bluuebunny/crossref_metadata_2025 huggingface dataset:
Singularidad tecnológica y transhumanismo
Authors: Gayozzo Huamanchumo Piero Arturo
Published: June 2021

Las novedades tecnológicas de la Cuarta Revolución Industrial han permitido el planteamiento de estrategias para trascender las limitaciones humanas, estrategias que son ampliamente amparadas por la filosofía transhumanista. El artículo explica la relación que existe entre el ‘transhumanismo’ y la ‘singularidad tecnológica’. Para ello, se definirá brevemente qué es la Cuarta Revolución Industrial y qué es el transhumanismo. Luego se evaluarán los tres modelos principales de singularidad tecnológica y se ofrecerá una definición apropiada de este concepto futurista. Finalmente se brindará una reflexión sobre la relación entre singularidad tecnológica y la filosofía transhumanista y se concluirá que no son sinónimos, sino que la primera es una eventualidad que permitirá la segunda.
El uso de tecnologías de asistencia sanitaria digital por parte de la población mayor desde una perspectiva de género e intrageneracional
Authors: Criado Quesada Blanca , Zorrilla Muñoz Vanessa , Agulló Tomás María Silveria
Published: June 2021

El uso y acceso a las tecnologías de la información y la comunicación (TIC) se han convertido en un motor del día a día de toda la población. De hecho, en el actual contexto sociosanitario, determinadas actividades en línea han cobrado especial importancia, como las videollamadas, las compras online o la asistencia sanitaria en línea. El objetivo de este trabajo se centra en conocer el uso y la opinión de este tipo de herramientas de ‘telesalud' y 'teknokuidado’ por parte de la población mayor de 65 años, e indagar en esta brecha generacional desde una perspectiva de género. El método central será la explotación del cuestionario del Observatorio Nacional de las Telecomunicaciones y de la Sociedad de la Información (ONTSI) Los ciudadanos ante la e-sanidad, 2016, sumado a las referencias actuales. Se constata cierta desconfianza en el uso de internet en materia de ‘e-salud’, lo que deriva en una escasa implementación de tecnologías de monitorización y telecuidado. Si bien éstas cuentan con valoraciones muy positivas, el nivel de uso es limitado. Destaca un perfil de usuario mayoritariamente hombre de entre 65 y 80 años, con estudios superiores, residente en grandes ciudades, conviviente con hijos/as y/o pareja y una percepción optimista de su estado de salud. Como conclusión cabe indicar que existe una evidente reducción de la brecha digital en las personas mayores. Además, en el caso de las mujeres, especialmente las octogenarias, se observa que siguen estando invisibilizadas e infrarrepresentadas también en cuanto al uso y opinión de estas TIC, en coherencia con su menor presencia social y digital confirmada en las últimas investigaciones.
¿Sin salida?: biomedicalización y resistencias en las comunidades virtuales de atención de personas diagnosticadas de agorafobia
Authors: Jover-Leal Assumpta , Grau-Muñoz Arantxa
Published: June 2021

Las comunidades virtuales de atención constituyen espacios legos que cumplen con funciones distintas en la gestión del malestar. En esta investigación nos fijamos en los grupos on-line de Facebook de personas diagnosticadas de agorafobia para escrutar la articulación de respuestas legas de gestión del diagnóstico biomédico de la agorafobia como trastorno. Nos servimos de la netnografía, a través del análisis de discursos de las entradas y de entrevistas cualitativas complementarias, como diseño metodológico. El marco teórico que nos aportan los conceptos de medicalización y la biomedicalización nos sirven como coordenadas que nos permiten comprender que las articulaciones de estrategias de atención desarrolladas por las personas dolientes no se abaten sobre el discurso biomédico ni se desligan totalmente de él. Los resultados de esta investigación nos permiten observar que los entornos legos on-line posibilitan tanto la emergencia de estrategias de atención legas que dialogan con las estrategias expertas, como la irrupción de muestras de la biomedicalización que reclaman el autocontrol y la vigilancia de las personas dolientes.
Digital capitalism and the e-health revolution
Authors: Cometta Mosè
Published: June 2021

This paper discusses the challenges posed by the advent of e-health. To contextualise the phenomenon, it defines the environment in which it arises: digital capitalism. The predatory dynamics of this social structure are likely to transform medical practice. Contemporary medicine seems to be poised between a renewed attention to the patient and their dignity – perspective of the medical humanities – and the reduction of the patient to a mere object of study and discipline – biomedicine. By favouring the quantification of the patient and a depersonalising approach, digital medicine risks breaking the bond between these two sides of medicine. At the same time, the development of medical technologies in a capitalist environment poses other risks that need to be weighed up: from the gratuitous appropriation of personal data to the creation of a discriminatory and classist healthcare system. Only by openly addressing these problems will it be possible to integrate these new technologies in a democratic way that promotes the common good.
KONTEKSTUALISASI MISI MELALUI TRADISI PUKUL SAPU DI DESA MORELLA
Authors: Tupamahu Chresty Thessy
Published: June 2021

