bluuebunny/crossref_metadata_2025 huggingface dataset:
Multimodal Analgesia After Posterior Fossa Decompression With and Without Duraplasty for Children With Chiari Type I
Authors: Shao Belinda , Tariq Abdul A. , Goldstein Hannah E. , Alexiades Nikita G. , Mar Krista M. , Feldstein Neil A. , Anderson Richard C.E. , Giordano Mirna
Published: May 2020

BACKGROUND:

Multimodal analgesia (MMA) may reduce opioid use after surgery for Chiari malformation type I. An MMA protocol was implemented after both posterior fossa decompression without dural opening (PFD) and posterior fossa decompression with duraplasty (PFDD).

METHODS:

Scheduled nonsteroidal antiinflammatory drugs (ketorolac or ibuprofen) and diazepam were alternated with acetaminophen, and as-needed oxycodone or intravenous morphine. The primary outcome was total opioid requirement over postoperative days 0 to 2.

RESULTS:

From 2012 to 2017, 49 PFD and 29 PFDD procedures were performed, and 46 of 78 patients used the protocol. Patients with PFD required less opioids than patients with PFDD. Among patients with PFDD, patients with MMA protocol usage had a lower mean opioid requirement than patients with no MMA protocol usage (0.53 ± 0.49 mgEq/kg versus 1.4 ± 1.0 mgEq/kg, P = .0142). In multivariable analysis, MMA protocol usage status independently predicted a mean decrease in opioid requirement of 0.146 mg equivalents/kg (P = .0497) after adjustment for procedure and surgeon. Statistically significant differences were not demonstrated in antiemetic requirements, discharge opioid prescriptions, total direct cost, and length of stay.

CONCLUSIONS:

A protocol of scheduled nonsteroidal antiinflammatory drugs alternating with scheduled acetaminophen and diazepam was associated with opioid use reductions.
Predictors of Potentially Unnecessary Transfers to Pediatric Emergency Departments
Authors: Richard Kathleen R. , Glisson Kyle L. , Shah Nipam , Aban Immaculada , Pruitt Christopher M. , Samuy Nichole , Wu Chang L.
Published: May 2020

OBJECTIVES:

With soaring US health care costs, identifying areas for reducing cost is prudent. Our objective was to identify the burden of potentially unnecessary pediatric emergency department (ED) transfers and factors associated with these transfers.

METHODS:

We performed a retrospective analysis of Pediatric Hospital Information Systems data. We performed a secondary analysis of all patients ≤19 years transferred to 46 Pediatric Hospital Information Systems–participating hospital EDs (January 1, 2013, to December 31, 2014). The primary outcome was the proportion of potentially unnecessary transfers from any ED to a participating ED. Necessary ED-to-ED transfers were defined a priori as transfers with the disposition of death or admission >24 hours or for patients who received sedation, advanced imaging, operating room, or critical care charges.

RESULTS:

Of 1 819 804 encounters, 1 698 882 were included. A total of 1 490 213 (87.7%) encounters met our definition for potentially unnecessary transfer. In multivariate analysis, age 1 to 4 years (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.34–1.39), female sex (OR, 1.08; 95% CI, 1.07–1.09), African American race (OR, 1.51; 95% CI, 1.49–1.53), urban residence (OR, 1.75; 95% CI, 1.71–1.78), and weekend transfer (OR, 1.06; 95% CI, 1.05–1.07) were positively associated with potentially unnecessary transfer. Non-Hispanic ethnicity (OR, 0.756; 95% CI, 0.76–0.78), nonminor severity (OR, 0.23; 95% CI, 0.23–0.24), and commercial insurance (OR, 0.86; 95% CI, 0.84–0.87) were negatively associated.

CONCLUSIONS:

There are disparities among pediatric ED-to-ED transfers; further research is needed to investigate the cause. Additional research is needed to evaluate how this knowledge could mitigate potentially unnecessary transfers, decrease resource consumption, and limit the burden of these transfers on patients and families.
Pathogenesis and Management of Indirect Hyperbilirubinemia in Preterm Neonates Less Than 35 Weeks: Moving Toward a Standardized Approach
Authors: Pillai Anish , Pandita Aakash , Osiovich Horacio , Manhas Deepak
Published: May 2020

Premature infants have a higher incidence of indirect hyperbilirubinemia than term infants. Management of neonatal indirect hyperbilirubinemia in late preterm and term neonates has been well addressed by recognized, consensus-based guidelines. However, the extension of these guidelines to the preterm population has been an area of uncertainty because of limited evidence. This leads to variation in clinical practice and lack of recognition of the spectrum of bilirubin-induced neurologic dysfunction (BIND) in this population. Preterm infants are metabolically immature and at higher risk for BIND at lower bilirubin levels than their term counterparts. Early use of phototherapy to eliminate BIND and minimize the need for exchange transfusion is the goal of treatment in premature neonates. Although considered relatively safe, phototherapy does have side effects, and some NICUs tend to overuse phototherapy. In this review, we describe the epidemiology and pathophysiology of BIND in preterm neonates, and discuss our approach to standardized management of indirect hyperbilirubinemia in the vulnerable preterm population. The proposed treatment charts suggest early use of phototherapy in preterm neonates with the aim of reducing exposure to high irradiance levels, minimizing the need for exchange transfusions, and preventing BIND. The charts are pragmatic and have additional curves for stopping phototherapy and escalating its intensity. Having a standardized approach would support future research and quality improvement initiatives that examine dose and duration of phototherapy exposure with relation to outcomes.
Marijuana Legalization and Youth
Authors: Ladegard Kristie , Thurstone Christian , Rylander Melanie
Published: May 2020

