bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Management of an Aspergillus Empyema in a 3-Year-Old Child
Authors: Kanakis Meletios A. , Petsios Konstantinos Th. , Giannopoulos Nicholas M. , Bobos Dimitrios , Hatzianastasiou Sofia , Sianidou Lida C. , Lioulias Achilleas
Published: May 2020

Aspergillus empyema in nonimmunocompromised children is rare. A case of surgical management of invasive aspergillosis in a previously healthy 3-year-old child is presented. The patient was initially admitted to a hospital with severe respiratory deterioration and clinical instability, originally attributed to sepsis. After surgical intervention and the diagnosis of invasive aspergillosis, intravenous therapy with voriconazole was initiated. During postoperative care, the patient’s condition remained stable with mild functional respiratory deficits. The diagnosis and treatment of Aspergillus empyema remains challenging, especially in cases that the recognition of aspergillosis is delayed and urgent surgical management of the empyema is required due to rapid clinical deterioration of the patient. The early initiation, prolonged administration, and close monitoring of high-dose antifungal treatment are highly recommended.
Acceptance for Social Health Insurance among Health Professionals in Government Hospitals, Mekelle City, North Ethiopia
Authors: Tewele Alemtsehay , Yitayal Mezgebu , Kebede Adane
Published: May 2020

Background. Ethiopia is one of the countries with high out-of-pocket payments leading to catastrophic health expenditure. The government of Ethiopia introduced social health insurance (SHI) scheme with the overall objective of achieving universal health care access. Studying health professionals’ acceptance to pay for social health insurance is crucial for the successful implementation of the scheme. Therefore, this study aimed to assess the acceptance of social health insurance and its associated factors among health professionals in government hospitals, Mekelle city, North Ethiopia. Methods. An institution-based cross-sectional study design was used. The study participants were selected using systematic random sampling. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 20. Bivariable and multivariable logistic regression models at a 5% level of significance, and odds ratios with 95% CI level were used to determine the association between the health professionals’ acceptance of health insurance and explanatory variables. Results. The study revealed that 62.5% of the respondents were willing to participate in the SHI scheme in which 74.9% were willing to pay 3% or more of their monthly salary. Health professionals’ acceptance for SHI significantly associated with monthly salary (AOR = 9.49; 95% CI: 2.51, 35.86), awareness about SHI (AOR = 3.89; 95% CI: 1.05, 14.28), history of difficulty in covering medical bills (AOR = 6.2; 95% CI: 2.42, 15.87), attitudes towards social health insurance (AOR = 7.57; 95% CI: 3.14, 18.21), and perceived quality of health care services if SHI implemented (AOR = 2.89; 95% CI: 1.18, 7.07). Conclusion. The study indicated that there were still a high proportion of health professionals who were not willing to pay for SHI. Therefore, strengthening awareness creation, creating awareness about SHI, promoting the scheme using the different channels of communication to bring about favorable attitude, and providing health care services with required standard quality could help to increase the acceptance of SHI by health professionals.
An Experimental Study Examining the Size Effect on the Compressive Dynamic Performance of Nuclear Power Containment Concrete
Authors: Li Furong , Chen Guoxing , Long Hui
Published: May 2020

To study the size effect of nuclear power containment concrete (NPCC) under compressive dynamic performance, the cube concrete specimens with 3 different cube sizes were measured at 10 different loading strain rates using a hydraulic servo, and the failure mode and compressive strength of NPCC were compared and analyzed under different loading conditions. Based on the comparative analysis of experiment results, the following conclusions can be drawn: the effect of loading strain rate has caused NPCC to develop from static strain rate, mainly cement cementitious layer damage and uniform distribution of cracks, to dynamic strain rate, where there are partial coarse aggregate failures and oblique cracks as the main crack distribution. Due to the size effect, the integrity of large‐scale NPCC specimen after compression failure is relatively high. With the increase of loading strain rate and decrease of cube size, compressive strength of NPCC is gradually increased, and, with the increase of loading strain rate, the size effect on the mechanical properties of NPCC becomes more significant. Moreover, this paper quantitatively analyzes the influence of the coupling effect of strain rate and size effect on the compressive strength of NPCC, and its mechanism is discussed in depth. The research results are of great significance to the safety of nuclear power concrete containment.
Multiattribute Group Decision-Making Method Using a Genetic K-Means Clustering Algorithm
Authors: Qingguo Liu , Xinxue Liu , Jian Wu , Yaxiong Li
Published: May 2020

Multiattribute group decision-making (MAGDM) problems are characterized by the large number, uneven levels, and bounded rationality of decision-makers; multiple attributes and fuzziness of decision problems; and complex group behaviours. Considering these characteristics, we propose a MAGDM method using a genetic K-means clustering algorithm. First, we briefly review the traditional multiattribute decision-making method based on prospect theory (PT) and trapezoidal intuitionistic fuzzy numbers (TrIFNs) under the premise of human bounded rationality and uncertain decision environment. Then, the aggregation model of decision information given by decision-makers is established using the genetic K-means algorithm in order to determine optimal clustering results. Each clustering center represents decision information given by decision-makers in each cluster, and the weight of each clustering center is determined by considering the tightness of decision information within a cluster and the count of decision-makers in each cluster. Finally, the ranking of schemes is obtained according to the comparison rules of TrIFNs. We design comparison simulation experiments to test the proposed method and the simulation results demonstrate that the proposed method is apprehensible and feasible to solve MAGDM problems.
Integrated Bioinformatics Analysis of the Clinical Value and Biological Function of ATAD2 in Hepatocellular Carcinoma
Authors: Meng Xiangyu , Wang Lu , Zhu Bo , Zhang Jun , Guo Shuai , Li Qiang , Zhang Tao , Zheng Zhichao , Wu Gang , Zhao Yan
Published: May 2020