Mengabarkan Injil ialah upaya orang percaya dalam menyampaikan kabar kasih karunia Allah kepada seseorang, sehingga ia berpaling dari dosa-dosanya dan percaya kepada Allah melalui Anak-Nya, Yesus Kristus dengan kuasa Roh Kudus. Melihat kondisi di Maluku, dan secara khusus di Desa Morela, maka berita Injil pun haruslah sampai dan mengubah hidup mereka. Saat ini hampir sebagian besar orang Maluku masih belum mendengar tentang Tuhan Yesus dan karya keselamatan-Nya. Karena tradisi Pukul Sapu telah menjadi salah satu tradisi yang sangat populer dan hampir sebagian besar orang Maluku mengetahui tradisi ini, maka upaya menyampaikan Injil melalui tradisi ini dapat dimanfaatkan, dengan harapan ada banyak orang yang mendengar dan menerima kabar keselamatan, secara khusus masyarakat di desa Morella. Keberhasilan pelayanan lintas budaya atau pelayanan khusus melalui suatu tradisi tidak hanya ditentukan pada pemahaman tentang tradisi tersebut, melainkan juga dibutuhkan pemahaman yang luas akan ilmu kontekstualisasi itu sendiri, sehingga antara tradisi dan strategi atau metode yang akan dipakai dapat rancang atau disiapkan dengan baik agar peluang untuk bisa masuk atau menceritakan Injil melalui tradisi tersebut dapat diterima dan juga dapat dipahami dengan baik.
Uji Efek Antioksidan Formulasi Nanoemulsi Ekstrak Etanol Daun Parang Romang (Boehmeria virgata)
Authors: - Magfirah -
Published: June 2021

ABSTRAKUpaya menangkal terjadinya penyakit degeneratif akibat terakumulasi radikal bebas,  salah satunya adalah pemanfaatan daun parang romang (Boehmeria virgata)  yang memiliki potensi kandungan antioksidan yang diformulasikan dalam sediaan nanoemulsi. Tujuan dari penelitian ini mengetahui aktivitas antioksidan formulasi nanoemulsi ekstrak etanol daun parang romang. Daun Parang romang diekstraksi secara maserasi.selanjutnya diformulasi menjadi sediaan nanoemulsi dengan metode simple lattice design. Spektrofotometer UV-Vis digunakan untuk mengukur aktivitas antioksidan.. Hasil penelitian menunjukkan aktivitas antioksidan dengan metode  DPPH  pembanding kuersetin dan formulasi nanaoemulsi  masing-masing  diperoleh nilai IC50 yaitu 19,82 μg /mL dan 96,36 μg /ml. Hal ini menunjukkan bahwa formulasi nanoemulsi ekstrak daun parang romang memiliki aktivitas antioksidan yang kuat. Kata Kunci : Daun Parang romang, Nanoemulsi, Antioksidan, DPPH.
Finite Difference Analysis of Unsteady Heat and Flow of an Incompressible Third
Grade Fluid
Authors: Nayak I
Published: June 2021

An unsteady flow and heat transfer problem with viscous dissipation
of a third order fluid placed within two long parallel flat porous
walls is studied in present work. The governing equations are non- dimensionalized
and finally a non-linear coupled system of partial differential
equation is obtained. An approximated solution is obtained using finite
difference method of fully implicit form. With help of high speed MATLAB
programming numerical solution is procured and presented graphically.
Investigation is made on effect of different physical parameters
on flow and heat profile. The notable finding in the current work is that
for smaller values of visco-elastic parameter ®, the velocity rises with
raising the values of ®. But for larger visco-elastic parametric values
of ®, a reversed effect is seen on velocity field. Also with the increase
of viscous-dissipation parameter, more viscous-dissipation heat generated
that increases the temperature field.
Integrity of Wheel Related Graphs
Authors: Basavanagoud B. , Policepatil Shruti
Published: June 2021

If a network modeled by a graph, then there are various graph
theoretical parameters used to express the vulnerability of communication
networks. One of them is the concept of integrity. In this paper, we determine exact values for the integrity of wheel related graphs.
Bielecki–Ulam–Hyers stability of non–linear Volterra impulsive integro–delay
dynamic systems on time scales
Authors: Omar Shah Syed , Zada Akbar , Tunc Cemil , Ali Asad
Published: June 2021

In this manuscript, the stability in terms of Bielecki–Ulam–
Hyers and stability in terms of Bielecki–Ulam–Hyers–Rassias of non–
linear Volterra impulsive integro–delay dynamic systems on time scales
are obtained using the fixed point approach along with Gronwall inequal- ¨
ity and Lipschitz condition.
PERAN DIPLOMASI PUBLIK DALAM MEMPERKUAT HUBUNGAN BILATERAL INDONESIA - AMERIKA SERIKAT PADA MASA PEMERINTAHAN SUSILO BAMBANG YUDHOYONO (2004 – 2014)
Authors: Plehanku Dina puspita
Published: June 2021

Abstract Public Diplomacy as a part of soft power has been the main principle of Indonesia’s diplomacy under President Yudhoyono. Due to the ineffectiveness of Track 1 Diplomacy, Government-to-Government (G2G) relations, in promoting the positive image of Indonesia, the role of public diplomacy becomes important. Thus, public diplomacy practice which involves all aspects of society; Government to Government (G2G), Government to People Contact (G2P), and People to People Contact (P2P), is relevant in order to promote Indonesia to American society and strengthening its bilateral relations as well. This research, therefore, is trying to discuss the role of public diplomacy in strengthening the RI-US bilateral relations and its benefits to Indonesia’s foreign policy. The findings show that public diplomacy contributes in strengthening RI-US bilateral relations by the use of public diplomacy instruments such as cultural and educational exchanges, official visits and social media. Keywords: Soft Power, Public Diplomacy, RI-US Bilateral Relations.
Kebangkitan Ekonomi China Dan Pengaruhnya Terhadap Beberapa Negara Di Kawasan Asia
Authors: Santoso Bambang
Published: June 2021

