bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction Value of SPECT/CT in Avascular Necrosis of Femoral Head After Femur Neck Fracture
Authors: Park Sung Jun , Ko Bong Seong , Moon Kyoung Ho , Lee Minkyung
Published: September 2019

Introduction:

The aim of this study was to determine the diagnostic value of single-photon emission computed tomography/computed tomography (SPECT/CT) in prediction of avascular necrosis (AVN) after femoral neck fracture and to evaluate whether photon defect in femoral head as seen in SPECT/CT can be an index for choice of surgical method.

Methods:

This study was based on 97 patients who took SPECT/CT after femoral neck fracture from November 2012 to November 2017, with 64 patients with femoral intertrochanteric fracture in which chances of AVN is rare as a comparison group. Among 97 patients with femoral neck fracture, osteosynthesis was conducted in 7 patients with less than 15% of photon defect in damaged femoral head and 7 patients who wanted osteosynthesis, despite photon defect more than 15%, and 83 patients with photon defect more than 25% had arthroplasty. Patient with osteosynthesis was followed up with AVN by conducting magnetic resonance imaging (MRI) in 1 year after the surgery.

Results:

Quantitative analysis of SPECT/CT in 14 patients who had femoral neck osteosynthesis showed that 7 patients with femoral neck fracture showed photon defect of 15% or more, but less than 25% and 3 patients in these were diagnosed with AVN after 1-year follow-up by MRI. Sensitivity and specificity of SPECT/CT in predicting AVN was 100% and 63.6%, respectively, with prediction accuracy of 71.4%. Among 14 patients with femoral neck fracture who had osteosynthesis, photon defect in 3 patients diagnosed with AVN was 19.6% ± 5.2%, but photon defect in 11 patients who was not diagnosed with AVN was 10.7% ± 5.2%, showing statistically significant difference between 2 groups ( P = .001).

Conclusion:

Single-photon emission computed tomography/CT in patients with femoral neck fracture is considered to have diagnostic value in predicting occurrence of AVN, and percentage of photon defect is considered to be an useful index in determining the operative method.
Interpreting the Maritime and Overland Trade Regulations of 1882 between Chosŏn and the Qing: How logics of appropriateness shaped Sino–Korean relations
Authors: Park Jung Mee , Wang Chun-Ping
Published: September 2019

Prior research on Qing China’s relationship towards Chosŏn Korea in the late 19th century suggested that China’s influence over Korea was a continuation of the tribute system. However, the Qing’s awareness of Westphalian laws altered Sino–Korean relations. In 1882, Qing China signed the Maritime and Overland Trade Regulations with Chosŏn Korea. Unlike the previous treaties that China signed with western states, the Qing negotiated terms economically beneficial to China in the agreement. The Qing officials determined much of the terms found in the Regulations. The Qing officials had leverage over Chosŏn officials partly because China had amassed cultural capital through centuries of tributary exchanges. The logics of appropriateness (LoA) or ‘bounded rationality’ of the tribute system shaped the Qing’s and Chosŏn’s responses, even in treaty negotiations. We argued that the Regulations reflected the Qing’s attempts to ‘modernize’ tributary relations with Westphalian LoA in light of the Qing’s own domestic crisis. Domestic insurrections such as the Taiping Rebellion led members of the self-strengthening ( Ziqiang) movement to focus on foreign affairs and adopt Westphalian international laws. The Qing’s goals to self-strengthen via an unequal agreement with Chosŏn, however, failed when westerners criticized China’s perceived suzerain authority over Korea. The criticisms highlighted the cleavages between the tributary and Westphalian systems as individuals attempted to justify their roles within these institutions.
Performance of PROMIS Computer Adaptive Testing As Compared With Established Instruments for Multiple-Ligament Knee Injuries
Authors: Trasolini Nicholas A. , Korber Shane , Gipsman Aaron , San Austin E. , Weber Alexander E. , Hatch George F. “Rick”
Published: September 2019

Background:

The Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) is a patient-reported outcome metric that has been validated for anterior cruciate ligament (ACL) injuries, ACL reconstructions, and meniscal injuries. Thus far, the system has not been validated for multiligament knee injuries. The Multiligament Quality of Life (MLQOL) questionnaire is a validated, disease-specific patient-reported outcome instrument for this population that can serve as a gold standard for validation of the newer PROMIS.

Purpose/Hypothesis:

The purpose of this study was to further validate the PROMIS CAT for multiligament knee reconstruction. We hypothesized that the PROMIS CAT modules would correlate with the Lysholm knee score (Lysholm), Tegner activity scale (Tegner), and MLQOL for postoperative multiligamentous knee injury patients and that the PROMIS CAT would use fewer question items than the Lysholm, Tegner, and MLQOL while still avoiding floor and ceiling effects.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 30 patients meeting the inclusion criteria were retrospectively identified and agreed to participate (87% male; mean ± SD age, 36.3 ± 13.5 years). Consenting patients were administered the Lysholm, Tegner, MLQOL, and PROMIS CAT for Physical Function, Mobility, and Pain Interference. Spearman correlations were used to test agreement across survey instruments. Floor and ceiling effects were assessed for all instruments.

Results:

PROMIS Pain Interference had excellent correlation with MLQOL Activity Limitations ( r = 0.71, P < .0001). Excellent-good correlations were detected between PROMIS Physical Function and MLQOL Activity Limitations ( r = –0.63, P = .0002) and PROMIS Mobility and MLQOL Activity Limitations ( r = –0.62, P < .0002). Good correlations were found between the Lysholm and the PROMIS Physical Function and PROMIS Mobility (for each, r = 0.50, P = .005). Additional correlations were present with other subsections. There were no floor or ceiling effects for the PROMIS CAT instrument in any category.

