bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Parathyroid Carcinoma: A Case Report and Review of the Literature
Authors: Dutta Aditya , Pal Rimesh , Jain Nimisha , Dutta Pinaki , Rai Ashutosh , Bhansali Anil , Behera Arunanshu , Saikia Uma Nahar , Vishwajeet Vikarn , Collier David , Boon Hannah , Korbonits Márta , Bhadada Sanjay Kumar
Published: September 2019

Primary hyperparathyroidism (PHPT) is a rare endocrine disease in the pediatric population. Sporadic parathyroid adenomas remain the most common cause of pediatric PHPT. Parathyroid carcinoma (PC) is an extremely rare cause of pediatric PHPT. We report a 16-year-old boy presenting with a nonhealing fragility fracture of the right leg along with florid features of rickets. Examination revealed a neck mass, mimicking a goiter. Biochemical findings were consistent with PHPT. Imaging was suggestive of a right inferior parathyroid mass infiltrating the right lobe of thyroid. The patient underwent en bloc surgical excision of the parathyroid mass along with the right lobe of thyroid. Histopathology was suggestive of a PC. He achieved biochemical remission with normalization of serum calcium and parathyroid hormone levels. At follow-up, there was no biochemical or imaging evidence of recurrence or metastasis. Genetic analysis revealed heterozygous germline deletion of CDC73. An extensive literature search on PC was conducted, with an emphasis on the pediatric population. Thirteen cases of pediatric PC were identified. The median age of presentation was 13 years; there was no sex predilection. All cases were symptomatic; 31% had a visible neck mass. The median serum calcium and intact parathyroid hormone levels were 14.3 mg/dL and 2000 pg/mL, respectively. All patients underwent surgical excision, with 27% showing metastatic relapse. Our findings indicate that the preoperative features that could point toward a diagnosis of PC in a child with PHPT are a tumor size of >3 cm, thyroid infiltration on imaging, and severe hypercalcemia at presentation.
Efficacy and Safety of Once-Weekly Thyroxine for Thyroxine-Resistant Hypothyroidism
Authors: Jayakumari Chellama , Nair Abilash , Puthiyaveettil Khadar Jabbar , Das Darvin V , Prasad Nandini , Jessy S J , Gopi Anjana , Guruprasad Padmanabhan
Published: September 2019

Context

Noncompliance with thyroxine therapy is the most common cause of poor control of hypothyroidism. An open-label prospective study to compare once-weekly thyroxine (OWT) with standard daily thyroxine (SDT) was undertaken.

Design

Patients taking thyroxine doses of >3 μg/kg/d, with or without normalization of TSH, were included and administered directly observed OWT or nonobserved SDT according to patient preference based on their weight for 6 weeks. Furthermore, patients on OWT were advised to continue the same at home without supervision.

Results

Twenty six of 34 patients on OWT and 7 of 18 patients on SDT achieved a TSH <10 μIU/mL (P < 0.05), and 2 patients from the SDT arm were lost to follow-up. During home treatment, 15 of 25 at 12 weeks and 19 of 23 contactable patients at a median follow-up of 25 months maintained TSH below target. Thyroxine absorption test was unable to predict normalization of TSH at 6 weeks of OWT therapy. No adverse events were seen with OWT-treated patients over the 12-week follow-up period. OWT has significantly higher efficacy (OR = 5.1) than SDT for patients with thyroxine-resistant hypothyroidism and is not associated with side effects.

Conclusion

OWT benefits a majority of patients in the long-term treatment of thyroxine-resistant hypothyroidism, in the real-world setting.
Referrals for Elevated Thyroid Stimulating Hormone to Pediatric Endocrinologists
Authors: Gammons Sarah , Presley Brent K , White Perrin C
Published: September 2019

Objective

We aimed to determine the reproducibility of TSH testing in pediatric patients referred to pediatric endocrinologists and to identify the threshold TSH levels that would predict the presence of antithyroid autoantibodies and inform decisions by pediatric endocrinologists to initiate or continue treatment with levothyroxine.

Study Design

We analyzed a retrospective case series of 325 children aged 1 to 18 years referred for hypothyroidism to the endocrinology clinic at a tertiary care children’s hospital. The receiver operating characteristic area under curve (AUC) determined the ability of the initial TSH level to predict pediatric endocrinologists’ treatment decisions, presence of thyroid autoantibodies, and reproducibility of elevated TSH on repeat testing.

Results

Of 325 patients, 191 were treated. The treated patients were more likely to have had a higher referral TSH, positive autoantibodies, and abnormal thyroid gland examination findings. An initial TSH of 5 had a specificity of only 14% for a repeat TSH of ≥5. An initial TSH level of 11 had a specificity of 90% for a repeat TSH of ≥11, with sensitivity of 90%. TSH was a relatively poor predictor (AUC, 0.711) of the presence of autoantibodies with optimal classification at TSH >8.8 mIU/L. It was better (AUC, 0.878) at predicting whether endocrinologists started or continued treatment with levothyroxine, with optimal classification at 8.2 mIU/L. TSH levels combined with antibody status and thyroid examination findings had the best ability to predict treatment (AUC, 0.930).

