bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship Between Social Deprivation and a Weekend Emergency Medical Admission
Authors:   MED Directorate, St James’s Hospital, Dublin, Ireland, Conway Richard , Cournane Seán ,   Medical Physics and Bioengineering Department, St. Vincent’s University Hospital, Dublin, Byrne Declan , O’Riordan Deirdre ,   MED Directorate, St James’s Hospital, Dublin 8, Ireland, Coveney Seamus ,   School of Geographical and Earth Sciences, University of Glasgow, University Avenue, Glasgow, Silke Bernard ,   MED Directorate, St James’s Hospital, Dublin 8, Ireland
Published: June 2021

Background: Deprivation increases admission rates; the specific effect of deprivation with regard to weekend admissions is unknown. Methods: We calculated annual weekend admission rates for each small area population unit and related these to quintiles of Deprivation Index from 2002-2014. Univariate and multivariable risk estimates were calculated using truncated Poisson regression. Results: There were 30,794 weekend admissions in 16,665 patients. The admission rate was substantially higher for more deprived areas, 12.7 per 1000 (95%CI 9.4, 14.7) vs 4.6 per 1000 (95%CI 3.3, 5.8). More deprived patients admitted at the weekend had a significantly lower 30-day in-hospital mortality (10.3% vs 14.5%, p<0.001). Conclusion: Deprivation is a powerful determinant of weekend admissions, however these comprise a group of patients with better outcomes.
The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings
Authors:   Department of Respiratory Medicine, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefiled, Faruqi Shoaib , Kishore Nalla ,   Department of Respiratory Medicine, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefiled, Bodington Richard ,   University of Hull and the Hull York Medical School, Department of Respiratory Medicine, Castle Hill Hospital, Castle Road, Cottingham, Meghjee Salim ,   Department of Respiratory Medicine, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefiled, Thirumaran Muthu ,   Department of Respiratory Medicine, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefiled
Published: June 2021

Aims: In this retrospective study we assess the diagnostic yield of computed tomography pulmonary angiogram (CTPA) and the incidence of alterative and incidental diagnoses. Methods: The results of all CTPA scans performed in our trust over a period of 18 months were reviewed and all diagnoses noted. Data collected was descriptively analysed. Results: A total of 1138 scans were performed (56.5% men, mean age 59 years). A diagnosis of pulmonary embolism (PE) was made in 20.2%, an alternative aetiology for presenting symptoms in 26.4% and incidental findings in 19.5%. The commonest alternative diagnosis was pneumonia (9.5%). Conclusions: Significant numbers of CTPA yield unexpected findings, which may provide an explanation for the clinical presentation. Furthermore substantial numbers of incidental pathologies are also diagnosed which may lead to inappropriate resource utilization and increased patient anxiety.
Fever, delirium and incontinence: not always a UTI
Authors:   Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, McNicholas Emily , Abdelhafiz Ahmed H ,   Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham
Published: June 2021

Unexplained fever and confusion is a common reason for emergency medical admission. When this occurs in the context of new urinary incontinence, a urinary tract infection may be considered to be the most likely cause. However it is also important to consider spinal pathology when this combination of symptoms arises. We present a case of a retropharygeal collection presenting in a patient with this combination of symptoms.
Pneumomediastinum as a complication of MDMA (3,4-methylenedioxymetamfetamine, Ecstasy) ingestion
Authors:   Department of Respiratory Medicine, Hull Royal Infirmary, Hull and East Riding Hospitals NHS Trust, Hull, UK, Ezoubi Suleiman , Kahal Hassan ,   Department of Diabetes and Endocrinology, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK, Waring W Stephen ,   Acute Medical Unit, York Teaching Hospitals NHS Foundation Trust
Published: June 2021

MDMA (3,4-methylenedioxymethamfetamine, Ecstasy) is a widely used recreational drug. We present a case of pneumomediastinum as a complication of MDMA use in a 21-year-old man with no previous history of lung or gastrointestinal pathology. We have performed a literature review, and summarised the symptoms, signs, and prognosis for this under-recognised complication of a commonly used recreational drug. We recommend enquiring about illicit drug use in any patient presenting with spontaneous pneumomediastinum.
Improving acute care for adolescents and young adults on medical admission units: The interventions that matter
Authors:   Diabetes and Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth, Whicher CA , Shah Rajiv ,   Department of Infectious Diseases, Nottingham University Hospitals, Gleeson H ,   United Hospitals Birmingham Trust, Raddlebarn Road, Selly Oak, Birmingham, Vaughan Louella ,   Centre for Health Improvement Research, Chelsea and Westminster Hospital, London, Albon L ,   Queen Alexandra Hospital, Cosham, Portsmouth
Published: June 2021

It had become a familiar routine. My seventh admission with diabetic ketoacidosis (DKA) in a year. Each time I was admitted it was the same; a DKA protocol, a diabetes specialist nurse visit, and a few questions from the doctors checking if “everything is okay?” On each admission, I would be discharged home after a couple of days. We all knew I’d be back again within a month or two.
An Unusual Case of Acute Muscle Weakness
Authors:   Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary’s Hospital, London, Harrogate Suzanne R , Mills Edouard ,   Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary’s Hospital, London, Qureshi Asjid ,   Department of Endocrinology, London Northwest Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow, de Wolff Jacob F ,   Acute Physiology, London Northwest Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow
Published: June 2021

