bluuebunny/crossref_metadata_2025 huggingface dataset:
Modelo de ensino-aprendizagem híbrido de alemão no Brasil: uma tendência contemporânea desafiadora?
Authors: Garcia André Luiz Ming , Redel Elisângela , Martiny Franciele Maria
Published: February 2021

Neste trabalho, apresentamos uma pesquisa sobre crenças discentes a partir de dois cursos híbridos de alemão como língua estrangeira realizados por uma instituição de ensino de língua e cultura alemãs na cidade de São Paulo. Como arcabouço teórico, buscou-se apoio sobretudo em Barcelos (2001) e Almeida Filho (2013), entre outros autores dedicados às temáticas deste artigo. A metodologia de pesquisa apresenta análises qualitativas e quantitativas, baseadas em aplicação de questionário na perspectiva da Linguística Aplicada, focalizando as crenças dos estudantes a respeito do ensino a distância (modalidade EaD) antes e após a sua participação nos cursos. Constatamos que a busca por uma maior flexibilidade espaço-temporal e por uma redução nos custos de cursos tradicionais na modalidade exclusivamente presencial são fatores que motivaram a maior parte dos participantes da pesquisa a optarem pela modalidade EaD. Além disso, verificamos que parte da insatisfação com tal modalidade registrada dos entrevistados se deve a deficiências que eles identificaram na estrutura dos cursos e do ambiente virtual de aprendizagem, sendo que a plataforma utilizada nem sempre oferece recursos suficientes para desenvolver a necessária autonomia do alunado. Tal cenário reflete a problematização do uso das tecnologias em prol do desenvolvimento adequado do ensino a distância, bem como a necessidade de formação docente a fim de que seja possível encarar os novos desafios para o ensino-aprendizagem de línguas na modalidade híbrida.
Tradições discursivas: de seu status linguístico-teórico e sua dinâmica
Authors: Costa Alessandra Castilho Ferreira da
Published: February 2021

Reconsiderando a tripartição coseriana do linguístico (em um nível universal, do falar em geral; um histórico, das línguas particulares; um individual, dos discursos produzidos em situações específicas), o romanista alemão Peter Koch propõe o acréscimo, no nível histórico, duma historicidade dos textos ou das tradições discursivas, constituindo regras distintas das regras da língua. Neste estudo programático de 1997, publicado na série ScriptOralia da editora Narr (Tübingen, Alemanha), o autor define o conceito de tradição discursiva; delimita seu campo teórico, postulando quatro campos linguísticos, referentemente, a atividade do falar (universal), as línguas particulares (histórico), as regras do discurso ou tradições discursivas (histórico) e o discurso (individual); discute ainda suas implicações para as fronteiras entre Linguística Textual e Linguística Variacional, universais da comunicação e gêneros textuais e intertextualidade e interdiscursividade; ademais, apresenta seu proveito para a Literatura e Linguística, os estudos de oralidade e história da língua. Por fim, descreve a dinâmica de sua formação e transformação pelos processos de diferenciação, mistura, convergência e desaparecimento. O objetivo da presente tradução é tornar acessível ao público brasileiro esta obra de referência sobre a noção de tradição discursiva, que exerce decisiva influência tanto na Romanística alemã quanto em recentes pesquisas históricas do Português Brasileiro.
DaF Lehren und Lernen mit digitalen Medien: Einführung in das thematische Dossier
Authors: Rozenfeld Cibele Cecílio de Faria , Marques-Schäfer Gabriela
Published: February 2021

...
Restructuring the Gut Microbiota by Intermittent Fasting Lowers Blood Pressure
Authors: Shi Huanan , Zhang Bojun , Abo-Hamzy Taylor , Nelson James W. , Ambati Chandra Shekar R. , Petrosino Joseph F. , Bryan Robert M. , Durgan David J.
Published: February 2021

Rationale:

In recent years, it has been demonstrated that a pathological change in the gut microbiota, termed gut dysbiosis, can be an underlying factor for the development of hypertension. Prevention of this dysbiosis can attenuate or abolish hypertension. Translational mechanisms to prevent gut dysbiosis as well as understanding of the mechanisms linking gut dysbiosis to hypertension are lacking.

Objective:

We first examined the efficacy of intermittent fasting (IF) in altering the gut microbiota and lowering blood pressure (BP). Next, we utilized a multi-omics approach to examine microbial influenced metabolites that may serve as the link between the gut microbiota and host BP regulation.

Methods and Results:

We demonstrate that IF significantly altered the makeup of the gut microbiota, cecal and plasma metabolome, and prevented the development of hypertension in the spontaneously hypertensive stroke-prone rat. The beneficial effects of IF were shown to be due to alterations of the gut microbiota through germ-free transplantation studies. Germ-free rats receiving microbiota from IF spontaneously hypertensive stroke-prone rat had significantly lower BP as compared with germ-free rats receiving microbiota from ad libitum fed spontaneously hypertensive stroke-prone rats. Through whole genome shotgun sequence analysis of the microbiota and untargeted metabolomics of cecal content and plasma, we identified bile acid metabolism as a potential mediator in BP regulation. Finally, we show supplementation with cholic acid, or activation of the G protein-coupled bile acid receptor (TGR5), significantly reduced BP of the spontaneously hypertensive stroke-prone rats.

