bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel ultrasound guided approach for lumbar periradicular injections with investigating the radicular artery nearby (IRAN) technique
Authors: Gharaei Helen
Published: April 2021

The object of this study is to introduce a novel USG approach for lumbar periradicular injections by investigating radicular artery nearby (IRAN) technique and to assess the feasibility and preliminary means by fluoroscopy. Study design: The USG periradicular injection is performed under real time imaging. An axial scanning view is obtained through identifying the spinous processes, lamina, zygapophyseal joints and transverse processes. Setting: The curve probe put transversally and the needle site check in axial and sagittal view. Methods: The IRAN technique was defined by sliding probe a little lower under the facet joint in sagittal plane to view the pulse of nearby radicular artery by Doppler or Pulse Echo. Then spinal needles are advanced with in-plane technique toward the artery until touch the nearby bone. Results: Fluoroscopy examination confirms that the needle tip is correctly placed under the pedicle along the nerve root and lateral to the pars interarticularis with no intravascular injection. Limitation: Although searching for small vessels is difficult in cadaver studies, the IRAN technique would be confirmed in the future on Cadaver. Conclusion: The IRAN technique as a new anatomic landmark allow an easy and corrected periradicular placement of the needle.
Brief resolved unexpected event: prevalence, etiology and epidemiologic characteristics in Lebanon. a retrospective study of hospitalizations in a tertiary-care center
Authors: Antoun Stephanie , Sabbagh Sandra
Published: April 2021

Objective: A Brief Resolved Unexplained Event (BRUE) is a common condition in infancy. However, no epidemiological study has been undergone in Lebanon. This study aims to establish the prevalence and the characteristics of the population hospitalized after a BRUE. Material and methods: A single-center retrospective study performed from 1998 to 2018 included 156 hospitalized infants, aged less than one year old, in a tertiary medical center. Data were collected from hospital archives. Results: Most infants (92.9%) hospitalized after a BRUE were aged less than 6 months old, with a slight masculine predominance (52.6%). No pathognomonic symptom was identified. In terms of recurrence of the initial episode, it occurred in 55.1% of the cases. A transfer to a reanimation unit took place in 35.9% of patients, with an average stay of 6.3 days. Two infants were deceased and six were readmitted for the same chief complaint. Final confirmed diagnosis was a Gastro-Esophageal Reflux (GER) in 60.9%. Consequently, a milk change occurred in 17.9% and a GER treatment in 65.4%. Conclusion: Infants younger than one year and hospitalized for a BRUE present a majority of confirmed GER diagnosis, and seem to have an excellent prognosis.
Outcomes of intrauterine interventions for the treatment in fetal urinary tract obstructions
Authors: Pavlichenko M , Kosovtsova N , Bashmakova N
Published: April 2021

Introduction: The leading cause of chronic renal failure in newborns, which occurs soon after birth is obstructive uropathies. Objectives: To prove the effectiveness of nephroamniotic shunting based on the evaluation of perinatal outcomes of this procedure, as well as a comparative analysis of the use of the stent manufactured by "Cook" (Ireland), 3.0 Fr/100 mm and the stent “SDE–MED”, 3.0 Fr/50 mm with the original shape of pigtails. Methods: After checking the safety of the stent “SDE-MED”, 3.0 Fr/50 mm developed by FGBU Mother and Child Care Research Institute with the original shape of pigtails in an animal experiment, the stent was used in clinical practice for intrauterine shunting in cases of unilateral or bilateral hydronephrosis of grade III to IV and posterior urethral valve disorder. In the final part of the study, a comparison of the outcomes of nephroamniotic shunting using two different stents was made. Results: The “SDE–MED” 3.0 Fr/50 mm stent provided more effective fixation in the fetal kidney cavity system in comparison to the stent manufactured by “Cook” (Ireland) 3.0 Fr/100 mm. Conclusion: Intrauterine shunting surgery of the upper urinary tract is a pathogenetically justified method of treating urinary tract obstructions and can be used to correct all types of fetal renal obstructions.
Tench (Tinca tinca (Linnaeus, 1758)). Thematic bibliography
Authors:   Institute of Fisheries NAAS, Kyiv, Hrytsynyak Ir. , Shvets T. ,   Institute of Fisheries NAAS, Kyiv
Published: April 2021

Purpose. Forming a thematic bibliographic list of publications on the morphological, ecological, physiological and biochemical characteristics of the tench (Tinca tinca L.), its cultivation and the state of its stocks in natural water bodies. Methodology. The complete and selective methods were applied in the process of the systematic search. The bibliographic core has been formed with the publications exclusively in Ukrainian and Russian from the fund of scientific library of the Institute of Fisheries NAAS of Ukraine. Practical value. The list may be useful for scientists, practitioners, students, whose area of interests includes the study of physiological, biochemical, ecological and other characteristics of cyprinids, in particular tench, as well as the restoration of its stocks. Key words: tench, reproduction, morphological, physiological and biochemical characteristics, fishing.
Empowerment Influence on Turnover Intention of Public Secondary School Teachers in Katsina State Nigeria
Authors:   Department of Educational Foundations Federal University PMB: 5001 Dutsinma, Katsina State Nigeria, Salisu Abba
Published: April 2021

