bluuebunny/crossref_metadata_2025 huggingface dataset:
Négociation et distribution des savoirs en audience pour l’asile
Authors: Bouhamidi Lou
Published: September 2022

Cette communication se donne pour objectif de montrer comment la hiérarchie épistémique manifeste en audition pour l’asile se voit négociée, voire renversée par les demandeurs d’asile, avocats, et agents décisionnaires. Envisager la demande d’asile à l’aune du concept de rite d’institution (Bourdieu, 1982) permet de définir et de situer ces relations de pouvoir à l’oeuvre. À partir de plusieurs documents (des comptes-rendus d’entretien à l’OFPRA et la transcription d’une plaidoirie) et à travers une approche ethnographique, je me propose d’analyser les types de connaissances légitimes ou non en audience pour l’asile. Mon étude révèle que la connaissance précise du droit, les critères de recevabilité du récit de vie requis par la procédure, le pays d’origine du demandeur ainsi que les habitus professionnels partagés importent particulièrement dans la détermination du statut de réfugié. De plus, en tant que maillon de cette chaine sociolinguistique des savoirs, l’avocat joue un rôle important dans le changement du statut de l’information, convertissant des données épistémiques en données argumentatives.
Begegnungsclown für demenziell erkrankte Menschen
Authors: Flores Simone
Published: September 2022

Als Begegnungsclown Berta Bohnesupp besuche ich Menschen in regionalen Pflegeeinrichtungen und nehme sie mit auf eine Weltreise der Erinnerungen. Um Zugang zu den Bewohnern zu finden, ist es unter anderem wichtig, sich auf Unbekanntes und Unerwartetes einzulassen. Dadurch entstehen Inseln des Vertrauens und herzerwärmende Begegnungen.
Das Gezeitenmodell im Maßregelvollzug
Authors: Herwig Gitte
Published: September 2022

Ist Recovery im Maßregelvollzug nur ein Mythos oder tatsächlich möglich? Im Interview schildern eine pflegerische Stationsleitung und eine Pflegefachverantwortliche wie der Paradigmenwechsel von der klinischen Recovery zur persönlichen Recovery mithilfe des Gezeitenmodells gelingen kann.
Management of Massive Pulmonary Embolism
Authors: Polaková Eva , Veselka Josef
Published: September 2022

Pulmonary embolism is a potentially lethal manifestation of venous thromboembolic disease. It is one of the three main causes of cardiovascular morbidity and mortality in developed countries. Over the years, better diagnostic and risk stratification measures were implemented. A generous range of new treatment options is becoming available, particularly for management of massive pulmonary embolism. Nonetheless, clinicians often face uncertainty in clinical practice due to lack of scientific support for available treatment options. The aim of this article is to review management of massive pulmonary embolism.
Random lasing approach could probe progression of Huntington’s disease
Authors: Patrick Chris
Published: September 2022

The technique can differentiate healthy mouse brains from those with Huntington’s disease.
Final report on key comparison APMP.M.P-K7.3 in hydraulic gauge pressure from 10 MPa to 100 MPa
Authors: Wongthep Padipat , Kajikawa Hiroaki , Changpan Tawat , Sainoo Likit , Khamnounsak Chaveng , Kobata Tokihiko , Ega Adindra Vickar , Samodro R Rudi Anggoro , Thang Nguyen Nam , Tuan Hoang Le , Manalo Radley F , Salazar Maryness I
Published: September 2022

Main text

This report describes the results of a key comparison among hydraulic high pressure standards that have been maintained by seven National Metrology Institutes (NMIs: NIMT, NMIJ/AIST, NPLI, RCM-LIPI, NMIM, VMI and NMLPHIL). This comparison was carried out during the period March 2016 to October 2017 within the framework of the Asia-Pacific Metrology Programme (APMP) in order to determine their degrees of equivalence in the pressure range from 10 MPa to 100 MPa, gauge mode. The pilot institute was the National Institute of Metrology (Thailand) (NIMT). All participating institutes used hydraulic pressure balance as their pressure standards. In order to ensure reliability, two high precision pressure transducers were used as the transfer standard. The sensing element of the transducers was a precision quartz crystal resonator attached to a small Bourdon tube. During the comparison, the transfer standard was calibrated at the pilot institute two times, before and after circulating the transfer standard to participants. From the two NIMT calibration results, the transfer standard was sufficiently stable to meet the requirements of the comparison. The long-term instability obtained from the two calibration results was taken into account as the uncertainty of the transfer standard for all participants. As the matter of fact NPL India and NMIM participated in this comparison as one of the linkage institutes and participating institutes, respectively. However, it was found later that the systems of hydraulic pressure balance reference standards used in this comparison were not functioning. Therefore, the comparison results were withdrawn. The degrees of equivalence of each national measurement standard were expressed quantitatively by deviations from the key comparison reference value of the corresponding CCM key comparison, CCM.P-K7 through the linkage institute, NMIJ/AIST. In conclusion, the hydraulic pressure standards in the range 10 MPa to 100 MPa, gauge mode of the five participating NMIs were found to be equivalent within their claimed uncertainties.

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database https://www.bipm.org/kcdb/.