Various states have legalized marijuana for medical purposes and/or decriminalized recreational marijuana use. These changes coincide with a decrease in perceived harmfulness of the drug and an increase in its use among youth. This change is of critical concern because of the potential harmful impact of marijuana exposure on adolescents. Marijuana use has been associated with several adverse mental health outcomes, including increased incidence of addiction and comorbid substance use, suicidality, and new-onset psychosis. Negative impacts on cognition and academic performance have also been observed. As the trend toward legalization continues, the pediatric community will be called on to navigate the subsequent challenges that arise with changing policies. Pediatricians are uniquely positioned to provide innovative care and educate youth and families on the ever-evolving issues pertaining to the impact of marijuana legalization on communities. In this article, we present and analyze the most up-to-date data on the effects of legalization on adolescent marijuana use, the effects of adolescent use on mental health and cognitive outcomes, and the current interventions being recommended for use in pediatric office settings.
Screening for Problematic Internet Use
Authors: D’Angelo Jonathan , Moreno Megan A.
Published: May 2020

Problematic Internet use (PIU) by adolescents is of growing concern among both parents and pediatricians. Early controversies may have contributed to challenges in defining and measuring PIU. A variety of screening tools have evolved, aligned with different constructs of PIU, although a validated screening tool does exist. Current data and American Academy of Pediatrics policy reflect evidence-driven screening for PIU for all youth.
Primary and Secondary Prevention of Youth Suicide
Authors: Horowitz Lisa , Tipton Mary V. , Pao Maryland
Published: May 2020

Youth suicide is a national and global public health crisis. Pediatricians can use primary and secondary prevention strategies to intervene with youth before or after the onset of suicidal behaviors. Universal suicide risk screening programs can be used to identify youth in medical settings who may otherwise pass through the health care setting with undetected suicide risk. Pediatricians are uniquely positioned to help foster resilience in their young patients and equip families of at-risk youth with safety plans and lethal means safety counseling. Pediatricians on the frontlines of this critical public health crisis require education and training in detecting suicide risk, managing those who screen positive, and connecting their patients to much needed mental health interventions and treatments. Evidence-based suicide risk screening and assessment tools, paired with interventions, are feasible and potentially life-saving in the medical setting.
Platelet Disorders
Authors: Haley Kristina M.
Published: May 2020

After vascular injury and exposure of subendothelial matrix proteins to the intravascular space, mediators of hemostasis are triggered and allow for clot formation and restoration of vascular integrity. Platelets are the mediators of primary hemostasis, creating a platelet plug and allowing for initial cessation of bleeding. Platelet disorders, qualitative and quantitative, may result in bleeding signs and symptoms, particularly mucocutaneous bleeding such as epistaxis, bruising, petechiae, and heavy menstrual bleeding. Increasing evidence suggests that platelets have functional capabilities beyond hemostasis, but this review focuses solely on platelet hemostatic properties. Herein, normal platelet function as well as the effects of abnormal function and thrombocytopenia are reviewed.
Metacognição no transtorno bipolar: uma revisão sistemática
Authors: Silva Rafael de Assis da , Tancini Marcelo Baggi , Cheniaux Elie , Mograbi Daniel C.
Published: May 2020

RESUMO Objetivo Realizar uma revisão sistemática investigando a metacognição no transtorno bipolar (TB). Os objetivos secundários incluem explorar os correlatos clínicos e sociodemográficos da metacognição no TB e como a metacognição varia de acordo com o estado afetivo, estabelecer uma comparação com outros transtornos mentais e investigar se as intervenções metacognitivas no TB são eficazes ou não. Métodos Realizou-se uma revisão sistemática da literatura científica sobre a metacognição em pacientes com TB. Foram buscados estudos clínicos originais sobre o tema nas bases de dados Medline, ISI , PsycINFO e SciELO. Os termos de busca empregados foram: “metacognition” OR “metacognitive” OR “metamemory” AND “bipolar” OR “mania” OR “manic” . Resultados Foram selecionados nove artigos. A metacognição parece estar mais prejudicada no TB do que em controles e menos prejudicada do que na esquizofrenia. Por sua vez, parece não haver diferença entre bipolares e deprimidos unipolares quanto à capacidade metacognitiva. Maior nível educacional e maior duração da doença parecem estar associados a uma melhor capacidade metacognitiva, enquanto a maior gravidade dos sintomas de TB está associada a uma pior metacognição. O treinamento metacognitivo em pacientes com TB é uma perspectiva clínica promissora. Conclusão Os estudos sobre metacognição no TB são escassos, mas a literatura existente indica possíveis fatores clínicos e sociodemográficos associados a pior metacognição no transtorno, sugerindo também que intervenções terapêuticas metacognitivas podem ser clinicamente relevantes para o manejo do TB.
Comparison of automated and manual protocols for magnetic resonance imaging assessment of liver iron concentration
Authors: Lopes Izabella de Campos Carvalho , Schütze Manuel , Bolina Marina Borges , Oliveira Sobrinho Tarcísio Ângelo de , Ramos Laura Filgueiras Mourão , Diniz Renata Lopes Furletti Caldeira , Fernandes Juliano de Lara , Siqueira Maria Helena Albernaz
Published: May 2020