Conclusions:

These studies demonstrate the BP-lowering effects of IF involves manipulation of the gut microbiota and metabolome and implicate disrupted bile acid signaling as novel mechanisms by which gut dysbiosis contributes to hypertension.
SARS‐CoV‐2 Viremia is Associated With Inflammatory, But Not Cardiovascular Biomarkers, in Patients Hospitalized for COVID‐19
Authors: Myhre Peder L. , Prebensen Christian , Jonassen Christine Monceyron , Berdal Jan Erik , Omland Torbjørn
Published: February 2021

Background

COVID‐19 may present with a variety of cardiovascular manifestations, and elevations of biomarkers reflecting myocardial injury and stress are prevalent. SARS‐CoV‐2 has been found in cardiac tissue, and myocardial dysfunction post‐COVID‐19 may occur. However, the association between SARS‐CoV‐2 RNA in plasma and cardiovascular biomarkers remains unknown.

Methods and Results

COVID MECH (COVID‐19 Mechanisms) was a prospective, observational study enrolling consecutive, hospitalized patients with laboratory‐confirmed infection with SARS‐CoV‐2 and symptoms of COVID‐19. Biobank plasma samples used to measure SARS‐CoV‐2 RNA and cardiovascular and inflammatory biomarkers were collected in 123 patients at baseline, and in 96 patients (78%) at day 3. Patients were aged 60±15 (mean ± SD) years, 71 (58%) were men, 68 (55%) were White, and 31 (25%) received mechanical ventilation during hospitalization. SARS‐CoV‐2 RNA was detected in plasma from 48 (39%) patients at baseline. Patients with viremia were more frequently men, had more diabetes mellitus, and lower oxygen saturation. Patients with viremia had higher concentrations of interleukin‐6, C‐reactive protein, procalcitonin, and ferritin (all <0.001), but comparable levels of cTnT (cardiac troponin T;
P
=0.09), NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide;
P
=0.27) and D‐dimer (
P
=0.67) to patients without viremia. SARS‐CoV‐2 RNA was present in plasma at either baseline or day 3 in 50 (52%) patients, and these patients experienced increase from baseline to day 3 in NT‐proBNP and D‐dimer concentrations, while there was no change in cTnT.

Conclusions

SARS‐CoV‐2 viremia was associated with increased concentrations of inflammatory, but not cardiovascular biomarkers. NT‐proBNP and D‐dimer, but not cTnT, increased from baseline to day 3 in patients with viremia.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04314232.
Children’s Rights when Financing Development through Multilateral Development Banks: Mapping the Field and Looking Forward
Authors: Türkelli Gamze Erdem
Published: February 2021

Children and their rights are increasingly recognised as an integral part of the global development agenda as set out by the 2030 Agenda and the accompanying sdg s (Sustainable Development Goals). UN Human Rights Council Resolution 34/16 calls for a child rights-based approach to implementing these goals. Aspirations aside, children’s rights are largely invisible when the debates shift to how development is financed. Consequently, a children’s rights-based inquiry into the governance of institutions that finance development, is largely absent. This article seeks to overcome the relative scarcity of critical academic reflection on how and to what extent children’s rights feature in how development projects are financed by multilateral development banks (mdb s). The article first identifies common strands in norms mdb s use to govern themselves, their clients and borrowers. It then proceeds to situate how children’s rights fit into these administrative governance frameworks and goes on to address future perspectives of engagement to address shortcomings.
Small cell carcinoma of the cervix complicated by syndrome of inappropriate antidiuretic hormone secretion: a case report
Authors: Zhao Cai-Fu , Zhao Su-Fen , Du Ze-Qing
Published: February 2021

Small cell carcinoma of the cervix is a rare malignant tumor in the clinical setting. Clinical manifestations of this tumor are mostly similar to those of normal types of cervical cancer. Small cell carcinoma of the cervix only shows symptoms of neuroendocrine tumors, such as syndrome of inappropriate antidiuretic hormone secretion (SIADH). Most of the hyponatremia caused by SIADH can be managed after removal of the cause. Hyponatremia is a predictor of poor prognosis and can be used as an indicator of partial recurrence. We report a case of small cell carcinoma of the cervix complicated by SIADH. Our patient presented with irregular vaginal bleeding after menopause. After one cycle of chemotherapy, there was trembling of the limbs, and a laboratory examination showed low Na+ and low Cl− levels. After limited water intake, intravenous hypertonic saline, and intermittent diuretic treatment, the patient’s blood Na+ levels returned to normal. After a radical operation, the above-mentioned symptoms disappeared.
Autonomous Vehicle Safe Operating Speeds on the Automated Skyway Express in Jacksonville, Florida
Authors: Loken Andrew E. , Steelman Joshua S. , Rosenbaugh Scott K. , Faller Ronald K.
Published: February 2021

