bluuebunny/crossref_metadata_2025 huggingface dataset:
A judicialização da intolerância religiosa: Um estudo do caso “Edir Macedo”
Authors: Santos Júnior José Elísio dos , Monteiro Lorena Madruga
Published: December 2021

Resumo Diante dos inúmeros atos discriminatórios contra as religiões afro-brasileiras na atualidade, o Poder Judiciário tem sido cada vez mais provocado para dirimir essa demanda. Assim, o presente trabalho buscou analisar a judicialização da intolerância contra as religiões afro-brasileiras, tendo como caso empírico a análise do caso Edir Macedo julgado pelo Tribunal Regional da 1.ª Região, o qual traz à tona um conflito entre princípios constitucionais, que se originou devido a publicação e circulação do livro de sua autoria denominado “Orixás, caboclos e guias: Deuses ou demônios?”.
A Conquista do direito ao casamento LGBTI+: da Assembleia Constituinte à Resolução do CNJ.
Authors: Figueiredo Ivanilda
Published: December 2021

Resumo A Constituição de 1988 determinou que a união estável seria apenas entre homem e mulher. O Código Civil de 2003 fez a mesma determinação para o casamento. Até ali não existiam normas jurídicas proibindo uniões entre pessoas do mesmo gênero, nem tampouco as reconhecendo. Partindo dessas ausências (demandas suprimidas) e normatizações, apresentaremos o esforço para a conquista do direito ao casamento LGBT por meio de estratégias parlamentares e judiciais que maturaram o debate público e garantiram a vitória.
Juvenicídio: a expressão da Necropolítica na morte de jovens no Brasil
Authors: Costa Ana Paula Motta
Published: December 2021

Resumo Neste artigo analisa-se a mortalidade de jovens no Brasil, como um processo de Juvenicídio e expressão contemporânea de Necropolítica. Explicita-se as conceituações teóricas e de origem do Juvenicídio, como condição final de um processo social mais amplo que vem ocorrendo na América Latina; e de Necropolítica, como poder do estado de decidir quem pode morrer e quem pode viver. Analisa-se os fundamentos de tais conceitos e as expressões contemporâneas e brasileiras de Necropolítica. Finalmente, relaciona-se tais conceitos com o que vem acontecendo com os jovens no território nacional. Trata-se de uma leitura teórica reflexiva sobre um problema social da atualidade, que é indicador da violação de direitos de crianças e adolescentes. Tal realidade decorre de um processo histórico, que se identifica com a formação da sociedade brasileira, mas que, ao mesmo tempo, tem relação direta com a ação e omissão do estado, muitas vezes conivente com a naturalização da violência. Indica-se que a resistência possível a tudo isso está na garantia de direitos, os quais estão previstos nos tratados internacionais dos quais o Brasil é signatário e ordenamento jurídico pátrio.
O cavaleiro negro em Tropa de Elite: arquétipos, dispositivos e imaginários
Authors: Matos Marcus V. A. B. De
Published: December 2021

Resumo A soberania do estado é um paradoxo fundante nas teorias do direito e da constituição, e tem sido constantemente ressignificada ao longo da história, para servir a interesses políticos diferentes – e frequentemente contraditórios. Direito e Estado, justificados pela emergência de uma teoria moderna da soberania, foram historicamente descritos através da razão e da razoabilidade, porém nunca deixaram de ser construídos de maneira fictícia. A soberania já foi discutida dentro das categorias de espaço e tempo, e descrita através dos efeitos das decisões soberanas. Mais recentemente, esse debate incluiu também uma virada dos paradigmas espaço-temporais, para uma abordagem visual. Neste artigo, estes temas serão discutidos a partir de métodos desenvolvidos nos campos do direito e literatura, direito e psicanálise, e direito e cinema, para visualizar o que é a noção que compreendemos contemporaneamente como soberania. Para isso, será desenvolvida uma investigação visual da ideia de soberania, tomando-a não apenas como um conceito fundante da teoria do direito, mas também como um “tropo”: uma espécie particular de figura de linguagem, uma narrativa metafórica, alegórica, e ilustrada; capaz de ser modernizada, porém, mantendo suas características iniciais. Esse artigo busca investigar o conceito de “soberania” através de evidências coletadas na “cultura popular”. Trata-se de uma investigação sobre um arquétipo que emergiu, repetidamente, na história da cultura ocidental, mas que nunca foi completamente explorado na teoria política e no direito: a figura do “cavaleiro negro”. Em específico, este artigo se concentrará na construção da personagem Capitão Nascimento, no filme Tropa de Elite (2007) de José Padilha, e na maneira como este filme atualizou o arquétipo do “cavaleiro negro”, trazendo-o para dentro do regime visual da “guerra particular” do Rio de Janeiro nas décadas de 1990; e ressignificado-o com a emergência da virada conservadora no início do século 21.
Mulheres Negras e Direitos Humanos: Educação Popular no giro do Esperançar
Authors: Braga Graça Elenice dos Santos , Santos Maria José dos , Ramos Adilson dos
Published: December 2021

Resumo Colabora com a visibilização de mulheres negras na conquista por uma educação humanizada. Sugere reflexões sobre o esperançar coletivo no rompimento com estigmas da educação tradicional, a fim de despertar reflexões que impulsionem novas políticas e pedagogias outras na educação pública.
Pandemias e epidemias em perspectiva histórica: uma introdução
Authors: Hochman Gilberto , Birn Anne-Emanuelle
Published: December 2021