A previously healthy 35-year old man presented to hospital with acute leg weakness following an alcohol binge. On assessment, tachycardia, urinary retention and bilateral upper and lower limb proximal weakness with preserved peripheral power were noted. Biochemistry revealed marked hypokalaemia, which responded to intravenous replacement, and biochemical thyrotoxicosis, leading to the diagnosis of Thyrotoxic Periodic Paralysis (TPP). Anti-thyroid therapy and beta-blockers were commenced and his neurological symptomatology resolved as he became progressively euthyroid. TPP is a rare acquired subtype of hypokalaemic periodic paralysis, typically causing proximal muscle weakness associated with thyrotoxicosis. It is most common in young Asian males. Acute treatment requires cautious oral potassium supplementation, beta-blockade, and anti-thyroid therapy. TPP is prevented by maintaining euthyroidism; otherwise recurrence is likely.
A Fellowship Further Afield
Authors:   Acute Internal Medicine, Acute Medicine Unit, University College Hospital, Euston Rd, Fitzrovia, London, Khan Tehmeena
Published: June 2021

In the current climate of uncertainty over trainee working conditions and uneasy medical politics, more and more trainees are choosing to take planned time out of training. This is no longer considered an activity that unnecessarily prolongs one’s training, and is generally welcomed by trainees and training programme directors alike.
Progressing care in the Medical High Dependency Unit: unit configurations, staffing, standards, and daily routine
Authors:   ueen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, Wright Christopher John , Allan Russell ,   Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF
Published: June 2021

There are currently various models of care for provision of high dependency care for acutely ill medical patients across the UK. Acute Physicians are integral to the development and progression of this both challenging and rewarding area of medicine. This article outlines current standards, best evidence, and our own experience of both setting up and developing a medical high dependency unit (MHDU).
Problem-based review: Immune-mediated complications of ‘Checkpoint Inhibitors’ for the Acute Physician
Authors:   The Christie, Manchester, UK, Webb Philip , Rice Terry W ,   The University of Texas MD Anderson Cancer Center, Houston, Texas, Cooksley Timothy ,   Acute Medicine Department of Acute Medicine, Manchester Royal Infirmary, Oxford Road, Manchester
Published: June 2021

Immunotherapy with ’checkpoint-inhibitors‘ has significantly improved outcomes for patients with a range of malignancies. However, significant immune-mediated toxicities of these therapies are well-described. These immune-mediated toxicities can affect virtually all organ systems and are potentially fatal. The timing of onset of the adverse effects is dependent on the organ system affected and can occur after completion of the treatment. The increasing utilisation of ‘checkpoint-inhibitors’ means that Acute Physicians are likely to see a number of immune-mediated complications presenting to the AMU. The fundamental principles of management of immune-mediated toxicities are early recognition, supportive treatment, escalating steroid therapy (dependent on the severity of the toxicity), close liaison with Oncology and specialist organ team input. Research into the optimal strategies and pathways for the management of immune-mediated toxicity, as well as increased collaboration between Acute Physicians and Oncologists, will be necessary.
Use of a flumazenil infusion to treat chlordiazepoxide toxicity
Authors:   Royal Victoria Hospital, Belfast, UK, Wallace IR , Campbell EC ,   Royal Victoria Hospital, Belfast, UK, Trimble Micheal ,   Royal Victoria Hospital, Belfast, UK
Published: June 2021

“Alcohol detox” is a common presentation to acute medical services and is usually managed via standardised guidelines and protocols. We present a case of chlordiazepoxide toxicity, requiring repeated bolus doses and subsequently 24 hours of an intravenous infusion of flumazenil in response to guideline directed management of an alcohol withdrawal state. The use of prolonged flumazenil infusions to treat benzodiazepine toxicity is infrequently described. Chlordiazepoxide is metabolised in the hepatic microsomal pathway and hepatic impairment can lead to accumulation of toxic metabolites, which may have been the explanation for toxicity in this case. In patients at risk of liver dysfunction we advise the use of benzodiazepines not requiring phase 1 oxidative metabolism, such as lorazepam or oxazepam.
Cruising through the journey without getting drowned: The saga of a PhD student in the Netherlands
Authors:   VU University Medical Centre, Section acute medicine, Department of Internal Medicine, Amsterdam, The Netherlands, Van Galen Louise , Wachelder Joyce ,   Department of Internal Medicine, Máxima Medical Centre, Eindhoven/ Veldhoven, the Netherlands
Published: June 2021

Young medical trainees all over the world are encouraged to investigate unknown areas of medicine that need clarification. This often leads them to undertake a PhD (Doctor of Philosophy). Being curious, critical, and creative are necessary competences which enable us to engender scientific research within acute (internal) medicine. Worldwide, huge numbers of professionals are pursuing a PhD, with the aim of receiving a ‘Doctor’-title. These PhD trajectories vary distinctly between countries. Since the distances in the scientific world are getting smaller and it is becoming more easy to work with each other across borders, it might be interesting to know what it requires to become an academic ‘doctor’ overseas. Hereby, we provide a concise insight in to the differences between doing PhD in (acute) medicine in the Netherlands and in the UK
Book Review: Oxford Desk Reference, Acute Medicine
Authors:   University Hospital Southampton Foundation Trust, Roseveare Chris
Published: June 2021

