bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Technology in Supporting the Education of Community Health Workers and their Leaders
Authors: Panjabi Raj , Long Lesley-Anne , Bailey Michael , Conteh Magnus
Published: September 2021

Community health workers (CHWs) often represent the first point of contact for many individuals in low-income countries accessing health services. Unfortunately, due to the low quality of care, outcomes for many people are unpredictable. Although the causes for poor quality of care are multifaceted, one obvious cause is that many CHWs are undertrained. Given the scope of the problem and the lack of resources available to solve it, governments and donor organizations are looking at digital technologies to help address problems such as access to services, health worker training, and decision-making. Access to and understanding of educational content can be improved by combining classroom education with distance learning to create a blended learning approach. Furthermore, by integrating the educational experience offered to CHWs through technology with related support services such as data collection, logistics management and AI-based decision support, governments can compensate for the quality of care gap.
Diagnosis and assessment
Authors: Selikowitz Mark
Published: September 2021

The first step in the treatment of ADHD is making the correct diagnosis. Only when it is known that a child has ADHD and that all other possible causes of child’s problems have been excluded, can a proper treatment programme be devised. The best person to make the diagnosis is a specialist paediatrician with an interest and expertise in developmental and learning difficulties in children. Educational psychologists also play a vital role in the process by which ADHD is diagnosed. This chapter outlines diagnosis and assessment of ADHD, including the history, examination, psychometric testing (intelligence, academic achievement, other abilities), special investigations, and formulation of a management plan.
Medicines—general principles
Authors: Selikowitz Mark
Published: September 2021

All the medicines used to treat ADHD aim to normalize the amount of neurotransmitter in the frontal lobes of the brain. Each child with ADHD needs medication that is selected with care and based on several considerations. Medicine can potentially reduce many difficulties experienced by children with ADHD, although some may not need medication. This chapter discusses medicines in the treatment of ADHD, including how they work, how to find the right medicine for a particular child and aspects of ADHD that are helped by medicines (learning, behaviour, social skills, emotional state). It also covers the place of medicine in the treatment of ADHD, treatment of ADHD without medication, and how to explain the role of medications to a child.
Administrative Procedure and Judicial Review in the United Kingdom
Authors: Nason Sarah
Published: September 2021

This chapter focuses on administrative procedure and judicial review in the United Kingdom. Initially, it should be stressed that administrative law is different across the UK due to devolution. The UK Supreme Court generally acts as a final court of harmonizing case-law principles. As the UK constitution is uncodified, the existence of constitutional provisions concerning judicial review remains somewhat controversial, but the necessity of judicial review is thought to be required by the rule of law. The scope of judicial review is generally governed by judicial precedent. Under section 84 of the Criminal Justice and Courts Act 2015, the High Court must refuse to grant a remedy 'if it appears to the court to be highly likely that the outcome for the applicant would not have been substantially different if the conduct complained of had not occurred'. In general, there is no right on judicial review to claim damages for losses caused by unlawful administrative actions. It is usually only possible to receive damages in judicial review claims if there is another established cause of action, separate to the ground for judicial review.
EU Countries and the UK
Authors: Andenas Mads
Published: September 2021

This chapter compares European Union countries to the United Kingdom. It aims at ascertaining not so much whether a common core exists but how it is shaped and evolves, also in response to influences by supranational legal orders. EU countries do not adhere to one model. Administrative law is subject to rapid development, and even countries that share many structures and general features do not develop at the same speed or in the same direction. In the UK, there is no specialized administrative court jurisdiction. There is one general court system that deals with civil, criminal, and administrative cases; but there are many administrative tribunals and appeals tribunals. Nearly all the EU countries have a specialised administrative court system, and the majority has a constitutional court. The chapter considers the perceived divide between civil law countries and the common law in the UK, in the light of the relationship between national law and EU and European Convention on Human Rights (ECHR) law. It also looks at the four main features of the legal systems selected for comparison: the constitutional relevance of judicial review; the limitations of judicial review; procedural errors or omissions; and annulment and damages.
Judicial Oversight of Procedural Fairness and Propriety in Europe: Diversity Within Commonality
Authors: della Cananea Giacinto
Published: September 2021

This chapter explores the common and distinctive elements that emerge from the comparative analysis of legal systems, in terms of commonality and diversity in administrative law. It begins by outlining the main institutional features of the legal systems selected for the comparison, with an initial focus on the idea of a 'divide' between civil law and common law. The two important features of the legal systems examined in this book include judicial independence and judicial specialization. The chapter then discusses the procedural requirements at the heart of the factual analysis. It concludes by reflecting on the relevance and significance of this analysis for the general enquiry concerning the common core of European administrative laws.
Assessing and Performing Authenticity
Authors: Graumann Thomas
Published: September 2021