ABSTRAK Penelitian ini bertujuan untuk mengetahui hal-hal yang mendasari kebangkitan ekonomi negara China. Dewasa ini  China telah dikenal luas sebagai raksasa ekonomi di asia dalam perekonomian dunia. Dengan memainkan berbagai peran, sebagai produsen, pemasok, pesaing, pembaharu dan penyedia sumber daya manusia yang handal, China akan mendominasi perekonomian dunia. Menjadi pemain yang tangguh dalam penekanan biaya produksi, peningkatan teknologi dan jasa, serta memiliki ketahanan ekonomi yang kuat dalam memajukan negara.Metode penulisan yang digunakan adalah tipe penulisan deskriptif dengan penelitian kualitatif. Dalam penulisan ini penulis menggunakan data sekunder yang diperoleh dari sejumlah literatur dan dituliskan dengan menggunakan teknik penulisan deduktif.Penelitian ini menunjukkan bahwa perkembangan ekonomi yang dicapai oleh China tidak lepas dari berbagai aspek yakni, strategi pembangunan berjangka dan mitra dagang yang dijalin dengan dunia internasional. Strategi pembangunan berjangka yang diterapkan oleh China sangat mengedepankan zona-zona industrinya. Hal ini membuat perkembangan perekonomian China menjadi pusat perhatian dunia. Kata Kunci: Kebangkitan Ekonomi China, Gaige Kaifang, Konsep Pembangunan                     IlmiahABSTRACT This study aims to determine the things that underlie the country's economic rise of China. Nowadays China is widely regarded as an economic giant in Asia in the world economy. By playing a variety of roles, as a manufacturer, supplier, competitor, innovator and provider of qualified human resources, China will dominate the world economy. Be a formidable player in the production cost reduction, improved technology and services, as well as having a strong economic resilience in developing countries.The method used is the type of writing descriptive qualitative research . In this paper the author uses secondary data obtained from a number of literature and writing written using deductive techniques.This study suggests that the economic growth achieved by China can not be separated from the various aspects of the development strategy and futures trading partners are woven with the international community. Term development strategy adopted by China is promoting its industrial zones. This makes the development of the Chinese economy into the world limelight. Keywords: Evocation Economics of China, Gaige Kaifang, Scientific DevelopmentConcept
Penguatan Sistem Keamanan Amerika Serikat Dalam Upaya Penanggulangan Wabah Ebola Pada Tahun 2014
Authors: Haryani Nungky
Published: June 2021

Tulisan ini membahas tentang penguatan sistem keamanan Amerika Serikat dalam upaya penanggulangan penyebaran Wabah Ebola pada tahun 2014. Tujuan penulisan penelitian ini adalah, (1) Mengetahui bagaimana perkembangan virus Ebola tahun 2014 sehingga menjadi ancaman ancaman bersama,(2) Mengetahui bagaimana upaya Amerika Serikat dalam penanggulangan virus Ebola di Afrika Barat di Amerika Serikat. Penelitian ini menggunakan konsep ancaman transnasional, keamanan nasional, dan Human Security. Metode Penelitian menggunakan penelitian kualitatif dengan format penelitian studi kasus. Data dikumpulkan menggunakan teknik studi pustaka, untuk membantu penulis dalam mengumpulkan data penelitian.Hasil penelitian ini adalah penyebaran virus Ebola yang meluas tahun 2014, disebabkan mudahnya penularan virus dari satu orang ke orang lain, selain itu didukung adanya globalisasi yang memudahkan perpindahan orang, barang, dsb sehingga virus Ebola dapat menyebar. Penyebaran virus Ebola yang semakin meluas, menuntut negara-negara di dunia termasuk Amerika Serikat untuk menanggulangi penyebarannya, baik di dalam negeri ataupun luar negeri.  Keywords: Virus Ebola, Transnational Threat, National Security, and Human Security
Upaya Penanganan Tingkat Perdagangan Satwa Liar oleh Pemeritah Indonesia Pada Tahun 2013-2016
Authors: Khoirunnisa Ani , Pricille Pricille
Published: June 2021

ABSTRACTWildlife trade is a wild trade in protected animals without regard to the existing rules. Some people are still buying and selling animals protected illegally, both buying and selling transactions that are alive to be maintained , or in the form of animals that have been preseerved. In fact, the trade in these animals has caused considerable losses for Indonesia. This wildlife trade cae is not carried out only by individuals but there is an organized as consumers of every product from wild animals. Therefore one of the efforts made by Indonesia is to conduct various international collaborations, because in responding to the case of wildlife trade, it is not enough only from law enforcement, and involving more than one country, international coopeeration is needed.The research method that writer used is a qualitative method with a descriptive type of research approach that is by describing phenomenas that occur to find out the efforts of the Indonesia government in handling the level of wildlife trade in the period 2013-2016.With the cooperation efforts carried out by the Indonesia government to help cover the shortcomings and constraints faced by the Indonesian government regarding the lack of human resources and also substantial financial resources to overcome the practice of wildlife trade. Keywords: Wildlife Trade, Green Politics, International Cooperation, International Organizations
Peranan Asian Development Bank Terhadap Pertumbuhan Ekonomi di Indonesia tahun 2016-2020
Authors: Faadhilah Salsabila , Wijaya Syafira Maulina , Rahma Almira , Firdaus Muhammad
Published: June 2021

