bluuebunny/crossref_metadata_2025 huggingface dataset:
The American Pathology of Inequitable Access to Medical Care
Authors: Hoffman Allison K. , Hall Mark A.
Published: July 2020

This chapter maps out the complex picture of access to medical care in the United States. It reflects on how variable access illustrates an American ambivalence about health solidarity. The chapter first considers healthcare financing as one critical element that defines access to medical care and describes the multifaceted US healthcare financing structure, predominated by public insurance programs for select populations and regulated private insurance for others. Next, this chapter describes how access is equally shaped by legal requirements that create treatment obligations for doctors or hospitals regardless of how someone pays for care. There is no constitutional right to health in the United States, but various layers of statutory and common law have created some guarantees. That said, despite efforts to increase access over the past decades, the United States is still extraordinary, as compared to peer nations, on the unevenness of access to medical care among its population.
Competing Narratives on Bible Translation in India
Authors: Israel Hephzibah
Published: July 2020

This article focuses on Bible translation in India as a form of biblical criticism. It points out some of the limitations in scholarly approaches to the study of Bible translation in India and highlights the critical perspectives that a postcolonial translation approach can bring to scholarship on Bible translation and biblical criticism. This article argues for a radical rethinking and contextualizing of Bible translation that focuses on hitherto marginalized Indian translators who undertook translation of large parts of the Bible into verse. The article’s premise is that translation across genres should be taken as seriously as conventional linguistic translation since this approach offers a significant challenge to the concept of “authorized” Bible translation and, more significantly, to continued philological scholarship focused on comparisons of lexical items that obfuscate histories of power and marginalization.
Humanism in the Medieval World
Authors: Shook John R.
Published: July 2020

The centuries covered in this chapter extend from the end of antiquity to the start of the Renaissance; roughly from the sixth century through the fourteenth century. Humanist ideas and ideals making a difference during medieval times have to be understood on their own terms. Christian humanism and humanitarianism upheld the moral worth and dignity of persons, an ideal that grew in significance from the late Middle Ages through the Renaissance and thereafter. Humanist thought attaining a degree of independence from Christian doctrine can be classed into four main categories: the human ability to reason without following religion; the human competence to understand the world without religion; the human aptitude for virtue and morality without religion; and the human facility for political organization without religion.
Migration and Immigrant Organizational Forms in Latin America
Authors: Escala Rabadán Luis , Bada Xóchitl
Published: July 2020

Over the past two decades, scholarly research has increasingly documented and analyzed the role, variety, and significance of immigrants’ associations, specifically regarding their links to countries of origin and their centrality to the rise and consolidation of immigrant communities in destination countries. However, despite the increasing interest in the organizational dimension of Latin American immigrants, our knowledge in this field remains fragmented, and several gaps can be identified in the literature. This chapter provides a systematic review of the existing literature on immigrant organizational forms. The authors identify and offer possible explanations for the similarities and differences among these immigrant social structures. In addition, they consider examples of immigrant organizations as agents of incorporation and political participation in both sending and receiving countries. The geographical focus covers Latin American immigrants in the Americas and Europe, namely in the United States and Spain, their main destinations.
The Sociology of Gender in Latin America From Social Mothers to Sexual Rights
Authors: Herrera Gioconda
Published: July 2020

In Latin America, gender inequalities as a field emerged in the 1970s, when scholars began to look at women’s experiences in a wide array of areas then being studied by Latin American sociology, including urbanization, migration into cities, transformation of agrarian structures, and social movements. Since then, the field of sociology of gender has grown steadily across the continent. The first section of this chapter discusses three approaches to gendered analysis in Latin America: women’s subordination, unequal power relationships between women and men in various spaces, and gender as a performative practice. It then charts the evolution of two significant subfields in Latin American sociology: gender, work, and social reproduction; and gender, collective action, and the state. It discusses trajectories and debates arising within these subfields, underlining the contributions gender analysis has made toward broadening the definition and scope of crucial social institutions in sociological analysis: the family, work, and the state. Finally, it introduces three specialists’ sections that contribute to an understanding of the changing dynamics in Latin American societies: the study of gender violence across the continent; the particular focus on care in the study of social reproduction and public policies; and the evolution of the labor market with respect to gender.
Violence Against Women
Authors: Sagot Montserrat
Published: July 2020

Beginning in the 1980s, Latin American feminist movements identified violence against women as one the main social problems in the region, resulting from a system of gender oppression intertwined with economic and political oppression. This chapter discusses Latin American scholarship’s most important theoretical contributions to the study of violence against women, as well as the proposals for addressing the problem and the controversies around those proposals. The chapter first traces the analyses of this form of violence under dictatorships. It then addresses how the transition to democracy afforded feminists opportunities to put the issue on the public agenda. The chapter also presents new concepts that have been developed to understand the escalation of lethal violence, as well as Latin American scholars’ and activists’ most recent strategies for ending violence against women.
Urban Violence and the Spatial Question
Authors: Davis Diane E.
Published: July 2020