The desire to assure the authenticity of documents and conciliar acts observed in the councils of the fifth century finds exaggerated expression in the two later ecumenical councils of Constantinople (680–1) and Nicaea II (787). In dramatic style, the necessity to be dealing with ‘correct’ and authentic acts is performed through almost theatrical acting in the council(s). Under the personal supervision of the emperor and based on observations of differently numbered and written quires, at Constantinople the ‘falsifications’ of the acts of the previous ecumenical council are in this way detected, and expunged. At Nicaea, the patriarch and council demonstratively act out the probity of their own procedures—and thus of their theological judgement—by means of philological and codicological scrutiny, described in detail in the acts.
The Stenographic Protocol
Authors: Graumann Thomas
Published: September 2021

This chapter traces the external factors limiting the stenographers in their task, while underlining the competency and professionalism with which they executed their duties. Challenges of their work latch on to certain ‘conventions’ allegedly allowing misrepresentation, raising questions of the exactitude and comprehensiveness of a protocol and the possibilities of dictation by a superior rather than recording, and revealing the desire to have records changed. Statements attributed to the entire council, so claiming to represent a common mind, attract particular criticism. In defending their work, secretaries and notaries reveal the exercise of critical judgement as to the main direction of the meeting and the purposes of individual interventions, and the observations and mechanisms by which they sought to assure its appropriateness. Conversely, criticism usually results from a different understanding of these factors, sometimes reified in hindsight, and discontent with the material decisions presents itself as critique of allegedly flawed recording.
‘Transferring’ Shorthand Notes to Longhand Transcript
Authors: Graumann Thomas
Published: September 2021

This chapter discusses the scant evidence for the effects of the process of transcribing shorthand notes taken down during council sessions into a longhand record. It identifies a unique case where the original notes may still be reconstructed and can demonstrate their transcription as an act of interpretative ‘translation’ into the final wording. Analogous practices and their effects may be expected on other occasions. Additionally, paratextual notes surviving in some manuscripts of the Chalcedonian acts are decoded and discussed as potentially pertaining to the processes of transcription, control, and copying, and in this way opening a window into the usually hidden practical execution of these steps.
Abstracting and Summary Records
Authors: Graumann Thomas
Published: September 2021

Different from the purportedly full records giving the interventions of named participants in direct speech, councils can use other types of protocols that deliberately obscure some of these elements, for instance by neglecting to identify individuals by name, and even by recording only the statements of the presidents and their chief aides, or by omitting pertaining documentation. Papyrological records of civil proceedings from the same period reveal these texts to be conforming to conventional bureaucratic practice and so disprove suspicions of manipulation and unreliability of such protocols. By paying attention to the materiality of conciliar records, a case of missed documentation can be attributed to the effects of unsafe storage, not wilful suppression.
The Structure and Elements of the ‘Ideal’ Session-Record and the Role of ‘Editing’
Authors: Graumann Thomas
Published: September 2021

Summarizing the findings of the previous chapters, this chapter sketches what might be considered an ideal type of a conciliar session protocol, as it starts with a conventional frame giving date and place and elucidation of the occasion, then progresses through the agenda and culminates in the recording of the oral verdicts of the bishops, concluding with the written formulization in a verdict signed by them. The protocol of the much-criticized Council of Ephesus (449) paradoxically comes very close to this ideal, when taken on its own terms. The seeming contradiction between this document’s smooth formality and the alleged tyrannical manipulations of the meeting it portrays alerts us to the role of a deeper editing, here and generally, by which the records were made to match the designs and self-image of both ecclesiastical and civil authorities, and which cannot be entirely captured by the attention to the textual processes required for their production alone.
Coalition Governance in Western Europe
Authors: Bergman Torbjörn , Hanna Bäck , Johan Hellström
Published: September 2021

This chapter describes the ambitions of the volume. First, we build on the lessons from earlier studies of governments in Western and Central Eastern Europe to deepen our understanding of the coalition life cycle, covering the three stages of a government’s ‘life’, beginning with the formation process, then turning to the governance stage, and lastly turning to the final phase when governments eventually terminate. Second, we seek to capture how recent changes in the Western European party systems, which are also described here, influence the various stages of the coalition life cycle. Third, we are in particular interested in how coalition partners cooperate and make policy once a government has formed, aiming to contribute to the growing literature on the topic of coalition governance. The chapter ends with a description of the content of the volume.
Finland: Forming and Managing Ideologically Heterogeneous Oversized Coalitions
Authors: Raunio Tapio
Published: September 2021

Examining coalition governance in Finland, this chapter argues that due to the ideological heterogeneity of Finnish cabinets, prime ministers and governments emphasize the importance of ex ante control mechanisms. Government programmes have become very detailed and there are both established written rules and informal conventions for cabinet decision-making and for solving conflicts within the government. The prime minister is strongly constrained by the types of cabinets formed in Finland. Heading oversized, ideologically heterogeneous governments, prime ministers must strike a balance between active leadership and accommodating the preferences of the coalition partners. The key to managing such broad coalitions is building and maintaining trust among the governing parties. Coalition governance in Finland is also characterized by stability: the existing practices have remained basically unaltered at least since the mid-1990s, and the rise of populism has not changed how cabinets are formed or work. Prime ministers, the coalition partners, and their parliamentary groups know and mainly respect the rules of the game, and this contributes to the survival of the broad Finnish cabinets.
Sweden: The Rise and Fall of Bloc Politics
Authors: Johan Hellström , Lindahl Jonas
Published: September 2021

