bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics and outcome of influenza virus infection among adults hospitalized with severe COVID-19: A retrospective cohort study from Wuhan, China
Authors: Tong Xunliang , Xu Xiaomao , Lv Guoyue , Wang He , Cheng Anqi , Wang Dingyi , Fan Guohui , Zhang Yue , Li Yanming
Published: January 2021

BackgroundCoronavirus disease 2019 (COVID-19) is an emerging infectious disease that rapidly spreads worldwide and co-infection of COVID-19 and influenza may occur in some cases. We aimed to describe clinical features and outcomes of severe COVID-19 patients with co-infection of influenza virus.MethodsRetrospective cohort study was performed and a total of 140 patients with severe COVID-19 were enrolled in designated wards of Sino-French New City Branch of Tongji Hospital between Feb 8th and March 15th in Wuhan city, Hubei province, China. The demographic, clinical features, laboratory indices, treatment and outcomes of these patients were collected.ResultsOf 140 severe COVID-19 hospitalized patients, including 73 patients (52.14%) with median age 62 years were influenza virus IgM-positive and 67 patients (47.86%) with median age 66 years were influenza virus IgM-negative. 76 (54.4%) of severe COVID-19 patients were males. Chronic comorbidities consisting mainly of hypertension (45.3%), diabetes (15.8%), chronic respiratory disease (7.2%), cardiovascular disease (5.8%), malignancy (4.3%) and chronic kidney disease (2.2%). Clinical features, including fever (≥38°C), chill, cough, chest pain, dyspnea, diarrhea and fatigue or myalgia were collected. Fatigue or myalgia was less found in COVID-19 patients with IgM-positive (33.3% vs 50/7%, P = 0.0375). Higher proportion of prolonged activated partial thromboplastin time (APTT) > 42 s was observed in COVID-19 patients with influenza virus IgM-negative (43.8% vs 23.6%, P = 0.0127). Severe COVID-19 Patients with influenza virus IgM positive have a higher cumulative survivor rate than that of patients with influenza virus IgM negative (Log-rank P= 0.0308). Considering age is a potential confounding variable, difference in age was adjusted between different influenza virus IgM status groups, the HR was 0.29 (95% CI, 0.081-1.100). Similarly, difference in gender was adjusted as above, the HR was 0.262 (95% CI, 0.072-0.952) in the COX regression model.ConclusionsInfluenza virus IgM positive may be associated with decreasing in-hospital death.
Establishment of an evaluation index system of competencies for graduating students in general practice medicine
Authors: Zhao Rui , Liu Feng , Zhu Kun
Published: January 2021

Background: The competencies of graduating students in general practice medicine have attracted attention. This study aimed to construct an evaluation index system of competencies for graduating students in general practice medicine and to promote the reform and optimization of training programs for general medicine talent in colleges.Methods: The two-round Delphi method was used to determine the evaluation index system of competencies for graduating students in general practice medicine, and the analytic hierarchy process (AHP) was used to calculate the weights of all levels of elements.Results: The evaluation index system of competencies for graduating students in general practice medicine was established with 3 primary factors, 9 secondary factors and 32 tertiary factors. The Delphi results revealed that the active coefficient of experts was 1 and the authority coefficient was 0.858. The 3 primary factors were knowledge level, job skills and professionalism with weights of 0.1532, 0.4207 and 0.4261, respectively. Among the secondary factors, the top three weight coefficients were professional ethics (0.2614), community practice (0.1526) and communication skills (0.1308). Among tertiary factors, "scientific research" exhibited the lowest value with a weight coefficient of 0.0049.Conclusion: In this study, we constructed an evaluation index system of competencies for graduating students in general practice medicine. The consensus on the content of the competencies of graduating students in general practice medicine suggests that these elements are necessary for those who will become general practitioners. This system can be used as the basis to evaluate the ability of graduating students in general practice medicine and provide guidance for the cultivation and evaluation of general medicine talent.
Intraoperative Hemodynamic Optimization Using The Hypotension Prediction Index And Its Impact Of Tissular Perfusion. Protocol For The Predict H Trial
Authors: Olazábal Juan Victor Lorente , Jiménez Ignacio , Ripollés-Melchor Javier , Becerra Alejandra Isabel , Wesselink Wilbert , Reguant Francesca , Mojarro Irene , Fuentes Maria de los Ángeles , Abad-Motos Ane , Agudelo Elizabeth , Machancoses Francisco H. , Callejo Paula , Bosch Joan , García Manuel Ignacio Monge
Published: January 2021

Background: Intraoperative arterial hypotension is associated with poor postoperative outcomes. The Hypotension Prediction Index, developed from machine learning, predicts the occurrence of arterial hypotension from the analysis of the arterial pressure waveform. The use of this index can reduce the duration and severity of intraoperative hypotension in adults undergoing noncardiac surgery.Methods: We will conduct a multicenter, randomized, controlled trial (N=80) in high-risk surgical patients scheduled for elective major abdominal surgery. All participants will be randomly assigned to a control or intervention group. Hemodynamic management in the control group will be based on standard hemodynamic parameters. Hemodynamic management of patients in the intervention group will be based on functional hemodynamic parameters provided by the HemoSphere platform (Edwards Lifesciences Corp.), including dynamic arterial elastance, dP/dtmax and the Hypotension Prediction Index. Tissue oxygen saturation will be non-invasively and continuously recorded by using near-infrared spectroscopy technology. Biomarkers of acute kidney stress (cTIMP2 and IGFBP7) will be obtained before and after surgery. The primary outcome will be intraoperative time-weighted average of a mean arterial pressure < 65mmHg.Discussion: The aim of the study is to determine whether a goal-directed algorithm based on the prevention of arterial hypotension using the Hypotension Prediction Index reduces the duration and severity of intraoperative hypotension when compared with the recommended standard therapy and if this intraoperative strategy is associated with better tissue oxygenation and organ perfusion. Trial registration: ClinicalTrials.gov, NCT04301102. Registered on March 10, 2020.
Proses Berpikir Metafora dalam Menyelesaikan Masalah Matematis Soal HOTS Berdasarkan Kemampuan Kognitif Siswa
Authors: Annizar Anas Ma'ruf , Zahro Fina Syahida
Published: January 2021

