bluuebunny/crossref_metadata_2025 huggingface dataset:
A Pragmemic Analysis of Igbo Postproverbials
Authors: Oboko Uche , Umezinwa Jennifer
Published: April 2021

Igbo proverbs (Ilu Igbo) are linguistic expressions which projects principles with the intent to address diverse social, political, economic and culturally contextual issues that bother on values, morals and the identity of the Igbo people of Eastern Nigeria. Proverbs are handed down to different generations by speech acts of storytelling, conversing, rebuking or admonishing. The researchers carried out a pragmatic analysis of Igbo proverbs as a social practice, to establish their meaning and how its social significance are internalized and continually recreated. Language is central to the process of producing meaning. Using the Theory of Pragmeme by Jacob Mey (2001), the paper evaluates the pragmatic acts, the extent to which some of these proverbs are reformed and doctored, yet, maintain qualities of the Igbo culture while accommodating the identity of the 21st century ideology of the Igbo people. Primary and secondary methods of data collection are adopted. Being a qualitative study, the research randomly selected 12 Igbo proverbs that cut across the five Igbo speaking states of eastern Nigeria. The findings are that Igbo proverbs are essentially custodians of the Igbo cultural identity and orientalism, most proverbs have been moderated to fit the emerging trends in the identity of the Igbo ancestry.
Proverbs and Postproverbial Stance in Selected Plays of Emeka Nwabueze and Zulu Sofola
Authors: Ezenwamadu Nkechi Judith , Ojiakor Chinyere Theodora
Published: April 2021

Since the birth of Nigerian literature, writers have produced impressive collection of literature in English. African oral traditions like proverbs have been in use in creative works. Over time, there have been some alterations in proverbs as their usage and meanings slightly assume different dimensions on their seriousness, effects and explicitness of the message therein, forming either an extension to the traditional proverbs or coinages of certain expressions. It is contended that the meaning of proverbs can be interpreted within the semantic, ideational, stimulus-response, realist and contextual theories, as proverbs play significant roles in literary works. This paper anchors on J.L. Austin’s Speech Act Theory and examines the proverb uses and postproverbial reflections with the view to foregrounding their implications in two plays of common thematic preoccupations—Zulu Sofola’s Old Wines are Tasty and Emeka Nwabueze’s A Parliament of Vultures. Ultimately, it will highlight the proverbial stance and significance of the texts, thereby ascertaining the proverbial mutations in contexts.
Sociocultural Relevance of Communication Strategies of Adolescent Sexual and Reproductive Health Programmes in Mozambique: A Study of Programa Geração Biz Activities in Nampula Province
Authors: Silva Lurdes da Balbina Vidigal Rodrigues
Published: April 2021

Adolescent sexual and reproductive health (ASRH) challenges in Mozambique include early marriages, early pregnancies and HIV/AIDS. In 1999 the Programa Geração Biz (PGB) was created to address youths’ problems and improve their sexual and reproductive health (SRH). However, studies show Mozambican youths continue to be exposed to risks related to their SRH. Mozambique is a multicultural country but only 40% of Mozambicans speak Portuguese, the official language, while 93.5% of the population uses a Bantu language as their mother tongue. This raises an important issue – should PGB communication strategies (CS) take into account the country’s complex cultural reality? Studies recognise the role of culture in enhancing effective delivery of communication programmes. Concurrently, studies point to a lack of research analyzing CS of health campaigns.

This paper’s aims are: (i) to examine PGB communication strategies; (ii) identify cultural challenges to these strategies; and (iii) determine the implications of these impediments for the PGB.

Research methods included non-participant observation, in-depth interviews and focus group discussions. Research questions were based on the McGuire Communication/Persuasion Model, and data analyzed thematically using Nvivo Pro11.

Results revealed the following: (i) interpersonal methods are used to deliver preventive messages, with sociocultural approaches often ignored or not used to reduce cultural barriers; (ii) cultural chal¬lenges identified include initiation rites, taboos surrounding sexuality, language and health terminologies, and parents’ attitudes towards early marriages; and (iii) these factors hinder effective delivery of programme messages.

