bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone Industry from the Late Neolithic Site Hotnisa–Orlovka
Authors:   ", Markova Hristina ,   St. Cyril and Methodius",   University of Veliko Tarnovo
Published: November 2021

The worked bones from the Late Neolithic site Hotnitsa–Orlovka provide information about production and use of bone objects from Central North Bulgaria in this period. The domesticated animals are the main source of the bone industry (mainly large ungulates like Bos taurus and smaller mammals like ovis/capra). The ancient inhabitants of Hotnitsa–Orlovka prefered the longitudinally split long bones (mainly metapodium) and flat bones (ribs). The finishing of the bone objects is produced by abrision with sandstones. It is observed that some of the types have productive standardization which was planned specifically so that the use of unnecessary labor and the throwing away of raw material are avoided. This in turn leads to the thought of specialized bone industry. Despite the lack on stratigraphy posiotion of the artefacts, paralels can be drawn between the general characteristics of the findings from Hotnitsa– Orlovka and a number of other Late Neolithic sites from the Balkans.
Carbonized Textiles from Cemetery of the Church No 2 in Drastar (Grave No 192)
Authors:   Regional Museum of History – Veliko Tarnovo, Bulgaria, Chokoev Ivan
Published: November 2021

This article presents the results from the investigations of the textiles found in grave № 192 from Church № 2 cemetery in Drastar (medieval Silistra, Bulgaria), discovered in 1995. In grave cremated individual was found. This unusual practice can be explained with sanitary measures, in archaeologist’s opinion, which have to do with the plague epidemics of the turn of the 14 th century. The carbonized textile remains discovered in the zone of the skull. Woolen and silk (1.2 weft faced compound twill – samite, and tabby woven) textiles were identified.
Research on the game effectiveness of the national basketball wheelchair team
Authors:   ", Aleksieva Milena ,   St. Cyril and Methodius",   University of Veliko Tarnovo, Petkova Miroslava
Published: November 2021

Before the European Championships, the Bulgarian National Wheelchair Basketball Team hold three friendly meetings in the town of Gabrovo in “Orlovets” hall against the teams of Bosnia and Herzegovina and Romania. The purpose of the study is to analyze the performance of the players from the Bulgarian Wheelchair Basketball Team. Information is collected on the playing activities of nine athletes on 14 indicators during the two friendly meetings with the Bosnia and Herzegovina team. The analysis shows that the average values of eight of the studied indicators are better at the first control match of our national team against the team of Bosnia and Herzegovina, and in the second match the remaining six of the indicators shows up.
Evalution of useful skills on children and students with impered vision – an empirical study
Authors:   ", Marcheva-Yoshovska Petya ,   St. Cyril and Methodius",   University of Veliko Tarnovo
Published: November 2021

One of the main goals in the education of visually impaired children and pupils in Bulgaria is their preparation for independent life, which is accomplished through a curriculum of special subjects. The leading place among them takes the useful skills program. The report provides a brief overview of the scientific literature on the issue in question, and revealing opportunities to support the overall development of visually impaired learners. In this connection, the results of assessing the social skills of visually impaired children are presented using the checklist of Sasks and Siberman
Relationships PR – Journalism: between the PR’s Hemony and the Mutual Colonization
Authors:   ", Indjov Ivo ,   St. Cyril and Methodius",   University of Veliko Tarnovo
Published: November 2021

The study is an overview of the journalism – PR relationship at the terminological, theoretical and empirical-analytical levels. It traces the current state of the discussion of these relations in advanced media democracies such as Germany, with additional examples from the Anglo-Saxon countries, and draws some parallels with Bulgarian reality. The emphasis of the study is on what is occurring in journalism, without underestimating the importance of the appropriate partnership between the two actors. The thesis, which is proven in the course of the analysis, is that journalism and PR are doomed to mutual colonization which takesplace in the climate of PR hegemony and deepens with the development of digitalization.
Markers of (Un)Trustworthiness in Journalistic Texts
Authors:   St. Kliment Ohridski University of Sofia, Bulgaria, Eftimova Andreana
Published: November 2021

In connection with the frequent breach of P. Grice’s maxim about truth, the paper seeks answers to the questions of whether Bulgarians recognize the unreliable information in the media and what is the role of linguistic means in the process of interpreting the truth of the messages. The paper also comments on the results of an experiment aimed at verifying the role of three groups of language tools in forming a sense of reliability or unreliability of journalistic information among recipients.
Several Documents from the Fund of Cultural and Education Society “Trakiya” – Topolovgrad, Connected with the Thracian Bulgarians National Liberation Movement
Authors:   ", Ivanov Stanislav ,   St. Cyril and Methodius",   University of Veliko Tarnovo
Published: November 2021

The current publication presents five documents from the archive of the Cultural and education society “Trakiya” – Topolovgrad, preserved in the State Archive – Yambol (Fund 889 – Cultural and education society “Trakiya” – Topolovgrad), with some additional information about the national liberation movement of the Thracian Bulgarians in the early 20th century. The published documents contain evidence for the revolutionary activities of some IMARO leaders – Hristo Arnaudov, Apostol Dogramadjiev, Boyko Chavdarov and Dimitar Madjarov.
Combating Fake News with the Toolbox of the Law and Self-Regulation – the Bulgarian Case
Authors:   ", Injov Ivo ,   St. Cyril and Methodius",   University of Veliko Tarnovo
Published: November 2021

