bluuebunny/crossref_metadata_2025 huggingface dataset:
Novice Interpreters: Competencies and Training Needs
Authors: AL- Wasy Baleigh Qassim , Moneus Ahmed Mohammed
Published: June 2023

The lack of practical training in interpreting courses at universities represents considerable challenges. Many university interpretation students suffer from inadequate training that prepares them for the interpretation market. Graduates will not be hired as interpreters unless they have high-quality interpretation skills. In spite of the crucial role of consecutive and simultaneous interpreting training in preparing well-qualified interpreters, researchers have not treated this role in much detail. The present study investigates the impact of consecutive and simultaneous interpreting training on fostering EFL learners' interpretation competencies. The study sample consists of 26 students from the fourth level in the Translation Department, UST, Yemen, who are studying consecutive and simultaneous interpreting. The students will be exposed to extensive training in interpreting courses, including many practical activities such as role-playing, focus group discussion, simulation, pairs work, discussion, and interaction. A smart screen, PowerPoint presentation, live videos, and EU Interpretation training toolbox will be used. To evaluate the impact of this intensive training on developing interpreters' competencies, the students' interpretation performance will be mid-assessed during training and post-assessed at the end of the training, using standard criteria in evaluating interpreters. The study will pave the way for addressing the weakness of interpretation students in the interpreting field.
Strategies for Translating Culture-Specific Metaphor on Taboos in Abdo Khal’s “Throwing Sparks”
Authors: Youssef Sameh S. , Albarakati Mohammed A
Published: June 2023

This paper investigates the strategies of translating Arabic culture-specific metaphor on taboos into English in “Throwing Sparks” by Abdo Khal, the 2010 winner of the Arabic Booker prize. The paper introduces the Triangle of Culture-specific Metaphor on Taboos (TCMT), which explains the intertwined relations between using cultural elements in metaphor to express taboo in a literary work. The study aims to answer the question of how do translators tackle culture-specific metaphors on taboos, and duly suggests means to improve them. Samples from four taboo types are selected for analysis, namely sex, homosexuality, poverty and slavery. The study finds that the techniques used to render the culture-specific metaphor on taboos are keeping the metaphor when the target reader is thought to understand the culture element, changing the metaphor for another type using explicitation when the target reader is thought to misunderstand the culture element and demetaphorizing the metaphor when the topic is not seen as a taboo in the target culture. The study suggests solutions for the translation of culture-specific metaphors, especially when they have religious reference, as the translators tended to translate them literally, which resulted in producing absurd images that create flaws in the semantics of the utterance.
Componential Analysis of Ana/Mat'/Mother Words: Mother Prototype Extension
Authors: Bakenova Aigul , Mazhitayeva Shara , Kenzhegaliyev Sayan , Zhartybayev Assylbek , Balmagambetova Zhannat , Yesmatova Mendykyz
Published: June 2023

The research is aimed at identifying the specifics of ana (mother -Kazakh)/mat’ (mother-Russian)/mother semantic broadening in the Kazakh, Russian and English languages. The componential analysis method of lexicalized word definitions is used to do this. It has been revealed that they present a prototype of mother semantic markers, as well as “woman”, “giving birth”, “raising”, and “single-generation” distinguishers, which produce the intention meaning. It is important to emphasize that a “mother” prototype semantic broadening is associated with the changes in the world around us, the development of health reproduction technologies, as well as the change of social values. Implicational meanings arise due to variation of “giving birth”, “raising”, “having”, “kinship” intentional functional and relational semes, e.g. a surrogate mother, a birthmother, a genetic mother, etc. This leads to a mother’s ideal prototypical image “blurring” in the minds of native speakers.
How do Arab Writers Interact With Their Readers? An Analysis of the Use of Metadiscourse Markers
Authors: Almakrob Ahmed Yahya
Published: June 2023

A considerable body of research has investigated the use of metadiscourse in academic writing in different languages, and it is assumed in the literature that the use of metadiscourse is language- and culture-specific. However, little research has investigated how Arab writers interact with their readers in Arabic research articles (RAs). Thus, following Hyland’s (2005) models, this study explores the use of the interactional metadiscourse in the introductions of 94 Arabic RAs totalling 88,350 words published between 2013-2022. Findings showed that Arab writers tend to establish a relationship with readers and involve them as discourse participants through the use of the inclusive pronoun naḥnu نحن ‘we’ and the rhetorical forms. Arab writers used both grammatical and lexical items to express their views with confidence with a high degree of commitment. They were found to use reader-accuracy markers to mitigate their arguments. They, however, appeared not to evaluate what is presented through their personal feelings, and this might be due to sociocultural reasons, which requires further investigation.
Role Reversal: An Overview of Audiovisual Translation into English
Authors: Díaz-Cintas Jorge , Hayes Lydia
Published: June 2023