Abstract Objective: To compare automated and manual magnetic resonance imaging protocols for estimating liver iron concentrations at 1.5 T. Materials and Methods: Magnetic resonance imaging examination of the liver was performed in 53 patients with clinically suspected hepatic iron overload and in 21 control subjects. Liver iron concentrations were then estimated by two examiners who were blinded to the groups. The examiners employed automated T2* and T1 mapping, as well as manual T2* and signal-intensity-ratio method. We analyzed accuracy by using ROC curves. Interobserver and intraobserver agreement were analyzed by calculating two-way intraclass correlation coefficients. Results: The area under the ROC curve (to discriminate between patients and controls) was 0.912 for automated T2* mapping, 0.934 for the signal-intensity-ratio method, 0.908 for manual T2*, and 0.80 for T1 mapping, the last method differing significantly from the other three. The level of interobserver and intraobserver agreement was good (intraclass correlation coefficient, 0.938-0.998; p < 0.05). Correlations involving T1 mapping, although still significant, were lower. Conclusion: At 1.5 T, T2* mapping is a rapid tool that shows promise for the diagnosis of liver iron overload, whereas T1 mapping shows less accuracy. The performance of T1 mapping is poorer than is that of T2* methods.
Spinopelvic sagittal balance: what does the radiologist need to know?
Authors: Savarese Leonor Garbin , Menezes-Reis Rafael , Bonugli Gustavo Perazzoli , Herrero Carlos Fernando Pereira da Silva , Defino Helton Luiz Aparecido , Nogueira-Barbosa Marcello Henrique
Published: May 2020

Sagittal balance describes the optimal alignment of the spine in the sagittal plane, resulting from the interaction between the spine and lower limbs, via the pelvis. Understanding sagittal balance has gained importance, especially in the last decade, because sagittal imbalance correlates directly with disability and pain. Diseases that alter that balance cause sagittal malalignment and may trigger compensatory mechanisms. Certain radiographic parameters have been shown to be clinically relevant and to correlate with clinical scores in the evaluation of spinopelvic alignment. This article aims to provide a comprehensive review of the literature on the spinopelvic parameters that are most relevant in clinical practice, as well as to describe compensatory mechanisms of the pelvis and lower limbs.
Proportional vascularization along the fallopian tubes and ovarian fimbria: assessment by confocal microtomography
Authors: Castro Pedro Teixeira , Aranda Osvaldo Luiz , Marchiori Edson , Araújo Luiz Felipe Bittencourt de , Alves Haimon Diniz Lopes , Lopes Ricardo Tadeu , Werner Heron , Araujo Júnior Edward
Published: May 2020

Abstract Objective: To evaluate and reconstruct three-dimensional images of vascularization along the fallopian tube (FT), as well as to determine its relationship with the ovary and ovarian fimbria, and to quantify the blood vessels along the FT according to its anatomical segments, using confocal microtomography (micro-CT). Materials and Methods: Nine specimens (six FTs and three FTs with ovaries) were fixed in a solution of 10% formalin for > 24 h at room temperature. Iodine staining was performed by soaking the specimens in 10% Lugol’s solution for 24 h. All specimens were evaluated using micro-CT. A morphometric analysis was performed on the reconstructed images to quantify the vascular distribution along the FT. Results: In the FTs evaluated, the density of blood vessels was significantly greater in the fimbrial segments than in the isthmic segments (p < 0.05). The ovarian fimbria was clearly identified, demonstrating the important relationship between these vessels and the FT fimbriae. Conclusion: We believe that the vascularization in the fimbriae is greater than and disproportional that in the other segments of FT, and that the ovarian fimbria plays an important role in the development of that difference.
Early trends and predictors of renal function following computed tomography-guided percutaneous cryoablation of a renal mass in patients with and without prior renal impairment
Authors: Staziaki Pedro V. , Vadvala Harshna V. , Furtado Vanessa Fiorini , Daye Dania , Arellano Ronald S. , Uppot Raul N.
Published: May 2020

Abstract Objective: To assess trends and predictors of the glomerular filtration rate (GFR) after renal mass cryoablation in patients with and without history of renal impairment. Materials and Methods: This was a retrospective study of 39 patients who underwent computed tomography-guided percutaneous cryoablation of a renal mass, divided into two groups: those with prior renal impairment (PRI+); and those without prior renal impairment (PRI−). The GFR trend and the chronic kidney disease stage were evaluated at baseline, as well as at 1, 6, and 12 months after cryoablation. Predictors of GFR at 1 and 6 months were modeled with linear regression. Results: In both groups, the mean GFR at 1 month and 6 months was significantly lower than at baseline (p < 0.001 and p = 0.01, respectively). Although the GFR was lower across all time points in the PRI+ group (−26.1; p < 0.001), the overall trend was not statistically different from that observed in the PRI− group (p = 0.89). Univariate analysis showed that the decline in GFR at 1 and 6 months correlated with the baseline GFR (0.77 and 0.63; p < 0.001 and p = 0.03, respectively) and with the size of the ablation zone (−7.6 and −12.84, respectively; p = 0.03 for both). However, in the multivariate model, baseline GFR was predictive only of GFR at 1 month (p < 0.001). Conclusion: The trend in GFR decline after cryoablation is similar for patients with and without a history of renal impairment. Baseline GFR predicts the mean GFR in the early post-cryoablation period.
Impact of artificial intelligence on the choice of radiology as a specialty by medical students from the city of São Paulo
Authors: Brandes Gabriela Irene Garcia , D’Ippolito Giuseppe , Azzolini Anderson Gusatti , Meirelles Gustavo
Published: May 2020