This chapter examines coalition formation and coalition governance in Sweden. Swedish coalition politics have historically been characterized by a near-unidimensional political conflict along the left–right policy dimension, along with minority government rule (and a high share of minority cabinets).. In addition, Swedish politics has long been characterized by ‘two-bloc politics’, where the socialist and the non-socialist bloc have competed for power. However, the growing electoral successes for the populist radical right party, the Sweden Democrats, has recently and at least temporary, ended this. Although the increasing fragmentation and polarization of Swedish politics has made bargaining over government more difficult, it has not changed how coalition cabinets work and the existing practices of coalition governance since the early 1990s remains intact. Collegiality and consensus are still the dominant characteristics of Swedish coalition governance.
Global Intersectionality and Contemporary Human Rights
Authors: Bond Johanna
Published: September 2021

The book enriches our understanding of international human rights by using intersectionality theory, the concept that aspects of identity, such as race and gender, are mutually constitutive and intersect to create unique experiences of discrimination and subordination, to examine contemporary human rights issues. Perpetrators of sexual violence in armed conflict, for example, often target victims based on both gender and ethnicity. Human rights remedies that fail to capture the intersectional nature of human rights violations do not offer comprehensive redress to victims. The book explores the influence of intersectionality theory on human rights in the modern era and traces the evolution of intersectionality as a theoretical framework in the United States and around the world. The book draws upon critical race feminism and human rights jurisprudence to argue that scholars and activists have under-utilized intersectionality theory in the global discourse of human rights. As the central intergovernmental organization charged with the protection of human rights, the United Nations has been slow to embrace the insights gained from intersectionality theory. Global Intersectionality argues that the United Nations and other human rights organizations must more actively embrace intersectionality as an analytical framework in order to fully address the complexity of human rights violations around the world.
Genealogy and Critique
Authors: Reginster Bernard
Published: September 2021

The chapter examines the concept of a genealogy of morality and its critical significance. I consider and criticize interpretations of Nietzsche’s genealogical inquiries that take them to challenge the epistemic standing of moral judgments. I argue that genealogies aim instead to determine the function of these judgments by identifying what particular affective need they are suited to serve. This functional approach allows to shed light on the much-disputed role of history in genealogical inquiry, and to circumscribe what Nietzsche has in mind when he calls into question the “value” of moral values. In particular, I address two salient problems his functional approach poses for a functional critique of morality: respectively, the problem of dysfunctionality and the problem of multiple functionality.
The Roll of the Dice
Authors: Elliott Andrew C. A.
Published: September 2021

The topic of probability is introduced through analysis of games of chance, using the casino games of roulette and the dice game craps. The nature of probability is explored, including different interpretations of what probability actually is. Ways of combining probabilities are described. The player will lose in the long run, but how long a run is needed for this to show itself? The asymmetry between the player and the gambling house is explored. The Gambler’s Fallacy is contrasted to the law of large numbers.
Chance Discoveries
Authors: Elliott Andrew C. A.
Published: September 2021

The chapter begins with a discussion of the chances of finding buried treasure and the laws governing it if you do. Treasure may be valuable in other than material terms: many architectural finds were made by accident. Chance discoveries play an important role in science: is it possible to systematically encourage opportunities for this scientific serendipity? Are accidental discoveries inevitable or are they mere contingencies?
Dante's New Life of the Book
Authors: Eisner Martin
Published: September 2021

This study uses the material transmission history of Dante’s innovative first book, the Vita nuova (New Life), to intervene in recent debates about literary history, reconceiving the relationship between the work and its reception, and investigating how different material manifestations and transformations in manuscripts, printed books, translations, and adaptations participate in the work. Just as Dante frames his collection of thirty-one poems surrounded by prose narrative and commentary as an attempt to understand his own experiences through the experimental form of the book, so later scribes, editors, and translators use different material forms to embody their own interpretations of it. Traveling from Boccaccio’s Florence to contemporary Hollywood with stops in Emerson’s Cambridge, Rossetti’s London, Nerval’s Paris, Mandelstam’s Russia, De Campos’s Brazil, and Pamuk’s Istanbul, this study builds on extensive archival research to show how Dante’s strange poetic forms continue to challenge readers. In contrast to a conventional reception history’s chronological march, each chapter analyzes how one of these distinctive features has been treated over time, offering new perspectives on topics such as Dante’s love of Beatrice, his relationship with Guido Cavalcanti, and his attraction to another woman, while highlighting Dante’s concern with the future, as he experiments with new ways to keep Beatrice alive for later readers. Deploying numerous illustrations to show the entanglement of the work’s poetic form and its material survival, Dante’s New Life of the Book offers a fresh reading of Dante’s innovations, demonstrating the value of this philological analysis of the work’s survival in the world.
A Philology of World Literature
Authors: Eisner Martin
Published: September 2021