This chapter examines the spatial correlates of urban violence in Latin America, identifying how urbanization processes over the past several decades have created socio-spatial exclusion. It links those spatial patterns to the emergence and proliferation of illicit activities, organized crime, and territorially expanding networks of violence emanating from marginal neighborhoods to the city as a whole. Both state and non-state armed actors are key actors in this path-dependent process by virtue of their efforts to monitor and/or control urban territory for their own gain. In addition, the chapter assesses several recent programs undertaken by local authorities in attempts to reduce the scourge of urban violence. Drawing on examples from Medellín, Sao Paulo, and Mexico City, it identifies the spatial interventions that have made most headway in improving security for urban citizens and discusses the governance arrangements that have made these spatial interventions possible.
Illicit Drugs and Organized Crime in Latin America
Authors: Durán-Martínez Angélica
Published: July 2020

Illicit drugs have long affected public security, social relations, and politics in Latin America. Until recently, the analysis of illicit drugs primarily focused on Colombia and, to some extent, Mexico, and most scholarship was policy-oriented, dealing with the influence of the US and the Global Drug Prohibition Regime. In recent years, the scholarship has expanded its theoretical and methodological approaches as well as its geographical scope. This chapter analyzes key contributions emerging from new research: the mapping of the political, social, and economic constellations of actors and discourses that sustain policies related to illicit drugs; the critical revision of certain assumptions, fostering a more nuanced understanding of the multiple social and political relations involved in illicit drug markets; and greater attention to how illicit and licit actors relate, including unpacking the links between state actors and criminal groups.
Deaf and Hard-of-Hearing Students and Academic Language(s)
Authors: Scott Jessica , Cohen Scott
Published: July 2020

Frequently, literacy research with deaf and hard-of-hearing (DHH) students focuses on the development of basic reading skills. However, for middle/secondary DHH students, academic language demands are relevant to the ability to read texts and learn new content. Academic English, which has been called the language of schooling (Schleppegrell, 2001), includes a constellation of features such as specialized vocabulary, densely packed syntax, and markers of organization (Uccelli, Phillips-Galloway, Barr, Meneses, & Dobbs, 2015). Academic English is often challenging for hearing and DHH learners alike, and proficiency with academic English may be related to reading comprehension (Chenhansa & Schleppegrell, 1998; Scott & Hoffmeister, 2017). Academic American Sign Language (ASL), though profoundly understudied, is an important tool for conveying complex concepts to DHH learners who use ASL (Harris, 2016). This chapter explores the academic language(s) that DHH students may encounter when reading to learn in content areas and what is known about their relationship with broader literacy skills for this population.
The Interplay Between Pragmatics and Reading Comprehension in Children Who Are Deaf or Hard of Hearing
Authors: Paatsch Louise , Toe Dianne
Published: July 2020

Strong language skills are linked to children’s literacy and social and emotional outcomes, and they are critical for educational success throughout life. However, many children who are deaf and hard of hearing (DHH) experience challenges with developing language and literacy outcomes that are commensurate with their peers with typical hearing. In particular, some children who are DHH have difficulties in understanding and using language in social contexts, specifically in regard to the more subtle and complex pragmatic skills such as contingency, inferencing, topic maintenance, and repair. This chapter suggests that such challenges evident in natural conversations may impact children’s reading comprehension. It further explores the interplay between pragmatic skills, Theory of Mind, and the complex inferential and metacognitive skills required for reading comprehension in children and young people who are DHH. Finally, the chapter addresses the implications of these links and suggests future directions for research.
Reading Comprehension
Authors: Sullivan Susan , Oakhill Jane , Arfè Barbara , Gómez-Merino Nadina
Published: July 2020

Much has been written about the components that contribute to reading success, such as vocabulary knowledge, phonological awareness, orthographic knowledge, syntax, and inference and integration skills. But much less is known about how these skills contribute to reading comprehension in learners who are deaf or hard of hearing (DHH). With the spread of universal hearing screening of newborns, and the new generation of technologies in hearing compensation (i.e., digital hearing aids and cochlear implants [CIs]), the prospects for children with hearing loss with regard to successful reading comprehension should be substantially improved. However, despite these developments, reading and writing often remain a challenge for DHH children. The chapter begins with a summary of the skills required for successful comprehension in typically hearing readers, and then considers what we know about reading comprehension in DHH children. It concludes with a discussion of where researchers should be focusing their future investigations in order to serve educators and learners most effectively.
Psychoeducational Assessment, Classroom Testing, and the Measurement of Literacy in Deaf and Hard-of-Hearing Learners
Authors: Morere Donna
Published: July 2020