The paper discusses the possibilities of countering fake news in Bulgarian media with the instruments of media law, regulation, self-regulation and co-regulation. The study has reached the following important conclusions: 1. The laws are inadequate to the new challenge. There are temptations to fight it through the Criminal Code or a special law that can turn the prosecution service into a repressive media supervisor. 2. The State can contribute to curbing disinformation in the media by highlighting their ownership and funding. 3. The ethical codes oblige journalists to be responsible to society, but self-regulation is de-legitimized by the division in the guild. The solution lies in the development of co-regulation: the state stimulates the media by setting a condition for advertising in them: that they should agree on one code and that their ethics committee should be able to penalize them financially for fake news.
Comparative analysis of physical growth and weight indicators between pivot and other handball posts 19-years
Authors:   NSA “Vassil Levski”, Bulgaria, Avramov Emil
Published: November 2021

The modern effective management of the training process in the handball game requires the knowledge of age characteristics and the interrelationships between the physical development and the physical capacity of adolescents. One of the main figures in the team is the pivot. Its game contributes to the full realization of the other players. This has led us to research the game of the pivot, in order to reveal some regularities in his style of play and hence to clarify of approaches in the training process, in improving mainly individual actions and group interactions. The aim of the study is to establish the level of some anthropometric indicators in order to optimize the selection of the game post pivot. Our objective assessment of the state of anthropometric status is an important condition for an adequate correction and improvement of the handball hand selection.
Varia: Clusters as social capital. Romania and Bulgaria – leading the creation of media clusters in the Balkans
Authors: Nowosad Andrzej
Published: November 2021

Clusters mean collaboration, knowledge, trust in individual public units which gives better results than the sum of the different activities of the same units. The media play a major role in building social capital. The aim of this study is to analyze the Balkan countries in the field of media clusters, showing the leading role of Romania and Bulgaria.
Short Handbook for Aesthetic Education in Urban Environment
Authors:   ", Teofilova Marina ,   St. Cyril and Methodius",   University of Veliko Tarnovo
Published: November 2021

The city as a dynamic and multi-layered image of our immersive cultural and social environment, with all the flaws and problems of modern society, has the advantage to form and educate today. It is a truism that the referent environment of friendly circles largely dictates the behavior and tastes of the new generation, and this impact is difficult to be resisted by the family and institutions. And the circle of peers, thanks to its new, readily available technology and communication channels, has expanded monstrously, surpassing all limitations, including geographical and moral ones. The virtual Internet space and the new technologies have completely replaced the real space, schoolyard, street and park bench. Doesn’t the City as a continually growing, living organism reconcile in its dichotomous flesh the contradictions of past and future, of ugly and beautiful, of what we define as a historical and cultural heritage and art and what we condemn as subculture and kitsch?
Abolitionism and the End of the Legal Slave Trade in Great Britain
Authors:   ", Atanasov Pavlin ,   St. Cyril and Methodius",   University of Veliko Tarnovo
Published: November 2021

The article deals with the problem of emergence and development of abolitionism in Great Britain at the end of the 18th and the beginning of the 19th centuries. At that time the country played a leading role in the transatlantic slave trade and it was an irony in history that it was Britain that became home of a popular movement that aimed to put an end to the infamous human traffic and, eventually, to slavery in general. From an isolated idea of few people abolitionism grew into the first real civil rights movement in Great Britain which gained a powerful social support and in 1807 succeeded to pass the Slave Trade Act in the Parliament. The author presents both the arguments of the supporters and the opponents of the transatlantic trade focusing on the roles of the leading abolitionists, such as Granville Sharp, Thomas Clarkson and William Wilberforce. Since the abolitionists’ views were more well-grounded than those of the planters, they were able to win the public opinion and to carry the day.
The „Ottoman Presence“ in Contemporary History Textbooks – Myth or Reality
Authors:   ", Simeonova Yulia ,   St. Cyril and Methodius",   University of Veliko Tarnovo
Published: November 2021

During the last few years, an attempt has been made in Bulgarian society to impose the con-tention that the Ottoman period is represented in the school history and civilizations textbooks through the definition “Ottoman Presence”. The present article seeks to provide a scientifically grounded review of the educational documentation concerning school history education, and in particular the history textbooks, to ascertain whether such a definition is present or absent.
The Historical Theme in the Works of Sculptor Boris Gondov
Authors:   Academy of Fine Arts, Sofia, Bulgaria, Angelova Stanislava
Published: November 2021

In the works of sculptor Boris Gondov the historical theme occupies an important place. He transforms vivid events and personalities of the story deeply and masterfully into a plastic direction. Our near and distant pasts excite the author and he creates memorable images such as those of Patriarch Evtimii, King Boris I, King Samuel, Kolyo Ficheto, Dimitar Blagoev and many others. Through them he discovers his attitude to a certain historical period and the personalities of history. Boris Gondov always looks for the original compositional and plastic solution and transforms his images in the light of their role and appreciation of their work in history.
Hemorrhaging laparoscopic partial nephrectomy — feasibility of a novel simulation model
Authors: Lusty Avril J. , Bleackley Joanne , Roberts Matthew , Watterson James , Raîche Isabelle
Published: November 2021