The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
High-performance HV-CMOS sensors for future particle physics experiments — an overview
Authors: Zhang C. , Casse G. , Franks M. , Hammerich J. , Karim N. , Powell S. , Vilella E. , Vossebeld J.
Published: September 2022

HV-CMOS (High Voltage-CMOS) sensors are emerging as a prime candidate for future tracking detectors that have extreme requirements on material budget, pixel granularity, time resolution and radiation tolerance. These sensors have the advantages of full monolithic structure, low manufacture cost, fast charge collection and high radiation tolerance. Confirmed and potential tracking applications in physics experiments include the Mu3e experiment, proton EDM searches, future upgrades of LHC (Large Hadron Collider) and CEPC (Circular Electron Positron Collider). The HV-CMOS group at Liverpool is doing generic R&D to push the boundaries of HV-CMOS sensors performance, especially in terms of single point resolution, fast-timing capability and radiation tolerance. This contribution gives an overview of the latest research by the Liverpool HV-CMOS group and presents the HV-CMOS prototypes developed in Liverpool.
“RIPTIDE” — an innovative recoil-proton track imaging detector
Authors: Massimi C. , Musumarra A. , Leone F. , Pellegriti M.G. , Romano F. , Spighi R. , Villa M.
Published: September 2022

Neutron detectors perform key tasks in many research fields as nuclear, particle and astroparticle physics as well as neutron dosimetry, radiotherapy, and radiation protection. Neutron detectors exhibiting tracking capability are still missing, although several approaches to neutron momentum reconstruction have been proposed. In this context, we aim at developing a novel RecoIl-Proton Track Imaging DEtection system “RIPTIDE”, in which the light output of a fast scintillation signal is used to perform a complete reconstruction in space and time of the neutron-proton elastic scattering. The 3D track reconstruction is going to be implemented by state-of-the-art high-sensitivity imaging detector (CMOS, MCP-Timepix). Preliminary Geant4 simulations of the proposed set-up show up a good detection efficiency in a compact active volume. The envisaged electronic readout can be easily adapted according to a specific application (event-by-event mode or integration mode). The system can be rescaled by increasing the detection volume or by combining several detection modules. Further developments of the basic detection technique can be adapted for fast charged particle detection tracking as well.
Suppression of electrical breakdown phenomena in liquid TriMethyl Bismuth based ionization detectors
Authors: Gerke Björn , Peters Simon-Nis , Marquardt Nils , Huhmann Christian , Hannen Volker Michael , Holtkamp Michael , Karst Uwe , Yvon Dominique , Sharyy Viatcheslav , Weinheimer Christian , Schäfers Klaus
Published: September 2022

Organometallic liquids provide good properties for ionization detectors. TriMethyl Bismuth
(TMBi) has been proposed as a detector medium with charge and Cherenkov photon readout for
Positron Emission Tomography. In this work, we present studies for the handling of TMBi at
different electric fields and under different environmental conditions to find applicable
configurations for the suppression of electrical breakdowns in TMBi at room temperature. A simple
glass cell with two electrodes filled with TMBi was constructed and tested under different
operation conditions. Working at the vapour pressure of TMBi at room temperature of about
40 mbar and electric fields of up to
20 kV/cm
in presence of a small oxygen contamination
we found the formation of a discharge channel in the liquid and a steady increase in the
current. Further reduction of pressure by pumping caused the TMBi to boil and a spontaneous
combustion. Eliminating the oxygen contamination led the TMBi under the same condition to only
decompose. When operating the setup under an argon atmosphere of 1 bar we did not observe
breakdowns of the electrical potential up to field strengths of 20 kV/cm. Still, in
presence of a small oxygen contamination fluctuating currents in the nA range were observed, but
no decomposition or combustion. We conclude from our experiments that TMBi at room temperature in
a pure argon atmosphere of 1 bar remains stable against electrical breakdown at least up to
electric field strengths of 20 kV/cm, presumably because the formation of gaseous TMBi was
prevented.
Can distribution grid infrastructure accommodate residential electrification and electric vehicle adoption in Northern California?
Authors: Elmallah Salma , Brockway Anna M , Callaway Duncan
Published: September 2022

In this paper we ask: in what ways will utilities need to upgrade the electric distribution grid to accommodate electrified loads, and what will those upgrades cost? Our study focuses on the PG&E service area in Northern California, which serves 4.8 million electricity customers and is subject to aggressive targets for both EV adoption and electrification of residential space and water heating. We create spatio-temporally detailed electricity demand forecasts, and compare that demand to distribution infrastructure limits across a range of technology adoption scenarios. We find that electrification of residential space and water heating will lead to fewer impacts on distribution feeder capacity than EV charging, but that both transitions will require an acceleration of the current pace of upgrades. We also find that timing and location have a strong influence on total capacity additions in important ways: for example, scenarios that favor daytime EV charging have similar impacts to those with managed nighttime residential charging, but uncontrolled nighttime residential charging could have significantly larger impacts. We project that these upgrades will add at least $1 billion and potentially over $10 billion to PG&E’s rate base. We conclude that measures that enable the completion of a high number of upcoming upgrade projects—including addressing workforce and supply chain constraints, and pursuing non-wires alternatives like energy storage and demand response—are critical to successful electrification.
Utility of an integrated health system specialty pharmacy in provision of extended-release buprenorphine for patients with opioid use disorder
Authors: Shah Rushabh , Hendrickson Sarah , Fanucchi Laura , Lofwall Michelle , Platt Thom , Rhudy Christian
Published: September 2022