This chapter discusses the assessment of students who are deaf or hard of hearing (DHH). It addresses the differences between assessment for research purposes, psychoeducational assessment, and classroom assessment. Research on the factors affecting the literacy development of students who are DHH can inform both classroom and psychoeducational testing, and examples of such research are presented. Approaches to applying the outcomes of this research and the types of measures they use for psychoeducational and classroom assessment are discussed. Issues related to the use of tests that are developed and normed on the general population for the assessment of students who are DHH are addressed, as are those associated with the use of measures designed for and normed on students who are DHH. The distinction between tests designed for diagnostic and placement purposes and those designed for classroom progress monitoring is clarified as is the appropriate use of both types of measures.
Literacy in Learners Who Are Deaf or Hard of Hearing With Disabilities
Authors: Bruce Susan M. , Borders Christy
Published: July 2020

This chapter discusses literacy research and practices for learners who are deaf or hard of hearing with disabilities (DWD). Investigation of available literature is arranged across disability areas, including (a) learning disabilities, (b) intellectual disabilities, (c) autism spectrum disorder, and (d) deafblindness. The relevance of different types of literacy, such as academic literacy, functional literacy, and new literacies, to learners who are DWD is discussed. The state of evidence for educational practices in assessment and intervention in the areas of reading, writing, and spelling for each disability area is presented. Effective literacy assessment and intervention can only occur when the disability is identified early, and individually appropriate instructional approaches and strategies are applied by professionals who understand the interactive effects of deafness and the identified disability and possess the expertise to implement the interventions recommended by research. There is a need for additional research on literacy in learners who are DWD.
Written Word Recognition and Production Processes
Authors: Daigle Daniel , Berthiaume Rachel
Published: July 2020

Expert reading and writing involve, among other knowledge processes, automatized word recognition and production. These processes are not learned and used globally. In fact, decades of research have shown that word recognition and production processes can be broken down into micro-processes that need to be addressed explicitly during reading and writing instruction. They involve, in particular, phonological, morphological, and visual-orthographic processes. After reviewing what word recognition and production processes are, the main research conclusions from studies conducted among populations of deaf and hard-of-hearing (DHH) readers and writers are presented. Although most of these findings relate to phonological processing, the chapter illustrates the potential importance that other processes can play in DHH students’ abilities to recognize and produce written words. Finally, the chapter highlights the main challenges that DHH students face when learning to read and write, and it proposes some elements considered in the context of reading and writing instruction in order for teachers to help students overcome these difficulties.
Beyond the Neural Correlates of Consciousness
Authors: Kriegel Uriah
Published: July 2020

The centerpiece of the scientific study of consciousness is the search for the neural correlates of consciousness (NCC). Yet science is typically interested not only in discovering correlations, but also—and more deeply—in explaining them. When faced with a correlation between two phenomena in nature, we typically want to know why they correlate. The purpose of this chapter is twofold. The first half attempts to lay out the various possible explanations of the correlation between consciousness and its neural correlate—to provide a sort of ‘menu’ of options from which we probably would ultimately have to choose. The second half raises considerations suggesting that, under certain reasonable assumptions, the choice among these various options may be in principle underdetermined by the relevant scientific evidence.
A Posteriori Physicalism
Authors: Levine Joseph
Published: July 2020

Levine (1998, 2001) argues that though the conceivability of zombies manifests the existence of an explanatory gap between the physical and the mental, there was good reason to adopt materialism. On the other hand, Levine (2014) voices doubt about the viability of materialism in the face of the explanatory gap. The inference to the rejection of materialism takes the form of an inference to the best explanation; the best explanation of the existence and persistence of the explanatory gap is that there is a genuine metaphysical gap. This chapter will outline the principal argument that the rejection of materialism follows rather directly from the conceivability of zombies and explain why that argument is unacceptable. A related argument against materialism will be considered and rejected before considering an argument that some materialists have presented, that the explanatory gap is not really such a problem for materialists after all. The chapter will try to explain why the inference to the best explanation still holds in the face of this argument.
Consciousness and Attention
Authors: Mole Christopher
Published: July 2020

The English word ‘attention’ can be used loosely. As a tactic for preventing an enquiry into attention’s relationship to consciousness from lapsing into ill-definition, we shall treat ‘attention’ as a term to be defined by the role that is assigned to it in our explanations of empirically established psychological phenomena (especially those involving the modulation of reaction times). We will review evidence that shows that such modulations are associated with processing that stands in various relations to consciousness. The psychological phenomena that explain such modulations should not be identified with the causes of consciousness. Nor do they operate exclusively within the field of conscious awareness. If the explanation of those phenomena is to cast explanatory light on how and when consciousness occurs, it will need to do so in the context of some more complex explanatory theory.
Consciousness and Memory
Authors: Hill Christopher S.
Published: July 2020

This chapter is concerned with relationships between three forms of consciousness and three types of memory. The three forms of consciousness are introspective consciousnessaccess consciousnessand phenomenal consciousness.There are three types of memory that are arguably connected, either directly or indirectly, with one or more of the aforementioned forms of consciousness—long-term memory, working memory, and iconic memory. The chapter will consider the relationship between each type of consciousness and each type of memory.
Consciousness and Action
Authors: Kozuch Benjamin
Published: July 2020