Introduction: Intraoperative surgical complications pose significant potential risks to patients. Uncontrolled bleeding during laparoscopic partial nephrectomy is one such event that requires collaboration and communication between surgical team members. We developed and evaluated a multidisciplinary surgical simulation scenario and model of intraoperative hemorrhage during a laparoscopic partial nephrectomy to facilitate the practice of these crucial non-technical skills.
Methods: A simulation scenario using a novel, titratable bleeding partial nephrectomy model was developed. The operating room simulation consisted of an intubated mannequin placed in the lateral decubitus position and laparoscopic renal model. The multidisciplinary simulation scenario included anesthesia and urology residents and progressed from bleeding to a pulseless electrical activity arrest. The degree of renal model bleeding was modified based on the progression of the urology resident. After the scenario participants were debriefed and completed a post-simulation survey assessing: 1) their perception of the simulated scenario; and 2) their teaching of non-technical skills in their residency training.
Results: The porcine model was successfully reproduced for nine consecutive weeks and functioned well to simulate bleeding from a laparoscopic partial nephrectomy site; the bleeding was able to be titrated based on resident progression and excision of the simulated tumor. All residents stated the scenario was valuable to assess and improve non-technical surgical skills and that their exposure to practice non-technical skills in their existing curriculum could be improved.
Conclusions: Simulating an intraoperative bleeding partial nephrectomy, combined with an intraoperative crisis scenario, is a feasible, immersive, and reproducible model and can challenge residents’ non-technical skills.
National consensus quality indicators to assess quality of care for active surveillance in low-risk prostate cancer: An evidence-informed modified Delphi survey of Canadian urologists/radiation oncologists
Authors: Timilshina Narhari , Finelli Antonio , Tomlinson George. Tomlinson , Gagliardi Anna , Sander Beate , Alibhai Shabbir M.H.
Published: November 2021

Introduction: Although many low-risk prostate cancer (PCa) patients worldwide currently receive active surveillance (AS), adherence to clinical guidelines on AS and variations in care at the population level remain poorly understood. We sought to develop system-level quality indicators (QIs) and performance measures for benchmarking the quality of care during AS.
Methods: Convenient sampling method was used to identify an expert panel among practicing urologists and radiation oncologists across Canada. QI development involved two phases: 1) proposed QIs were identified through a literature search and published clinical guidelines on AS; and 2) indicators were selected through a modified Delphi process during which each panelist independently rated each indicator based on clinical importance. QI items were chosen as appropriate measures for quality of AS care if they met prespecified criteria (disagreement index <1 and median importance of 7 or greater on a nine-point scale).
Results: Among 42 invited expert panel members, the response rate was 45% (n=19). Expert panel members were well-represented by type of physician (84% urologists, 16% radiation oncologists) and practice setting (79% academic, 21% non-academic). The expert panel endorsed 20 of 27 potential indicators as appropriate for measuring quality of AS care.
Conclusions: We developed a set of QIs to measure AS care using published guidelines and clinical experts. Use of the indicators will be assessed for feasibility in healthcare databases. Reporting quality of care with these AS indicators may enhance adherence, reduce variation in care, and improve patient outcomes among low-risk PCa patients on AS.
A population-based retrospective cohort study analyzing contemporary trends in the surgical management of urinary stone disease in adults
Authors: Golomb Dor , Dave Sumit , Gabrigna Berto Fernanda , McClure J. Andrew , Welk Blayne , Wang Peter , Bjazevic Jennifer , Razvi Hassan
Published: November 2021

Introduction: We aimed to review the trends and incidence of surgical intervention for adults with upper urinary tract stones in Ontario, Canada, and to hypothesize potential causes for the observed changes.
Methods: We carried out a retrospective, population-based cohort study using administrative databases held at the Institute of Clinical Evaluative Sciences (IC/ES) to identify all adults (≥18 years) who underwent surgical treatment for urolithiasis, defined by records using a combination of both hospital and physician billing from 2002–2019. Descriptive statistics were used to summarize baseline patient demographics, and surgical trends were analyzed using the Cochrane-Armitage test for trend.
Results: From 2002–2019, 140 263 patients were treated surgically for urolithiasis. During this time period, the total number of surgically treated stone disease increased by 80.5%. By type of procedure, percutaneous nephrolithotomy (PCNL) increased by 187% and ureteroscopy (URS) increased by 158%, while the number of shockwave lithotripsy (SWL) declined by 31.4%. The adult population in Ontario in the years evaluated grew by 24.4%. The number of surgical procedures per 100 000 people over this time grew by 45.3%. For every 1% increase in the population, there was a 2.6% rise in stone-related surgical procedures.
Conclusions: The number of stone-related surgical procedures performed rose significantly and cannot be accounted for by population growth alone. This rise was proportionally larger in the female population, further supporting a narrowing of the gender gap in urinary stone disease. The reasons for the increase are likely multifactorial and may imply an increasing incidence of surgically treated stone disease. The change in the proportion of URS and SWL performed may demonstrate a continued shift in surgical preference or may be reflective of resource limitations and availability. The increase in PCNL volumes may also suggest a greater complexity of cases. These findings should be considered for future resource planning and require further study.
The Relationship Between Feeding Patch Quality and Fodder Species of Wild Elephants in the Teknaf Wildlife Sanctuary, Cox’s Bazar, Bangladesh
Authors: Hossen Amir , Røskaft Eivin
Published: November 2021