Background: Secondary school teacher’s turnover is one of the problems bedeviling education sector in Katsina state. The sector can hardly be improved unless the situation is changed. To change the situation the stakeholders should focus on the need to enhance secondary school teacher’s satisfaction, commitment and empowerment. Purpose: The study examines the influence of empowerment on turnover intention of teachers of public secondary schools in Katsina State Nigeria. In addition the study examines which dimension among the dimensions of empowerment best influences turnover intention of teachers of public secondary schools in Katsina state, Nigeria. Methods: Empowerment and Turnover Intention questionnaires were used to get the needed data. Multiple regression analysis was used to analyze the data gathered using SPSS version 20.0. Results: The results show that the dimensions of empowerment significantly and negatively explain 40% of variance of turnover intention. Additionally, among the dimensions of empowerment namely; perceived control, perceived competence and goal internalization, perceived competence makes the largest contribution followed by perceived control; beta -.35 and -.31 respectively. Conclusion: the study establishes that empowerment significantly and negatively relates to turnover intention of teachers of public secondary schools in Katsina state Nigeria.
Financing of State Universities in India: A Case Study
Authors:   School of Social Sciences and Policy, Department of Development Studies, Central University of South Bihar, Bihar-824236, India, . C. Krishnan
Published: April 2021

The fiscal crisis facing the economy has led to withdrawal of the state from major sectors of the economy including education. With the advent of the liberalized economic policy the private sector has been playing a pivotal role in the economic development. Higher education ceases to be the ‘merit good’ and the universities are encouraged to mobilize resources by their own efforts rather than depending on government grants. This has impacted the financing of state and central universities across India. Actually, this paper evaluates the funding of state universities in India through a case study, taking into consideration the changing contours of financing higher education. The core idea of the study is to analyse the resource mobilization as well as its utilization by the selected university. The study is based on secondary data. The discussion on the funding pattern reveals that the university is highly dependent on state grants for their day-to-day functioning. Though the efforts to generate internal resources is picking up, the university has failed to address the long run financial crunch of the university. The study concludes that unless the universities explore alternative channels of resources mobilization, it would be difficult to offer quality education in this era of globalization.
The Future of Inpatient Community Hospital Care: Is There One?
Authors: Krugman Scott D. , Rauch Daniel A.
Published: April 2021

Community hospital inpatient pediatric programs face a variety of challenges including financial instability, variable censuses, difficulty maintaining qualified staff, and a lack of focus for the hospital. With the addition of new payment models, such as bundled payments and global budgets, along with a global pandemic, the future of community hospital pediatric inpatient care is uncertain at best. In this article we summarize the challenges, opportunities, and potential solutions to maintaining high-quality care for hospitalized children in community hospitals.
A Practical Guide for Cardiologists to the Pharmacological Treatment of Patients with Type 2 Diabetes and Cardiovascular Disease
Authors: Ahmad Tariq , Riello Ralph J , Inzucchi Silvio E
Published: April 2021

Patients with type 2 diabetes are at increased cardiovascular risk. Until recently, reductions in HbA1c and the use of specific glucose-lowering agents have not had a clear, reproducible benefit in reducing the incidence of cardiovascular disease. However, over the past 5 years, members of two categories of diabetes medications, sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, have been associated with improved rates of major adverse cardiovascular events when used in high-risk type 2 diabetes patients. Importantly, these effects are not necessarily linked to these agents’ effects on HbA1c. Sodium–glucose cotransporter 2 inhibitors have also been associated with reductions in heart failure hospitalization, a benefit that appears to extend to individuals without diabetes with established heart failure. Cardiovascular specialists should become familiar with these emerging data and be prepared to implement corresponding strategies in their practice to improve the cardiovascular outcomes of their patients. Recent clinical trial data and the changing landscape of corresponding professional guidelines are reviewed. Practical recommendations for safe prescribing of these anti-diabetes drugs are provided.
David L. McConnell and Marilyn D. Loveless, Nature and the Environment in Amish Life
Authors: Werner Sarah
Published: April 2021

David L. McConnell and Marilyn D. Loveless, Nature and the Environment in Amish Life (Baltimore: Johns Hopkins University Press, 2018), xiv+294 pp., $49.95 (pbk), ISBN: 9781421426167.
Critical Planetary Romanticism
Authors: Bauman Whitney A.
Published: April 2021

Queer Theory (QT) has expanded since the 1990s beyond critiques of normative understandings of gender and sex, to a broader critique of normative thinking in general. The destabilizing force of QT has been utilized to critique understandings of ‘nature’, highlighting how nature is a historically constructed and changing category. This article puts queer theorists into dialogue with ‘critically romantic’ scientists of the nineteenth and early twentieth centuries. Though not often thought of as ‘queer’ critically romantic scientists such as Ernst Haeckel understood that ‘nature’, from an ecological and evolutionary standpoint, was an unstable category. Using these earlier thinkers in dialogue with QT, I bring queer thinking back to nature in an erotics of thought, or what I call a critical planetary romanticism (CPR). A CPR opens us on to the evolving and entangled planetary community and the co-construction of the planetary grounds of our own thought.
Special Issue Introduction
Authors: Keller Mary L.
Published: April 2021

Special Issue Introduction
method to streamline p-hacking
Authors: Hussey Ian
Published: April 2021