Purpose

Extended-release (ER) monthly injectable buprenorphine offers an alternative to daily sublingual (SL) dosing for treatment of opioid use disorder (OUD) that may be attractive to several patient populations, including those with barriers to adherence and the frequent follow-up that are necessary for traditional SL buprenorphine. Despite the potential benefits of ER-buprenorphine, there are significant barriers to healthcare provider adoption that may prevent utilization in the populations that would benefit.

Our health system began providing clinic-administered ER-buprenorphine as treatment for OUD in May 2018 at a single clinic. Expansion was limited due to difficulties with delayed and inaccurate medication delivery and heavy administrative burden. To facilitate uptake of ER-buprenorphine for patients who could benefit, our integrated health-system specialty pharmacy (HSSP) assumed responsibility for medication distribution and administrative management beginning in October 2019. The HSSP provided accurate medication delivery, alleviated administrative burdens of benefits investigation and Risk Evaluation and Mitigation Strategy compliance, and decreased medication wastage by implementing a medication return process. Subsequently, ER-buprenorphine services were expanded to 4 additional sites, allowing 244 more patients to receive treatment.

Conclusion

HSSP support can provide significant benefit to patients and the health system through coordinating ER-buprenorphine dispensing and delivery.
Social work practice with self-neglect and homelessness: Findings from vignette-based interviews
Authors: Harris Jess , Martineau Stephen , Manthorpe Jill , Burridge Stan , Ornelas Bruno , Tinelli Michela , Cornes Michelle
Published: September 2022

This article reports social workers’ attitudes and approaches to working with people experiencing multiple exclusion homelessness (MEH) who self-neglect, and whether these people receive services, including safeguarding, differently from other populations. It draws on telephone interviews in 2020 with twenty-two social workers working with adults in a range of statutory local authority and National Health Service hospital roles in England. Interviews used two almost identical vignettes featuring self-neglect to prompt discussion and solicit experiences; one included homelessness and drug use to draw out any differences. Following transcription, interview data were analysed thematically. What emerged is a rich understanding of practice responses to self-neglect, but also uncertainties within contemporary social work: whether people who are homeless fall under the ‘umbrella’ of Adult Social Care and safeguarding; and whether self-neglect ‘fits’ under safeguarding. Additionally, participants described barriers to successful multi-agency support for people experiencing MEH, including stigma and exclusion from some statutory services. There was evidence that recent learning from Safeguarding Adults Reviews and local deaths has led to some examples of stronger multi-agency working in this context. The findings suggest more clarity is needed within the profession to ensure that people experiencing MEH benefit from strengthened social work input and safeguarding expertise.
Policy Uncertainty and Information Flows: Evidence from Pension Reform Expectations*
Authors: Ciani Emanuele , Delavande Adeline , Etheridge Ben , Francesconi Marco
Published: September 2022

We examine how workers’ expectations about pension reform vary with proximity to reforms, information availability and worker characteristics. Using newly collected data, we find that (1) expectations about reform are revised upward by about 10 percentage points in the year prior to a reform, from a median of 50%, regardless of whether the reform is announced; (2) expectations increase more the stronger the media activity about imminent reforms; (3) the effect of information on expectations varies systematically with characteristics that proxy cognitive ability and information value; (4) expectations do not converge as a result of reform announcements or implementations.
Market Participation and Moral Decision-Making: Experimental Evidence from Greenland
Authors: Agneman Gustav , Chevrot-Bianco Esther
Published: September 2022

The relationship between market participation and moral values is the object of a long-lasting debate in economics, yet field evidence is mainly based on cross-cultural studies. We conduct rule-breaking experiments in 13 villages across Greenland (N = 543), where stark contrasts in market participation within villages allow us to examine the relationship between market participation and moral decision-making, holding village-level factors constant. First, we document a robust positive association between market participation and moral behaviour towards anonymous others. Second, market-integrated participants display universalism in moral decision-making, whereas non-market participants make more moral decisions towards co-villagers. A battery of robustness tests confirms that the behavioural differences between market and non-market participants are not driven by socioeconomic variables, childhood background, cultural identities, kinship structure, global connectedness and exposure to religious and political institutions.
Efficacy of the Stroll Safe Outdoor Fall Prevention Program: A Randomized Controlled Trial
Authors: Chippendale Tracy , Albert Steven M , Mahmood Atiya
Published: September 2022

Background and Objectives

Outdoor falls can negatively affect the independence and well-being of community-dwelling older adults. Although there is some overlap, there are also differences in risk factors for indoor and outdoor falls. There are no existing community-based fall prevention programs that specifically target outdoor fall prevention. To fill this gap, the Stroll Safe program was developed.