We examined the relationship between the presence or absence of elephants in patches of land and the most common ecological factors, such as fodder species, water bodies, resting places, elephant movement trails, and soil types, across ten transect sites in the Teknaf Wildlife Sanctuary (TWS), Bangladesh. By ground-truthing 360 line transects and 1080 quadrate blocks, we recorded a total of 184 fodder species, including 71 monocotyledons, 58 dicotyledons, and 55 domesticated plant species. Three categories of domesticated fodder species were recorded that consisted of 13 cultivated crops, 24 vegetables, and 18 homestead garden plants. We also applied dung-pile dissection techniques to a total of 250 dung piles between August 2018 and July 2019. Highly statistically significant differences among the abundances of different fodder species and presence of elephants were found across different transect sites. The average fodder species density was found to be 3.44 plant species per site per km2, while the elephant density was 0.63 individuals per site per km2. A significant strong correlation was found between fodder species density and the number of elephants among the transect sites (P = 0.02). The numbers of ground-recorded fodder species were higher than those found in dung piles. The presence of elephants across transect sites was influenced not only by fodder species but also by other ecological factors, such as water bodies, resting places, movement trails, and soil types.
“I Apology no no I Mean I Am Sorry … Please Let Me Explain That First”: Enhancing Communicative Language Competence of Thai University Students Through CEFR-Based Online Intercultural Communication
Authors: Huttayavilaiphan Rutthaphak
Published: November 2021

During this COVID-19 pandemic, no one can deny the value of online communication. It has saved our lives by preventing us from going outdoors and becoming infected, while also facilitating achievement of various personal and professional goals. Online communication can also assist us with our academic goals, whether it is used to communicate with supervisors or with people from other lingua-cultural backgrounds to practice the language. This form of communication is emphasized in the Common European Framework of Reference for Languages (CEFR) framework, which is one of the most significant guidelines for language teaching and learning throughout the world. The present research has two aims: first, to determine the extent to which CEFR-based online intercultural communication can improve Thai students’ communicative language competence, and second, to investigate Thai students’ attitudes toward CEFR-based online intercultural communication and international volunteers. The results received from 15 fifth-year dual B.A. (Chinese) and B.CM. (Traditional Chinese Medicine) students and international volunteers using various research instruments revealed that Thai students could increase their communicative language competence after participating in CEFR-based intercultural communication activities. This encompassed linguistic, sociolinguistic, and pragmatic abilities that correspond to the CEFR (2001) scales. In terms of attitudes, the study indicated that, because they were more confident in their communicative language ability, they had a positive attitude toward the CEFR-based online intercultural communication activities and their international volunteers. Finally, further research on this topic should include a proper design of online communication activities as well as methods for assessing students’ competency both before and after participation.
„Socialist postmodernism”: residential architecture in Kyiv Podil district (Ukraine)
Authors: Linda Svitlana
Published: November 2021

Despite the short chronological span of the socialist era architecture heritage, it remains little investigated and underappreciated. Given the political and cultural isolation of the Soviet Union republics and strict architectural design regulations, there was a widespread belief that architects should not use innovative trends. This article exemplifies residential quarters in the historic Podil district, designed and built in the 1970s-1980s in Kyiv. They vividly demonstrate the postmodern ideas embodied in Ukrainian architecture. Methodologically, the article bases on the Ch. Jencks definition of postmodernism and in the comparison of his ideology with the implemented Kyiv project. It states that Kyiv architects proposed not typical Soviet construction projects but international postmodern architectural solutions. It proves that, on the one hand, Ukrainian architects had perfect qualifications to draw construction projects implementing advanced world trends of the time. But on the other hand, it highlights that postmodernism in architecture did not merely confine to Western Europe and the United States but also penetrated the Iron Curtain, exemplifying innovative architectural thinking which ran contrary to the modernist paradigm.
Análise comparativa da inﬂuência de otimizadores no desempenho de uma CNN para detecção do câncer de mama
Authors: Santos Stefane A. , Moreira Andressa G. , P. Junior Ialis C.
Published: November 2021

O campo da inteligência artificial (IA) apresenta notáveis avanços na medicina. Estudos analisam a aplicação de Redes Neurais Convolucionais para a detecção de câncer de mama. Neste artigo, é realizada uma análise comparativa entre os métodos de otimização (Adam, Adadelta, Adagrad, Adamax, Nadam, RMSprop) aplicados a uma arquitetura VggNet16 para a classificação de neoplasias em imagens histopatológicas. Os experimentos foram realizados com a criação de modelos para os fatores de ampliação (40x, 100x, 200x, 400x) das imagens extraídas do dataset BreakHis. O otimizador Adam obteve o melhor resultado para o conjunto de imagens, especificamente na base 400x.
Entendido: Um Aplicativo para a Comunidade LGBTQIA+
Authors: Silva José Alexsandro do Nascimento , Esmeraldo Guilherme Álvaro Rodrigues Maia , Feitosa Robson Gonçalves Fechine
Published: November 2021

