bluuebunny/crossref_metadata_2025 huggingface dataset:
The Virtual Hospitalist: A Single‐Site Implementation Bringing Hospitalist Coverage to Critical Access Hospitals
Authors: Kuperman Ethan F. , Linson Eric L. , Klefstad Kate , Perry Evelyn , Glenn Kevin
Published: September 2018

BACKGROUND

On‐site hospitalist care can improve patient care, but it is economically infeasible for small critical access hospitals (CAHs). A telemedicine “virtual hospitalist” may expand CAH capabilities at a fractional cost of an on‐site provider.

OBJECTIVE

To evaluate the impact of a virtual hospitalist on transfers from a CAH to outside hospitals.

DESIGN, SETTING, AND PARTICIPANTS

A six‐month pilot program providing “virtual hospitalist” coverage to patients at a CAH in rural Iowa.

MEASUREMENTS

The primary outcome was the rate of outside transfers from the CAH Emergency Department (ED). The secondary outcomes included transfer from either the ED or the inpatient wards, daily census, length of stay, transfers after admission, virtual hospitalist time commitment, and patient and staff satisfaction. The preceding 24‐week baseline was compared with 24 weeks after implementation, excluding a two‐week transition period.

RESULTS

At baseline, there were 947 ED visits and 176 combined inpatient and observation encounters, compared to 930 and 176 after implementation, respectively. Outside transfers from the ED decreased from 16.6% to 10.5% (157/947 to 98/930, P < .001), and transfers at any time decreased from 17.3% to 11.9% (164/947 to 111/930, P < .001). Daily census, length of stay, and transfers after admission were unchanged. Time commitment for a virtual hospitalist was 35 minutes per patient per day. The intervention was well received by the CAH staff and patients.

CONCLUSIONS

The virtual hospitalist model increased the percentage of ED patients who could safely receive their care locally. A single virtual hospitalist may be able to cover multiple CAHs simultaneously.
Paediatric orthopaedics through paintings
Authors: Camurcu Y. , Sofu H. , Ucpunar H. , Duman S. , Cobden A.
Published: September 2018

Purpose

Some famous artistic representations created throughout the centuries can reveal a hidden or mysterious diagnosis of some diseases and these paintings have always drawn the attention of physicians interested in art. Artistic illustration of a child with a malformation or disability can reflect the characteristic appearance of a disease and its historic perspective. Some articles have revealed the definite diagnosis of a child with achondroplasia through portraits of dwarfs and some studies have discussed the secret diagnosis of a crippled child with Pes Equinovarus or poliomyelitis. In this study, we aim to introduce some paintings that reveal musculoskeletal diseases related to paediatric orthopaedics.

Methods

Paintings painted since the Renaissance were reviewed and collected via web searches. Artistic paintings depicting children with suspected paediatric orthopaedic diseases were analyzed in this study.

Results

Paintings in which artists have depicted children with achondroplasia, poliomyelitis and clubfoot were found.

Conclusion

The investigation of a drawing depicting a disabled child may encourage an orthopaedic surgeon to introduce an analytical approach using visual cues. These paintings may also enhance the observational skills of paediatric orthopaedic surgeons, give information about the historical process of a disease and demonstrate the impact of the disease at the time the painting was painted.
Referral patterns of emergency physicians regarding head and neck pathology in Western Australia
Authors: Ong Jo Ann , Gebauer Dieter , Kruger Estie , Tennant Marc
Published: September 2018

Those dual qualified in oral and maxillofacial surgery (OMFS) in Australia have a scope of practice that includes dentoalveolar surgery, facial fractures, craniofacial deformities, salivary gland disease, temporomandibular joint disorders, and the treatment of oral and facial cancers with reconstruction. This differs from other countries such as the UK, the US, France and Brazil, which can lead to complexities of interaction when internationally trained health professionals, who may be unaware of this wide breadth of practice, are the ‘gatekeepers’ at tertiary health facilities. 1 – 3
Divided Mediterranean, Divided World: The Influence of Arabic on Medieval Italian Poetry
Authors: Samar Attar
Published: September 2018

Divided Mediterranean, Divided World: The Influence of Arabic on Medieval Italian Poetry describes the significant role played by Arabic and Islamic poetry, legends, tales, and philosophy on major Italian poets in the Middle Ages in spite of the denial of some of the poets themselves of such an influence. Psychologists do not seem to pay much attention to the love–hate syndrome that affects sensitive souls in politically unstable states. Similarly, many literary critics continue to turn a blind eye to the influence of Arabic on Medieval Italian poetry. Historians also present history to us not only through documents they have read in archives, but they similarly express their own divergent personal opinions and interpretations of historical events.
Emotional Distance: Transnational Pleasure in Tayeb Salih's Season of Migration to the North
Authors: Rimun Murad
Published: September 2018