To improve students' critical thinking skills in solving High Order Thinking Skill (HOTS) questions, the ability to think metaphorically in learning is required. Thus, this study aimed to describe the metaphorical thinking process of students in solving HOTS mathematical problems by PISA approach. In this study, the research method was descriptive with a qualitative approach. The sampling technique was purposive sampling technique, which was a sampling technique suitable for this study. The results showed that based on the works of the three subjects, they had distinct characteristics in solving the problems. S1 who was classified in high category had a metaphorical form by looking at the room from the top side and based on the indicators, S1 had met the metaphorical thinking indicators. S2 who was classified in low category still did not have metaphorical form as compared to the indicators of identifying problems. However, S2 also had gone through metaphorical thinking process when compared to the indicators of connecting and deciding the main concept, as well as was able to illustrate ideas. Meanwhile, S3 who was classified in the middle category had a metaphorical form by only looking at the room side. S3 also had met several indicators of metaphorical thinking.
ANALISA PERBEDAAN MANAJEMEN AKTIVA TETAP DALAM MYOB DAN ACCURATE V4
Authors: Novianti Eka
Published: January 2021

Studi ini membahas mengenai pengelolaan aktiva tetap dalam dua software akuntansi yang dikenal masyarakat umum MYOB Premier dan Accurate 4. Tujuan penulisan adalah untuk memandu penggunaan aplikasi akuntansi dalam mengelola aktiva tetap sejak awal pengadaan sampai pelaporan. Pembahasan dua jenis aplikasi diharapkan juga dapat memberikan solusi kepada user dalam melakukan pemilihan aplikasi akuntansi yang akan digunakan. Masing-masing software tersebut memiliki cara berbeda dalam mengelola aktiva tetap, mulai dari pembelian sampai mengelola penyusutan dan pelaporan aktiva tetap yang disajikan secara lengkap dan cepat sesuai kebutuhan manajemen dalam mengambil keputusan.
Optimalisasi Ekspor Produk Ekonomi Kreatif Indonesia Menuju Peningkatan Dayasaing
Authors: Madelan Sugiyono
Published: January 2021

Indonesia’s creative economy product exports have not been optimal. The purpose of this study is to optimize the goals of creative economic development in Indonesia. This research was conducted using secondary time series data for the period 2010-2017. The research method uses linear programming and goal programming. The results showed that exports of creative economy products responded to an increase in export selling prices based on the demand behavior of the exports of creative economy products. The factor of export competitiveness of Indonesia’s creative economy products lies in the use of cheaper labor costs. Exports of creative economy products do not automatically increase, if the education level of the workforce increases, but rather comes from an increase in creativity. Fashion products are efficient products compared to producing exports of craft products and culinary products. Finally, the development of the creative economy is more optimal for the purpose of increasing exports of creative economy products than for the purpose of increasing employment, namely by producing fashion products.
Time Series Analyses and Modeling of Environmental Systems: Case Studies in Kuwait
Authors: Alhumoud Jasem M. , Almeshaan Nourah
Published: January 2021

Background:

Time series is a sequence of measurements made at regular time intervals. Tremendous work has been done on pipe break investigation and maintenance, using different models. However, the authors have not found any research work on pipe failures in water distribution networks using time series.

Objective:

The principal objective of this paper was to investigate the applications of time series analysis in modeling man-made (pipe breaks) and natural (rainfall) environmental systems.

Methods:

This objective was satisfied by employing the Time-Domain (Box-Jenkins) approach to assess two case studies in Kuwait of a water distribution network (pipe failures), and from rainfall rates measurement of a solid waste disposal site, respectively. The statistical analysis of these data was conducted with the aid of the BMDP and SAS computer software packages and by the use of the P2T programming procedure for the Box-Jenkins method.

Results:

The results showed a significant correlation between the data and the time series models provides good estimates of pipe reliability and rainfall measurements.

Conclusion:

Based on the significant results, time series analyses could and should be useful by water authorities in planning pipe maintenance and inspection. Moreover, it is recommended and it would be very useful to conduct similar studies on pipes carrying other fluids such as gas, air and oil.
Deep Learning Models for Predicting Severe Progression in COVID-19-Infected Patients: Retrospective Study
Authors: Ho Thao Thi , Park Jongmin , Kim Taewoo , Park Byunggeon , Lee Jaehee , Kim Jin Young , Kim Ki Beom , Choi Sooyoung , Kim Young Hwan , Lim Jae-Kwang , Choi Sanghun
Published: January 2021

Background

Many COVID-19 patients rapidly progress to respiratory failure with a broad range of severities. Identification of high-risk cases is critical for early intervention.