Abstract Objective: To evaluate the impact of artificial intelligence (AI) on undergraduate medical students’ choice of radiology as a specialty. Materials and Methods: In February 2019, an anonymous online survey was sent to medical students. The research contemplated questions on how much students think they know about AI technologies, how much AI discourages them from choosing radiology as a specialty, and whether they believe there is a threat to the radiology job market. Results: A total of 101 students, most of them doing their internship, answered the questionnaire. More than half of them (52.5%) said they believe AI poses a threat to the radiology job market, but 64.3% claimed not to have proper knowledge about these new technologies, and 31.7% said they would like more information on the technologies’ operation and progress before making a decision on whether or not to practice radiology as a specialty. Conclusion: A significant proportion of the surveyed students perceive AI as a threat to the radiological practice, which impacts their career choice. However, the majority claims to have insufficient knowledge of it and believes more information is needed for decision-making.
Nobres e Anjos, 45 anos depois: Gilberto Velho e a antropologia de urbanas sensibilidades
Authors: Bispo Raphael , Zampiroli Oswaldo
Published: May 2020

RESUMO Nobres e Anjos: um estudo de tóxicos e hierarquia foi a tese de doutoramento de Gilberto Velho (1945-2012), defendida em 1975 na Universidade de São Paulo, mas publicada apenas no ano de 1998. Este ensaio procura estimular um duplo movimento ao retomar uma obra que há quarenta e cinco anos serve de inspiração a inúmeros antropólogos: num primeiro plano, relembrar e situar as vivências de juventudes que encontraram suas formas de estar na cidade associadas às satisfações subjetivas geradas pelo uso de drogas nas franjas de um regime autoritário. Por outro lado, refletir sobre a maneira pela qual esse campo plural da antropologia urbana tem se constituído na prática e teoricamente entre nós, considerando a obra de Velho como referência central para a afirmação de um modo específico e original de estudo das cidades nas teorias sociais brasileiras - o que nomearemos aqui de antropologia de urbanas sensibilidades.
Obrigações e a construção de vínculos no candomblé
Authors: Rabelo Miriam C. M.
Published: May 2020

RESUMO Obrigações no candomblé são ritos realizados após a feitura (iniciação) para fortalecer os laços entre a filha de santo e seu orixá; a sequência desses ritos descreve uma trajetória de crescimento e maturação no terreiro. Em um sentido mais amplo, o conceito de obrigação fala de um modo próprio de criar e manter vínculos cujas dimensões temporais, éticas e políticas exploro ao longo deste texto. As muitas e diferentes obrigações construídas e por vezes rompidas no candomblé revelam um universo pluralista, próximo do sentido que William James atribui ao termo, embora um tipo muito particular de pluralismo, cujas características procuro descrever.
International trade in GMOs: have markets paid premiums on Brazilian soybeans?
Authors: Oliveira Paulo Ricardo Silva , Silveira José Maria Ferreira Jardim da , Magalhães Marcelo Marques de , Souza Roney Fraga
Published: May 2020

Abstract: The introduction of GMO technology into global market chains and the rejection by consumers in some markets have led to the reorganization of soybean trades. Brazil has adopted the technology later than other countries and specialized in supplying non-GMO soybean between 1996 and 2005. On the other hand, the United States and Argentina, which adopted the technology in 1996, exported to countries with less social aversion to the GM-technology. The aim of this paper is to investigate the relation between changes in global market chains (price, source and destination and market shares) and GMO technology adoption, focusing on evidences for price premiums for non-GM soybeans produced in Brazil, by the analysis of the trade unit values (TUV). In order to do so, we employ multivariate methods (Principal Components and Hierarchical Cluster analyses) and estimate a Random Effect model based on a bilateral trade dataset covering the years from 1986 to 2010. Results show that GM-technology adoption significantly changed trade patterns. However, premiums were paid for Brazilian soybean only in niche markets, where the market share is lower.
Skin-to-skin contact and breastfeeding of newborns in a university hospital
Authors: Campos Paola Melo , Gouveia Helga Geremias , Strada Juliana Karine Rodrigues , Moraes Bruna Alibio
Published: May 2020