No Brasil morre uma pessoa LGBTQIA+ a cada 16 horas. Cerca de 20% das empresas não contratam LGBTQIA+. A expectativa de vida das pessoas transgênero é de 35 anos. Por conta dos problemas sociais aos quais essa comunidade está submetida, percebe-se a necessidade de informação e promoção de pautas sociais voltadas a ela. Nesse contexto, foi realizada uma pesquisa com 670 pessoas de 22 estados brasileiros, que responderam a um questionário sobre temas de interesse das pessoas LGBTQIA+. A partir da análise das respostas do questionário, o presente trabalho descreve um aplicativo para dispositivos móveis que contempla, em uma perspectiva social, a abordagem de temas para a promoção da educação, segurança, saúde e emprego para essa comunidade.
Um Estudo sobre a Influência do Jogo Black Stories na Prática e Aprendizagem de Levantamento de Requisitos de Software
Authors: Lima Jorge Girão Limaverde , Ferreira Andressa Bezerra
Published: November 2021

O aprendizado e a prática da Engenharia de Requisitos requer diversas habilidades e competências de estudantes e profissionais da área de Engenharia de Software (ES). Dentre elas, podemos citar a capacidade de comunicação rápida, abstração e imersão. Mediante esse contexto, este trabalho busca apresentar um estudo sobre a influência do jogo Black Stories no desenvolvimento de tais competências. Para tanto, um grupo de alunos e ex-alunos de ES foi submetido a um experimento que consiste em partidas consecutivas do jogo. Após isso, foi constatada a influência positiva do jogo nas habilidades necessárias para o levantamento e descoberta de requisitos de software.
Politische Anthropologie und Anthropologiekritik
Authors: Hemmerich Luca , Jörke Dirk
Published: November 2021

Anthropologische Begründungsfiguren gelten in der zeitgenössischen Politikwissenschaft als überholt. Zugleich sind anthropologische Annahmen im politischen Denken jedoch allgegenwärtig. Diese Spannung nehmen wir zum Anlass für eine Verteidigung der Notwendigkeit und Möglichkeit der politischen Anthropologie. Dazu systematisieren wir erstens die Stellung anthropologischer Prämissen in der politischen Theorie, indem wir diese nach ihrem Explikationsgrad, der Stärke ihres Gehalts, ihrem epistemischen Zugang sowie ihrer theoretischen Funktion klassifizieren. Zweitens typologisieren wir verschiedene argumentative Motive (post-)moderner Anthropologiekritik, um zu zeigen, dass sie zwar methodisch wichtige Hinweise für das Projekt der politischen Anthropologie liefern, es aber nicht notwendigerweise als Ganzes untergraben. Drittens schlagen wir angesichts aktueller Problemstellungen in der politischen Theorie wie der Frage nach den Subjekten politischer Ordnung eine Erneuerung der politischen Anthropologie vor. Durch unsere Systematisierung der Stellung von anthropologischen Annahmen und anthropologiekritischen Argumenten möchten wir einen Beitrag zur Klärung der Rolle der Anthropologie für das politische Denken leisten und eine Wiederaufnahme des Projekts der politischen Anthropologie motivieren.
Medienkompetenz bei Beschäftigten in der Behindertenhilfe
Authors: Heitmann-Möller André , Hasseler Martina , Stölting Lina , Isensee Antonia
Published: November 2021

Gegenwärtig ist die Datenlage zur Medienkompetenz bei Beschäftigten in der Behindertenhilfe noch etwas unklar. Die Medienkompetenz ist jedoch besonders für die Teilnahme an Weiterbildungsangeboten im Blended-Learning-Format wichtig. Mit einer explorativen bundesweiten Online-Umfrage wurde versucht einen Einblick in diese Thematik zu gewinnen.
WSI-Verteilungsbericht 2021: Die Einkommenssituation und Abstiegsängste der Mittelschicht
Authors: Zucco Aline , Özerdogan Anil
Published: November 2021

Durch einen Anstieg der mittleren Einkommen kam es in den letzten Jahren zu einem leichten Rückgang der Einkommensungleichheit. Dieser Verteilungsbericht nimmt diese positive Entwicklung zum Anlass, auf die Situation der sogenannten Mittelschicht und ihre vormals zentralen Angst – die Abstiegsangst – zu blicken. Auf Basis der SOEP zeigt sich, dass die Abstiegsängste der Mittelschicht zwischen 2010 und 2019 deutlich zurückgegangen sind, nicht zuletzt wegen der guten konjunkturellen Rahmenbedingungen, die auch zu einem Absinken der Arbeitslosenquote führte. Vor diesem Hintergrund stellt sich die Frage, wie sich die Covid-19-Krise auf die Einkommensungleichheit und die Abstiegsängste ausgewirkt hat. Die Daten der HBS-Erwerbspersonenbefragung weisen darauf hin, dass ärmere Einkommensgruppen häufiger Einbußen hatten und sich auch vermehrt um ihre berufliche Zukunft und ihre finanzielle Situation sorgen. Somit könnte der positive Trend der letzten Jahre durch die Covid-19-Krise zum Stoppen gekommen sein und die Einkommensungleichheit wieder steigen. Es gilt also daher, vor allem die von der Krise stark betroffenen Gruppen durch Qualifizierung und Stärkung der Tarifbindung zu schützen.
Das Regierungssystem der USA
Authors: Oswald Michael T.
Published: November 2021