ATPase family AAA domain‐containing protein 2 (ATAD2), a chromatin regulator and an oncogenic transcription cofactor, is frequently overexpressed in many cancers, particularly in hepatocellular carcinoma (HCC). By integrating open‐access online mRNA datasets and our institutional tissue data on HCC, the clinical role and functions of ATAD2 were analyzed by bioinformatic algorithms. We systematically examined ATAD2 expression in HCC based on a large sample population, integrating data from our institution and the GEO, Oncomine, and TCGA datasets. Aberrant ATAD2 expression related to pathways was identified by bioinformatic algorithms. The effects of ATAD2 downregulation on the cycle cell were also determined. A pooled analysis from 28 datasets indicated that ATAD2 overexpression was found in HCC (SMD = 8.88, 95% CI: 5.96–11.81, P < 0.001) and was correlated with poor survival. Subgroup analysis of Asian patients with a serum alpha‐fetoprotein (AFP) concentration < 200 ng/ml in stage I + II showed that the ATAD2‐high group had a more unfavorable overall survival (OS) rate than the ATAD2‐low group. The receiver operating characteristic curve indicated that the efficiency of ATAD2 for HCC diagnosis was considerable (area under the curve = 0.89, 95% CI: 0.86–0.91). Functional analysis based on bioinformatic algorithms demonstrated that ATAD2 participates in cell division, mitotic nuclear division, DNA replication, repair, and cell cycle processes. ATAD2 knockout in HCC cells downregulated cyclin C and cyclin D1 protein levels and resulted in G1/S phase arrest in vitro. The kinesin family member C1 (KIFC1), shugoshin 1 (SGO1), GINS complex subunit 1 (GINS1), and TPX2 microtubule nucleation factor (TPX2) genes were closely related to ATAD2 upregulation. ATAD2 may interact with TTK protein kinase (TTK) to accelerate HCC carcinogenesis. ATAD2 plays a vital role in HCC carcinogenesis by disturbing the interaction between chromatin proteins and DNA. Targeting ATAD2 represents a promising method for the development of therapeutic treatments for cancer.
Direct Current Electric Field Stimulates Nitric Oxide Production and Promotes NO-Dependent Angiogenesis: Involvement of the PI3K/Akt Signaling Pathway
Authors: Wei Xing , Guan Linbo , Fan Ping , Liu Xinghui , Liu Rui , Liu Yu , Bai Huai
Published: May 2020

Electric fields (EFs) promote angiogenesis in vitro and in vivo. These results indicate the feasibility of the application of EFs to modulate angiogenesis. Nitric oxide (NO) derived from endothelial nitric oxide synthase (eNOS) is an important regulator of angiogenesis. However, the role of direct current EFs in eNOS activity and expression in association with angiogenesis of endothelial cells has not been investigated. In the present study, we stimulated human umbilical vein endothelial cells (HUVECs) with EFs and evaluated the activity and expression of eNOS. EFs induced significant phosphorylation of eNOS, upregulation of the expression of eNOS protein, and an increase in NO production from HUVECs. L-NAME, a specific inhibitor of eNOS, abolished EF-induced HUVEC angiogenesis. EFs stimulated Akt activation. Inhibition of PI3K activity inhibited EF-mediated Akt and eNOS activation and inhibited NO production in the endothelial cells. Moreover, EFs stimulated HUVEC proliferation and enhanced the S phase cell population of the cell cycle. We conclude that EFs stimulate eNOS activation and NO production via a PI3K/Akt-dependent pathway. Thus, activation of eNOS appears to be one of the key signaling pathways necessary for EF-mediated angiogenesis. These novel findings suggest that NO signaling may have an important role in EF-mediated endothelial cell function.
Ampicillin Treatment Increases Placental Interleukin-1 Beta Concentration and Polymorphonuclear Infiltration in Group B Streptococcus-Induced Chorioamnionitis: A Preclinical Study
Authors: Giraud Antoine , Allard Marie-Julie , Segura Mariela , Roche Frédéric , Patural Hugues , Sébire Guillaume
Published: May 2020

Background: Antibiotic therapy during preterm labor with intact membranes has been associated with an increased risk of neonatal death. Objectives: Using an established rat model of group B Streptococcus (GBS)-induced chorioamnionitis, we hypothesized that ampicillin treatment increases placental inflammation, as shown in other bacterial infections. Methods: At gestational day 19, 19 Lewis dams were intraperitoneally (i.p.) inoculated by 108 CFU of β-hemolytic serotype Ia GBS (strain #16955 susceptible to ampicillin). Dams were treated i.p. with either 200 mg/kg of ampicillin (n = 9) or 0.9% saline (n = 10) at 48 and 60 h post-GBS inoculation. Cesarean sections were performed 72 h post-GBS inoculation. Results: Ampicillin treatment was associated with an increased number of polymorphonuclear cells (PMN) infiltrating the decidua (mean 1,536 vs. 532 PMN/mm2; p < 0.001) and a higher placental concentration of IL-1β (mean 26.4 vs. 7.9 pg/mg; p < 0.01) compared to saline-treated dams. These effects were observed in dams without GBS bacteremia. Conversely, ampicillin treatment was associated with a decreased placental concentration of proinflammatory cytokines in dams with GBS bacteremia. Conclusions: Ampicillin increases placental inflammation in a rat model of GBS-induced chorioamnionitis without bacteremia. This proinflammatory effect of ampicillin could be due to bacterial lysis. Our findings do not query the intrapartum antibiotic prophylaxis against GBS disease. They pave the way for future preclinical studies combining anti-inflammatory treatments and antibiotic therapy for GBS-induced chorioamnionitis.
Adult Intussusception: An Uncommon Condition and Challenging Management
Authors: Tarchouli Mohamed , Ait Ali Abdelmounaim
Published: May 2020