Conclusion:

The PROMIS CAT correlates well with existing outcome measures for multiligament knee injury patients without floor or ceiling effects. The PROMIS CAT is a concise adjunct to the validated injury-specific outcome tool for multiligament knee injury. Surgeons should consider implementing the PROMIS CAT because of its broad validity, including ACL injuries, meniscal tears, and now multiligament knee injuries.
Implementation and Outcomes of a Community Assessment Service-Learning Activity Within Academic Learning Communities
Authors: Johnson Michelle , Goldberg Charlie , Willies-Jacobo Lindia , Wan Lori , Guluma Kama , Smith Sunny
Published: September 2019

A community needs assessment and engagement activity was implemented in 2013 in the core preclinical curriculum as part of the doctoring course within Academic Communities at UC San Diego School of Medicine. This required educational experience included curricular learning objectives as well as goals to strengthen community service within academic communities. This activity was implemented and sustained within the academic communities with each community serving a different community of San Diego. Survey data from preclinical students from 2014 to 2017 consistently reported that the community assessment activity helped sustain or develop a service project in the academic community (67.1%-79.6% strongly agree or agree) and increased students’ knowledge of the needs in the assigned San Diego community (76.3%-80.6% strongly agree or agree). Students felt that the community assessment and engagement activity was a valuable learning experience (62.5%-77.8% strongly agree or agree). As a result of this educational intervention, 14 projects were implemented in the community. A subset of particularly interested and motivated medical students then took on leadership roles in these projects. Student-led scholarly assessment of the impact of some of these interventions resulted in 2 peer-reviewed publications thus far and 9 national presentations at the time of this publication. These assessments demonstrate not only educational impact, but health-system-level changes and meaningful change in patient outcomes.
Sphingolipid metabolism determines the therapeutic efficacy of nanoliposomal ceramide in acute myeloid leukemia
Authors: Barth Brian M. , Wang Weiyuan , Toran Paul T. , Fox Todd E. , Annageldiyev Charyguly , Ondrasik Regina M. , Keasey Nicole R. , Brown Timothy J. , Devine Viola G. , Sullivan Emily C. , Cote Andrea L. , Papakotsi Vasiliki , Tan Su-Fern , Shanmugavelandy Sriram S. , Deering Tye G. , Needle David B. , Stern Stephan T. , Zhu Junjia , Liao Jason , Viny Aaron D. , Feith David J. , Levine Ross L. , Wang Hong-Gang , Loughran Thomas P. , Sharma Arati , Kester Mark , Claxton David F.
Published: September 2019

Key Points

Distinct sphingolipid metabolism of AML with MDS-related changes defines unique sensitivity to nanoliposomal C6-ceramide. Vinblastine alters sphingolipid metabolism to enhance the sensitivity of AML to nanoliposomal C6-ceramide.
Association between potassium concentrations, variability and supplementation, and in-hospital mortality in ICU patients: a retrospective analysis
Authors: Engelhardt Lilian Jo , Balzer Felix , Müller Michael C. , Grunow Julius J. , Spies Claudia D. , Christopher Kenneth B. , Weber-Carstens Steffen , Wollersheim Tobias
Published: September 2019

Background

Serum potassium concentrations are commonly between 3.5 and 5.0 mmol/l. Standardised protocols for potassium range and supplementation in the ICU are lacking. The purpose of this retrospective analysis of ICU patients was to investigate potassium concentrations, variability and supplementation, and their association with in-hospital mortality.

Methods

ICU patients ≥ 18 years, with ≥ 2 serum potassium values, treated at the Charité - Universitätsmedizin Berlin between 2006 and 2018 were eligible for inclusion. We categorised into groups of mean potassium concentrations: < 3.0, 3.0–3.5, > 3.5–4.0, > 4.0–4.5, > 4.5–5.0, > 5.0–5.5, > 5.5 mmol/l and potassium variability: 1st, 2nd and ≥ 3rd standard deviation (SD). We analysed the association between the particular groups and in-hospital mortality and performed binary logistic regression analysis. Survival curves were performed according to Kaplan–Meier and tested by Log-Rank. In a subanalysis, the association between potassium supplementation and in-hospital mortality was investigated.

Results

In 53,248 ICU patients with 1,337,742 potassium values, the lowest mortality (3.7%) was observed in patients with mean potassium concentrations between > 3.5 and 4.0 mmol/l and a low potassium variability within the 1st SD. Binary logistic regression confirmed these results. In a subanalysis of 22,406 ICU patients (ICU admission: 2013–2018), 12,892 (57.5%) received oral and/or intravenous potassium supplementation. Potassium supplementation was associated with an increase in in-hospital mortality in potassium categories from > 3.5 to 4.5 mmol/l and in the 1st, 2nd and ≥ 3rd SD (p < 0.001 each).

Conclusions

ICU patients may benefit from a target range between 3.5 and 4.0 mmol/l and a minimal potassium variability. Clear potassium target ranges have to be determined. Criteria for widely applied potassium supplementation should be critically discussed.