Conclusions

TSH levels slightly above the reference range should not prompt referral to pediatric endocrinologists unless another basis for clinical concern is present.
Metreleptin Supplementation for Improving Lipid and Glycemic Profiles in Acquired Diabetes Lipodystrophy: A Case Report
Authors: Nagayama Ayako , Ashida Kenji , Moritaka Kanoko , Hidaka Mami , Gobaru Mizuki , Tanaka Seiji , Hasuzawa Nao , Akasu Shoko , Goto Yuka , Motomura Seiichi , Hara Kento , Tsuruta Munehisa , Wada Nobuhiko , Nakayama Hitomi , Tajiri Yuji , Nomura Masatoshi
Published: September 2019

Most childhood cancer survivors who undergo hematopoietic stem cell transplantation subsequently develop impaired glucose tolerance and hypertriglyceridemia. These conditions are presumably associated with total-body irradiation–related acquired lipodystrophy and may lead to cardiovascular disease. Metreleptin (recombinant leptin) may help improve the lipoprotein profile, insulin sensitivity, and quality of life of patients with total-body irradiation-related lipodystrophy. This report describes the safe and effective use of metreleptin supplementation for insulin resistance and dyslipidemia in acquired incomplete lipodystrophy.

A 24-year-old Japanese woman with diabetes mellitus and hypertriglyceridemia was admitted to our hospital. She was diagnosed with acute lymphocytic leukemia at 3 years of age and had undergone systemic chemotherapy and total-body irradiation before allogeneic stem cell transplantation. She was also diagnosed with hypertriglyceridemia and diabetes mellitus at 11 years of age. She had a low adiponectin level, low-normal leptin level, and diabetes mellitus with marked insulin resistance. Thus, acquired incomplete lipodystrophy was diagnosed. Her serum triglyceride and lipoprotein profiles improved within 1 month of treatment initiation. Glycemic metabolism and insulin sensitivity in the skeletal muscles improved after 6 months.

As previously reported, metreleptin therapy is effective in improving lipid and glycemic profiles in generalized lipodystrophy. In the present case, we considered that metreleptin supplementation could reduce the remnant VLDL cholesterol fraction and improve diabetes mellitus. We conclude that it may be an effective alternative therapy for improving the expected prognosis of patients with acquired incomplete lipodystrophy, including childhood cancer survivors.
Morphine on Trial
Authors: Black Sara
Published: September 2019

This article examines medical-legal debates over the criminal responsibility of morphine addicts in the fin de siècle, at a time when the use of psychotropic drugs was not yet illegal. Addicted defendants argued that morphine had produced a temporary state of insanity at the time of the crime. However, medical-legal experts emphasized the regulatory influence of morphine over the addicted body, navigating between moralistic arguments about the primacy of free will and deterministic arguments about the role of physiology in establishing criminal responsibility. Withdrawal, rather that morphine, served as the primary condition for criminal irresponsibility in most cases of addiction. Therefore morphine became a fundamental element of the addicted individual, required for these defendants to be considered sane and morally responsible.

Cet article examine les débats médico-légaux sur la responsabilité pénale des morphinomanes de la fin du dix-neuvième siècle, une époque où l'usage des psychotropes n'était pas encore illégal. Les inculpés morphinomanes ont soutenu qu'au moment du crime, la morphine les avait rendus fous. Par contre, les experts ont cherché un terrain d'entente entre les arguments moralisateurs sur le libre arbitre et les arguments déterministes qui privilégiaient le rôle de la physiologie dans la responsabilité pénale. C'était le sevrage, la privation de la morphine plutôt que la drogue elle-même, qui était la condition principale de l'irresponsabilité criminelle du morphinomane. Par conséquent, la morphine est devenue un élément fondamental de l'individu morphinomane, et sans morphine l'individu n'était ni sain d'esprit, ni moralement responsable.
Failure to identify modifiers of NEBULIN related nemaline myopathy in two pre-clinical models of the disease
Authors: Qiu Boyang , Ruston Julie , Granzier Henk , Justice Monica J. , Dowling James J.
Published: September 2019

Nemaline myopathy is a rare neuromuscular disorder that affects 1 in 50,000 live births, with prevalence as high as 1 in 20,000 in certain populations. 13 genes have been linked to nemaline myopathy, all of which are associated with the thin filament of the muscle sarcomere. Of the 13 associated genes, mutations in NEBULIN accounts for up to 50% of all cases. Currently, the disease is incompletely understood and there are no available therapeutics for patients. To address this urgent need for effective treatments for patients affected by NM, we conducted a large scale chemical screen in a zebrafish model of NEB related nemaline myopathy and a ENU based genetic screen in a mouse model of NEB exon 55 deletion, the most common NEBULIN mutation in nemaline myopathy patients. Neither screen was able to identify a candidate for therapy development, highlighting the need to transition from conventional chemical therapeutics to gene-based therapies for the treatment of nemaline myopathy.
As parcerias público-privadas e a infraestrutura no Brasil
Authors: Nakamura Andre Luiz dos Santos
Published: September 2019

The public-private partnerships and the infrastructure in Brazil As parcerias público-privadas foram apresentadas como a solução para a falta de investimento público em infraestrutura no Brasil. Entretanto, trata-se de um modelo de contratação complexo que merece todo o planejamento necessário para que se mostre adequado ao interesse público. A opção pelo modelo de parcerias público-privadas nem sempre é a opção mais barata, se comparada ao investimento público. Somente em casos de comprovada maior eficiência do agente privado deverá o Estado optar pelo modelo contratual de parcerias público-privadas, sob pena de grandes prejuízos aos cofres públicos e da consequente responsabilização de agentes estatais. Public-private partnerships were presented as the solution to the lack of fund for investment in infrastructure in Brazil. However, it is a complex contracting model that deserves all the necessary planning to be adequate to the public interest. The option of public-private partnerships is not always a cheaper option compared to public investment. Only in cases of proven greater efficiency of the private agent should the State opt for the contractual model of public-private partnerships, under penalty of great losses to the public coffers and the consequent accountability of state agents.
Case Report: Kikuchi-Fujimoto Disease: A case of supraclavicular lymphadenopathy
Authors: Sarfraz Shiza , Rafique Hamza , Ali Hassam , Hassan Syed Zawahir
Published: September 2019