RESUMO O artigo apresenta as principais questões e os desafios da história e dos historiadores na análise das epidemias e pandemias. Aborda a importância da produção histórica brasileira e latino-americana nesse campo para a compreensão das epidemias como fenômenos globais e suas tendências atuais. Discute a pandemia de COVID-19 na geração de demandas crescentes por análises históricas das epidemias do passado e conclui apresentando os artigos do dossiê.
Tradução e adaptação transcultural do Unilateral Hearing Loss Questionnaire para a língua portuguesa brasileira
Authors: Levy Cilmara Cristina Alves da Costa , Siqueira Nelma Caroline de Moraes
Published: December 2021

RESUMO Objetivo Tradução e adaptação transcultural do Unilateral Hearing Loss Questionnaire para a língua portuguesa brasileira, e aplicação do questionário em um grupo de crianças/adolescentes com perda auditiva unilateral, usuárias de aparelho de amplificação sonora individual, e seus respectivos pais/responsáveis. Métodos O trabalho foi dividido em duas partes: tradução e adaptação transcultural do Unilateral Hearing Loss Questionnaire para a língua portuguesa brasileira e aplicação nas crianças/adolescentes e em seus pais/responsáveis, a fim de realizar a comparação entre as respostas do questionário por meio do percentual de concordância. Resultados A análise do trabalho dos tradutores brasileiros considerou a equivalência semântica e houve apenas dois ajustes terminológicos. A retrotradução não apresentou discrepâncias conceituais, apenas problemas linguísticos. Uma comparação entre as respostas dos entrevistados permitiu realizar o percentual de concordância. Conclusão O questionário de perda auditiva unilateral para crianças e pais foi traduzido para o português brasileiro, apresentando equivalência e semântica e idiomática. A análise descritiva do percentual de concordância entre crianças/adolescentes com perda auditiva unilateral e seus pais/responsáveis mostrou ser um preditor na equivalência das repostas.
Pipes Aloft: After Hours and ‘Shows and Showers’
Authors: Gillespie Alana
Published: December 2021

This note presents a first glance at two newly discovered texts by Brian O'Nolan. 
Représentations de la transmission de la drépanocytose chez les jeunes passés de la pédiatrie à la médecine pour adultes
Authors: TEIXEIRA Maria , EPELBOIN Alain , LIONNET François , BENKERROU Malika , RAFFET Eliane , ALBERTI Corinne , MELLERIO Hélène , Gottot Serge , VODOUHE Constant
Published: December 2021

En Ile-de France, les jeunes franciliens atteints de drépanocytose ont des difficultés à penser les mécanismes biologiques de l’hérédité de leur pathologie, tout en ayant parfaitement intégrer l’idée qu’il leur faut éviter le cumul de l’identique. Ces représentations de la transmission et de l’hérédité ont un impact sur leur existence sociale et affective, sur le choix de leur conjoint et leur projet d’enfant.
CHARACTERISTIC OF XONOTLITE SYNTHESIZED BY HYDROTHERMAL REACTION USING RICE HUSK ASH AND ITS APPLICATION TO ABSORB CHROME (III) SOLUTION
Authors: Pham Trung Kien , Quan Tran Ngo
Published: December 2021

In this paper, we report on synthesizing xonotlite, calcium silicate hydrate (CSH), via a hydrothermal reaction using rice husk from the Mekong Delta, Vietnam. The rice husks were burnt at 1000 °C for 3 h. Grey rice husk ash was collected, then mixed with Ca(OH)2 at a Ca/Si molar ratio of 1 : 1. This was followed by a hydrothermal reaction at 180 °C for 24 h and 48 h to obtain the xonotlite mineral. Before and after adsorption, 3-mm xonotlite pellets were thoroughly characterized using X-ray diffractometry (XRD), X-ray fluorescence (XRF), scanning electron microscopy (SEM) and ultraviolet-visible (UV-VIS) spectroscopy. This material has potential application in chromium(III) removal during a chrome-plating process. The adsorption efficiency of the 3-mm pellet samples reached more than 76 % after 12 h.
A NOVEL DESIGN OF PERISTALTIC CARBON NANO PUMP AND AN ANALYSIS OF HELIUM FLOW
Authors: Günay M. Gokhan , Kemerli Ubade
Published: December 2021

A novel nano-scale pump that can transport atoms or small molecules with a peristaltic motion is designed. It is proven by molecular-dynamics simulations that the introduced nano-pump design works properly. The designed nano-pump consists of one main carbon nanotube named the flow tube and two rotors where multi-walled carbon nanotubes are attached. The pumping of helium atoms by the designed peristaltic carbon nano-pump is investigated by molecular-dynamics simulations. For varying rotor speeds and blade counts, time-averaged velocity, temperature, and pressure results of pumped helium atoms are calculated, and relationships between them are modeled as polynomial surfaces. The results showed that rotor frequency increases the velocity of helium linearly and the temperature and pressure of helium non-linearly. Furthermore, the blade count of the proposed mechanism does not substantially affect the velocity as per the previous studies in the literature.
HIGH-TEMPERATURE DEFORMATION BEHAVIOR AND HOT-PROCESSING MAP OF 25CrMo4 AXLE STEEL BASED ON FRICTION CORRECTION
Authors: Liu Keran , Huo Yuanming , He Tao , Huo Cunlong , Jia Changyuan , Duo Xiangyang , Wang Baoyu
Published: December 2021