This article depicts the current state of the art of English-language audiovisual translation (AVT) and sheds light on the recent changes impacting media localisation practices, viewing patterns, and viewer agency. The motivations that have catapulted practices like subtitling and dubbing into English on video-on-demand (VOD) platforms are considered, and special emphasis is placed on the move from English-language content to the production and distribution of originals created in a multitude of languages and showcased on streaming platforms with subs and dubs in English. Some of the latest technological advancements are discussed as they have influenced the viewing experience and audience selection of AVT modes, leading to a significant change in viewing patterns and preferences of anglophone viewers. Challenges posed to studying and training in English AVT are identified and the importance of inverting one’s gaze and perceiving English as the target language of translation, rather than the source language, is stressed in this new paradigm. Concrete suggestions are made for potential avenues of research in this flourishing field, which will hopefully contribute to painting a more detailed picture of English AVT.
Multilingual and Multi-Generational Italian Identity in a Netflix Series: Subtitling Generazione 56k (2021) into English
Authors: Manfredi Marina , Bartolini Chiara
Published: June 2023

This paper reports an investigation into the representation of “Italianness” in the recent Netflix Italian series Generazione 56k, which was exported to English-speaking countries. This series deals with characters from different generations and displays regional varieties. This qualitative study examined the macro- and micro-strategies used in the creation of English subtitles for the first season. The focus is on key functions of telecinematic discourse, i.e., characterisation, realism, and humour, realised through the use of (a) multilingualism in the broadest sense, including geographical dialects, and (b) multi-generational language (colloquialisms, “unconventional language”, particularly, teenage and youth language, and taboo). Findings reveal a tendency towards neutralisation strategies in the English subtitles. Even considering the constraints inherent in the subtitling mode, these strategies do not successfully represent “Italianness” with its local geographical diversity, and only partially convey the representation of multi-generational language, also affecting humour. The themes engaging millennials, however, are expressed and might be appreciated by an international audience. In the light of our analysis and conclusions, it may be interesting to understand whether younger generations, increasingly accustomed to “multilingualism” especially in Netflix programmes, would also envisage a different subtitling experience.
On applying “economical technologies” in children’s polyclinic
Authors: Kochergina E. A. , Trefilov R. N. , Shinkarik I. G. , Minaeva N. V.
Published: June 2023

Objective. To analyze the work of childrens polyclinic within the framework of the projects Economical Production. An active prevalence and introduction of economical production concerns different spheres of human productive activities including office processes, service, management, social sphere and healthcare service.

Materials and methods. The project Organization of entering stream of patients, visiting a district pediatrician at reception days for conditionally ill children was realized as the first one aimed at improvement of work of childrens polyclinic.

Results. In April 2017, economical technologies in the sphere of community health protection were introduced in Perm Krai to improve the most problematic processes in the activity of polyclinics. Economic technologies help to raise the availability, quality and safety of medical care at the expense of creating optimal logistics of patients streams, organization of ergonomics of working space, effective use of medical technique and equipment. An important element of success regarding the economical production is involvement of workers in improvement of processes as well as devotion of the head of organization to design work. It was shown at the example of childrens polyclinic how the improvement projects were realized; the standards of the improved processes of other medical institutions were introduced.

Conclusions. One of improvement projects, its stages and the list of countermeasures for elimination of the causes of the revealed problems is described in details; the results of the other realized projects are presented. The major part of solutions regarding the improvement within the framework of economical production in the sphere of public healthcare are organizational and do not require additional material costs.
Early Recognition of Overweight Hyperglycaemia May Improve Clinical Outcomes in Type 2 Diabetes
Authors: Chockalingam Anand ,   Division of Cardiovascular Medicine, University of Missouri, Columbia, MO, USA,   Cardiology Section, Harry S Truman VA Medical Center, Columbia, MO, USA, Natarajan Pandiyan ,   Nova IVF Fertility, Chettinad Super Speciality Hospital (Retired), Chennai, India, Dorairajan Smrita ,   Nephrology Section, Harry S Truman VA Medical Center, Columbia, MO, USA, Khan Uzma ,   Division of Endocrinology, University of Missouri, Columbia, MO, USA
Published: June 2023