Kikuchi-Fujimoto Disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare cause of cervical lymphadenopathy. Patients usually present with localized lymphadenopathy, fever and fatigue. Because of the poorly understood etiology, it can be mistaken for an infectious disease or even malignance. Here we discuss a case of KFD that initially presented with left sided cervical lymphadenopathy that later progressed to left supraclavicular lymph nodes. Due to its characteristic overlap with other disorders like tuberculous lymphadenitis and lymphoma, KFD remains an arduous diagnosis for physicians. Therefore, one should be made aware of symptoms that can lead to misdiagnosis in patients.
Could EAISI-trained providers provide better quality of IUD services? Results of a secondary data analysis of complications as a proxy indicator
Authors: Gehani Manish , Pal Manoj , Arya Anupama , Singh Shobhana , S. Kaushik , O’Connell Kathryn A. , Cagatay Levent , Sengupta Sumon , Singal Sunita
Published: September 2019

Background: For accelerating its progress towards FP2020 goals, the Government of India has focused on improving the quality of intrauterine device (IUD) services. EngenderHealth has supported the Governments of Rajasthan and Gujarat since 2014 through its Expanding Access to IUD Services in India (EAISI) project by building the capacity of service providers, monitoring their compliance with standard practices, and strengthening health systems. This study sought to assess whether EAISI trained providers provide a better quality of IUD services as compared to non-EAISI trained providers, as indicated by a reduction in confirmed IUD complications?

Methods: This study was an analytical cross-sectional study of secondary data collected from the follow-up registers of 176 intervention facilities (138 in Rajasthan and 38 in Gujarat) during Phase I of EAISI project. The analysis included clients who returned between April 2018 and March 2019 to the same facility for a follow-up visit. Multivariate logistic regression was performed to determine factors associated with IUD complications.

Results: A total of 56,733 IUD insertions were conducted, and 10,747 (18.9%) client follow-ups were documented. Of these, 49.4% (N=5,305) clients received IUDs from EAISI-trained providers, while 50.6% (N=5,442) received IUDs from non-EAISI trained providers. A total of 4.0% (N=432) of clients experienced complications (Expulsion: 1.3%, Missing Strings: 1.7%, Infection: 1.1%). Clients who received IUDs from non-EAISI-trained providers were 55.5% more likely [95% CI (26.2%, 91.5%), p<0.0005] to have complications compared to clients who received insertions from EAISI-trained providers. Other significant factors include the type of IUD, timing of the follow-up visit and timing of the insertion.

Conclusion: The findings demonstrate that intensive, hands-on training of providers to improve clinical skills for IUD insertions can have a positive impact on the reduction of post-insertion complications.
Metabolic tracing reveals novel adaptations to skeletal muscle cell energy production pathways in response to NAD+ depletion
Authors: Oakey Lucy A. , Fletcher Rachel S. , Elhassan Yasir S. , Cartwright David M. , Doig Craig L. , Garten Antje , Thakker Alpesh , Maddocks Oliver D. K. , Zhang Tong , Tennant Daniel A. , Ludwig Christian , Lavery Gareth G.
Published: September 2019

Background: Skeletal muscle is central to whole body metabolic homeostasis, with age and disease impairing its ability to function appropriately to maintain health. Inadequate NAD+ availability is proposed to contribute to pathophysiology by impairing metabolic energy pathway use. Despite the importance of NAD+ as a vital redox cofactor in energy production pathways being well-established, the wider impact of disrupted NAD+ homeostasis on these pathways is unknown.

Methods: We utilised skeletal muscle myotube models to induce NAD+ depletion, repletion and excess and conducted metabolic tracing to provide comprehensive and detailed analysis of the consequences of altered NAD+ metabolism on central carbon metabolic pathways. We used stable isotope tracers, [1,2-13C] D-glucose and [U-13C] glutamine, and conducted combined 2D-1H,13C-heteronuclear single quantum coherence (HSQC) NMR spectroscopy and GC-MS analysis.

Results: NAD+ excess driven by nicotinamide riboside (NR) supplementation within skeletal muscle cells resulted in enhanced nicotinamide clearance, but had no effect on energy homeostasis or central carbon metabolism. Nicotinamide phosphoribosyltransferase (NAMPT) inhibition induced NAD+ depletion and resulted in equilibration of metabolites upstream of glyceraldehyde phosphate dehydrogenase (GAPDH). Aspartate production through glycolysis and TCA cycle activity was increased in response to low NAD+, which was rapidly reversed with repletion of the NAD+ pool using NR. NAD+ depletion reversibly inhibits cytosolic GAPDH activity, but retains mitochondrial oxidative metabolism, suggesting differential effects of this treatment on sub-cellular pyridine pools. When supplemented, NR efficiently reversed these metabolic consequences. However, the functional relevance of increased aspartate levels after NAD+ depletion remains unclear, and requires further investigation.