ABSTRACT Objective: To determine the prevalence of skin-to-skin contact (STSC) and breastfeeding (BF) stimulation, as well as the reasons for these practices not to be performed; to identify whether women were given information on these practices along the pre-natal monitoring. Method: A cross-sectional study carried out in a university hospital with 586 women. Data collection was from February to September 2016. Data was collected from patient records and from a questionnaire. A descriptive analysis was performed. Results: Immediately after birth, 60.1% of the newborns (NBs) had STSC, and 44.9% were stimulated to suck at the breast. After primary care, 24.1% had STSC, and 69.3% were stimulated to suck at the breast; 47.7% of the newborns did not have STSC due to their unfavorable clinical conditions; 79.2% of the women were not able to inform the reason why BF was not stimulated; 58.5% of the women had pre-natal guidance about STSC, and 90.8% about BF. Conclusion: Both STSC and BF rates could be improved, in view of the benefits provided by these practices.
BRAZILIAN VERSION OF THE SHRINERS HOSPITAL UPPER EXTREMITY EVALUATION (SHUEE): TRANSLATION, CULTURAL ADAPTATION, AND EVALUATION OF PSYCHOMETRIC PROPERTIES
Authors: Nicolini-Panisson Renata D’Agostini , Tedesco Ana Paula , Davids Jon Robert , Wagner Lisa Vorpagel , Mattiello Rita , Donadio Márcio Vinícius Fagundes
Published: May 2020

ABSTRACT Objective: To validate the upper limb assessments tool, Shriners Hospital Upper Extremity Evaluation (SHUEE), for individuals with hemiplegic cerebral palsy in the Brazilian population. Methods: Validation study to translate and culturally adapt the Manual and the instrument. The psychometric properties evaluated were reliability and convergent validity. Reliability was determined by internal consistency (Cronbach’s α coefficient), ceiling and floor effect, sensitivity to changes, and intra- and interobserver agreement. Convergent validity was performed using the Pediatric Motor Activity Log, the self-care scale of the Pediatric Evaluation of Disability Inventory, and the Manual Ability Classification System. Results: We evaluated 21 individuals with hemiplegic cerebral palsy, with a mean age of 8.7±4.0 years. After the instrument was translated, there was no need for cultural adaptation. The total Cronbach’s α coefficient was 0.887 (95% confidence interval [95%CI] 0.745-0.970). We calculated sensitivity to changes in five subjects who underwent treatment with Botulinum Toxin Type A and physical therapy, with a significant difference between pre- and post-treatment evaluations in the Spontaneous Functional Analysis and Dynamic Positional Analysis. Convergent validity showed a significant correlation of the Spontaneous Functional Analysis and Dynamic Positional Analysis with the scales evaluated. All items of SHUEE presented high intra- and interobserver agreement. Conclusions: The results revealed that the Brazilian version of the SHUEE demonstrated good reliability and convergent validity, suggesting that it is an adequate and reliable tool for individuals with hemiplegic cerebral palsy in the Brazilian population.
THE URBAN AND THE GLOBAL IN THE EARLY MODERN PERIOD IN A COMPARATIVE PERSPECTIVE
Authors: Dantas Mariana , Hart Emma
Published: May 2020

Abstract: This dossier argues that the historical phenomena of the urban and the global have interacted in a dialogical fashion: urban dynamics sustained the creation of a modern and globally connected world while the global movement of people, goods, ideas, and practices helped to define urban realities and ideals. The perspective that emphasizes the interconnection between the city and globalization-the global city-is prevalent in urban studies that focus on the late twentieth and early twenty-first centuries. Applying the same analytical perspective to the early modern period using an implicit comparison between different urban centers and communities elucidates the role cities like Rio de Janeiro played in that era of globalization, as well as the impact that historical moment had on the city.
Preocupações e necessidades dos pais de crianças hospitalizadas
Authors: Rodrigues Joana Isabel Barbosa , Fernandes Susana Margarida Gonçalves Caires , Marques Goreti Filipa dos Santos
Published: May 2020

Resumo A hospitalização pediátrica é um acontecimento crítico, com repercussões na vida da criança internada e da sua família. Este estudo teve como objetivos auscultar as principais preocupações e necessidades experienciadas pelos pais durante a hospitalização de um filho em situação de internamento agudo e explorar eventuais diferenças entre o pai e a mãe no conjunto de vivências partilhadas. Para isso, realizou-se um estudo qualitativo, de natureza exploratória, do qual participaram 16 casais (16 pais e 16 mães) com um filho internado no serviço de pediatria de um hospital do norte de Portugal. Os dados foram recolhidos por meio de entrevistas e avaliados com base na metodologia de análise de conteúdo. O discurso dos pais evidencia como preocupações mais expressivas as referentes ao estado de saúde do filho e, entre as necessidades mais prementes, as associadas à sua recuperação e regresso ao domicílio. Os resultados encontrados revelam igualmente a presença de expressivas diferenças nas vivências desses casais, não devidas à variável pai/mãe, mas à centralidade do papel assumido em termos dos cuidados ao filho (cuidador principal ou secundário).
A Phase Ib Study of Single-Agent Idelalisib Followed by Idelalisib in Combination with Chemotherapy in Patients with Metastatic Pancreatic Ductal Adenocarcinoma
Authors: Borazanci Erkut , Pishvaian Michael J. , Nemunaitis John , Weekes Colin , Huang Julie , Rajakumaraswamy Nishanthan
Published: May 2020

Trial Information

Lessons Learned

Although this study of idelalisib in patients with PDAC was limited in size and duration because of early termination, idelalisib exposure resulted in an overall safety profile consistent with studies in hematological malignancies, except that the incidences of diarrhea and colitis were reduced in patients with PDAC. Preclinical studies of the PI3K pathway in PDAC and positive clinical results of PI3K inhibition in other cancers support the continued development of PI3K inhibitors in PDAC.