Introduction: Intussusception is a rare condition in adults. A pathological lesion is usually found with a significant percentage of malignancy. The optimal treatment is still not universally clear. Methods: This is a retrospective review of adult patients with a diagnosis of intestinal intussusception and surgically treated at our institution from January 2009 to December 2018. Clinical, operative, and histological details were collected and analyzed. Results: A total of 26 cases, 16 males and 10 females, were diagnosed with surgically proven intussusception during the 10-year period. The mean age was 45 years (range 21–70). Using ultrasound and/or computed tomography as imaging study, the preoperative diagnosis was made in 21/26 (81%) patients. Five intussusceptions were discovered only upon exploratory laparotomy for intestinal obstruction. There were 19 (73%) cases of enteric and 7 (27%) cases of colonic intussusceptions. All patients underwent surgical exploration. Intestinal resection with immediate anastomosis was the technique of choice for most patients. A single patient underwent stoma for peritonitis secondary to intestinal perforation. An organic cause has been systematically revealed, and no idiopathic intussusception was detected. Etiology was malignant in 9 (35%) cases. Conclusion: Adult intussusception should be considered in any patient with subacute abdominal pain. Considering the high rate of malignancy, intestinal resection without attempting reduction is highly recommended for colonic intussusceptions. However, a more selective approach can be adopted for enteric intussusceptions.
Unusual Case of Indolent Choroidal Alterations Mimicking Neurofibromatosis Type 1
Authors: Abdolrahimzadeh Solmaz , Formisano Martina , Guglielmelli Fabio , Amodeo Stefano , Costa Maria Carmela , Scuderi Gianluca
Published: May 2020

Indolent, non-progressive choroidal alterations can be strongly suggestive of neurofibromatosis type 1 (NF1) but are also rarely of unknown aetiology. A 63-year-old man presented for a routine examination. Comprehensive ophthalmological examination and retinal imaging was performed. Visual acuity was 20/20. The anterior segment and fundus were unremarkable. Near-infrared reflectance (NIR) with spectral-domain optical coherence tomography showed unilateral hyperreflective areas in the left posterior pole, corresponding to choroidal nodules on enhanced depth imaging and hypofluorescent areas on indocyanine green angiography. Dermatological evaluation and genetic testing for NF1 were negative. Chest computed tomography, liver function, HLA-A29, and angiotensin-converting enzyme level were negative. The patient has remained in good health and the choroidal alterations have remained non-progressive for 3 years. Choroidal alterations observed with NIR could be a manifestation of somatic mosaicism or a variation of a new unclassified correlated condition that may be better elucidated in the future, given the use of novel imaging techniques that are currently available in ophthalmology.
Recovery from COVID-19 Pneumonia in a Patient with Acute Severe Colitis
Authors: Garcia Karoline Soares , Moutinho Bruna Damásio , Azevedo Matheus Freitas Cardoso de , Queiroz Natalia Sousa Freitas , Milani Luciane Reis , Sanches Lucas Navarro , Barros Luisa Leite , Oba Jane , Carlos Alexandre de Sousa , Damião Aderson Omar Mourão Cintra , Sipahi Aytan Miranda
Published: May 2020

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has increased concern regarding SARS-CoV-2 infection in inflammatory bowel disease (IBD) patients, especially those on immunosuppressive therapies or with active disease. There are limited reports describing the clinical features of COVID-19 in an IBD population, and the impact of immunosuppression on the severity of the infection remains unclear. Case Report: A 33-year-old female patient with a long history of ulcerative colitis, poorly controlled, was admitted with COVID-19 a few days after being discharged from the hospital for treatment of acute severe ulcerative colitis. High-risk factors for COVID-19 complications, i.e., high-dose steroids (40 mg prednisone) and severe active disease, were present at admission. Despite the development of extensive pulmonary involvement, the patient had a favorable outcome. Discussion: Management of IBD patients during the COVID-19 pandemic has been challenging. Measures to minimize the potential risk of SARS-CoV-2 infection, including strict social distancing and self-isolation, in the IBD population have been recommended, especially for high-risk patients. Although steroid tapering and persistence of biologics are advised by professional groups, the best treatment strategy for IBD patients presenting a flare during the outbreak has yet to be defined.
Blade Runner BR, 2071
Authors: Gonçalves Marco Antonio
Published: May 2020

Este artigo analisa o cinema de Adirley Queirós tomando seu primeiro longa metragem, A cidade é uma só? (2013), como fio condutor da interpretação. Seu cinema, situado entre Brasília e Ceilândia, sitia lugares e espaços naturalizados, dessubstancializa conceitos como os de localidade, periferia, identidade, memória, finitude, história, arquitetura, ficção, documentário. Seu cinema evoca diálogos fecundos através de figurações da alteridade, da distopia, da entropia em cenários urbanos posmetropolis, em que se percebe a insurgência das cidades satélites enquanto lócus de contestação e crítica a projetos, tão redentores quanto autoritários, como os propostos pela ideologia modernista que planeja e institui Brasília, nos anos 1950 e 1960, no Brasil central.
Qualidade das prescrições de profilaxia para tromboembolismo venoso em um hospital universitário no Brasil
Authors: Brito Giovanna Daneluz de , Fioramonte Guilherme Da Silva , Marques Gustavo Lenci
Published: May 2020