The US political system has long been a role model for Western democracies. Its constitution captured the spirit of the Enlightenment and stipulated – at least on paper – general human rights and freedom of action for individuals for the first time in history. The construction of the separated institutions that share power ensures stability, but due to the division in society it also creates problems – especially in the form of blockades in politics. The textbook explains the basics of the political system and the individual powers – embedded in the history of the nation's origins. There are also chapters on elections, populism and the media system, accompanied by examples and digressions.
Widerstand als Waffe
Authors: Kuster Trond
Published: November 2021

Bis heute gilt Noam Chomsky als berühmtester lebender Intellektueller. Seit den 1960er Jahren leistet er Widerstand gegen Unrecht und übt Zeitkritik unter Berufung auf die universellen Werte der Aufklärung. Die Konjunkturen seines politischen Engagements sind ein Spiegel, sowohl der US-amerikanischen als auch der Geschichte der Intellektuellen. Die vorliegende Arbeit widmet sich dem gesellschaftspolitischen Wirken des Intellektuellen Chomsky. Sie untersucht – auf Grundlage erstmals erschlossener historischer Quellen aus dem Vorlass des 1928 geborenen Linguisten – dessen jüdische Sozialisation, seine Werte und Selbstverortung sowie sein Politik- und Verantwortungsverständnis. Behandelt werden unter anderem Chomskys Einsatz gegen den Vietnamkrieg sowie seine Verbindung zur Neuen Linken und zur globalisierungskritischen Bewegung. Auch kontroverse Interventionen des streitbaren Denkers werden angesprochen. Angesiedelt an der Schnittstelle von Intellektuellen-, Sozialer- und US-amerikanischer Zeitgeschichte beantwortet Trond Kusters Studie die Frage, wie es Noam Chomsky seit sechs Jahrzehnten möglich ist, die Rolle des Intellektuellen auszuüben. Sie gibt außerdem Aufschluss darüber, ob und wie heute intellektuelles Engagement noch möglich ist.
48-year-old with Altered Mental Status and Respiratory Failure: A Case Report
Authors: Pile Justin , Truong Justina
Published: November 2021

Introduction: The differential diagnosis for altered mental status and respiratory failure is broad. Careful physical examination, appropriate use of diagnostic tools, and accurate interpretation and correlation of test results are important for piecing together the puzzle of a patient with altered mental status that emergency physicians commonly face. In certain cases, such as this one, rapid diagnosis and management is crucial for improving patient morbidity and mortality.
Case Presentation: A 48-year-old male with altered mental status and respiratory failure presented to the emergency department after being found unconscious on his porch. Vital signs were notable for temperature 105.5 °F, blood pressure 202/102 millimeters of mercury, pulse 126 beats per minute, respiratory rate 30 breaths per minute, and oxygen saturation 91% on room air. Physical examination revealed an obese male lying in bed awake in severe distress with labored breathing and unable to converse. His physical examination was significant for dry mucous membranes, tachycardia, and bilateral lower extremity 1+ pitting edema. He also appeared to have Kussmaul respirations with severe tachypnea, but his breath sounds were clear to auscultation bilaterally. On further examination, the patient appeared to have intravenous (IV) injection markings along his arms suggesting the possibility of IV drug use.
Discussion: With limited history, the only context clues initially available to assist in the diagnosis were abnormal vital signs and physical examination. The patient was tachycardic, hyperthermic, hypertensive, hypoxic, and tachypneic with altered mental status; he eventually required endotracheal intubation for hypoxic respiratory failure. The complexity of his condition prompted a large list for the differential diagnoses. Toxidromes, endocrine abnormalities, infectious process, cardiac and/or renal etiologies, and neurological pathology such as a cerebrovascular accident were considered. In the case of this patient, urgent diagnosis and management was crucial to prevent further decompensation and improve his outcome.
Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound
Authors: McCuskee Sarah , Anderson Kenton
Published: November 2021

Case Presentation: A 64-year-old female with history of umbilical hernia repair with mesh 18 years prior, cystocele, and diabetes mellitus presented with 10 days of abdominal and flank pain. The patient was tachycardic, normotensive, afebrile, and had an erythematous, tender, protuberant abdominal wall mass. Point-of-care ultrasound (POCUS) revealed an irregular, heterogeneous extraperitoneal fluid collection with intraperitoneal communication; these findings were consistent with an abscess and infected mesh with evidence for intraperitoneal extension. The diagnosis of enterocutaneous fistula (ECF) with infected mesh and abdominal wall abscess was confirmed with computed tomography and the patient was admitted for antibiotics and source control.
Discussion: A rare complication of hernia repair with mesh, ECF typically occurs later than more common complications including cellulitis, hernia recurrence, and bowel obstruction. In the emergency department, POCUS is commonly used to evaluate for abscess; in other settings, comprehensive ultrasound is used to evaluate for complications after hernia repair with mesh. However, to date there is no literature reporting POCUS diagnosis of ECF or mesh infection. This case suggests that distant surgery should not preclude consideration of mesh infection and ECF, and that POCUS may be useful in evaluating for these complications.
Thyroid Storm-induced Takotsubo Cardiomyopathy Presenting as Acute Chest Pain: A Case Report
Authors: Ashdown Brayden , Hynes Emilie
Published: November 2021