Scholars in Arab post-colonial literature have spoken of the lure of the West for immigrants in terms of the West's superiority of education, technological development, military prowess, political weight, and economic clout. Sudanese novelist Tayeb Salih presents a different, but not inconsistent, narrative: his novelSeason of Migration to the Northsuggests that the lure of the West, in the case of England, consists in its accommodation of emotional distance. Even though Tayeb Salih's literary work acknowledges the role of emotional detachment in undermining the notions of community, home, and integration,Seasonasserts that emotionlessness is the source of gratification for the transnational protagonist Mustafa Sa'eed. In so doing,Seasonargues against the immigrant and transnational notion of emotional apathy being a source of pain for diasporic subjects. Mustafa Sa'eed's lack of emotions allows him to interact with the fiction of West through embodying Oriental and other performances. The protagonist's emotional detachment from English society, its women, and preconceived notions about the Orient, paradoxically, enables him to derive pleasure from his physical trysts, nomadism, anti-colonial revenge, and pretend play.
State Crime and Digital Resistance: Introduction
Authors: Kasm Saeb , Alexander Anne
Published: September 2018

None
Secrets and Lies: The Proliferation of State Surveillance Capabilities and the Legislative Secrecy Which Fortifies Them – An Activist's Account
Authors: Nyst Carly
Published: September 2018

As new technologies upend traditional power structures grounded in an information asymmetry between the state and its populace, governments are finding new ways to entrench state secrecy and inhibit individual secrecy. The global migration of everyday activities to the online realm is being met by surveillance technologies and techniques which have turned the Internet into a virtual panopticon. As states seek to legitimize the extension of surveillance into almost every realm of public and private lives, they are constructing legal frameworks that embed technical capabilities in layers of secrecy and opacity, rolling back hard-won legal protections and removing surveillance from the jurisdiction of accountability and redress mechanisms. This article focuses on the multiple layers of human rights violations inflicted by modern state spycraft. First, the inhibition of the enjoyment of rights such as privacy, free association, speech and opinion, and second, the deprivation of citizens from access to information, redress and the ability to engage in legislative and democratic debates on an even playing field.
A caring welfare state in South Korea: challenges and prospects
Authors: Kim Hee-Kang
Published: September 2018

The purpose of this article is to examine the implications of care ethics in a Korean welfare state. It shows how Confucianism, developmentalism and neoliberalism can both promote and restrict the establishment of a Korean caring welfare state. Despite the fact that these Korean contexts can either support or undercut the development of a caring welfare state, it is clear that none of these contexts places particular importance on the value of care and care relationships. In the Confucian and neoliberal contexts, care is a family or private issue, while developmentalism fails to appreciate care due to its prioritisation of economic development.
Towards a situated ethics of care: some moral dilemmas around aspects of care in an unequal society
Authors: Faur Eleonor , Tizziani Ania
Published: September 2018

This article analyses moral dilemmas around aspects of care from gender and class perspectives. Based on quantitative data and qualitative research for the surrounding area of Buenos Aires, we probe how contemporary women and men in Argentina organise, experience and perceive the relationship between working life and their responsibilities for caring for family members. A situated ethics of care, as explored in the article, reinforces the notion that care is always contextual – it can only be understood within a social and political milieu – and presents distinctions among subjects that hold unequal positions in class and gender hierarchies.
Review Essay
Authors: Edelheim Johan R.
Published: September 2018

Innovation in Hospitality Education: Anticipating the Educational Needs of a Changing Profession, Jeroen A. Oskam, Daphne M. Dekker and Karoline Wiegerink (eds) (2018) Cham: Springer, 232 pp., ISBN: 9783319613789, h/bk, £99.99
Embodying Islam: The political, social and spiritual use of the body in performative practice
Authors: Bridgeman Lauren
Published: September 2018

Attitudes towards the performing body in Islam are complex and varied. The highly codified ritual prayer salat is central to daily life, while dancing is oft regarded as an immoral and frivolous activity. Sufi Muslims embrace movement-based practices as part of a spiritual experience and receive harsh criticism from other Islamic denominations. Yet, many people enjoy dancing, at celebrations, for example, and those living in conservative countries put themselves at extreme risk to do so. This article explores this paradox by analysing the political, social and spiritual use of the body in Islam through three embodied practices: dance, salat and Sufi worship. How does belief affect Muslims’ experiential and everyday modes of being? How does it manifest in performative aspects of both culture and religion? What are the politics of performance in Islam? This research reveals how history, culture and Islamic ideology intersect to form dynamic and multifarious interpretations of the body and its boundaries.
Arterial infusion of rapamycin in the treatment of rabbit hepatocellular carcinoma to improve the effect of TACE
Authors: Wu Tao , Yao Yihui , Sun Ruimin , Wang Huili , Yin Xiaoxiang , Zhang Junna , Zhou Qing , Huangfu Chaoshen
Published: September 2018

Background

Hepatocellular carcinoma is one of the leading causes of cancer-related death. Hepatic transcatheter arterial chemo-embolization (TACE) is commonly used clinically for advanced hepatocellular carcinoma treatment.

AIM

The aim of this study was to evaluate whether arterial infusion of rapamycin can improve the effect of TACE in treatment of rabbit hepatocellular carcinoma.

Material and Methods

Eighteen healthy New Zealand white rabbits weighing 2.6 ± 0.3 kg were used in a standardised hepatocellular carcinoma model and randomly divided into three groups of 6 rabbits. Group A: the rabbits were treated with rapamycin and TACE by administering arterial perfusion of 2 mg/kg rapamycin + 1 mg/kg epirubicin, 0.2 mg/kg mitomycin, and lipiodol emulsion embolization. Group B: rapamycin was reduced to 1 mg/kg. And for Group C, the rabbits received only TACE treatment. 14 days post operation, CT scan and digital subtraction angiography (DSA) was performed to examine TACE efficacy. The rabbits were killed by air embolism and the expression of HIF-1a, VEGF, iNOS, and CD34 were measured in an immunohistochemical assay of thetumor tissue.