The deformation behavior and microstructure of 25CrMo4 axle steel was systematically investigated by thermal compression deformation. The hot-compression test of a 25CrMo4 axle steel sample was carried out on a Gleeble-3800 thermal mechanical simulation tester. The flow behavior of the alloy was studied at the deformation temperature (900–1200 °C), strain rates (0.01; 0.1; 1.0) s–1 and the maximum deformation of 60 %. The flow curves under different deformation conditions were obtained, and the effects of the deformation temperature and strain rate on the appearance of the flow curves are discussed. The true stress-strain curve obtained by experiment is modified by friction. Based on the corrected experimental data, the activation energy determined by the regression analysis was Q = 311 kJ/mol, and the constitutive model was constructed. The high-temperature flow behavior of the 25CrMo4 axle steel was described by the Zener-Hollomon parameter. The optimum hot-deformation process parameters were determined based on the hot processing maps, followed by the analysis of the microstructure characteristics of the alloys under optimum hot working. The results show that the suitable hot-deformation process parameters of the alloy are as follows: deformation temperature is 1050–1200 °C, and strain rate is 0.01 s–1 to 0.14 s–1.
Phoradendron iltisiorum (Santalaceae), nuevo registro para el estado de Guerrero, México
Authors: Galván-González Luis Gil , Espejo-Serna Adolfo , Cerros-Tlatilpa Rosa
Published: December 2021

Se presenta el primer registro de Phoradendron iltisiorum Kuijt especie epiparásita endémica de México, para el estado de Guerrero. Se reportan cuatro nuevas locali-dades en Guerrero y Oaxaca. También se reconoce a Cladocolea andrieuxii y C. spathiflora como nuevos hospederos parásitos de P. iltisiorum.
Aphyllon ludovicianum (Orobanchaceae), newly reported in coastal Alabama and Florida, U.S.A.
Authors: Schneider Adam C. , Bickell Jessica , Benton Ben E. , Collins L. Turner
Published: December 2021

We describe the first records of the parasitic plant Aphyllon ludovicianum in Alabama and Florida, a range extension and disjunction of over 400 miles eastward and over 500 miles southward. A key to the two species of Aphyllon in Alabama and Florida is included.
Chlorin E6-photodynamic therapy basal cell carcinoma
Authors: Kapinus V. N. , Kaplan M. A. , Yaroslavtseva-Isayeva E. V. , Spichenkova I. S. , Ivanov S. A.
Published: December 2021

Purpose of the study. Evaluation of the therapeutic efficacy of chlorin E6-photodynamic therapy (PDT) with photosensitizers (PS) photoditazine, photolone and photoran in patients suffering basal cell skin carcinoma.

Materials and methods. The efficacy of chlorin E6-PDT was studied in 532 patients with basal cell skin cancer (BCC) aged 28 to 93 years. PhS Photoditazine was used in 72 (13,5 %) patients at a dose of 0.5-1.0 mg/kg, PhS Photolon - in 281 (52,8 %) patients at a dose of 1.1-1.6 mg/kg and PhS Photoran - in 179 (33,6 %) people at a dose of 1.1-1.6 mg/kg.

Sessions of local irradiation of tumor foci were performed on a laser device "Latus-2" (662 nm) with a power density of 200-500 mW/cm2, light energy was applied to the tumors at a dose of 100-300-600 J/cm2.

Results. During the follow-up period from 6 months to 5 years, 16.2 % of cases of relapse were diagnosed in the study group. When analyzing the results, it was found that the percentage of relapses was minimal when using all PhS in patients who underwent PDT for the first time established BCC of the initial stages (neoplasms up to 2.0 cm) and amounted to 2.2 % (4 patients out of 183), and with a prevalence of the process of more than 2.0 cm and up to 4.0 cm, 9.5 % (10 patients out of 105) of relapses were found. In the results of treatment of recurrent skin malignancies with PDT using derivatives of chloride E6, depending on the prevalence of the process, a similar trend was observed: with the size of tumor foci up to 2.0 cm, the percentage of repeated relapses was less and amounted to 17.1 % (18 patients out of 105) than in the treatment of neoplasms more than 2.0 cm and up to 4.0 cm (28.8 % of relapses - 21 patients out of 73).

Conclusions. Chlorin E6-PDT makes it possible to effectively treat primary and recurrent BCC in an independent variant, and the results of treatment depend on a number of factors, including the prevalence of the disease and the presence or absence of previous treatment.
Psychoemotional motivation of motor act development (pilot study)
Authors: Nizhelskoy Viktor A. , Zaytseva Tatiana N. , Gerasimenko Marina Yu.
Published: December 2021

BACKGROUND: In clinical practice, video motion analysis is widely used. It is known that such a higher mental function as creative thinking manifests itself in the motor activity of the body, as a result of which the movement becomes expressive. Since the quality of the images presented affects the organization of movement, it is presumably possible to characterize this psychosomatic connection through an assessment of the expressiveness of movement.
AIMS: fixation in graphic and digital format of expressive movement, as well as the identification of spatio-temporal criteria for the quantitative assessment of expressiveness.
MATERIAL AND METHODS: The experiment involved 3 healthy volunteers with different levels of acting training. The structure of expressive movement was presented in a graphic and digital format, which made it possible to calculate spatio-temporal indicators and give an objective quantitative assessment of the quality of expressiveness of movements of the participants in the experiment.
RESULTS: It has been established that expressive movements arise with the integration of the following components: motor abilities and motor experience, movement image, plastically expressive structure of movement construction. In addition, expressive movements affect deep psychological functions: imagination, creative thinking, emotional control, etc.
CONCLUSION: The inclusion in the course of medical rehabilitation of patients with various pathologies of the direction of ergotherapy, based on the analysis and assessment of the expressiveness of movement, will contribute to the complex restoration of the connection between consciousness and movement, correction of psychosomatic deviations, the expansion of movement patterns, improvement of body feeling and movement control.
Rehabilitation program for acute poisoning in a toxicological hospital
Authors: Goldfarb Yuri S. , Badalyan Amayak V. , Marina Marina Yu. , Shchetkin Vladislav A. , Potskhveriya Mikhail M.
Published: December 2021