Conclusions: These data highlight the need to consider carbon metabolism and clearance pathways when investigating NAD+ precursor usage in models of skeletal muscle physiology.
B.2. A broad perspective on Estonian haiku as compared to its Japanese origins
Authors: Lindström Kati
Published: September 2019

The article aims to give a broad overview of the main formal characteristics of Estonian haiku and to compare it to its Japanese origin. The analysis is based on texts published in the literary magazine "Looming" from 1963-1998, and focuses on two main issues: the openness of the form (in Eco's sense) and the use of tropes. It also touches upon the different mechanisms for meaning generation in Estonian haiku. The use of tropes is analysed in the light of Yuri Lotman's notions of "rhetorical – anti-rhetorical culture" and "meta-trope". The author concludes that while Japanese haiku is an open text and the meanings are created between different texts rather than inside the text, Estonian authors tend to prescribe the possible associations of their text. Thus it can be said that a notion "haiku" refers to considerably different kinds of texts in Japanese and Estonian literature.
A.1. Heard and unheard strophes in the parodos of Aeschylus' Seven against Thebes
Authors: Steinrück Martin
Published: September 2019

[No abstract]
A.2. Democratisation of Greek society during the Archaic Era?
Authors: Kõiv Mait
Published: September 2019

The purpose of this paper is to ask critical questions about the widespread conception of the universal democratisation of the Greek society during the archaic and classical periods, leading from the Dark Age monarchies via archaic aristocracies to the establishment of the classical Greek democracy. The concept is based on the opinion of Aristotle, and on the combination of the evidence from the Homeric epics, the poems of Hesiod, archaic poetry and what is known about the late archaic and classical Greek city states, mostly on the example of Athens. Crucial for it are the assumptions that Homeric epics predate the Hesiodic poems and the lyric poetry, and that they give a reliable depiction of the poet's contemporary society, which allows to consider the 'Homeric kingship' as a normal social phenomenon of the Dark Age and to view everything known from the other sources as a result of further development. If we question these assumptions about Homeric epics, neither of which can be considered as certain, the whole conception will be seriously weakened. The other evidence we have - the half-legendary stories about the archaic era and the information we possess about the archaic legislation - does not depict any clear trend in the social development. It is therefore asked in this paper, if it would not be more reasonable to view the Dark Age and archaic communities as preserving a social balance between the nobility and the commoners by giving the initiative to the elite, but still preserving the participation of the fighting commoners in the governmental affairs. In such case there would be no reason to assume a general development from monarchies to aristocracies and from aristocracies to the more democratic forms of government during this period.
A.4. "Besser, dem gemeinen Volk anzugehören": zur Rolle des Chors in der senecanischen Tragödie
Authors: Gärtner Thomas
Published: September 2019

Eine systematische Untersuchung des Verhältnisses, in welchem die Chöre der echt senecanischen Tragödien zur jeweiligen dramatischen Handlung stehen, läßt zwei grundverschiedene Typen der Chorgestaltung erkennen: einerseits den unbeteiligt aus einer Position programmatisch gepriesenener Mittelmäßigkeit heraus das Unglück der hochgestellten Helden beobachtenden und analysierenden Chor, andererseits die konträre Spielform eines selbst am Leiden der Großen beteiligten und in der Bewältigung dieses Leidens absorbierten Chors. Beide Spielformen laufen Gefahr, verkannt zu werden in der modernen Forschung, die noch immer das philosophisch didaktische Element in Senecas Schrifttum auch in den Tragödien in den Mittelpunkt rückt. Die analytische Ausprägung, die immer wieder auf das Axiom rekurriert, alles Hochstehende sei gefährdet, wird mißverstanden in dem Sinne, daß Seneca durch die Äußerungen des Chors zeigen wolle, Macht und Größe führe automatisch zu Hybris und Korruption; die leidende Variante wird ebenfalls fehlgedeutet, indem das, was in Wirklichkeit philosophisch sublimierte Leidensbekundung des Chors ist, als philosophisches Theorem aufgefaßt wird, welches der "Dichterphilosoph" dem Chor zur Belehrung des Lesers in den Mund lege.
A.3. Die Bedeutung der Buchgliederung für die kompositionelle Gestaltung der Metamorphosen Ovids
Authors: Gärtner Thomas
Published: September 2019

Die Makrostruktur der ovidischen Metamorphosen bildet ein bislang ungelöstes Problem der Forschung. Ältere Gliederungsansätze abstrahieren völlig von der vom Autor vorgegebenen Buchstruktur und nehmen nach genealogischen Kriterien eine der überlieferten Buchgliederung gänzlich fremde Einteilung vor. Dagegen orientieren sich neuere Forscher wieder mehr an der vorgegebenen 15 Bücher Form und suchen vor allem die Buchpentade mit weitreichenden Folgerungen als strukturelles Prinzip zu erweisen. Entgegen diesen Ansätzen wird in der vorliegenden Arbeit versucht, auf die Annahme einer makrostrukturellen Epochengliederung zu verzichten und stattdessen die einzelnen Bücher als autonome Dispositionseinheiten zu verstehen, die ihren Reiz zumeist aus einer Dichotomie von zwei konträren Großteilen erhaben epischen bzw. erotisch elegischen Inhalts beziehen. Die Spannung zwischen solchen konträren Gestaltungsweisen einzelner Großteile bestimmt das Innere der einzelnen Bücher als Lektüreeinheiten wie auch die Grenzen zwischen den einzelnen Büchern. The macrostructure of Ovid's Metamorphoses is a hitherto unsolved problem. Earlier studies entirely ignore the structure of books given by the author and impose a disposition totally alien to the transmitted grouping of books. On the other hand, more recent approaches emphasize the division of the poem into 15 books and try especially to demonstrate that five book groups are the main structural principle in order to draw from this far reaching conclusions. Deviating from these approaches, the present article intends to dismiss the thesis of a macrostructural order of epochs and rather to understand the single books as autonomous structural units which owe their attractiveness to the tension arising between two main parts of either epic or elegiac content. This tension characterizes the whole of the single books as reading units and also the transitions between single books.
B.1. Die Alte Geschichte in Wien und die aktuelle österreichische Forschung zum antiken Barbaricum
Authors: Tomaschitz Kurt , Lisový Igor
Published: September 2019