The conclusion is that the CS used by PGB does not sufficiently take into account the Mozambican sociocultural context. Taboos around sexuality have silenced open communication in this regard. Ideas of sexual abstinence, condom use and campaigns against early marriage stand in opposition to certain orientations of traditional initiations.
A Duty to Consult Foreign Investors When Changing the Regulatory Framework? Implications for Non-Communicable Disease Prevention and Beyond
Authors: Henckels Caroline
Published: April 2021

Several decisions of international investment tribunals can be read as suggesting that the fair and equitable treatment standard may oblige governments to consult foreign investors in the course of developing new laws and policies. This position would significantly expand the concept of fair and equitable treatment, and goes far beyond what most domestic legal systems require of governments. Generally speaking, there may be sound instrumental and normative reasons for engaging in consultation with affected stakeholders in the course of legislative and policy development. However, with the exception of treaty provisions that otherwise so provide, no duty of consultation in the lawmaking process arises from fair and equitable treatment clauses, customary international law or general principles of law. Therefore, industries such as the tobacco industry are unlikely to succeed in a claim of failure to properly engage in consultation in the process of lawmaking.
Manhaj al-Daraqutni dalam Menilai Periwayatan al-Tafarrud daripada Perawi Thiqa dalam Karya “Al-ʿIlal al-Warida fi al-Ahadith al-Nabawiyya”
Authors: Aizul bin Yaakob Mohd , Shamsudin Roshimah
Published: April 2021

The scholarship of al-Daraqutni in the discipline of hadith gains prominence through his work “al-ʿIlal al-Warida fi al-Ahadith al-Nabawiyya”. His evaluation of the al-tafarrud, narrated by a reliable transmitter, was alleged to be inconsistent, whereby some of the narrations were accepted by him, and some were not. As for the narration of al-tafarrud, which contained additional elements from a trustworthy transmitter, al-Daraqutni commented using the term “ziyada thiqa maqbula”. This lexicon implied that al-Daraqutni accepted the narrations in totality. However, Ibn Hajar objected by citing that al-Daraqutni did not accept ziyada thiqa unconditionally. There seemed to be a contradiction between al-Daraqutni’s usage of terminology in contrast to other scholars such as Ibn Hajar. Therefore, this article intends to analyze the methods employed by al-Daraqutni in evaluating al-tafarrud, transmitted by trustworthy transmitters as mentioned in his book “al-ʿIlal al-Warida”. This qualitative study was analyzed using content analysis by means of inductive and deductive methods. The research found that the method used by al-Daraqutni to evaluate the al-tafarrud transmission was consistent throughout and showed no contradiction. Not only did he emphasized the trustworthiness of the transmitters, he further scrutinized the reference to qarina, which accompanied the narration, before concluding his evaluation.
Paul’s strained relationship with the Apostle James at the time of writing Galatians
Authors: Reiher Jim
Published: April 2021

When Paul penned Galatians, he was seeking to distance himself from the apostles in Jerusalem. He was in fact angry and disappointed in them, especially James the brother of the Lord. Galatians captures Paul’s frustration with James. In a number of key phrases used, we see James and the other Jerusalem apostles criticised and dismissed. It is possible that Paul was misinformed about the position of James on key questions for Gentile converts (circumcision and law keeping), but even if misinformed, he was still angry with James at the time of writing. Despite some theologians downplaying the unkind phrases used against James and the other Jerusalem apostles, this paper demonstrates hostility from Paul towards James in the letter of Galatians. Once established, the question is then asked whether or not this extra consideration (the tension between Paul and James) helps to identify the time of the composition of the letter. Does it fit better with a North Galatian or a South Galatian theory? Both possibilities are explored, and the conclusion made: the Southern Galatian theory best fits with the tension between Paul and James in this epistle.
The Bible, Science & Creation
Authors: Lucas Ernest C.
Published: April 2021

This paper argues that Genesis 1–3 should not be read for scientific information but as an ancient Near Eastern figurative story which conveys theological truth about the nature of God, the created order, and humans, and of the role of humans in the created order. It goes on to argue that two of the key theological assertions in these chapters – that we live in a created universe and that humans are made in the image and likeness of God – are compatible with the Big Bang Theory of the origin of the cosmos and an evolutionary understanding of human origins.
Defining the error called subordinationism
Authors: Giles Kevin
Published: April 2021