Background

Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal solid tumors and is often refractory to treatment. Phosphatidylinositol-3 kinase (PI3K) δ inhibition influences regulatory immune cell function and improves survival in preclinical PDAC models. Here, idelalisib, an inhibitor of PI3Kδ, was investigated as treatment for metastatic PDAC.

Methods

This was an open-label, multicenter, phase Ib, nonrandomized, dose-escalation study. Study aims were to investigate the maximum tolerated dose, safety, pharmacokinetics/pharmacodynamics, and efficacy of idelalisib alone and in combination with chemotherapeutics—nab-paclitaxel and modified (m)FOLFOX6.

Results

Because of early termination, only 16 patients were enrolled in the single-agent idelalisib arm, 12 of whom received at least one dose of idelalisib. The most common treatment-emergent adverse events (≥25%) related to idelalisib (n = 12) were increased aspartate aminotransferase, pyrexia, and maculopapular rash. One patient presented with diarrhea; no cases of colitis were reported. One patient discontinued treatment because of pyrexia and maculopapular rash; two patients died because of disease progression.

Conclusion

This study was terminated because factors contributing to safety concerns in phase III studies of idelalisib for hematological malignancies were not fully understood. In this small sample of patients with metastatic PDAC, exposure to idelalisib resulted in safety findings consistent with previous studies, with reduced diarrhea/colitis.
Quantitative Proteomics of All 14 Renal Tubule Segments in Rat
Authors: Limbutara Kavee , Chou Chung-Lin , Knepper Mark A.
Published: May 2020

Significance Statement

The renal tubule’s 14 distinct segments consist of epithelial cells with different transport and metabolic functions. Identifying the proteins mediating each function is crucial to gaining an overall understanding of kidney physiology and pathophysiology. New developments in protein mass spectrometry have resulted in a marked increase in sensitivity of protein detection and quantification. In this study, the authors manually microdissected kidney tubules from rat kidneys and leveraged the advances in protein mass spectrometry to identify and quantify the proteins expressed in each of the 14 tubule segments. They used these data to create an online information resource, the Kidney Tubule Expression Atlas, to allow researchers throughout the world to browse segment-specific protein expression data and download them for their own investigations.

Background

Previous research has used RNA sequencing in microdissected kidney tubules or single cells isolated from the kidney to profile gene expression in each type of kidney tubule epithelial cell. However, because proteins, not mRNA molecules, mediate most cellular functions, it is desirable to know the identity and amounts of each protein species to understand function. Recent improvements in the sensitivity of mass spectrometers offered us the ability to quantify the proteins expressed in each of 14 different renal tubule segments from rat.

Methods

We manually dissected kidney tubules from rat kidneys and subjected samples to protein mass spectrometry. We used the “proteomic ruler” technique to estimate the number of molecules of each protein per cell.

Results

Over the 44 samples analyzed, the average number of quantified proteins per segment was 4234, accounting for at least 99% of protein molecules in each cell. We have made the data publicly available online at the Kidney Tubule Expression Atlas website (https://esbl.nhlbi.nih.gov/KTEA/). Protein abundance along the renal tubule for many commonly studied water and solute transport proteins and metabolic enzymes matched expectations from prior localization studies, demonstrating the overall reliability of the data. The site features a “correlated protein” function, which we used to identify cell type–specific transcription factors expressed along the renal tubule.

Conclusions

We identified and quantified proteins expressed in each of the 14 segments of rat kidney tubules and used the proteomic data that we obtained to create an online information resource, the Kidney Tubule Expression Atlas. This resource will allow users throughout the world to browse segment-specific protein expression data and download them for their own research.
From Town-Halls to Wikis: Exploring Wikipedia’s Implications for Deliberative Democracy
Authors: Klemp Nathaniel J. , Forcehimes Andrew T.
Published: May 2020

This essay examines the implications Wikipedia holds for theories of deliberative democracy. It argues that while similar in some respects, the mode of interaction within Wikipedia represents a distinctive form of “collaborative editing” that departs from many of the qualities traditionally associated with face-to-face deliberation. This online mode of interaction overcomes many of the problems that distort face-to-face deliberations. By mitigating problems that arise in deliberative practice, such as “group polarization” and “hidden profiles,” the wiki model often realizes the epistemic and procedural aspirations of deliberative democracy. These virtues of the Wikipedia model should not, however, lead to the simple conclusion that it ought to replace traditional face-to-face deliberation. Instead, this essay argues that the collaborative editing process found within Wikipedia ought to be viewed as a promising supplement to traditional deliberation. These two modes of communication ought to be viewed in Madisonian terms – as distinctive forms of interaction that check and balance the vices of one another. When combined, the wiki model promotes the virtues of inclusion and accuracy at large scales, while the face-to-face model excels in conditions of localism and promotes the virtues of solidarity and social capital.
Diversity for What?: The Paradox of University Diversity and the New Civic Rationale
Authors: Marichal Jose
Published: May 2020