Objetivo: Embora preconizada, a profilaxia para tromboembolismo venoso não é sempre corretamente prescrita. O objetivo deste estudo é avaliar o nível de adequação das prescrições de profilaxia para tromboembolismo venoso para pacientes internados em um hospital universitário. Métodos: Trata-se de um estudo analítico transversal no qual foram avaliadas prescrições para pacientes internados nas unidades clínicas, cirúrgicas e críticas de um hospital universitário durante 30 dias. Excluíram-se pacientes em uso de anticoagulantes para finalidade diferente da profilática. Os critérios de avaliação da profilaxia de tromboembolismo venoso basearam-se na 9ª Diretriz do American College of Chest Physicians. Resultados: 358 prescrições foram analisadas. 65 foram excluídas. Das 293 prescrições selecionadas, 106 (36,18%) foram consideradas incorretas. A subprescrição foi a principal causa de inadequação, observada em 72 casos (67,9%). Inadequações foram maiores nas unidades cirúrgicas (48,72%) do que nas clínicas (35,11%) e críticas (26,2%) (p = 0,0013). Conclusões: Preocupantes taxas de inadequação da profilaxia para tromboembolismo venoso para pacientes internados foram encontradas, havendo predomínio da subprescrição. As maiores inadequações foram encontradas nas unidades cirúrgicas. Intervenções são necessárias para otimizar essa importante prática de segurança ao paciente hospitalizado.
O Mini-CEX na avaliação de habilidades clínicas na graduação médica
Authors: Diniz Neto Abdias Pereira , Lima Clarice Freitas Timóteo de , Carvalho Kelly Rayane Paiva , Santos Ruana Manso Porfírio dos , Lima Roberto Santos , Fernandes Raphaella Amanda Maria Leite
Published: May 2020

Introdução: Instrumentos de avaliação de habilidades clínicas na medicina são importantes para a análise do conhecimento, habilidades e atitudes do estudante. Dentre eles, o Mini Clinical Evaluation Exercise (mini-CEX) vem se destacando por avaliar o estudante em ambiente real de prática, além de fornecer feedback imediato. Objetivo: Realizar uma revisão sistemática da literatura sobre a aplicação do instrumento mini-CEX na graduação do curso de medicina. Métodos: As bases de dados pesquisadas foram: Eric, Pubmed e Science Direct. Através de duas estratégias de busca diferentes: Busca A, com período de pesquisa de 2011 a 2016 e a Busca B, com intervalo de 2006 a 2016, foram incluídos artigos que abordam o mini-CEX como instrumento de avaliação das habilidades clínicas em acadêmicos de medicina. Foram consideradas as características gerais dos estudos, o uso do mini-CEX na graduação médica e os critérios avaliados por esse instrumento. Resultados: Dos 140 artigos encontrados, três atenderam aos critérios de inclusão. Os estudos avaliaram as habilidades clínicas dos estudantes de medicina com o uso do mini-CEX, a partir da: habilidade de comunicação, atitude/profissionalismo, humanização, raciocínio clínico, habilidades de aconselhamento, organização/eficiência e competência clínica geral. Dentre essas competências, a anamnese, o exame físico e a capacidade de comunicação são melhores avaliados pelo mini-CEX quando comparado a outros métodos de avaliação de competências. Além disso, competências como comportamentos pessoal e profissional obtiveram as maiores pontuações gerais. Conclusões. O mini-CEX parece ser uma ferramenta eficaz, de fácil aplicação e confiável na avaliação das habilidades clínicas dos acadêmicos de medicina.
Factors associated with increased atrial septum thickness in infants with Hypoplastic Left Heart Syndrome (HLHS)
Authors: Carvalho Bárbara Justo , Aiello Vera Demarchi
Published: May 2020

Introduction: In the usual procedures performed on newborns affect by Hypoplastic Left Heart Syndrome (HLHS), phenotypic variations influence the success of the treatment, especially the characteristics related to the atrial septum and foramen ovale (FO) in case of catheter septostomy. Objectives: To analyze macroscopics features of the atrial septum of hearts with HLHS in order to define and guide therapeutic procedures on this structure. Methods: 18 hearts of deceased patients diagnosed with HLHS were evaluated for FO patency and size, bulging of its blade, atresia or patency of the mitral valve and caliber of the ascending aorta and pulmonary trunk. Histological sections of the atrial septum were made for measurements of maximum and minimum thickness of the lamina. Results: The mean age of the patients was 34.5 days (57% male), with a mean atrial septal thickness of 1.90 mm (0.63 - 4.09 mm). The mean diameter of the pulmonary trunk and aorta were 1.16 cm and 0.22 cm, respectively. FO was patent in 39% of cases. The mitral valve was atresic in 21% of the specimens. There was a significant difference in the thickness of the atrial septum in cases with patent or closed FO, being greater in cases where the FO was closed (p = 0.047). The ratio FO/age presented a statistically significant negative correlation with atrial septum thickness (r = -0.76 and p <0.05). Conclusions: The results indicate that the patency and size of the oval foramen have repercussions on the thickness of the atrial septum, suggesting that this factor may limit the success of therapeutic interventions, especially catheter septostomy.
Incidência de near miss neonatal em uma maternidade de médio porte do Nordeste Brasileiro
Authors: Cantalice Anajás da Silva Cardoso , Carvalho Karlla Kellyane Alves , Oliveira Lucian Batista de
Published: May 2020