Research Design and Methods

A cluster-randomized controlled trial design was used with randomization at the site level. Participants (N = 86) were aged 60 and older, with a history of an outdoor fall or who had a fear of falling outdoors. Eight naturally occurring retirement community program sites were randomly assigned to the treatment or wait list control group. Outcome measures included the Outdoor Falls Questionnaire, the Falls Behavioral Scale for the Older Person, and the Falls Efficacy Scale-International to examine knowledge of risks, safe strategy use, protective behaviors, and fear of falling. An Analysis of Covariance (ANCOVA) was used to compare change scores between groups with covariates included for any initial differences between groups. A linear mixed model was also conducted to account for any clustering effects.

Results

Significant differences (ps < .05) were found between groups for knowledge of outdoor fall risks and safe strategy use. Effect sizes were large (Cohen’s d = 1.2–1.9). Results were retained at 6-week follow-up.

Discussion and Implications

Stroll Safe is effective in improving knowledge of outdoor fall risks and increasing safe strategy use for community mobility. Stroll Safe fills a gap in outdoor fall prevention programs.

Clinical Trials Registration Number: NCT03624777
Iterative prior resampling and rejection sampling to improve 1-D geophysical imaging based on Bayesian evidential learning (BEL1D)
Authors: Michel Hadrien , Hermans Thomas , Nguyen Frédéric
Published: September 2022

The non-uniqueness of the solution of inverse geophysical problem has been recognized for a long-time. Although stochastic inversion methods have been developed, deterministic inversion using subsequent regularization is still more widely applied. This is likely due to their efficiency and robustness, compared to the computationally expensive and sometimes difficult to tune to convergence stochastic methods. Recently, Bayesian evidential learning 1-D imaging has been presented to the community as a viable tool for the efficient stochastic 1-D imaging of the subsurface based on geophysical data. The method has been proven to be as fast, or sometimes even faster, than deterministic solution. However, the method has a significant drawback when dealing with large prior uncertainty as often encountered in geophysical surveys: it tends to overestimate the uncertainty range. In this paper, we provide an efficient way to overcome this limitation through iterative prior resampling (IPR) followed by rejection sampling. IPR adds the posterior distribution calculated at a former iteration to the prior distribution in a subsequent iteration. This allows to sharpen the learning phase of the algorithm and improve the estimation of the final posterior distribution while rejection sampling eliminates models not fitting the data. In this contribution, we demonstrate that this new approach allows BEL1D to converge towards the true posterior distribution. We also analyse the convergence behaviour of the algorithm and derive guidelines for its application. We apply the approach for the interpretation of surface waves dispersion curves but the approach can be generalized to other geophysical methods.
Suppressive mechanisms of regulatory B cells in mice and humans
Authors: Matsumura Yutaka , Watanabe Rei , Fujimoto Manabu
Published: September 2022

B cells include immune-suppressive fractions, called regulatory B cells (Bregs), which regulate inflammation primarily through an interleukin 10 (IL-10)-mediated inhibitory mechanism. Several B-cell fractions have been reported as IL-10-producing Bregs in murine disease models and human inflammatory responses including autoimmune diseases, infectious diseases, cancer and organ-transplant rejection. Although the suppressive functions of Bregs have been explored through the hallmark molecule IL-10, inhibitory cytokines and membrane-binding molecules other than IL-10 have also been demonstrated to contribute to Breg activities. Transcription factors and surface antigens that are characteristically expressed in Bregs are also being elucidated. Nevertheless, defining Bregs is still challenging because their active periods and differentiation stages vary among disease models. The identity of the diverse Breg fractions is also under debate. In the first place, since regulatory functions of Bregs are mostly evaluated by ex vivo stimulation, the actual in vivo phenotypes and functions may not be reflected by the ex vivo observations. In this article, we provide a historical overview of studies that established the characteristics of Bregs and review the various suppressive mechanisms that have been reported to be used by Bregs in murine and human disease conditions. We are only part-way through but the common phenotypes and functions of Bregs are still emerging.
Intensity-modulated irradiation for superficial tumors by overlapping irradiation fields using intensity modulators in accelerator-based BNCT
Authors: Sasaki Akinori , Hu Naonori , Takata Takushi , Matsubayashi Nishiki , Sakurai Yoshinori , Suzuki Minoru , Tanaka Hiroki
Published: September 2022

The distribution of the thermal neutron flux has a significant impact on the treatment efficacy. We developed an irradiation method of overlapping irradiation fields using intensity modulators for the treatment of superficial tumors with the aim of expanding the indications for accelerator-based boron neutron capture therapy (BNCT). The shape of the intensity modulator was determined and Monte Carlo simulations were carried out to determine the uniformity of the resulting thermal neutron flux distribution. The intensity modulators were then fabricated and irradiation tests were conducted, which resulted in the formation of a uniform thermal neutron flux distribution. Finally, an evaluation of the tumor dose distribution showed that when two irradiation fields overlapped, the minimum tumor dose was 27.4 Gy-eq, which was higher than the tumor control dose of 20 Gy-eq. Furthermore, it was found that the uniformity of the treatment was improved 47% as compared to the treatment that uses a single irradiation field. This clearly demonstrates the effectiveness of this technique and the possibility of expanding the indications to superficially located tumors.
Disability in the Premodern Arab World
Authors: Scalenghe Sara
Published: September 2022