Autonomous vehicles (AV) differ significantly from traditional passenger vehicles in both their behavior and physical characteristics. As such, the validity of the guidance provided in the Manual for Assessing Safety Hardware, Second Edition (MASH 2016) is questionable in AV applications. Impact angles, speeds, and vehicle weights specified in MASH 2016 are inextricably linked to the traditional vehicles underlying the estimates. For AV applications, these parameters must be estimated from the ground up, stepping outside the guidance of MASH 2016. In this paper, a conservative method for evaluating existing infrastructure to support AV traffic is proposed. The method integrates traditional structural analyses with unconventional methods of estimating impact conditions. This methodology was developed for the Jacksonville Transportation Authority, who, when faced with unique challenges in maintaining and expanding their Automated Skyway Express, opted to convert the system from monorail to AV traffic. Leading AV developers were surveyed to develop a portfolio of potential candidates for the conversion. Estimated impact conditions were then compared against the capacity of the system’s existing concrete parapets. Ultimately, safe operating speeds for each AV candidate were recommended on the bases of structural capacity and vehicle stability. All but one AV candidate were deemed capable of safely operating at the desired speed of 25 mph without any modifications to the barrier. Although the methodology was developed for a particular case, it is applicable to future implementations of AVs on existing infrastructure, provided the roadway is confined similarly to the Skyway deck.
Using Real-Time Data to Detect Delays and Improve Customer Communications at New York City Transit
Authors: Caspari Adam , Wood Daniel , Campbell Angel , Jefferson Darian , Huynh Tuan , Reddy Alla
Published: February 2021

New York City Transit operates one of the world’s largest transit systems, and it can be difficult for the agency’s communications team to keep track of the numerous service disruptions that need to be communicated to customers. This paper introduces the Transit Visualization tool, which processes real-time train location data to automatically identify areas of the system where service may not be living up to customers’ expectations. Specifically, the Transit Visualization is set up to identify areas of the system where trains are operating at lower-than-normal speeds and areas of the system where there are atypically long gaps between trains. Any occurrence of slow speeds or long gaps is assigned a severity level (Moderate, Severe, or Very Severe) to indicate the magnitude of the problem. An overview of any problems the application identifies is shown on an interactive web map, as well as on several easy-to-digest summary tables. The map also displays real-time locations of trains and buses throughout the transit system. The Transit Visualization has been successfully rolled out to the subways communications team and has become a mission-critical tool for communicating delays to customers, especially during the course of the COVID-19 pandemic.
Performance Evaluation of Studded Tire Ruts for Asphalt Mix Designs in a Cold Region Environment
Authors: Abaza Osama A. , Dahms Daniel
Published: February 2021

Studded tire wear is one of the most important contributing factors that govern pavement life on high traffic volume roads in south-central Alaska. It has been estimated that the annual cost to repair damage caused by studded tires in Alaska is approximately $13.7 million. Polymer modified asphalt binders and hard aggregate are commonly used in mix designs in the State of Alaska Department of Transportation and Public Facilities projects in an attempt to resist studded tire wear. This research provides a field performance-based analysis of the use of hard aggregate and polymer modified binders related to the reduction of the impact of studded tire wear. To analyze the performance of modification in asphalt mix designs, roadway data was gathered from the Alaska Department of Transportation Pavement Management System Database and roads were grouped into deterioration families based on mix design properties. Relationships of each deterioration are presented to show cumulative average annual daily traffic versus total rut depth, comparing mix designs with and without hard aggregate and polymer modification. Findings indicated that both polymer modification and hard aggregate can be used to reduce the impact of studded tire wear. The benefits of polymer modification and hard aggregate proved more significant as cumulative traffic volumes increase. Recommendations from the performance analysis included continuing the use of hard aggregate and polymer modified binders on Alaskan roadways with continuous research on the use of more highly modified asphalt binders to further reduce the impact of studded tire wear.
Economic, social and cultural rights and their dependence on the economic growth paradigm: Evidence from the ICESCR system
Authors: Petel Matthias , Putten Norman Vander
Published: February 2021

In light of the expanding critical academic literature on the social and ecological limits to a growth-based paradigm, this article investigates the ties between economic, social and cultural rights (ESC rights) and economic growth in the case law of the Committee on Economic, Social and Cultural Rights (CESCR). It shows that the CESCR assumes economic growth to generally improve the realisation of ESC rights because it increases States’ financial capacity and leads to employment creation. However, while the Committee deems that growth models should be inclusive, the CESCR never adopts a critical perspective on the possibility or desirability to pursue economic growth indefinitely. Despite recent evidence on the contested possibility to decouple economic activity from resource use, the Committee’s recent ecological turn remains embedded in the growth paradigm. This article argues that the Committee should advocate towards decreasing the dependence of ESC rights on growth, especially when a State has reached a certain level of affluence.
Influences of slotted blade on performance and flow structure of a transonic axial compressor
Authors: Zhang Guochen , Gao Tianyi , Xu Zhihui , Liu Pengcheng , Zhang Chengfeng
Published: February 2021