Results

HIF-1a, VEGF and iNOS protein expression in Group A was significantly lower than that of Group B and Group C (P<0.05). The tumor MVD in group C was significantly higher than that of group A and group B (P<0.05); and the tumor MVD of group B was significantly higher than group A (P<0.05).

Conclusion

Arterial infusion of rapamycin combined with TACE can improve treatment efficacy by decreasing HIF-1a, VEGF, iNOS and CD34 expression.
SSR Markers Suitable for Marker Assisted Selection in Sunflower for Downy Mildew Resistance
Authors: Şahin Ezgi Çabuk , Kalenderoğlu Aral , Aydın Yıldız , Evci Göksel , Uncuoğlu Ahu Altınkut
Published: September 2018

The effectiveness of Pl genes is known to be resistant to downy mildew (DM) disease affected by fungus Plasmopara halstedii in sunflower. In this study phenotypic analysis was performed using inoculation tests and genotypic analysis were carried out with three DM resistance genes Plarg, Pl13 and Pl8. A total of 69 simple sequence repeat markers and 241 F2 individuals derived from a cross of RHA-419 (R) x P6LC (S), RHA-419 (R) x CL (S), RHA-419 (R) x OL (S), RHA419 (R) x 9758R (S), HA-R5 (R) x P6LC (S) and HA89 (R) x P6LC (S) parental lines were used to identify resistant hybrids in sunflower. Results of SSR analysis using markers linked with downy mildew resistance genes (Plarg, Pl8 and Pl13) and downy mildew inoculation tests were evaluated together and ORS716 (for Plarg and Pl13), HA4011 (for Pl8) markers showed positive correlation with their phenotypic results. These results suggest that these markers are associated with DM resistance and they can be used successfully in marker-assisted selection for sunflower breeding programs specific for downy mildew resistance.
Improved Adaptive Neuro-Fuzzy Inference System Using Gray Wolf Optimization: A Case Study in Predicting Biochar Yield
Authors: Ewees Ahmed A. , Elaziz Mohamed Abd
Published: September 2018

This paper presents an alternative method for predicting biochar yields from biomass thermochemical processes. As biochar is considered a renewable and sustainable energy source, it has received more attention. Several methods have been presented to predict biochar, such as neural network (NN) and least square support vector machine (LS-SVM). However, each of them has its own drawbacks, such as getting stuck in a local optimum, which occurs in NN, and lack of uncertainty and time complexity, as in LS-SVM. Therefore, this paper avoids this limitation by using a hybrid method between the adaptive neuro-fuzzy inference system (ANFIS) and gray wolf optimization (GWO) algorithm. The proposed method is called ANFIS-GWO, which consists of two stages. In the first stage, GWO is used to learn the parameters of ANFIS using the training set. Meanwhile, in the second stage, the testing set is used to evaluate the performance of the proposed ANFIS-GWO method. Three experiments were performed to assess the performance of the proposed method. The first experiment used a set of UCI (University of California, Irvine) benchmark datasets to evaluate the effectiveness of ANFIS-GWO. The aim of the second experiment was to evaluate the performance of the proposed ANFIS-GWO method to predict biochar yield from manure pyrolysis. The third experiment aimed to estimate the values of input parameters of pyrolysis that maximize biochar production. The obtained results were compared to those of other methods, such as ANFIS using gradient descent, practical swarm optimization, genetic algorithm, whale optimization algorithm, sine-cosine algorithm, and LS-SVM. The results of the ANFIS-GWO method were >35% of the standard ANFIS and also better than those of other methods.
Legal aspects of storage and transmission of laboratory results
Authors: Gassner Ulrich M. , Modi Julian N. , Ponader Alexander , Ruf Simone
Published: September 2018

Background:

Even though technology advances and laboratory tests have become commonplace, there is a multitude of sources for errors. Furthermore, as the new General Data Protection Regulation (GDPR) adds to the thicket of storage and deletion periods, strategies for the best approach have to be developed.

Legal context and methods:

On the one hand, this article discusses civil claims due to damages arising from false laboratory results. This is done by a de lege lata analysis of the central liability provisions in the respective fields. On the other hand, different storage periods and deletion obligations for data in clinical laboratory testing and the best way of handling them are analyzed.

Results and conclusions:

Depending on the cause of the error, there are several possible liable parties. The most advantageous claims for the patient are those against the manufacturer in case of a defective device as he is regularly strictly liable. But also other parties involved can face similar claims due to their own wrongdoing. Although there can be claims against multiple parties involved, a fair allocation of damages according to the areas of responsibility of every party can be achieved through recourse. Concerning storage and destruction obligations, first the applicable timeframes have to be identified. Compliance can then be achieved by the implementation of technical and organizational measures. In the event of data-protection misconduct, there is a risk of considerable fines.
New Moravian deniers of the C 301 type struck under Břetislaus I and found at the Vraclav hillfort
Authors: Lukas Jiří
Published: September 2018