The analytic strategy of p-hacking has rapidly accelerated the achievement of psychological scientists’ goals (e.g., publications & tenure), but has suffered a number of setbacks in recent years. In order to remediate this, this article presents a statistical inference measure that can greatly accelerate and streamline the p-hacking process: generating random numbers that are < .05. I refer to this approach as pointless. Results of a simulation study are presented and an R script is provided for others to use. In the absence of systemic changes to modal p-hacking practices within psychological science (e.g., worrying trends such as preregistration and replication), I argue that vast amounts of time and research funding could be saved through the widespread adoption of this innovative approach.
Roles of phosphatidyl inositol 3 kinase gamma (PI3Kγ) in respiratory diseases
Authors: Sala Valentina , Della Sala Angela , Ghigo Alessandra , Hirsch Emilio
Published: April 2021

Phosphatidyl inositol 3 kinase gamma (PI3Kγ) is expressed in all the cell types that are involved in airway inflammation and disease, including not only leukocytes, but also structural cells, where it is expressed at very low levels under physiological conditions, while is significantly upregulated after stress. In the airways, PI3Kγ behaves as a trigger or a controller, depending on the pathological context. In this review, the contribution of PI3Kγ in a plethora of respiratory diseases, spanning from acute lung injury, pulmonary fibrosis, asthma, cystic fibrosis and response to both bacterial and viral pathogens, will be commented.
Introduction
Authors: Auffrey Christopher , Mehta Vikas
Published: April 2021

This issue of the Interdisciplinary Journal of Signage and Wayfinding presents a range of work truly reflecting both this journal’s interdisciplinarity and its attention to both signage and wayfinding research. The title of this issue, Signage Perceptions, Experiences, and Aesthetic Judgements, reflects the range of scholarship included, but also highlights the complex nature of the multiple factors influencing the effectiveness of signage as an essential means of visual communication. As the articles in this issue demonstrate, the interrelated factors of regulation, design, and display context, taken together, will impact viewer perceptions and judgments about the messages on signs, and may lead to different viewer behavior entirely apart from the actual text used. Ultimately, the matters explored in this issue have important implications for commerce and wayfinding, as would be expected of explorations of signage effectiveness, but also connect with the range of related quality of life issues which underscore the importance of signage and wayfinding research in a broader societal context.
DEVELOPMENT OF FORAGE PEAR VARIETIES UNDER DIFFERENT WATER SALINITY LEVELS
Authors: Silva Carolina das Chagas , MENEZES ADEMIR SILVA , Aragão Marcio Facundo , Pinheiro Neto Luí Gonzaga , Moreira Francisco José Carvalho , Sampaio George Martins
Published: April 2021

This study aimed to evaluate the effect of different levels of water salinity in the development of two varieties of cactus pear (Opuntia and Nopalea). The spineless cactus is native from Mexico, but nowadays can be found in many places throughout the world. The experiment was performed at the Federal Institute of Ceará – IFCE/Campus Sobral. The experimental design was a randomized factorial 5 x 2, with five levels of salinity in the irrigation water (0.0; 5.0; 10; 15 and 20 dS m-1) and two varieties of cactus pear Small or sweet (Nopalea cochenillifera Salm-Dick) and ‘elephants ear’ (Opuntia sp) with four replications. Variables studied were: plant height (cm), length and circumference of the paddle (cm), cladode thickness (cm) fresh weight (g) and dry weight (g). The variety “elephants’ ear” is more suitable for cultivation under irrigation with saline water, because it presented a better vegetative performance compared to the small variety, being more tolerant to saline stress in different levels of salinity. The effect of the interaction between salinity and varieties showed a decrease for all variables analyzed, with reduction in forage development of palm varieties for higher salinity levels.
Intrusion Detection for Mobile Ad Hoc Networks Based on Node Reputation
Authors: Lin Tao , Wu Peng , Gao Fengmei , Wu Tianshu
Published: April 2021

The mobile ad hoc network (MANET) is more vulnerable to attacks than traditional networks, due to the high mobility of nodes, the weakness of transmission media and the absence of central node. To overcome the vulnerability, this paper mainly studies the way to detect selfish nodes in the MANET, and thus prevent network intrusion. Specifically, a data-driven reputation evaluation model was proposed to detect selfish nodes using a new reputation mechanism. The mechanism consists of a monitoring module, a reputation evaluation module, penalty module and a response module. The MANET integrated with our reputation mechanism was compared with the traditional MANET through simulation. The results show that the addition of reputation mechanism can suppress the selfish behavior of network nodes and enhance network security.
Prognosis Prediction of Stroke based on Machine Learning and Explanation Model
Authors: Qin Qiuli , Zhou Xuehan , Jiang Yong
Published: April 2021

The prognosis prediction of stroke is of great significance to its prevention and treatment. This paper used machine learning to predict stroke prognosis, and use SHAP method to make feature importance and single sample analysis. Firstly, feature engineering, use Borderline-SMOTE algorithm to deal with data imbalance, use Support Vector Machine(SVM) to build a prognostic prediction model, and use Random Forest(RF), Decision Tree(DT), Logistic Regression(LR) for comparative analysis, and find the performance of SVM after feature engineering better than other models, the accuracy, specificity, F1 score, AUC value reach 0.8306, 0.8356, 0.8415 and 0.9140. Then, the model was further analyzed for explainability, and it was found that the top three causes of the disease were Glasgow Coma Score, NIHSS and atrial fibrillation. Finally, try to analysis a single sample, which is performed to determine that the patient is a low-risk patient, and suffering from atrial fibrillation is the largest potential risk factor for the patient.
Human-in-the-loop: Role in Cyber Physical Agricultural Systems
Authors: Sreeram Maitreya , Nof Shimon Y.
Published: April 2021