Penelitian ini memiliki tujuan untuk mengetahui mengenai peranan Asian Development Bank terhadap pertumbuhan perekonomian di Indonesia. Sebagaimana yang kita ketahui Asian Development Bank  (ADB) atau yang dikenal juga sebagai Bank Pembangunan Asia adalah sebuah lembaga keuangan multilateral dengan tujuan untuk menangani dan memerangi kasus kemiskinan yang ada di negara-negara Asia dan juga pasifik, Lembaga perbankan internasional tentunya memiliki peran krusial dan juga penting dalam melakukan perbaikan serta peningkatan ekonomi dan pembangunan di suatu negara, kemudian bagaimana cara mereka berperan dan apa saja perannya dalam rangka meningkatkan pertumbuhan ekonomi adalah hal yang akan dibahas dalam penelitian kali ini. Penelitian kali ini menggunakan metode kualitatif dalam menjelaskan masalah-masalah yang ada dalam penelitiannya dan dalam pengumpulan datanya dilakukan dengan menggunakan sumber-sumber seperti jurnal, buku-buku, serta website institusi resmi. Hasil dari pembahasan penelitian yang kami lakukan menunjukkan bahwa dengan adanya Asian Development Bank (ADB) memiliki pengaruh yang penting untuk keberlangsungan pembangunan dan stabilitas ekonomi bagi negara-negara Asia, termasuk Indonesia. ADB banyak membantu Indonesia dalam berbagai bidang
A clinical study of basti (kal-basti) in the management of katigata vatavyadhi w.s.r.t. Lumbar Spondylosis.
Authors: Gharge Archana
Published: June 2021

Several studies have suggested an important role of Basti treatment in the asthimajjagata Vatavyadhi like katigata vata.Even the use of Panchatiktaghritakshir basti in same has been studied & has proved best.But the use of Kal Basti(16 bastis) & that Anuvasana Basti of which with Panchatiktaghrita instead of oil has not been studied earlier.This study was aimed to find the combined effect of basti & Panchatiktaghrita in Asthimajjagata vatavyadhi like katigatavata (degenerative changes at lumbosacral region) together to give best results.
Clinical evaluation of shiva guggulu and simhnad guggulu in the management of amavata
Authors: Ingole Rajesh
Published: June 2021

Amavata is one of the dreadful disorders and included under the vata vyadhis in Ayurveda. The annual incidence rate of rheumatoid arthritis is low however the prevalence rate of the same is very high. Of all the rheumatic disorders, rheumatoid arthritis still remains a formidable disease, as it causes severe crippling deformities and functional disabilities. The disease can undergo spontaneous remission and it is difficult to forecast the outcome of the disease and it makes the evaluation of new drug is also difficult. If proper attention has not been paid the condition turns to its worse. The severe pain and crippling deformities with functional abnormalities make the patient seek doctorâ€™s advice. Even in the modern system of medicine the drug therapy for rheumatoid arthritis is empirical and is focused on 3 issues-1. Relieving the pain along with control of inflammation,2. Improving and maintaining the function and3. Prevention of the deformity.However, none of the medicine available at present can give everlasting benefit thereby permanent remission from the symptoms. The drugs which are available as on today are only of value in achieving the symptomatic relief. But their use is restricted because of the number of adverse effects attached to their usage. It is because of this reason the people are looking towards a safe and effective drug.
Intellectual capital and Tobin’s Q as measures of bank performance
Authors: Nsour Esra A. Al , Dahiyat Ahmad A. Al , Weshah Sulaiman
Published: June 2021

This paper aims at examining the effect of the Value Added by Intellectual Capital (VAIC) in terms of its three components: capital employed efficiency, human capital efficiency, and structure capital efficiency on the financial performance of commercial banks listed on the Amman Stock Exchange for the period 2010–2018.Value Added of Intellectual Capital (VAIC) model was used to measure the intellectual capital while Tobin’s Q ratio was used as an indicator of bank financial performance. The study has used parametric techniques like multiple linear regression and correlation coefficient, and other statistical methods to investigate its hypothesis. It was found that only human capital efficiency and capital employed efficiency had impacts on the banks’ financial performance. These results emphasize the importance of using the VAIC model to evaluate the financial performance of these banks, as well as encourage banks to make further investments in intellectual capital’s components, and concentrate on human resources to build up their knowledge, skills and capabilities, because of their greatest role in value creation.
Short Communication Response of Rice to Zn Application Under Salt Affected Soil in Hafizabad District, Pakistan
Authors: Arshadullah Muhammad , Ali Arshad , Hyder Syed Ishtiaq , Mahmood Imdad Ali , Zaman Badr-uz-
Published: June 2021

The effect of different levels of Zn (0, 5, 10 and 15 kg/ha) was evaluated on growth and ionic concentration of rice variety (cv. CM.204 ) directly sown on raised bed under saline-sodic soil. Tillering, number of grains/spike, 1000 grain weight and paddy yield significantly (p = 0.05) increased with the increase in the rate of Zn application. Paddy yield was the maximum at the application of 15 kg Zn/ha, being 29% more than the control treatment. The maximum number of tillers/hill (62), number of grains/spike

(121) and 1000 grain weight (26.40 g) were recorded with Zn application @ 15 kg/ha. The maximum paddy yield (7906 kg/ha) was attained @ 15 kg Zn/ha. The maximum Zn (45 ppm) in grain was determined from treatment receiving 15 kg Zn/ha followed by 10 kg Zn/ha (38 ppm).
Peste Des Petits Ruminants of Goats, Outbreak and Economic Losses : A Case Study
Authors: Islam Ausraful , Singh Amitav , Islam Mohammad Amirul , Majumder  Shankar
Published: June 2021