Diabetes is the ninth leading cause of death, directly accounting for 1.5 million deaths annually worldwide. Despite several breakthrough discoveries, little progress has been made in type 2 diabetes outcomes over the past 100 years. Younger age (below 60 years), a diet high in calories and processed food, and severe obesity (body mass index >35 kg/m2) may identify reversible beta cell dysfunction. Much of the clinical presentation pertains to flooding the body’s adaptive limits with overnutrition. Recognizing this as a global societal trend brought about by lifestyle changes, sedentary work, mental stress and unlimited access to calorie-dense foods is crucial. Insulin resistance and genetic abnormalities cannot account for the dramatic increase in diabetes, from only 1% five decades ago to nearly 10% today. Obesity – and not insulin resistance – is at the core of the problem. As well as hyperglycaemia, end-organ damage can also be reversed with diet and weight loss in many affected individuals. We present the evolution of our understanding and compelling reasons to reframe diabetes in the severely obese to what it really is – overweight hyperglycaemia. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles. The objective of this review is to better understand global trends and the potential to improve outcomes by reframing the diabetes narrative towards remission. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles.
Epigenetics of the Pathogenesis and Complications of Type 2 Diabetes Mellitus
Authors: Mannar Velmurugan ,   Department of Medicine, Aarupadai Veedu Medical College, Puducherry, India, Boro Hiya ,   Department of Endocrinology and Metabolism, Aadhar Health Institute, Hisar, India, Patel Deepika ,   Department of Endocrinology, Mediheal Hospital, Nairobi, Kenya, Agstam Sourabh ,   Department of Cardiology, VMMC and Safdarjung Hospital, New Delhi, India, Dalvi Mazhar ,   Department of Endocrinology, Mediclinic Al Noor Hospital, Abu Dhabi, United Arab Emirates, Bundela Vikash ,   Department of Gastroenterology, Aadhar Health Institute, Hisar, India
Published: June 2023

Epigenetics of type 2 diabetes mellitus (T2DM) has widened our knowledge of various aspects of the disease. The aim of this review is to summarize the important epigenetic changes implicated in the disease risks, pathogenesis, complications and the evolution of therapeutics in our current understanding of T2DM. Studies published in the past 15 years, from 2007 to 2022, from three primary platforms namely PubMed, Google Scholar and Science Direct were included. Studies were searched using the primary term 'type 2 diabetes and epigenetics' with additional terms such as ‘risks’, ‘pathogenesis’, ‘complications of diabetes’ and ‘therapeutics’. Epigenetics plays an important role in the transmission of T2DM from one generation to another. Epigenetic changes are also implicated in the two basic pathogenic components of T2DM, namely insulin resistance and impaired insulin secretion. Hyperglycaemia-induced permanent epigenetic modifications of the expression of DNA are responsible for the phenomenon of metabolic memory. Epigenetics influences the development of micro- and macrovascular complications of T2DM. They can also be used as biomarkers in the prediction of these complications. Epigenetics has expanded our understanding of the action of existing drugs such as metformin, and has led to the development of newer targets to prevent vascular complications. Epigenetic changes are involved in almost all aspects of T2DM, from risks, pathogenesis and complications, to the development of newer therapeutic targets.
An Overview of Risk Factors for Diabetic Foot Amputation: An Observational, Single-centre, Retrospective Cohort Study
Authors: Yuzuguldu Burak ,   Division of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA, Zengin Bugra ,   Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, Simsir Ilgin Yildirim ,   Division of Endocrinology and Metabolism Disorders, Faculty of Medicine, Ege University, Izmir, Turkey, Cetinkalp Sevki ,   Division of Endocrinology and Metabolism Disorders, Faculty of Medicine, Ege University, Izmir, Turkey
Published: June 2023

Introduction: Not only are early detection and treatment of diabetic foot ulcers important, but also acknowledging potential risk factors for amputation gives clinicians a considerable advantage in preventing amputations. Amputations impact both healthcare services and the physical and mental health of patients. This study aimed to investigate the risk factors for amputation in patients with diabetic foot ulcers. Methods: The sample for this study was patients with diabetic foot ulcers who were treated by the diabetic foot council at our hospital between 2005 and 2020. A total of 32 risk factors for amputation were identified and investigated among 518 patients. Results: Our univariate analysis showed that 24 of 32 defined risk factors were statistically significant. In the multivariate analysis using the Cox regression model, seven risk factors remained statistically significant. The risk factors most significantly associated with amputation were Wagner grading, abnormal peripheral arteries, hypertension, high thrombocyte levels, low haematocrit levels, hypercholesterolaemia and male sex, respectively. The most common cause of death in patients with diabetes who have undergone amputation is cardiovascular disease, followed by sepsis. Conclusion: To enable optimum treatment of patients with diabetic foot ulcers it is important for physicians to be aware of the amputation risk factors, and thus avoid amputations. Correcting risk factors, using suitable footwear and routinely inspecting feet are crucial factors for preventing amputations in patients with diabetic foot ulcers.
Surgical Treatment of Solitary Metachronous Adrenal Metastasis from Urothelial Carcinoma of the Urinary Bladder
Authors: Politis Dimitrios ,   Second Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece, Konstantakou Panagiota ,   Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece, Bramis Konstantinos ,   Second Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece, Alexandraki Krystallenia I ,   Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece, Spyroglou Ariadni ,   Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece, Mastorakos George ,   Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece, Anastasiou Ioannis ,   First Department of Urology, National and Kapodistrian University of Athens, Laikon University Hospital, Athens, Greece, Papaconstantinou Ioannis ,   Second Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece, Dimopoulos Meletios A ,   Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
Published: June 2023