Trial registration German Clinical Trials Register, DRKS00016411. Retrospectively registered 11 January 2019, http://www.drks.de/DRKS00016411
Revisiting the one in four: the prevalence of psychiatric disorder in the population of England 2000–2014
Authors: Bebbington Paul E. , McManus Sally
Published: September 2019

Mental health problems are often said to affect one in four people in Britain, although with no consistent explanation of what the figure includes. We used three English national population surveys of psychiatric morbidity from 2000, 2007 and 2014 to provide prevalence rates for recent psychiatric problems. We combined disorders progressively to demonstrate the effects of cumulation. Psychosis had a prevalence of around 1%, severe common mental disorders added about 8%, and including less-severe common mental disorders gave a value around one in six. The figure of one in four required the inclusion of various other disorders. These values were strikingly stable over the surveys.
Safety and Efficacy of Nivolumab Monotherapy in Recurrent or Metastatic Cervical, Vaginal, or Vulvar Carcinoma: Results From the Phase I/II CheckMate 358 Trial
Authors: Naumann R. Wendel , Hollebecque Antoine , Meyer Tim , Devlin Michael-John , Oaknin Ana , Kerger Joseph , López-Picazo Jose M. , Machiels Jean-Pascal , Delord Jean-Pierre , Evans Thomas R.J. , Boni Valentina , Calvo Emiliano , Topalian Suzanne L. , Chen Tian , Soumaoro Ibrahima , Li Bin , Gu Junchen , Zwirtes Ricardo , Moore Kathleen N.
Published: September 2019

PURPOSE

Nivolumab was assessed in patients with virus-associated tumors in the phase I/II CheckMate 358 trial (ClinicalTrials.gov identifier: NCT02488759 ). We report on patients with recurrent/metastatic cervical, vaginal, or vulvar cancers.

PATIENTS AND METHODS

Patients received nivolumab 240 mg every 2 weeks. Although patients with unknown human papillomavirus status were enrolled, patients known to have human papillomavirus–negative tumors were ineligible. The primary end point was objective response rate. Duration of response (DOR), progression-free survival, and overall survival were secondary end points. Safety and patient-reported outcomes were exploratory end points.

RESULTS

Twenty-four patients (cervical, n = 19; vaginal/vulvar, n = 5) were enrolled. Most patients had received prior systemic therapy for metastatic disease (cervical, 78.9%; vaginal/vulvar, 80.0%). Objective response rates were 26.3% (95% CI, 9.1 to 51.2) for cervical cancer and 20.0% (95% CI, 0.5 to 71.6) for vaginal/vulvar cancers. At a median follow-up of 19.2 months, median DOR was not reached (range, 23.3 to 29.5+ months; + indicates a censored observation) in the five responding patients in the cervical cohort; the DOR was 5.0 months in the single responding patient in the vaginal/vulvar cohort. Median overall survival was 21.9 months (95% CI, 15.1 months to not reached) among patients with cervical cancer. Any-grade treatment-related adverse events were reported in 12 of 19 patients (63.2%) in the cervical cohort and all five patients in the vaginal/vulvar cohort; there were no treatment-related deaths. In the cervical cohort, nivolumab treatment generally resulted in stabilization of patient-reported outcomes associated with health status and health-related quality of life.

CONCLUSION

The efficacy of nivolumab in patients with recurrent/metastatic cervical and vaginal or vulvar cancers is promising and warrants additional investigation. No new safety signals were identified with nivolumab treatment in this population.
Catecholamine-Secreting Tumors in Pediatric Patients With Cyanotic Congenital Heart Disease
Authors: Agarwal Swashti , Jindal Ishita , Balazs Andrea , Paul David
Published: September 2019

Catecholamine-secreting tumors are rare among the pediatric population but are increasingly being reported in children with sustained hypoxia secondary to cyanotic congenital heart disease (CCHD). With this review, we report the clinical characteristics of these tumors in children with CCHD. The articles included in the present review were identified using PubMed through February 2019. A manual search of the references retrieved from relevant articles was also performed. Pheochromocytomas and paragangliomas (PPGL) in children are commonly associated with high-risk germline or somatic mutations. There is evidently a higher risk of tumorigenesis in children with CCHD as compared with the general pediatric population, even in the absence of susceptible gene mutations. This is due to molecular mechanisms involving the aberrant activation of hypoxia-response elements, likely secondary to sustained hypoxemia, resulting in tumorigenesis. Due to overlapping symptoms with CCHD, the diagnosis of PPGL may be delayed or missed in these patients. We studied all previously reported PPGL cases in children with CCHD and reviewed phenotypic and biochemical features to assess for contributing factors in tumorigenesis. Larger studies are needed to help determine other potential predisposing factors and to establish screening guidelines in this high-risk population. A delay in diagnosis of the PPGL tumors can lead to exacerbation of cardiac failure, and therefore early diagnosis and intervention may provide better outcomes in these patients, necessitating the need for regular surveillance. We recommend routine biochemical screening in patients with sustained hypoxia secondary to CCHD.
Benzodiazepines Suppress Neuromodulatory Effects of Pudendal Nerve Stimulation on Rat Bladder Nociception
Authors: Ness Timothy J. , McNaught Jamie , Clodfelder-Miller Buffie , Nelson Dwight E. , Su Xin
Published: September 2019

BACKGROUND:

Neuromodulation, as a therapeutic modality for pain treatment, is an alternative to opioid therapies and therefore receiving increased interest and use. Neuromodulation at a peripheral nerve target, in the form of bilateral electrical pudendal nerve stimulation (bPNS), has been shown to reduce bladder hypersensitivity in rats and anecdotally reduces pain in humans with pelvic pain of urological origin. Recent studies have identified a role for spinal γ-aminobutyric acid (GABA) receptors in this effect. Concomitant medication use, such as benzodiazepines, could alter responses to neuromodulation, and so before the development of a clinical trial to confirm translation of this potential therapy, the potential interactions between acute and chronic use of benzodiazepines and bPNS were examined in a preclinical model.