BACKGROUND: Diagnostics and treatment of acute poisoning, as well as the rehabilitation measures carried out in relation to them, including the stationary stage, are aimed at the most complete restoration of the lost capabilities of the body.
AIMS: Increasing the efficiency of medical rehabilitation of acute poisoning (AP) in a toxicological hospital through a combination of drug therapy and non-drug treatment with preformed physical factors.
MATERIAL AND METHODS: Of 1,207 patients with AP psychopharmacological agents (pPFA), neurotoxicants (pNT), cauterizing agents (pCA) and snake bites (SB), who were in the toxicology department of the N.V. Sklifosovsky, 421 patients with an unfavorable course of AP were subjected to an in-depth examination. Intravenous laser hemotherapy (LGT), hyperbaric oxygenation (HBO), mesodiencephalic modulation (MDM), wave biomechanotherapy (WBMT) and ethylmethylhydroxypyridine succinate (EP) were used in cases of 291 patients of the main groups.
RESULTS: The unfavorable course of AP was accompanied by an increase in the duration of treatment by 2.26.8 times due to the addition of pneumonia (pPFA), toxicohypoxic encephalopathy (pNT), severe burns of the gastrointestinal tract (pCA) and local edematous-inflammatory changes (SB). There was a syndrome of high blood viscosity and moderate endotoxicosis. The best clinical and laboratory results were obtained with a combination of LHT (90 minutes) with EP (pPFA), HBO and EP (pCA), HBO, MDM, EP (heavy pNT), HBO, EP (moderate pNT) and WBMT (SB). The adaptive capabilities of the organism, the state of the autonomic nervous system (pNT), neuropsychological indicators and electrical activity of the brain (pNT) improved.
CONCLUSION: Programmed rehabilitation made it possible to achieve a noticeable reduction in the incidence of symptoms of the studied poisoning (by 54.693.4%), the time to resolve their manifestations (by 9.175%), as well as inpatient treatment (by 16.159.3%), improving functional performance.
Informatization of Intelligent Manufacturing to Green Innovation Reform of Tobacco Manufacturing Enterprises in the Era of Big Data
Authors: Shen Junyi , Bi Kexin , Zhuang Wencan , Shi Jianbang
Published: December 2021

Objectives: Based on intelligent manufacturing technology, this paper studies the informatization method of green innovation reform of tobacco manufacturing enterprises in the era of big data. Methods: By combing the literature at home and abroad, this paper expounds the technologies
of data mining and data visualization based on the idea of lean management. On this basis, the basis of data management in the silk workshop of X tobacco enterprise is investigated and analyzed in detail from the aspects of human resources, equipment and management environment. Taking the
blade feeder in the silk workshop of X cigarette factory as the research object, this paper establishes the self inspection model of equipment health state by using the weighted sum method of overall linearity and local nonlinearity. Results: The system can self check the health status of
equipment and visually display the results. This method realizes timely and effective inspection and early warning of equipment health status. At the same time, the visual Kanban of workshop site management can provide production and equipment information to relevant personnel in time. This
meets its demand for data visualization and changes the current situation of workshop data table display. Conclusion: This method reengineers the information business process of tobacco enterprises and establishes a new performance evaluation system. This effectively improves the existing
management system of the workshop.
Diagnostic and Therapeutic Value of Procalcitonin and D-dimer in Sepsis Study on the Expression of Procalcitonin (PCT) and D-dimer (D-D) in Serum of Sepsis Patients and Their Correlation
Authors: Zhao Jingyuan , Dong Long , Wu Xue , Yan Xiaowei , Liu Chong , Hua Liwei
Published: December 2021

Altogether 89 septic patients admitted to our hospital from February 2018 to March 2019 were selected as the experimental group, and 60 healthy people underwent physical examination during the same period were selected as the control group. The expression of PCT and D-D in serum
was detected by enzyme-linked immunosorbent assay (ELISA), and the diagnostic value of PCT and D-D in septic patients was evaluated by receiver operating characteristic curve (ROC). Peason correlation coefficient was used to analyze the correlation between PCT and D-D, and the correlation
among inflammatory factors interleukin-6 (IL-6), platelet activating factor (PAF), tumor necrosis factor -α (TNF-α). Logistic regression was used to analyze the independent risk factors affecting the onset of sepsis. The expressions of serum PCT and D-D in septic patients were
higher than those in the control group. AUC of patients with sepsis diagnosed by serum PCT and D-D were 0.929 and 0.905. The expression of IL-6, PAF and TNF-α in the experimental group was significantly higher than that in the control group. There was a positive correlation between PCT
and D-D in the experimental group, and a positive correlation of PCT, D-D with IL-6, PAF and TNF-α. Patients with old age, high lactic acid, high CRP, high urea nitrogen, high serum creatinine, high PCT and high D-D expression have an increased risk of sepsis. Our study showed that the
expression of PCT and D-D increases in septic patients, which has a satisfactory diagnostic value for septic patients, and inhibition of PCT and D-D expression can be used as a potential therapeutic target for septic patients.
Screening Patterns in Abusive Abdominal Trauma
Authors: Alcaide Amador Doriann M. , Marine Megan , Karmazyn Boaz
Published: December 2021