Objetivo: Verificar a incidência de near miss neonatal (NMN), indicador de “quase morte” por complicações pré ou pós-natais, em uma maternidade de médio porte no Nordeste brasileiro. Modelo do estudo: Coorte retrospectiva, com abordagem indutiva e procedimentos descritivos. Metodologia: Analisou-se prontuários de nascidos no mês de janeiro de 2016, identificando-se os casos de NMN conforme os seguintes critérios: idade gestacional < 32 semanas, recém-nascido (RN) que necessitou de manobra de reanimação ou deprimido, peso ao nascimento < 1500 g, necessidade de cuidados em unidade de terapia intensiva neonatal (UTIN), necessidade de ventilação mecânica, escore de Apgar no 1º e 5º minutos < 7. Para verificar a associação entre as variáveis maternas e o diagnóstico de NMN, foi utilizado o teste t de Student. Resultados: Foram avaliados 120 RN. Dentre eles, 26 nascidos de parto normal e 94 de parto cesáreo. A média de idade materna foi de 26,61 (±7,9). A maioria das genitoras apresentava doenças cardiovasculares (71,7%) e 70,8% pré-natal com número de consultas inferior a sete. Identificou-se uma incidência de 30% de NMN, sendo a maioria do sexo masculino (55%). A taxa de internação na UTIN foi de 17,5%. O menor número de filhos vivos e médias superiores de partos cesáreos apresentaram associação significativa (p < 0,05) com o NMN. Conclusão: O indicador de NMN apresentou uma elevada incidência, mesmo em hospital de referência para gestação de alto risco, sendo um método de grande relevância para avaliação e prevenção de morbidades graves do RN.
Análise geográfica e cartografia histórica: subsídios para entender a organização espacial da área gênese de Petrópolis (RJ)
Authors: Antunes Fernando De Souza , Fernandes Manoel Do Couto
Published: May 2020

Com um passado rico na produção de seu espaço urbano, a cidade de Petrópolis (RJ) sofreu mudanças ao longo do tempo nas formas, funções, estrutura e processos. Este trabalho visa discutir e avaliar a organização espacial da cidade serrana procurando remontar seu planejamento inicial. Para isso, se usou a Planta de Petrópolis (1846) e adotaram as categorias de análise forma, função, estrutura e processo. Como a Planta é um levantamento planimétrico sem origem espacial, projeção cartográfica ou coordenadas, foi preciso digitalizá-la, georreferenciá-la e vetorizá-la, a fim de extrair informações da área gênese da cidade para subsidiar as análises geográficas pretendidas. Os resultados apontam principalmente mudança da função inicial dos quarteirões previamente estabelecidos, substituída pela atividade industrial que criou polos de atração de mão de obra. Esses resultados se confirmaram na análise das formas espaciais pretéritas, criadas no contexto sociopolítico-econômico que as funcionalizou e modificou ao longo do tempo
As Dimensões do Geográfico: da quantidade à qualidade; do ente ao ser
Authors: Martins Elvio Rodrigues
Published: May 2020

Este texto é a continuação do trabalho intitulado “As Dimensões do Geográfico: um diálogo com Armando Corrêa da Silva”. Nesta segunda parte procuramos avançar no problema lógico e ontológico identificado por Armando presente na ciência geográfica, denominado impasse aristotélico-kantiano. Há aqui uma proposta de sistematização do discurso geográfico, articulando suas diferentes categorias, considerando os problemas de lógica frente às dimensões espaço-temporais.
Focal Pulsed Field Ablation for Pulmonary Vein Isolation and Linear Atrial Lesions
Authors: Koruth Jacob S. , Kuroki Kenji , Kawamura Iwanari , Stoffregen William C. , Dukkipati Srinivas R. , Neuzil Petr , Reddy Vivek Y.
Published: May 2020

Background:

A novel ablation and mapping system can toggle between delivering biphasic pulsed field (PF) and radiofrequency energy from a 9-mm lattice-tip catheter. We assessed the preclinical feasibility and safety of (1) focal PF-based thoracic vein isolation and linear ablation, (2) combined PF and radiofrequency focal ablation, and (3) PF delivered directly atop the esophagus.

Methods:

Two cohorts of 6 swine were treated with pulsed fields at low dose (PF
LD
) and high dose (PF
HD
) and followed for 4 and 2 weeks, respectively, to isolate 25 thoracic veins and create 5 right atrial (PF
LD
), 6 mitral (PF
HD
), and 6 roof lines (radiofrequency+PF
HD
). Baseline and follow-up voltage mapping, venous potentials, ostial diameters, and phrenic nerve viability were assessed. PF
HD
and radiofrequency lesions were delivered in 4 and 1 swine from the inferior vena cava onto a forcefully deviated esophagus. All tissues were submitted for histopathology.

Results:

Hundred percent of thoracic veins (25 of 25) were successfully isolated with 12.4±3.6 applications/vein with mean PF times of <90 seconds/vein. Durable isolation improved from 61.5% PF
LD
to 100% with PF
HD
(
P
=0.04), and all linear lesions were successfully completed without incurring venous stenoses or phrenic injury. PF
HD
sections had higher transmurality rates than PF
LD
(98.3% versus 88.1%;
P
=0.03) despite greater mean thickness (2.5 versus 1.3 mm;
P
<0.001). PF lesions demonstrated homogenous fibrosis without epicardial fat, nerve, or vessel involvement. In comparison, radiofrequency+PF
HD
sections revealed similar transmurality but expectedly more necrosis, inflammation, and epicardial fat, nerve, and vessel involvement. Significant ablation-related esophageal necrosis, inflammation, and fibrosis were seen in all radiofrequency sections, as compared with no PF sections.