Introduction: Stress-induced cardiomyopathy is a rare but serious cause of chest pain, which in recent studies has been shown to carry a similar in-hospital mortality to acute ST-elevation myocardial infarction. The pathophysiology of the disease is thought to be secondary to dysregulated catecholamine effects on myocardium.
Case Report: We present a case of a previously healthy female without known thyroid disease who presented to the emergency department for acute chest pain and was found to have thyroid storm-induced cardiomyopathy in a typical stress-induced cardiomyopathy pattern without evidence of coronary disease on catheterization.
Conclusion: Thyrotoxicosis can cause dysregulation of catecholamines and is a rare cause of stress-induced cardiomyopathy. It requires distinct therapies and should be considered by emergency physicians in the workup of acute chest pain with concern for stress-induced cardiomyopathy.
Timely Diagnosis of Pneumoperitoneum by Point-of-care Ultrasound in the Emergency Department: A Case Series
Authors: Yum Jung , Hoffman Taryn , Naraghi Leily
Published: November 2021

Introduction: Pneumoperitoneum is a life-threatening diagnosis that requires timely diagnosis and action. We present a case series of patients with perforated hollow viscus who were accurately diagnosed by emergency physicians using point-of-care ultrasound (POCUS) while in the emergency department (ED).
Case Series: Three elderly patients presented to the ED with the complaints of syncope, abdominal pain with constipation, and unresponsiveness. The emergency physicians used POCUS to diagnose and then expedite the necessary treatment.
Conclusion: Point-of-care ultrasound can be used by emergency physicians to diagnose
pneumoperitoneum in the ED.
Gastric Pneumatosis: An Atypical Presentation of Desmoid Tumor
Authors: Jorge Catarina , Varela Miguel , Soares Júlio , Uribe Hugo , Flores Luis , Moreno Javier
Published: November 2021

Case presentation: A middle-aged woman presented to the emergency department with a chief complaint of abdominal pain, fever, vomiting, and diarrhea. Abdominal computed tomography revealed gastric pneumatosis and air in the portal system. The patient had an unfavorable clinical course with pneumoperitoneum and septic shock due to secondary peritonitis. She underwent emergency laparotomy where neoformation of the mesentery root was found with infiltration of the small intestine and jejunal perforation. The anatomopathological study of the tumor revealed that it was a desmoid tumor.
Discussion: To our knowledge this is the first report in the literature of gastric pneumatosis as the initial presentation of a mesenteric desmoid tumor. Although it usually has a benign clinical course, its locally invasive characteristics can lead to critical illness. Physicians shouldn’t overlook these types of complications, as early identification and surgical intervention can modify the prognosis and shorten hospital stay.
Rat-bite Fever: A Rare Diagnosis for a Common Pediatric Presentation: Case Report
Authors: Edholm Anthony , Heyer Marissa , Nemetski Sondra
Published: November 2021

Introduction: Fever and rash is a common pediatric presentation to the emergency department but can present a diagnostic challenge to the clinician. Here we report the successful identification and treatment of a rare zoonotic exanthem that was facilitated by a thorough history and physical exam.
Case Report: Rat-bite fever is a potentially fatal systemic illness characterized by relapsing fever, rash, and migratory polyarthralgias. Treatment includes antibiotics for Streptobacillus moniliformis, the most common pathogen, as well as appropriate hygiene education and prevention strategies. We report a case of S. moniliformis in the absence of an actual rodent bite.
Conclusion: Due to the generally non-specific presentation of the illness, as well as the growing trend of caring for domestic rodents, it is crucial that clinicians ask details related to zoonotic and other exposures while obtaining medical histories.
COVID-19 Associated Thyroid Storm: A Case Report
Authors: Sullivan Kevin , Helgeson Jana , McGowan Andrew
Published: November 2021

Introduction: The distinction between coronavirus disease 2019 (COVID-19) and thyroid storm can be extremely difficult to determine on clinical grounds alone as there is significant overlap between the signs and symptoms of each.
Case report: We present a case of a patient with thyroid storm triggered by underlying COVID-19 infection.
Conclusion: Infection with severe acute respiratory syndrome coronavirus 2 is linked to dysregulation of the thyroid gland through numerous mechanisms, although thyroid storm triggered by COVID-19 appears rare, with only a single case previously identified in the literature.
Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis
Authors: Moschella Phillip , Shull Hannah , Pittman Mark , Gleason Alex , Roth Prerana
Published: November 2021

Introduction: The increasing incidence of Neisseria gonorrhoeae infections and emergence of cephalosporin-resistant strains means the threat of disseminated gonococcal infection and endocarditis needs to be reimagined into the differential diagnosis for patients treated in the emergency department (ED) for sexually transmitted infections and for endocarditis itself. Only 70 cases of disseminated gonococcal infection (DGI) with endocarditis had been reported through
2014.1-4 In 2019, however, an outbreak of DGI with one case of endocarditis was reported.5 This case series of three patients with DGI and endocarditis, in addition to the recent outbreak, may represent a warning sign for reemergence of this threat.
Case Report: We describe three cases within a recent three-year period of gonococcal endocarditis as seen and treated at our institution. These cases show divergent presentations of this insidious disease with both classical and atypical features. One case displayed a classic migratory rash with positive urine testing and a remote history of sexually transmitted infections, while another patient developed isolated culture-confirmed endocarditis with negative cervical testing and imaging, and the final case was a male patient who presented to the ED with fulminant endocarditis as the first ED presentation of infection.
Conclusion: Secondary to an overall rise in incidence and possibly due to increasing antibiotic-resistance patterns, gonococcal endocarditis should be included in the differential diagnosis of any case of endocarditis. Reciprocally, increased vigilance should surround the evaluation of any patient for sexually transmitted diseases while in the ED for both the development of DGI and endocarditis.
Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus
Authors: Fogam Michael , Leigh Natasha , She Trent
Published: November 2021