Background: Diagnosis of abusive abdominal trauma (AAT) is often clinically occult. Abdominal CT is the preferred method to diagnose abdominal injuries. However, due to risk of ionizing radiation, and cost, it is performed only in selected children. Recently, elevated liver enzymes were used to screen for occult AAT, but its accuracy is unknown due to inconsistent methodology and results.    
Objective: To determine the accuracy of elevated liver enzymes (transaminases) in the diagnosis of AAT and if pancreatic enzymes and clinical findings help in patients’ selection for abdominal CT.      
Methods:   A retrospective (2011-2020) study on children younger than 3 years suspected of child abuse. The study group included children that had abdominal CT for suspected AAT, while the control group included similar number of children randomized from 5208 children evaluated for child abuse without an abdominal CT. Patients who had an incomplete medical record, were evaluated for cardiac arrest, or had a CT without contrast were excluded.   
Results:   AAT is rare 0.6% (30/5434) in children suspected of child abuse. Transaminases were obtained in 99.1% of the AAT patients and 55.3% of the control cases. 93.1% (27/29) patients with abdominal injuries had elevated transaminases. The specificity and sensitivity for the transaminases in detecting positive abdominal CT was 93.3% and 90.0%, respectively. Only one additional case was identified with elevated pancreatic enzymes and negative transaminases. There was no clinical or imaging findings that could differentiate between patients with negative and positive abdominal CT scans. Based only on elevated transaminases, 11 CT scans need to be performed for a single positive study.  
Conclusion/Potential Impact: Transaminases have high sensitivity in predicting AAT. Universal use of transaminases in all children suspected of child abuse may result in 11 CT scans for one positive study. Therefore, more clinical judgement is necessary in selecting patients for CT.
Transjugular Intrahepatic Portosystemic Shunt Reduction for Medically Refractory Hepatic Encephalopathy
Authors: Toliver Brandon , Schmitz Schmitz , Haste Paul M.
Published: December 2021

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is an established intervention for symptomatic portal hypertension. Following TIPS creation, 22-50% of patients experience hepatic encephalopathy (HE), with symptoms ranging from mild confusion to coma. While HE can be medically managed, refractory cases may require downsizing of the TIPS which can be accomplished by deploying a smaller caliber stent within the original shunt. Decreasing shunt diameter redirects blood flow back through liver parenchyma. The purpose of this study was to evaluate the efficacy of TIPS downsizing for the treatment of medically refractory post-TIPS HE.
Methods: An IRB-approved, HIPAA compliant retrospective review was performed. A search of an institutional radiology database yielded 45 patients who underwent TIPS downsizing between 2011-2021. Four patients were excluded due to lack of post-TIPS HE, and a total 41 patients were included in the study. Clinical and serologic data were obtained for all 41 patients. The primary objective was to determine the efficacy of TIPS downsizing for reduction of HE as measured by the West Haven criteria. Secondary endpoints included post-downsize recurrence of ascites or gastrointestinal bleeding, procedural complications, and thirty-day mortality.
Results: TIPS downsizing was performed in all 41 patients with a 9.8% thirty-day mortality rate. No deaths were attributable to the procedure itself. Of the remaining patients, twenty-seven patients (65.9%) had improvement in HE and 10 patients (24.4%) proceeded to TIPS occlusion due to refractory HE. The average pre-downsize and post-downsize West Haven grades were 2.9 ± 0.5 and 1.9 ± 1.2, respectively. One patient (2.4%) had spontaneous TIPS thrombosis after downsizing and developed gastrointestinal bleeding requiring embolization; 15 patients (36.6%) experienced recurrent ascites.
Conclusion: In this population, TIPS downsizing improved medically refractory HE in 65.9% of patients with a 2.4% risk of recurrent gastrointestinal bleeding, 36.6% risk of recurrent ascites, and 9.8% thirty-day mortality.
Pigs in a Blanket: Evaluation of a Novel Device to Support Premature Neonatal Thermal Regulation
Authors: Tomlin Grant , Bluhm Nicholas David–Paul , Carrell Lagora , Bible Melissa , Linnes Jacqueline
Published: December 2021

Background: 1.47 million preterm births worldwide tragically end in neonatal death (death within 28 days after birth). Contributing to this is the inability for preterm neonates to thermoregulate. In low-resource areas, access to incubators may be non-existent. Kangaroo Mother Care/Skin-to-Skin care (KMC/STS) is one method used in such situations and involves the caregiver strapping the infant to their chest in a kangaroo-like pouch. This method is effective but does not provide warming when the caregiver needs rest, nor does it allow the infants heart and respiratory rate to be monitored reliably. We created a device that aims to solve these issues in a safe, cost effective, and efficient way.
Methods: Pilot studies were performed with 3 pigs to develop parameters that will validate the devices efficacy in a pre-clinical trial. Newborn pigs from 0-5 days old were used as the model for these initial trials. Test configurations were designed to demonstrate 1) the pigs could not regulate their core temperature without the device and 2) the heating elements of the device provided better support than a simple blanket. The pig’s core temperature was used as the standard measurement across all trials.
Results: When exposed to an ambient temperature of 20oC, the pigs were not able to regulate their core temperature, which dropped 0.5oC per hour. After reaching hypothermic temperature (below 36.5oC), pigs placed in the warming device returned to a healthy core temperature (38.6oC) over the course of one hour. Pigs in the device with heating off only recovered partially. No pig had any abrasions or burns.
Conclusion: These studies prove the devices feasibility and have established the parameters needed to design a larger trial. If the device continues to show similar efficacy in the future tests, it could be used to help lower premature infant mortality in low-resource settings.
Identifying Bladder Cancer Stage And Use Of Chemotherapy In The Electronic Medical Record: How Reliable Is Natural Language Processing?
Authors: Devanathan Nirupama , Haggstrom David , Cary Clint
Published: December 2021