Objective

The aim of this study is to develop deep learning models that can rapidly identify high-risk COVID-19 patients based on computed tomography (CT) images and clinical data.

Methods

We analyzed 297 COVID-19 patients from five hospitals in Daegu, South Korea. A mixed artificial convolutional neural network (ACNN) model, combining an artificial neural network for clinical data and a convolutional neural network for 3D CT imaging data, was developed to classify these cases as either high risk of severe progression (ie, event) or low risk (ie, event-free).

Results

Using the mixed ACNN model, we were able to obtain high classification performance using novel coronavirus pneumonia lesion images (ie, 93.9% accuracy, 80.8% sensitivity, 96.9% specificity, and 0.916 area under the curve [AUC] score) and lung segmentation images (ie, 94.3% accuracy, 74.7% sensitivity, 95.9% specificity, and 0.928 AUC score) for event versus event-free groups.

Conclusions

Our study successfully differentiated high-risk cases among COVID-19 patients using imaging and clinical features. The developed model can be used as a predictive tool for interventions in aggressive therapies.
Analysis of glycidyl nitrate polymerization reaction
Authors: Maksimowski Paweł , Merchel Julia
Published: January 2021

Poly(glycidyl nitrate) (PGN) is a high-energetic polymer whose properties are determined by the presence of an –ONO2 explosophoric group. PGN can be obtained by polymerization of glycidyl nitrate (GN) monomers. The preferred polymerization route is via the activated monomer mechanism, due to its two main advantages: narrow molecular mass distribution of the obtained polymer and ability to control the heat generated during the reaction. The study allowed the GN monomer to be obtained as a product of nitration of epichlorohydrin. A series of GN polymerization reactions was conducted under different conditions (temperature, time and reactant amounts). The analysis showed that the lower the catalyst to initiator ratio, the higher the molecular mass of the obtained polymer (PGN). A temperature between 0-10 °C is the optimum temperature for GN polymerization. The longer the GN polymerization time the higher the molecular mass of the PGN. The GN polymerization reaction was scaled up without affecting the molecular mass or other properties of the obtained polymers. The following tests were carried out to determine the basic properties of PGN: GPC, 1H NMR, FTIR, DSC, TG, calorific value, viscosity, sensitivity to friction and impact.
The illegal synthesis of picric acid in the context of applicable legal regulations
Authors: Polis Mateusz , Wilk Zenon , Nikolczuk Karolina
Published: January 2021

Homemade explosives (HME) are increasingly used in terrorist attacks. These materials can be defined as physical mixtures of commonly available raw materials or those obtained by synthesis e.g. picric acid. For most compounds there are at least several synthesis routes which allow a suitable route to be matched for the available materials. The aim of the task was to investigate the possibility of producing picric acid using raw materials and equipment available to the average user. The obtained product was tested for safety, i.e. sensitivity to friction and impact was determined.
Pengaruh stres kerja terhadap kepuasan hidup pada buruh garmen perempuan di Cicurug Kabupaten Sukabumi
Authors: Al Akbar Multazam , Vinaya Vinaya
Published: January 2021

Objektif: Banyaknya industri pengolahan garmen yang ada di Cicurug, Kabupaten Sukabumi membuat sebagian besar perempuan di sana bekerja di pabrik garmen.  Salah satu masalah pekerjaan yang dialami oleh buruh di Cicurug adalah target kerja dan jam kerja yang berlebihan. Masalah tersebut sering menjadi pemicu stress sehingga terkadang berdampak pada kepuasan hidup terutama pada buruh garmen perempuan yang sudah menikah. Penelitian ini bertujuan untuk mengetahui apakah ada pengaruh stres kerja terhadap kepuasan hidup pada buruh garmen perempuan di Cicurug, Kab. Sukabumi.Metode: Penelitian ini menggunakan pendekatan kuantitatif dengan menggunakan kuesioner. Alat ukur yang digunakan untuk mengukur stres kerja dari Parker dan DeCotiis (1983) dan untuk mengukur kepuasan hidup dari Diener dan Pavrot (dalam Diener, 2008). Sampel penelitian ini adalah 152 buruh garmen perempuan yang sudah menikah. Teknik sampel yang digunakan pada penelitian ini adalah accidental sampling. Metode analisis data dengan menggunakan analisis regresi linear sederhana.Temuan: Hasil pengolahan data menujukkan bahwa stres kerja tidak berpengaruh terhadap kepuasan hidup buruh garmen di Cicurug, Kab. Sukabumi. Penelitian ini menemukan bahwa sebagian besar responden buruh garmen wanita memiliki tingkat stress kerja yang rendah dan tingkat kepuasan hidup yang juga rendah.Kesimpulan: Hipotesis penelitian diterima.
Empati Dan Religiusitas Sebagai Prediktor Agresivitas Suami Pada Pasangan: Studi Pada Jamaah Pengajian Nurussalam Kecamatan Semen Kabupaten Kediri
Authors: Prastuti Endang , Nurhayati Yulia Ratri
Published: January 2021