In its classical form, epiphenomenalism is the view that conscious mental events have no physical effects: while physical events cause mental events, the opposite is never true. Unlike classical epiphenomenalism, contemporary forms do not hold that conscious mental states always lack causal efficacy, only that they are epiphenomenal relative to certain kinds of action, ones we pre-theoretically would have thought consciousness to causally contribute to. Two of these contemporary, empirically based challenges to the efficacy of the mental are the focus of this chapter. The first, originating in research by Libet, has been interpreted as showing that the neural events initiating voluntary actions precede our conscious willing of them, meaning the conscious will cannot be what causes them. The second challenge, originating in studies by Milner and Goodale, consist of instances in which the content of visual consciousness and motor action dissociate, casting doubt on the intuitive view that visual consciousness guides visually based motor action.
Imaginative Experience
Authors: Kind Amy
Published: July 2020

When developing accounts of imaginative experience, philosophers generally (though not universally) accept two pieces of phenomenological data as a starting point: (1) the experiential character of imagining is importantly similar to that of perceiving; (2) despite this similarity, the experiential character of imagining is nonetheless importantly different from perceiving. Someone who aims to explain imaginative experience must discharge two principal tasks: explain the similarity between the experiential character of imagination and the experiential character of perception, and explain the difference. The main focus of this chapter is the second of these tasks. Three views that aim to explain how the character of imaginative experience differs from the experiential character of related mental states like perception are considered. Close examination reveals that none gives an adequate account of the character of imaginative experience. The final section briefly explores what their failure teaches us about the project of giving an account of imaginative experience.
Meditation to Kill and Be Killed By
Authors: Victoria Brian
Published: July 2020

Can meditation kill? This chapter claims that meditation-induced samādhi, and the power associated with it, were used in Imperial Japan (1868–1945). The Zen school is founded on samādhi and the power associated with it. Without samādhi, “Zen,” (Sankrit Dhyāna; English meditation) would become just another “mental health” practice, rather than the basis for a profound realization of the true nature of the self. However, despite the long-acknowledged mental power intrinsic to samādhi, there is the ever-present danger of its misuse or abuse by both self and others. In modern times, this abuse was most clearly visible during the period of Japan’s military aggression, beginning with the Sino-Japanese War of 1894–1895 and extending through Japan’s ultimate defeat in August 1945. This chapter examines the use of samādhi power within Imperial Japan and warns how easily meditation can be directed towards the destruction, and not the enrichment, of life.
Virtue Ethics in Psychotherapy
Authors: Laney Michael , Brenner Adam
Published: July 2020

The ethical pressures on a therapist are great, particularly since effective therapy demands that we become deeply and affectively involved in a patient’s life as told to us such that we become part of their stories and conflicts as well. While deontology and consequentialism provide guidance with respect to a therapist’s acts in themselves or in their consequences, another ethical perspective focuses squarely on the character of the therapist him or herself. This chapter reviews this perspective—called virtue theory—and applies it to the work of therapy, especially how a virtuous character and the virtuous actions that emanate from it are more than just moral prescripts but necessary to and partly constitutive of effective therapy itself.
Studying Empirical Aesthetics in Museum Contexts
Authors: Smith Jeffrey K. , Smith Lisa F.
Published: July 2020

Conducting aesthetic research in museum contexts is examined in terms of the types of questions that can be investigated, research designs, participants, procedures, and interpretation of results. The nature of research in museums is also contrasted with research done in psychological laboratories. The challenges faced in the conduct of this research are examined and specific recommendations are made, including a plea for careful consideration of what we already know about aesthetic experiences in museums and integrating that knowledge into the broader field of empirical aesthetics.
Media as Method in the Age of Revolution
Authors: Iskandar Adel
Published: July 2020

This chapter focuses on the importance of examining media as institutions, industries, practices, and content in explorations of contemporary Middle Eastern and North African history, society, and politics. It argues that understanding media is imperative to the very comprehension of colonial legacies, perennial currents of revolutionary discourse, and the rise of neoliberal authoritarianism. By reviewing the critical role that media and communication play as institutions and practices in the configuration of state-centered power as well as the revolutionary resistance to these, the objective is to contribute to the theoretical understandings of contemporary histories in the region. Furthermore, forthcoming research needs to account for state authoritarianism, corporate monopolization, the mobilization of online deliberation, and the militarization of knowledge production.
6-Minute Push Test in Youth Who Have Spina Bifida and Who Self-Propel a Wheelchair: Reliability and Physiologic Response
Authors: Damen Karlijn M S , Takken Tim , de Groot Janke F , Backx Frank J G , Radder Bob , Roos Irene C P M , Bloemen Manon A T
Published: July 2020

Objective

Despite the common occurrence of lower levels of physical activity and physical fitness in youth with spina bifida (SB) who use a wheelchair, there are very few tests available to measure and assess these levels. The purpose of this study was to determine reliability and the physiologic response of the 6-minute push test (6MPT) in youth with SB who self-propel a wheelchair.