In the determination of outbreak of peste des petits ruminants (PPR) and the economic losses caused by the disease 1392 distributed goats at Dimla thana of Nilfamari district, purchased from different markets, were studied during March, 2007 to May, 2007. Among the distributed goats, 54.7% died before treatment, 14.7% died after treatment and 30.6% survived after treatment. Survival rate was 67.51%. Maximum number (77.6%) of goats died before treatment in the flocks of Modhupur. Survival rate of the treated goats in the locally purchased flock was the highest (98.9%) whereas that in the goats purchased from Lalmonirhat was the lowest (34.3%). Survival percentage of the non-vaccinated goats was higher (71.60%) than that of the vaccinated goats (64.95%). Among the treated goats, 7.9% were pregnant, 4.4% of them aborted and 3.5% remained pregnant though they were infected. Infectious keratoconjunctivitis (IKC) was observed in 2.5% PPR infected goats. The total economic loss was estimated at Bangladesh Tk 10,16434 ($ 14520.49). Locally collected goats had the highest probability (80.6%) of survival after treatment whereas those collected from Rangpur had the highest probability (81.3%) of death before  treatment. Probability that the goats will die after treatment was the highest among the goats purchased from Lalmonirhat (59.5%). Survival of goats was significantly (P<0.05) associated with place of purchase. Goats purchased from the local areas were 26.8 times more likely to survive than those collected from Modhupur. Goats of Lalmonirhat were 1.993 times more likely to survive than those of Modhupur
Social isolation, time spent at home, financial stress and domestic violence during the COVID-19 pandemic
Authors: Morgan Anthony , Boxall Hayley
Published: June 2021

In this study we use data from a large online survey of Australian women to examine whether the increased time spent at home, social isolation and financial stress resulting from COVID-19 containment measures were associated with a higher likelihood of physical and sexual violence among women in current cohabiting relationships with and without a history of violence. An increase in the amount of time spent at home with a partner did not in itself increase the likelihood of violence among either group. However, the probability of repeat or first-time violence was between 1.3 and 1.4 times higher for women who had less frequent contact with family and friends outside of the household during the pandemic. While financial stress prior to the pandemic was a strong predictor of violence for both groups, the probability of first-time violence was 1.8 times higher among women who experienced an increase in financial stress. We conclude that the pandemic was associated with an increased risk of violence against women in current cohabiting relationships, most likely from a combination of economic stress and social isolation.
“CURB” your enthusiasm and consider HIV
Authors:   Barnet Hospital Education Centre, Wellhouse Lane, Barnet EN5 3D, Jacobs Phillip , Beckles Michael A ,   Department of Acute Medicine, Royal Free Hospital, Al-hussaini Abtehale ,   Department of Acute Medicine, Royal Free Hospital
Published: June 2021

We present the case of a 40-year old female who was initially seen by her GP and the Emergency Department with pneumonia failing to respond to oral antibiotics. Her severity assessment score categorised her as being in a low risk group and she was discharged. Subsequent admission and further investigations diagnosed Human Immunodeficiency Virus infection and Pneumocystis jeruvici pneumonia. It is important for emergency departments and acute physicians to apply risk validation tools appropriately and to be alert to underlying immunosuppression.
An Unusual cause of ‘Troponinaemia’
Authors:   General Intensive Care Unit, St George’s Hospital, London, Chakraborty Arup , Bhimjiyani Arti ,   Milton Keynes Hospital, Milton Keynes, Smith Richard William ,   Milton Keynes General Hospital, Milton Keynes, UK
Published: June 2021

58 year old policeman presented with a 4 week history of cough, haemoptysis, exertional dyspnoea, ear discomfort and sore throat. He was previously healthy and taking no regular medications. He was a non-smoker and had no risk factors for coronary artery disease. He had recently completed two courses of antibiotics for a presumed ear infection. He had also experienced occasional minor epistaxis with constitutional symptoms of weight loss and night sweats over recent months. Clinical examination was unremarkable.
Lead Poisoning presenting as acute severe myalgia: Why was the diagnosis delayed and what lessons can we learn as acute physicians?
Authors:   Department of Medicine, Hutt Valley Hospital, Lower Hutt, New Zealand, McLaren JM , Petterson T ,   Department of Medicine, Hutt Valley Hospital, Lower Hutt, New Zealand, McGouran DCR ,   Department of Medicine, Hutt Valley Hospital, Lower Hutt, New Zealand
Published: June 2021

Patients presenting to the “front door” with acute neuromuscular symptoms are challenging. Toxins need consideration as possible causative agents if there is the possibility of relevant exposure. This requires a thorough history1 and an awareness of local ethnic, social and industrial cultures within the practice locality. We describe a case of lead poisoning in a 35 year old man who presented with severe, progressive, myalgia. We consider that basic errors in clinical processing delayed a potentially difficult and serious diagnosis and these are discussed. The importance of maintaining a thorough initial clerking process within the Acute Medical Unit is highlighted. This should include a comprehensive occupational history. Acute physicians should familiarize themselves with local industry and the toxic syndromes they can produce.
Emphysematous Pyelonephritis in a non-diabetic post-operative Transsexual patient
Authors:   Department of Medicine, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex, Grant Paul , Lipscomb David ,   Department of Medicine, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex, Edgell Helen ,   Department of Medicine, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex
Published: June 2021

We describe the rare condition of emphysematous pyelonephritis (EPN) in a non-diabetic patient who had previously undergone gender reassignment surgery. The report discusses the acute management and treatment and then provides background to the aetiology and historical aspects of the condition.
A young woman with HIV and hemiparesis
Authors:   Milton Keynes hospital NHS Foundation Trust Standing Way, Eaglestone Milton Keynes MK6 5LD, Nelatur Varun , Smith Bill ,   Milton Keynes hospital NHS Foundation Trust Standing Way, Eaglestone Milton Keynes MK6 5LD, Mital Dushyant ,   Milton Keynes hospital NHS Foundation Trust Standing Way, Eaglestone Milton Keynes MK6 5LD, Parekh Mehul ,   Milton Keynes hospital NHS Foundation Trust Standing Way, Eaglestone Milton Keynes MK6 5LD
Published: June 2021