With increasing automation, the ‘human’ element in industrial systems is gradually being reduced, often for the sake of standardization. Complete automation, however, might not be optimal in complex, uncertain environments due to the dynamic and unstructured nature of interactions. Leveraging human perception and cognition can prove fruitful in making automated systems robust and sustainable. “Human-in-the-loop” (HITL) systems are systems which incorporate meaningful human interactions into the workflow. Agricultural Robotic Systems (ARS), developed for the timely detection and prevention of diseases in agricultural crops, are an example of cyber-physical systems where HITL augmentation can provide improved detection capabilities and system performance. Humans can apply their domain knowledge and diagnostic skills to fill in the knowledge gaps present in agricultural robotics and make them more resilient to variability. Owing to the multi-agent nature of ARS, HUB-CI, a collaborative platform for the optimization of interactions between agents is emulated to direct workflow logic. The challenge remains in designing and integrating human roles and tasks in the automated loop. This article explains the development of a HITL simulation for ARS, by first realistically modeling human agents, and exploring two different modes by which they can be integrated into the loop: Sequential, and Shared Integration. System performance metrics such as costs, number of tasks, and classification accuracy are measured and compared for different collaboration protocols. The results show the statistically significant advantages of HUB-CI protocols over the traditional protocols for each integration, while also discussing the competitive factors of both integration modes. Strengthening human modeling and expanding the range of human activities within the loop can help improve the practicality and accuracy of the simulation in replicating a HITL-ARS.
Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults
Authors: Thorsness Rebecca , Swaminathan Shailender , Lee Yoojin , Sommers Benjamin D. , Mehrotra Rajnish , Nguyen Kevin H. , Kim Daeho , Rivera-Hernandez Maricruz , Trivedi Amal N.
Published: April 2021

Significance Statement

Prior work suggests that uniform access to health insurance coverage and health care services reduces disparities in treatment and outcomes of patients with CKD. This study assessed whether expansions of Medicaid coverage to low-income adults in the United States under the Affordable Care Act (ACA) were associated with changes in the incidence rate of kidney failure. The authors found that, in the entire adult population aged 19–64 years, the ACA’s Medicaid expansions were associated with a statistically significant 3% relative reduction in kidney failure incidence in the early period (years 2 and 3) after expansion. However, this decline was not sustained in the later period (years 4 and 5) after expansion. Further research is needed to understand the relationship between expanding health insurance coverage and the incidence of kidney failure.

Background

Low-income individuals without health insurance have limited access to health care. Medicaid expansions may reduce kidney failure incidence by improving access to chronic disease care.

Methods

Using a difference-in-differences analysis, we examined the association between Medicaid expansion status under the Affordable Care Act (ACA) and the kidney failure incidence rate among all nonelderly adults, aged 19–64 years, in the United States, from 2012 through 2018. We compared changes in kidney failure incidence in states that implemented Medicaid expansions with concurrent changes in nonexpansion states during pre-expansion, early postexpansion (years 2 and 3 postexpansion), and later postexpansion (years 4 and 5 postexpansion).

Results

The unadjusted kidney failure incidence rate increased in the early years of the study period in both expansion and nonexpansion states before stabilizing. After adjustment for population sociodemographic characteristics, Medicaid expansion status was associated with 2.20 fewer incident cases of kidney failure per million adults per quarter in the early postexpansion period (95% CI, −3.89 to −0.51) compared with nonexpansion status, a 3.07% relative reduction (95% CI, −5.43% to −0.72%). In the later postexpansion period, Medicaid expansion status was not associated with a statistically significant change in kidney failure incidence (−0.56 cases per million per quarter; 95% CI, −2.71 to 1.58) compared with nonexpansion status and the pre-expansion time period.

Conclusions

The ACA Medicaid expansion was associated with an initial reduction in kidney failure incidence among the entire, nonelderly, adult population in the United States; but the changes did not persist in the later postexpansion period. Further study is needed to determine the long-term association between Medicaid expansion and changes in kidney failure incidence.
Species of Cixiidae and Issidae (Hemiptera: Auchenorrhyncha: Fulgoromorpha) Distributed in Sinop and Kastamonu (Turkey)
Authors: TANYERİ Rukiye , ZEYBEKOĞLU Ünal
Published: April 2021

In this study, Cixiidae and Issidae (Hemiptera: Auchenorrhyncha) species collected from various localities in Sinop and Kastamonu between the years 2016-2018 were evaluated. 12 species belonging to 7 genera from Issidae and 4 species belonging to 4 genera from Cixiidae were determined. In addition, distributional data of the species in Turkey and in the world, and collection localities were given. Among the identified species, Kervillea placophora, Mycterodus confusus (Issidae) and Reptalus panzeri (Cixiidae) were recorded for the first time from the Black Sea Region of Turkey.
Why a Fair Compromise Requires Deliberation
Authors: Spang Friderike
Published: April 2021