This book was published in hardback by Oxford University Press in 2016. Comprising 824 pages of small font text, it covers the full range of conditions which would be encountered on the acute medical take in considerable detail. The book is laid out in a traditional format, with most of the chapters defined by a physiological system – cardiovascular, respiratory, endocrinology, etc, and subsections for individual diagnoses within each of the chapters.
Predicting length of stay for acute medical admissions using the ALICE score: a simple bedside tool
Authors:   Plymouth Hospitals NHS Trust Derriford Hospital, Derriford Road, Plymouth, UK, Wilding Daniel , Evans Kate ,   Plymouth Hospitals NHS Trust Derriford Hospital, Derriford Road, Plymouth, UK
Published: June 2021

Background: Early identification of patients likely to have a short admission permits best use of limited resources to facilitate rapid discharge where possible. The ALICE score is a simple bedside tool developed in one hospital as a decision aid. This study sought to confirm its widespread applicability. Method: Retrospective review of 250 consecutive admissions at five acute hospitals. Clinical records were reviewed for a total of 1003 patients. ALICE score was calculated for each patient and compared to LoS data. Results: There was a statistically significant positive correlation between rising ALICE scores and increasing length of stay irrespective of final diagnoses. Conclusion: The ALICE score provides a simple bedside tool to predict length of stay.
The Experience of a District General Hospital with a Large Outdoor Music Festival in England
Authors:   Acute Medicine and Toxicology, North Manchester General Hospital, Kamour A , Yardley R. ,   Anaesthetics, Royal Preston Hospital, Stuart J. ,   North Manchester General Hospital, Longshaw M. ,   North Manchester General Hospital
Published: June 2021

Objectives: To assess the impact of the Parklife annual music festival on the local hospital, North Manchester General. Methods: Data was obtained retrospectively by analysis of emergency department records during the weekend of Parklife 2015. Results: 32 patients were identified, 56% reported taking drugs. 34% were admitted for overnight observation. 4 patients presented with methaemoglobinaemia following oral ingestion of amyl nitrate. One patient had a methaemoglobin fraction of 90.6%, which is amongst the most extreme recorded in literature. Conclusion: Music festivals can impose a burden on local health services. Organisers should operate an efficient surveillance system in order to prevent the sale and use of recreational drugs, providing adequate on-site health services and working in collaboration with local emergency services.
An unusual case of sepsis: liver abscess masquerading as pneumonia
Authors:   Queens Hospital Burton, Burton on Trent, The Burton Hospitals NHS foundation Trust,UK, Kozhippally Mohandas , Sivaraman Subash ,   Queens Hospital Burton, Burton on Trent, The Burton Hospitals NHS foundation Trust,UK
Published: June 2021

A 63-year-old woman presented with fever, tachycardia and tachypnoea, with right sided chest and hypochondrial pain. Chest radiograph showed right basal consolidation and she was treated for community acquired pneumonia with intravenous antibiotics. Subsequent clinical deterioration in presence of a previous history of complicated diverticulitis, persistent right hypochondrial pain and deranged liver function tests prompted further investigations that confirmed presence of a large pyogenic liver abscess. Following appropriate antibiotic treatment and image guided drainage of the abscess, the patient made a complete recovery. This case illustrates the importance of considering a subdiaphragmatic source of sepsis even in the presence of chest radiographic abnormalities, when a patient fails to respond to initial treatment for pneumonia.
Training in Medicine – Oxford University Press, 2016 Edited by Elaine Jolly, Andrew Fry and Afzal Chaudhry
Authors:   University Hospital Southampton Foundation Trust, Roseveare Chris
Published: June 2021

When I first saw the title of this book, my initial assumption was that it was a training ‘guidebook’ – one of those texts which aims to help trainees to navigate their way through the treacherous waters of work-life balance, ARCPs, e-portfolio and so on. In this regard the title is misleading – this is in fact a medical text book, aimed at those undertaking ‘early years speciality training’ with a particular focus on Core Medical Training. Published in 2016, it is the most recent addition in of a series of books produced by Oxford University Press, whose other titles include Training in Anaesthesia, Ophthalmology and Obstetrics and Gynaecology.
Measuring impact of telephone triage in Acute Medicine
Authors:   Department of Medicine, Ysbyty Gwynedd, Bangor UK, Asmat Huma , Khalid Shinwari Shah ,   Department of Medicine, Ysbyty Gwynedd, Bangor UK, Cooksley Timothy ,   Department of Acute Medicine, Manchester Royal Infirmary, Manchester, Duckitt Roger ,   Department of Acute Medicine, Worthing Hospital, Worthing, UK, Le Jeune Ivan ,   Department of Research and Education in Emergency medicine, Acute medicine and Major trauma (DREEAM), Nottingham University Hospitals NUH Trust, Nottingham, UK, P Subbe Christian ,   Consultant in Acute, Respiratory & Critical Care Medicine Bangor University & Ysbyty Gwynedd Hospital Bangor, Wales
Published: June 2021

The Society for Acute Medicine’s Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources. Calls from Emergency Departments rarely resulted in admission avoidance. Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant. Consultant triage might result in admission avoidance but the impact of local context on the effectiveness is not clear.
Research Protocol: Intravenous Access during Resuscitation: the IVAR trial
Authors: Smulders YM , WB Nanayakkara Prabath ,   Department of Internal Medicine, Section Acute Medicine, Amsterdam University Medical Centre, VU University, The Netherlands
Published: June 2021