METHODS:

Bladder hypersensitivity was produced by neonatal bladder inflammation in rat pups coupled with a second inflammatory insult as an adult. Diazepam (1–5 mg/kg intraperitoneal [i.p.]) or vehicle was administered acutely (with or without bPNS) and chronically (5 mg/kg subcutaneous [s.c.] daily for 2 weeks before the final experiment). bPNS was delivered as bilateral biphasic electrical stimulation of the mixed motor/sensory component of the pudendal nerves. Visceromotor responses (VMRs; abdominal muscle contractile responses to urinary bladder distension [UBD]) were used as nociceptive end points. Due to the profound effects of diazepam, the effect of midazolam (0.5–1.0 mg/kg i.p.) on VMRs and bPNS effects was also studied.

RESULTS:

Diazepam and midazolam both produced a dose-dependent, flumazenil-reversible inhibition of VMRs to UBD. bPNS resulted in statistically significant inhibition of VMRs to UBD in hypersensitive rats that had received vehicle injections. Select doses of diazepam and midazolam suppressed the inhibitory effect of bPNS on VMRs.

CONCLUSIONS:

This study suggests that inhibitory effects of bPNS on bladder pain could be suppressed in subjects receiving benzodiazepine therapy, suggesting that potential clinical testing of pudendal nerve stimulation for the treatment of painful bladder syndromes may be confounded by the use of benzodiazepines. Clinical assessment of other forms of neuromodulation should also be screened for impacts of benzodiazepines.
A Prospective, Ex Vivo Trial of Endobronchial Blockade Management Utilizing 3 Commonly Available Bronchial Blockers
Authors: Gilbert Christopher R. , Mallow Christopher , Wishire Candice L. , Chang Shu-Ching , Yarmus Lonny B. , Vallieres Eric , Haeck Katherine , Gorden Jed A.
Published: September 2019

BACKGROUND:

Lung isolation with bronchial blockers is a well-described and accepted procedure, often described for use during the management of massive hemoptysis. Recommendations for balloon inflation are sparse, with some advocating for saline whereas other suggest air, including the manufacturers. We sought to evaluate the optimal method for balloon inflation in an ex vivo trial.

METHODS:

We performed a prospective trial utilizing 3 commercially available bronchial blockers commonly described for use in lung isolation and massive hemoptysis management. We utilized the Arndt Endobronchial Blocker (Cook Medical), the Cohen Tip Deflecting Endobronchial Blocker (Cook Medical), and the Fogarty Venous Thrombectomy Catheter (Edwards LifeSciences). Balloon size and deflation assessment were tested within 3 different scenarios comparing air versus saline.

Welch t test was performed to compare means between groups, and a generalized estimating equation model was utilized to compare balloon diameter over time to account for correlation among repeated measures from the same balloon.

RESULTS:

All 3 endobronchial blocker systems were observed in triplicate. During free-standing balloon inflation, all 3 endobronchial systems displayed a greater degree of balloon deflation over time with air as opposed to saline (P < .001). Within a stent-based model, inflation with air of all 3 endobronchial systems, according to manufacturer recommendations, demonstrated significantly decreased time until fluid transgression occurred when compared to a saline model (P < .001). Within a stent-based model, inflation with air, according to clinical judgment, demonstrated significantly decreased time until fluid transgression in the Arndt (P = .016) and the Fogarty (P < .001) system, but not the Cohen (P = .173) system, when compared with saline.

CONCLUSIONS:

The utilization of saline for balloon inflation during bronchial blockade allows for more consistent balloon inflation. The use of saline during balloon inflation appears to delay passive, spontaneous balloon deflation time when compared to air during a model of endobronchial blockade. The approach of saline inflation should be tested in humans to demonstrate the overall applicability and validity of the current findings.
The torso-like gene functions to maintain the structure of the vitelline membrane in Nasonia vitripennis, implying its co-option into Drosophila axis formation
Authors: Taylor Shannon E. , Tuffery Jack , Bakopoulos Daniel , Lequeux Sharon , Warr Coral G. , Johnson Travis K. , Dearden Peter K.
Published: September 2019

Axis specification is a fundamental developmental process. Despite this, the mechanisms by which it is controlled across insect taxa are strikingly different. An excellent example of this is terminal patterning, which in Diptera such as Drosophila melanogaster occurs via the localized activation of the receptor tyrosine kinase Torso. In Hymenoptera however, the same process appears to be achieved via localized mRNA. How these mechanisms evolved and what they evolved from remains largely unexplored. Here, we show that torso-like, known for its role in Drosophila terminal patterning, is instead required for the integrity of the vitelline membrane in the hymenopteran wasp Nasonia vitripennis. We find that other genes known to be involved in Drosophila terminal patterning, such as torso and Ptth, also do not function in Nasonia embryonic development. These findings extended to orthologues of Drosophila vitelline membrane proteins known to play a role in localizing Torso-like in Drosophila; in Nasonia these are instead required for dorso-ventral patterning, gastrulation, and potentially terminal patterning. Our data underscores the importance of the vitelline membrane in insect development, and implies phenotypes caused by knockdown of torso-like must be interpreted in light of its function in the vitelline membrane. In addition, our data implies that the signalling components of the Drosophila terminal patterning systems were co-opted from roles in regulating moulting, and co-option into terminal patterning involved the evolution of a novel interaction with the vitelline membrane protein Torso-like.
Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia
Authors: Peter Beate , Potter Nancy , Davis Jennifer , Donenfeld-Peled Inbal , Finestack Lizbeth , Stoel-Gammon Carol , Lien Kari , Bruce Laurel , Vose Caitlin , Eng Linda , Yokoyama Hanako , Olds Daniel , VanDam Mark
Published: September 2019

Background: Speech or language therapy is typically initiated reactively after a child starts showing delays. Infants with classic galactosemia (CG), an inborn error of metabolism with a known high risk for both speech and language disorders, hold the keys towards evaluating whether preventive treatment is effective when the risks are known at birth.  We present pilot data from a randomized parallel trial of an innovative proactive speech and language intervention program, the Babble Boot Camp (BBC). 