This article examines the underlying logic behind what I call the new civic rationale for university diversity. I draw on a diverse literature to explore the varying ways in which diversity could be connected to democratic participation. I argue that the prevailing conception of diversity, what I call the contact thesis is inadequate preparation for democratic participation in a diverse society because it does not challenge the “underlying liberal architecture” that shapes both the practice and scholarship of college diversity. I make the case for emphasizing a participatory culture that favors multiple and intersectional identities over fixed identities, public work over understanding, and participatory democracy over pluralist democracy. The challenge for colleges and universities in the coming years is to design curriculum and pedagogy that emphasizes diversity as a fluid, adaptable and emerging phenomenon while simultaneously grounding it within fixed ethnic and cultural identities.
Deliberating Future Issues: Minipublics and Salmon Genomics
Authors: MacKenzie Michael Kenneth , O’Doherty Kieran
Published: May 2020

In this paper we are interested a class of issues that are especially difficult to address through public engagement processes. These are issues which should (or must) be addressed in the current period but have associated costs, benefits, and impacts that are concentrated in the future. These issues – which might be called ‘future issues’ – are difficult to manage democratically because any public opinions that might help guide policy decisions have not yet developed. At the same time, governments and administrative agencies are often compelled to act before the full implications of these issues are evident and before potentially affected publics are formed and aware of the implications or consequences of these developments. At best, governments and administrators can try to facilitate positive developments or prevent negative outcomes by anticipating potential concerns or conflicts associated with future issues and addressing these in the current period. We argue that small deliberative forums that combine random-selection, education and deliberation are a practical solution to this dilemma. These small forums – or minipublics – can be used to simulate discursive opinions on subjects that have not, or have not yet become topics of widespread public discourses. Our analysis is based on data from a minipublic on salmon genomics that was conducted in November 2008 by the Centre for Applied Ethics at the University of British Columbia. We argue that participating in deliberative events like this one can help citizens develop substantive opinions on technologically and temporally complex issues. We also argue that minipublics can be used to develop anticipatory maps of collectively sanctioned recommendations and discursively developed concerns or considerations. Minipublics on future issues can offer policy makers important insights into the likely parameters of public debates that have not – or have not yet – occurred.
Framing a Deliberation. Deliberative Democracy and the Challenge of Framing Processes
Authors: Barisione Mauro
Published: May 2020

Among both scholars and practioners, the critical importance of framing processes in the realm of deliberative democracy has been neither formally acknowledged nor adequately studied so far. The purpose of this theoretical article is to craft and define the analytical concepts and methodological tools necessary to shed light on this complex relationship. After introducing the notion of ‘deliberative frame’, which is examined across two distinct framing processes – ‘primary’ and ‘derivative’ (or secondary) – this article presents ‘deliberative frame analysis’ (DFA) as a qualitative method which can uncover the ‘meta-frame’ and the specific issue framings (or the deliberative ‘frames’) within a deliberation. This is achieved by examining selected elements both of the organizational context and information materials, and will be illustrated by the example of a famous deliberative poll carried out at European level. Finally, the introduction of authentically competing frames (i.e. ‘counterframes’ and not merely counterarguments) into the deliberative setting, along with the structural possibility for ‘reframing’ in the course of the deliberation, is indicated as a substantive precondition for neutralizing the overall framing effects and thus avoiding a heavily biased deliberation outcome. The article therefore offers a more comprehensive understanding of framing processes as a key challenge for deliberative politics, particularly as regards the legitimacy claims of its various experiments and practices, which are increasingly common in most established democracies.
Favorable Conditions to Epistemic Validity in Deliberative Experiments: A Methodological Assessment
Authors: Caluwaerts Didier , Ugarriza Juan E.
Published: May 2020

Methodological evaluations of deliberative mini-publics usually focus on the internal and external validity of experimental designs. Even though such a focus on causal inference and generalization is important, it is incomplete. We argue that the epistemic validity of experimental designs should also be taken into account in order to ensure measuring truly a deliberative exercise rather than just a regular discussion. By ensuring the inclusion and publicity of all arguments, the process of arguing back-and-forth between multiple positions is theoretically claimed to generate better outcomes and should therefore be validated along epistemic lines. Here, we suggest some methodological techniques for enabling the epistemic validity assumption of deliberative experimental designs. These techniques relate to the sampling of the groups and the treatments they receive.
In Search of Deliberative Democracy in China
Authors: Zhou Wei
Published: May 2020

In democratic countries, deliberative democracy is proposed to rectify problems of liberal democracy. This paper explores deliberative democracy in China, conventionally regarded as an authoritarian country. After examining some deliberative practices and institutions in China and its more democratic public sphere, a conclusion is drawn that despite problems such as flawed institutional design and state domination, an immature deliberative democracy exists in China. The prospect of deliberative democracy in China is optimistically predicted, based on the public’s strong democratic consciousness, the government’s interest in democratic reform and the relatively moderate practices of deliberative democracy.
Emerging Communication Technologies and the Practices of Enhanced Deliberation: The Experience of Benjamin Franklin Transatlantic Fellows Summer Institute
Authors: Von Burg Alessandra B. , Von Burg Ron , Mitchell Gordon R. , Louden Allan D.
Published: May 2020