AbstrakObjektif: Tujuan penelitian ini adalah untuk mengetahui pengaruh; (1) empati terhadap agresivitas suami Jamaah Pengajian Nurussalam Kediri; (2) religiusitas terhadap agresivitas suami Jamaah Pengajian Nurussalam Kediri; (3) empati dan religiusitas terhadap agresivitas suami pada Jamaah Pengajian Nurussalam Kediri.Metode: Penelitian ini menggunakan jenis penelitian kuantitatif korelasional dengan metode non probability sampling. Teknik pengambilan sampel menggunakan sampel jenuh dengan jumlah subjek 48 orang. Data analisis menggunakan teknik analisis regresi linier berganda.Temuan: Hasil penelitian menunjukkan bahwa; (1) sebagian besar empati suami pada Jamaah Pengajian Nurussalam Semen Kediri tergolong tinggi; (2) sebagian besar religiusitas suami pada Jamaah Pengajian Nurussalam Kediri tergolong tinggi; (3) sebagian besar agresivitas suami pada Jamaah Pengajian Nurussalam Kediri tergolong rendah; (4) ada pengaruh empati terhadap perilaku agresivitas suami pada Jamaah Pengajian Nurussalam Kediri; (5) ada pengaruh religiusitas terhadap perilaku agresivitas suami pada Jamaah Pengajian Nurussalam Kediri; (6) ada pengaruh empati dan religiusitas terhadap perilaku agresivitas suami pada Jamaah Pengajian Nurussalam Kediri.Kesimpulan: Hipotesis penelitian diterima, artinya terdapat pengaruh empati dan religiusitas terhadap perilaku agresi suami pada Jamaah Pengajjian Nurussalam Kediri.
Physical properties of soil in the early stage of an agroforestry system in the High Andean zone
Authors: Muñoz-Rodríguez Martin Alonso , Delgado-Vargas Iván Andrés , Guerrero Jennyfer Cristina , Andrade Anyi Valeria
Published: January 2021

In  Nariño,  Colombia,  land  use  has  generated  some  problems  such  as  erosion,  compaction,  lack  of  fertility,  among  others,  so  it  is  necessary  to  search  for  alternatives  to  mitigate  these  impacts.  The  objective  of  this  study was to evaluate some physical properties of the soil in an agroforest system  with  Morella  pubescens  (Humb.  &  Bonpl.  ex  Willd.)  Wilbur  with  Smallanthussonchifolius (Poepp.)  H.Rob,  in  the  experimental  farm  of  Botana,  in  the  city  of  Pasto,  Nariño,  where  the  bulk  density,  real  density,  total porosity, structural stability properties and distribution of aggregates were  analyzed.  The  datas  were  obtained  in  two  phases:  f1  and  f2  before  and after agroforestry system implementation, respectively. A randomized complete block design with three treatments and three replications were used. The treatments corresponded to plant densities, T1: S sonchifoliuos, sowed  to  1x1m,  T2:0.8x0.8m  y  T3:0.5x0.5m,  with  three  replications.  M  pusescens was stablished to 4x4m between plants and 9 m between rows and  the  control  (f1).    The  statistics  have  differences  between  f1  (control)  and f2 (treatments), to the structural stability properties and distribution of  aggregates.  The  ground  suffered  a  structural  stability  change  to  stable  lightly  (0.97  D.P.M)  in  f1  to  a  stable  moderate  (2.53  D.P.M),  in  f2.  The  distribution of aggregates passed to 60% in f1 to 70.3% in f2, with a media aggregation  status.  The  different  agroforest  systems  management  could  help,  in  the  long  term,  by  improving  the  structure  of  the  ground  through  the vegetal material of arboreal component, the application of a minimum farming and the addition of organic matter.
Evaluation of pre-germination treatments on four native species of the High Andean forest
Authors: Bacca Pedro Pablo , Burbano Diana Lucía , Moreno Angélica Sofía
Published: January 2021

High Andean forests are strategic ecosystems with high diversity of native and endemic plants; however, these natural ecosystems are affected by agricultural expansion. Knowledge on the propagation of native plants is essential to restore these environments. This research aimed to evaluate germination in the following native species: Viburnum triphyllum Kunt. (Caprifoliaceae), Oreopanax floribundum Kunth, (Araliaceae), Weinmannia tomentosa L.f. (Cunoniaceae), and Tournefortia fuliginosa Benth. (Boraginaceae) in Botana experimental farm of Universidad de Nariño. This study was conducted between October (2016) and February (2017). For each species, an unrestricted randomized split-plot design was established. The main plot included the substrates (S), and the sub-plots included the different pre-germination treatments (PM) with three repetitions. The results showed statistically differences in germination percentage among pre-germination treatments for O. floribundum. The highest germination percentage (42%) for this species was achieved with seed imbibition for 48 hours at 22°C. Moreover, W. tomentosa showed statistical differences for S and PM, with a germination percentage of 74% with imbibition for 48 h at 22°C and sand substrate. T. fuliginosa did not show relevant differences; however, it had a germination percentage of 47%. V. triphyllum did not germinate; therefore, further evaluations of pre-germination treatments should be required.
Effect of supplementation with organic acids on productive and reproductive parameters in guinea pigs
Authors: Vela Christian , Morales-Cauti Siever
Published: January 2021