Method: Five children with CG, otherwise healthy, participated in the BBC from approximately 2 to 24 months of age. One of these was randomly selected as control receiving conventional management. A pediatric speech-language pathologist met weekly via telepractice with the parents in the treatment cohort. Parents implemented the prespeech, speech, and language stimulation and expansion activities according to the protocol. The control child was still too young for conventional treatment. Primary outcome measures were speech sound production complexity in babble and speech and expressive vocabulary size. Secondary outcome measures were developmental milestones in communication, motor, and cognition. Outcomes in the treatment cohort were compared to typical children and the control child and to typically developing children represented in test norms and cases described in the literature . The trial is ongoing.

Results:  All four treated children had higher speech sound skills in babble, three had higher speech sound skills in meaningful speech, two had higher expressive vocabularies, and three had higher communication and personal-social skills, compared to the control child with CG.

Discussion: Given the high risk for speech and language delays in children with CG, finding on-schedule abilities in two or more of the treated children but not the untreated child is unexpected under random conditions. The trends toward beneficial effects of the BBC on speech sound production, expressive language, and communication milestones warrant appropriately powered larger clinical trials with full randomization.

Trial registration: ClinicalTrials.gov NCT03838016 (12th February 2019).
Case Report: Massive epistaxis from juvenile angiofibroma in an adolescent with severe haemophilia A
Authors: Lapeña Jose Florencio F. , Mejia Olivia Agnes D.
Published: September 2019

Epistaxis may be profuse in individuals with normal bleeding parameters, but in an individual with haemophilia, it may be life-threatening. It is even more dangerous when epistaxis is caused by an undetected concomitant juvenile angiofibroma, and only one such case has been reported in the English literature. We report another case, of an 18-year-old Filipino adolescent with severe haemophilia A who was referred for repeated massive epistaxis. The epistaxis had been attributed to his haemophilia and managed with nasal packing, multiple blood transfusions and Factor VIII administration. After two years of unsuccessful management, nasal endoscopy was performed for the first time, revealing an intranasal mass. Imaging showed a right intranasal vascular tumour supplied mainly by the right sphenopalatine artery. He subsequently underwent preoperative embolization and endoscopic excision of the tumour with Factor VIII transfused pre-, intra-, and post-operatively, and recombinant Factor VII added post-operatively. Final histopathology was consistent with juvenile angiofibroma. There has been no nasal obstruction or recurrence of epistaxis seven years since the surgery. Clinicians should be more meticulous in assessing epistaxis in any patient with a bleeding disorder and investigate more subtle symptoms such as nasal obstruction. Verification of the source by direct visualization and ancillary diagnostic techniques (such as imaging) when indicated should be the standard of care for all patients presenting with epistaxis, whether or not a concomitant bleeding disorder exists. A high index of suspicion for juvenile angiofibroma should be maintained in adolescent males with epistaxis and nasal obstruction.
A Reclamação como Instrumento de Unidade no Direito Brasileiro
Authors: Pugliese William Soares , Pessoa Thiago Simões
Published: September 2019

Trata-se o presente texto sobre uma proposta de racionalização do sistema recursal brasileiro, alinhando-se os precedentes vinculantes ao cabimento da reclamação constitucional. Nesta linha, será realizada uma análise desde a formação de decisões judiciais, à luz da integridade, até a formação dos precedentes e sua consequente aplicação e vinculatividade às demais instâncias ordinárias.
O AGRAVO INTERNO NO CPC/2015 E SUA RELAÇÃO COM AS TÉCNICAS DO DISTINGUISHING E OVERRULING
Authors: Pinheiro Guilherme César
Published: September 2019

Este artigo pretende discutir a relevância que o recurso de agravo interno adquiriu no Novo CPC na hipótese de interposição contra decisão monocrática (unipessoal) que aprecia o mérito do recurso (art. 932, IV e V), dando-lhe ou negando-lhe provimento, com fundamento na existência de precedente vinculante (art. 927) sobre a matéria tratada nas razões recursais ou na decisão recorrida. A questão que se coloca é que o recurso não pode ser compreendido apenas como um meio de técnico que a parte manifesta seu inconformismo com a decisão, mas sim como direito constitucional, decorrente do contraditório e da ampla defesa, criador de um espaço procedimental discursivo e viabilizador de correção normativa e legitimidade das decisões judiciais. A partir disso é que se visa a chamar atenção para a relação do agravo interno com as técnicas do distinguishing e overruling, que são essenciais para que o recorrente obtenha êxito em seu recurso.
Processos Estruturais: uma transição entre estados de coisa para a tutela dos direitos
Authors: Galdino Matheus
Published: September 2019

Com base em desdobramentos do que é sustentado em doutrina contemporânea, apresenta uma compreensão do processo estrutural, distinta, mas não incompatível, com a doutrina tradicional. Afirma que o fundamento distintivo do processo estrutural decorre de uma mudança de racionalidade (de causal para teleológica), direcionada a uma transição não imediata entre estados de coisa. Referida transição permite identificar as características dos direitos direta e indiretamente tutelados pelo processo estrutural. Ao fim é possível identificar o âmbito de atuação dos processos estruturais e sua função na tutela dos direitos.
LA CARGA DE LA PRUEBA EN PROCEDIMIENTOS DE CIRUGÍA PLÁSTICA Y RECONSTRUCTIVA
Authors: Fröde Carina Gómez
Published: September 2019

El artículo aborda la teoría de la carga de la prueba en los procedimientos de cirugía plástica y reparadora, explicando en qué consistiría la teoría, su contextualización en el sistema legal mexicano y cómo se aplicaría a los procedimientos analizados
A legitimidade democrática da jurisdição constitucional e as audiências públicas
Authors: Nunes Raphael Marcelino de Almeida
Published: September 2019