This chapter argues for the importance of integrating the multiplicity of material copies of a work, such as Dante’s Vita nuova, into investigations of its meaning. Discussing different approaches to analyzing the textual tradition, such as reconstructing the original text or examining the cultural context of a given moment of reception, this chapter proposes exploring the relationship between those multiple copies, which should be understood as participating in the work. Adopting the idea of a ‘philology of world literature’ first proposed by Erich Auerbach, this chapter situates this approach in relation to the recent return to philology and the current interest in world literature. It argues that this integration of history and form could serve as a model for literary study and shows how this approach offers a new awareness of the complexity and richness of Dante’s work.
The Painting (Composition)
Authors: Eisner Martin
Published: September 2021

This chapter scrutinizes the challenges editors confronted in their typographical composition of Dante’s poem with two beginnings. Should the first beginning be followed by the rest of the poem and then the second beginning or both beginnings and then remaining verses? The various solutions proposed in the early printed editions, nineteenth-century translations, and early modern manuscripts, show the complexity of Dante’s own poetic strategy in this poem on the anniversary of Beatrice’s death, which aims to defeat time and overcome Beatrice’s death by adding more time. Exploring the persistence of this issue in the most recent editions, the chapter considers the poem in light of Dante’s decision to represent himself in the prose as painting an angel. Connecting this remark to Dante’s reflections on angels and representation in the De vulgari eloquentia and the Commedia, this chapter examines Dante’s thinking about the materiality of texts and the relationship between word and image in the context of a larger tradition that stretches from Augustine and Petrarch to Sterne’s Tristram Shandy.
Conclusion
Authors: George Erika
Published: September 2021

In conclusion, the book reflects on what these different developments mean for international law. It describes an emerging “transnational legal order” promoting policy and practice in the absence of a binding regulatory instrument. It presents and addresses concerns and caveats over business enterprises incorporating rights versus co-opting rights. It is argued that self-regulation is a misnomer in that constituencies outside the corporation co-create conditions for enforcement. Information and activism that raised awareness concerning the adverse human rights impacts associated with particular business practices and have prompted change in many instances, at minimum the creation of a corporate code or policy that incorporates reference to human rights and speaks to responsibility. Less well articulated is accountability to victims of rights violations and access to remedy. Ensuring policies that are in place are put into practice and corporate performance is consistent with responsibility to respect remains a challenge. Mandating information can aid and accelerate efforts to ensure business enterprises take the responsibility to respect human rights seriously—a “smart mix” of strategies will be required, and we must appreciate that soft law and social pressure are an important part of the mix.
Upper Quadrant Edema Patient-Reported Outcome Measure Is Reliable, Valid, and Efficient for Patients With Lymphatic and Venous Disorders
Authors: Deutscher Daniel , Hayes Deanna , Cook Karon F , Werneke Mark W , Tucker Carole A , Mioduski Jerome E , Levenhagen Kim , Tidhar Dorit , Pfarr Megan , Kallen Michael A
Published: September 2021

Objective

The main aims of this study were to (1) create a patient-reported outcome measure (PROM) item bank for measuring the impact of upper quadrant edema (UQE) on physical function by calibrating responses to newly developed items; and (2) assess reliability, validity, and administration efficiency of scores based on computerized adaptive test (CAT) and 10-item short-form (SF) administration modes.

Methods

This was a retrospective study including data from patients treated in outpatient rehabilitation clinics for UQE that responded to all 27 candidate items at intake. Item response theory model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning were evaluated. UQE-CAT– and UQE-SF–generated scores were assessed for reliability, validity, and administration efficiency.

Results

The total cohort included 3486 patients (mean [SD] age = 61 [13] years; range = 14–89 years). After removing 2 items, a 25-item solution was supported for its unidimensionality and fit to the item response theory model with reliability estimates of more than 0.93 for scores based on both CAT and SF administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways and were moderately responsive to change with negligible floor and acceptable ceiling effects. CAT scores were generated using an average of 5.6 items (median = 5).

Conclusion

Scores on the UQE PROM were reliable, valid, and efficient for assessing perceived physical function of patients with upper quadrant edema; thus, the measure is suitable for research and routine clinical administration.