Theologians are generally agreed that ‘subordinationism’ is a serious and dangerous theological error, a heresy. How this error should be defined is, however, not agreed. In this essay several definitions are outlined and examples of teaching that has been judged to involve subordinationism are given. One key question raised in this essay is, whether or not the contemporary evangelical ‘complementarian’ doctrine of the eternal role subordination of the Son is an example of this perennial error.
Evangelical Historiography: The Debate over Christian History
Authors: Clary Ian Hugh
Published: April 2021

The debate over Christian history has at times been acrimonious with those advocating the ‘supernaturalist’ approach accusing profession historians of compromise, and the ‘naturalist’ historians accusing the providential historians of sub-academic standards. Is there an approach that can appropriate the best of both without pointing accusatory fingers? This essay traces this debate in detail and offers a third way to approach history as a Christian that is grounded in Scripture and takes into account the audience an historian writes for.
The Restoration of Shalom: An Intertextual Reading of Leviticus 16 and Psalm 65
Authors: Parker B. J.
Published: April 2021

In this paper I seek to explore the intertextual relationship between The Day of Purification (or Day of Atonement) in Leviticus 16 and Psalm 65. I adopt Ziva Ben-Porat’s approach to reading intertextually as the approach allows the exegete to attempt to balance concerns of both the reader and historical development. I argue that markers in the text of Psalm 65 such as כפר , creation theology, and עטרת שנת, activate both the entire text of Leviticus 16 and the theological world it connotes. The outcome is a psalm that draws on a rich theological tradition that became especially important in the post-exilic period.
‘Visiting the Guilt of the Fathers on the Children’: Is God Immoral?
Authors: Duke Rodney K.
Published: April 2021

The repeated Old Testament injunction that God ‘visits the guilt of the fathers on the sons’ raises difficulties for the modern reader who might question the justice or morality of such divine behaviour. This paper explores: the injunction within its various literary, sociological, historical and theological contexts; how this injunction is applied internally in the Old Testament; and how it differs from the realm of the criminal justice system and the theme of individual responsibility. As result, one learns that this phrase, in its full expression, uses figurative and formulaic language from the legal context of covenant. It belongs to an expression that emphasizes the lasting mercy of God, while still communicating the serious collective consequences of breaking covenant.
The Relationship between Justification and Sanctification in the Structure of Calvin’s Soteriology: Toward a More Nuanced Approach
Authors: Christ T. Michael
Published: April 2021

There is broad agreement among Calvin scholars that the Genevan Reformer recognized justification and sanctification as distinct and inseparable salvific benefits. Yet scholars disagree concerning the precise structure Calvin used to maintain the benefits’ distinction and inseparability. Is justification the cause of union and sanctification or do both graces obtain with equal priority because both are grounded in union with Christ? This article suggests a nuanced reading of Calvin, which distinguishes between definitive and progressive sanctification. With respect to Calvin’s architectonic structure, justification and definitive sanctification enjoy equal priority, as both depend immediately upon union with Christ. But with respect to progressive sanctification, justification enjoys a relative priority. It is hoped that this reading of Calvin satisfies the concerns of both sides, leading to a more accurate and versatile formulation of the Reformer’s soteriology.
The Hermeneutics of Conditionalism: A Defense of the Interpretive Method of Edward Fudge
Authors: Date Christopher M.
Published: April 2021

A little over a decade after Edward Fudge invited critical readers of The Fire That Consumes to ‘measure this work by every proper standard’, Robert Peterson responded in a paper presented at the 1994 ETS Convention entitled ‘The Hermeneutics of Annihilationism: The Theological Method of Edward Fudge’. In his paper Peterson alleges to ‘have pointed out deficiencies in [Fudge’s] methodological approach’ and concludes that ‘evaluated in terms of hermeneutics and theological method, [Fudge’s] case appears to be weak’. This paper presents a case for conditional immortality and the annihilation of the finally impenitent, arguing that they—and not the traditional view—result from exegesis done according to accepted hermeneutical principles, responding to Peterson’s critique along the way.
Manuscript and Material Evidence for James Ussher’s Authorship of A Body of Divinitie (1645)
Authors: Perkins Harrison
Published: April 2021