Two fragments of extraordinarily rare Moravian deniers of the C 301 type struck under Břetislaus I before 1030 were found during archaeological surface examinations at the Vraclav hillfort (Ústí nad Orlicí district, Pardubice region) in 2006–2016. There is the name of Břetislaus without his princely title on obverse, and the name of St. Clement, the Moravian patron, on reverse. Besides the described fragments, only four specimens of this type are known from foreign hoards (finds). Both fragments from the Vraclav hillfort represent the earliest precisely datable proof of penetration of the Moravian coins into the Bohemian territory.
Ottoman copper coin found in Bohdanovce nad Trnavou in Slovakia
Authors: Budaj Marek , Novák Vlastimil
Published: September 2018

In 2016, an Ottoman copper coin was studied by the authors in a private collection. It was reportedly found in Bohdanovce nad Trnavou (Trnava district, Slovakia). The coin was identified as the manghir struck under the Ottoman Sultan Murad III (AH 982–1003/AD 1574–1595) in Miṣr (Cairo) in AH 982/AD 1574 (in AD 1574–1595 respectively, because of the enthronement date). It is the earliest Ottoman copper issue discovered in Slovakia which was accidentally lost very likely in connection with the Ottoman raids against Hungary at the end of the 16th century. The remaining five Ottoman copper pieces found in Slovakia date back much later, to the end of the 17th century (Sulayman II, Ahmad II).
Unused contemporary report about the Podmokly hoard
Authors: Ryant Jiří
Published: September 2018

The hoard of Celtic coins found in Podmokly (Rokycany district, west Bohemia) in 1771 is extraordinary by its scope and content, and it attracted intensive attention of many numismatists in the past. The story was also transformed into a nonfiction book. The author of this article brings to light a new unpublished record from the memorial book of the Roman-Catholic parish in Zvíkovec, where the location of Podmokly used to belong to. This report was cited by the local priest Václav Krolmus (1790–1861) in his chronicle together with comparison of prices of some selected agricultural products. The limited information about the finding context of the hoard in the known sources is compared with this newly published report.
The Hungarian 20-kreuzer pieces struck under the Austrian Emperor Franz I
Authors: Langr Josef , Richtera Lukáš
Published: September 2018

Starting with 1830, the mint in Vienna began to strike the Hungarian 20-kreuzer pieces. Later on, the mint in Kremnica continued with their production. The recent specialized literature does not discuss the beginning of the striking process in detail, and all existing minting years and varieties are not listed there. This article is focused on mapping all these coins and revision of the existing minting years of the particular types ever listed.
Synthesis and Characterization of Polymer-Silica Composite Hydrogel Particles and Influence of Hydrogel Composition on Cement Paste Microstructure
Authors: Krafcik Matthew J. , Bose Baishakhi , Erk Kendra A.
Published: September 2018

The objective of this research is to define the fundamental structure-property relationships of water-swollen polymer hydrogel particles that are employed as internal curing agents in cementitious mixtures, in addition to reporting a novel synthesis procedure for combining pozzolanic materials with hydrogel particles. Solution polymerization was performed to incorporate amorphous nanosilica particles within acrylic-based polymer hydrogel particles of varying chemical compositions (i.e., monomer ratio of acrylic acid (AA) to acrylamide (AM)). Experiments were designed to measure the absorption capacity and kinetics of hydrogel particles immersed in pure water and cementitious pore solution, as well as determine the impact of particles on cement paste microstructure. While majority-AM hydrogel particles displayed relatively stable absorption values during immersion in pore solution, majority-AA hydrogel particles desorbed fluid over time, most likely due to the interactions of multivalent cations in the absorbed solution with the anionic polymer network. Interestingly, the addition of negatively charged nanosilica particles accelerated and enhanced this desorption response. When incorporated into cement paste, majority-AM hydrogel particles encouraged the formation of calcium hydroxide and calcium silicate hydrate within the void space previously occupied by the swollen particles. When nanosilica was added to the hydrogel particles, a 53 % increase in the number of hydrogel voids containing hydrated product was observed for the 17 % AA hydrogel particles, and a 140 % increase was observed for the 83 % AA hydrogel particles. These results suggest that the combination of nanosilica with polymeric hydrogel particles provides a favorable environment for the pozzolanic reaction to proceed and that nanosilica aids in the replenishment of hydrogel void space with hydrated cement phases.
Combined Effects of Internal Curing, SCMs, and Expansive Additives on Concrete Shrinkage
Authors: Khajehdehi Rouzbeh , Feng Muzai , Darwin David , Lafikes James , Ibrahim Eman Khalid , O’Reilly Matthew
Published: September 2018