Conclusions:

The lattice-tip catheter can deliver focal PF to durably isolate veins and create linear lesions with excellent transmurality and without complications. The PF lesions did not damage the phrenic nerve, vessels, and the esophagus.
Treatment Differences in Chronic Heart Failure Patients With Reduced Ejection Fraction According to Blood Pressure
Authors: Veenis Jesse F. , Brunner-La Rocca Hans-Peter , Linssen Gerard C.M. , Van Gent Marco W.F. , Hoes Arno W. , Brugts Jasper J. ,   for the CHECK-HF Investigators
Published: May 2020

Background:

Prescribed dosages of heart failure (HF) therapy in patients with a reduced left ventricular ejection fraction remain lower than guideline recommended. It remains unclear whether systolic blood pressure (BP) influences prescription of HF drugs to HF patients with a reduced left ventricular ejection fraction in a European setting. This study aimed to investigate the role of systolic BP on the prescription rate and actual dose of guideline-recommended HF therapy.

Methods:

A total of 8246 patients with chronic HF with a reduced left ventricular ejection fraction from 34 Dutch outpatient HF clinics were included. Detailed information on prescription rates and dosages of HF drugs were assessed according to systolic BP categories (<95, 95–109, 110–129, and ≥130 mm Hg).

Results:

Patients with systolic BP <95 mm Hg receive more often triple therapy (β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist; 40.3% versus 30.4% respectively,
P
<0.001) compared with ≥130 mm Hg. Patients with systolic BP <95 mm Hg received significantly more often mineralocorticoid receptor antagonists (64.5% versus 43.8%), ivabradine (8.3% versus 3.6%), and diuretics (94.2% versus 78.6%) and less often renin-angiotensin system inhibitors (75.4% versus 82.8%) compared with ≥130 mm Hg (
P
for all trends, <0.001). The prescribed dosages of β-blockers and renin-angiotensin system inhibitors were significantly lower in patients with systolic BP <95 mm Hg compared with ≥130 mm Hg (
P
for all trends, <0.001).

Conclusions:

In this large cross-sectional cohort of patients with reduced left ventricular ejection fraction, patients with lower systolic BP receive more HF drugs but at lower dose relative to the target dose recommended in HF guidelines. Discussion is warranted regarding what target BP is acceptable and what should be limiting factors in uptitration to adequate levels of HF medication.
In‐Depth Extracorporeal Cardiopulmonary Resuscitation in Adult Out‐of‐Hospital Cardiac Arrest
Authors: Dennis Mark , Lal Sean , Forrest Paul , Nichol Alistair , Lamhaut Lionel , Totaro Richard J. , Burns Brian , Sandroni Claudio
Published: May 2020

The use of extracorporeal cardiopulmonary resuscitation (E‐
CPR
) for the treatment of patients with out‐of‐hospital cardiac arrest who do not respond to conventional cardiopulmonary resuscitation CPR) has increased significantly in the past 10 years, in response to case reports and observational studies reporting encouraging results. However, no randomized controlled trials comparing E‐
CPR
with conventional CPR have been published to date. The evidence from systematic reviews of the available observational studies is conflicting. The inclusion criteria for published E‐
CPR
studies are variable, but most commonly include witnessed arrest, immediate bystander
CPR
, an initial shockable rhythm, and an estimated time from
CPR
start to establishment of E‐
CPR
(low‐flow time) of <60 minutes. A shorter low‐flow time has been consistently associated with improved survival. In an effort to reduce low‐flow times, commencement of E‐
CPR
in the prehospital setting has been reported and is currently under investigation. The provision of an E‐
CPR
service, whether hospital based or prehospital, carries considerable cost and technical challenges. Despite increased adoption, many questions remain as to which patients will derive the most benefit from E‐
CPR
, when and where to implement E‐
CPR
, optimal post‐arrest E‐
CPR
care, and whether this complex invasive intervention is cost‐effective. Results of ongoing trials are awaited to determine whether E‐
CPR
improves survival when compared with conventional
CPR
.
Genetic Programming with Delayed Routing for Multiobjective Dynamic Flexible Job Shop Scheduling
Authors: Xu Binzi , Mei Yi , Wang Yan , Ji Zhicheng , Zhang Mengjie
Published: May 2020

Dynamic Flexible Job Shop Scheduling (DFJSS) is an important and challenging problem, and can have multiple conflicting objectives. Genetic Programming Hyper-Heuristic (GPHH) is a promising approach to fast respond to the dynamic and unpredictable events in DFJSS. A GPHH algorithm evolves dispatching rules (DRs) that are used to make decisions during the scheduling process (i.e., the so-called heuristic template). In DFJSS, there are two kinds of scheduling decisions: the routing decision that allocates each operation to a machine to process it, and the sequencing decision that selects the next job to be processed by each idle machine. The traditional heuristic template makes both routing and sequencing decisions in a non-delay manner, which may have limitations in handling the dynamic environment. In this article, we propose a novel heuristic template that delays the routing decisions rather than making them immediately. This way, all the decisions can be made under the latest and most accurate information. We propose three different delayed routing strategies, and automatically evolve the rules in the heuristic template by GPHH. We evaluate the newly proposed GPHH with Delayed Routing (GPHH-DR) on a multiobjective DFJSS that optimises the energy efficiency and mean tardiness. The experimental results show that GPHH-DR significantly outperformed the state-of-the-art GPHH methods. We further demonstrated the efficacy of the proposed heuristic template with delayed routing, which suggests the importance of delaying the routing decisions.
On a Nonargument for Cleft Sources in Sluicing
Authors: Vicente Luis , Barros Matthew , Messick Troy , Saab Andrés
Published: May 2020