The paper deals with the question of research of Classical Antiquity in Austria, first of all at the University of Vienna, and also problems of "barbaricum" in the contemporary Austrian historiography. The emphasis is put on the role of G. Dobesch, Professor of the University of Vienna.
A.1. Phrynichos beim Gewährsmann und beim Abschreiber Ammians
Authors: Ryan Francis X.
Published: September 2019

The article examines and finds wanting a recent thesis according to which a source used by Ammianus Marcellinus knew that Phrynichos produced his play on the sack of Miletos only after Athens had been sacked; then it proceeds to ask whether the chronological information vainly sought in the source of Ammianus has been preserved from another source by a copyist of Ammianus.
A.4. Pompey's politics and the presentation of his theatre-temple complex, 61-52 BCE
Authors: Temelini Mark A.
Published: September 2019

After celebrating his third triumph Pompey the Great decided to build a splendid theatre-temple complex during the political and social anxieties of the 50s BCE. This monument was an architectural undertaking hitherto never attempted at Rome. The building was designed with Rome's first permanent stone theatre, a temple of Venus Victrix and a quadriporticus. He also added a senate building in an attempt to soften senatorial antagonism. The importance of religion in the political life of Pompey demonstrates how the structure was a victory monument honouring his military achievements and represented his desire for popularity and everlasting fame. The purpose of this study is to examine the political and religious circumstances and considerations influencing Pompey's decision to present this structure to the Roman people.
A.1. Die stromnai des Polykrates von Samos
Authors: Ryan Francis X.
Published: September 2019

Athenaios retails a story, little heeded, but variously understood when not misunderstood, according to which Polykrates of Samos was a purveyor of stromnai while still a private citizen. This paper offers two new explanations of the word stromnai, gives some reasons for attaching credence to the report, and surmises that the original version of the story preserved by Athenaios made Polykrates responsible locally for innovations also seen elsewhere.
A.4. Ilia und Anio bei Ovid, Amores 3.6: eine amphibolische Vermählung
Authors: Zgoll Christian
Published: September 2019

In Amores 3.6 greift Ovid den römischen Gründungsmythos auf, die Vermählung der von Mars unfreiwillig geschwängerten und später verstoßenen Vestalin Ilia mit dem Flußgott Anio. Eine Rekonstruktion von Ovids "Arbeit am Mythos" zeigt, wie der Dichter durch erzählerische Abwandlung, durch Psychologisierung, Erotisierung und Ironisierung dieser "Vermählung" durchaus amphibolische Züge verleiht. Der Blick auf die antike Bildersprache metapoetischer Reflexion und auf entsprechende Intertexte eröffnet ein tieferes Verständnis für den merkwürdigen Umstand, daß Ovid ein so breit ausgeführtes und ernstes mythisches exemplum zum Kernstück einer Liebeselegie macht, indem er eine weitere, hinter der narrativen Oberfläche liegende Aussageintention erkennen läßt: Die Flüsse im "Flüssekatalog" verweisen durchweg auf große epische Stoffe und Werke, der Anio selbst auf die Annalen des Ennius; Ilia aber trägt Züge der personifizierten Elegie. Die Vermählung von Ilia und Anio ist daher auch insofern "amphibolisch", als sie nicht nur auf der Erzählebene die Verbindung zweier mythischer Personen etwas schillernd darstellt, sondern sich zugleich als poetologische Chiffre für das Zusammenfließen zweier verschiedener poetischer Stile, des elegischen und des epischen Dichtens, erweist. Der namenlose, von mehreren Zuflüssen gespeiste "Sturzbach" der Rahmenhandlung aber entpuppt sich als vorausgreifendes Bild für die neuartige Vermischung verschiedenster Gattungen in Ovids Metamorphosen.
A.2. The ostrakon Revaliense: a revised text
Authors: Worp Klaas A.
Published: September 2019

This paper contains a new edition of the ostrakon Revaliense, which was first published by Konstantin Vilhelmson in 1926 and subsequently in SB IV.7274.
Population structure of Gammarus izmirensis (Amphipoda) inhabiting Yiğitler Brook (Nif Stream, İzmir)
Authors: Özbek Murat , Ulutürk Efe
Published: September 2019

Yiğitler Brook, one of the branches of Nif Stream, has a regular flow regime throughout the year. The brook is one of the important aquatic habitats in terms of biological diversity by having relatively unpolluted water. The main objective of the present study is to get information about the population structure of Gammarus izmirensis Özbek, 2007 whose type locality is Yiğitler Brook. There is no information about the species in literature except its original description paper. Gammarus specimens were sampled in monthly intervals between October 2015 and November 2016. Samplings were performed at one locality. During the study, a total of 1938 G. izmirensis specimens were investigated. Of them; 850 were females, 586 were males and 502 were juveniles. The maximum body length was 14.5 mm in males and 14.0 mm in females. The number of juveniles is higher in March and August. The species has a multivoltine life cycle with two generations (spring and summer) throughout the year.
Analysis of profitability of shrimp value chain in Delta State, Nigeria
Authors: Achoja Felix Odemero
Published: September 2019