Objective: To compare the effects of central versus peripheral drug administration on the rate of return of organised electrical activity and/or spontaneous circulation during CPR. Study design: Randomized clinical trial. Study population: Hospitalized patients and patients presenting at the emergency department, older than 18 years, requiring CPR. Intervention: Central venous access Main study parameters/endpoints: Combined primary endpoint: rate of appearance of organised electrical activity or return of spontaneous circulation. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: All patients are treated according to the guidelines of the European Resuscitation Council, which are endorsed by the local VUMC CPR-committee. Central access will be obtained by cannulation of the external or internal jugular vein. To avoid interference with initial management, central venous access will be obtained after initiation of chest compressions, first attempt at defibrillation (if applicable), securing the airway and obtaining a peripheral access. All resuscitated patients require vascular access and almost all successfully resuscitated patients require central venous access. Obtaining central access during CPR may be associated with a slightly higher complication rate, such as arterial puncture and pneumothorax. Possible benefits for study subjects are a higher success rate of CPR.
Oxford specialist handbooks in neurology: Stroke Medicine
Authors:   Stroke Medicine and Elderly Care, Southern Health NHS Foundation Trust, McNaught Jennie
Published: June 2021

This is a pocket sized book (if your pockets are 20×18×2 cm big, that is) and it weighs less than two decent stethoscopes. Its small physical size belies the comprehensive coverage given to the subject. It is a really a compact textbook covering all aspects of stroke care.
Characteristics and outcome of acute medical admissions with hyponatremia: even mild hyponatremia is associated with higher mortality
Authors:   Maastricht University, Maastricht, the Netherlands, Joosen Dorien A.W.A. , Zwietering N Anne ,   Maastricht University, Maastricht, the Netherlands, Bosch Milou ,   Maastricht University, Maastricht, the Netherlands, Stassen Patricia M. ,   Maastricht University, Maastricht, the Netherlands
Published: June 2021

Hyponatremia is a common finding in hospitalized patients. In this retrospective cohort study we assessed the characteristics and outcome of acute medical admissions with hyponatremia. Compared to the normal sodium group, those with hyponatremia were significantly older and the Charlson Comorbidity Index (CCI) was higher. The number of admissions to MCU/ICU between both groups was similar, but hyponatremic patients had a longer length of stay and both 28-day and one-year mortality were higher, even in patients with mild hyponatremia. Hyponatremia was independently associated with mortality after adjustment for age, CCI and polypharmacy, as was found in the subgroup with mild hyponatremia.
Long-term health related quality of life in patients with sepsis after intensive care stay: A systematic review
Authors:   Amsterdam University Medical Centre, VU University, The Netherlands, Alam Nadia , Panday RS Nannan ,   Amsterdam University Medical Centre, VU University, The Netherlands, Heijnen JR ,   Amsterdam University Medical Centre, VU University, The Netherlands, van Galen LS ,   Amsterdam University Medical Centre, VU University, The Netherlands, Kramer Mark H H ,   Amsterdam University Medical Centre, VU University, The Netherlands, Nanayakkara Prabath WB ,   Amsterdam University Medical Centre, VU University, The Netherlands
Published: June 2021

Sepsis is a major health care issue and sepsis survivors are often confronted with long-term complications after admission to the intensive care unit (ICU) which may negatively influence their health related quality of life (HRQOL). This study aimed to systematically evaluate the outcome in terms of HRQOL in patients with sepsis after ICU discharge. A literature search was conducted in the bibliographic databases PubMed, EMBASE, and CINAHL, including reference lists of published guidelines, reviews and associated articles. Sixteen studies were included, thirteen (81.3%) reported that sepsis survivors suffer from impaired HRQOL in physical and mental domains which persist from months to years after a sepsis episode. More focus on improving long-term outcomes for patients surviving sepsis and the ICU is needed.
Medical High Dependency Unit series, Article 4: Tracheostomy management
Authors:   Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, Black Euan , Allan Russell ,   Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF
Published: June 2021

The number of patients with tracheostomies managed within high dependency units is increasing. National audits have suggested that the care of these patients could have been improved upon with a significant minority of cases resulting in death or serious adverse events. Because of this, it is crucial that staff working within medical high dependency units have a good understanding of the indications for and techniques of insertion of tracheostomies. In addition, knowledge of the various tube types and ancillary equipment is mandatory. Ideally, care should be standardised across hospital sites and all staff trained to deal with routine and basic emergency care using national guidelines. It is fundamental that medical staff without expertise in the advanced management of emergencies are aware of the equipment required and who to contact within their hospital should such procedures be necessary. Temporary tracheostomies should be removed at the earliest opportunity under the guidance of the teams responsible for their insertion.
Painful lymphadenopathy due to silicone breast implant rupture following extensive global air travel
Authors:   Microbiology Department, Portsmouth Pathology Service, Queen Alexandra Hospital, Cosham, Hampshire PO63LY, Theodosiou Anastasia A , Houghton Rebecca ,   Microbiology Department, Portsmouth Pathology Service, Queen Alexandra Hospital, Cosham, Hampshire PO63LY, Shepherd Nicholas ,   Microbiology Department, Portsmouth Pathology Service, Queen Alexandra Hospital, Cosham, Hampshire PO63LY, Lillie Patrick ,   University Hospitals Southampton NHS Foundation Trust
Published: June 2021