James Ussher was one of the most important theologians in England and Ireland during the seventeenth century, with connections to both theology and politics. Perhaps the most influential theological work attributed to him has been A Body of Divinitie, a lengthy and detailed catechism that was very popular among his contemporaries. Yet, some scholars have disputed his authorship of this text. In this essay, I bring forward manuscript and material evidence to demonstrate Ussher’s continual use of the content of the Body, and I consider the historical context that helped cause doubt about his authorship. This shows that the content legitimately belonged to Ussher.
Rethinking Mark 3:17: Did Jesus give both Boanērges and Huioi Brontēs as Apostolic Names?
Authors: Keshet Hanoch Ben
Published: April 2021

Hebrew-to-Greek transliteration hints in Mark 3:17 seem to point to Hebrew, not Aramaic, as the originating language of boanērges, and to a suggested original name of bōḥănê regeš or bōḥănê rōgez. If the well-attested plural onomata, names, in Mark 3:17 is taken at face value, then huioi brontēs may not be Mark’s translation of boanērges, but rather it could be Jesus’s own original Greek name for James and John. If Jesus named Simon both Kēphâ and Petros, then there is good reason to consider the possibility that he also gave the two brothers a Semitic name, bōḥănê regeš, and a simple, striking Greek name, huioi brontēs.
Derrida, the Gift and John Barclay’s Paul and the Gift
Authors: McFarlane Graham W. P.
Published: April 2021

Simon Wiesenthal encapsulates the impossibility of forgiveness in the face of Holocaust evil. Deconstructionist, Jacques Derrida articulates what he describes as the aporia of forgiveness—that once given it degenerates into an economy of exchange and thus negates the ‘purity’ of forgiveness. In Paul and the Gift John Barclay offers a New Testament response to contemporary voices. He argues that whilst the gift of the gospel is unconditional, it does not come unconditioned and identifies six ‘perfections’ of the gift of grace we receive in response to the Gospel. The free gift does indeed come with conditions. Anselm and McLeod Campbell are offered as examples of atonement that incorporate various aspects of Barclay’s presentation of gift.
The Statesmanship of Job: Puritan Joseph Caryl on Job as the Model Magistrate
Authors: Carrington Adam M.
Published: April 2021

This article examines English Puritan Joseph Caryl’s political reading of the biblical book of Job. In his era’s definitive commentary on that work, Caryl included parts of the book within the ‘mirror for princes’ genre, a long-standing genre focused on instructing current and future rulers. Focusing on Job 29, Caryl described Job as exemplifying what magistrates should pursue, why they should pursue it, and how they should do so, namely a ruler dedicated to justice, protective of the people and the church in an evil age, and an impartial administrator of the law. This article adds to the literature on English Puritan political thought, which has not directly addressed Caryl’s reading of Job, as well as contributing to present discussions on the characteristics of good rulers in present times.
The Trinitarian Thinking of John Bunyan in The Pilgrim’s Progress
Authors: Banks John S.
Published: April 2021

In John Bunyan’s day trinitarian debate was raging from Oxford to Bedfordshire. In spite of Bunyan’s rough upbringing, he is often considered a literary genius in Britain’s early-modern period, which tends to distract scholars from the fact that he was also a brilliant theologian-apologist. While Bunyan may have been deprived of the traditional tools of scholasticism, he is nevertheless more than capable as a trinitarian apologist. The early formation of Bunyan’s trinitarian thoughts providentially occurred prior to conversion and are evident in his earlier theological writings which prepared him to engage in the trinitarian conversation of the seventeenth century. The two trinitarian instances in the Pilgrim’s Progress which are analyzed in this article not only show Bunyan’s ability to bridge theology for a popular audience but also demonstrate a skillful ability to address the Ranters and Quakers who wandered through Bedfordshire terrorizing the flock with strange doctrine.
Blessed Are Those Who Have Not Seen and Yet Have Known By Faith: Knowledge, Faith, and Sight in the New Testament
Authors: Boone Mark J.
Published: April 2021

The New Testament speaks of our having faith rather than sight. This distinction is not made to distinguish faith from knowledge. Rather, it is to distinguish one kind of knowledge from another. We may know by trust in reliable authority; this knowledge is necessarily secondhand, but it is knowledge all the same. This, I argue, is the New Testament idea of faith. Another way of knowing is firsthand. Sight in the New Testament, I argue, is a metonym for firsthand knowledge. In this article I consider the meaning of faith and sight in the relevant New Testament passages, with an extended exegesis of 2 Cor. 5:7 and Heb. 11:1.
Decoding first complete chloroplast genome of toothbrush tree (Salvadora persica L.): insight into genome evolution, sequence divergence and phylogenetic relationship within Brassicales
Authors: Khan Abdul Latif , Asaf Sajjad , Lubna  , Al-Rawahi Ahmed , Al-Harrasi Ahmed
Published: April 2021