This study investigated the profitability of shrimp value chain. Primary data were obtained using well structured questionnaire from randomly selected 240 shrimp operators (harvesters, processors and marketers). Descriptive and inferential statistical tools were used to analyze collected data. The result revealed that the mean profit realized was N70,092 N36,255 and N26,097.30 by harvesters, processors and marketers respectively. Value added at was N500 and N1000 per basket by processors and marketers respectively. Test of hypothesis indicates that quantity sold (0.218), price (0.033), bargaining power (0.002) and union dues (0.099), showed positive and significant relationship with shrimp value chain profitability. While market levy and store rent showed negative relationship with profitability in shrimp value chain. It was recommended that there should be moderate store rent. Marketers should increase their bargaining power at the point of procurement and union dues should be reduced so that shrimp value chain profitability can be enhanced.
Evaluation of the lagoon fishery on occupational health and safety
Authors: Köken Seda , Ceyhan Tevfik , Tosunoğlu Zafer
Published: September 2019

Lagoons are important parts of the fishery sector as the areas where the entry and exit of waters are used under controlled conditions. At the present time, the protective and preventive measures have been started to be applied against the hazards and risks in the fields of occupational health and safety. Lagoon fisheries are among the fishery activities (including purse seine fishing, scuba fishing) in marine and coastal waters that are coded as 03.11.01 in the NACE code in occupational health and safety in the workplace hazard classes declaration and are classified as dangerous. In this study, it is aimed to examine the fishery in terms of occupational health and safety. For this reason, randomly 3 lagoons were determined among the 6 lagoons that continue their active activities on the coasts of the Aegean Sea between October 2017 and April 2018, 92 surveys were interviewed face to face. The 97% of the fishermen surveyed were male and 3% female employees. 90% of D1, 74% of D2 and all D3 employees are primary school graduates. The rate of health examinations of employees before work is 29% in D1, 97% in D2 and 17% in D3. The 25% of the employees in D1, 29% in D2 and 26% in D3 have knowledge about occupational accidents and occupational diseases. In terms of occupational accidents in lagoon, cutting, crushing, fracture-dislocation, suffocation and head injuries were frequently determined as 50%, 19%, 9% and 6%, respectively. The pier platforms where occupational accidents are most prevalent in lagoon barrier trap are not safe by employees, 44% in D1, 11% in D2 and 35% in D3.
The effects of zinc pyrithione on total hemocyte counts of mussel (Mytilus galloprovincialis Lamarck, 1819)
Authors: Katalay Selma , Ayhan Melike Merve , Günal Aysel Çağlan
Published: September 2019

In this study, the effect of Mediterranean mussels (Mytilus galloprovincialis) which accumulate contaminants in the marine environment exposed to 20 and 40 µg/Lsublethal zinc pyrithion (ZnPT) at high levels for 48 and 96 hours on total hemocyte counts was determined. Total hemocyte count is a good bioindicator to assess the effects of environmental pollutants . It was determined that total hemocyte counts were increased in mussels exposed to zinc pyrithione when compared to the control group (p<0.05). It has been found that this substance, which has different usage areas and contaminate aquatic environment, negatively effect the mussels even in low concentrations.
Aeromonas and Plesiomonas spp. in fishery products and their effects
Authors: Kılınç Berna
Published: September 2019

Aeromonas and Plesiomonas genus of bacteria have been frequently found in fishery products. The pathogen species of these genus can be caused infections and diseases in humans. For this reason the purpose of this review is to recognise the genus of Aeromonas and Plesiomonas, the sources of contamination, the incidence of these bacteria in waters, fishery products and stored fishery products were reviewed. In addition to this; the diseases and infections of Aeromonas and Plesiomonas spp. and the prevention methods for being controlled of these genus of bacteria in fishery products were examined.
Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review
Authors: Leary Jana C , Walsh Kathleen E , Morin Rebecca A , Schainker Elisabeth G , Leyenaar JoAnna K
Published: September 2019

BACKGROUND

Although the majority of children are hospitalized in nonchildren's hospitals, little is known about the quality and safety of pediatric care in community hospitals.

OBJECTIVE

The aim of this study was to conduct a scoping review and synthesize literature on the quality and safety of pediatric inpatient care in United States community hospitals.

METHODS

We performed a systematic literature search in October 2016 to identify pediatric studies that reported on safety, effectiveness, efficiency, timeliness, patient‐centeredness, or equity set in general, nonuniversity, or nonchildren's hospitals. We extracted data on study design, patient descriptors, and quality outcomes and assessed the risk of bias using modified Newcastle‐Ottawa Scales.

RESULTS

A total of 44 articles met the inclusion criteria. Study designs, patient populations, and quality outcome measures were heterogeneous; only three clinical domains, (1) perinatal regionalization, (2) telemedicine, and (3) imaging radiation, were explored in multiple studies with consistent directionality of results. A total of 30 studies were observational, and 22 studies compared community hospital quality outcomes with other hospital types. The remaining 14 studies reported testing of interventions; 12 showed improved quality of care postintervention. All studies reported an outcome addressing safety, effectiveness, or efficiency, whereas timeliness, patient‐centeredness, and equity were infrequently addressed. Risk of bias was moderate or high for 72% of studies.