A 25-year-old Caucasian flight attendant with an extensive travel history presented with night sweats, fevers, weight loss and axillary and supraclavicular lymphadenopathy. Apart from surgical breast augmentation, she had no past medical or surgical history. She was anaemic, leucopenic and lymphopenic, and a broad infection screen was negative. Cross-sectional imaging revealed ipsilateral silicone breast implant rupture, with leaking of implant contents into the surrounding tissue. Histological examination of an axillary lymph node core biopsy confirmed the diagnosis of silicone lymphadenopathy. This case illustrates the broad differential for acute painful lymphadenopathy in the context of global travel, and the use of targeted infection testing, early cross-sectional imaging and biopsy to arrive at an unexpected diagnosis.
Euglycaemic DKA secondary to Canaglifozin, an easily missed diagnosis
Authors:   Acute Medicine Frimley Park Hospital, Frimley, GU16 7UJ UK, Bhatnagar Raj Kumar , Kurera Isuri ,   Frimley Park Hospital, Frimley, GU16 7UJ UK, Perry Robert ,   Frimley Park Hospital, Frimley, GU16 7UJ UK, Tringham Jennifer ,   Frimley Park Hospital, Frimley, GU16 7UJ UK
Published: June 2021

Diabetic ketoacidosis (DKA) is a state of hyperglycaemia, ketosis and metabolic acidosis. This carries a significant morbidity and mortality particularly if left untreated or if the diagnosis is delayed. We present a case of euglycaemic DKA in a 48 year old female with non-insulin treated T2DM who had good glycaemic control. Initial investigations revealed moderate metabolic acidosis, persistent ketonuria and blood glucose levels < 11mmol/l. There was a significant delay in diagnosing DKA following admission with multiple consultant reviews. Detailed history revealed the recent addition of Canagliflozin (SGLT2 inhibitor). This can rarely be a precipitant of euglycaemic DKA. With appropriate DKA treatment, rapid correction of acidaemia and ketosis occurred allowing her to be discharged home within 24 hours.
Men… I er jo venner i virkeligheden! Sammenstød mellem evidensbaserede anvisninger på socialt samvær og børns sociale liv i børnehaven
Authors: Buus Anne Mette
Published: June 2021

Med metodisk og teoretisk inspiration fra etnografisk daginstitutionsforskning belyser denne artikel, hvordan politiske og forvaltningsmæssige ambitioner om at effektivisere pædagogisk praksis ved hjælp af evidensbaserede metoder konkret former sig og virker i et daginstitutionelt hverdagsliv. I artiklen undersøges børns sociale relationer som en målsætning for en evidensbaseret indsats, som en del af børns sociale liv og som omdrejningspunkt for sammenstød mellem evidensbaserede anvisninger og situerede handlinger. Artiklen konkluderer, at metodens entydige og kausale anvisninger for socialt samvær ikke er kompatible med de sociale samværsregler, der udspiller sig i børns fleksible og situerede samvær. Konsekvensen af denne diskrepans er en accelererende kompleksitet, som øger afstanden mellem pædagogisk personale og børn. Endvidere diskuterer artiklen, hvordan kompleksitet er et grundvilkår ved pædagogisk praksis, men træder frem med en styrke, som er ny i forbindelse med en evidensbaseret metode. Ligeledes er det nyt, at daginstitutionspædagogikkens virkninger afkobles kritik og tvivl.
English abstract
But… in reality, you are friends, right! Collisions between evidence-based instructions on social interactions and the social life of children in day-care centres
With methodological and theoretical inspiration from ethnographic research on day-care centres, this article sheds light on how political and administrative ambitions of making the pedagogical practice effective, by the means of evidence-based methods, are shaped and operate in the everyday life of a day-care centre. This article examines the social relations of children as the objective for an evidence-based action, as a part of the social life of children, and as a pivotal point for collisions between evidence-based instructions and situated actions. The article concludes that the unambiguous instructions for social interactions, which the method suggests, are not compatible with the rules of social interaction playing out in the adaptable and situated interactions between children. The consequence of this discrepancy is an accelerating complexity, which increases the distance between the pedagogical staff and the children. Furthermore, the article discusses how complexity might be a basic condition of pedagogical practice, but emerges with a strength that is new in connection with an evidence-based method. Likewise, it is new that the effects of day-care pedagogy are disconnected from critical reflection and doubt.
Gradience in prosodic representation: vowel reduction and neoclassical elements in Brazilian Portuguese
Authors: Guzzo Natália Brambatti , Garcia Guilherme Duarte
Published: June 2021