Background: Large automated electronic medical record (EMR) databases, together with natural language processing (NLP) algorithms, have the potential to be valuable tools in studying the patterns and effectiveness of treatment. Therefore, the current study sought to develop novel tools to identify bladder cancer cases, their clinical stage, and the chemotherapy they receive in electronic medical records.
Methods: EMR data were obtained from Indiana University Health hospitals from 2008 to 2015.  We developed 2 novel algorithms using natural language processing (NLP) on unstructured data to identify (a) bladder cancer cases and clinical stage, and (b) chemotherapy names and line of chemotherapy. The sensitivity, specificity, PPV, and NPV for the clinical staging and treatment algorithm were calculated against the gold standard of manual chart review
Results: A total of 2,559 unique bladder cancer patients were identified and stratified using the clinical staging algorithm, defined as metastatic, muscle invasive, or non-muscle invasive.  We identified 657 metastatic cases, 567 muscle invasive cases, and 604 non-muscle invasive cases. Further, we calculated the PPV for metastatic cases as 69.9%, muscle invasive as 80.4%, and non-muscle invasive as 79.1%. Next, the treatment algorithm was applied to metastatic patients to identify the type of chemotherapy received and 1st or 2nd line of therapy. The PPV for identifying the 1st and 2nd lines were 70.5% and 55.6%, respectively. The PPV for gemcitabine/carboplatin or cisplatin was 57.5%, but for methotrexate, vinblastine, doxorubicin, cisplatin, was 37.5%.
Conclusion and Potential Impact: The performance of the algorithm demonstrates the potential for NLP to identify cancer cases, stage, and presence of treatment. While providing meaningful information, the accuracy of the approach suggests that a hybrid method using both NLP algorithms and manual chart review remains the most robust approach. The low performance of the algorithm to identify line of therapy further highlights the need for further NLP development in this area and emphasizes the ongoing need for either human entry or review of structured data.
Detection of Parkinsonian Motor Symptoms Using Non-Invasive Motion Sensing Technology
Authors: Sakaleros John , Shamloo Farzin , Shanghavi Aditya , Sereno Anne
Published: December 2021

Parkinson’s Disease (PD) is characterized by impaired movement, resting tremor, and muscle rigidity. The Unified PD Rating Scale (UPDRS) is a standardized protocol used by neurologists to measure progression of disease as well as evaluation of treatments. However, this examination is subjective, time consuming, and results can be affected by stress, diet, or sleep. Our goal is to develop a non-invasive device that can record objective clinically-relevant measurements during subtasks of the UPDRS to allow for remote evaluations, which would be beneficial considering the frequency of clinical visits for medication adjustments. Five healthy individuals (ages 21-59) completed UPDRS tasks 3.6 (pronation/supination of hands) and 3.17 (rest tremor amplitude). Participants performed these tasks twice, first normally and second simulating PD patients (tremor, bradykinesia, reduction of movement amplitude) after viewing example videos. Motion data including linear and angular accelerations in 3 dimensions was acquired using a lightweight wrist-mounted motion sensor. Three features were extracted: (1) Power of higher frequency components of the linear acceleration signal (rest task), as a measure of resting tremor amplitude. (2) Power of higher frequency components of the rotational acceleration signal (pronation/supination task), as a measure of bradykinesia. (3) Standard deviation of the local maxima of the rotational acceleration (pronation/supination task), as a measure of reduction in movement speed and amplitude. These features were used to correctly differentiate trials completed with and without simulated PD symptoms, using an SVM classifier with leave-one-out cross validation accuracy of 95%. These findings suggest it is possible to capture clinical features of PD using motion sensors. Future work in PD patients will examine how these measures correlate with UPDRS evaluations and whether they will be helpful in providing a quick, objective telehealth measure of progression and treatment response that can supplement current tools.
Applying Grounded Theory to Understand Asian Women’s Motivations to Donate Healthy Breast Tissue
Authors: Wu Cynthia , Ridley-Merriweather Katherine E. , Storniolo Anna Maria V.
Published: December 2021

Background: The Komen Tissue Bank (KTB) is a clinical trial and the only global biorepository that collects and stores healthy breast tissue to be used as controls in breast cancer (BC) research. Due to a variety of barriers, there is a lack of participation by racial and ethnic minority women in tissue donation. In order to increase this participation, it is necessary to understand why or why not these populations choose to participate in clinical trials such as the KTB. This study used grounded theory methodology to explore the motivations behind Asian women’s decisions to donate their breast tissue. 
Methods: Guided by grounded theory, we conducted interviews with previous breast tissue donors who self-identified as Asian (n=20). We then transcribed and coded the interviews to discover common attitudes and motivations for participating in breast tissue donation. 
Findings: Preliminary findings were obtained from 11 interviews. We identified three common themes that influenced these women’s donations: altruistic behavior, comfort with science, and Asian identity. Identified sub-themes include factors such as personal ties to BC and background in research and clinical trials. It is of note that over half of the women expressed Asian identity and comfort with science as important factors, and all mentioned altruistic tendencies, either towards family or towards research and others.
Conclusion and Future Work: We identified common factors for donating healthy breast tissue from using grounded theory to interview previous donors of Asian descent. We will transcribe and code 9 more interviews, as well as use those interviews to confirm theoretical saturation. The findings from this study will be used in the future to inform a framework for developing recruitment strategies to increase overall participation of historically excluded individuals in the KTB. Future work will include exploring the motivations of Latinas regarding donating their healthy breast tissue.
Disparities and Poor Outcomes for Patients Diagnosed with Lung Cancer Through the Emergency Department
Authors: Blucker Nathaniel , Pettit Nicholas
Published: December 2021