Main reason of compressor instability is boundary layer separation on the surface of blades. As one of flow control methods of the compressor, slotted blade has attracted many researchers’ attention because of its simple geometric structure and remarkable flow control effect. In order to evaluate its availability in the compressor, a type of convergent slot is designed to implement in a single-stage transonic axial compressor. Three configurations, i.e. rotor slot, stator slot and rotor-stator combined slot, are introduced to study the aerodynamic performance of compressor by numerical simulations. Furthermore, flow structures have been analyzed to explain the corresponding mechanism. The results show that overall stability margin of the compressor has been improved by flow control with slotted blade. Behavior of the rotor slot is better than that of the stator slot, but due to mass flow leakage in the slot, peak efficiency and chocking mass flow rate of the compressor are decreased by 1.18% and 3.8% respectively. The low momentum flow on pressure surface is sucked into the jet slot of stator blade, which improves the overall stability margin of 0.63%. The combined scheme with slotted rotor and slotted stator has obtained the best aerodynamic behavior with the increase of the overall stability margin of 2.83%. During the future research, main goal will be improvement of the compressor performance and extension of the mass flow rate range.
Effect of prophylactic laser during small-gauge vitrectomy for epiretinal membranes
Authors: Linton Edward F , Kim Stephen J , Patel Shriji N
Published: February 2021

Purpose:

To determine the rate of post-operative retinal detachment after elective pars plana vitrectomy for epiretinal membrane, and to test for the mitigating effect of prophylactic endolaser.

Methods:

We identified 459 eyes of 411 patients undergoing vitrectomy for epiretinal membrane at Vanderbilt University Medical Center between January 2010 and May 2017. Patients who underwent concurrent endolaser without any identified retinal break were included in the exposure cohort. Patients who underwent no prophylactic retinopexy or ablation were included in the unexposed cohort. Exposure data, demographic data, and outcome data were tabulated for comparison.

Results:

The final analysis included 343 eyes of 343 patients. Approximately 7% of eyes undergoing ERM surgery were found to have a full-thickness retinal break which was not seen preoperatively. The overall rate of postoperative RD was 2.04%. Postoperative retinal detachment occurred in 0 of the 34 eyes exposed to prophylactic laser, and in 7 of the 309 control eyes. Odds ratio was found to be 0.60 ( p = 0.598 (95%CI 0.0327–10.7), p = 0.72), indicated the results were not statistically significant.

Discussion:

Looking at patients undergoing routine vitrectomy surgery for epiretinal membrane, no retinal detachments occurred in the group receiving prophylactic treatment, though this association did not reach statistical significance. With modern surgical techniques, post-operative retinal detachment remains relatively rare after vitrectomy for ERM though a thorough intraoperative exam is critical to identify occult retinal breaks.
A critical reflection on the use of improvement science approaches in public health
Authors: Fischbacher Colin M. , Lewsey Jim , Muirie Jill , McCartney Gerry
Published: February 2021

Objective:

‘Improvement science’ is used to describe specific quality improvement methods (including tests of change and statistical process control). The approach is spreading from clinical settings to population-wide interventions and is being extended from supporting the adoption of proven interventions to making generalisable claims about new interventions. The objective of this narrative review is to evaluate the strengths and risks of current improvement science practice, particularly in relation to how they might be used in population health.

Methods:

A purposive sampling of published studies to identify how improvement science methods are being used and for what purpose. The setting was Scotland and studies that focused on health and wellbeing outcomes.

Results:

We have identified a range of improvement science approaches which provide practitioners with accessible tools to assess small-scale changes in policy and practice. The strengths of such approaches are that they facilitate consistent implementation of interventions already known to be effective and motivate and empower staff to make local improvements. However, we also identified a number of potential risks. In particular, their use to assess the effectiveness of new interventions often seems to pay insufficient attention to random variation, measurement bias, confounding and ethical issues.

Conclusions:

The use of current improvement science methods to generate evidence of effectiveness for population-wide interventions is problematic and risks unjustified claims of effectiveness, inefficient resource use and harm to those not offered alternative effective interventions. Newer methodological approaches offer alternatives and should be more widely considered.
COVID-19 and suicide risk in the construction sector: preparing for a perfect storm
Authors: King Tania L. , Lamontagne Anthony D.
Published: February 2021

Aims:

Worldwide, construction industries are considered to be key economic pillars of the societies they serve, and construction workers constitute a sizeable proportion of the global paid workforce. In many parts of the world, construction workers are at elevated risk of suicide. Here, we examine the extent to which construction workers may be differentially exposed to the economic effects of COVID-19.

Methods:

A narrative review and synthesis of the literature was conducted.

Results:

The economic and labour market shock resulting from the COVID-19 pandemic has led to a convergence of factors that may significantly exacerbate suicide risk among construction workers, particularly among those with lower skills.

Conclusions:

With important insights from previous financial crises, it is vital that governments, industry and workplaces act rapidly to mitigate suicide risk among vulnerable groups such as construction workers. Mental healthcare investment is needed, and must be complemented by prevention and control in the workplace and in the general community. Anticipating, preparing and acting to ameliorate this risk, particularly among low skilled construction workers, will save many livelihoods, as well as lives.
A novel methodology for marine dual fuel engines sensors diagnostics and health management
Authors: Stoumpos Sokratis , Theotokatos Gerasimos
Published: February 2021