Arab Sunni Muslim discourses and experiences of physical and sensory impairments are surveyed from the rise of Islam in the seventh century until about 1800. The geographical focus of this discussion, which is primarily a function of the available scholarship, is Egypt and Greater Syria, the area that corresponds roughly to today’s Syria, Lebanon, Jordan, and Israel and the Palestinian territories. Impairments appear frequently in premodern Arabic writings, especially in literature, chronicles, biographies and autobiographies, legal texts, and medical compendia, leaving the reader with the impression that people with impairments were everywhere in the Arab world. Yet, to date only a handful of articles and two historical monographs about the Arab world are explicitly situated within the field of disability history. This chapter provides a new benchmark on which historians of disability working in the Arab world can build in future studies.
Social History of Medicine and Disability History
Authors: Kudlick Catherine
Published: September 2022

Disability history and social history of medicine are two subfields that share many common topics and sources but that approach them very differently. For medical historians, disability takes center stage as a problem that requires fixing, and the “victims” are primarily patients. For disability historians, disability suggests not just the person or practitioner, but also a unique understanding of all the elements, including politics, economics, and culture, that shape relationships for the disabled. Following a brief history of each subfield, two examples are presented—responses to epidemics and the idea of cure—to discuss how scholars can be in more productive conversation. As is demonstrated here, disability is not just a topic to be studied, but rather a tool of analysis. While the distinctive roots and purposes of the two subfields ensure that they will always be fundamentally incompatible, they can, and should, engage in productive conversation.
Documents, Ethics, and the Disability Historian
Authors: Richards Penny , Burch Susan
Published: September 2022

The factors driving research into disability history methodology in its practical dimensions (such as finding and analyzing sources and presenting findings), the cultural values that inform it, and who populates intended audiences all contribute to the invisible infrastructure of historical production. When historians of disability access a rich source of data, they also must ask who created it, who benefited from its preservation, and whose stories are left untold. Sharing knowledge—through preservation and dissemination—equally shapes disability historical work. In all of this, access and accessibility—from built spaces and source types to research aids and scholarly products—remain paramount. Ways to proceed with sensitivity and creativity in the exploration of disabled peoples’ and disability’s pasts are presented from the perspective of the United States.
Disability and Work in British West Africa
Authors: Grischow Jeff
Published: September 2022

World War II significantly affected the development of disability programs in British West Africa during the late colonial period. Beginning in the early 1940s, Britain’s Colonial Office worked with the West African governors to develop rehabilitation programs for disabled African veterans. In Britain, rehabilitation for disabled veterans took the form of social orthopedics, which equated citizenship with the ability to work; British programs therefore prioritized reintegration into the workforce as the main goal of rehabilitation. The colonial programs attempted to transfer the social orthopedics program to Africa. The project failed because the African veterans did not want to be remade into productive workers on the Western/capitalist model. However, it did produce two lasting legacies: the creation of a network of Disabled People’s Organizations during the 1950s and 1960s, and the development of a successful onchocerciasis control program between 1974 and 2002.
Deaf-Blindness and the Institutionalization of Special Education in Nineteenth-Century Europe
Authors: Vierestraete Pieter , Söderfeldt Ylva
Published: September 2022

Careful analysis of underexplored and neglected case studies demonstrates how an initial interest in the behavior and constitution of early-nineteenth-century deaf-blind persons gradually made possible a professional and impersonal approach. The deaf-blind person in the early nineteenth century had been a creature of mostly unrefined, but therefore authentic, sensory experience, whose reduction to the supposedly simpler senses of smell, touch, and taste made the basic nature of humankind appear more clearly. In contrast, the educated deaf-blind person later in the century was a vessel for the display of pedagogic expertise. The institutionalization of special education for deaf-blind persons in western Europe thus can be characterized by a shift from listening to the “sound” of deaf-blind persons to a mere repetition of the discursive “noise” of professionals.
Disability and Madness in Colonial Asylum Records in Australia and New Zealand
Authors: Coleborne Catharine
Published: September 2022

Case records examined here are those of inmates in two public institutions for the insane in colonial Victoria, Australia, and in Auckland, New Zealand, between 1870 and 1910. In the international field of mental health studies and histories of psychiatry, intellectual disability has been the subject of detailed historical inquiry and forms part of the critical discussion about how institutions for the “insane” housed a range of inmates in the nineteenth century. Yet the archival records of mental hospitals have rarely been examined in any sustained way for their detail about the physically disabled or those whose records denote bodily difference. References to the physical manifestations of various forms of intellectual or emotional disability, as well as to bodily difference and “deformity,” were part of the culture of the colonial institution, which sought to categorize, label, and ascribe identities to institutional inmates.
Prevalence, clinico-laboratory features, and the functional outcome of children with scrub typhus meningoencephalitis—a cohort study
Authors: Baidya Amitava , Gunasekaran Dhandapany , Dhodapkar Rahul , Parameswaran Narayanan , Kaliaperumal Venkatesh
Published: September 2022