Background

Salvadora persica L. (Toothbrush tree – Miswak; family-Salvadoraceae) grows in the arid-land ecosystem and possesses economic and medicinal importance. The species, genus and the family have no genomic datasets available specifically on chloroplast (cp) genomics and taxonomic evolution. Herein, we have sequenced the complete chloroplast genome of S. persica for the first time and compared it with 11 related specie’s cp genomes from the order Brassicales.

Results

The S. persica cp genome was 153,379 bp in length containing a sizeable single-copy region (LSC) of 83,818 bp which separated from the small single-copy region (SSC) of 17,683 bp by two inverted repeats (IRs) each 25,939 bp. Among these genomes, the largest cp genome size (160,600 bp) was found in M. oleifera, while in S. persica it was the smallest (153,379 bp). The cp genome of S. persica encoded 131 genes, including 37 tRNA genes, eight rRNA genes and 86 protein-coding genes. Besides, S. persica contains 27 forward, 36 tandem and 19 palindromic repeats. The S. persica cp genome had 154 SSRs with the highest number in the LSC region. Complete cp genome comparisons showed an overall high degree of sequence resemblance between S. persica and related cp genomes. Some divergence was observed in the intergenic spaces of other species. Phylogenomic analyses of 60 shared genes indicated that S. persica formed a single clade with A. tetracantha with high bootstrap values. The family Salvadoraceae is closely related to Capparaceae and Petadiplandraceae rather than to Bataceae and Koberliniacaea.

Conclusion

The current genomic datasets provide pivotal genetic resources to determine the phylogenetic relationships, genome evolution and future genetic diversity-related studies of S. persica in complex angiosperm families.
Effects of empagliflozin in different phases of diabetes mellitus-related cardiomyopathy: a prospective observational study
Authors: Oka Satoshi , Kai Takahiko , Hoshino Katsuomi , Watanabe Kazunori , Nakamura Jun , Abe Makoto , Watanabe Akinori
Published: April 2021

Background

Diabetes mellitus-related cardiomyopathy (DMCMP), defined as left ventricular (LV) dysfunction caused by hyperglycemia in the absence of coronary artery disease, leads to heart failure (HF). Previous studies have shown that treatment with sodium-glucose co-transporter 2 inhibitor (SGLT2i) reduces the risk of exacerbation of HF. The beneficial effects of SGLT2i on HF depend not only on indirect actions such as osmotic diuresis but also on direct actions on the myocardium, leading to improvements in LV function. However, it remains unclear whether SGLT2i treatment is equally effective in any phase of DMCMP. The aim of this observational study was to compare the efficacy of SGLT2i treatment on LV dysfunction between early and advanced DMCMP.

Methods

Thirty-five symptomatic non-ischemic HF patients with LV ejection fraction > 40% and type 2 diabetes mellitus (T2DM) treated with empagliflozin (EMPA group) and 20 controls treated without SGLT2i were enrolled. According to the myocardial extracellular volume fraction (ECV), a reliable marker of cardiac fibrosis quantified by cardiac magnetic resonance, the EMPA group was further divided into early DMCMP (n = 16, ECV ≤ 30%) and advanced DMCMP (n = 19, ECV > 30%) groups and followed up prospectively. Echocardiography was performed at baseline and after 12 months. LV function assessed as LV global longitudinal strain (LVGLS) and the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e′) were compared.

Results

ECV was strongly correlated with T2DM duration (r2 = 0.65, p < 0.001). At baseline, each group had a similar background. After 12 months, the EMPA group, especially the early DMCMP group, showed remarkable improvements in LVGLS (ΔLVGLS: 2.9 ± 3.0% (EMPA) vs. 0.6 ± 2.2% (controls), p = 0.005, and 4.6 ± 1.5% (early DMCMP) vs. 1.6 ± 3.3% (advanced DMCMP), p = 0.003) and E/e′ (ΔE/e′: − 1.5 ± 4.7 vs. − 0.3 ± 3.0, p = 0.253, and − 3.4 ± 5.5 vs. − 0.1 ± 3.5, p = 0.043).