Progressive Multifocal Leucoencephalopathy (PML) is a rare and invariably fatal neurological disease that is seen patients with untreated HIV infection and as a complication of immune suppression with agents such as natalizumab. With the increasing occurrence of HIV, it is important to consider this condition in the differential diagnosis of patients with neurological features. We present the case of a young woman with a long history of HIV infection who presented with neurological symptoms; recognition of this diagnosis enabled identification of her poor compliance with treatment. The investigation and treatment of this condition is discussed.
An unexpected cause of sepsis in a patient with dental decay
Authors:   Department of Intensive Care Reinier de Graafweg 3 2625 AD Delft, The Netherlands, Zwinkels Rob LJ , van der Sar – van der Brugge Simone ,   Department of Intensive Care Reinier de Graafweg 3 2625 AD Delft, The Netherlands, Sleeswijk Visser Steven J ,   Department of Intensive Care Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands
Published: June 2021

A 42-year old man attended our emergency department with sudden onset of nausea, fever and cold sweats. In the days prior to presentation, he had developed a radiating pain in the thoracic spine. Furthermore, he had been suffering from dyspnoea on exertion for several weeks. He was a smoker, but had no significant past medical history.
Problem-based review: The Patient with Acute Adrenal Failure
Authors:   Churchill Hospital, University of Oxford, OX3 7LU, Rogers Angela , Pillinger Toby ,   Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford OX3 9DU, Wass John A H ,   Oxford Centre for Diabetes, Endocrinology and Metabolism,Churchill Hospital, University of Oxford, OX3 7LU
Published: June 2021

Acute adrenal crisis is an important condition to consider in any shocked patient presenting to the acute medical unit. This article aims to highlight the key aspects of initial management, focussing on the importance of rapid recognition and prompt initiation of steroid treatment.
Problem-based review: The patient with acute heart failure
Authors:   North Western Deanery, Holzmann Tim , Eltenton Georgina ,   Manchester University, Anderson Simon ,   Manchester Royal Infirmary, Bonny Stephen J ,   Stepping Hill Hospital
Published: June 2021

Acute heart failure is a common and potentially life threatening presentation to hospitals in the UK. Acute Physicians at the front door of the hospital will often be involved with the initial management of these patients. Despite its many underlying causes, certain general treatment principles exist. We present a typical clinical scenario followed by an overview of the pathophysiology and management of acute heart failure and cardiogenic pulmonary oedema. The aim is to cover a broad spectrum of therapies ranging from medical treatment up to invasive devices, thereby discussing the available options from the Emergency Department to the Intensive Care Unit.
Problem based review: The patient taking methadone
Authors:   The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR, Arora Anshu , Williams Karen ,   NHS Foundation Trust, 44 London Road, Gloucester
Published: June 2021

Methadone Maintenance Treatment (MMT) is an effective therapy for opioid-dependence; its use is based on a harm reduction philosophy and represents one of a range of treatment approaches for opioid-dependent individuals. The medical literature supports MMT as a well established and cost-effective treatment for opioid-dependence that allows a return-to-normal physiological, psychological and societal functioning. The effectiveness of MMT is enhanced by psycho-social interventions such as contingency management and addressing other co-existing health and social needs. MMT saves lives and reduces violent and non-violent crime, drug use and the transmission of HIV, hepatitis C and other communicable diseases. For some people, MMT may continue for life, while others may eventually be able to discontinue and remain abstinent. Methadone interacts with numerous drugs and prolongs the corrected QT interval (QTc) with risk of sudden cardiac death. It has a prolonged half-life and premature discharge of patients after methadone overdose may be fatal. Each patient must be assessed, treated and monitored on an individual basis. Successful outcomes through MMT require knowledge, experience, vigilance, and diligence on the part of the physician, the patient and all of those involved in treatment.
Spontaneous spinal extradural haematoma presenting with chest pain: a case report and literature review
Authors:   Rotherham General Hospital Moorgate Road Rotherham S60 2UD UK, Skilling Jessica M , Tempest Nicola M ,   Rotherham General Hospital Moorgate Road Rotherham S60 2UD UK, Abdelhafiz Ahmed H ,   Rotherham General Hospital Moorgate Road Rotherham S60 2UD UK
Published: June 2021

An 85 year old lady was admitted to hospital after experiencing an abrupt onset of right sided chest and mid thoracic back pain. This pain was exacerbated by movement and coughing but not by inspiration. There was no history of recent injury. Her past medical history included atrial fibrillation (AF), aortic stenosis, hypertension and chronic obstructive pulmonary disease. Medication on admission included bendrof lumethiazide 2.5mg od, digoxin 125 mcg od, doxazosin 4mg od, enalapril 20mg od, warfarin and salbutamol and seretide inhalers. Prior to the onset of the pain she had been independently mobile with a stick.
The workload of stroke thrombolysis: A prospective study in a district general hospital setting
Authors:   Neurology Wessex Neurological Centre, Southampton General Hospital, Southampton, Slaght Seán J , Weir Nic U ,   Neurology Wessex Neurological Centre, Southampton General Hospital, Southampton, Lovett Joanna K ,   Neurology Wessex Neurological Centre, Southampton General Hospital, Southampton
Published: June 2021