Impact

The newly developed UQE PROM is reliable and valid and offers efficient administration modes for assessing perceived physical function of patients with UQE caused by lymphatic and venous disorders, both for research and routine clinical care in busy outpatient rehabilitation settings. As an item response theory–based measure, the UQE PROM allows administration of condition-specific functional questions with low response burden for patients. This study supports a transition to PROMs that are based on modern measurement approaches to achieve high accuracy and efficiency.
The Real Effects of Monetary Expansions: Evidence from a Large-scale Historical Experiment
Authors: Palma Nuno
Published: September 2021

The discovery of massive deposits of precious metals in America during the early modern period caused an exogenous monetary injection to Europe’s money supply. I use this episode to identify the causal effects of money. Using a panel of six European countries, I find that monetary expansions had a material impact on real economic activity. The magnitudes are substantial and persist for a long time: an exogenous 10% increase in the production of precious metals in America measured relative to the European stock leads to a front-loaded response of output and, to a lesser extent, inflation. There was a positive hump-shaped response of real GDP, with a cumulative increase up to 0.9% six to nine years later. The evidence suggests that this is because prices responded to monetary injections with considerable lags.
Jumping on the Bandwagon: Comparing the Efficacy of Chlorhexidine Versus Povidone-Iodine Preoperative Skin Antiseptic in Preventing Surgical Site Infections Following Pediatric Orthopaedic Surgery
Authors: Beber Samuel A. , Sanborn Ryan M. , Miller Patricia E. , Kasser James R. , Waters Peter M. , Watkins Colyn J. , Shore Benjamin J.
Published: September 2021

Background:

Adult literature has demonstrated chlorhexidine (CH) superiority at preventing surgical-site infections when compared with povidone-iodine (P-I). The purpose of this study is to compare the rate of postoperative infections after preoperative skin cleansing with either CH or P-I in pediatric orthopaedic surgery in an effort to identify superiority.

Methods:

We retrospectively identified all patients (18 y and below) that underwent orthopaedic surgery at our institution in 2015, when P-I was the preoperative skin antisepsis of choice, and in 2018, when a change in protocol resulted in more frequent use of CH. Open fractures, infections, neuromuscular, and tumor surgeries were excluded. Orthopaedic surgeries were classified according to their subspecialty (sports-related/upper extremity, hip and lower extremity, trauma-related, or spine procedure). A 1:1 propensity score matching was conducted within each procedure group on the basis of age, sex, and year using nearest-neighbor matching. Spine procedures could not be matched and were subsequently excluded from analyses.

Results:

Propensity score matching matched 1416 CH cases with 1416 P-I controls. The infection rate for CH was 19 infections per 1000 cases (27/1416; 1.9%) compared with an infection rate of 11 infections per 1000 cases (16/1416; 1.1%) for P-I subjects. No difference was detected in infection rate across preoperative skin antisepsis groups (P=0.12). Moreover, it was found that CH and P-I resulted in significantly equivalent infection rates to within ±1.5% (P=0.004). When stratified by procedure type, CH used in sports/upper extremity procedures resulted in 29 more infections per 1000 cases compared with P-I use (16/450; 3/450; P=0.005). No difference was detected in infection rate across CH and P-I skin antisepsis groups in lower extremity procedures (9/792; 8/792; P=1.00) or in trauma-related procedures (3/174; 4/174; P=1.00).

Conclusions:

CH and P-I are both protective against postoperative infections after sports/upper extremity, lower extremity, and trauma-related pediatric orthopaedic procedures. P-I may provide improved protection over CH as a preoperative skin antisepsis in upper extremity and sports-related procedures.

Level of Evidence:

Level III—comparative cohort.
Coffee consumption and gastric cancer: a pooled analysis from the Stomach cancer Pooling Project consortium
Authors: Martimianaki Georgia , Bertuccio Paola , Alicandro Gianfranco , Pelucchi Claudio , Bravi Francesca , Carioli Greta , Bonzi Rossella , Rabkin Charles S. , Liao Linda M. , Sinha Rashmi , Johnson Ken , Hu Jinfu , Palli Domenico , Ferraroni Monica , Lunet Nuno , Morais Samantha , Tsugane Shoichiro , Hidaka Akihisa , Hamada Gerson Shigueaki , López-Carrillo Lizbeth , Hernández-Ramírez Raúl Ulises , Zaridze David , Maximovitch Dmitry , Aragonés Nuria , Martin Vicente , Ward Mary H. , Vioque Jesus , Garcia de la Hera Manoli , Zhang Zuo-Feng , Kurtz Robert C. , Lagiou Pagona , Lagiou Areti , Trichopoulou Antonia , Karakatsani Anna , Malekzadeh Reza , Camargo M. Constanza , Curado Maria Paula , Boccia Stefania , Boffetta Paolo , Negri Eva , La Vecchia Carlo
Published: September 2021

Objective

This study aimed to evaluate and quantify the relationship between coffee and gastric cancer using a uniquely large dataset from an international consortium of observational studies on gastric cancer, including data from 18 studies, for a total of 8198 cases and 21 419 controls.

Methods

A two-stage approach was used to obtain the pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for coffee drinkers versus never or rare drinkers. A one-stage logistic mixed-effects model with a random intercept for each study was used to estimate the dose–response relationship. Estimates were adjusted for sex, age and the main recognized risk factors for gastric cancer.