I argue in this paper that the process of compromising needs to be deliberative if a fair compromise is the goal. More specifically, I argue that deliberation is structurally necessary in order to achieve a fair compromise. In developing this argument, this paper seeks to overcome a problematic dichotomy that is prevalent in the literature on deliberative democracy, which is the dichotomy between compromise and deliberation. This dichotomy entails the view that the process preceding the achievement of a compromise is essentially a process of negotiating or bargaining, which, I claim, should not be the case if a fair compromise is the goal. The reason for this claim is, in a nutshell, that negotiation or bargaining processes do not provide for an in-depth understanding of the reasons that each party has for holding their respective position. However, an in-depth understanding of each other’s reasons, is, as I will show, a necessary condition for achieving a fair compromise. In contrast to negotiation or bargaining, the deliberative process, by its very structure, provides for mutual understanding and is therefore a necessary condition for achieving a fair compromise.
Fundamental Arbitrage under the Microscope: Evidence from Detailed Hedge Fund Transaction Data
Authors: von Beschwitz Bastian , Lunghi Sandro , Schmidt Daniel
Published: April 2021

We exploit detailed transaction and position data for a sample of long-short equity hedge funds to study the trading activity of fundamental investors. We find that hedge funds exhibit skill in opening positions, but that they close their positions too early, thereby forgoing about a third of the trades' potential profitability. We explain this behavior with the limits of arbitrage: hedge funds close positions early in order to reallocate their capital to more profitable investments and/or to accommodate tightened financial constraints. Consistent with this view, we document that hedge funds leave more money on the table after opening new positions, negative returns, or increases in funding constraints and volatility.
Methodology for Identifying the Boundaries of Agglomerations based on Statistical Data
Authors: Tolmachev D.E. Tolmachev , Kuznetsov Pavel D. , Ermak Sergey V.
Published: April 2021

Significant difference in development between the municipalities is an obstacle for achieving economic sustainability in many Russian regions. Regional development strategies and plans of various municipalities often cannot be synchronised because of their incompatibility. Moreover, municipalities usually lack necessary resources to implement their strategies. To solve these problems, we identified groups of municipalities (key units of the settlement system (KUSS)) based on the existing socio-eco- nomic relations, common challenges and development potential. We propose a methodology for identifying KUSS and describe its application. This methodology relies on statistical data available at the municipal level. To assess the interconnection of municipalities, we used 6 statistical socio-economic indicators and 1 integrated index of Gross Municipal Product (GMP). The difference in the first 6 indicators of the development of municipalities demonstrated, that less developed municipalities tend to more developed ones. We used the values of gross municipal product to define high mutual attraction of large municipalities (similar to the gravity model). The distance between municipalities reduced their mutual influence. Due to the limited data set, it was necessary to consider the reliability of the identified inter-municipal relations. Thus, we compared the obtained results with empirical data on population distribution and circular migration between municipalities in the region. The comparison of our calculations and actual data showed high precision of the presented methodology. The resulting grouping of municipalities allowed identifying 21 key units of the settlement system in Sverdlovsk oblast. The proposed methodology can be used for deter- mining large groups of municipalities in Sverdlovsk oblast, as well as in other Russian regions.
Portraits of primary school pre-service teachers at a South African university: Implications for nuanced student support
Authors: Ramsaroop Sarita , Petersen Nadine
Published: April 2021

In this article, we report on a study of two South African primary school teacher education cohorts undertaken to investigate and understand their readiness to succeed in higher education and to plan support accordingly. Using the methodology of portraiture, we generated data from a combination of student questionnaires and examination results. Qualitative content analysis enabled the construction of six personas and three main themes. The portraits helped with an understanding of the complexity of the themes, in particular with how an identification of both the malleable and non-malleable elements affecting students' lives could inform and shape interventions for successful transition into university. More specifically, the dominance of particular characteristics in the personas provided information about which student groups required the most psychosocial and academic support and where it was required. The portraits also helped us to gauge the value of existing first-year initiatives, such as the educational excursion, for promoting student enculturation and in overcoming their initial anxieties and preconceptions. We argue for more nuanced information about students to inform a multi-pronged approach to student support that may extend much longer than teacher educators anticipate.
Tricuspid regurgitation: new diagnostic and therapeutic evidences
Authors: Colli Andrea , De Martino Andrea , Falcetta Giosuè , Croccia Mariagrazia , Del Re Federico , Pascarella Clemente , Ravenni Giacomo , Celiento Michele , Barzaghi Carlo , Levantino Maurizio
Published: April 2021