Guinea pig production systems demand organic alternatives to improve their productivity, due to the increased demands of this type of livestock operations. The present study aimed to evaluate the effect of organic acids on the productive and reproductive indices in reproductive Guinea pigs in an intensive breeding farm in Lima. 60 pools were used with 10 Guinea pigs in each one (9 females and one male).  They were randomly divided into 4 treatment groups: T1: 1mL/L, T2: 2mL/L, T3: 4mL/L; all with 15 pools in total (5 pools each with dosage of 5, 10 and 15 days, respectively), and T4: Control (15 pools without dosage); the observation period was 3 months. No significant difference was found (p> 0.05) between treatments for weight gain, percentage of maternal mortality, percentage of abortions, percentage of pregnancy, number of offspring born and percentage of viability. For the percentage of mortality of pups and average weight of the offspring, a significant difference was found (p <0.05), demonstrating that T3 reached a higher weight index at birth of offspring (T3: 147.7 / 142.7 / 146.8g) and lower percentage of mortality in rabbits (T3: 0 / 1.8 / 3.0%). No significant difference was found in terms of dosing days. It is concluded that supplementation with organic acids with T3 (4mL/L) improved the weight at birth of the offspring and the mortality percentage in kits.
PERCEPÇÕES SOBRE PRÁTICAS DE CONSUMO DAS MULHERES NO CONTEXTO DO INSTITUTO FEDERAL DE EDUCAÇÃO, CIÊNCIA E TECNOLOGIA DE SERGIPE- IFS
Authors: Siqueira Rosana Rocha , Soares Maria José Nascimento
Published: January 2021

O presente estudo busca analisar as percepções sobre práticas de consumo das mulheres no contexto do IFS. As análises são pautadas no questionamento acerca das preocupações ambientais na agenda de consumo das mulheres. O estudo realizado no período de 2013 a 2015 caracterizase como uma pesquisa explicativa qualitativa e quantitativa centrada na abordagem fenomenológica proposta por Alfred Schutz e pressupostos da Análise de Conteúdo segundo Bardin (1977). Os dados revelaram que o consumo surge como forma de melhorar as condições de vida e “recompensar” os esforços empreendidos por meio do trabalho, seja este formal ou informal. Nota-se inclusive a dificuldade de vislumbrar um viés ético capaz de atender a necessidade de ações que reduzam os impactos socioambientais atrelados à produção e ao consumo sem que o consumidor sinta-se sacrificado diante da insaciabilidade volátil de suas necessidades. Assim, o percebido ainda não se concretiza de forma plena no vivido destas mulheres, pois alguns obstáculos ainda atrapalham participações efetivas e contínuas.
Vem para a rua: convite a uma nova forma de experimentar a cidade.
Authors: Espindola dos Santos Mariana
Published: January 2021

Este artigo tem como intuito elaborar uma explanação sobre as formas de conhecer a cidade, tomando como norte da pesquisa o convite a vivenciar os espaços urbanos como artistas visuais e ativistas. Os projetos Stop Telling Women To Smile e o Coletivo Feminicidade  promovem uma convocação aos seus seguidores de se tornar ativista. Para a elaboração  deste artigo, a pesquisa acompanhou as redes sociais dos artistas, além de uma observação participativa nas oficinas e nas colagens proporcionadas pelo Coletivo Feminicidade. A  experiência proporcionou uma reflexão maior sobre a interação de artistas e ativistas com seus públicos para além das redes sociais, contribuindo para diálogos sobre as suas xperiências em pensar como seus corpos interagem em grandes centros urbanos.
Performance e discurso pornográfico em um vídeo do site Hotboys
Authors: Silva Victor Antonio de Araujo Alves da
Published: January 2021

Este trabalho pretende tecer uma discussão acerca do campo pornográfico mainstream a partir de um vídeo do site Hotboys. Pretendo neste artigo operar com os conceitos deperformatividade, performance e discurso para observar como o discurso se constrói no vídeo e como as coreografias e performances reiteram ou contradizem esse discurso. No mais este trabalho irá capitalizar os conceitos de máxima visibilidade e construção narrativa de consentimento para analisar a imagem pornográfica inserida nas práticas discursivas. Este trabalho é parte integrante da pesquisa de mestrado e propõe um debate no campo das ciências sociais sobre gênero e sobre pornografia.
Comment ne pas etre "pigeonholed"; l'ethos entrepreneurial (Como não ser um pombo engaiolado; o ethos empresarial)
Authors: Maingueneau Dominique
Published: January 2021

Dans une perspective d'analyse du discours, cet article aborde un ethos collectif particulièrement important dans le monde contemporain: l'ethos "entrepreneurial" qui est censé animer les acteurs les plus prestigieux et les plus dynamiques de l'économie, en particulier ceux qui travaillent dans le monde des "start-up". L'exposé s'articule autour de l'étude de trois textes  (un journal quotidien, une publicité pour une école, un magazine pour cadres) qui participent de la représentation médiatique de cet ethos et dont le public cible appartient au monde du business. L'analyse prend pour fil directeur le terme anglais "pigeonholed", qui caractérise l'anti-ethos que doit à tout prix rejeter le bon entrepreneur. Elle s'appuie, pour cela, sur le discours prescriptif des professionnels du conseil en management, qui façonnent le discours partagé par l'ensemble des acteurs de ce monde. L'étude débouche sur une réflexion sur les affinités entre discours religieux et discours économique en matière d'incorporation d'ethos.
Prevalence of Medical Humanities Teaching in Medical Schools: Review of Curricula in the United States, Canada, and the United Kingdom
Authors: Howick Jeremy , Zhao Lunan , McKaig Brenna , CAMPANER RAFFAELLA , Rosa Alessandro , Oke Jason , Ho Dien
Published: January 2021