In Brazilian Portuguese, neoclassical elements (NCEs) may combine with both independent lexical words (e.g., psico in psicolinguística ‘psycholinguistics’) and non-lexical words (e.g., psico in psicologia ‘psychology’). This has led to the proposal that they have distinct prosodic representations depending on the type of structure that they form: NCE+Indep(endent lexical word) prosodizes recursively in the PWd, whereas NCE+Dep(endent form) prosodizes as a simple PWd. However, both NCE+Indep and NCE+Dep are subject to vowel reduction processes that yield similar surface forms: the NCE in NCE+Indep is targeted by word-final raising, and the NCE in NCE+Dep is targeted by raising in pretonic position. This similarity in surface forms poses a problem for the proposal of separate prosodic representations, as different forms of prosodization imply different phonological behavior. We analyze native speakers’ judgements and productions with respect to reduction of the NCE-final vowel under the hypothesis that, if these NCE structures are prosodized differently and undergo different processes, the process that is more frequent in the Brazilian Portuguese grammar (word-final raising) should have higher acceptance and production rates. Results confirm our hypothesis. We argue that the gradient application of phonological processes reflects prosodic distinctions that cannot be captured in a framework that only considers the application or non-application of said processes.
Infecção cervicofacial grave de origem odontogênica – relato de caso
Authors: Rodrigues Cristovão Marcondes de Castro , Santos Daniela Meneses , Maciel Oliveira Mirlany Mendes , De Almeida Vinicius Lima , Soares dos Reis Danyella Carolyna , Batista Jonas Dantas
Published: June 2021

Introdução: as infecções odontogênicas tem como principal origem a necrose pulpar com invasão bacteriana no tecido periapical e periodontal, podendo levar à formação de quadros de celulite e posteriormente de abscesso, além disso, possuem o potencial de disseminar-se pelos espaços faciais profundos e comprometer a vida do paciente. Complicações graves, decorrentes dos quadros de infecções odontogênicas, podem ocorrer, se o tratamento instituído não for adequado, como: trombose do seio cavernoso, abscesso cerebral, mediastinite e até óbito. Objetivo: discutir o manejo das infecções odontogênicas disseminados em espaços faciais profundos, através do relato de caso clínico. Caso clínico: paciente de 52 anos, portador de diabetes mellitus tipo 2, com infecção odontogênica, no exame clínico inicial apresentava trismo, disfonia, dispneia, disfagia, hiperemia e edema em lado esquerdo da face, envolvendo os espaços canino, bucal, submandibular e cervical além de unidades dentárias com foco infeccioso. Em exame de tomográfica computadorizada, observou-se desvio da via área, presença de um grande volume de gás e de lojas de infecção. Optou-se como tratamento a remoção dos focos dentários e drenagem intraoral foi realizada pela equipe da CTBMF com anestesia local e posteriormente drenagem sob anestesia geral, intubação com uso de fibroscopia pela equipe de cirurgia cabeça e pescoço. Considerações finais: as infecções odontogênicas que envolvem espaços faciais profundos devem ser tratadas com urgência e o tratamento de escolha dessa condição deve ser remoção imediata do foco infeccioso, exploração e drenagem rápida e agressiva dos espaços faciais envolvidos e associação com antimicrobianos de amplo espectro com características bactericidas.
Turismo, una alternativa de desarrollo local con enfoque de género. Caso de estudio: La Garita - Salinas Grandes, León, Nicaragua.
Authors: Bolaños Cerda Idania , Hernández Pinell Dania , Cisneros López Rosa , Esquivel Zelaya Guisell
Published: June 2021

El Turismo es una fuente de desarrollo local a nivel mundial que contribuye a diferentes paradigmas, existiendo una relación directa entre turismo y desarrollo al punto de considerar como equivalentes las expresiones desarrollo turístico y desarrollo regional. (Acerenza, 1997). En el estudio El turismo, una alternativa de desarrollo local con enfoque de género en la comunidad rural La Garita, Salinas Grandes, zona de amortiguamiento de la Reserva Natural Isla Juan Venado, departamento de León, Nicaragua, se plantean las necesidades, condiciones de los servicios básicos y potencialidades, para el desarrollo de la actividad turística con enfoque de género en esta comunidad; aplicando una metodología mixta se utilizó fichas de inventarios, encuestas y entrevistas para la obtención de los resultados. Se identificó ocho atractivos naturales con potencial turístico, clasificados seis como oferta primordial y dos como oferta complementaria en la producción de turismo con alcance nacional e internacional, y cinco atractivos culturales como oferta complementaria con alcance local. La población reconoció la actividad turística como una herramienta de desarrollo para su comunidad, aduciendo igualdad de género en los miembros de la familia. Se detectó siete microempresas turísticas (hostales, comedores, tour operadora), distinguiéndose que, los hombres se dedican a las actividades de pesca y paseos en lancha, en cambio las mujeres a la cocina, atención de eventos, administración de los negocios, entre otras; organizadas en la prestación de servicios turísticos. Las principales limitaciones para el desarrollo turístico en esta comunidad son: el camino de acceso en mal estado, falta de agua potable permanentemente y de servicios de aguas residuales. Instituciones como MARENA, UNAN – León y MEFCCA trabajan como aliados estratégicos para mejorar las condiciones de vida de la población y preservación de las especies de flora y fauna en la localidad. Las necesidades de capacitación se enfocan en preparación de alimentos, atención al cliente, contabilidad, guías de turistas.
Factores socioeconómicos y el uso de métodos anticonceptivos en mujeres en edad fértil en Nicaragua
Authors: Avilés Peralta Yader , Sánchez Quintero Marvin , Valiente Gutiérrez Oswan
Published: June 2021