Internal curing (IC) using prewetted lightweight aggregate (LWA) has often been used to improve the cracking performance of concretes with low water-to-binder (w/b) ratios (<0.42) when autogenous shrinkage and self-desiccation are of concern. Shrinkage-compensating admixtures (SCAs) are also used to improve the cracking performance of concrete. A modified version of ASTM C157, Standard Test Method for Length Change of Hardened Hydraulic-Cement Mortar and Concrete, in which length-change measurements begin 5 1/2 ± 1/2 h after casting concrete, was used to evaluate the effects of IC obtained through the use of intermediate-sized prewetted LWA, partial replacements of cement with the supplementary cementitious materials slag cement and silica fume (SCMs); incorporation of calcium oxide–based and magnesium oxide–based SCAs; and combinations of IC, SCMs, and SCAs using eleven concrete mixtures with moderate w/b ratios (0.45). The results show that the modified ASTM C157 method helps to capture the early-age behavior of concrete mixtures. IC provided by partial replacement of total aggregate with intermediate-sized prewetted LWA is effective in reducing drying shrinkage in concrete made with moderate w/b ratios. Partial replacements of cement with slag cement and silica fume induce increased first-day expansion and reduce shrinkage. A further increase in first-day expansion and a reduction in shrinkage is obtained when IC is used in conjunction with slag cement and silica fume. The SCAs evaluated in this study reduce the tendency to develop shrinkage strain. The calcium oxide–based SCA induces the more rapid expansion of greater magnitude, while the magnesium oxide–based SCA expands more gradually. When the calcium oxide–based SCA is incorporated in a mixture containing SCMs or SCMs and IC, expansion is further increased. The same observation cannot be made for mixtures incorporating SCMs with the magnesium oxide–based SCA.
Development of predictive prognostic nomogram for NECs of rectum on population-based exploration
Authors: Lv Yang , Pu Ning , Mao Wei-lin , Chen Wen-qi , Wang Huan-yu , Han Xu , Ji Yuan , Zhang Lei , Jin Da-yong , Lou Wen-Hui , Xu Xue-feng
Published: September 2018

Aim

We aim to investigate the clinical characteristics of the rectal NECs and the prognosis-related factors and construct a nomogram for prognosis prediction.

Methods

The data of 41 patients and 1028 patients with rectal NEC were retrieved respectively from our institution and SEER database. OS or PFS was defined as the major study outcome. Variables were compared by chi-square test and t-test when appropriate. Kaplan–Meier analysis with log-rank test was used for survival analysis and the Cox regression analysis was applied. The nomogram integrating risk factors for predicting OS was constructed by R to achieve superior discriminatory ability. Predictive utility of the nomogram was determined by concordance index (C-index) and calibration curve.

Results

In the univariate and multivariate analyses, tumor differentiation, N stage, M stage and resection of primary site were identified as independent prognostic indicators. The linear regression relationship was found between the value of Ki-67 index and the duration of OS (P < 0.05). Furthermore, the independent prognostic factors were added to formulate prognostic nomogram. The constructed nomogram showed good performance according to the C-index.

Conclusions

Contrary to WHO classification guideline, we found that the rectal NEC diseases are heterogeneous and should be divided as different categories according to the pathological differentiation. Besides, the nomogram formulated in this study showed excellent discriminative capability to predict OS for those patients. More advanced predictive model for this disease is required to assist risk stratification via the formulated nomogram.
Mitochondrial disease: an uncommon but important cause of diabetes mellitus
Authors: Yee Ming Li , Wong Rosemary , Datta Mineesh , Fazio Timothy Nicholas , Mohammad Ebrahim Mina , Mcnamara Elissa Claire , De Jong Gerard , Gilfillan Christopher
Published: September 2018

Mitochondrial diseases are rare, heterogeneous conditions affecting organs dependent on high aerobic metabolism. Presenting symptoms and signs vary depending on the mutation and mutant protein load. Diabetes mellitus is the most common endocrinopathy, and recognition of these patients is important due to its impact on management and screening of family members. In particular, glycemic management differs in these patients: the use of metformin is avoided because of the risk of lactic acidosis. We describe a patient who presented with gradual weight loss and an acute presentation of hyperglycemia complicated by the superior mesenteric artery syndrome. His maternal history of diabetes and deafness and a personal history of hearing impairment led to the diagnosis of a mitochondrial disorder.

Learning points:

The constellation of diabetes, multi-organ involvement and maternal inheritance should prompt consideration of a mitochondrial disorder.

Mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes (MELAS) and maternally inherited diabetes and deafness (MIDD) are the most common mitochondrial diabetes disorders caused by a mutation in m.3243A>G in 80% of cases.

Metformin should be avoided due to the risk of lactic acidosis.

There is more rapid progression to insulin therapy and higher prevalence of diabetic complications compared to type 2 diabetes.

Diagnosis of a mitochondrial disorder leads to family screening, education and surveillance for future complications.

Superior mesenteric artery syndrome, an uncommon but important cause of intestinal pseudo-obstruction in cases of significant weight loss, has been reported in MELAS patients.
Hyponatremia after anticoagulant treatment: a rare cause of adrenal failure
Authors: Zampetti Benedetta , Attanasio Roberto , Cozzi Renato
Published: September 2018

A 69-year-old male was admitted for severe hyponatremia disclosed after an accidental fall. He was anticoagulated from 2 months after the implantation of a biologic aortic valve prosthesis. The work-up disclosed adrenal failure and MRI showed bilateral adrenal hemorrhage. Clinical picture and lab parameters normalized quickly after the appropriate replacement treatment. Anticoagulation excess should be added to the list of drugs potentially causing hyponatremia.

Learning points:

Hyponatremia requires a complete and timely workup in order to start an appropriate treatment for the improvement of clinical conditions.

History is crucial: a detailed list of drugs potentially causing hyponatremia should be collected. Anticoagulants should be added to the list, mostly in the event of excessive anticoagulation.

Intra-adrenal hemorrhage is a rare cause of hyponatremia and adrenal failure.