Urothelial cancer is a common neoplasm and metastatic disease correlates with a poor prognosis. Isolated adrenal gland metastases of urothelial carcinoma are quite rare, and management options can decide a patient’s prognosis. Herein we report the case of a 76-year-old man with a metachronous solitary adrenal metastasis from a bladder carcinoma, who underwent adrenalectomy as part of his treatment. Furthermore, we discuss the cases of solitary adrenal metastases of urothelial carcinoma available in the literature, to identify key features to direct appropriate treatment of this rare metastatic site of urothelial cancer and improve prognosis and survival. Still, further prospective studies are needed to design effective therapeutic strategies.
The Clinical Septet of Van Wyk–Grumbach Syndrome: A Case Series from a Tertiary Care Centre in Kalyana Karnataka, India
Authors: Waddankeri Swaraj ,   Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India, Waddankeri Meenakshi ,   Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India, Waddankeri Shrikant ,   Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India, Arora Kshitij ,   Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India
Published: June 2023

Van Wyk–Grumbach syndrome is a rare, female juvenile hypothyroidism disorder that is characterized by precocious puberty with clinical, radiological and hormonal pathologies. We present a case series of three patients with this unusual condition who were evaluated and followed up over a 3-year period between January 2017 and June 2020. All three patients presented with short stature (<3rd centile), low weight (<3rd centile), absence of goitre, no axillary or pubic hair, delayed bone age by more than 2 years, elevated thyroid-stimulating hormone with low T3 and T4 (primary hypothyroidism), and raised follicle-stimulating hormone with pre-pubertal levels of luteinizing hormone. Abdominal ultrasonography showed bilateral multi-cystic ovaries in two patients and a right-sided bulky ovary in the third patient. One of the patients also had a pituitary ‘macroadenoma’. All the patients were successfully managed with levothyroxine. We discuss the pathophysiological mechanisms with a brief literature review.
Proton Pump Inhibitor Use and Risk of Dementia in Older Adults: A Systematic Review
Authors: Gao Xiaoyi ,   Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis, MO, USA, Shao Zi Yi ,   Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis, MO, USA, Grysman Noam ,   Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis, MO, USA, Grossberg George T ,   Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis, MO, USA
Published: June 2023

Proton pump inhibitors (PPIs) are commonly used for gastroesophageal reflux disease. Previous studies have raised concerns about the impact of PPIs on cognition in older adults, but the evidence supporting this concern is lacking. This article aims to analyse the available data regarding the impact of long-term PPI use on cognition in older adults. We searched PubMed for relevant studies conducted between 2015 and 2022. Seventeen such studies were identified. Limitations to available research data include the fact that studies are mainly observational, use heterogeneous study methods and do not account for confounding variables such as B12 deficiency, Helicobacter pylori infection, and thyroid dysfunction. Overall, this search did not find a compelling association between PPI use and cognitive decline.
The Clinical and Social Economic Profile of Patients Diagnosed with COVID-19 at Likuni Mission Hospital, Malawi.
Authors: Lubanga Adriano , Lipenga Alfred , Mwapasa Victor , Kanyinji Gift , Ndlovu Darlington , Sichinga Tuntufye , Mwenye-Phiri George , Ng’oma Louis , Mwenyekonde Elled , Jeon Donghyun , Han Seok , Choe Kaylin , Seung Joanna , Kong Justin , Nyirenda Thomas
Published: June 2023

Background: The COVID-19 pandemic has caused devastating effects on the world since its discovery in the city of Wuhan in 2019. It has claimed millions of lives and has significantly affected the economies of the world. However, the characteristics of affected populations in poorest settings in Africa are not clearly known. Aims and Objectives: The study was undertaken to evaluate common clinical presentations of patients diagnosed with COVID-19, asses the socio-economic and demographic profiles and analyze the clinical course, and comorbidities of COVID-19 positive patients at Likuni mission hospital, central region of Malawi. Methods: This was a cross sectional study, however we looked at retrospective data from for all patients diagnosed from January 2021 to January 2022. Results: Patients were predominantly female (65%), less than 40 years, without any known comorbidity and had at least 3 symptoms before being diagnosed. The most common symptoms were fever, cough, chest pains, headache, shortness of breath, and general body weakness. A significantly higher population were from low social economic status (p<0.05). Over 95% of the population suffered minor ailment and did not need hospitalization and advanced life support. All patients that required hospitalization were above the age of 60 and the results were statistically significant (p<0.05). More than 90% of the cases were locally spread and did not have traceable positive contact. Conclusion: The diversity of clinical and epidemiological characteristic of patients diagnosed with COVID-19 across gender, socio-economic status, age group and occupation is extremely important. Our results provides an understanding of the characteristics of patients in a poor setting like Malawi and will inform policy makers at local hospitals and district levels including researchers and the ministry of health.
Political Considerations in Implementing Initiatives to Improve the Mental Well-Being of Employees in the Workplace
Authors: Weinberg Ashley
Published: June 2023