La capacidad de la mujer para decidir si quiere embarazarse y en qué momento, tiene una repercusión directa en su salud y bienestar socioeconómico (Caudillo, Benavides, Valdez, Flores, y Hernández, 2017, p.52). Este estudio analiza los factores socioeconómicos que determinan el uso de métodos anticonceptivos en mujeres nicaragüenses en edad fértil, utilizando la Encuesta Nicaragüense de Demografía y Salud (ENDESA, 2011). El tipo de investigación es cuantitativo, correlacional y no experimental y el análisis econométrico se fundamenta en el modelo logístico para la variable dicotómica uso y no uso de algún método anticonceptivo.  Los resultados de la investigación explican que para el año 2011, el 59.8% de las mujeres en edad fértil usaban al menos un método anticonceptivo y el más utilizado era la Oclusión Tubárica Bilateral OTB o Ligadura (21.3%), seguido de la inyección anticonceptiva (20.9%) y la píldora anticonceptiva (8.2%). Por estructura de edades, el rango de 15-20 años tiene el menor porcentaje de uso de anticonceptivo con el 30.7%, sin embargo este valor aumenta a 61.4% en el rango de 21-29 años hasta 73.3% en mujeres de 30-36 años. Un dato relevante es que 6 de cada 10 mujeres en edad fértil han estado embarazada al menos una vez al tener la edad de 21 años. Respecto al modelo, se encontró que el acceso a un lugar para obtener el método anticonceptivo no garantiza su uso. Las características relacionadas a la edad, región, área de residencia, etnia, haber estado embarazada alguna vez, haber tenido relaciones sexuales en los últimos 12 meses, uso de condón en la primera relación sexual y tener pareja cumplen con la relación teórica esperada respecto al uso de métodos anticonceptivos en las mujeres en edad fértil. Haber estado embarazada (98.2%) y tener pareja (69.7%) poseen los efectos marginales más altos.
Expediente v.10, n.2, 2021
Authors: Editorial Comitê
Published: June 2021

Informações sobre a elaboração do v.10, n.2 de maio/ago. de 2021.
How Relatedness Need Satisfaction or Frustration and Motivation Relate to Well-Being on Social Networking Sites
Authors: Chen Yunxiang , Li Ruoxuan , Liu Xiangping
Published: June 2021

Given the widespread use of social networking sites across the world and their importance in people’s lives, explaining users’ well-being on these platforms is certainly worthy of research inquiry. However, little attention has been given to well-being in the context of social networks. Building on the dual process model of the self-determination theory, we hypothesized that for the relatedness need, 1 of 3 basic psychological needs, its satisfaction (RNS) and frustration (RNF) might trigger different motivations (autonomous vs. controlled) and in turn affect people’s social networking well-being. Data were collected through self-reported questionnaires from 494 freshmen (Mage = 18.81 ± 0.92 years, 190 men). Structural equation modeling analyses supported the hypothesized model: Autonomous and controlled motivations partially mediated the relationship between RNS or RNF and social networking well-being. Specifically, RNS was significantly related to positive affect in social networks, being mediated by autonomous motivation. RNF was significantly related to negative affect and general well-being in social networks, with the former relation being mediated by controlled motivation. It can be concluded that RNS and RNF play pivotal but distinct roles in shaping individuals’ motivation and further exert an important influence on the level of well- or ill-being during social networking usage. Implications for future research are discussed.
Use of Shape Restricted Regression Methods for Fitting Model of Per Capita GDP: A Global Economic Scenario of 2018
Authors: Tasnim Sanjida
Published: June 2021

The aim of the study is to analyze the pattern of Gross domestic product (GDP) according to Human development index (HDI) for 184 countries of the world. GDP per capita indicates only economic prosperity but not the overall development of the citizens of a country. This research tries to find out the beneath relationship of the financial state and human development of countries using the data of 2018. For demonstrating this analysis several parametric and non-parametric regression methods subject to shape restriction have been used. The study targets to shed light on comparative performance of shape constrained regression with cone projection, polynomial regression, LOESS, Istonic regression with pooled adjacent violators algorithm, Kernel regression, smoothing spline and generalized additive model in convex situation.
Transformation and Simplification of Aquatic Vegetation Structure and Reoligotrophication of a Lake During the Last 40 Years
Authors: Brzozowski Michał , Pełechata Aleksandra , Kaczmarek Lech , Pełechaty Mariusz
Published: June 2021

The recovery or reconstruction of aquatic vegetation has recently been reported as a result of water quality improvement after anthropogenic eutrophication. The objectives of this study were: to investigate long-term trends in aquatic vegetation abundance in relation to decreasing water fertility and to present new directions in changes of the submerged aquatic vegetation structure, species richness, and biodiversity in Lake Kuźnickie (western Poland) with the perspective of the last 40 years (1978–2018). Lake Kuźnickie is an example of water quality improvement taking place without any additional reclamation measures, except a reduction in nutrient discharge into the lake from its direct catchment. Currently, the study lake represents a mesotrophic status. The Trophy State Index evidenced a decrease in the lake’s fertility compared to previous decades. The water quality improvement manifests in a significant reduction in the total phosphorus concentration. An analysis of the spatial changes in the phytolittoral evidenced a decrease in rush vegetation between 1978 and 2018 by over 2 ha. In the period 1978–2018, the aquatic vegetation structure in Lake Kuźnickie underwent significant reconstruction. Currently, charophytes play a much greater role in the lake compared to the last 40 years, contributing to the maintenance of the lake’s high water quality. Moreover, the endangered charophyte
Lychnothamnus barbatus
has recovered. Concurrently, however, the biodiversity and species richness of the submerged vegetation has decreased. At present, only four species dominate in the lake, including two charophytes
L. barbatus
,
Nitellopsis obtusa
, and two vascular plants
Ceratophyllum demersum
and
Myriophyllum spicatum
. Over 40 years, Lake Kuźnickie has changed from a eutrophic lake dominated by vascular plants to a mesotrophic lake with a codominant contribution by charophytes. The lake is characterized by good water quality, optimal for the development of aquatic vegetation, especially charophytes.
Does the slope of the yield curve of the interbank market influence prices on the Warsaw Stock Exchange? A sectoral perspective
Authors: Majerowska Ewa , Bednarz Jacek
Published: June 2021