Rationale and Objectives Medical humanities are becoming increasingly
popular, required, and recognized as positively impacting medical
education and medical practice. However, the extent of medical
humanities teaching in medical schools is largely unknown. We aimed to
review medical school curricula in Canada, the UK, and the US. Our
secondary objective was to compare the inclusion of medical humanities
in the curricula with rankings of medical schools. Methods We searched
the curriculum websites of all accredited medical schools in Canada, the
UK, and the US to check which medical humanities topics were taught, and
whether they were mandatory or optional. We then noted rankings both by
Times Higher Education and U.S. News and World Report and calculated the
average rank. We formally explored whether there was an association
between average medical school ranking and medical humanities offerings
using Spearman’s correlation and inverse variance weighting
meta-analysis. Results We identified 18 accredited medical school
programmes in Canada, 41 in the UK, and 156 in the US. Of these, 9
(56%) in Canada, 34 (73%) in the UK and 124 (79%) in the US offered
at least one medical humanity that was not ethics. The most common
medical humanities were Unspecified Medical Humanities, History, and
Literature (Canada), Sociology and Social Medicine, Unspecified Medical
Humanities, and Art (UK), and Unspecified Medical Humanities,
Literature, and History (US). There was a negative relationship between
the ranking of the medical school and whether they offered medical
humanities. Conclusions The extent and content of medical humanities
offerings at accredited medical schools in Canada, the UK, and the US
varies. The quality of our analysis was limited by the data provided on
the Universities’ curriculum websites. Given the potential for medical
humanities to improve medical education and medical practice, this
variation should be investigated further.
Diabetes Care in an Urban Indigenous American Community: Challenges and Suggestions for the Future
Authors: Pollak Margaret
Published: January 2021

Indigenous Americans living with type 2 diabetes in urban areas like Chicago face significant challenges to meeting the care recommendations of their medical providers. Based upon mixed-methods research, including both qualitative and quantitative measures, in Chicago’s Indigenous community, I have found that diabetes-care and -prevention challenges faced by individuals in this community include (1) the high financial and time costs of care, (2) lack of recognition of or response to acute symptoms of high glucose levels, (3) prioritization of other life responsibilities, (4) distrust of western medicine, and (5) fatalistic views about diabetes development and prognosis. If we are to reduce rates of type 2 diabetes and its related complications in Indigenous American populations, we need to reframe our view of who Indigenous peoples are and what the type 2 diabetes epidemic means in these communities, and consider how to best develop solutions for care that are feasible in urban settings. This aim can be achieved through a greater awareness of the challenges faced by urban Natives caring for type 2 diabetes and by engaging with these communities to develop collaborative programs to improve care in these settings.
Documenting Current Practices of Accommodating Linguistic Needs of Deaf Defendants
Authors: Shine Beau
Published: January 2021

Deaf defendants are an underexamined population in criminal justice research, and very few studies have examined their involvement in the criminal justice system. In addition, research on accommodating the linguistic needs of deaf defendants is sparse. Failure to accommodate the linguistic needs of deaf defendants presents several concerns, including disparate treatment and violations of ADA-guaranteed rights that may lead to inadmissible evidence, dismissals of cases, and not-guilty verdicts, as well as lawsuits and litigation, all of which create additional strain on an already overburdened system. The current study combines previous research on deaf defendants with the findings of data gathered from courtroom practitioners nationwide to gain an understanding of the current practices used to facilitate communication during criminal trials involving deaf defendants.
Nonepithelial Esophageal Tumors: Leiomyomas and GI Stromal Tumors
Authors: von Holzen Urs , Wiener Daniel C , Wee Jon O
Published: January 2021

Nonepithelial esophageal tumors can be classified into two groups. The most common group consists of GI stromal tumors (GISTs). The less common group consists of several tumors similar to tumors arising from soft tissues of other body parts (eg, lipomas, liposarcomas, leiomyomas, leiomyosarcomas, peripheral nerve sheath tumors). Differentiation between these two groups is based on the near-universal expression of CD117 in GISTs, as opposed to other spindle cell tumors. Although some of these tumors are asymptomatic and discovered accidentally during CT or endoscopies for other reasons, they often cause some unspecific symptoms (eg, bloating, dysphagia, early satiety). Contrast-enhanced CT with IV and oral contrast is the examination of choice to evaluate these tumors, as extent of the tumor and presence of metastatic disease can be determined. Surgical resection is generally recommended for tumors larger than 2 cm or symptomatic tumors.

This review contains 4 figures, 2 tables, and 35 references.
Key Words: GIST, leiomyoma, leiomyosarcoma, nonepithelial esophageal tumors, esophagus, diagnosis, treatment, follow-up
Management of Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma
Authors: Macedo Francis Igor , Yakoub Danny , Dudeja Vikas , Merchant Nipun B.
Published: January 2021

The incidence of pancreatic cancer continues to rise, and it is now the third-leading cause of cancer-related deaths in the United States. Only 15 to 20% of patients are eligible to undergo potentially curative resection, as most tumors are deemed unresectable at the time of diagnosis because of either locally advanced disease or distant metastases. Improvements in preoperative CT imaging have enabled better determination of the extent of disease and allowed for better operative planning. Based on their relationship to the surrounding vasculature and structures and presence or absence of distant disease, pancreatic tumors are classified into four categories: resectable, borderline resectable pancreatic cancer (BRPC), locally advanced pancreatic cancer (LAPC), and metastatic. With the recent advent of more effective chemotherapy regimens, efforts have focused on using neoadjuvant therapy approaches to increase the likelihood of achieving an R0 in patients with BRPC and possibly convert unresectable, locally advanced tumors to potentially resectable tumors. Response with neoadjuvant therapy regimens has resulted in increased number of patients eligible for resection, many times requiring vascular resection. Herein, we describe recent changes in the classification, important surgical and pathologic considerations and updated multimodal therapeutic options in the complex management of BRPC and LAPC.
 This review contains 5 figures, 2 tables, and 78 references.
Key Words: borderline resectable pancreatic cancer, CA 19-9, FOLFIRINOX, locally advanced pancreatic cancer, nab-paclitaxel, neoadjuvant chemotherapy, pancreatectomy, portal vein resection, radiation therapy, gemcitabine
Noninvasive Hemodynamic Monitoring in the ICU
Authors: Johnson Timothy G , Hopper Herbert. A. , May Addison K
Published: January 2021