A U.S. Department of State funded program, the Ben Franklin Transatlantic Fellows Summer Institute, has taught hundreds of high-school aged students from Eurasia and the United States practices of democratic deliberation using networked media. A survey of the program’s curricular innovations since 2006, involving integration of YouTube, Facebook, and documentary film, yields insight on how the advent and circulation of “(de-)liberation” technologies present pathways for young students to practice efficacious and convivial forms of cosmopolitan citizenship in our digital age.
The Power of Ambiguity: How Participatory Budgeting Travels the Globe
Authors: Ganuza Ernesto , Baiocchi Gianpaolo
Published: May 2020

From its inception in Brazil in the late 1980s, Participatory Budgeting has now been instituted in over 1500 cities worldwide. This paper discusses what actually travels under the name of Participatory Budgeting. We rely on science studies for a fundamental insight: it is not enough to simply speak of “diffusion” while forgetting the way that the circulation and translation of an idea fundamentally transform it (Latour 1987). In this case, the travel itself has made PB into an attractive and politically malleable device by reducing and simplifying it to a set of procedures for the democratization of demand-making. The relationship of those procedures to the administrative machinery is ambiguous, but fundamentally important for the eventual impact of Participatory Budgeting in any one context.
Cultural Rights and Deliberative Policy. Beyond Habermas’ “Between Facts and Norms”
Authors: Makariev Plamen
Published: May 2020

A framework derived from Jürgen Habermas’ Between Facts and Norms is utilized to address the question of how claims for minority rights that emerge from ethical-political discourses may receive public recognition. The major difficulty in this regard turns upon discrepancies between the interpretations of minority cultural needs by the members of a given community and interpretations of the same needs on the part of those outside of the community in question. The discussion includes a critical analysis of proposed resolutions of this problem put forward in Between Facts and Norms, in other works of Habermas, and in the various publications of James Bohman, Jorge Valadez, Michael Rabinder James, and Monique Deveaux. I argue that the best way to assess the cogency of discourses across cultural “barriers” does not involve minimizing requirements for their deliberativeness, as the latter four of these authors tend to accept, but rather strictly differentiating between the procedure and substance of the deliberation.
The Role of Information in Public Participation
Authors: Gudowsky Niklas , Bechtold Ulrike
Published: May 2020

A large body of scientific literature on public participation research evaluates specific methods, describes outcomes and impacts of a process or deals with participants’ and officials’ expectations. Yet, there is surprisingly little work on a key part of most participatory processes that deal with complex issues: the information passed to participants. Topics like Global Warming cannot be grasped easily. Even if global warming is happening very quickly on a geological time scale, for human beings it is not easily perceivable. Such a discrepancy between everyday experiences and scientific knowledge can influence one’s opinion tremendously. Therefore, providing sound information and respecting the power of information is essential for meaningful outcomes of participatory processes. In this paper we examine different communication and information pathways within participatory processes. As the main object of interest, we analyzed ‘World Wide Views on Global Warming’. In this distinct process of information and deliberation, citizens formulated recommendations for the decision makers of the 2009 UN climate summit in Copenhagen and voted on different aspects of how to deal with global warming. Results from this process connected to insights from a literature review, contribute to a refined picture of the role information plays within participatory processes and social learning.
“Citizens As Analysts” Redux: Revisiting Aaron Wildavsky on Public Participation
Authors: FOREST PG
Published: May 2020

In 1979, Aaron Wildavsky published a lengthy paper called “Citizens as Analysts” in which he developed his thoughts on public participation. For today’s scholars and practitioners from the health sector, this paper is intriguing and attractive. It is intriguing because the author is clear that the ultimate goal of public participation is not the exercise of direct political authority, but instead the development of better policies and more sustainable institutions. While people don’t need to participate in every single decision to comply, they need to feel that overall, the process has been designed to take their interests into account. Wildavsky’s paper is also attractive because its author dealt upfront with the normative aspects of public participation research. In his view, public participation is one example of a teleological social process, defined by its ends rather than by its initial conditions. Contrary to some current approaches to public deliberation, we are invited to pay more attention to the outcomes of the process than to the process itself.
Rousiley C.M. Maia, Deliberation, the Media, and Political Talk, New York: Hampton Press, 2012
Authors: Steiner Jurg
Published: May 2020

Book Review
Communities of fate and the challenges of international public participation in transnational governance contexts
Authors: Einsiedel Edna F.
Published: May 2020

A trans-national public consultation on climate change was held in 38 countries to provide citizen input to the 2009 UN Framework on Climate Change Conference of the Parties (COP15) meeting in Copenhagen. The uniform process involving 100 citizens in the participating countries focused on the key policy questions debated by participating countries. Based on the Canadian experience with this consultation and interviews with 13 other project managers primarily from developing countries, this paper explores several areas of tension: the tensions between the goals of uniformity and standardization versus recognition and accommodation of cultural complexities; the global versus local contexts; public ‘deficits’ versus capacities and capacity-building; the importance of tailoring for policy impacts versus exploring the values behind policy choices; and the complexities afforded by the issue itself. The paper concludes that these tensions are unavoidable in public consultations in transnational governance contexts involving global issues. These tensions need to be explicitly recognized and accommodated, while acknowledging the continuing importance of public consultation experiments in these transnational contexts.