décadas para a elaboração das performances trans. Os momentos apresentados ao longo do artigo permitem assinalar, finalmente, como as diferentes performances trans oferecem elementos para uma crítica potente e transformadora do ideal feminino cisheteronormativo.
A crise afetiva e identitária do médico psiquiatra em Memória de elefante, de António Lobo Antunes
Authors: Silva Suzana Costa da
Published: June 2021

A descrição de um dia inteiro do personagem “médico psiquiatra” do romance Memória de elefante (1979), de António Lobo Antunes, é realizada pelas próprias lembranças do passado em meio aos acontecimentos atuais. A vida degradante e depressiva, que se instaura após sua estada em África como médico, será uma marca desse indivíduo à deriva, que, fragmentado, não restabelece sua identidade perdida. Em crise, vive os dramas da separação da mulher e o distanciamento das filhas e busca, nas pequenas ações do cotidiano, as evasões para o seu desamparo. Sem interação social e pessoal, vive o desencanto solitário da frustração de uma realidade insignificante, somados a um nível depressivo que o mantém inerte em suas decisões. A angústia, o sofrimento amoroso e a profunda crise de identidade permeiam a narrativa, tornando líquidas a sensibilidade e a dignidade desse homem, marcas de uma escrita envergada à ótica da pós-modernidade em que o autor desafia o público a decodificar as vozes que soam nesse discurso, representando o seu rigor comunicativo. António Lobo Antunes fornece já no primeiro romance de sua vida, uma escrita psicológica e quase autobiográfica, quando muitas informações ficcionais se confundem com a realidade vivenciada pelo autor. Maria Alzira Seixo, Ana Paula Arnaut, Stuart Hall, Zygmunt Bauman entre outros teóricos serão utilizados para promover discussões sobre a escrita e a crise do sujeito em seu tempo e espaço. O Pierrot de um mundo pósmoderno ainda está aprisionado ao passado, um tempo que não será recuperado, a não ser pelas memórias do que poderia ter sido e não foi.
Minimizing Nonessential Follow-up for Hip Fracture Patients
Authors: Reich Michael S. , Switzer Julie A. , Sibley Andrew , Schroder Lisa K. , Vang Sandy , Nguyen Mai P.
Published: June 2021

Introduction:

Hip fractures pose a significant burden to patients and care providers. The optimal protocol for postoperative care across all surgically treated hip fracture patients is unknown. The purpose of this study was to investigate the effect that routine follow-up had on changing the clinical course.

Methods:

This was a retrospective review of all low-energy hip fractures (ie, femoral neck fractures, pertrochanteric hip fractures, and subtrochanteric fractures) treated surgically from January 2018 through December 2019. Charts were reviewed for demographic information; the procedure performed; the number of postoperative follow-up visits each patient had with the orthopaedic surgery team; the number of sets of postoperative radiographic images obtained; and postoperative complications.

Results:

Eight hundred eleven patients with 835 hip fractures were included in the study. The overall number of patient visits was 1,788, and the number of radiograph sets was 1,537. The median number of follow-up visits was two visits/fracture (interquartile range: 1 to 3 visits, maximum = 9 visits), with the median follow-up length of 54 days (interquartile range: 33 to 97 days) with the treating orthopaedic surgeons. Sixty-two (7.6%) patients had 81 (4.5%) postoperative visits and 26 (1.7%) sets of images that led to treatment changes. Among them, 48 (77.4%) patients had concerns that were initiated by the patients and/or care provider. Fourteen standard patient visits led to treatment changes that were not initiated as concerns by the patient and/or care provider.

Discussion:

Most clinic visits and radiographs did not lead to a change in the care plan. We recommend that emphasis be placed on comprehensive orthogeriatric care of these patients, and we believe that these data provide the impetus to work toward improving the care pathways for elderly patients with hip fractures.
Patient Perception of Physician Attire in the Outpatient Setting During the COVID-19 Pandemic
Authors: Omari Ali M. , Sodha Samir , Koerner John D. , Alberta Frank G. , Levine Harlan B. , Seidenstein Ari , Klein Gregg R.
Published: June 2021

Introduction:

In response to the SARS-CoV-2 pandemic, physician attire has evolved to incorporate personal protective equipment (PPE). Although PPE is mandated for all healthcare workers, variability exists in choice and availability. The purpose of this study was to determine patient perception of physician attire during the COVID-19 pandemic in an outpatient setting.

Methods:

Three hundred sixty-eight patients who presented to our outpatient orthopaedic clinics completed an anonymous survey. In addition to demographic characteristics, patient preferences for attire, PPE, and social distancing were obtained.