Background and Hypothesis: Cancer is currently the second leading cause of death in the United States, with lung cancer being the leading cause of cancer death. Approximately 40% of patients with lung cancer are diagnosed emergently, many at advanced stages, and occur despite the existence of lung cancer screening. However, local trends among Eskenazi Health patients are unknown. We hypothesize that individuals diagnosed with lung cancer through emergency presentations at Eskenazi Health will experience greater negative outcomes than individuals who are diagnosed through elective routes.
Experimental Design of Project Methods: This is a retrospective chart review utilizing the Eskenazi Health electronic medical health records system. Patients with an ICD-coded lung cancer diagnosis within the five-year period between 2016 and 2021 were analyzed. We compared characteristics, health care utilization, and outcomes for adult patients who had a diagnosis of lung cancer. Our primary outcome was the number of patients diagnosed with lung cancer emergently.
Results: Thus far, 74% of the cases viewed have been considered emergent diagnoses of lung cancer. Of the total cases, 54% of emergent diagnoses and 32% of non-emergent are stage IV. Mortality rates of both stage IV groups respectively are 74% and 62.5%. Overall mortality rates were 56.6%, and 45.9% for emergent and non-emergent diagnoses respectively. Amongst the diagnoses viewed, 93.8% failed to occur due to lung cancer screening. Rates of screening amongst the emergent group were lower at 6.6%, as opposed to non-emergent cases at 24%.
Conclusion and Potential Impact: A significant portion of lung cancer diagnoses at Eskenazi Health are taking place due to presentation through emergent routes. The stage of these diagnoses suggests possible missed opportunities for earlier diagnosis. Additionally, a large part of the patient population currently qualifies for lung cancer screening despite low rates of screening being performed. Future work should emphasize reducing the number of patients emergently diagnosed with lung cancer.
Clinical Activity of Anti-HER2-Antibody Drug Conjugates in HER2-Mutated Metastatic Cancer Patients
Authors: Brougham Albert J. , Solzak Jeffrey , Radovich Milan
Published: December 2021

Background/Objective: Antibody drug conjugates (ADCs) deliver potent cytotoxic therapy in a highly targeted manner by binding cancer-specific cell surface antigens. HER2 is a receptor tyrosine kinase that is commonly amplified in breast and gastric cancers, but more recently has been shown to harbor gain-of-function activating mutations in several cancer types. Recent observations have suggested that HER2-ADCs may be viable therapies for patients that harbor these activating mutations. This research retrospectively explores the efficacy of HER2-ADCs in metastatic cancer patients in a real-world setting.
Methods: Patient information was gathered from the Precision Genomics program at IU Health, narrowed for specific mutation criteria (HER2 pathogenic mutation), cross referenced with OncoKB to legitimize oncogenicity, and selected for patients prescribed HER2-ADCs. For these patients, pre-treatment and mid-treatment CT-scans were analyzed following RECIST protocols. The primary outcomes were overall response rate (ORR), clinical benefit rate (CBR), and progression free survival (PFS). Secondary outcomes were to tabulate the frequency and clinical characteristics of HER2-mutated tumors.
Results: Out of 517 patients with somatic HER2 mutations, 60 patients had a pathogenic HER2 mutation. Of these 60 patients, the most common tumor types were 26.67% Breast and 11.67% Bladder/Urothelial. 11 of 60 patients were prescribed a HER2-ADC (Trastuzumab Emtansine = 10, Trastuzumab Deruxtecan = 1). 8 of 11 patients were evaluable for response with RECIST criteria with 1 patient having a partial response, 4 patients having stable disease and 3 patients having progressive disease. ORR=13%, CBR=63%, Median PFS = 2.77 months (95% CI: 2.15-3.39 months).
Conclusion/Implications: To our knowledge, this is the first report of HER2-ADCs demonstrating clinical activity in HER2-mutated cancers across tumor types. Further clinical trials are ongoing that will validate these initial findings.
Post-COVID-19 Fatigue: Demographic Distribution and Relation to Chronic Illnesses
Authors: Chaudhary Aysha , Paters Jessica , Flanagan Mindy , Pfafman Rachel , Carroll Jeanne , Chang Fen-Lei
Published: December 2021