Methods

In this reliability and observational study, a sample of 53 youth with SB (5–19 years old; mean age = 13 years 7 months; 32 boys and 21 girls) who used a wheelchair performed 2 exercise tests: the 6MPT and shuttle ride test. Heart rate, minute ventilation, respiratory exchange ratio, and oxygen consumption were measured using a calibrated mobile gas analysis system and a heart rate monitor. For reliability, intraclass correlation coefficients (ICCs), SE of measurement, smallest detectable change for total covered distance, minute work, and heart rate were calculated. Physiologic response during the 6MPT was expressed as percentage of maximal values achieved during the shuttle ride test.

Results

The ICCs for total distance and minute work were excellent (0.95 and 0.97, respectively), and the ICC for heart rate was good (0.81). The physiologic response during the 6MPT was 85% to 89% of maximal values, except for minute ventilation (70.6%).

Conclusions

For most youth with SB who use a wheelchair for mobility or sports participation, the 6MPT is a reliable, functional performance test on a vigorous level of exercise.

Impact

This is the first study to investigate physiologic response during the 6MPT in youth (with SB) who are wheelchair using. Clinicians can use the 6MPT to evaluate functional performance and help design effective exercise programs for youth with SB who are wheelchair using.
Treatment of Unfavorable Bleeding Patterns in Contraceptive Implant Users
Authors: Edelman Alison B. , Kaneshiro Bliss , Simmons Katharine B. , Hauschildt Jennifer L. , Bond Kise , Boniface Emily R. , Jensen Jeffrey T.
Published: July 2020

OBJECTIVE:

To evaluate whether a short course of tamoxifen decreases bothersome bleeding in etonogestrel contraceptive implant users.

METHODS:

In a 90-day, double-blind randomized control trial, we enrolled etonogestrel implant users with frequent or prolonged bleeding or spotting. A sample size of 40 per group (N=80) was planned to compare 10 mg tamoxifen or placebo twice daily for 7 days after 3 consecutive days of bleeding or spotting no more than once per 30 days (maximum three treatments). Participants then entered a 90-day open-label study where all received tamoxifen if needed every 30 days (maximum three treatments). Participants used text messages to record daily bleeding patterns. Our primary outcome was the total number of consecutive amenorrhea days after the first treatment. Secondary outcomes included time to bleeding or spotting cessation and restart after first treatment, overall bleeding patterns, and satisfaction.

RESULTS:

From January 2017 to November 2018, 112 women enrolled in the study; 88 (79%) completed 90 days, and 79 (71%) completed 180 days. Participant characteristics did not differ between groups; mean age 24, majority identified as white not Hispanic with at least some college education. After the first treatment, the tamoxifen group reported an average of 9.8 (95% CI 4.6–15.0) more consecutive days of amenorrhea and more total days of no bleeding (amenorrhea or spotting) in the first 90 days (median 73.5 [range 24–89] vs 68 [range 11–81], P=.001). The placebo group showed a similar treatment benefit after first active use of tamoxifen in the open-label phase. At the end of the randomized study (first 90 days), women who received tamoxifen reported higher satisfaction (median 62 mm [range 16–100]) than those treated with placebo (46 mm [range 0–100]; P=.023).

CONCLUSION:

A short course of tamoxifen reduces problematic bleeding and improves satisfaction in users of etonogestrel implants.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02903121.
Evaluation of a Trauma Service: Patient and Family Perspectives
Authors: Wake Elizabeth , Battistella Tania , Dale Kate , Scott Matthew , Nelson Renee , Marshall Andrea P.
Published: July 2020

Background:

Patient satisfaction is an indicator of the quality of care that underpins a patient's health care experience. A focus on both the patient and the family is important when evaluating satisfaction from the perspective of patients with trauma and is consistent with delivery of patient- and family-centered care. Using the literature to guide development, we designed and implemented a questionnaire to evaluate attitudes and experiences of patients and families case managed by the trauma service. This article reports the findings of this quality improvement project.

Methods:

A cross-sectional cohort pragmatic design was used. The questionnaire was conducted with 142 trauma patients and 49 family members. Data included hospital admission data, application of a satisfaction tool, and free text comments.

Results:

Both patients and their family members rated the trauma service highly in the satisfaction scoring. Differences in the communication practices encountered by patients and families were identified.

Conclusions:

Strategies to involve family members and promote family-centered care are required in the context of trauma patients to improve the safety, quality, and satisfaction of the care they receive while being managed by the trauma service.
Early use of endotoxin absorption by oXiris in abdominal septic shock
Authors: Wei Tiantian , Chen Zhiwen , Li Peiyun , Tang Xin , Marshall Mark R. , Zhang Ling , Fu Ping
Published: July 2020

Rationale:

Septic shock leads to multiple organ failure and increases mortality rate. We reported a critical patient with abdominal septic shock, which was the first case successfully treated with continuous renal replacement therapy (CRRT) and a newly designed endotoxin removal device oXiris in mainland China.