Results:

Scrubs (81%, 298/368) were found to be the most acceptable physician attire. Eye protection (34.2%, 126/368) and gloves (32.6%, 120/368), however, were deemed much less acceptable; 93.5% (344/368) of patients reported that no mask was unacceptable, with 41.0% (151/368) preferring a surgical mask. Predilection for a surgical mask and N95 rose with increasing patient education level. Interestingly, 55.2% (203/368) responded that physicians should stop wearing PPE only when the Center for Disease Control recommends.

Conclusion:

During the COVID-19 pandemic, most of the patients found scrubs to be the most acceptable attire in an office-based outpatient setting. Patients also found physician mask-wearing to be important but are less accepting of providers wearing eye and hand protection.
Infrastructure failure propagations and recovery strategies from an Alpine Fault earthquake scenario
Authors: Davies Alistair , Zorn Conrad , Wilson Thomas , Wotherspoon Liam , Beavan Sarah , Davies Tim , Hughes Matthew
Published: June 2021

While it is well established that community members should participate in resilience planning, participation with genuine decision-making power remains rare. We detail an end-to-end disaster impact reduction modelling framework for infrastructure networks, embedded within a scenario-based participatory approach. Utilising the AF8+ earthquake scenario, we simulate hazard exposure, asset failure and recovery of interdependent critical infrastructure networks. Quantifying service levels temporally offers insights into possible interdependent network performance and community disconnection from national networks, not apparent when studying each infrastructure in isolation. Sequencing participation enables feedbacks between integrated modelling and participants’ impact assessments. Shared ownership of modelling outputs advances stakeholders’ understanding of resilience measures, allowing real-time implementation, increasing community resilience. Readily understood by central government, this format may increase support and resourcing, if nationally significant. Finally, this method tested integrated modelling and impacts assessments, identifying and enabling improvements for both.
Performance and Techno-Economic Analysis of Inlet Fogging System Implementation in Heavy Duty Industrial Gas Turbines
Authors: AGBADEDE Roupa , KAİNGA Biweri
Published: June 2021

This study investigates the performance and economic benefits of applying inlet fogging in a heavy duty industrial gas turbine. To achieve the aim of the study, a heavy duty industrial gas turbine engine was modelled using a gas turbine performance software, GasTurb. The modelled engine was derived from the Frame 9E class of gas turbines. Consequent upon completing the engine modelling, ambient temperature profile data obtained from a location in Niger Delta region of Nigeria were used as input into the engine model to simulate its effect on the engine performance. Inlet fogging was simulated on the industrial gas turbine by inputting a water-to-air ratio of 0.4%, to cool and reduce the air inlet temperature by 10 degree Celsius. The simulation plots show that the gas turbine performance which dropped as a result of increased ambient temperature was enhanced by the application of inlet fogging. Economic analysis shows that approximately $2.4 million profit was recorded in one year when inlet fogging system was employed.
COMMUTATIVITY THEOREMS FOR RINGS WITH CONSTRAINTS ON COMMUTATORS
Authors: ABUJABAL H. A. S. , ASHRAF MOHD
Published: June 2021

Let $R$ be a left (resp. right) $s$-unital ring and $m$ be a positive integer. Suppose that for each $y$ in $R$ there exist $J(t)$, $g(t)$, $h(t)$ in $Z[t]$ such that $x^m[x,y]= g(y)[x,y^2f(y)]h(y)$ (resp. $[x,y]x^m= g(y)[x,y^2f(y)]h(y))$ for all $x$ in $R$. Then $R$ is commutative (and conversely). Finally, the result is extended to the case when the exponent $m$ depends on the choice of $x$ and $y$.
PRIME IDEALS IN STRUCTURAL MATRIX NEAR-RINGS
Authors: LEE ENOCH K. S.
Published: June 2021

This paper studies different types of prime ideals and their radicals in structural matrix near-rings. Relationships between various types of prime ideals of a near-ring and the corresponding structural matrix near-ring are given.
El libro de texto universitario de ciencias en la formación docente
Authors: Maturano Carla Inés , Mazzitelli Claudia Alejandra , Guirado Ana María
Published: June 2021