Relatively recently governments have begun to show some of the leadership required to incorporate well-being within their calculations about work-related behaviour. This is important not only for fulfilling our individual potential, but also in signalling recognition of the central role of well-being – both physical and psychological – within equations about productivity and performance. This article considers notable national examples of good practice from Denmark, UK and Canada, as well as highlighting a range of organisational factors that help explain slow progress within workplaces, even when government-level support for improving mental well-being of employees already exists. Such organisational factors include political considerations and so this paper shines a spotlight on organisational politics surrounding mental well-being at work. In this way, I describe the potential for practitioners in occupational psychology, health and well-being roles and in human resources to develop further and utilise positive political skills to facilitate positive change. Furthermore, examples of political skills in action at all levels of an organisation are considered, ranging from harnessing the active commitment of senior management teams, to campaigning for appropriate training for middle managers, as well as raising awareness of mental health across all employees in the workplace. There is great potential for positive economic as well as individual health outcomes where organisations give far greater priority to psychological health than previously. The emergence of research-based guidance to improve psychological health at work, as well as recent commitment by some governments around the world to well-being priorities, has signposted new directions for mental well-being in the workplace. What remains concerning is that uptake of such guidance varies and its implementation often lags behind awareness. This paper considers a range of readily applicable and cost-effective organisational strategies which can be championed by practitioners for improving the mental well-being of the workforce, while it also makes explicit the role of political behaviour in seeking improvements to psychosocial aspects of the workplace.
The contemporary utilization of TandemHeart® in Severe Cardiogenic Shock and Acute Decompensated Heart Failure
Authors: Shah Sidra , Haq Syed , Golzarian Hafez , Cole William , Laird Amanda , Patel Sandeep
Published: June 2023

Severe cardiogenic shock in the setting of acute decompensated heart failure, refractory to aggressive pharmacologic intervention is synonymous with high mortality. Recent innovative advancements in mechanical circulatory system [MCS] has provided some semblance of hope, with use exponentially increasing due to the favorable outcomes. These devices serve as bridge towards definitive therapy by providing hemodynamic stability. The TandemHeart® (LivaNova Inc) has gained increased notoriety due to the increased degree of support provided in in left ventricular failure. A nationwide shock database analysis found increased mortality benefits of TandemHeart® over Impella®. However, there continues to remain scarce data and limited clinical trials demonstrating the efficacy of TandemHeart® over other devices. We present three assorted cases of cardiogenic shock refractory to Impella® successfully managed with the TandemHeart® system. We discuss the indication, utility, and the potential benefits provided by the TandemHeart® system including ability to add oxygenator in circuit, ease to convert to VA-ECMO, use in prosthetic aortic valve, and capable of offloading left atrium and left ventricle.
Challenges in the Evaluation of the Patient Presenting with Isolated Neurological Hand Dysfunction: A Case Series
Authors: Soriano Edward
Published: June 2023

Isolated neurological hand dysfunction including symptoms of weakness, numbness, clumsiness and dystonia are not uncommon complaints presenting to physicians in primary care as well as to neurologists, physiatrists, orthopedists and neurosurgeons. Etiologies of neurological hand dysfunction range from lesions of the central and peripheral nervous system pathways as well as the neuromuscular junction and muscle. In this article we present a series of four patients referred to a rural Physical Medicine & Rehabilitation presenting with similar symptoms of neurological hand dysfunction that ultimately had very different diagnoses. The goal of this article is to review the appropriate history, physical and examination findings and pertinent neuroanatomy needed to direct the clinician towards the workup needed to accurately diagnose and treat neurological hand dysfunction.
Getting the Lead Out: A Career-Long Perspective on Leaded Gasoline, Dust, Soil, and Proactive Pediatric Exposure Prevention
Authors: Mielke Howard , Egendorf Sara
Published: June 2023

This commentary considers the long arc of lead (Pb) poisoning from antiquity to the 21st century. While Pb exposure is commonly attributed to paint or water, this article aims to discuss the underrecognized impacts of air Pb and soil Pb and to address controversial misconceptions related to these exposure sources. The Roman Aristocracy experienced lead poisoning mainly from the ingestion of foods, lead cookware, and lead-contaminated water and wine, but by the 20th century, lead exposure occurred by ingestion and inhalation. The introduction of tetraethyl lead (TEL) additives in gasoline was approved in 1925 in the US and produced an exponential increase in inhalable air lead exhaust particles through the 1970s. These five decades of widespread lead aerosol exposure were enabled by the Lead Industries Association (LIA), which confounded pediatricians, healthcare providers, and government agencies by promoting lead-based paint as the primary agent of childhood lead exposure. Empirical evidence of lead poisoning, environmental exposures, and proactive lead prevention in the general population was impossible until analytical instruments became commonly available for clinical studies and environmental measurements in the 1960s and 1970s. Soil studies in Baltimore, Maryland, beginning in the mid-1970s, indicated that lead particles exhausted from vehicles fueled by leaded gasoline excessively contaminated urban soils compared with non-urban soils. The invisible lead-contaminated air fouled multiple exposure routes via inhalation and ingestion. In addition to misunderstandings about sources of lead exposure, misinformation currently abounds regarding the timeline of banning lead in gasoline. The US Center for Disease Control (CDC) lists the ban as beginning in 1996. The banning of leaded gasoline first occurred in Japan starting in 1972, and after a 1984 Senate Hearing, the US Congress agreed on a rapid phasedown. A US Environmental Protection Agency (EPA) timeline confirmed that most leaded gasoline was banned by the end of 1986. Banning leaded gasoline was associated with sharp declines in the US population’s blood lead, which prompted global efforts to ban leaded gasoline. The eventual result was a complete global ban on highway use of leaded gasoline achieved in August 2021. Leaded gasoline is still used in piston-engine aircraft and the US EPA is proceeding to complete the ban on lead additives in fuel. Using precautionary principles to recover lead-contaminated urban environments and prevent new toxicant exposures are essential challenges and opportunities for present and future generations.
Food Insecurity Moderates Association Between Perceived Fresh Fruit and Vegetable Access and Vegetable Intake in the Rural Southern US
Authors: Antonacci Cerra , Hermstad April , Haardörfer Regine , Kegler Michelle
Published: June 2023