Patient concerns:

A 51-year-old man developed gastric ulcer perforation after resection of a benign peritoneal tumor and had a second abdominal surgery. His blood pressure decreased to 70/40 mm Hg with oliguria, requiring large doses of noradrenaline and intravenous fluid for resuscitation. The abdominal cavity was not sutured after the second open surgery due to severe abdominal infection and distention. His leukocyte count was over 30109/L, while the blood lactic acid was 12.5 mmol/L and procalcitonin (PCT) was >100 ng/mL.

Diagnosis:

Since the bacterial culture of peritoneal exudate showed positive with Enterobacter aerogenes and Pseudomonas aeruginosa after the second surgery, and the patient had severe low blood pressure, hyoxemia and oliguria, combined with the laboratory tests results, he was diagnosed with Gram-negative related septic shock, acute kidney injury, and multiple organ dysfunction.

Interventions:

CRRT with oXiris membrane was performed for 80hours and followed by AN69 ST membranes during the subsequent 27 days. Antibiotics together with other medical treatment were applied to the patient in the meantime.

Outcomes:

At the end of 80 hours treatment with oXiris, PCT of the patient had decreased to 14.52 ng/mL and lactic acid decreased to 4.2 mmol/L. The total sequential organ failure assessment (SOFA) score decreased from 15 to 11. Urine output steadily increased to 250 mL/h, and vital signs and blood pressure were stable without noradrenaline. At the end of the 27 days of conventional CRRT, his kidney function had completely recovered with a total sequential organ failure assessment score (SOFA score) of 6.

Lessons:

oXiris, with its enhanced endotoxin adsorption, appeared to accelerate improvement in organ dysfunction and ultimate survival in our patient. In critical patients with abdominal septic shock, oXiris is an important adjunctive consideration to supplement definitive source control and antimicrobial therapy.
Study protocol for the Fex-Can Childhood project
Authors: Ljungman Lisa , Anandavadivelan Poorna , Jahnukainen Kirsi , Lampic Claudia , Wettergren Lena
Published: July 2020

Background:

This study protocol describes the Fex-Can Childhood project, comprising two studies: The Fex-Can Childhood observational study (OS) and the Fex-Can Childhood randomized controlled trial (RCT). The Fex-Can Childhood OS aims to determine the prevalence and predictors of sexual dysfunction and fertility-related distress in young adult childhood cancer survivors (aged 19–40) compared to an age matched comparison group; the Fex-Can Childhood RCT will evaluate the effect of a web-based psycho-educational intervention (Fex-Can intervention) on sexual dysfunction and fertility-related distress.

Methods:

The Fex-Can Childhood OS will have a population-based cross-sectional design. All individuals treated for childhood cancer in Sweden at the age of 0 to 17 years (current age 19–40) will be identified through the National Quality Registry for Childhood Cancer. Established self-reported instruments will be used to measure sexual function, fertility-related distress, body image, anxiety and depression, and health-related quality of life. Self-efficacy related to sexual function and fertility, and fertility-related knowledge, will be assessed by study-specific measures. Clinical variables will be collected from the registry. Results will be compared to an age-matched comparison group from the general population.

Participants in the Fex-Can Childhood OS who report a high level of sexual dysfunction and/or fertility-related distress will be invited to participate in the RCT. The Fex-Can intervention comprises two programs: The Fex-Can Sex and the Fex-Can Fertility targeting sexual dysfunction and fertility-related distress, respectively. The control condition will be a wait-list. Sexual function and fertility-related distress will be the primary outcomes. The secondary outcomes include body image, anxiety and depression, health-related quality of life and self-efficacy related to sexual function and fertility. Post- and follow-up assessments will be conducted directly after end of intervention (primary end point), at 3 months and 6 months after end of intervention. Additionally, a process-evaluation including study-specific items and a qualitative interview will be conducted.

Discussion:

The Fex-Can Childhood project will advance knowledge in the areas of sexual function and fertility-related distress among young adult survivors of childhood cancer. If the Fex-Can intervention proves to be efficacious, steps will be taken to implement it in the follow-up care provided to this population.
A rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy
Authors: Ding JiaXiang , Qu Zhen , Yu Feng
Published: July 2020

Introduction:

Thrombotic microangiopathy (TMA) is characterized by endothelial injury followed by formation of multiple microthrombi in the target organs due to various causes, including malignant hypertension (MHT). Here, we reported a rare case of MHT with splenic TMA changes.

Case concerns:

A 27-year-old Chinese Han male with a history of hypertension and proteinuria, admitted to our hospital because of renal failure with MHT and thrombocytopenia.

Diagnosis:

This case diagnosed with TMA based on the patient's MHT and thrombocytopenia. The patient final diagnosis was confirmed by the spleen pathological findings, other differential diagnoses were ruled out.