O artigo trata do instituto das audiências públicas sob a perspectiva de análise de sua dupla função, qual seja, a de suprir déficits epistêmicos e a de garantir a participação da sociedade civil e de instituições interessadas nos debates realizados na Suprema Corte. A análise tem por objetivo testar a hipótese de que o referido instituto, no cumprimento dessa dupla função, poderia garantir a legitimidade democrática da jurisdição constitucional para tomada decisões em relação a questões sensíveis de natureza política.
ESTÁGIO SUPERVISIONADO, PROFISSIONALIZAÇÃO E PROFISSIONALIDADE DOCENTE: DO QUE ESTAMOS FALANDO?
Authors: Araújo Osmar Hélio Alves
Published: September 2019

O objetivo deste artigo é discutir o estágio supervisionado nos cursos de licenciatura, no Brasil, como espaço de referência, essencialmente, para a profissionalização docente. Para tal arte, argumenta-se que o estágio é subsídio para a profissionalização docente dos futuros professores, por meio de atividades que fomentam a construção da identidade profissional e o desenvolvimento de competências inerentes à docência. Nesta pesquisa, de natureza teórica, parte-se da hipótese que para o estágio se (re)afirmar como um espaço da construção da profissionalização docente exige, necessariamente, ser construído como práxis, e um movimento coletivo, associado à autonomia, condições de apreensão e socialização da profissão.
RELAÇÃO DO PERFIL DE ERROS DE LEITURA E ESCRITA NA DISLEXIA E DIFICULDADES DE APRENDIZAGEM
Authors: Chiaramonte Thaís Contiero , Capellini Simone Aparecida
Published: September 2019

Escolares com diagnóstico de Dislexia do Desenvolvimento apresentam sobrecarga de Memória Operacional Fonológica, ocasionando maior dificuldade em realizar as conversões fonografêmicas no momento da escrita, por isso o objetivo deste estudo foi comparar e relacionar os erros de leitura e escrita de escolares com Dislexia do Desenvolvimento e Dificuldades de Aprendizagem. Foi aplicado a prova de Leitura de Palavras do PROHMELE e Escrita de Palavras do Pró-Ortografia, para realizar a comparação dos erros dos escolares. Foi possível concluir que escolares com Dislexia apresentam perfil com mais erros de erros de correspondência unívoca enquanto a comparação com os demais escolares apresenta um perfil de erros de regularidades e irregularidades ortográficas parecidos.
A TEORIA DA SUBJETIVIDADE E O TRANSTORNO DO ESPECTRO AUTISTA: - O QUE JÁ FOI PESQUISADO?
Authors: Silva Karla Fernanda Wunder da , Rozek Marlene
Published: September 2019

Neste artigo, são apresentados os resultados de uma pesquisa que teve como objetivo geral verificar se há uma abordagem científica que trate da constituição subjetiva da pessoa com Transtorno do Espectro Autista (TEA) na perspectiva da Teoria da Subjetividade de Fernando González Rey. Os dados estão apresentados neste artigo em forma de tabelas e quadros, buscando facilitar a visualização das produções elencadas para análise Dentre os resultados do mapeamento destaca-se que: um grande número de pesquisas e publicações que tratam sobre o TEA não são realizadas pela área da educação; as temáticas mais procuradas são as que remetem aos processos inclusivos e seus resultados; não foram encontradas pesquisas e produções que realizassem o encontro do TEA com a Teoria da Subjetividade. Desta forma, reforça-se a necessidade de aproximação destes conceitos, buscando uma nova forma de perceber a pessoa com TEA.
UMA HISTÓRIA DENTRO DA OUTRA, UMAS GEOGRAFIAS QUE SE ESBARRAM: O ANIVERSÁRIO DE ZUZA - UMA MARIONETE QUE QUERIA SER PRÍNCIPE!
Authors: Moreira Lopes Jader Janer , Diaz Marcos Chica , Braga Nilcéa Beatriz
Published: September 2019

Esse texto narra uma vivência. Uma experiência de encontros. Um desejo que uniu pessoas e artefatos culturais. Conta a vontade de um boneco que nasce da fronteira da vida e da morte e chega ao espaço de uma escola pública localizada no interior da Zona da Mata de Minas Gerais. É ai que estão as crianças. É um texto aberto! Que convida ao leitor a esse estar junto com as palavras e com muitas imagens que estão nesse espaçotempo que é gente fazendo e sendo. Não são fechamentos, formas de conceber. Mas são escolhas e criações.
TANTAS MÃOS: EDUCAR É MAIS QUE CONDUZIR, É DAR-SE AS MÃOS
Authors: Carvalho Carlos Roberto , Mello Marisol Barenco
Published: September 2019

Esta entrevista é um texto dialógico, aonde os intelocutores conversam confrontando os pontos de vista e de cegueira, baseados em suas trajetórias de estudos e leituras de dois grandes pensadores do século XX: Hannah Arendt e Mikhail Bakhtin. Trata-se de uma conversa e os autores convidam os leitores a espiar dois velhos amigos falando de liberdade, de escritura, de literatura, de transformação, de linguagem e de educação. Um convite explicito  ao pensar sem corrimãos a partir de suas vivências concretas no mundo.Palavras-chave: Hanna Arendt; Mikhail Bakhtin; linguagem e educacão.
ARENDT E A CRISE DA EDUCAÇÃO COMO CRISE DO TEMPO HISTÓRICO
Authors: Alves Neto Rodrigo Ribeiro
Published: September 2019