The ACTH test is still the gold standard for the diagnosis of hypoadrenalism.
FAM129A regulates autophagy in thyroid carcinomas in an oncogene-dependent manner
Authors: Nozima Bruno Heidi , Mendes Thais Biude , Pereira Gustavo José da Silva , Araldi Rodrigo Pinheiro , Iwamura Edna Sadayo Miazato , Smaili Soraya Soubhi , Carvalheira Gianna Maria Griz , Cerutti Janete Maria
Published: September 2018

We previously proposed that high expression of FAM129A can be used as a thyroid carcinoma biomarker in preoperative diagnostic exams of thyroid nodules. Here, we identify that FAM129A expression is increased under nutrient and growth factor depletion in a normal thyroid cell line (PCCL3), overlapping with increased expression of autophagy-related protein and inhibition of AKT/mTOR/p70S6K. Supplementation of insulin, TSH and serum to the medium was able to reduce the expression of both FAM129A and autophagy-related protein and reestablish the AKT/mTOR/p70S6K axis. To determine the direct role of FAM129A on autophagy, FAM129A was transfected into PCCL3 cells. Its overexpression induced autophagic vesicles formation, evidenced by transmission electron microscopy. Co-expression of FAM129A and mCherry-EGFP-LC3B in PCCL3 showed an increased yellow puncta formation, suggesting that FAM129Ainduces autophagy. To further confirm its role on autophagy, we knockdown FAM129A in two thyroid carcinoma cell lines (TPC1 and FTC-236). Unexpectedly, FAM129A silencing increased autophagic flux, suggesting that FAM129A inhibits autophagy in these models. We next co-transfected PCCL3 cells with FAM129A and RET/PTC1 and tested autophagy in this context. Co-expression of FAM129A and RET/PTC1 oncogene in PCCL3 cells, inhibited RET/PTC1-induced autophagy. Together, our data suggest that, in normal cells FAM129A induces autophagy in order to maintain cell homeostasis and provide substrates under starvation conditions. Instead, in cancer cells, decreased autophagy may help the cells to overcome cell death. FAM129A regulates autophagy in a cell- and/or context-dependent manner. Our data reinforce the concept that autophagy can be used as a strategy for cancer treatment.
Dynamics of fatty acid regulatory genes during ovarian development in Penaeus monodon
Authors: Deenarn Pacharawan , Tobwor Punsa , Leelatanawit Rungnapa , Wongtriphop Somjai , Khudet Jutatip , Karoonuthaisiri Nitsara , Vichai Vanicha , Wimuttisuk Wananit
Published: September 2018

The delay in ovarian maturation in farmed black tiger shrimp Penaeus monodon has resulted in the widespread practice of feeding broodstock with the polychaetes Perinereis nuntia and their unilateral eyestalk ablation. Although this practice alters fatty acid content in shrimp ovaries and hepatopancreas, its effects on fatty acid regulatory genes have yet to be systematically examined. Here, microarray analysis was performed on hepatopancreas and ovary cDNA collected from P. monodon at different ovarian maturation stages, revealing that 72 and 58 genes in fatty acid regulatory pathways were differentially expressed in hepatopancreas and ovaries respectively. Quantitative real-time PCR analysis revealed that ovarian maturation was associated with higher expression levels of acetyl-CoA acetyltransferase, acyl-CoA dehydrogenase, acyl-CoA oxidase 3 and long-chain fatty acid transport protein 4 in hepatopancreas, whereas the expression levels of 15 fatty acid regulatory genes were increased in shrimp ovaries. To distinguish the effects of different treatments, transcriptional changes were examined in P. monodon with stage 1 ovaries before polychaete feeding, after one-month of polychaete feeding and after eyestalk ablation. Polychaete feeding resulted in lower expression levels of enoyl-CoA hydratase and acyl-CoA synthetase medium-chain family member 4, while the expression level of phosphatidylinositide phosphatase SAC1 was higher in shrimp hepatopancreas and ovaries. Additionally, eyestalk ablation resulted in a higher expression level of long-chain fatty acid-CoA ligase 4 in both tissues. Together, our findings describe the dynamics of fatty acid regulatory pathways during crustacean ovarian development and provide potential target genes for alternatives to eyestalk ablation in the future.
Issues in the quantitative analysis of the SIPRI arms industry database
Authors: Smith Ron , Dunne J. Paul
Published: September 2018

Although the Stockholm International Peace Research Institute’s data on the 100 largest arms (and military services) producing firms is very widely used for various purposes, there is relatively little quantitative statistical analysis of it. This article discusses some of the issues involved in the econometric analysis of the data. This is complicated by the difficulty of modeling the processes of mergers, acquisitions, and divestments which drives entry and exit from the list. Various models are estimated to examine (a) the relationship between arms sales and military expenditure, (b) the evolution of concentration and the size distribution of firms, (c) the cross-section relationship between size and growth of firms, (d) the times-series properties of the arms sales of individual firms, and (e) of arms sales by country of ownership.
The effectiveness of ankle foot orthosis on gait in children with spastic diplegic cerebral palsy
Authors: Sundar Das Dhruti , Mohapatra Jeetendra , Lenka Prasanna
Published: September 2018