Many hospitals are still setting up acute stroke thrombolysis services, often delayed by fears over workload. However, there are few data on how many patients require urgent assessment before one is treated. We prospectively studied all referrals to the 24-hour stroke thrombolysis service, February 2009 – January 2010, in Southampton General Hospital. 128 patients were referred to the thrombolysis team and 20 received thrombolysis. The most common reasons for treatment exclusion were: stroke severity (37%), time from onset (26%) or CT findings (15%). Approximately six patients required urgent assessment by the thrombolysis team for every one treated. These data are crucial to inform service planning.
The impact of education on the knowledge and documentation of Driving and Vehicle Licensing Agency (DVLA) driving restrictions by doctors
Authors:   Royal Hampshire County Hospital, Winchester, Hampshire, UK, Kemp Oliver , Lockwood Alistair ,   Royal Hampshire County Hospital, Winchester, Hampshire, UK, Lockwood Gabrielle ,   Royal Hampshire County Hospital, Winchester, Hampshire, UK, Simon Godwin ,   Royal Hampshire County Hospital, Winchester, Hampshire, UK, Kemp Juliette ,   Southampton General Hospital, Hampshire, UK
Published: June 2021

The impact of education on the knowledge and documentation of Driving and Vehicle Licensing Agency (DVLA) driving restrictions by doctors.
Delivering outpatient antibiotic therapy (OPAT) in an Acute Medical Unit
Authors:   Acute Medicine, City Hospital, Birmingham, Yan Yin May , Tonks Karl ,   City Hospital, Birmingham, Singh Manjit ,   City Hospital, Birmingham, Kavi J ,   City Hospital, Birmingham, Langford Nigel J ,   City Hospital, Birmingham
Published: June 2021

Outpatient antibiotic therapy (OPAT) is being developed and practised in an increasing number of acute hospitals within the United Kingdom. This article is a review of the OPAT service delivered by a large inner city hospital over the last two years. The service demonstrates the key elements of OPAT demonstrating different delivery models, aspects of patient selection, spectrum of infections treated, choice and delivery of antimicrobials, efficacy, patient safety, outcomes, and the cost-effectiveness of this programme.
Complications of Emergency Refeeding in Anorexia Nervosa: Case series and review
Authors:   Department of Gastroenterology, Royal Berkshire NHS Foundation Trust, Reading, UK, Webb G J , Smith K ,   Department of Gastroenterology, Royal Berkshire NHS Foundation Trust, Reading, UK, Thursby-Pelham F ,   Department of Gastroenterology, Royal Berkshire NHS Foundation Trust, Reading, UK, Smith T ,   Department of Gastroenterology, Southampton University Hospital NHS Trust, Southampton, Stroud M A ,   Department of Gastroenterology, Southampton University Hospital NHS Trust, Southampton, De Silva A N ,   Department of Gastroenterology, Royal Berkshire NHS Foundation Trust, Reading, UK
Published: June 2021

The refeeding syndrome is common among patients with anorexia nervosa. It may be lethal and has many manifestations. We report a case series of 14 anorexic patients admitted for feeding to a single British centre. There was a high prevalence of the refeeding syndrome, with three cases requiring higher dependency unit support and one death. We present a review of the refeeding syndrome in anorectics and highlight our impression that infection among such patients may be serious and under-recognised.
Acute Angle closure glaucoma (AACG): an important differential diagnosis for acute severe headache
Authors:   Acute Medicine, Royal Liverpool University Hospital, Acute Medical Unit, Prescot Street, Liverpool, Renton Bryan , Bastawrous Andrew ,   Ophthalmology, Wirral University Teaching Hospital
Published: June 2021

Acute headache is a common presenting symptom in the acute medical unit. We present a case of Acute Angle Closure Glaucoma (AACG) presenting with acute severe headache. It highlights the importance of remembering this ophthalmologic emergency and reminds us of its clinical presentation. The rapid assessment and diagnosis of AACG allowed prompt treatment and likely prevented the patient from losing her vision.
Outpatient parenteral antibiotic therapy for cellulitis
Authors:   Acute Physiology, Barnet Hospital, Wellhouse Lane, Barnet, Herfordshire, Jacobs Phil , Coleman Reg ,   Acute Physiology, Barnet Hospital, Wellhouse Lane, Barnet, Herfordshire
Published: June 2021

We read with interest the review of the OPAT service in Birmingham, featured in the most recent issue of Acute Medicine.1 Could the authors confirm the percentages of patients deemed suitable for outpatient therapy with the various conditions compared to the totals presenting to their organisation?
The value of the Modified Early Warning Score and biochemical parameters as predictors of patient outcome in acute medical admissions: a prospective study
Authors:   University of Colombo, Sri Lanka, Perera Yashasvi Sanja , Ranasinghe Priyanga ,   University of Colombo, Sri Lanka, Adikari Adikari Mudiyanselage Madura ,   University of Colombo, Sri Lanka, Welivita Welivitage Don Thilina Sampath ,   University of Colombo, Sri Lanka, Perera Wickramage Malith Eranda ,   University of Colombo, Sri Lanka, Roshan Wijesundara Mudiyanselage Dileepa ,   University of Colombo, Sri Lanka, Karunanayake Sembukutti Arachchige Ajith Panduka ,   University of Colombo, Sri Lanka, Constantine Godwin Roger ,   University of Colombo, Sri Lanka
Published: June 2021

Abstract We evaluated the effectiveness of MEWS and biochemical parameters in predicting outcomes for acute medical admissions. Data from consecutive admissions to the Acute Medical Unit (AMU) of National Hospital of Sri Lanka were collected. C-reactive protein (CRP), albumin, white cell count, platelet count and haemoglobin values were collected. Adverse endpoints were HDU/ICU admission, cardio-respiratory emergency/resuscitation and death. A MEWS score of >=5 together with increasing age, pulse rate, respiratory rate, AVPU score, CRP, CRP/Albumin ratio and reduced platelet and albumin level all increased the odds of reaching ‘adverse endpoints”. Adding a score for biochemical parameters increased the area under the ROC curve for reaching “adverse endpoints’. Biochemical parameters better predicted length of hospitalstay and adverse outcomes. A combined scoring system improved the sensitivity of prediction.
Acute Fulminant Necrotizing Amoebic Colitis: A potentially fatal cause of diarrhoea on the Acute Medical Unit
Authors:   St James’s University Hospital, Desai Purav , Sivaramakrishnan Nurani ,   Dewsbury and District Hospital
Published: June 2021