Interventions:

The patient was treated with hemodialysis and intravenous antihypertensive agents, and his condition gradually improved. However, he suddenly complained of abdominal pain and went into hemorrhagic shock, which was due to spontaneous spleen rupture on the third day of hospitalization. The pathological evidence after splenectomy showed splenic TMA.

Outcomes:

Hemodialysis was continued and the blood pressure was under control until his discharge from our hospital.

Conclusion:

Spontaneous splenic rupture could be a rare and critical complication associated with MHT-induced TMA, and it requires careful clinical attention.
The prognostic and predictive value of the albumin-bilirubin score in advanced pancreatic cancer
Authors: Zhang Tie-Ning , Yin Ruo-Han , Wang Li-Wei
Published: July 2020

Albumin-bilirubin (ALBI) showed its prognostic and predictive value in hepatobiliary disease like hepatocellular carcinoma. However, little has been known about its role in pancreatic cancer.

In this retrospective study, 149 patients with advanced pancreatic cancer (APC) treated in the Shanghai General Hospital from January 2009 to December 2014 were enrolled as the training cohort and 120 patients treated from January 2015 to December 2018 were taken as the validation cohort. We generated the ALBI score according previous studies. The correlations between ALBI and clinicopathological parameters were evaluated with the Pearson Chi-square test. Kaplan–Meier method and log-rank test were conducted to determine the correlation between ALBI and overall survival (OS). Then we used Cox regression model to investigate the prognostic significance of ALBI. We further assessed retrospectively whether ALBI score could be used to identify combination therapy candidates for APC.

Eastern Cooperative Oncology Group Performance Status, hemoglobin, aspartate aminotransferase, and alanine aminotransferase were found to be significantly correlated with ALBI. Kaplan–Meier analysis showed that the median OS in patients with a pretreatment ALBI ≥−2.6 was 7.0 months, which was significantly shorter than OS of patients with a ALBI <−2.6 (13.0 months, P = .001). ALBI was independently correlated with OS in multivariate analysis. In the subgroup analysis, ALBI showed significant prognostic value in patients with liver metastasis but not those without liver metastasis in all 3 cohorts. In addition, only in the group with ALBI <−2.6, patients receiving combination therapy showed better prognosis than those receiving monotherapy.

In conclusion, ALBI was a promising prognostic biomarker in APC with liver metastasis. ALBI also showed predictive value in identifying combination therapy candidates for patients with APC.
Safety and efficacy of an herbal formula, Gwakhyangjeonggi-san on atopic dermatitis with gastrointestinal symptoms
Authors: Son Mi Ju , Kim Min Hee , Kang Minseo , Kim Young-Eun , Jung Jeeyoun , Choi Inhwa
Published: July 2020

Introduction:

Gwakhyangjeonggi-san (GJS) is an herbal formula with anti-inflammatory and anti-allergic properties that is broadly used to treat a wide range of diseases including gastrointestinal disorders and allergic diseases. There have been several clinical studies conducted on its effects on atopic dermatitis (AD). So far, no randomized controlled trials have been conducted. Here, we describe the protocol for a randomized controlled study designed to investigate the efficacy and safety of GJS for treating patients with AD that have gastrointestinal symptoms.

Methods and analysis:

A randomized, double-blind, placebo-controlled, parallel-group, clinical trial has been designed to investigate the clinical efficacy and safety of GJS on patients with AD that have gastrointestinal symptoms. A total of 58 participants with AD will be recruited and randomly allocated to the GJS or placebo group in a 1:1 ratio. The participants will be administered GJS or placebo granules 3 times a day for 8 weeks. Data will be collected from the participants at baseline and after 4 and 8 weeks. The primary outcome measure will be the mean change in the SCORing of Atopic Dermatitis (SCORAD) index from baseline to 8 weeks. The secondary outcomes will include the eczema area and severity index (EASI), dermatology life quality index (DLQI), EuroQoL 5 dimensions 5 levels (EQ-5D-5L), and immunological factors. The Korean Gastrointestinal Symptom Rating Scale (KGSRS), Nepean Dyspepsia Index will also be obtained for assessing the gastrointestinal status.

Discussion:

The findings of this study are expected to provide evidence on the safety and effectiveness of GJS and for treating patients with AD that have gastrointestinal symptoms. Additionally, the study will explore the mechanism of GJS action via gut microbiome. This study will provide new perspectives on approaching treatment for AD.

Ethics and dissemination:

The study protocol was approved by the Institutional Review Board of Kyung Hee University Korean Medicine Hospital at Gangdong (KHNMCOH2019-06-002-001).