Esta investigación busca identificar las representaciones sociales del libro de texto universitario de ciencias y diseñar e implementar una propuesta para optimizar su utilización en la formación académica y en la futura práctica profesional de estudiantes de profesorado de Física, Química y Tecnología. Se aplicó una técnica de evocación y jerarquización y se formularon diversas preguntas para profundizar en el conocimiento y análisis de los libros de texto universitarios en relación con cuatro dimensiones (intrínseca, disciplinar, funcional y metodológica). Los resultados obtenidos permiten identificar un acercamiento acotado de los estudiantes a los libros que evidenciaría un escaso aprovechamiento que prioriza las secciones más tradicionales.
Trabajo matemático de un profesor basado en tareas y ejemplos propuestos para la enseñanza
Authors: Henríquez Rivas Carolina , Ponce Rodrigo , Carillo Yáñez José , Climent Nuria , Espinoza-Vásquez Gonzalo
Published: June 2021

El uso de tareas y ejemplos constituye una práctica fundamental en el trabajo del profesor en el aula para la enseñanza de un contenido. El objetivo de este artículo es caracterizar el trabajo matemático que propone un profesor a partir de las tareas y ejemplos que considera para la enseñanza de un teorema geométrico. Para ello, se analiza el espacio de trabajo matemático idóneo de un profesor de secundaria que participa en un taller formativo. Se presenta un estudio de caso basado en un diseño de caso único, a través de videograbaciones y observaciones. Los resultados revelan el privilegio de tratamientos algebraicos a partir de representaciones figurales y un cambio propuesto que involucra el uso de herramientas tecnológicas. Finalmente, se discute sobre aportes al estudio del trabajo matemático del profesor en el aula centrado en el uso de tareas y ejemplos.
¿Qué suena dentro de tu cuerpo? Un proyecto sobre el corazón en Educación Infantil
Authors: Mazas Beatriz , Cascarosa Esther , Mateo Ester
Published: June 2021

En este trabajo se presenta un proyecto realizado con niños de Educación Infantil (EI) a lo largo del curso escolar 2017/18, en torno al tema del «corazón». El objetivo principal fue responder a la pregunta: ¿Qué destrezas científicas afloran tras llevar a cabo una experiencia sobre el corazón en EI? Para ello, diseñamos una secuencia de actividades para trabajar las prácticas científicas que los alumnos realizaron con las maestras o bien con las profesoras de la Universidad. Estas actividades integraban las prácticas de la indagación, modelización y argumentación. Las sesiones fueron grabadas y transcritas para su análisis por episodios. Los resultados nos muestran que las actividades planteadas permiten trabajar las destrezas que engloban las prácticas científicas de indagación, modelización y argumentación en Educación Infantil para aprender sobre el corazón, construyendo modelos cada vez más complejos sobre el cuerpo humano y su funcionamiento y favoreciendo el pensamiento sistémico.
Dificultades de aprendizaje del modelo de sonido: una revisión de la literatura
Authors: Rico Arantza , Ruiz González Aritz , Azula Oier , Guisasola Aranzábal Jenaro
Published: June 2021

El aprendizaje del modelo científico del sonido (MCS) está presente en el currículum de ciencias de todos los niveles educativos y es un componente crítico de la alfabetización científica. Este trabajo presenta una revisión sistemática sobre la comprensión de los estudiantes del MCS en torno a tres ideas claves que emergen del análisis epistemológico: naturaleza del sonido y sus propiedades, propagación del sonido y modelo de onda. Cabe destacar que, independientemente de la etapa educativa, existe una dificultad en relacionar las propiedades intrínsecas del sonido con las magnitudes de onda y la persistencia de concepciones que atribuyen propiedades materiales al sonido. Además, no existe una clara progresión del aprendizaje sobre el MCS desde la Educación Primaria hasta los primeros años de Universidad. Finalmente, se discuten las implicaciones para la enseñanza-aprendizaje del MCS.
A produção científica subjugada à lógica econômica: elementos para uma análise crítica
Authors: Favaro Neide De Almeida Lança Galvão , Semzezem Priscila
Published: June 2021

A pesquisa é fundamental para o desenvolvimento humano e social, mas ela adquire distintos contornos na sociabilidade atual. Este estudo analisa a condição da produção científica brasileira, a partir da apreensão de seus determinantes econômicos. A compreensão destes elementos, suas causas e efeitos, tem raízes profundas, arraigadas na complexidade das transformações em curso. Para contribuir com seu desvelamento, recuperaram-se os fundamentos da relação do capital, com base na teoria marxista. São identificadas as contradições presentes e seus mecanismos econômicos, políticos e ideológicos que afetam a universidade brasileira e o trabalho docente. Nessa sociabilidade, a atividade científica tem contribuído diretamente para assegurar a reprodução do capital, estando subsumida à lógica mercantil, embora ela seja essencial para a promoção da emancipação humana. Alterar esta situação não é algo simples, exige uma luta radical.
Trabalhadores com educação superior e as transformações no mundo do trabalho
Authors: Zuccarelli Carolina
Published: June 2021