Scrub typhus is being reported as the most common cause of childhood meningoencephalitis (ME) in India. Hence, we planned to estimate the proportion of scrub typhus infection among children aged 1 month to 12 years with the clinical diagnosis of ME and to evaluate their demographic, clinical and laboratory characteristics. This cohort study was conducted in the Department of Pediatrics of a tertiary care teaching hospital in south India. One hundred and twenty-seven consecutive children aged 1 month to 12 years with the clinical diagnosis of ME were the participants. Their socio-demographic factors, clinical details, laboratory reports and outcomes were analyzed. The etiological agent was identified in 71 (56%) children. Orientia tsutsugamushi (Scrub typhus) was the most common infection (24.4%), of all children with ME. Children aged ≥5 years were frequently affected by scrub typhus ME. Eschar, capillary leak, hepatomegaly and splenomegaly were the predominant clinical features of scrub typhus ME. Thrombocytopenia and deranged liver function tests were common in scrub typhus ME. To conclude, Orientia tsutsugamushi was the most common organism identified in our study. Prompt recognition of some tell-tale clinical signs of scrub typhus (such as eschar, thrombocytopenia and hepatosplenomegaly), and timely initiation of antibiotics would lead to better outcomes as evident from the study.
Comparing the effect of different loading doses of phenobarbitone on serum phenobarbitone levels in babies with neonatal seizures and effect of therapeutic hypothermia on phenobarbitone levels
Authors: Palaparthy Vinod , Kumar Manish , Rebekah Grace , Thomas Niranjan
Published: September 2022

Background

With current recommendation for phenobarbitone dosing, we have noted that babies are extremely sedated with elevated serum phenobarbitone levels. We postulate that asphyxiated neonates with hypoxic liver injury have impaired drug metabolism and renal injury affects drug elimination, thus elevating serum drug levels. Therapeutic hypothermia (TH) could further affect the drug levels.

Objective

To determine the serum levels of the phenobarbitone in babies receiving different loading doses of phenobarbitone for neonatal seizures and to study the effect of asphyxia and TH on drug levels.

Design

Prospective observational cohort study.

Material and methods

Term neonates with seizures of any cause were given phenobarbitone up to a maximum loading of 40 mg/kg followed by maintenance dose of 5 mg/kg/day. Serum phenobarbitone levels were assessed after 4 h of the initial loading dose and subsequently at 24, 48 and 72 h from the time after maximum loading dose. Babies were divided into three groups Group 1 (HIE + TH—hypoxic ischemic encephalopathy undergoing TH), Group 2 (HIE − TH—hypoxic ischemic encephalopathy without TH) and Group 3 (non-HIE group).

Results

A total of 47 babies completed the study. Twenty-three (49%) received 20 mg/kg, 14 (30%) received 30 mg/kg and 10 (21%) received 40 mg per kg of phenobarbitone as loading dose. HIE was the major cause of seizures 28 (59%) followed by hypoglycemia 7 (14%), cerebral malformations 4 (8%), inborn errors of metabolism 2 (4%) and hypocalcemia 1 (2%) while the cause of seizures was not known in 6 (13%). Median (IQR) Phenobarbitone levels at 72 h in babies who received 20 mg/kg loading dose of phenobarbitone was 46.72 (44.02–50.49) mcg/ml in HIE + TH group, 40.53 (28.66–65.09) mcg/ml in HIE − TH group and 49 (37–65) mcg/ml in non-HIE group. After a loading dose of 30 mg/kg, phenobarbitone level was 63.76 (59.5–65.94) mcg/ml in HIE + TH group, 42.5 (34.75–48.75) mcg/ml in HIE − TH group and 42.07 (40–49.05) mcg/ml in non-HIE group. After 40 mg/kg loading dose, it was 62.3 (60.2–64.9) mcg/ml in HIE + TH group, 57.0 (49.8–60.2) mcg/ml in HIE − TH group and 48.15 (40.8–50.97) mcg/ml in non-HIE group. In babies who received >20 mg/kg loading dose, 100% of HIE + TH, 80% of HIE − TH and 60% of non-HIE had supratherapeutic levels of phenobarbitone.

Conclusion

At higher loading doses of 30 and 40 mg/kg, steady state concentration of serum phenobarbitone is higher in babies with hypoxic ischemic encephalopathy who underwent TH than in babies with non-HIE causes of seizures. Loading dose beyond 20 mg/kg should be used with close monitoring of serum drug level
The Future of Spine Care Innovation - Software not Hardware: How The Digital Transformation Will Change Spine Care Delivery
Authors: Simpson Andrew K. , Crawford Alexander M. , Striano Brendan M. , Kang James D. , Schoenfeld Andrew J.
Published: September 2022

Study Design.

Narrative review.

Objective.

To utilize the lessons from the digital transformation of industries beyond healthcare, weigh the changing forces within the healthcare ecosystem, and provide a framework for the likely state of spine care delivery in the future.

Summary of Background Data.