Trial registration number:

This study has been registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0004299).
Male mammary gland development after apatinib therapy in advanced gastric cancer
Authors: Hui Yan , Wang Jingchun , Han Jianguo , Guo Zhifeng , Sun Siqi , Wu Zifang , Wang Yanqiu , Han Zhimin , Chen Xiangbin
Published: July 2020

Rationale:

Most gastric cancer patients are diagnosed at mid- to late-stage and lose the chance of radical surgery, medical treatment is especially important to prolong the survival of patients. Apatinib mesylate, which is a small molecule vascular endothelial growth factor receptor 2 tyrosine kinase inhibitor, could be used as antiangiogenesis therapy for gastric cancer.

Patient concerns:

A 67-year-old man sought medical care for upper abdominal discomfort.

Diagnosis:

The patient was diagnosed as mixed medullary differentiated gastric adenocarcinoma, and immunohistochemistry suggested HER-2 (2+).

Interventions:

The patient received chemotherapy consisting of oxaliplatin combined with S-1 as first-line treatment, and targeted therapy with apatinib mesylate as second-line treatment.

Outcomes:

After 4 months of first-line chemotherapy, the patient received apatinib treatment immediately at a dose of 500 mg/d orally and died of cardiac arrest with 8.5 months of overall survival. During this period of targeted therapy with apatinib mesylate, this male patient suffered mammary gland development besides other common adverse reactions.

Lessons:

This case report is the first to report the case of male mammary gland development after oral apatinib.
The clinical efficiency of lycium-rehmannia pills in treating dry eye symptom
Authors: Lou Lili , Fu Hongling , Liu Hanmin
Published: July 2020

Background:

Dry eye symptom threatens human health and causes a larger burden of disease, the study aims to systematically compare the therapeutic effect of Lycium-rehmannia pills combined with topical eye drops and pure western medicine (western medicine eye drops) on dry eye symptom, to provide a reflection and enlightenment for clinical treatment.

Method:

PubMed, The Cochrane Library, EMbase, MEDLINE, CBM, WanFang, VIP, and CNKI databases were searched manually and automatically by the computer until March 2019 and relevant randomized controlled trials (RCTs) were selected. Article selection and data extraction were conducted by 2 researchers independently, then RevMan 5.3 was applied for meta-analysis.

Result:

Fifteen randomized controlled trials were included, including 1222 patients (eyes = 2382). The meta-analysis results showed that Lycium-rehmannia pills combined with western medicine were superior to the control group in terms of therapeutic efficiency [OR = 4.38, 95% confidence interval (CI) (3.26, 5.89), P < .00001]. There were controversial results that the study group was better than the control group in Basic Schirmer test [MD, 2.46, 95% CI (1.49, 3.44), P < .00001], tear break up time [MD, 3.79, 95% CI (3.57, 4.01), P < .00001], and Fluorescein test [MD, −1.29, 95% CI (−1.42, −1.15), P < .00001], but Lycium-rehmannia pills combined with western medicine could not reduce the incidence of adverse reactions, including eyelid inflammation [OR = 1.00, 95% CI (0.37, 2.72), P = 1.00] and congestion symptom [OR = 0.55, 95% CI (0.18, 1.65), P = .28].

Conclusion:

Lycium-rehmannia pills combined with western medicine is better than the control group of therapeutic efficiency in the treatment of dry eye symptom. Due to the quantity and quality limitations of the literature, there were controversial results that the study group was better than the control group in Basic Schirmer test, Tear break up time, Fluorescein test, and reduced adverse reactions, including inflammation of the eyelids and congestion. The above conclusion needs more clinical trials to test and verify.
The myocardial protective effect of monosodium phosphate cardioplegia in cardiopulmonary bypass in infants with an atrial septal defect
Authors: Yang Fang , Wang Jie , Zhai Bo
Published: July 2020

This study aimed to investigate the myocardial protective effect of liquid sodium phosphocreatine cardiac arrest in extracorporeal circulation surgery treating infants with atrial septal defects.

Eighty-four infants with atrial septal defects who required extracorporeal circulation surgery treatment at our hospital from January 2016 to June 2018 were divided into an observation group and a control group through a digitally randomized method, with 42 cases in each group. The control group adopted the conventional modified St Thomas II high potassium cold liquid crystal cardiac arrest, while the observation group adopted the liquid sodium phosphocreatine cardiac arrest.

The myocardial enzyme indexes of the 2 groups 3, 6, 12, and 24 hours postoperatively were higher than before establishing the cardiopulmonary bypass and the enzyme indexes of the control group at the same time were higher than that of the observation group; adenosine triphosphate, adenosine diphosphate, and other energy levels and the postoperative recovery rate energy levels of the observation group were higher than those in the control group, the difference was statistically significant (P < .05).

Liquid sodium phosphocreatine cardiac arrest used in extracorporeal circulation surgery treating infants with atrial septal defects can reduce myocardial ischemia-reperfusion injury, maintain energy supply during ischemia, strengthen the St Thomas II effect, and aid postoperative cardiac function recovery of high potassium cold liquid crystal cardiac arrest used in infants with atrial septal defects and treated with extracorporeal circulation surgery.