O aumento da escolaridade ocupa espaço relevante nas formulações sobre oportunidades no mercado do trabalho e sobre as chances de mobilidade social. Este artigo tem como objetivo discutir em que medida a mudança no perfil educacional da força de trabalho de graduados com educação superior corresponde à alocação em grupos ocupacionais com demanda equivalente a esse nível de qualificação. Analisar essa relação tem relevância no momento de expansão significativa da educação terciária no Brasil e de profundas mudanças estruturais que afetam o funcionamento do mercado de trabalho. O texto examina as evidências dos últimos quarenta anos acerca das mudanças no perfil educacional da força de trabalho, levando em conta a relação entre anos de estudo e as oportunidades e/ou desigualdades do mercado de trabalho. A partir de dados produzidos pelo Instituto Brasileiro de Geografia e Estatística, o artigo mostra que, apesar do crescente número de trabalhadores com educação superior, a maior parte deste grupo não está inserida em função compatível com seu grau de qualificação, indicando um crescimento da taxa de graduados em ocupações que não requerem esse nível de escolaridade. Os resultados mostram ainda que o acesso ao ensino superior e ao mercado de trabalho brasileiro segue marcado por significativas desigualdades de gênero e cor/raça.
Docência e conhecimento de si: espaço formativo em classes multisseriadas
Authors: Mota Charles Maycon De Almeida , Silva Fabrício Oliveira da , Pacheco Rios Jane Adriana Vasconcelos
Published: June 2021

O presente estudo trata da formação docente a partir do conhecimento de si, enquanto espaço de formação e de atuação profissional em classes multisseriadas. Objetivou-se compreender como os professores lidam e refletem sobre as diferenças em sala de aula. Trata-se de uma pesquisa-formação desenvolvida com três professores que vivem e convivem em contextos rurais em um município do interior da Bahia. Esta pesquisa é fundamentada no método (auto)biográfico. Como dispositivo de recolha de informações, utilizaram-se as narrativas. Percebeu-se que o conhecimento de si, como espaço de formação, desencadeia uma auto, eco e coformação, como princípios formativos que transversalizam o fazer docente em contextos de diversidade.
Strategies to Improve Financial Profitability in the Banking Industry
Authors: Said Khalid , Doll Yvonne
Published: June 2021

More than 50% of business failures in the United States are because of leaders’ inability to manage working capital. This qualitative, multiple case study is grounded in the cash conversion cycle theory. The purpose is to explore the strategies bank leaders have used to improve working capital management in three banks in Kentucky to increase bank profitability and improve financial stability. Data were collected using semistructured interviews with three different banking leaders who have implemented successful working capital strategies. Using methodological triangulation and Yin’s five-step data analysis resulted: (a) risk and liquidity, (b) top-down approach, and (c) investment approach. The findings from this study include strategies for improving the use of working capital, leading to business profitability and increases in employment opportunities.
Impacts of Petroleum, Petroleum Components, and Dispersants on Organisms and Populations
Authors:   University of South Florida, Murawski Steven , Grosell Martin , Smith Cynthia , Sutton Tracey , Halanych Kenneth , Shaw Richard , Wilson Charles
Published: June 2021

Following the Deepwater Horizon blowout, oil, degraded oil, oil mixed with dispersants, and management responses to the spill affected a variety of Gulf of Mexico organisms. This review provides examples of various documented impacts, common patterns, and trends across organisms and/or their environments, and discusses future implications as well as directions for future research. Organism effects are generally characterized as lethal and sublethal. Sublethal can be short term, long term, or permanent and multigenerational. We present individual examples of effects on behavioral response, olfaction, vision, cardiac function, and gene shift, based on research done in laboratories, mesocosm settings, and the field. Future research should emphasize collection and analysis of routine toxicological baselines and examine how and if molecular impacts cascade up to populations. This research will require development of rapid molecular tools and testing procedures to determine exposure compared to field-relevant exposure levels and to be able to extrapolate laboratory results to the field, especially given the mosaic of differing contaminant concentrations (below, at, or exceeding critical concentrations that result in lethal or sublethal effects) occurring in the environment. Recent chemical studies have identified a detectable suite of polycyclic aromatic hydrocarbon metabolites for which there are no toxicity data; further research is needed to determine their impacts on food webs.