Conclusions

The positive effects of empagliflozin on LV dysfunction were more remarkable in early than in advanced DMCMP. Early intervention of SGLT2i for DMCMP may be preferable.
Five-year microevolution of a multidrug-resistant Mycobacterium tuberculosis strain within a patient with inadequate compliance to treatment
Authors: Fernandez Do Porto Darío A. , Monteserin Johana , Campos Josefina , Sosa Ezequiel J. , Matteo Mario , Serral Federico , Yokobori Noemí , Benevento Andrés Fernández , Poklepovich Tomás , Pardo Agustín , Wainmayer Ingrid , Simboli Norberto , Castello Florencia , Paul Roxana , Martí Marcelo , López Beatriz , Turjanski Adrián , Ritacco Viviana
Published: April 2021

Background

Whole-genome sequencing has shown that the Mycobacterium tuberculosis infection process can be more heterogeneous than previously thought. Compartmentalized infections, exogenous reinfections, and microevolution are manifestations of this clonal complexity. The analysis of the mechanisms causing the microevolution —the genetic variability of M. tuberculosis at short time scales— of a parental strain into clonal variants with a patient is a relevant issue that has not been yet completely addressed. To our knowledge, a whole genome sequence microevolution analysis in a single patient with inadequate adherence to treatment has not been previously reported.

Case presentation

In this work, we applied whole genome sequencing analysis for a more in-depth analysis of the microevolution of a parental Mycobacterium tuberculosis strain into clonal variants within a patient with poor treatment compliance in Argentina. We analyzed the whole-genome sequence of 8 consecutive Mycobacterium tuberculosis isolates obtained from a patient within 57-months of intermittent therapy. Nineteen mutations (9 short-term, 10 fixed variants) emerged, most of them associated with drug resistance. The first isolate was already resistant to isoniazid, rifampicin, and streptomycin, thereafter the strain developed resistance to fluoroquinolones and pyrazinamide. Surprisingly, isolates remained susceptible to the pro-drug ethionamide after acquiring a frameshift mutation in ethA, a gene required for its activation. We also found a novel variant, (T-54G), in the 5′ untranslated region of whiB7 (T-54G), a region allegedly related to kanamycin resistance. Notably, discrepancies between canonical and phage-based susceptibility testing to kanamycin were previously found for the isolate harboring this mutation. In our patient, microevolution was mainly driven by drug selective pressure. Rare short-term mutations fixed together with resistance-conferring mutations during therapy.

Conclusions

This report highlights the relevance of whole-genome sequencing analysis in the clinic for characterization of pre-XDR and MDR resistance profile, particularly in patients with incomplete and/or intermittent treatment.
Risk factors for secondary hemophagocytic lymphohistiocytosis in severe coronavirus disease 2019 adult patients
Authors: Meng Mei , Chen Limin , Zhang Sheng , Dong Xuan , Li Wenzhe , Li Ranran , Deng Yunxin , Wang Tao , Xu Yan , Liu Jiao , Huang Yanxia , Chen Yizhu , Huang Sisi , Wen Zhenliang , Zhang Lidi , Du Hangxiang , Liu Yongan , Annane Djillali , Qu Jieming , Chen Dechang
Published: April 2021

Background

Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event and a fatal complication of viral infections. Whether sHLH may also be observed in patients with a cytokine storm induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still uncertain. We aimed to determine the incidence of sHLH in severe COVID-19 patients and evaluate the underlying risk factors.

Method

Four hundred fifteen severe COVID-19 adult patients were retrospectively assessed for hemophagocytosis score (HScore). A subset of 7 patients were unable to be conclusively scored due to insufficient patient data.

Results

In 408 patients, 41 (10.04%) had an HScore ≥169 and were characterized as “suspected sHLH positive”. Compared with patients below a HScore threshold of 98, the suspected sHLH positive group had higher D-dimer, total bilirubin, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, serum creatinine, triglycerides, ferritin, interleukin-6, C-reactive protein, procalcitonin, lactate dehydrogenase, creatine kinase isoenzyme, troponin, Sequential Organ Failure Assessment (SOFA) score, while leukocyte, hemoglobin, platelets, lymphocyte, fibrinogen, pre-albumin, albumin levels were significantly lower (all P < 0.05). Multivariable logistic regression revealed that high ferritin (>1922.58 ng/mL), low platelets (<101 × 109/L) and high triglycerides (>2.28 mmol/L) were independent risk factors for suspected sHLH in COVID-19 patients. Importantly, COVID-19 patients that were suspected sHLH positive had significantly more multi-organ failure. Additionally, a high HScore (>98) was an independent predictor for mortality in COVID-19.