Objective: This retrospective study examined the relationship between post-COVID (PC) fatigue and the presence of chronic illnesses.
Materials and Methods: Electronic health records of 122 Parkview PC Clinic patients were reviewed for demographics (age, gender, race), chronic illnesses (diabetes, hypothyroidism, hypertension, congestive heart failure, anemia, cancer, orthostatic hypotension), obesity (weight, BMI), complaint of fatigue, and activities affected by fatigue. Data was analyzed using Chi-square tests for categorical variables (or Fisher’s exact test for small cell sizes) and t-tests for continuous variables. Open thematic coding of activities most affected by PC fatigue was performed.
Results: 95 out of 122 patients (77.9%) were found to have PC fatigue. Except for measures related to obesity, none of the chronic illnesses assessed were correlated with the presence of fatigue. The weight of PC fatigue patients was significantly higher than those without fatigue (p=0.04). Examination of BMI and obesity status also indicated significantly higher BMI (p=0.01) and levels of obesity (p= 0.004) in PC fatigue groups compared to the PC non-fatigue groups. No significant differences were observed between the groups in either PT test. Examination of patient described activities effected by PC fatigue found work (30.4%), daily stamina (28.6%) and ability to exercise (16.7%) most impacted by PC fatigue.  Other activities affected by PC fatigue included housework (5.6%), hobbies (3.7%), shopping (1.9%) and driving (1.9%).
Conclusion: 77.9% of our PC patients showed symptoms of fatigue. This is comparable with existing literature. None of the demographic variables and PT tests, or most of the chronic health conditions investigated, were correlated with the presence of fatigue in PC patients. In contrast, measures associated with obesity, including high BMI and weight, were significantly associated with increased PC fatigue presentation. Open thematic coding of qualitative variables indicated work, daily stamina, and exercise were most affected in PC patients.
MAK122: A Novel Drug Utilizing Innovative Fracture Site Targeting Technology to Improve Bone Healing
Authors: Hux Nicholas , Nielson Jeffery , De Andrade Staut Caio , Alentado Vincent , Elsayed Abduallah , Dalloul Christopher , Zike Samuel , Tewari Nikhil , Nazzal Murad , Battina Hanisha , Brinker Alex , Shaikh Mustafah , Myers Sarah , Blosser Rachel , Dadwal Ushashi , Li Jiliang , Low Stewart , Low Philip , Kacena Melissa
Published: December 2021

Megakaryocytes play a pivotal role in the bone fracture healing process through enhancing osteoblast proliferation, osteoclastogenesis, and angiogenesis. Current fracture repair therapies require direct implantation during surgery (BMP-2, grafts etc.), which has limitations. In order to address this, a novel drug, compound MAK122, was created with targeting technology that directs its actions to the fracture site without needing to be implanted during surgery, limiting undesirable offsite effects, increasing the quantity of drug at the fracture site, and allowing for non-invasive treatment following assessment of the natural healing process. Therefore, this study examined the ability of MAK122 to stimulate megakaryocytes and subsequent bone healing. To accomplish this, male mice on a C57BL/6 background underwent a surgically induced femoral fracture. Following surgery, the mice were injected daily for the first 7 days with either saline (vehicle) or MAK122. Mice were then euthanized 2, 3 and 4 weeks post-surgery.  Fracture healing was assessed by standard and novel methodologies. Biweekly X-rays were evaluated and bone union was scored showing that MAK122 accelerated bone healing compared to controls. Ex vivo µCT analysis demonstrated that MAK122 increased callus volume and the percentage of mineralized callus tissue compared to vehicle treatment. Biomechanical testing showed that MAK122 treatment resulted in stronger repairs as compared to vehicle treated controls with nearly a 2-fold increase in twist to failure and toughness parameters. Additionally, histological assessment demonstrated accelerated remodeling in MAK122 treated femurs compared to those treated with saline. Taken together, these pre-clinical data suggest that MAK122 is capable of promoting an environment in which megakaryocytes can favorably influence bone remodeling mechanisms, expediting fracture repair in murine models. Though further pharmacokinetic, pharmacodynamic, and toxicology studies are required, MAK122 displays potential to serve as a state-of-the-art therapy for improving fracture healing in humans.
Association between Biomarkers of Inflammation and Delirium in Critically Ill Patients with COVID-19.
Authors: Gallagher Clare , Davis Joseph L. , Lee Eugene , Khan Sikandar H. , Perkins Anthony J. , Gao Sujuan , Khan Babar A.
Published: December 2021

Background: Critical illness with COVID-19 is associated with increased delirium duration and severity, and delirium is associated with poor health outcomes. The pathophysiology of delirium in this population is not well understood but neuroinflammation is hypothesized to play a key role.
Objective: To evaluate the relationship between biomarkers of systemic inflammation and delirium in critically ill patients with COVID-19.
Design: Observational retrospective data extraction study from March 1, 2020 – June 7, 2020. Biomarker levels and delirium occurrence were assessed up to the first 14 days in the intensive care unit (ICU).
Setting: Two large, urban, academic referral hospitals in Indianapolis, IN
Patients: Two hundred thirty-five patients admitted to the ICU with a positive SARS-Co-V2 PCR test
Methods and Main Results: A total of 235 consecutive patients admitted to the ICU were included in the analysis. The cohort had a mean age of 58.6 years (SD: 15.4), 43.4% were female, 45.9% were African American, with median Acute Physiology and Chronic Evaluation-II score of 18.0 (IQR: 13.0 -15.0). Delirium occurred in 176 (79.1%). Increased levels of C-Reactive Protein (CRP) were associated with increased odds of delirium and coma (OR: 1.27, 95% CI: 1.08, 1.49, p=0.004). Increased levels of D-dimer were not associated with increased odds of delirium/coma (OR: 0.94, 95% CI 0.76, 1.16, p=0.574). Increased levels of ferritin (OR: 1.04, 95% CI 0.84, 1.29, p=0.717) and lactate dehydrogenase (LDH) were also not associated with increased odds of delirium/coma (OR: 0.86, 95% CI 0.70, 1.06, p=0.149). Elevated levels of creatine kinase (CK) levels were associated with lower odds of delirium/coma (OR: 0.71 95% CI 0.52, 0.97, p=0.033).
Conclusion: Increased levels of biomarkers of inflammation and thrombosis were associated with greater odds of delirium and coma. Further studies are needed to validate these results in a larger population.
“This project was funded, in part, with support from the NIH NHLBI Short-Term Training Program in Biomedical Sciences Grantfunded, in part by T35HL110854 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.”