Introduction: Cerebral palsy is a life lasting disability and is one of the most expensive diseases. CP is defined as a non-progressive, chronic, involuntary movement disorder secondary to an injury or lesion of the immature brain. The lesion usually occurs prenatally on prenatally: only about 10 per cent of the lesions are of postnatal origin. In most patients, a specific cause is not identified. Orthotic management is a widely utilized method of treatment in children with CP due to its conservative nature. Orthosis continue to have an important role in many therapeutic regimens for children with CP. However; there have been differences in design variants of Orthosis prescribed for the common problem of Spastic Cerebral Palsy. Three AFO configurations frequently prescribed for children with spastic cerebral palsy they are Hinged AFO (HAFO), the Posterior leaf spring (PLS AFO), and the Solid AFO (SAFO). Methods: Thirty subjects with Spasticdieplegic Cerebral palsy aged from 5-15 years with (male=20 and female=16) chosen through randomized sampling and taken in this study. The Selected subjects underwent indicated AFOs (SAFO, PLSAFO, HAFO,). Each intervention was given up to three months with wearing schedule 6-12 hours per day. Results: Results shows a significant improvement in Gait Parameters and i.e. Step length (p<0.020), stride length (p<0.003), cadence (p<0.005), Velocity (p<0.002), but not significant difference in comparison between SAFO, PLSAFO and HAFO. Conclusion: The findings of the study support the hypothesis that there were significant differences between the three design variants of AFO in improving gait parameters in subject with spasticdieplegic Cerebral Palsy.
Bilateral sever´s disease–an uncommon finding
Authors: Luis Duarte Marcio , de Abreu Bruno Fernandes Barros Brehme , Harumi Ito Maura , Varandas Costa Maria Gabriela , Almeida Prado Jose Luiz Masson de , Pereira da Silva Marcelo de Queiroz
Published: September 2018

Calcaneal apophysitis is a common cause of heel pain in children and is also known as Sever´s disease. Rarely causes important disability and is transient in most of the times, but it can interfere with walking and physical performance in sports, causing concern to the patient and parents. It is the most common cause of heel pain in the physically active growing children–8-25 years-old–and is considered a benign, self-limiting condition of childhood and adolescence. Boys constitute two-thirds of the patients and the sport that tends to dominate is soccer. The diagnosis of calcaneal apophysitis is usually made with a typical history and physical examination. Pain with activity, especially running and jumping, and a positive “squeeze test”: pain is produced by medial and lateral compression of the heel where the calcaneal apophysis attaches to the main body of the calcaneus. Children with Sever’s disease don´t have growth disturbances in the calcaneal apophysis or any vary in bone density compatible with a necrotic or a repair process. Children with Sever’s disorder respond variably, poorly, or not at all to anti-inflammatory drugs. Heel cup fixating the heel pad provided better pain relief in young boys with Sever’s injury compared with the traditional heel wedge.
Guideline Adoption for Community-Acquired Pneumonia in the Outpatient Setting
Authors: Ambroggio Lilliam , Mangeot Colleen , Murtagh Kurowski Eileen , Graham Camille , Korn Paul , Strasser Marcie , Cavallo Charles , Brady Katherine , Campanella Suzanne , Clohessy Caitlin , Brinkman William B. , Shah Samir S.
Published: September 2018

BACKGROUND:

The Pediatric Infectious Diseases Society and Infectious Diseases Society of America national childhood community-acquired pneumonia (CAP) guideline encouraged the standard evaluation and treatment of children who were managed as outpatients. Our objectives were to (1) increase adherence to guideline-recommended diagnostics and antibiotic treatment of CAP at 5 pediatric primary care practices (PPCPs) by using quality-improvement methods and (2) evaluate the association between guideline adherence and unscheduled follow-up visits.

METHODS:

Immunocompetent children >3 months of age with no complex chronic conditions and who were diagnosed with CAP were eligible for inclusion in this stepped-wedge study. Interventions were focused on education, knowledge of colleagues’ prescribing practices, and feedback sessions. Statistical process control charts were used to assess changes in recommendations and antibiotic treatment. Unscheduled follow-up visits were compared across time by using generalized estimating equations that were clustered by PPCP.

RESULTS:

CAP was diagnosed in 1906 children. Guideline recommended therapy and pulse oximetry use increased from a mean baseline of 24.9% to a mean of 68.0% and from 4.3% to 85.0%, respectively, over the study period. Among children >5 years of age, but not among those who were younger, the receipt of guideline recommended antibiotics, as compared with nonguideline therapy, was associated with the increased likelihood of unscheduled follow-up (adjusted odds ratio, 2.12; 95% confidence interval: 1.31–3.43). Chest radiographs and complete blood cell counts were rarely performed at baseline.

CONCLUSIONS:

Recommendations for limited use of chest radiographs and complete blood cell counts and standardized antibiotic therapy in children is supported at PPCPs. However, the guideline may need to include macrolide monotherapy as appropriate antibiotic therapy for older children.
FINANCIAL POLICY RULES IN THE EDUCATIONAL SPHERE: SUBSTANTIATION ALGORITHM
Authors: Radionova Irina , Usyk Vira
Published: September 2018