Results

Compared to never or rare coffee drinkers, the estimated pooled OR for coffee drinkers was 1.03 (95% CI, 0.94–1.13). When the amount of coffee intake was considered, the pooled ORs were 0.91 (95% CI, 0.81–1.03) for drinkers of 1–2 cups per day, 0.95 (95% CI, 0.82–1.10) for 3–4 cups, and 0.95 (95% CI, 0.79–1.15) for five or more cups. An OR of 1.20 (95% CI, 0.91–1.58) was found for heavy coffee drinkers (seven or more cups of caffeinated coffee per day). A positive association emerged for high coffee intake (five or more cups per day) for gastric cardia cancer only.

Conclusions

These findings better quantify the previously available evidence of the absence of a relevant association between coffee consumption and gastric cancer.
Efficacy of black rice extract on obesity in obese postmenopausal women: a 12-week randomized, double-blind, placebo-controlled preliminary clinical trial
Authors: Jung Ah Jin , Sharma Anshul , Lee Sung-Hyen , Lee Sung-Joon , Kim Jung-Hwan , Lee Hae-Jeung
Published: September 2021

Objectives:

Postmenopausal obesity is a paramount health concern among older women. Black rice is a well-known pigmented rice variety with a higher anthocyanin content. Both in vitro and in vivo studies have demonstrated the effects of black rice on obesity. The present study aimed to investigate the effects of black rice extract (BRE) on obesity among obese postmenopausal women from Korea.

Methods:

This was a 12-week, randomized, double-blind, placebo-controlled preliminary clinical trial. The participants were postmenopausal women who had stopped menstruating for more than a year. Specifically, 105 participants were randomly assigned to the BRE (1 g/d) or placebo (maltodextrin, 1 g/d) group.

Results:

Eighty-eight participants completed the study, 47 in the intervention group and 41 in the placebo group. At the study endpoint, dual-energy x-ray absorptiometry assessment showed that the BRE group had a significantly lower trunk fat (P = 0.04), total fat (P = 0.04), and total body fat percentage (P = 0.04) than did the placebo group. The body fat percentage (P = 0.04) was lower in the BRE group with marginal significance, and there were no significant differences in anthropometric measures such as weight, body mass index, waist circumference, or waist-to-hip ratio estimated by bioelectrical impedance analysis.

Conclusion:

BRE supplementation for 12 weeks seems to be effective in reducing fat accumulation in postmenopausal women.
The Natural History of Acute Radiation-induced H-ARS and Concomitant Multi-organ Injury in the Non-human Primate: The MCART Experience
Authors: Farese Ann M. , Booth Catherine , Tudor Greg L. , Cui Wanchang , Cohen Eric P. , Parker George A. , Hankey Kim G. , MacVittie Thomas J.
Published: September 2021

The dose response relationship and corresponding values for mid-lethal dose and slope are used to define the dose- and time-dependent parameters of the hematopoietic acute radiation syndrome. The characteristic time course of mortality, morbidity, and secondary endpoints are well defined. The concomitant comorbidities, potential mortality, and other multi-organ injuries that are similarly dose- and time-dependent are less defined. Determination of the natural history or pathophysiology associated with the lethal hematopoietic acute radiation syndrome is a significant gap in knowledge, especially when considered in the context of a nuclear weapon scenario. In this regard, the exposure is likely ill-defined, heterogenous, and nonuniform. These conditions forecast sparing of bone marrow and increased survival from the acute radiation syndrome consequent to threshold doses for the delayed effects of acute radiation exposure due to marrow sparing, medical management, and use of approved medical countermeasures. The intent herein is to provide a composite natural history of the pathophysiology concomitant with the evolution of the potentially lethal hematopoietic acute radiation syndrome derived from studies that focused on total body irradiation and partial body irradiation with bone marrow sparing. The marked differential in estimated LD50/60 from 7.5 Gy to 10.88 Gy for the total body irradiation and partial body irradiation with 5% bone marrow sparing models, respectively, provided a clear distinction between the attendant multiple organ injury and natural history of the two models that included medical management. Total body irradiation was focused on equivalent LD50/60 exposures. The 10 Gy and 11 Gy partial body with 5% bone marrow sparing exposures bracketed the LD50/60 (10.88 Gy). The incidence, progression, and duration of multiple organ injury was described for each exposure protocol within the hematopoietic acute radiation syndrome. The higher threshold doses for the partial body irradiation with bone marrow sparing protocol induced a marked degree of multiple organ injury to include lethal gastrointestinal acute radiation syndrome, prolonged crypt loss and mucosal damage, immune suppression, acute kidney injury, body weight loss, and added clinical comorbidities that defined a complex timeline of organ injury through the acute hematopoietic acute radiation syndrome. The natural history of the acute radiation syndrome presents a 60-d time segment of multi-organ sequelae that is concomitant with the latent period or time to onset of the evolving multi-organ injury of the delayed effects of acute radiation exposure.
Vogt-Koyanagi-Harada disease
Authors: Joye Ashlin , Suhler Eric
Published: September 2021

Purpose of review

Here, we provide an overview of Vogt-Koyanagi-Harada disease (VKH), including recent updates in our understanding of disease pathophysiology, classification and therapeutics.