The sensors abnormalities, faults, failure detection and diagnosis for marine engines are considered crucial for ensuring the engine safe and smooth operation. The development of such system(s) is typically based on the manufacturers experience on sensors and actuators faults and failure events. This study aims to introduce a novel methodology for the sensors diagnostics and health management in marine dual fuel engines by employing a combination of thermodynamic, functional control and data-driven models. The concept of an Engine Diagnostics System (EDS) is developed to provide intelligent engine monitoring, advanced sensors’ faults detection as well as timely and profound corrective actions. This system employs a neural networks (NN) Data-Driven (DD) model along with appropriate logic controls. The DD model is set up based on the derived steady state data from a thermodynamic model of high fidelity and is capable of real-time prediction of the engine health condition behaviour. The concept of a novel Unified Digital System (UDS) is proposed that combines the engine’s existing control and diagnostic systems with the EDS. The functionality of the UDS system is validated by employing a digital twin of the considered marine dual fuel engine by investigating scenarios for assessing the engine performance that entail abnormalities in the engine’s speed and boost pressure sensors. The simulation results demonstrate that the developed UDS is capable of sufficiently capturing the engine’s sensors abnormalities and applying appropriate corrective actions to restore the engine operation in its original state. This study benefits the development future systems facilitating the engines condition assessment and self-correction of the engine sensors’ abnormalities, which will be required for smart and autonomous shipping.
Where crises converge: the affective register of displacement in Mexico City’s post-earthquake gentrification
Authors: Linz Jess
Published: February 2021

Affect theory suggests that imagining different futures for cities begins by feeling the present differently. This article considers the political potential of the affective register in the context of gentrifying Mexico City, where the 2017 earthquake, as a crisis-event, burst onto the ongoing crisis-ordinary of gentrification-based displacement. I argue that this convergence of crises opened an affective impasse, or a time and space lived in excess of predictability. This affective impasse both interrupted business-as-usual gentrification and channeled historical affects across 32 years from the 1985 earthquake, and in turn generated new political energies. Informed by affect theory and trauma studies, I use qualitative data to invite the reader into the impasse and observe its affective dynamics. The empirical sections describe the entry points to the impasse, the affective activities that subjects engage in there, and the role of historical trauma in reshaping the atmospheres that emerge from this space. The resulting research investigates how affective ways of navigating an impasse offer the potential to reshape ongoing struggles against displacement. This builds on recent work in urban geography that uses psychoanalysis and affect theory to understand gentrification’s complexities, contradictions, and ambivalences.
Turning Practicing Surgeons Into Health Technology Innovators: Outcomes From the Stanford Biodesign Faculty Fellowship
Authors: Fuerch Janene H. , Wang Paul , Van Wert Ryan , Denend Lyn
Published: February 2021

Background. The Stanford Biodesign Faculty Fellows program was established in 2014 to train Stanford Medical and Engineering faculty in a repeatable innovation process for health technology translation while also being compatible with the busy clinical schedules of surgical faculty members. Methods. Since 2014, 62 faculty members have completed the fellowship with 42% (n = 26) coming from 14 surgical subspecialties. This eight-month, needs-based innovation program covers topics from identifying unmet health-related needs, to inventing new technology, developing plans for intellectual property (IP), regulatory, reimbursement, and business models to advance the technologies toward patient care. Results/Conclusion. Intake and exit survey results from three years of program participants (n = 36) indicate that the fellowship is a valuable hands-on educational program capable of improving awareness and experience with skill sets required for health technology innovation and entrepreneurship.
Inguinal Hernias in Cirrhotic Patients: From Diagnosis to Treatment
Authors: Kykalos Stylianos , Machairas Nikolaos , Ntikoudi Evangelia , Dorovinis Panagiotis , Molmenti Ernesto P , Sotiropoulos Georgios C
Published: February 2021

Cirrhosis has a strong association with abdominal wall hernias, especially in the presence of concomitant ascites. Major predisposing factors for hernia formation in this particular group of patients include increased intra-abdominal pressure and decreased muscle mass due to poor nutrition. Management of these patients is highly challenging and requires an experienced multidisciplinary surgical and medical approach. The aim of our review is to clarify crucial diagnostic and management approaches. Crucial medical and technical issues on this topic are widely discussed with special focus on indication, timing, and type of surgical repair, with an additional reference to the actual role of laparoscopy.
Ultrasound and alternative multimodality imaging of intra-abdominal and pelvic cystic masses in the newborn
Authors: Lee Weiyong , Lee Margaret YW , Teo Harvey
Published: February 2021

Introduction: Ultrasound is used commonly to detect and diagnose intra-abdominal and pelvic cystic masses in the newborn as it is easily available, relatively low cost, and non-invasive. Discussion: The diagnosis can be made or narrowed down by determining the location, size, sonographic features, organ involvement, and internal vascularity. The differential diagnoses include hydronephrosis, multicystic dysplastic kidney, adrenal haemorrhage, cystic teratomas, ovarian cysts, enteric cysts, meconium cysts, and liver haemangiomas. With the appropriate radiological knowledge, the ultrasound practitioner can help obtain an accurate diagnosis. Conclusion: This pictorial essay will familiarise the reader with the different common causes of intra-abdominal and pelvic masses detected on ultrasound through a wide range of conditions. The role of ultrasound in the evaluation of these conditions will be discussed and alternative imaging correlates will be offered.
Cutaneous Metastasis of Prostate Adenocarcinoma: A Rare Presentation of a Common Disease
Authors: Dills Alexander , Obi Okechukwu , Bustos Kevin , Jiang Jesse , Gupta Shweta
Published: February 2021