The primary goal of hemodynamic monitoring in critically ill patients is to enable and direct targeted interventions to restore or maintain adequate cellular perfusion. Inadequate cellular perfusion defines a state of shock and propagates preexisting cellular injury, whether or not shock is overt or occult. Tissue perfusion is determined through a complex relationship between perfusion pressure and cardiac output. The goal of hemodynamic monitoring is to aid in determining which of these parameters should be altered to improve perfusion while limiting potential deleterious effects that these interventions may introduce. In today’s modern ICU, the critical care physician has access to multiple tools and equipment designed to elucidate the type of shock and guide treatment. Technologic advancements have led to less invasive methods of defining the physiologic picture of patients. This includes everything from the invasive pulmonary artery catheter to echocardiography and arterial wave form calculation. However, each of these modalities comes with its own advantages and disadvantages. Furthermore, one also has to factor in the cost of the device and the associated training required for the practitioner. This review examines the most commonly used non-invasive monitoring modalities used in clinical practice and offers an overview of each device.
This review contains 6 figures, 3 tables, and 95 references. 
Key Words: bioimpedance, echocardiography, ImaCor, LiDCO, NICO, noninvasive monitoring, PiCCO, pulmonary artery catheter, pulse contour
Colitis: Infectious, Ischemic, and Toxic Megacolon
Authors: Dyer Mitchell , Zuckerbraun Brian S.
Published: January 2021

Colitis is a common gastrointestinal illness that carries high morbidity and mortality in critically ill patients admitted to the intensive care unit. In critically ill patients, colitis can be a primary process or secondary result from their presenting illness. The etiology of the colitis ranges from infectious (bacterial, viral, and the most common gastrointestinal infection hospitalized patients Clostridium difficile), ischemic insult (both occlusive and nonocclusive disease), and finally inflammatory bowel disease. This chapter goes over the background, work-up and diagnosis, and finally treatment options and strategies for the most common etiologies that afflict this population of severely ill patients.
This review contains 3 figures, 6 tables, and 79 references.

Keywords:colectomy, colitis, diarrhea, fecal transplant, hematochezia, ischemia, inflammation, vancomycin, Clostridium difficile
Airway Management
Authors: Dargin James M. , Emlet Lillian L.
Published: January 2021

Endotracheal intubation is a commonly performed procedure in the intensive care unit (ICU). Active upper gastrointestinal bleeding, emesis in the airway, and the presence of a cervical collar are just a few examples of conditions encountered in critically ill patients that can make endotracheal intubation difficult. Furthermore, critically ill patients usually require intubation because they have exhausted their physiologic reserve and can deteriorate rapidly due to vasodilation from induction medications, reduction in preload from positive pressure ventilation, hypercapnia and acidosis during periods of apnea, hypoxia from failed attempts at intubation, and an increase in intracranial pressure during laryngoscopy attempts. Up to one third of patients undergoing emergency airway management will develop serious complications, including hypoxemia, hypotension, aspiration, or cardiac arrest. Careful planning, provision of the appropriate equipment and personnel, and an understanding of an individual patient’s physiologic derangements can help to prevent complications during intubation. 
This review 13 figures, 4 tables, and 27 references. 
Keywords: airway, intubation, endotracheal, rapid sequence, pre-oxygenation, bag-mask ventilation, laryngoscopy, cricothyrotomy, supraglottic airway
Breast Cancer in the Elderly
Authors: Pesce Catherine , Yao Katharine
Published: January 2021

Elderly patients with breast cancer are more likely to present with more favorable tumor characteristics and molecular subtypes; however, outcomes are worse, with lower survival rates compared with younger women. Less use of screening, undertreatment, the frequency of comorbidities, and the lack of information in clinical trials on the use of systemic therapy in this population all likely play a role. Unless patients have a prohibitive risk for surgery or a life expectancy less than 5 years, surgery should be considered for elderly patients who are surgically resectable. Radiation and chemotherapy are less likely to be used in elderly patients; however, with an increase in the use of neoadjuvant therapy for breast cancer patients, recommendations or guidelines for neoadjuvant therapy for the elderly are needed. Further tools that can assist physicians with risk assessment of elderly patients for both surgery and adjuvant therapies are needed. A multidisciplinary discussion that includes discussion of the need for adjuvant therapy is necessary and should be balanced against the patient’s comorbidities and functional status when deciding on the best course of treatment for these patients. It should be emphasized that elderly patients should be offered standard treatments that nonelderly patients receive, and these recommendations should only be modified if there is limited life expectancy or other socioeconomic factors that influence whether patients can undergo standard treatments.