O artigo interpreta a crise da autoridade e a crise da educação, tal como diagnosticadas por Hannah Arendt, como expressões de uma crise da temporalidade e da historicidade no mundo moderno. Diferentes reflexões sobre a atual ordem do tempo apontam para a contemporaneidade como expressão de transformações sociais e tecnológicas das quais emergiu um novo regime de historicidade em que o presente se encontra cada vez mais prolongado, desconectado do passado, pobre em experiência, desprovido de direcionalidade e com o futuro cada vez mais opaco, administrado e imediato. A crise da educação seria hoje expressão do enfraquecimento da tensão entre novidade e memória provocada por esse presentismo que abole a articulação entre o passado e o futuro, transformando a cultura em mercadoria para o consumo instantâneo e voraz de adultos e jovens governados pelo ideal de felicidade momentânea e imediata.
AVALIAÇÃO DO NÍVEL DE RUÍDO EMITIDO POR UM TRATOR AGRÍCOLA ACOPLADO A UMA COLHEDORA DE MILHO
Authors: Damasceno Flavio Alves , Soares Cláudio Magela , Oliveira Carlos Eduardo Alves , Ferraz Gabriel Araújo e Silva , Saraz Jairo Alexander Osorio
Published: September 2019

Objetivou-se com o presente trabalho avaliar e comparar o nível de ruído emitido por um trator acoplado a uma colhedora de milho durante a operação agrícola em diferentes rotações do motor, visando identificar zonas de salubridade para os trabalhadores. O experimento foi conduzido no município de Corumbá de Goiás-GO, durante o período de colheita de milho, em julho de 2015. Os dados de nível de ruído foram coletados utilizando-se um medidor de nível de pressão sonora digital, sendo coletados em área livre de obstáculos, com dimensões de 40 x 40 m, em solo coberto com capim. O trator foi acoplado à colhedora de milho sem carga no centro desta área. O nível de ruído foi coletado tomando como base o Ponto de Referência do Assento (PRA), na altura média do ouvido do operador, e distribuindo os pontos de coleta numa malha equidistante de 5 m em relação ao PRA. Os tratamentos utilizados foram: variação da rotação do motor de 1600, 1700, 1800 e 2000 rpm. O nível de ruído encontrado neste estudo, em todas as situações avaliadas, apresentou valor médio acima de 79,0 dB(A). O uso de protetor auricular é recomendado para os operadores situados a uma distância inferior a 8,0 m em qualquer rotação do motor e 3,0 m para diferentes variações de tomadas de potências.
DESEMPENHO PRODUTIVO DE COUVE-FLOR SUBMETIDA A DIFERENTES MANEJOS DE IRRIGAÇÃO E DOSES DE BORO EM AMBIENTE PROTEGIDO
Authors: Ferreira Ana Rosa , De Lima Júnior Joaquim Alves , De Oliveira Pedro Daniel , Carrera de Aviz William Lee , Aguiar Santos Helane Cristina
Published: September 2019

Com objetivo de fornecer informações técnicas sobre a produção da couve-flor irrigada em casa de vegetação no nordeste paraense, instalou-se um experimento na Fazenda Experimental da UFRA, no município de Igarapé-Açu, com a cultivar híbrida Desert, que apresenta adaptabilidade para o clima da região. O delineamento utilizado foi em blocos casualizados em esquema fatorial 4 x 3, com 12 tratamentos e 3 repetições. Os tratamentos foram constituídos por quatros tensões de água no solo (15, 30, 45 e 60 kPa), com indicativo no momento de irrigar e três doses de boro (0, 3 e 6 kg ha-1) aplicadas via foliar. O método de irrigação utilizado foi o gotejamento e o manejo de irrigação foi via tensiometria. As parcelas experimentais apresentaram 3,6 m2 constituídas de 8 plantas, com espaçamento de 0,8 m entre linhas e 0,5 m entre plantas. Em cada parcela, foram avaliadas 4 plantas centrais, totalizando 288 plantas. De acordo com os dados obtidos, a cultivar híbrida Desert mostrou-se promissora para o cultivo nas condições edafoclimáticas da região nordeste do Pará. A tensão que apresentou melhores resultados foi a de 37 kPa, obtendo produtividade de cabeça de 11,3 t ha-1, massa fresca de 450 g, massa seca de 31,48 g, diâmetro de 15,6 cm, circunferência de 50,99 cm e altura de 9,87 cm. As doses de boro não apresentaram diferença significativa.
CONTROL OF MAIZE WEEVIL WITH APPLICATION OF DIATOMACEOUS EARTH IN CORN GRAINS STORED IN DIVERSE TEMPERATURES
Authors: Fagundes Henrique Delevati , Dionello Rafael Gomes , Radünz Lauri Lourenço , Reichert Júnior Francisco Wilson
Published: September 2019

The insect known as maize weevil (Sitophilus zeamais) is one of the most important pests of stored corn in Brazil. Among the various forms of control, one can highlight the use of inert powders, which has advantages of not providing risk to the environment or to human and animal health, besides not having reports of insect resistance. Thus, this work evaluated the effect of different doses of diatomaceous earth on the development of Sitophilus zeamais on two temperature conditions on corn grain storage. A completely randomized design was adopted in a factorial 4x2x4 (diatomaceous earth dose x storage temperature x storage time) dosage, with three replicates. The diatomaceous earth doses were: 0, 250, 500 and 1000 g t-1 and subsequently stored at temperatures of 22 and 30°C for 90 days. The bulk density decreased during the storage for all diatomaceous earth doses applied, but in inverse proportion to the dose increment. Diatomaceous earth has proven better efficiency in the control of S. zeamais, with increase in dose and storage temperature. Dry weight decrease was observed in all doses and storage temperatures evaluated, but it was more pronounced in those grains that have not received the application of diatomaceous earth.
Sondheim scholarship: An overview
Authors: Gordon Robert
Published: September 2019