Prostate cancer is the most common cancer affecting men in the United States and the second greatest cause of cancer-related death. Metastases usually occur to bone followed by distant lymph nodes and then viscera. Cutaneous metastases are extremely rare. Their presence indicates advanced disease and a poor prognosis. As they are highly variable in appearance and may mimic a more benign process, biopsy is essential for identification. Serine proteases, particularly human tissue kallikreins, may play an important role in promoting metastasis and facilitate infiltration of the skin. Individual cancer genetics may predispose to more aggressive cancer and thus earlier and more distant metastases. In this article, we report our case of a 67-year-old man with a 4-year history of castrate-resistant prostate cancer with cutaneous metastases confirmed by histology. Despite multiple lines of systemic therapy, the patient suffered progressive disease with worsening performance status and was enrolled in hospice.
Custom-made Total Joint Replacement After Segmental Resection of Recurrent Follicular Ameloblastoma
Authors: Alba Ismael Vejar , Arias Guadalupe Jacinto , Soto Emmanuel Guerrero , Zenteno Sara Itzel López
Published: February 2021

Design:

Clinical case report.

Objective:

To present custom-made total joint replacement as a suitable option after resection of extensive odontogenic tumors.

Background:

Ameloblastoma is the most common odontogenic tumor. Clinical presentation is characteristic as it presents with a slow growth rate, but highly expansive and recurrent. Ample resection with safety margins is imperative to allow for a functional and predictable reconstruction.

Methods:

We present the case of a 51-year-old male diagnosed with a recurrent follicular ameloblastoma and was treated with segmental resection and subsequent reconstruction with custom-made total joint replacement.

Results:

Follow-up at 14 months after surgery showed satisfactory quality of life and proper functionality.

Conclusions:

Total custom joint replacement is an ideal option after extensive resections involving the articular region.
Treatable traits in an English cohort: prevalence and predictors of future decline in lung function and quality of life in COPD
Authors: Sarwar Muhammad Rehan , McDonald Vanessa Marie , Abramson Michael John , Paul Eldho , George Johnson
Published: February 2021

Background

“Treatable traits (TTs)” is a precision medicine approach for facilitating multidimensional assessment of every patient with chronic airway disease, in order to determine the core traits associated with disease outcomes where targeted treatments may be applied.

Objectives

To determine the prevalence of TTs in chronic obstructive pulmonary disease (COPD) and which traits predict future decline in lung function and quality of life (QoL).

Methods

A 4-year longitudinal evaluation was conducted using data from 3726 participants in the English Longitudinal Study of Ageing (ELSA). TTs were identified based on published recommendations. Traits that predicted decline in lung function and QoL were analysed using generalised estimating equations.

Results

Overall, 21 TTs, including pulmonary (n=5), extra-pulmonary (n=13) and behavioural/lifestyle risk-factors (n=3) were identified. In multivariate analyses, the traits of chronic bronchitis (β −0.186, 95% CI −0.290 to −0.082), breathlessness (β −0.093, 95% CI −0.164 to −0.022), underweight (β −0.216, 95% CI −0.373 to −0.058), sarcopenia (β −0.162, 95% CI −0.262 to −0.061) and current smoking (β −0.228, 95% CI −0.304 to −0.153) predicted decline in forced expiratory volume in 1 s (FEV1). Of the seven traits that predicted decline in QoL, depression (β −7.19, 95% CI −8.81 to −5.57) and poor family and social support (β −5.12, 95% CI −6.65 to −3.59) were the strongest.

Conclusion

The core TTs of COPD associated with a decline in lung function and QoL were identified. Targeting these impactful traits with individualised treatment using a precision medicine approach may improve outcomes in people with COPD.
“The elephant in the room;” a qualitative study of perinatal fears in opioid use disorder treatment in Southern Appalachia
Authors: Leiner Catherine , Cody Tamara , Mullins Nathan , Ramage Melinda , Ostrach Bayla M. M.
Published: February 2021

Background

Diagnoses of perinatal opioid use disorder (OUD) continue to rise in the United States. Patients and providers report obstacles to OUD treatment access. Difficulties include legal ambiguity related to Social Services notification requirements following a birth to people using opioids or in medication-assisted treatment for OUD.

Methods

Through semi-structured interviews, participant-observation, and a focus group conducted in a mostly rural, region of the Southern United States (where perinatal OUD is more prevalent), patients’ and providers’ perspectives about perinatal substance use treatment were initially sought for a larger study. The findings presented here are from a subset analysis of patients’ experiences and perspectives. Following ethics review and exemption determination, a total of 27 patient participants were opportunistically, convenience, and/or purposively sampled and recruited to participate in interviews and/or a focus group. Data were analyzed using modified Grounded Theory.

Results

When asked about overall experiences with and barriers to accessing perinatal substance use treatment, 11 of 27 participants reported concerns about Social Services involvement resulting from disclosure of their substance use during pregnancy. In the subset analysis, prevalent themes wereFears of Social Services Involvement,Preparation for Delivery, andProviders Addressing Fears.