Recent findings

Advancements in bioinformatics, metabolomics and genomics investigations continue to illuminate VKH pathogenesis, and may provide insight into future therapeutic options. Multimodal imaging is indispensable in the initial evaluation of VKH, and is becoming increasingly important in understanding disease pathogenesis, as well as monitoring therapeutic response. Enhanced VKH classification criteria, released in 2021, provide standardized guidelines and terminology for clinical and research purposes.

Modern research and imaging techniques continue to improve our understanding of VKH; more work is needed to further elucidate pathogenic mechanisms and establish optimal therapeutic recommendations.
Cardiac arrest in special circumstances
Authors: Lott Carsten , Truhlár Anatolij
Published: September 2021

Purpose of review

European Resuscitation Council Guidelines for Cardiopulmonary Resuscitation prioritize treatments like chest compression and defibrillation, known to be highly effective for cardiac arrest from cardiac origin. This review highlights the need to modify this approach in special circumstances.

Recent findings

Potentially reversible causes of cardiac arrest are clustered into four Hs and four Ts (Hypoxia, Hypovolaemia, Hyperkalaemia/other electrolyte disorders, Hypothermia, Thrombosis, Tamponade, Tension pneumothorax, Toxic agents). Point-of-care ultrasound has its role in identification of the cause and targeting treatment. Time-critical interventions may even prevent cardiac arrest if applied early. The extracorporeal CPR (eCPR) or mechanical CPR should be considered for bridging the period needed to reverse the precipitating cause(s). There is low quality of evidence available to guide the treatment in the majority of situations. Some topics (pulmonary embolism, eCPR, drowning, pregnancy and opioid toxicity) were included in recent ILCOR reviews and evidence updates but majority of recommendations is based on individual systematic reviews, scoping reviews, evidence updates and expert consensus.

Cardiac arrests from reversible causes happen with lower incidence. Return of spontaneous circulation and neurologically intact survival can hardly be achieved without a modified approach focusing on immediate treatment of the underlying cause(s) of cardiac arrest.
Calcium phosphate injection technique for treatment of distal radius fracture
Authors: Kim Dae-Geun , Kwack Byung Hoon
Published: September 2021

Introduction:

Distal radius fracture (DRF) is 1 of the common sites of osteoporotic fractures. Bone defects near fractures play an important role in the treatment of unstable distal radius fractures in older patients. To prevent this, bone grafts can be considered, and the most easily available and easy-to-use bone grafting materials are synthetic bone grafts. However, the efficacy of using injectable calcium phosphate (CaP), a synthetic bone substitute graft is controversial in terms of the volume required to provide adequate strength. In the case reports, we focus on the use of CaP in conventional surgery for osteoporotic distal radius fracture.

Patient concern:

In the first case, an 81-year-old woman presented with right wrist pain after a slip and fall accident. She had a right DRF with osteoporosis. In the second case, a 67-year-old woman presented with left wrist pain after falling. She was found to have a left DRF.

Diagnosis:

Radiography and computed tomography revealed the DRFs, and bone mineral density indicated osteoporosis. We defined these DRFs were unstable due to loss of position following anatomical reduction and the presence of osteoporosis.

Interventions:

We performed internal fixation using conventional locking plates. After fixation, a hole was made in the middle of the window of the plate, and CaP was injected through this hole.

Outcomes:

Six months postoperatively, complete bone union was achieved without subsidence of the distal fragment.

Conclusion:

This novel CaP injection technique can be a safe and effective technique for the treatment of unstable DRF to prevent malunion.
Incomplete abortion with elevated beta-human chorionic gonadotropin levels mimicking a molar pregnancy
Authors: Li Pei-Chen , Chang Kai-Hung , Ding Dah-Ching
Published: September 2021

Rationale:

Incomplete abortion often causes a lot of bleeding and may lead to severe anemia. The elevated beta-human chorionic gonadotropin (beta-hCG) level is often associated with a molar pregnancy. We report a case of incomplete abortion with elevated beta-hCG levels mimicking a molar pregnancy.

Patient concerns:

A 29-year-old woman experienced prolonged vaginal bleeding for several months. She had an artificial abortion one year before, however, vaginal bleeding was noted, and the local clinic prescribed progesterone and transamine to stop the bleeding. The amount of bleeding decreased after medication, but persistent bleeding was noted.

Diagnosis:

She visited our hospital where the urine pregnancy test was positive. Ultrasound and computed tomography showed a hematometra (4.5 cm × 4.3 cm), thickened endometrium, and mild ascites. An elevated serum beta-hCG level of 32980.4 mIU/mL was observed along with a hemoglobin level of 7.2 g/dL. Incomplete abortion or molar pregnancy was suspected.

Interventions:

Endometrial curettage was performed.

Outcomes:

Pathology showed the gestational product and chromosome analysis showed normal karyotyping. Incomplete abortion was diagnosed. Postoperative follow-up was uneventful and the beta-hCG level returned to normal after 3 months.