This review contains 2 figures, 11 tables, and 60 references
Key words: breast surgery, breast cancer in the elderly, elderly breast surgery, elderly oncology, geriatric breast surgery
Imaging and Staging for Stomach Malignancy
Authors: Gabr Moamen M , Berzin Tyler M
Published: January 2021

Therapeutic decisions regarding surgical, endoscopic, and medical management of gastric tumors depends on tumor type, anatomic location of the tumor, and, in the setting of malignant tumors, the clinical staging of the lesion. Common types of stomach tumors include adenocarcinoma, which accounts of 90% of stomach malignancies, lymphomas, gastrointestinal stromal tumors (GISTs), and neuroendocrine tumors. A detailed physical examination during initial evaluation may help target the approach during malignancy staging. Endoscopy offers a large armamentarium of tools for diagnosis and staging of gastric tumors. EUS is currently the mainstay in local staging and obtaining tissue diagnosis of primary tumor and nodal metastasis. Advances in imaging modalities have provided precise tools for diagnosis and staging of stomach malignancies.
This review contains 11 figures, 1 table, and 35 references.
Key Words: endoscopy, endoscopic ultrasonography, gastric malignancy, GIST, MALT lymphoma, neuroendocrine tumors, staging
Benign Tumors of the Spleen
Authors: Paniccia Alessandro , Chapman Brandon
Published: January 2021

Primary benign splenic tumors are uncommon and manifest with variable presenting signs and symptoms yet are frequently asymptomatic and discovered incidentally. Primary benign tumors involving the spleen can be broadly categorized as vascular/lymphatic tumors, tumorlike lesions, and cystic tumors. Although laboratory tests have little impact on the diagnosis of benign tumors of the spleen, radiologic imaging is mandatory and may narrow the differential diagnoses. However, it is often difficult to distinguish benign from malignant disease. Surgical management is based on the clinical presentation of the patient, disease etiology, and suspicion for malignancy. Surgical options include complete and partial splenectomy, andthe laparoscopic approach is favored.

This review contains 6 figures, 6 tables and 66 references
Key words: cystic, mass, spleen, splenectomy, tumor, tumorlike, vascular neoplasm
Pemphigus and Bullous Pemphigoid
Authors: Varma Aakaash , Czernik Annette , Levitt Jacob
Published: January 2021

Pemphigus disorders are characterized by acantholysis, whereas pemphigoid disorders are characterized by a dermal-epidermal split. Diagnosis of pemphigus or pemphigoid relies on a combination of positive anti-desmoglein or anti-collagen XVII serology, confirmatory direct immunofluorescence, and clinical features. Treatment for immunobullous disease revolves around various immunosuppressants, most often some combination of rituximab, prednisone, and IVIg. Paraneoplastic pemphigus is characterized by hemorrhagic crusting of the lips with positive indirect immunofluorescence on rat bladder epithelium, which should prompt a search for malignancy. Hailey-Hailey disease is a genetically mediated pemphigus that typically occurs in skin folds and responds to a number of agents including botulinum toxin, topical steroids, and other anecdotal therapies.
This review contains 17 figures, 2 tables, and 109 references.
Keywords: blister, pemphigus, bullous, rituximab, bullae, prednisone
Clinical Management of Feeding and Eating Disorders
Authors: Westmoreland Patricia , O’Melia Anne Marie
Published: January 2021

Eating disorders are diverse in etiology and presentation and are best treated by a multidisciplinary treatment team (physicians, nurses, dietitians, and psychotherapists). Effective treatment includes combinations of behavioral management, psychotherapy, and psychiatric medication. Pica and rumination disorder are typically treated with behavioral management. Treatment of avoidant/restrictive food intake disorder and restricting or binge/purge anorexia nervosa usually requires nutritional and medical management before patients are able to benefit from psychotherapy or psychiatric medication management. There are currently only two medications FDA approved for treatment in eating disorders. Fluoxetine is FDA approved for the treatment of bulimia. Lisdexamfetamine was recently approved for the treatment of binge eating disorder. Novel therapies, such as deep brain stimulation, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation, are being studied for the treatment of severe and enduring forms of anorexia nervosa.
This review contains 5 tables and 58 references
 Key words: behavioral management, diversity, FDA approval, fluoxetine, lisdexamfetamine, multidisciplinary team, novel therapies, psychotherapy, psychotropics
Treatment of Unhealthy Alcohol Use
Authors: Holt Stephen R , Fiellin David A
Published: January 2021

Unhealthy alcohol use represents the fifth leading cause of morbidity and mortality globally, and the first leading cause among persons 18 to 45 years of age. Despite the global impact of unhealthy alcohol use, the adoption of evidence-based treatments has been sluggish. Behavioral strategies for lower level drinking include the brief motivational interview, designed to be within the scope of any healthcare provider, and more specialist-driven approaches for those with alcohol use disorder (AUD) such as cognitive behavioral therapy and motivational enhancement therapy. Benzodiazepines remain the mainstay treatment for inpatient alcohol withdrawal treatment, whereas other medications have similar efficacy in managing patients in the outpatient setting with milder forms of withdrawal. For maintenance treatment of AUD, four FDA-approved medications exist, with efficacy in treating AUD, as well as several non–FDA-approved medications that have been found to be effective in promoting abstinence and reducing drinking. The use of medication to treat many patients with AUD falls within the scope of primary care providers.
This review contains 6 tables and 54 references.
Key Words: addiction, alcohol, counseling, drinking, pharmacotherapy, primary care, psychotherapy, relapse, treatment