Conclusions

Perinatal OUD patients may seek substance use treatment with existing fears of Social Services involvement. Patients appreciate providers’ efforts to prepare them for this potential reality. Providers should become aware of how their own hospital systems, counties, states, and countries interpret laws governing notification requirements. By becoming aware of patients’ fears, providers can be ready to discuss the implications of Social Services involvement, promote patient-centered decision-making, and increase trust.
Psychometric properties of the Persian version of delivery fear scale (DFS) in Iran
Authors: Shakarami Aazam , Iravani Mina , Mirghafourvand Mojgan , Jafarabadi Mohammad Asghari
Published: February 2021

Background

The aim of the present study was to evaluate the psychometric properties of the Persian version of delivery fear scale (DFS) among Iranian women population.

Methods

This is a methodological study that was conducted to evaluate the psychometric properties of DFS. Convenience sampling was used to select 200 pregnant women from the maternity ward of Razi Hospital in Ahvaz, Iran. In the first step, the scale was translated into Persian using backward-forward translation method. Afterwards, the following types of validity were examined: face validity based on impact score, construct validity based on confirmatory factor analysis (CFA), and concurrent validity. The Pearson correlation test was used to determine the correlation of DFS with pregnancy-related anxiety questionnaire (PRAQ), Childbirth Attitude Questionnaire (CAQ), Spielberger’s state-trait anxiety inventory (STAI), and the short form of Lowe’s childbirth self-efficacy inventory. Reliability of DFS was assessed by determining internal consistency (Cronbach’s alpha) and split-half method.

Results

CFA had satisfactory validity considering x2⁄df < 5 and the RMSEA < 0.08. /the obtained Cronbach’s alpha coefficient was 0.77. The split-half coefficient of the questionnaire was 0.83, indicating an acceptable reliability for the questionnaire. The results showed that DFS had a direct significant correlation with the CAQ (r = 0.72), PRAQ (r = 0.74), STAI-Y1 (r = 0.71) and STAI-Y1 (r = 0.63) and a reverse significant correlation with subscales of the short form of Lowe’s childbirth self-efficacy inventory including outcome expectancy (r= -0.75) and self-efficacy expectancy (r= -0.76).

Conclusions

The findings of the present study confirm the validity and reliability of the Persian version of DFS as an instrument for measuring fear of childbirth (FOC) in Iranian women population.
Temporal relationship of computed and structured diagnoses in electronic health record data
Authors: Schulz Wade L. , Young H. Patrick , Coppi Andreas , Mortazavi Bobak J. , Lin Zhenqiu , Jean Raymond A. , Krumholz Harlan M.
Published: February 2021

Background

The electronic health record (EHR) holds the prospect of providing more complete and timely access to clinical information for biomedical research, quality assessments, and quality improvement compared to other data sources, such as administrative claims. In this study, we sought to assess the completeness and timeliness of structured diagnoses in the EHR compared to computed diagnoses for hypertension (HTN), hyperlipidemia (HLD), and diabetes mellitus (DM).

Methods

We determined the amount of time for a structured diagnosis to be recorded in the EHR from when an equivalent diagnosis could be computed from other structured data elements, such as vital signs and laboratory results. We used EHR data for encounters from January 1, 2012 through February 10, 2019 from an academic health system. Diagnoses for HTN, HLD, and DM were computed for patients with at least two observations above threshold separated by at least 30 days, where the thresholds were outpatient blood pressure of ≥ 140/90 mmHg, any low-density lipoprotein ≥ 130 mg/dl, or any hemoglobin A1c ≥ 6.5%, respectively. The primary measure was the length of time between the computed diagnosis and the time at which a structured diagnosis could be identified within the EHR history or problem list.

Results

We found that 39.8% of those with HTN, 21.6% with HLD, and 5.2% with DM did not receive a corresponding structured diagnosis recorded in the EHR. For those who received a structured diagnosis, a mean of 389, 198, and 166 days elapsed before the patient had the corresponding diagnosis of HTN, HLD, or DM, respectively, recorded in the EHR.

Conclusions

We found a marked temporal delay between when a diagnosis can be computed or inferred and when an equivalent structured diagnosis is recorded within the EHR. These findings demonstrate the continued need for additional study of the EHR to avoid bias when using observational data and reinforce the need for computational approaches to identify clinical phenotypes.
Optically transparent vertical silicon nanowire arrays for live-cell imaging
Authors: Elnathan Roey , Holle Andrew W. , Young Jennifer , George Marina A. , Heifler Omri , Goychuk Andriy , Frey Erwin , Kemkemer Ralf , Spatz Joachim P. , Kosloff Alon , Patolsky Fernando , Voelcker Nicolas H.
Published: February 2021