L’Insufficienza tricuspidalica (IT) di tipo funzionale, secondaria a patologia delle sezioni sinistre del cuore, è la più frequente forma di patologia della valvola tricuspide nei paesi occidentali, mentre la forma organica, più spesso isolata, risulta meno frequente. Sebbene diversi studi abbiano recentemente dimostrato evidenze in favore di un approccio chirurgico più aggressivo nella correzione dell’insufficienza tricuspidale funzionale, solo una piccola parte di questi pazienti viene trattata; ancor più raro è il ricorso alla chirurgia in pazienti con malattia tricuspidale isolata, a causa dell’elevata mortalità ospedaliera, soprattutto in caso di sostituzione. Ciò evidenzia come sia necessario ridefinire i criteri di selezione dei pazienti e le tempistiche per le procedure chirurgiche isolate. Negli ultimi anni sono state sviluppate diverse opzioni di trattamento percutaneo simili a quelle usate per la patologia mitralica, ovvero con plicatura dei lembi, rimodellamento dell’anulus o sostituzione valvolare. Gli studi scientifici pubblicati finora hanno mostrato dati promettenti in termini di sicurezza ed efficacia. In futuro il trattamento percutaneo potrà rappresentare una valida alternativa per un ampio numero di pazienti con IT inoperabili o ad alto rischio per la chirurgia convenzionale, ma attualmente non è disponibile per un uso generale a causa di limitazioni anatomiche e la necessità di tecniche di imaging avanzate. Lo scopo di questo lavoro è quello di analizzare gli aspetti eziopatogenetici, diagnostici e prognostici dell’IT e di riassumere le opzioni terapeutiche attualmente disponibili alla luce delle moderne acquisizioni tecnologiche nel trattamento percutaneo di una valvulopatia per molti anni sottovalutata.
Vincere il tumore e proteggere il cuore
Authors: Lorusso Vito , Fioretti Agnese Maria
Published: April 2021

La moderna sfida dei cardiologi è affrontare le più efficaci terapie antitumorali senza causare complicanze cardio-logiche. Il tumore è la seconda causa di morte nel mondo occidentale ed è tuttoggi una malattia curabile grazie alle più recenti terapie come la targeted therapy, gli inibitori del ckeck point e le più tradizionali come chemioterapia, radioterapia ed ormonoterapia. Il paziente oncologico guarito di oggi non deve diventare il paziente cardiopatico di domani, infatti per tale ragione sono possibili diverse strategie. Questa presentazione è focalizzata sull’uso della doxorubicina non peghilata, un nuovo tipo di antraciclina efficace quanto la tradizionale ma dotata di maggiore sicurezza cardiologica, da somministrare da sola o in combinazione ad altre terapie antitumorali e, soprattutto, anche in pazienti ad alto rischio cardiologico perché già sottoposti in precedenza ad antracicline con indicazione a rechallenge.
Follow up a lungo termine dell’ablazione ibrida della fibrillazione atriale persistente o persistente di lunga durata con tecnica Convergent: la prima esperienza in Italia
Authors: Rillo Mariano , E. Maggio Pompeo , Aloisio Angelo , Aloisio Davide
Published: April 2021

Introduzione: I dati a lungo termine del follow up dei pazienti (pz) sottoposti ad ablazione (A) transcatetere con radiofrequenza (RF) endocardica (Endo) della fibrillazione atriale (FA) persistente (P) o di lunga durata (LD) si sono dimostrati meno incoraggianti rispetto a quelli ottenuti per la FA parossistica. Recentemente una tecnica ibridadi A epicardica (Epi) e Endo, ha dimostrato di essere più efficace della sola A-Endo. Scopo: lo scopo del nostro studio è stato quello di riferire la nostra esperienza nell’esecuzione di questo approccio. Metodi e risultati: 15 pz con FAP (11) o FAP-LD (4), 9 maschi e 6 femmine, età media 67 ± 7 anni, precedentemen-te trattati senza successo con singola (10 pz) o multiple (5 pz) sessioni di A-Endo sono stati sottoposti a A-Epi per silenziare l’atrio sinistro posteriore (ASP). Un mese dopo l’A-Epi abbiamo eseguito una A-Endo per cercare even-tuali aree residue delle vene polmonari (VP) o dell’ASP che avrebbero potuto richiedere un ulteriore trattamento. Inoltre, abbiamo eseguito una mappabipolare ad alta densità utilizzando il sistema CARTO 3D, con acquisizione di almeno 2.000 punti al fine di identificare la fibrosi al di fuori dell’ASP. L’A-Epi ha richiesto un numero di righe di linee di ablazione di 1 in 3 pz (20%) e 2 in 12 pz (80%), con una media di 9 ± 3 linee nella riga inferiore e 7 ± 1 nella superiore. In un solo pz abbiamo osservato versamento pericardico ed è stato l’unico fallimento della nostra serie. l’A-Endo ha dimostrato 19 gaps di conduzione che hanno interessato 4 VP nel 21,4% dei pz e 41 gaps dell’ASP nel 71,4% dei pz. La fibrosi al di fuori dell’ASP è stata osservata in 6 pz. Non sono stati rilevati episodi di FA nell’84,6% dei pz al diciottesimo mese di follow-up; il 30.8% dei pz è stato trattato con Amiodarone. Conclusioni: l’A-Epi e l’A-Endo si sono dimostrate efficaci per il trattamento della FAP o FAP-LD con un rischio accettabile di complicanze, sebbene il numero limitato di casi e la natura osservazionale dello studio richiedano cautela nelle conclusioni.
Un caso di shock: l’embolia polmonare ad alto rischio
Authors: Matteucci Amedeo , Celi Alessandro
Published: April 2021