Objective. Assess associations between perceived fresh fruit and vegetable access and obtaining fresh fruit and vegetables from various food sources with meeting national recommendations for fruit and vegetable intakes and BMI, and whether associations differ by food insecurity. Methods. Secondary data analysis of a cross-sectional survey evaluating a health equity initiative among 1,474 respondents in 6 rural Georgia counties. Logistic regressions assessed associations between perceived fresh fruit and vegetable access and fresh fruit and vegetable sources with meeting/not meeting fruit and vegetable recommendations and BMI, and interactions with food insecurity. Results. Respondents who obtained fresh fruit and vegetables at small local grocery stores, farmer’s markets, and community/home gardens had twice the odds of meeting national vegetable recommendations. Food secure adults with greater perceived fresh fruit and vegetable access had 1.5 times the odds of meeting national vegetable recommendations. Conclusions and Implications. Results highlight perceived access inequities for food insecure adults and the importance of food sources for vegetable consumption in the rural South.
Families of children with Autism Spectrum Disorder: Experiences during First COVID-19 Lockdown in Chile
Authors: Medeiros Maria , Bedregal Paula , Lermanda Victoria , Bronstein Jonathan
Published: June 2023

The lockdown due to COVID-19 pandemic brought a series of events that affected individuals, mostly related to mental health issues such as increased alcohol consumption, increased domestic violence and the emergence of psychiatric disorders. Children with Autism Spectrum Disorder (ASD) are particularly vulnerable, their routines were interrupted and professional help changed in this period. These situations were difficult to handle and adapt for children and their family. This qualitative cross-sectional exploratory study examined the experience of families with ASD children who are enrolled in an ASD outpatient clinical university center in Chile during the first lockdown due to COVID-19 pandemic. Twenty individual semi-structured interviews recorded by video call were carried out by mental health professionals to parents of ASD children aged between 2 to 18 years old and were transcribed verbatim. Using a Reflexive Thematic Analysis results display heterogeneity in the responses, with main themes related to: Information given, family changes, emotional/conductual changes in ASD children and relationship with social services. There was a balance between positive and negative perceptions. Several external family stressors increased while others disappeared during the lockdown. Both aspects should be taken into account developing more accurate services for ASD patients and their families.
Fatal Laryngeal Oedema in Cases of Burns: An Evaluation of Inhalational Injuries
Authors: Kaushik Rahul , Kumar Kuldeep , Singh Priti , Kumar Prafulla
Published: June 2023

The present case, reports the cause of death of a 45-year-old male victim of fire incident. Autopsy findings reveal gross laryngeal oedema with narrowing of the air passage. The burn injuries involved about 8 % of the total body surface area. The person suffered from inhalation injuries along with burn injuries. Inhalational injuries are not easy to diagnose and a clear suspicion of their presence plays a significant role in determining the survival of burn patient. A thorough literature review brought forth the fact that laryngeal oedema and inhalational injuries can be a delayed complication of burn injury and timely intubation could save patient’s life. Incidence of laryngeal oedema, clinical features of inhalational injuries and priorities in inhalational injuries research are discussed in the paper with review of literature.
Targeted Axillary Dissection: A Review Covering Technical Aspects, Current Recommendations and the Future
Authors: AA Winder , K Swift , A Miu
Published: June 2023