The interest rate curve is often viewed as the leading indicator of economic prosperity in a broad sense. This paper studies the ability of the slope of the yield curve in the term structure of interest rates to impact the sectoral indices on the Warsaw Stock Exchange, using daily data covering the period from 1 January 2001 to 30 September 2020. The results of the research indicate an ambiguous dependence of the logarithmic rates of return of sub-indices on the change of the interbank interest rate curve. The only sectors showing a clear relationship of this type is energy and pharmaceuticals.
Mediador Game: Um jogo baseado em processo de negócio para treinamento organizacional
Authors: Silva Thayna Gomes da , Lopes Tatiane Neves , Araujo Renata
Published: June 2021

Este trabalho apresenta o desenvolvimento do Mediador Game, umjogo digital baseado em processos de negócio para apoiar o treinamento deprocessos, aplicado na mediação de conflitos do poder judiciário. O jogo foiprojetado utilizando o método Play Your Process, desenvolvido em pesquisasanteriores, que descreve as etapas para transformar elementos de modelos deprocessos de negócio em elementos de design de jogos.
Impacto da Governança das Plataformas digitais na criação e apropriação de valor em Ecossistemas de negócio
Authors: Fonseca Sergio , Diirr Bruna
Published: June 2021

Na última década, as Plataformas digitais ganharam importância na orquestração das relações interorganizacionais, tornando-se pontos de controle em diversos Ecossistemas de negócio. Isso pode gerar conflitos entre os Líderes das Plataformas e outros participantes na busca de oportunidades para criação e apropriação de valor. Nesse trabalho, a Governança das Plataformas digitais é investigada pela perspectiva dos Complementors e busca-se criar mecanismos que permitam prognosticar como o controle do Líder sobre a Plataforma pode afetar a criação e apropriação de valor no Ecossistema. Ao final, será proposto um artefato que apoie tanto pesquisadores quanto praticantes na realização desses prognósticos.
Reden über etwas
Authors: Staub Christoph
Published: June 2021

The concept of something runs like a red thread through Husserl's explanations of the phenomenological theory of intentionality. "Something" is what we mean even when we use fictional and contradictory expressions. In the words of Emile Benveniste, how can this "something" be demarcated from language? In the search for a linguistically adequate understanding of this concept, topics as diverse as Augustine's theory of language, Franz Bopp's comparative grammar, text linguistics, or Heidegger's reading of the modistic treatise are treated within the framework of comparative studies. It is, as the phenomenological analysis of empty names or inner monologue shows, in particular situations of speaking that the concept of something and thus the meaning-bearing function of linguistic expressions comes into consciousness.
A Perennial Theology of Nature
Authors: Ramelow Anselm ,   Philosophy Documentation Center
Published: June 2021

However much scientific paradigms shift, the shifts are not so arbitrary that we would relinquish without need the simpler, more economic and elegant theories for more complicated ones. This is not just a matter of convenience but implies an objective fact about the universe, namely a reliable perfection that can only be assumed on the basis of the intelligent design of a benevolent creator God. Earlier thinkers may have been more aware that this is an assumption (e.g., Kant) and presupposes God’s benevolent intentions (Leibniz). This assumption of a unified order of reality in general constitutes itself a perennial consensus through the ages, whether in Aquinas, Leibniz, the German Idealists or American Transcendentalists. Dissenters such as William James or Nietzsche serve to highlight the assumption as theological—an assumption that is fortunately confirmed by our best available evidence, as well as by the way we do science and live our lives.
Charity in Interpretation: Principle or Virtue? A Return to Gregory the Great
Authors: Vandevelde Pol ,   Philosophy Documentation Center
Published: June 2021

I defend the view that charity in interpretation is both an epistemic and a moral virtue. In the first part, I examine Donald Davidson’s version of his principle of charity and question his ascription of beliefs by raising a phenomenological objection: beliefs themselves, before being ascribed, need to be interpreted when interpreters and the subjects they try to understand do not share the same cultural and historical background. In the second section, I examine the notion of epistemic virtue as discussed in virtue epistemology and question whether an epistemic virtue can be completely separated from a moral virtue. In the third section, I show how Gregory the Great, Father of the Church and Pope in the 6th century, understands the virtue of charity in interpretation not as a motivation (in a causal process of interpretation, as in virtue epistemology) but as an attraction to the good (in a teleological process) so that the interpreter is not only a technician producing an interpretation (following a “principle” of charity, as in Davidson) but a moral agent acting in a community.