Il tromboembolismo venoso, che comprende la trombosi venosa profonda e l’embolia polmonare, è una delle cause prevalenti di morbilità e mortalità in tutto il mondo. L’embolia polmonare ad alto rischio, che include i pazienti con instabilità emodinamica, rappresenta solo il 5-10% delle embolie polmonari alla presentazione, ma è gravata da un’elevata mortalità intraospedaliera. In quanto tale, la diagnosi precoce con l’ecocardiografia transtoracica bedside e/o con l’angiografia polmonare con tomografia compu-terizzata è fondamentale per iniziare tempestivamente il trattamento adeguato e migliorare la prognosi. Riportiamo di seguito il caso di un paziente riferito al nostro centro per embolia polmonare acuta complicata da shock. Parole chiave: Tromboembolismo venoso; Embolia polmonare; Shock; Trombolisi; Anticoagulanti.
Interpretazione dell’ECG: un momento fondamentale nella gestione clinica del paziente cardiologico
Authors: Carbone Vincenzo , Fenini Fabio , Agosti Sergio , Casalino Laura , Battista Zito Giovanni
Published: April 2021

Il caso clinico proposto si riferisce a un paziente che presenta diverse manifestazioni elettrocardiografiche riferibili a doppia via nodale. Tale reperto, di riscontro non raro, deve essere opportunamente riconosciuto in quanto potrebbe condurre all’erronea diagnosi di blocco atrio-ventricolare, con conseguenti ripercussioni terapeutiche. Parole chiave: Tachicardia da rientro nodale; Blocco atrio-ventricolare; Elettrocardiogramma; Doppia via nodale.
Cardiotossicità da ormonoterapia nel tumore della prostata
Authors: Lusardi Paola
Published: April 2021

Nel sesso maschile il tumore della prostata è il più rappresentato, ma la sopravvivenza a 10 anni dalla diagnosi è estremamente elevata (fino al 90%), sia per la diagnosi molto precoce attuata con le politiche di screening, sia per le elevate percentuali di malattia a rischio basso ed intermedio. La prognosi favorevole del tumore prostatico fa sì che il numero di comorbilità, quali dislipidemia, ipertensione, obesità, insufficienza renale cronica, cardiopatia ischemica e diabete, sia determinante sull’iter dei lungo sopravviventi. La terapia di deprivazione androgenica (ADT), che viene utilizzata nel setting terapeutico e palliativo, può essere considerata un fattore di rischio cardiovascolare aggiuntivo, in grado di accelerare i processi aterosclerotici sistemici e predisporre alla malattia coronarica e cerebrovascolare. Tutti i pazienti candidati o in trattamento con ADT devono pertanto essere valutati dal punto di vista cardiovascolare e metabolico e quindi stratificati per i fattori di rischio CV, ai fini di programmare la sorveglianza cardiologica e ridurre i danni potenziali dell’ADT.
Onco-ematologia in età giovanile: come chemioterapia e radioterapia hanno modificato la storia naturale
Authors: Brignardello Enrico
Published: April 2021

Oggi un bambino o un adolescente che si ammala di tumore ha una probabilità di “guarire” (intesa come sopravvivenza a 5 anni) > 80%. Questo innegabile successo dell’oncologia pediatrica ha però un “prezzo”, che si paga in termini di tossicità tardiva delle cure (i cosiddetti late effects delle terapie antitumorali). Le complicanze tardive cardio-vascolari, che sono certamente molto rilevanti sul piano clinico, devono perciò essere inquadrate e gestite nel conte-sto molto più ampio di questi late effects. Il monitoraggio clinico a lungo termine dei giovani adulti curati per tumore richiede infatti il coinvolgimento di molti specialisti d’organo (fra cui il cardiologo), la cui attività deve essere coordinata da un medico esperto in late effects, secondo un programma di follow-up personalizzato in funzione delle pregresse terapie oncologiche.
Questioni pratiche nel trattamento anticoagulante della fibrillazione atriale nel paziente oncologico
Authors: Castaldi Bruno
Published: April 2021

La fibrillazione atriale si verifica con una frequenza maggiore nei pazienti con neoplasie, in particolare anziani, spesso correlata a comorbidità o complicanze della terapia chirurgica e medica del cancro. Trattare la fibrillazione atriale in pazienti con neoplasie è una sfida, soprattutto in termini di terapia antitrombotica, perché il cancro comporta un aumento del rischio sia di trombosi che di emorragia, e la risposta anticoagulante può essere imprevedibile. Alla terapia con warfarin e con eparina a basso peso molecolare si sono aggiunti, grazie alla provata efficacia e sicurezza, anche gli anticoagulanti orali diretti. Compliance del paziente, interazioni farmacologiche, frequenti cambiamenti della malattia neoplastica, impongono però una sorveglianza continua e un approccio multidisciplinare.
Cardio-oncologia: dal servizio dedicato intraospedaliero al cardiologo generale
Authors: Asteggiano Riccardo
Published: April 2021

Il Cardiologo Generale (CG) è coinvolto nella gestione del paziente oncologico con possibili complicanze cardiovascolari (CV) sia per motivi epidemiologici, che per la correzione dei fattori di rischio comuni alle malattie CV e al cancro, che per l’individuazione e la cura di effetti tossici della terapia oncologica, soprattutto nel Follow-Up (F-U) a lungo termine. Per un’ottimale gestione del paziente Cardio-Oncologico (C-O) è necessaria una profonda azione di insegnamento ed educazione all’argomento ed una pianificazione rigorosa dell’organizzazione dei servizi di C-O che prevedano anche l’inclusione del CG.
Minimal data set ecocardiografico nella valutazione del paziente oncologico
Authors: Doimo Sara , Pavan Daniela
Published: April 2021