Conclusions

HScore should be measured as a prognostic biomarker in COVID-19 patients. In particular, it is important that HScore is assessed in patients with high ferritin, triglycerides and low platelets to improve the detection of suspected sHLH.
What do Germans really think about health-nudges?
Authors: Krisam Mathias , Maier Mona , Janßen Rebecca , Krisam Johannes
Published: April 2021

Background

In recent years, policymakers have increasingly used behaviourally informed policies, including ‘nudges’. They have been implemented to produce desirable social outcomes such as healthier eating and physical activity. In Germany, a small research team at the Federal Chancellery acts as the central unit to promote the introduction of nudges in the design of public life. Despite this, the nudging concept itself as well as the understanding around it has not spread widely among German citizens. When reporting about the concept, German media is often very critical of the concept.

Methods

Using a for age, sex and educational level nationally representative online survey with 1000 participants, we investigate whether German citizens know about the concept of nudging. We also explore if they approve of the theoretical concept as well as a list of seven specific interventions regarding healthy eating and physical activity. A particular focus is placed on whether the level of approval is dependent on the target group of the intervention, as well as different intervention-initiators.

Results

We find that nearly 80% of the respondents have never heard of nudging. However when being provided with a definition, we find that a strong majority (90%) supports the concept of nudging as well as all the specific interventions. Acceptance rates are higher if interventions are targeted at the general population compared to only children. All initiators – statutory health insurers, the government, private companies, and independent experts – are accepted as nudge initiators.

Conclusion

Amongst Germans nudges are an accepted method to promote health behaviours. Policy makers from various fields in Germany should take that into account to improve future health policy.
Testing a multicomponent lifestyle intervention for combatting childhood obesity
Authors: Vlaev Ivo , Taylor Michael J. , Taylor David , Gately Paul , Gunn Laura H. , Abeles Aliza , Kerkadi Abdelhamid , Lothian Jackie , Jreige Sahar Karim , Alsaadi Aziza , Al-Kuwari Mohamed G. , Ghuloum Suhaila , Al-Kuwari Hanan , Darzi Ara , Ahmedna Mohamed
Published: April 2021

Background

Childhood obesity is a major global health concern. Weight-management camps involving delivery of a program of physical activity, health education, and healthy eating are an effective treatment, although post-intervention weight-management is less well understood. Our objective was to assess the effectiveness of a weight-management camp followed by a community intervention in supporting weight-management for overweight children and children with obesity.

Methods

Participants were overweight Qatari schoolchildren or schoolchildren with obesity, ages 8–14 years, (n = 300) recruited over a three-year period across 14 randomly selected schools in the Doha area. They attended a two-week weight management camp, then a 10-week program of weekly lifestyle education and physical activity sessions, which also included behavior change techniques. The programme was cognitive behavioural therapy (CBT)-focused with a strong element of behavioural economics blended in.

Results

Participants saw a significant BMI SDS reduction as a result of the entire intervention (camp + education and activity sessions) both at the individual (p < 0.0001) and cluster/school (p = 0.0002) levels, and weight loss occurred during each intervention stage separately for the camp (p < 0.0001 for both the individual and cluster/school levels) and the lifestyle education and activity phase (p < 0.0001 and p = 0.0220 at the individual and cluster/school levels, respectively).

Conclusions

Weekly lifestyle education and activity sessions which include behavior change techniques may be useful in promoting continued weight management in the period following intensive, immersive childhood obesity interventions.