Abstract Diarrhoea is a common presenting complaint to the Acute Medical Unit. We report a case of acute fulminant necrotizing amebic colitis in a 73 year old man with no recent travel history preceding his admission. Such cases are often difficult to diagnose and hence associated with a high mortality, unless treated promptly and appropriately. This case report highlights the importance of early diagnosis and prompt initiation of treatment.
Safe discharge of patients with low-risk upper gastrointestinal bleeding (UGIB): Can the use of Glasgow-Blatchford Bleeding Score be extended?
Authors:   Division of Acute Medicine, Nottingham University Hospital, Le Jeune Iven Robert , L Gordon Adam ,   Division of Rehabilitation and Ageing, University of Nottingham, Farrugia Daniella ,   Division of Acute Medicine, Nottingham University Hospital, Manwani Richa ,   Division of Acute Medicine, Nottingham University Hospital, Neil Guha Indra ,   Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, Wynn James Martin ,   Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit
Published: June 2021

Introduction: Risk stratification of patients with suspected upper gastrointestinal bleeding (UGIB) using either Glasgow-Blatchford Bleeding Score (GBS) or preendoscopy Rockall score to facilitate early safe discharge (GBS=0, pre-Rockall=0) has been reported. This observational study compared score utility and considered the impact of extending the range of GBS or pre-Rockall scores permitting safe discharge. Methods: Consecutive adult patients presenting to acute medical admissions or the emergency department from September 2008-March 2009 with suspected UGIB had clinical history, vital signs, laboratory and endoscopy results prospectively recorded using electronic databases. GBS, pre-Rockall scores and a composite endpoint (blood transfusion, endoscopic therapy, interventional radiology, surgery or 30-day mortality) were calculated. Results: 388 patients with suspected UGIB were identified of which 92.3% were admitted (median (range) GBS=5 (0-19) and pre-Rockall=2 (0-11)) and 7.7% discharged (GBS=0 (0-4) and pre-Rockall=0 (0-4)). 186 (47.9%) underwent in-patient endoscopy. 151 (38.9%) were found to have the composite endpoint with 77.5% having transfusion, 45.7% endoscopic treatment and an 8.0% mortality within 30 days. AUROC (95% CI) for 30-day composite endpoint was 0.92 (0.89-0.94) using GBS and 0.75 (0.70-0.80) using pre-Rockall scores. Analysis using different GBS thresholds demonstrated that GBS=0, GBS ≤1 and GBS≤2 had superior utility in identifying freedom from an adverse clinical outcome at 30-days than pre-Rockall score 0. Conclusions: GBS is superior to pre-Rockall score in identifying patients with suspected UGIB who have a low likelihood of an adverse clinical outcome and can be considered for early discharge. Diagnostic performance at different thresholds suggests that patients with GBS≤2 could be considered for early discharge, doubling the number of eligible patients (15.2 to 32.5%). This has important patient safety and resource implications.
Dyspnoeic dysphasia: A series of unfortunate events
Authors:   Centre for Molecular Medicine, Rayne Institute, 5 University Street, London, Sewell GW , Marks DJB ,   Centre for Molecular Medicine, Rayne Institute, 5 University Street, London, Hasford C ,   Acute Medicine, University College London Hospital, 235 Euston Road, London
Published: June 2021

We describe a case of a 56 year old man with no previous medical history who presented with sudden onset dyspnoea, expressive dysphasia, and right arm sensory loss and paresis. A diagnosis of bilateral pulmonary embolism and transient cerebral ischaemic attack was confirmed by CT pulmonary angiogram and MRI. Paradoxical embolism through an occult patent foramen ovale (PFO) was subsequently proven by contrast echocardiography. This case highlights a number of short and long-term management conundrums, that to date are incompletely addressed by clinical trials. These include timing of anticoagulation in patients with both venous thromboembolism and cerebral infarction, and the risk:benefit ratio of surgical closure of patent foramen ovale.
ECG dispersion mapping predicts clinical deterioration, measured by increase in the Simple Clinical Score
Authors:   Hospital of South West Jutland, Esbjerg, Denmark, Kellett John , Emmanuel Andrew ,   Nenagh Hospital, Nenagh, Ireland, Rasool Shahzeb ,   Nenagh Hospital, Nenagh, Ireland
Published: June 2021

Objective: ECG dispersion mapping (ECG-DM) is a novel technique that reports abnormal ECG microalternations. We report the ability of ECG-DM to predict clinical deterioration of acutely ill medical patients, as measured by an increase in the Simple Clinical Score (SCS) the day after admission to hospital. Methods: 453 acutely ill medical patients (mean age 69.7 +/- 14.0 years) had the SCS recorded and ECGDM performed immediately after admission to hospital. Results: 46 patients had an SCS increase 20.8 +/- 7.6 hours after admission. Abnormal micro-alternations during left ventricular re-polarization had the highest association with SCS increase (p=0.0005). Logistic regression showed that only nursing home residence and abnormal micro-alternations during re-polarization of the left ventricle were independent predictors of SCS increase with an odds ratio of 2.84 and 3.01, respectively. Conclusion: ECG-DM changes during left ventricular re-polarization are independent predictors of clinical deterioration the day after hospital admission.