CONCLUSIONS

Literature on the inpatient care of children in community hospitals is limited, making it difficult to evaluate healthcare quality. Measures of timeliness, patient‐centeredness, and equity are underrepresented. The field would benefit from more multicenter collaborations to facilitate the application of robust study designs and to enable a systematic assessment of individual interventions and community hospital quality outcomes.
Things We Do For No Reason™: Routine Blood Culture Acquisition for Children Hospitalized with Community‐Acquired Pneumonia
Authors: Johnson David P , Lee Vivian , Gourishankar Anand , Rajbhandari Prabi , Schefft Matthew , Genies Marquita
Published: September 2019

Inspired by the ABIM Foundation's Choosing Wisely® campaign, the “Things We Do for No Reason™” (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent “black and white” conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.
Catheter-Associated Urinary Tract Infections in Adults: Diagnosis, Treatment, and Prevention
Authors: Clarke Karen , Hall Casey L , Wiley Zanthia , Tejedor Sheri Chernetsky , Kim James S , Reif Lisa , Witt Lucy , Jacob Jesse T
Published: September 2019

Urinary tract infections (UTIs) are among the most common healthcare-associated infections, and 70%-80% are catheter-associated urinary tract infections (CAUTIs). About 25% of hospitalized patients have an indwelling urinary catheter placed during their hospital stay, and therefore, are at risk for CAUTIs which have been associated with worse patient outcomes. Additionally, hospitals face a significant financial impact since the Centers for Medicare and Medicaid Services incentive program penalizes hospitals with higher than expected CAUTIs. Hospitalists care for many patients with indwelling urinary catheters and should be aware of and engage in processes that reduce the rate of CAUTIs. This article will discuss the diagnosis, treatment, and prevention of CAUTIs in adults.
Impact of the Hospital‐Acquired Conditions Initiative on Falls and Physical Restraints: A Longitudinal Study
Authors: Shorr Ronald I. , Staggs Vincent S. , Waters Teresa M. , Daniels Michael J. , Liu Minzhao , Dunton Nancy , Mion Lorraine C.
Published: September 2019

BACKGROUND

The Centers for Medicare & Medicaid Services (CMS) implemented the Hospital‐Acquired Conditions (HACs) Initiative in October 2008; the CMS no longer reimbursed hospitals for fall injury. The effects of this payment change on fall and fall injury rates are not well described, nor its effect on physical restraint use.

OBJECTIVE

The aim of this study was to examine the effects of the 2008 HACs Initiative on the rates of falls, injurious falls, and physical restraint use.

DESIGN/SETTING

This was a nine‐year retrospective cohort study (July 2006‐December 2015) involving 2,862 adult medical, medical‐surgical, and surgical nursing units from 734 hospitals.

MEASUREMENTS

Annual rates of change in falls, injurious falls, and physical restraint use during the two years before the payment rule went into effect were compared with one‐, four‐, and seven‐year rates of annual change after implementation, adjusting for unit‐ and facility‐level covariates. Stratified analyses were conducted according to bed size and teaching status.

RESULTS

Compared with prior to the payment change, there was stable acceleration in the one‐, four‐, and seven‐year annual rates of decline in falls as follows: ‐2.1% (‐3.3%, ‐0.9%), ‐2.2% (‐3.2%, ‐1.1%), and ‐2.2% (‐3.4%, ‐1.0%) respectively. For injurious falls, there was an increasing acceleration in the annual declines, achieving statistical significance only at seven years post CMS change as follows: ‐3.2% (‐5.5%, ‐1.0%). Physical restraint use prevalence decreased from 1.6% to 0.6%. Changes in the rates of falls, injurious falls, and restraint use varied according to hospital bed size and teaching status.

CONCLUSIONS AND RELEVANCE

Since the HACs Initiative, there was at best a modest decline in the rates of falls and injurious falls observed primarily in larger, major teaching hospitals. An increase in restraint use was not observed. Falls remain a difficult patient safety problem for hospitals, and further research is required to develop cost‐effective, generalizable strategies for their prevention. Journal of Hospital Medicine 2019;14:e31‐e36. © 2019 Society of Hospital Medicine
Effect of Hospital Readmission Reduction Program on Hospital Readmissions and Mortality Rates
Authors: Samarghandi Arash , Qayyum Rehan
Published: September 2019

RATIONALE

Although the Hospital Readmission Reduction Program (HRRP) has reduced the 30‐day readmission rates for patients with chronic obstructive pulmonary disease (COPD) across hospitals, the effect of HRRP on hospital mortality remains unknown. Therefore, we examined the association between hospital readmissions and mortality rates for patients discharged with acute exacerbation of COPD (AECOPD).

METHOD

The all‐cause hospital‐specific 30‐day risk‐standardized mortality rate (RSMR) and the 30‐day risk‐standardized readmission rate (RSRR) for patients with COPD from 2010 to 2017 were obtained from the Hospital Compare website. Hospital service area (HSA) information was obtained from the Dartmouth Atlas of Healthcare. The longitudinal relationship between the mortality and readmission rates of a hospital was assessed using mixed linear models.

RESULTS

Of the 3,685 hospitals analyzed, the unadjusted mean RSMRs increased from 7.8% to 8.4% during the study period at a yearly rate of 0.13 (95% CI = 0.12 to 0.14; P < .001), whereas the mean RSRRs declined from 20.7% to 19.6%. When examined according to the baseline readmission rate and interaction with time, each 1% higher‐than‐baseline readmission rate was associated with a smaller increase in mortality rate by 0.015% (95% CI = −0.02 to −0.01; P < .0001). Inclusion of change in readmissions in the model showed that each 1% decrease in readmission rate was associated with 0.04% (95% CI = −0.01 to −0.06; P = .008) increase in mortality.