On the basis of certain semantic intuitions, Barros (2012) argues that ellipsis does not require structural isomorphism between elided structure and its antecedent. We tackle this claim. Semantic intuitions cannot be a pointer to the analysis of silent structure. We provide empirical evidence that raises the question of to what extent semantic intuitions about plausible articulable syntax must inform one’s analysis of silent structure. We conclude that the answer to this question must be crosslinguistically informed. We conjecture that ellipsis introduces ellipsis-specific interpretive mechanisms, so that intuitions about “how the unelided structure would be interpreted” are not empirically relevant.
Salient Slices: Improved Neural Network Training and Performance with Image Entropy
Authors: Frank Steven J. , Frank Andrea M.
Published: May 2020

As a training and analysis strategy for convolutional neural networks (CNNs), we slice images into tiled segments and use, for training and prediction, segments that both satisfy an information criterion and contain sufficient content to support classification. In particular, we use image entropy as the information criterion. This ensures that each tile carries as much information diversity as the original image and, for many applications, serves as an indicator of usefulness in classification. To make predictions, a probability aggregation framework is applied to probabilities assigned by the CNN to the input image tiles. This technique, which we call Salient Slices, facilitates the use of large, high-resolution images that would be impractical to analyze unmodified; provides data augmentation for training, which is particularly valuable when image availability is limited; and the ensemble nature of the input for prediction enhances its accuracy.
The Effects of Physician and Hospital Integration on Medicare Beneficiaries' Health Outcomes
Authors: Koch Thomas G. , Wendling Brett W. , Wilson Nathan E.
Published: May 2020

We consider whether hospital acquisitions of physicians lead to improved clinical outcomes for medicare patients aged 65 and older. The analysis combines 2005–2012 Medicare fee-for-service and enrollment data with merger and physician affiliation information from the Levin Reports and SK&A, respectively. We determine the effect of acquisitions on several health outcomes: mortality, acute myocardial infarctions, acute circulatory conditions, ischemic heart disease, glaucoma, symptomatic diabetes complications, and asymptomatic diabetes complications. These outcomes represent the progression of hypertension and diabetes into worse health states. Our results indicate that hospital acquisitions of existing physician practices have little effect on the health outcomes we consider.
Velocity and Purpose among Reindeer Herders in the Verkhoyansk Mountains
Authors: Vitebsky Piers , Alekseyev Anatoly
Published: May 2020

Why would anyone want to travel fast? This paper places local evaluations of velocity in the context of purpose, distinguishing between the excursion of the hunter, the perpetual annual circuit of the reindeer herder and the one-off journey. Reindeer hooves and sledge runners enhance human velocity on the ground. In its extreme reduction of friction, aviation mimics the soul-flight of shamans and compresses distance, but also creates new purposes and concepts of destination, while telecommunication abolishes distance altogether. In generating their own purposes and rhythms, reindeer, aircraft and radio each generate different kinds of personhood and ways of feeling.
Slow Connection
Authors: Safonova Tatiana , Santha Istvan
Published: May 2020

Using ethnographic materials collected in 2008 and 2009 in a distant and isolated village in East Siberia, this article shows how slow and distorted connections contribute to the development of a specific eco-biopolitical space that can be likened to a spaceship physically disconnected from the mainland. Life in such a ‘bubble’ is dependent on supplies from the mainland, which create rhythms of activities in the community. The lack of access to state services and institutions is compensated by local initiatives to mimic such organisations. The state provides channels of escape from the village, such as emergency flights, but does not invest in infrastructures that would link this settlement to other places. The community ‘bubble’ exists not because of infrastructural absence per se, but because this isolation is asymmetrical. It is easier and faster to get from the village to the centre than it is to return. This imbalance expresses the power relations between the centre and periphery and systematically reproduces conditions in which resources drain from the village. This ‘slow connection’ is the condition for the creation of a specific eco-biopolitical regime, in which a rich place is occupied by people living in poverty.
Downward the Ground is Hard; Upward the Sky is Far
Authors: Legrain Laurent
Published: May 2020

This article provides an extended case study of an elder’s journey back to his homeland in Hovd Province after years of absence. The hazards of life mingled with lingering resentment have weakened the ties to the homeland and generate distance from his relatives so much that the return proves to be more complicated than expected. The story that the article tells is used to delineate theoretically a very general figure of prominence present in Mongolian social life that the author calls ‘the ruler’, i.e. a person capable of bringing order to the multiple forces that constitute a Mongolian nutag and able to put them all in line with his own agenda.
A revision of the genus Morphostenophanes Pic, 1925 (Coleoptera, Tenebrionidae, Stenochiinae, Cnodalonini)
Authors: ZHOU DE-YAO
Published: May 2020