Introduction: Adult intestinal malrotation with midgut volvulus is rare and most often diagnosed on abdominal imaging. Once the diagnosis is made, prompt surgical intervention is necessary. A finding suggestive of malrotation with midgut volvulus on abdominal imaging is the “whirlpool” sign where the superior mesenteric vein and superior mesenteric artery twist at the root of the abdominal mesentery. This sign was once thought to be pathognomonic, but recent studies have shown that it can be seen in asymptomatic patients.
Case Report: A 20-year-old female presented to our emergency department with diffuse abdominal pain. Computed tomography demonstrated the “whirlpool” sign with a concern for malrotation with midgut volvulus. Surgical consultation was obtained and the patient was rushed to the operating room for an exploratory laparotomy. Normal mesenteric attachments were seen and no significant pathology was identified during the laparotomy. The patient was eventually diagnosed with gastritis and discharged in stable condition.
Conclusion: Emergency physicians and surgeons alike should be cautious in confirming malrotation with midgut volvulus solely due to the “whirlpool” sign on abdominal imaging. Premature diagnostic closure can lead to unnecessary procedures and interventions for patients as in the case we report here.
Carpometacarpal Dislocation with Third Metacarpal Fracture
Authors: Jorgensen Colin , Christos Steve
Published: November 2021

Case Presentation: A 17-year-old male presented to the emergency department (ED) due to trauma to the right hand and wrist after punching a locker at school. He had significant soft tissue swelling. Radiographs demonstrated intra-articular metacarpal fractures with associated carpometacarpal dislocations. The dislocation was reduced bedside in the ED and ultimately underwent closed reduction surgical management with orthopedic surgery.
Discussion: Metacarpal fractures result from high-force impact injuries and account for 30-40% of all hand injuries. The most common sites of second through fifth metacarpal fractures are at the neck and the shaft, with the majority involving the fifth metacarpal neck (commonly coined “boxer’s fractures”). Carpometacarpal (CMC) dislocations are a rare injury associated with high-force impact trauma to the wrist. These injuries account for as little as 1% of all acute hand and wrist injuries. Carpometacarpal dislocations are often difficult to diagnose on physical examination due to significant soft tissue swelling, and they can easily be missed on anterior-posterior views of the hand. Lateral and oblique plain radiograph views are essential in the diagnosis as they are more likely to show dislocations. Despite appropriate plain radiographic views, subtle CMC dislocations may be difficult to discern dependent on the level of dislocation or subluxation and overlapping of joints. These injuries are rare due to otherwise highly stable ligamentous and muscular attachments within the wrist. Because of these attachments, dislocations are often associated with concomitant metacarpal fractures.
Disseminated Kaposi Sarcoma
Authors: Goyack Laura , Heimann Matthew
Published: November 2021

Case Presentation: A 28-year-old male with a recent diagnosis of human immunodeficiency virus presented to the emergency department with odynophagia and dysphagia for a month. Physical exam revealed Kaposi sarcoma partially occluding the airway. Point-of-care ultrasound was used to assist with the diagnosis of reactive lymphadenopathy, and computed tomography revealed systemic disease. Otolaryngology was urgently consulted, and the patient was admitted for prompt tracheostomy the following day.
Discussion: Kaposi sarcoma is a violaceous vascular neoplasm that is an acquired immuno-deficiency syndrome (AIDS)-defining illness. Mucocutaneous membranes should be thoroughly evaluated with patients suspected of AIDS. This case demonstrates the vital evaluation of the patient’s airway to assess patency. Highly active antiretroviral therapy should be initiated promptly, as well as chemotherapy in severe systemic cases.
Sentimiento de culpabilidad en la experiencia religiosa de san Agustín
Authors: Alonso del Campo Urbano ,   Order of Augustinian Recollects
Published: November 2021

El estudio del sentimiento de culpabilidad en la conversión de san Agustín requiere una especial atención, tanto por la importancia que en sí mismo encierra, como por la particular significación que adquiere en él. La «confesión» de Agustín implica la alabanza a Dios y la confesión de sus pecados. Encierra en sí, junto a la dimensión teológica del problema, otros aspectos de orden psicológico que quisiéramos resaltar aquí. No sería justo reducir el estudio de la culpabilidad religiosa a sus dimensiones psicológicas; pero tampoco lo sería si olvidásemos su significación. La culpabilidad religosa se realiza dentro de las dimensiones humanas de la persona. Dividimos el tema en dos apartados: en el primero presentamos, muy esquemáticamente, algunos aspectos generales de la culpabilidad psicológica; en el segundo, estudiamos más concretamente las diferencias entre los aspectos psicológicos de la culpabilidad y los valores religiosos de la misma en general y en san Agustín en particular.