I moderni trattamenti oncologici hanno aumentato notevolmente la sopravvivenza dei pazienti con neoplasia. Tutta-via, i farmaci chemioterapici e la terapia radiante possono indurre cardiotossicità, ovvero disfunzione ventricolare e scompenso cardiaco, la quale concorre ad essere una delle maggiori cause di morbidità e mortalità in questa tipologia di pazienti. L’ecocardiografia è la metodica di prima scelta nella valutazione anatomica e funzionale delle strutture cardiache nel paziente oncologico. Permette di identificare precocemente eventuali segni di compromissione della funzionalità cardiaca mediante immagini 2D e strumenti di analisi avanzata quali il 3D e lo studio degli indici di de-formazione miocardica. Fornisce informazioni preziose in merito alla funzione diastolica, agli apparati valvolari e del pericardio oltre a identificare possibili masse cardiache o pseudo masse. Il riscontro dei segni cardiotossicità permette di intervenire nella rimodulazione del trattamento chemioterapico riconsiderando la tipologia di farmaco utilizzata e la distribuzione delle dosi da somministrare, nonché l’introduzione della terapia cardioprotettiva.
Collective Intelligence Algorithms in Pedagogical Practice
Authors: Koliada Mykhailo G. , Bugayova Tatyana I.
Published: April 2021

The article considers the ideas of using artificial intelligence algorithms in pedagogics. It presents the methodology of the so-called collective pedagogical megasystem. The introduction of such an ephemeral construct is necessary only to understand the collective pedagogical intelligence system, formulate it in a model, find out its operation patterns and the laws it obeys. It would contribute to predicting pedagogical processes and phenomena and formulating new laws. The objective of the article is to demonstrate the application of collective intelligence algorithms in pedagogical practice for effective didactic decision-making. The matter is that in a real educational process, besides the well-known set of pedagogical conditions, there are some random and unpredictable reasons and factors that are hard to foresee or anticipate. Due to their stochastic nature, they occur spontaneously. These single reasons make a minor impact on the teaching methods selection, but in aggregate their influence gets so strong that they can upturn some prognostic conclusions. The problem also focuses on identifying the factors that would ensure the highest efficiency and productivity of studies among the known (expected) and random (unexpected) reasons. For these purposes, the most suitable algorithm for the selection training methods is the so-called ant algorithm which, on the one hand, considers the randomness of the influence parameters, and on the other, ensures steady and high productivity. A certain example was selected to demonstrate the process of applying the ant algorithm to reveal the best hierarchy of the pedagogical conditions (factors) that determines the optimum choice of the training method. The authors conclude that human intelligence is distributed and integrated at the same time, and the application of collective intelligence algorithms in pedagogical practice can yield some effective didactic decisions
Self-Determination as a Psychological Resource of Teacher’s Personal and Professional Development
Authors: Pochtaryova Elena Yu. , Vasyagina Nataliya N.
Published: April 2021

Self-determination in the context of a teacher’s personal and professional development has become a relevant research subject due to the humanistic and person-oriented education focused on the development of an active and self-identifying personality. The aim of the paper is the psychological analysis of motivational self-determination processes as a subjective foundation for the personal and professional development of a teacher. Based on the modern psychological approaches to the self-determination phenomenon, the paper discusses the integrative mechanisms and internalization factors that determine the satisfaction with the activity and productivity of a teacher. The authors present their reasons in favour of a conceptual model of personal and professional characteristics of a teacher’s self-determination. They argue that self-determination and associated concepts of autonomy, internally motivated activity, developing learning environment, dialogue, facilitation, persistence, and involvement identify the essence of personal and professional development of a teacher as a psychological resource system. The authors conclude that the axiological creative content of self-determination processes integrates the diverse types of motivational tendencies in the pedagogical activity, highlighting the consistency and coherence of a teacher’s personal and professional development
Educative Event as Professional Skills Transfer Method: The Young Reporters’ Programme at the XXIX Winter Universiade 2019
Authors: Rutskaya Kseniya A. , Nazarenko Elena M. , Kol’k Oksana A.
Published: April 2021

The Young Reporters’ Programme (sports journalism and media school) presented at the XXIX World Winter Universiade 2019 in Krasnoyarsk was «a project within the project». The article describes key conditions and methods for organizing the transfer of professional skills and defines key structural elements in sports journalism and media school within a large-scale sporting event. Special attention is given to solving two problems: creating high-quality media content by students during the Universiade; and identifying universal technological elements for designing a sports journalism and media school that would allow participants to master modern tools and apply them after completing the Young Reporters’ Programme. The approach of B. D. Elkonin and M. M. Mirkes to describing components of an educative event is the methodological basis of the study. The presented survey data are the result of implementing the Young Reporters’ programme in Krasnoyarsk in 2019. It was the first time when the professional media training for covering a large-scale international sporting event has been developed, implemented and described. The findings of this study may be used for designing internships and student practical sessions at universities with the main educational process considered as a certain project