The genus Morphostenophanes Pic, 1925 is redefined and revised. Seventeen new species and three new subspecies are described, including M. aenescens yelang Zhou, new subspecies, M. bannaensis Zhou, new species, M. brevigaster Zhou, new species, M. chongli Zhou, new species, M. crassus Zhou, new species, M. furvus Zhou, new species, M. furvus weishanus Zhou, new subspecies, M. gaoligongensis Zhou, new species, M. iridescens Zhou, new species, M. lincangensis Zhou, new species, M. linglong Zhou, new species, M. metallicus Zhou, new species, M. minor, Zhou, new species, M. planus Zhou, new species, M. purpurascens Zhou, new species, M. sinicus Zhou, new species, and M. yunnanus Zhou, new species from Yunnan, China; M. chongli glaber Zhou, new subspecies from Yunnan, China and North Vietnam; M. curvitibialis Zhou, new species from Guangxi, China, and M. luoxiaoshanus Zhou, new species from Hunan, Hubei and Jiangxi, China. M. birmanicus (Kaszab, 1980) is recorded from China (Yunnan) for the first time. M. papillatus Kaszab, 1941 is firstly recorded from Yunnan and Sichuan, China. Two poorly known species, M. aenescens Pic, 1925 and M. vietnamicus Kaszab, 1980 are redescribed. Male of M. atavus (Kaszab, 1960) is described in detail. Misidentifications of M. aenescens Pic. 1925 and M. atavus (Kaszab, 1960) in previous works are corrected. Six species groups are proposed. A species catalog, identification key and distributional maps for the genus are given.
Measuring the Middle Class in Africa – Income Versus Assets Approach
Authors: Němečková Tereza , Harmáček Jaromír , Schlossarek Martin
Published: May 2020

Traditionally, economists measure middle class from the income perspective. Considering quality of data for many African countries, relying solely on income may, unfortunately, lead to an incorrect picture. This article compares and analyses the African middle class measured by income and by ownership of assets. Results indicate that middle class sizes differ significantly in some countries, while in others they are more or less the same. Regression analyses performed to investigate potential correlates of the African income and assets middle class sizes indicate that the African assets middle class size is positively associated with income per capita and negatively with assets inequality. To a lesser extent, it is positively affected by education and negatively by ethnic fractionalisation. The African income middle class size depends positively on income per capita and education, while negatively on income inequality.
Heroines of enterprise: Post-recession media representations of women and entrepreneurship in a UK newspaper 2008–2016
Authors: Nadin Sara , Smith Robert , Jones Sally
Published: May 2020

This article analyses contemporary media representations of female entrepreneurs in the daily UK broadsheet ‘The Times’. While existing research shows how the media ignores or trivialises entrepreneurship of women, our focus is on the emergence of the successful female entrepreneur, an increasingly prominent, heroic media genre. We suggest that this is one response to the recession of 2008 and the broader neoliberal context in which women are positioned as central to economic recovery. We interrogate this recent expression of entrepreneurial femininity, adopting a critical perspective on postfeminism to reveal the values and ideals associated with this privileged form. We argue that this version of entrepreneurial femininity is the female equivalent of the mythologised male hero – accomplished, hard-working and successful at work and home. Implications are explored in terms of the expectations associated with entrepreneurship done by women, and the extent to which these challenge gendered norms; whom this ‘privileges’; who this excludes; and the negative impact such hegemonic femininities have on recognising and supporting ‘alternative’/heterogeneous forms of entrepreneurship done by both women and men.
Retained Bullets After Firearm Injury: A Survey on Surgeon Practice Patterns
Authors: Smith Randi N. , Tracy Brett M. , Smith Stephanie , Johnson Sean , Martin Niels D. , Seamon Mark J.
Published: May 2020

Retained bullets are common after firearm injuries, yet their management remains poorly defined. Surgeon members of the Eastern Association for the Surgery of Trauma ( N = 427) were surveyed using an anonymous, web-based questionnaire during Spring 2016. Indications for bullet removal and practice patterns surrounding this theme were queried. Also, habits around screening and diagnosing psychological illness in victims of firearm injury were asked. Most respondents were male (76.5%, n = 327) and practiced at urban (84.3%, n = 360), academic (88.3%, n = 377), Level 1 trauma centers (72.8%, n = 311). Only 14.5% ( n = 62) of surgeons had institutional policies for bullet removal and 5.6% ( n = 24) were likely to remove bullets. Half of the surgeons (52.0%, n = 222) preferred to remove bullets after the index hospitalization and pain (88.1%, n = 376) and a palpable bullet (71.2%, n = 304) were the most frequent indications for removal. Having the opportunity to follow-up with patients to discuss bullet removal was significantly predictive of removal (odds ratio (OR) = 2.25, 95% confidence interval (CI) = [1.05, 4.85], p = .04). Furthermore, routinely asking about retained bullets during outpatient follow-up was predictive of new psychological illness screening (OR = 1.94, 95% CI [1.19, 3.16], p = .01) and diagnosis (OR = 1.86, 95% CI = [1.12, 3.09], p = .02) in victims of firearm injury. Thus, surgeons should be encouraged to allot time for patients concerning retained bullet management so that a shared decision can be reached.
Team Sports and Sexual Violence: Examining Perpetration by and Victimization of Adolescent Males and Females
Authors: Cheever Jamie , Eisenberg Marla E.
Published: May 2020

The authors examined whether team athletic involvement is related to sexual violence victimization and perpetration among male and female high school students. A secondary data analysis was conducted with Minnesota Student Survey data gathered from 122,501 Minnesota eighth-grade, ninth-grade, and 11th grade students. Multivariable logistic regression indicates that sport-involved youth are more likely to be involved in sexual violence than peers not involved in sports. For example, highly sport-involved males are significantly more likely to coerce a partner into sex (odds ratio [OR] = 1.35, 95% confidence interval [CI] = [1.01, 1.67]) and be coerced (OR = 1.19, 95% CI = [1.02, 1.38]) than nonsport peers. The results suggest high school sport programs could be an important site to implement comprehensive sexual violence prevention programs targeted at individual actions as well as harmful cultural norms and systematic inequities.