For clinically node positive patients with breast cancer, traditionally the gold standard for management of the axilla has been axillary lymph node dissection. This however has been associated with a high rate of morbidity including lymphoedema and shoulder stiffness. With the introduction of neo-adjuvant systemic therapy many patients undergo pathological complete response within the breast and axilla, particularly in certain molecular subtypes of breast cancer propelling interest in de-escalation surgery to reduce this morbidity. Targeted axillary dissection is a procedure combining targeted lymph node biopsy, removing a previously marked node with confirmed cancer prior to neo-adjuvant systemic therapy and sentinel lymph node biopsy. The aim of the procedure is to accurately re-stage the axilla in patients with known nodal metastases after systemic therapy and reduce the morbidity associated with axillary dissection. Current meta-analyses have demonstrated that performing targeted axillary clearance has a consistently lower false negative rate when re-staging the axilla compared to sentinel or targeted node biopsy alone. This has led to a huge increase in popularity for the procedure. However, long-term data for oncological outcomes and morbidity are still lacking. This review article aims to provides an overview of targeted axillary dissection. Focusing on technical aspects, including clip selection, number of clipped nodes and localization techniques for identifying the clipped node prior to surgery. The improved false negative rates of targeted lymph node dissection compared to sentinel node biopsy in clinically node positive patients converting to clinically node negative patients after neo-adjuvant systemic therapy. Pathological and radiological factors that may help in predicting nodal response to neo-adjuvant systemic therapy. Current guidelines/ recommendations for patient selection and management of residual disease within the axilla based on limited data and future studies aiming to clarify treatment decisions for this group of patients.
Lock the Doors: The Myocarditis Disaster and a call for the broad examination of the CDC and FDA
Authors: Jablonowski Karl , Hooker Brian
Published: June 2023

“Lock the doors.” uttered by LeRoy Cain, the flight director of STS-107, meant the complete loss of Space Shuttle Columbia. Locking the doors initiated the protocol to preserve data and logs for the impending investigation. Some hard lessons were learned from the Space Shuttle Challenger disaster 17 years earlier, one of which was that the National Aeronautics and Space Administration (NASA) should not be put in a position to investigate itself. The interagency Columbia Accident Investigation Board (CAIB) was formed to learn what we could from the fate of Columbia. Had NASA been the investigating agency, given the culture, it is possible the concluding cause would have been a random event such as bird strike after takeoff or micrometeoroid in orbit. “We are convinced that the management practices overseeing the Space Shuttle Program were as much a cause of the accident as the foam that struck the left wing.”[1] Those management practices point to lock-stepping, where dissenting opinions are discouraged or suppressed. NASA’s opinion was that foam is safe. When Bob Page, chair of NASA’s Intercenter Photo Working Group, saw foam strike the wing he raised an alarm that the heat shield may be compromised. He and two members of the Debris Assessment Team made a total of three requests to the Department of Defense (DoD) to obtain high-resolution images of Columbia’s left wing. A request that, by all accounts, the DoD was willing and able to fulfill. Those requests were subsequently canceled by the shuttle program managers. The CAIB report went on to say, “[t]he Board was also influenced by discussions with members of Congress, who suggested that this nation needed a broad examination of NASAʼs Human Space Flight Program, rather than just an investigation into what physical fault caused Columbia to break up during re-entry.” There are two vitally important lessons we have learned from NASA. The first is that a government agency should not be able to investigate itself. The second is that lock-stepping is lethal. The most advanced population health surveillance in the United States couldn’t find a single healthy child who died of COVID-19. Zero is a powerful number. Zero is also the number of vaccines that impart superior immunity over that of natural immunity. If we could choose one feature that the emergent 5th endemic cold virus could have, it would unequivocally be a minimal effect on children – safeguarding our future and allowing the progression of natural immunity. There is nothing mild about pediatric myocarditis. Even with the best medical management, 1/3rd of all patients never completely recovers, and will live with dilated cardiomyopathy. If untreated, 80% of children will develop chronic heart disease. These children are subject to a high risk of sudden death and may require an urgent heart transplant[2].
Spectrum of fibro osseous lesions of jaw: An institutional study
Authors: Wagh S P , Bhavthankar J D , Mandale M S , Humbe J G , Nandkhedkar V A , Zanwar P R
Published: June 2023

Fibroosseous lesions (FOLs) of craniofacial complex are poorly defined but pathologically diverse group of conditions. FOLs are represented by variety of disease processes mimicking clinically and histopathologically as neoplasms, developmental dysplastic lesions or inflammatory reactive process leading to difficulties in diagnosis and hence clinicopathological correlation is required.

To analyse fibro osseous lesions for demographic details and clinicopathological correlation.

26 cases of clinicopathologically diagnosed FOLs such as fibrous dysplasia, ossifying fibroma and cherubism were studied from archives of the Department over a 14yr period (2009 to 2022) and clinicopathologically reviewed.

In retrospective study 26 cases of FOLs showed that FOLs are more commonly seen in second decade of life with female predilection and mandible is most commonly affected. Amongst these ossifying fibroma is found to be most common in our study 46% (12/26) as compared to fibrous dysplasia 42% (11/26) and Cherubism 12% (3/26).