CONCLUSION

This hospital‐level analysis of AECOPD showed that although the 30‐day all‐cause readmission rates declined, the mortality rates increased. Hospitals with lower readmission rates had higher mortality rates over time.Journal of Hospital Medicine 2019;14:e25‐e30. © 2019 Society of Hospital Medicine
Hospital Medicine Has a Specialty Code. Is the Memo Still in the Mail?
Authors: Flansbaum Bradley , Leykum Luci , Lapps Joshua
Published: September 2019

The Centers for Medicare and Medicaid Services awarded Hospital Medicine a Medicare specialty code, “C6”, in 2016. We examined the early uptake of C6 code using the 2017 Medicare Part B utilization data. We also compared the actual C6 specialty code usage against estimated rates of overall hospitalist billing using threshold‐based hospitalist rates of Evaluation and Management codes to assess the integration of the newly introduced code. Billing activity associated with the C6 code was approximately one‐tenth of expected rates.
Open Problem—Regarding Static Priority Scheduling for Many-Server Queues with Reneging
Authors: Ward Amy R.
Published: September 2019

We study the many-server queue shown in Figure 1(a). Customers from class j ∈ {1, 2} arrive according to renewal processes having rate λj > 0 and request processing. There are N ∈ {1, 2,…} servers, each working at rate one. All servers are fully flexible; that is, every server can serve customers from both classes. Each customer has a randomly distributed patience time that may depend on the class and reneges (abandons the system without receiving service) if service does not begin before the patience time expires. The system incurs the penalty p1 > 0 when a class 1 customer reneges and the penalty p2 > 0 when a class 2 customer reneges. Upon arrival, each class j customer independently samples from the distribution determined by cumulative distribution function (cdf) [Formula: see text] having mean 1/θj < ∞ to find its patience time and from the distribution determined by cdf [Formula: see text] having mean 1/μj < ∞ to determine its service time (that is, the required processing time).
Educação Superior Pública e o Future-se: o projeto do capital em tempos de ascensão da extrema direita
Authors: Gonçalves Filho Antonio , Farage Eblin
Published: September 2019

Este artigo traz algumas reflexões sobre a educação superior no Brasil a partir das determinações dos organismos internacionais, “sujeitos políticos coletivos” do capital. Aponta os processos advindos da crise internacional do capital e da crise do chamado socialismo real, que se expressam em profunda reestruturação do papel dos Estados nacionais, derivando em contrarreformas, nas diversas áreas sociais, como forma de minimizar o papel do Estado e garantir a apropriação privada do fundo público. Demonstra como a educação passa a ser considerada uma mercadoria importante na tentativa de reestruturação do capitalismo e aponta os principais eixos estruturantes do projeto de contrarreforma da educação superior do governo de extrema direita no Brasil, o FUTURE-SE. Palavras chaves: Educação Superior – Projeto do Capital – Contrarreforma da Educação – FUTURE-SE
O ensino a distância e as tendências da apropriação dos fundamentos do Serviço Social
Authors: Da Silva Antonio Israel Carlos
Published: September 2019

O artigo problematiza a relação entre a ampliação de novos agentes profissionais pela via do ensino a distância (EAD) e as tendenciais repercussões na apropriação dos fundamentos teórico-metodológicos e ético-políticos do Serviço Social brasileiro. Realizou-se revisão de literatura e pesquisa documental, no sentido de identificar as mediações pedagógicas que envolvem a apreensão do conhecimento na formação profissional à distância. Identificou-se que, tendencialmente, a formação à distância se particulariza por uma reconfiguração teórico-cultural e ideológica, se compararmos ao projeto hegemônico de formação do Serviço Social brasileiro. Palavras-Chave: ensino a distância; Serviço Social; capitalismo contemporâneo
Orthodontic adhesives for fixed appliances: A review of available systems
Authors: Alkadhimi Aslam , Motamedi Farnaz
Published: September 2019

Achieving high bond strength of orthodontic brackets to enamel, and hence a low failure rate, are the basic demands for orthodontic bracket-bonding systems. Given that continuous replacements of loose brackets are clinically inefficient, time-consuming, and costly, the search for an ‘ideal orthodontic adhesive’ has been a hot topic for many years. Since a substantive number of studies have been focusing on brackets, adhesive systems, and enamel surface conditioning methods in recent years, the authors feel that a review article of this kind can be helpful for the busy clinician to update his/her knowledge about the various adhesive systems available on the market, supported by relevant evidence.

CPD/Clinical Relevance: As there are no clinical guidelines currently in the literature for the selection of the ‘ideal orthodontic adhesive’ and the availability of a substantial number of materials, this review article might help clinicians in the selection process by presenting the available bonding materials, along with supporting evidence from the literature.
Complete dentures – assessment of the loose denture
Authors: Dziedzic Arek , Puryer James
Published: September 2019

Patients with complete dentures will often present to a clinician complaining that their dentures are loose. A careful history, clinical examination and denture examination is needed so that the cause of their loose dentures can be determined. Only once a suitable diagnosis has been reached can an appropriate treatment plan be developed. This paper aims to guide readers through this history and examination process to help them formulate a suitable diagnosis before embarking on any potential treatment options.

CPD/Clinical Relevance: The paper provides a guide as to how to assess an edentulous patient presenting with loose complete dentures.