The purpose of the article is to substantiate the educational sphere financial rules, what can answer the question of how education financing indices must change under the alteration of macroeconomic indices, which determine the national economy state. The authors are investigating the issue regarding the substantiation and specification of educational sphere financial rules and related public administration benefits. The research has applied the fiscal and monetary rules analysis methodology. The applied result of the education financing rules substantiation issue research consists in the application of the algorithm, which covers 5 stages: rules idea formulation, the assessment of variables relationships significance according to the rules idea, the selection of endogenous and exogenous variables with significant relationships, the definition of gaps between the actual and trend values of the selected variables, the derivation of the equation of dependencies between the gaps.
On Theory (as Pedagogy) in a Time of Excess
Authors: Radin Jessica
Published: September 2018

Drawing on the articles collected by Aaron W. Hughes in the newly published "Theory in a Time of Excess", this article argues that critical theory in religion has an important role to play in the public sphere of 2017. This is particularly true if scholars take seriously the suggestion of several of the authors in this edited volume, that critical theory in the study of religion must consist of the constant questioning both of specific theories, and of the social, political, and historical paradigm in which both theories and methods are chosen by scholars.
Do the medical humanities enrich learning during an undergraduate anaesthetic placement?
Authors: Westall Helen , Riyat Amardeep
Published: September 2018

This article was migrated. The article was marked as recommended. The value of humanities may not be immediately apparent to those focused on the medical sciences. Medical humanities offer a range of learning opportunities, complementing the sciences to enhance medical education(Lake, Jackson and Hardman, 2015). This study examines whether the humanities enrich learning during an undergraduate anaesthetic placement. Method26 third-year medical students completed a questionnaire following a two-week placement in anesthetics. Students had previously completed a compulsory humanities project. Inductive thematic analysis was carried-out on qualitative data by two independent assessors, before combining results to find common themes. Summary of Results69% reported no previous experience of studying the humanities.80% considered studying humanities beneficial.34% responded that humanities were significant to anaesthesia. 85% used the humanities project to further explore and reflect on previous anaesthetic learning.ConclusionsDespite minimal exposure, students agree with medical educationalists that the humanities can complement the sciences to create and change in ideas and behaviours, and therefore improve patient care (Oyebode, 2010). The majority of students regarded the medical humanities project a useful learning exercise; students valued the opportunity to choose a personally pertinent topic before using creative techniques to explore and reflect on it further. Students' responses frequently demonstrated a deepening of knowledge leading to a favourable change in their attitudes and behaviour across topics difficult to explore using solely the sciences. Not all students responded enthusiastically to this style of learning with some preferring a more traditional approach.Take home messages The medical humanities are an important facet of the undergraduate curriculum.The humanities project offered students a structure with which to further explore, analyse and reflect on a topic of personal interest within anaesthesia creating a deeper, holistic learning experience.The medical humanities may be particularly beneficial in developing non-technical skills in medical students extending beyond the anaesthetics placement.
Model for estimating construction waste generation in masonry building
Authors: Nagalli André , de Carvalho Karina Querne
Published: September 2018

The civil construction sector is an important generator of solid waste. Estimating the quantities of construction waste is crucial in the waste management process. In Brazil, although legislation has required that builders promote waste management since 2002, there are no specific generation models. This work describes a predictive waste generation model implemented with good results in Curitiba, Paraná, Brazil. Through the analysis of 48 buildings and their characteristics, including human and management aspects, a model is proposed to estimate the total volume of waste that is expected on a building site. The analysis considered the following parameters: work execution time, total constructed area, type of masonry, team training and monitoring. The model application revealed that the model is preferred to single or direct relations, such as those that the literature usually recommends. The model presented good results for projects with a total constructed area larger than 4000 m2. Finally, the average error associated with the prediction was 29·8%, which is considered acceptable due to the complexity of the phenomena and the lack of better models.
Hacia la promoción de la salud
Authors: Hernández Álvarez Mario
Published: September 2018

La promoción de la salud ha tenido en su corta historia varias acepciones. Henry Sigerist la mencionó en 1944 como la primera tarea de la medicina, en términos de la preservación de la salud de las comunidades. Posteriormente, Leavell y Clark, en 1953, en el marco de la “medicina preventiva”, la asimilaron a las actividades educativas para modificar los factores de riesgo relacionados con el comportamiento de las personas y que podrían generar enfermedad.
Isolation of phosphoproteins from symbiotic and aposymbiotic Aiptasia anemones for elucidation of the phosphoproteome v1
Authors: Simona Fabia , Zhang Huoming , R Voolstra Christian
Published: September 2018

The analysis of gene expression data via RNA sequencing (RNA-Seq) has become a standard method for model and non-model organisms to identify genes of interest associated with a specific stressor of physiological state. More recently, mass spectrometry (MS)-based proteomics started to become a standard method to assay the phenotype of an organism via means of its expressed proteins. MS has also become the method of choice for the study of protein phosphorylation. Phosphoproteomics targets proteins that are subjected to phosphorylation via means of their serine, threonine, and tyrosine residues. Phosphorylation is a reversible modification that plays a key role in controlling the activity of proteins as well as their function and subcellular localization. To bring MS-based phosphoproteomics to the emerging coral model system Aiptasia, we developed a protocol for phosphosphproteins extraction and generation of a phosphoproteome assay (spectral) library, a comprehensive non-redundant collection of Aiptasia phosphoproteins. Based on the assay library, we then performed accurate label-free quantification (by DIA/SWATH-MS) of the Aiptasia phosphoproteome. Our method reproducibly identifies and quantifies a broad fraction of the phosphorylated proteome of Aiptasia and is comparable to methods developed for other model systems