In the present study FOL were slightly more prevalent in females than male, affecting individuals below 30 years of age. Our data showed several overlapping epidemiological and clinicopathological features. Thus combination of different modalities seems to be necessary for an accurate diagnosis.
Sostenibilidad fiscal de las asociaciones público-privadas: elementos clave y buenas prácticas para una gestión fiscal responsable en infraestructura económica y social a lo largo de todo el ciclo de vida de proyectos en América Latina y el Caribe
Authors: Dominguez Enrique , Suárez-Alemán Ancor
Published: June 2023

Una gestión fiscal oportuna y eficiente pasa por asegurar procesos de planificación, ejecución y monitoreo de aquellos elementos que pudiesen comprometer el espacio fiscal durante todo el ciclo de vida de los proyectos. Y, a través de dichos procedimientos, identificar riesgos, estimar y presupuestar compromisos adquiridos y planear estrategias que favorezcan la sostenibilidad de los activos. Si bien existen herramientas para monitorear la capacidad fiscal a nivel macroeconómico (indicadores de desempeño, límites y/o reglas fiscales, transparencia en los balances financieros, entre otros), el objetivo del presente documento es ofrecer una propuesta integral que las complemente; esto es, además de considerar el impacto fiscal agregado de los proyectos, valorar otras dimensiones de igual importancia que son necesarias para el buen desempeño fiscal de los proyectos bajo esquemas APP. El trabajo presenta una ruta para fortalecer las buenas prácticas en gestión fiscal, ponderando la importancia de componentes clave en la ejecución de contratos vía APP como la correcta preparación de proyectos, la aplicación del marco normativo, un eficiente y eficaz arreglo institucional, el adecuado registro, contabilidad y reporte de los compromisos adquiridos por el gobierno, así como los medios para garantizar los pagos por el o los servicios que ofrecerá el activo en condiciones de calidad (adecuadamente mantenidos). El documento presenta un marco fiscal desarrollado a partir de cuatro dimensiones (factibilidad, impacto, asequibilidad y responsabilidad) que buscan favorecer la sostenibilidad de los proyectos de Asociaciones Público-Privadas durante toda su vida útil. La propuesta plantea un enfoque integral que se fundamenta sobre elementos claves y mejores prácticas identificadas en el contexto regional e internacional para garantizar un ejercicio fiscal responsable. Lejos de plantear un esquema fijo, cerrado y/o determinado, busca construir un espacio abierto y dinámico, que ayude a evaluar y mejorar el aprendizaje fiscal en la región. De este modo, el objetivo es presentar cuatro dimensiones que fortalezcan los procesos de planificación fiscal en torno a la infraestructura a desarrollar, favoreciendo mecanismos para preparar proyectos, asignar recursos y garantizar, a través de una continua supervisión y mantenimiento, la disponibilidad y calidad de los servicios. El presente documento debe ser entendido como un conjunto de elementos técnicos y estrategias que ayuden a usar eficiente y responsablemente los recursos públicos, generando confianza en el sector privado, y siendo lo suficientemente flexible para adaptarse a distintos contextos y situaciones.
Synodality, Sign and Instrument of Communion and Evangelisation
Authors: Pellitero Iglesias Ramiro
Published: June 2023

English translation. The original article can be found here

The ongoing synodal process (16th Ordinary General Assembly: For a Synodal Church: Communion, Participation and Mission), which began in October 2021 and will culminate in the same month of 2024, is encouraging a broad participation of the faithful in the synods, starting from the particular Churches. In terms of its concrete objective, it is a reflection on synodality and its exercise around synodal assemblies. This article explores synodality as a constitutive dimension of the Church and its meaning in practice. It delves into the organic cooperation between pastors and faithful as the basis for the participation of the baptised in synods. It looks at some specific aspects of synods: their service in favour of communion and mission, as an instrument of discernment of the “dynamic fidelity” which characterises the Church's journey; the appropriateness of a journey from the peripheries to the centre; the attitudes proper to those who participate in a synod; and the theological-pastoral dimensions of the synod. All this, taking into account the experience of the Church and the current reflection.
Safety Evaluation of Arsenicum album in Acute and Sub-Acute Toxicity Studies in Rats
Authors: Lal Roshan , Sharma Mahima , Behera Sangita , Regar Raj Kumar , Tripathi Deepika , Kumar G. V. Narasimha , Singh Satvinder , Verma Digvijay , Gupta Pankaj , Kaushik Subhash , Khurana Anil
Published: June 2023

Arsenic album is frequently prescribed in homoeopathy for many diseases. However, its safety data is not available. Thus, the study’s purpose is to evaluate the oral toxicity of Arsenic album 6C, 30C, and 200C in rats. Arsenic album (6C, 30C, and 200C) was given at 2000 μl/kg for acute toxicity and observed for up to 14 days. For subacute toxicity, it was given for 28 days and observed for clinical signs, change in body weight and Mortality. Hematological, biochemical, organ weight and histopathological analyses were assessed. Results indicate no mortality of arsenic album in acute toxicity and LD50 is >2000 μl/kg. In the subacute toxicity study, arsenic album (200 μl/kg) did not show any significant changes in above parameters. It may be concluded that the arsenic album (6C, 30C, and 200C) is safe and produces no toxicity when administered orally for a prolonged duration at 200 μl/kg in rats.