The article outlines critical approaches to the work of Sondheim and his collaborators since John Lahr’s sceptical journalistic article in 1979. The article underlines how the pioneering scholarly work of Joanne Gordon (Art Isn’t Easy, 1990) and Stephen Banfield (Sondheim’s Broadway Musicals, 1993) established the reputation of Sondheim’s major stage musicals as modern classics. Gordon’s hermeneutic analysis of his books and lyrics between 1962 and 1987 introduced the notion of Sondheim as an auteur, while Banfield’s masterly scrutiny of Sondheim’s compositional process illustrated his skill as a ‘dramatist in song’, providing a definitive guide to comprehending Sondheim’s music as a key factor in the affect of the stage musicals. A consideration of three edited collections on Sondheim’s work leads to a discussion of recent scholarly books, including McLaughlin’s Sondheim and the Reinvention of the American Musical (2016), which focuses on postmodern approaches to representation in each of the musicals up to 2008.
La bioprospección entre la gobernanza Antártica y los Estados soberanos: El caso argentino genoma blanco Entre 2005 y 2015
Authors: Novas Mariano A.
Published: September 2019

Por más de cincuenta años, el Tratado Antártico permitió el desarrollo y la cooperación científica en un continente con «soberanías congeladas». Este Tratado se encuentra hoy ante un nuevo desafío: el auge de la bioprospección. Esta actividad científica entra en tensión con la gobernanza antártica ya que resulta incompatible con artículos del Tratado vinculados a intercambio de información y cooperación científica. Para examinar esa tensión, este artículo se centra en el proyecto Genoma Blanco impulsado por Argentina entre 2005 y 2015. Argumento que, si bien el desarrollo de la bioprospección tiende a no adecuarse a los principios de la gobernanza antártica, el proyecto Genoma Blanco constituye un caso singular que combina principios de soberanía nacional con requerimientos de la gobernanza antártica. Este trabajo se basa en el análisis de documentos oficiales presentados por los estados miembros en las Reuniones Consultivas del Tratado Antártico durante 2005 y 2015 y en entrevistas a actores involucrados.
Gobierno municipal y coordinación interjurisdiccional de políticas públicas: reflexiones teóricas desde el conurbano bonaerense
Authors: Gutiérrez Ricardo A. , Alonso Guillermo V.
Published: September 2019

En contextos de restricción presupuestaria y dependencia normativa, la coordinación con niveles superiores de gobierno constituye un factor fundamental para que los gobiernos municipales puedan asumir eficazmente sus responsabilidades administrativas. Pero, ¿bajo qué condiciones los funcionarios municipales buscarán coordinar —o no— con otras jurisdicciones? En respuesta a esa pregunta, este trabajo ofrece reflexiones teóricas inspiradas en nuestras investigaciones de los gobiernos municipales del llamado Conurbano Bonaerense. Entendemos que la coordinación no puede darse por descontada como una práctica recurrente ni puede ser derivada automáticamente de reglas formales como las que conforman un sistema federal. Argumentamos que la decisión de coordinar (o no) tiene lugar bajo dos supuestos operativos: 1) los gobiernos municipales siempre prefieren mantener la autonomía de hacer y no hacer; 2) la decisión entre coordinar o preservar la autonomía depende de un cálculo de costos y beneficios impulsado por dos motivaciones básicas: reclamar el crédito y evitar la culpa.
Procesos de selección de personal en la administración pública de la Provincia de Buenos Aires. Una elipsis al régimen de concursos para el acceso a las funciones jerarquizadas
Authors: Gil García Magdalen , Piana Ricardo S.
Published: September 2019

La profesionalización del empleo público resulta central para el fortalecimiento de las instituciones públicas y el mejoramiento de su rendimiento. Si bien no hay un único mecanismo o vía para promoverla, existe consenso en que requiere la conformación de carreras basadas sobre criterios de mérito. El objetivo de este trabajo es contribuir al análisis de la situación en materia de profesionalización en el ámbito subnacional, a partir de la política de Procesos de Selección de Personal para la ocupación de cargos jerárquicos en la provincia de Buenos Aires. A través del análisis de fuentes primarias y secundarias, el artículo da cuenta que la política no ha logrado resolver el manejo discrecional de los nombramientos, persistiendo la politización de los cargos reservados a los funcionarios de carrera.
Política, Estado y Administración Pública en las provincias Argentinas (vol. 1)
Authors: Bazza Alcides
Published: September 2019

de Horacio Cao.Buenos Aires, Prometeo Libros, 2018
Performance Analysis of One Model of Communication and Information System in Military Operation
Authors: Devetak Sasa M. , Susa Vladimir B. , Pavlovic Boban Z. , Slavkovic Rade V. , Karovic Samed M.
Published: September 2019

This paper presents a model of communication and information system in military operations. Here OPNET MODELER simulation package is applied because it is suitable for network modelling, topology and capacity planning. Simulation of different types of IP traffic and monitor their performance to optimise the functionality of network elements, management performance network applications, and as well as in research and development of new network technologies. Application of the method of mass service are determined by the capacity needed for voice transmission on the links in the model and using the OPNET MODELER simulation program are analysed performance modeled communication information system in data transmission. The results of the simulation are presented through target the service settings: workload links communication and information system, e-mail download response time, http page download response time and packet loss in data transfer. The aim of the research has shown that modeled communication information system with defined elements (nodes), the capacity of links (according to the specification of telecommunication devices) and defined traffic can respond to the requirements of command forces in the military operation in terms of telecommunication service. The results of the analysed service target parameters show that modeled communication and information system provides an efficient flow of information and the tra nsfer of voice and IP data for the needs of command and control in military operations.