Lessons:

Incomplete abortion with elevated beta-hCG levels is a rare condition that mimics a molar pregnancy. Transvaginal ultrasound, quantitative serum hCG evaluation, and other laboratory tests (e.g., complete blood count) are essential preoperative investigations.
A case report of IgG4-related kidney disease with cirrhosis as the first manifestation
Authors: Wan Hongpin , Fang Zheng , Li Zhen , Luo Min , Zhang Jianbin
Published: September 2021

Introduction:

Immunoglobulin G4-related kidney disease (IgG4-RKD) is a recently identified inflammatory disorder most often classified as IgG4-related tubulointerstitial nephritis or IgG4-related membranous nephropathy based on the predominant renal pathology. However, almost all the cases are complicated by extrarenal organ involvement that includes lymph nodes, pancreas, lacrimal glands, salivary glands, and/or retroperitoneum. IgG4-RKD with cirrhosis as the initial presentation followed by massive proteinuria and renal dysfunction is very rare.

Patient concerns:

A 35-year-old Chinese male presented to a local hospital with abdominal distension, edema, and black tarry stool 5 years before. Abdominal color ultrasonography at that time suggested cirrhosis, and the diagnosis was upper gastrointestinal hemorrhage with decompensated cirrhosis. About two weeks before, edema was aggravated, and massive proteinuria and renal impairment were detected with significantly elevated serum IgG. Abdominal computed tomography indicated cirrhosis and diffuse renal enlargement with multiple low-density foci, while light microscopy of renal biopsy tissue indicated atypical membranous nephropathy with interstitial nephritis. Immunohistochemistry revealed 20–50 IgG-positive plasma cells per high-power field among interstitial infiltrating cells, accounting for ∼40% of all IgG-positive plasma cells.

Diagnoses:

According to clinical manifestations and immunohistochemical findings, the diagnosis was IgG4-RD/IgG4-RKD featuring atypical membranous nephropathy, interstitial nephritis, and decompensated cirrhosis.

Interventions:

Methylprednisolone 40 mg/day was administered for IgG4 related kidney disease. Other symptomatic therapies were also administered.

Outcomes:

Half a month following the treatment, 24-hour proteinuria decreased from 10.67 g/d to 2.16 g/d and serum creatinine decreased significantly.

Conclusion:

IgG4-RKD with cirrhosis as the first manifestation followed by renal dysfunction is very rare. Simultaneous occurrence of these two conditions which improved after the treatment indicates that there may be an association between IgG4 related kidney disease and cirrhosis.
Better outcomes for everybody evaluates the effectiveness and cost-effectiveness of a pharmacist-led intervention, delivered by community pharmacists in collaboration with physicians, in improving disease control, compared with usual care, in asthma and COPD patients during and after COVID-19
Authors: Manfrin Andrea , Jackson Catherine , Campisi Raffaele , Oteri Alessandro , Copani Agata , Desideri Enrico , Tsiachristas Apostolos , Candio Paolo , Di Tomaso Giulia , Vitale Maria , Crimi Nunzio
Published: September 2021

Introduction:

In 2025, more than 400 million people will have asthma, and chronic obstructive pulmonary disease (COPD) will be the third leading cause of death by 2030. This trial, called better outcomes for everybody, will evaluate the effectiveness and cost-effectiveness of a pharmacist-led intervention delivered by community pharmacists in collaboration with physicians to asthma and COPD patients to improve disease control compared with usual care.

Methods:

A pragmatic parallel 2-arm randomized controlled trial will be conducted in one Italian region (Sicily). A 2:1 randomization and sample size of 900 adult patients (450 with asthma, 450 with COPD) will be sufficient to detect a difference of 15% between the intervention and control groups using a dichotomized score (controlled versus non-controlled) of the Asthma Control Test (ACT) and the Clinical Chronic Obstructive Pulmonary Disease Questionnaire (CCQ) with a two-tails, 99% power and 5% significance level. A hundred pharmacists will recruit 9 consecutive patients each and administer either ACT or CCQ according to the patients’ disease. Patients will be followed up for 12 months, and the pharmacists will meet their patients every three months. The control group will receive usual care, the intervention a bespoke, structured, and systematic consultation immediately after baseline and 6 months later. The primary outcomes are asthma and COPD control at baseline and 12 months. Secondary outcomes: risk of uncontrolled asthma and COPD, number of active ingredients, pharmaceutical care issues, adherence to medications, minimal clinically important differences in asthma and COPD, and a full health economic evaluation. The analysis will follow an intention-to-treat principle. Generalized estimating equations will be used to test the primary outcomes. Ethics approval was obtained.

Discussion:

This is the first study conducted in Italy to assess the effectiveness and cost-effectiveness of a pharmacist-led intervention in asthma and COPD patients at the same time. This research could introduce a new model of care that can be adapted to other chronic conditions in primary care settings. The results will be disseminated to service users and their families via media, healthcare professionals via professional training and meetings, and researchers via conferences and publications.

Trial registration:

ISRCTN, ID: 38734433 Registered on June 15, 2021