Advances in technology have transformed the way in which we as consumers interact with most products and services, driven by devices, platforms, and a dramatic increase in the availability of digital data. Spine care delivery, and much of healthcare in general, has lagged far behind, hamstrung by regulatory limitations, narrow data networks, limited digital platforms, and cultural attachment to legacy care delivery models.

Methods.

We present a narrative review of the current state of the spine field in this dynamic and evolving environment.

Results.

The past several decades of spine innovation have largely been driven by “hardware” improvements, such as instrumentation, devices, and enabling technologies to facilitate procedures. These changes, while numerous, have largely resulted in modest incremental improvements in clinical outcomes. The next phase of growth in spine care, however, is likely to be more reflective of the broader innovation ecosystem that has already transformed most other industries, characterized by improvements in “software”, including: (1) leveraging data analytics with growing electronic health records databases to optimize interactions between patients and providers, (2) expanding digital and telemedicine platforms to create integrated hybrid service lines, (3) data modeling for patient and provider decision aids, (4) deploying provider and service line performance metrics to improve quality, and (5) movement toward more free market dynamics as patients increasingly move beyond legacy limited health system networks.

Conclusion.

Spine care stakeholders should familiarize themselves with the concepts discussed in this review, as they create value for patients and are also likely to dramatically shift the spine care delivery landscape.
Generalization of pain-related avoidance behavior based on de novo categorical knowledge
Authors: Glogan Eveliina , Gatzounis Rena , Bennett Marc Patrick , Holthausen Katharina , Meulders Ann
Published: September 2022

People with chronic pain often fear and avoid movements and activities that were never paired with pain. Safe movements may be avoided if they share some semantic relationship with an actual pain-associated movement. This study investigated whether pain-associated operant responses (movements) can become categorically associated with perceptually dissimilar responses, thus motivating avoidance of new classes of safe movements—a phenomenon known as category-based avoidance generalization. Using a robotic arm, 2 groups were trained to categorize arm movements in different ways. Subsequently, the groups learned through operant conditioning that an arm movement from one of the categories was paired with a high probability of pain, whereas the others were paired with either a medium probability of pain or no pain (acquisition phase). Self-reported pain-related fear and pain expectancy were collected as indices of fear learning. During a final generalization test phase, the movements categorically related to those from the acquisition phase were made available but in the absence of pain. Results showed that the generalization of outcome measures depended on the categorical connections between arm movements, ie, the groups avoided and feared the novel generalization movement categorically related to the pain-associated acquisition movement, depending on how they had previously learned to categorize the movements. This suggests that operant pain-related avoidance can generalize to safe behaviors, which are not perceptually, but categorically, similar to a pain-associated behavior. This form of pain-related avoidance generalization is problematic because category-based relations can be extremely wide reaching and idiosyncratic. Thus, category-based generalization of operant pain-related avoidance merits further investigation.
Effectiveness of an integrative medicine approach to improve cognitive dysfunction and dementia: An observational study
Authors: Lee Ji Hyun , Kim Man Gi , Kim Do Yeun , Shin Hye-Won , Kang Hakmook , Koo Byung Soo , Kim Kwang Ki
Published: September 2022

Despite the urgent need to control dementia, an effective treatment has yet to be developed. Along with the Korean government’s policy of cooperation between conventional medicine (CM) and Korean medicine (KM), integrative medical services for dementia patients are being provided. This study aimed to compare the integrative medical clinic (IMC) for dementia used by Dongguk University Hospitals (DUH) with other service models and to review the characteristics and treatment outcomes of patients who had visited DUH over the past 5 years. Patients’ electronic medical records from May 2015 to June 2020 were searched and their data were analyzed to evaluate the IMC’s service model. Patient demographic and clinical characteristics, diagnostic tests, and treatment patterns for CM and KM were collected. The proportion of patients who did not show worsening cognitive function was described in detail. A strength of the DUH integrative medicine clinic is its ability to manage both KM and CM patients in the same space at the same time. Among the 82 patients who visited the clinic during our study period, 56 remained for data analysis after we excluded patients who met the exclusion criteria; nineteen patients had diagnoses of mild cognitive impairment. Among collaboration patterns, the first visit to the IMC had the highest proportion (55.4%). Among diagnosed tests in CM, laboratory tests and neuropsychological tests were used the most. In KM, a heart rate variability test was frequently used. The most common CM treatment prescribed was anticonvulsants, with 22 patients (39.2%) receiving donepezil, whereas the most frequent KM treatments were acupuncture (82.1%) and herbal medicine (78.6%). Twelve patients were followed up with the Mini-Mental State Examination, and 8 demonstrated either no worsening or improved cognition (baseline Mini-Mental State Examination range: 21–26). All 8 patients had mild cognitive impairment including 6 with amnestic, multidomain impairment. This study searched for a way to improve cognitive dysfunction and dementia using an integrative approach, and it shows promising results for mild cognitive impairment. However, more precisely designed follow-up studies are needed to address the present work’s limitations of a retrospective study design and a small sample size.
Meta-analysis of the effect of sodium-dependent glucose transporter 2 inhibitors on C-reactive protein in type 2 diabetes
Authors: Sun Wenwen , Xing Yuling , Kong Dexian , Zhang Zhimin , Ma Huijuan , Yang Linlin
Published: September 2022

Background:

As novel hypoglycemic drugs, the effects of sodium-dependent glucose transporter 2 inhibitors (SGLT-2I) on inflammatory factors such as C-reactive protein (CRP) remain unclear.