Programmable nano-bio interfaces driven by tuneable vertically configured nanostructures have recently emerged as a powerful tool for cellular manipulations and interrogations. Such interfaces have strong potential for ground-breaking advances, particularly in cellular nanobiotechnology and mechanobiology. However, the opaque nature of many nanostructured surfaces makes non-destructive, live-cell characterization of cellular behavior on vertically aligned nanostructures challenging to observe. Here, a new nanofabrication route is proposed that enables harvesting of vertically aligned silicon (Si) nanowires and their subsequent transfer onto an optically transparent substrate, with high efficiency and without artefacts. We demonstrate the potential of this route for efficient live-cell phase contrast imaging and subsequent characterization of cells growing on vertically aligned Si nanowires. This approach provides the first opportunity to understand dynamic cellular responses to a cell-nanowire interface, and thus has the potential to inform the design of future nanoscale cellular manipulation technologies.
A systematic review of nutraceutical interventions for mitochondrial dysfunctions in myalgic encephalomyelitis/chronic fatigue syndrome
Authors: Maksoud Rebekah , Balinas Cassandra , Holden Sean , Cabanas Hélène , Staines Donald , Marshall-Gradisnik Sonya
Published: February 2021

Background

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating illness, characterised by persistent fatigue that is unrelieved by rest, in combination with a range of other disabling symptoms. There is no diagnostic test nor targeted treatment available for this illness. The pathomechanism also remains unclear. Mitochondrial dysfunctions have been considered a possible underlying pathology based on reported differences including structural and functional changes in ME/CFS patients compared to healthy controls. Due to the potential role that mitochondria may play in ME/CFS, mitochondrial-targeting nutraceutical interventions have been used to potentially assist in improving patient outcomes such as fatigue. The aim of this systematic review is to appraise literature assessing these nutraceuticals as a possible intervention for treating ME/CFS.

Methods

A systematic search of Pubmed, Embase, Medline (EBSCO host) and Web of Science (via Clarivate Analytics) for journal articles published between January 1995 and 10th November 2020 was conducted. Articles assessing nutraceutical interventions and ME/CFS patient outcomes were retrieved. Using specific inclusion and exclusion criteria, the list of articles was further refined. Quality was measured using the Rosendal scale.

Results

Nine intervention studies were included in this review. The studies investigated patient symptom severity changes such as altered fatigue levels in response to mitochondrial-targeting nutraceuticals. Improvements in fatigue levels were observed in six of the nine studies. Secondary outcomes assessed include biochemical, psychological, and quality of life parameters.

Conclusion

There is insufficient evidence on the effectiveness of mitochondria- targeting nutraceuticals in ME/CFS patients. Future well-designed studies are required to elucidate both the involvement of mitochondria in the pathomechanism of ME/CFS and the effect of mitochondrial-modifying agents on illness severity.
A novel mutation in early‐onset sarcoidosis/Blau syndrome: an association with Propionibacterium acnes
Authors: Okazaki Fumiko , Wakiguchi Hiroyuki , Korenaga Yuno , Nakamura Tamaki , Yasudo Hiroki , Uchi Shohei , Yanai Ryoji , Asano Nobuyuki , Hoshii Yoshinobu , Tanabe Tsuyoshi , Izawa Kazushi , Honda Yoshitaka , Nishikomori Ryuta , Uchida Keisuke , Eishi Yoshinobu , Ohga Shouichi , Hasegawa Shunji
Published: February 2021

Background

Early-onset sarcoidosis (EOS) and Blau syndrome (BS) are systemic inflammatory granulomatous diseases without visible pulmonary involvement, and are distinguishable from their sporadic and familial forms. The diseases are characterized by a triad of skin rashes, symmetrical polyarthritis, and recurrent uveitis. The most common morbidity is ocular involvement, which is usually refractory to conventional treatment. A gain-of-function mutation in the nucleotide-binding oligomerization domain-containing protein 2 (NOD2) gene has been demonstrated in this disease; however, little is known about the relationship between the activation ofNOD2and the pathophysiology of EOS/BS. Here we describe EOS/BS with a novel mutation in theNOD2gene, as well as detection ofPropionibacterium acnes(P. acnes) in the granulomatous inflammation.

Case presentation

An 8-year-old Japanese girl presented with refractory bilateral granulomatous panuveitis. Although no joint involvement was evident, she exhibited skin lesions on her legs; a skin biopsy revealed granulomatous dermatitis, andP. acneswas detected within the sarcoid granulomas by immunohistochemistry withP. acnes-specific monoclonal (PAB) antibody. Genetic analyses revealed that the patient had aNOD2heterozygous D512V mutation that was novel and not present in either of her parents. The mutantNOD2showed a similar activation pattern to EOS/BS, thus confirming her diagnosis. After starting oral prednisolone treatment, she experienced an anterior vitreous opacity relapse despite gradual prednisolone tapering; oral methotrexate was subsequently administered, and the patient responded positively.

Conclusions

We presented a case of EOS/BS with a novel D512V mutation in theNOD2gene. In refractory granulomatous panuveitis cases without any joint involvement, EOS/BS should be considered as a differential diagnosis; genetic analyses would lead to a definite diagnosis. Moreover, this is the first report ofP. acnesdemonstrated in granulomas of EOS/BS. Since intracellularP. acnesactivates nuclear factor-kappa B in aNOD2-dependent manner, we hypothesized that the mechanism of granuloma formation in EOS/BS may be the result ofNOD2activity in the presence of the ligand muramyl dipeptide, which is a component ofP. acnes.These results indicate that recognition ofP. acnesthrough mutantNOD2is the etiology in this patient with EOS/BS.