Methods:

We conducted a meta-analysis of studies on SGLT-2I in the treatment of type 2 diabetes (T2DM) to observe the changes of CRP in patients with T2DM. We searched 4 electronic databases (CNKI, PubMed, EMBASE, and Cochrane Library) for articles published up to December 31, 2021. Studies were analyzed using a random-effects model to obtain standard deviation mean differences (SMDs) and 95% confidence intervals (CIs). Sensitivity and subgroup analyses were performed. Publication bias was evaluated using funnel plots and Egger test.

Results:

We included data from 927 patients in 13 confirmatory trials that showed a significant decrease in CRP among patients with T2DM treated with SGLT-2I. The decrease was more significant with than without SGLT-2I. In subgroup analysis according to nationality, medication, and comorbidities, CRP reduction was associated with nationality, SGLT-2I type, and the presence of comorbidities. Sensitivity analysis showed that our results were reliable and found no evidence of substantial publication bias.

Conclusions:

SGLT-2I could reduce CRP levels in patients with T2DM.

Registration:

International Prospective Register for Systematic Reviews (PROSPERO) number CRD42021268079.
Roles of activator protein-2 gamma in breast cancer: A narrative review (SANRA)
Authors: Zhang Yifei , Mostafa Asal AA , Sriboonvorakul Natthida , Hu Jiamiao
Published: September 2022

Activator protein-2 gamma (AP-2γ) is a crucial transcription factor involved in breast cancer development. Abnormal expression and activity of AP-2γ have also been identified as important markers of malignancy. In the last decade, the importance of AP-2γ in breast cancer progression has been widely studied. In this review, we summarize the current knowledge on the regulatory roles of AP-2γ in breast cancer oncogenesis and progression and its potential as a diagnostic biomarker and drug target in breast cancer treatment.
Correlation between serum levels of microRNA-21 and inflammatory factors in patients with chronic heart failure
Authors: Li Weiwei , Li Yanan , Jiang Feng , Liu Huan
Published: September 2022

As the leading cause of hospitalization and mortality worldwide, heart failure (HF) has caused significant burden on both individuals and the whole society. Thus, increasing knowledge about the phytopathology of HF is in demand for both diagnosis and treatment. Previous studies have shown that both microRNA 21 (miRNA-21) and inflammatory factors are closely related to the development of cardiac fibrosis, hypertrophy, and HF. However, whether there is any crosstalk between the 2 has not been examined. The current study evaluated the correlation between serum levels of miRNA-21 and critical inflammatory factors during the progress of chronic heart failure (CHF), providing new insights in understanding the physiopathology of CHF and identifying CHF biomarkers. In the presented study, serum level of miR-21, cardiac neurohormone, and critical inflammatory factors were measured and compared on 120 (67 male/53 female) CHF patients and 100 (58 male/42 female) health people with non-failing hearts. Echocardiography was also conducted to assess the severity of CHF. Correlations between different factors were calculated and tested for statistical significance. From our results, CHF patients showed significantly decreased serum levels of miR-21 while increased levels of inflammatory factors and cardiac neurohormone (P < .05). Levels of miR-21 negatively correlate with cardiac function while positively correlates with myocardial remodeling (P < .05). Levels of miR-21 negatively correlate with inflammation in CHF (P < .05). These findings indicate the potential crosstalk between serum miR-21 and inflammation during CHF progression, suggesting the potential of miR-21 in CHF diagnosis, severity indication, and treatment.
Relationship between physical fitness and arterial stiffness in Korean older adults
Authors: Yoo Tae Kyung , Rhim Hye Chang , Park Soo Hyun , Park Saejong , Lee Jong-Young
Published: September 2022

Pulse-wave velocity (PWV) is a widely used clinical marker of arterial stiffness. Associations between several physical fitness measures and arterial stiffness have been examined. However, these results were inconsistent. Therefore, we conducted a cross-sectional study to assess the relationship between various physical fitness parameters and arterial stiffness in older adults. From January 2014 to December 2015, 1500 participants (men, n = 587; mean age, 71.78 ± 5.10 years) in South Korea were enrolled in the study. Koreans aged >65 years who agreed to participate in the study were enrolled. Individuals who were unable to exercise because of underlying conditions were excluded. VO2 max (mL/kg/min), handgrip strength (kg), handgrip strength (kg)/body weight (kg) ratio, one-leg standing time (s), and 10-meter walking speed (m/s) were measured. The brachial-ankle pulse wave velocity (baPWV) was measured using a VP-1000 instrument. VO2 max (mL/kg/min), handgrip (kg)/body weight (kg) ratio, one-leg standing time (s), and 10-meter walking speed (m/s) were significantly inversely associated with baPWV. This association was consistent even after adjusting for confounding factors. Our study revealed a significant association between various aspects of physical fitness and arterial stiffness. This study suggests that physical fitness is a useful predictor of arterial stiffness in older adults.