Trial registration

ClinicalTrials.gov NCT02972164, November 23, 2016.
Estimating the programmatic cost of targeted mass drug administration for malaria in Myanmar
Authors: Kyaw Shwe Sin , Delmas Gilles , Drake Tom L. , Celhay Olivier , Pan-ngum Wirichada , Pukrittayakamee Sasithon , Lubell Yoel , Aguas Ricardo J. , Maude Richard James , White Lisa J. , Nosten Francois
Published: April 2021

Background

Mass drug administration (MDA) has received growing interest to accelerate the elimination of multi-drug resistant malaria in the Greater Mekong Subregion. Targeted MDA, sometimes referred to as focal MDA, is the practice of delivering MDA to high incidence subpopulations only, rather than the entire population. The potential effectiveness of delivering targeted MDA was demonstrated in a recent intervention in Kayin State, Myanmar. Policymakers and funders need to know what resources are required if MDA, targeted or otherwise, is to be included in elimination packages beyond existing malaria interventions. This study aims to estimate the programmatic cost and the unit cost of targeted MDA in Kayin State, Myanmar.

Methods

We used financial data from a malaria elimination initiative, conducted in Kayin State, to estimate the programmatic costs of the targeted MDA component using a micro-costing approach. Three activities (community engagement, identification of villages for targeted MDA, and conducting mass treatment in target villages) were evaluated. We then estimated the programmatic costs of implementing targeted MDA to support P. falciparum malaria elimination in Kayin State. A costing tool was developed to aid future analyses.

Results

The cost of delivering targeted MDA within an integrated malaria elimination initiative in eastern Kayin State was approximately US$ 910,000. The cost per person reached, distributed among those in targeted and non-targeted villages, for the MDA component was US$ 2.5.

Conclusion

This cost analysis can assist policymakers in determining the resources required to clear malaria parasite reservoirs. The analysis demonstrated the value of using financial data from research activities to predict programmatic implementation costs of targeting MDA to different numbers of target villages.
Impact of China’s zero mark-up drug policy on drug cost of NCDs’ outpatients: an interrupted time series analysis
Authors: Du Jielin , Xie Jiajia , Qian Yan , Wu Mingyue , Huang Wenjing , Yin Jin , Peng Xin , Deng Dan
Published: April 2021

Background

China proposed the Zero Markup Drug Policy (ZMDP), which popularized in tertiary hospitals across the country in 2017, to control drug expenditures’ rapid growth further and reduce the public’s medical burden. This study aims to evaluate the impact of ZMDP on the drug cost of chronic disease outpatients in the tertiary hospital in Chongqing.

Methods

We collected and described the drug-cost data for outpatients with chronic diseases in a Chongqing’s tertiary hospital from 2015 to 2019. The instantaneous and long-term changes of the outpatient volume and average drug cost after the ZMDP were evaluated using interrupted time series (ITS). We also analyzed the policy’s impact under the stratification of gender, age, and basic medical insurance types.

Results

A total of 350,848 outpatients were collected from January 2015 to February 2019. After the ZMDP, the outpatient volume for diabetes, hypertension, and coronary heart disease (CHD) all showed a downward trend, with a decrease of 53.04 (P = 0.012), 142.19 (P < 0.01) and 12.16 (P < 0.001) per month. Simultaneously, the average drug cost decreased by 4.44 yuan (P = 0.029), 5.87 yuan (P < 0.001) and 10.23 yuan (P = 0.036) per month, respectively. By gender, the average drug cost of diabetes in males had the most considerable instantaneous change, reducing by 51.21 yuan (P = 0.017); the decline of CHD in women is the most obvious, with an average monthly decrease of 12.51 yuan (P < 0.001). By age, the instantaneous change of CHD was the greatest for those older than 65 years old, with a decrease of 102.61 yuan (P = 0.030). CHD in 46–65 years old showed the most significant reduction, with an average monthly decline of 11.70 yuan (P < 0.01). BMIUE’s hypertension had the most considerable instantaneous change, which decreased 59.63 yuan (P = 0.010). BMIUE’s CHD showed the most apparent downward trend, with an average monthly decrease of 10.02 yuan (P = 0.010).

Conclusion

The ITS analysis is an effective method of health policy evaluation. The implementation of the ZMDP can reduce the drug cost for chronic disease outpatients in the tertiary hospital and their economic burden. Follow-up policies still require targeted price adjustments in the health service system to adjust the drug cost-effectively.
Pembrolizumab-induced myasthenia gravis-like disorder, ocular myositis, and hepatitis: a case report
Authors: Tian Chia-Yi , Ou Yang-Hao , Chang Shih-Liang , Lin Chih-Ming
Published: April 2021

Introduction

Pembrolizumab and other immune checkpoint inhibitors are the emerging treatment for selected, high-grade malignancies. However, a small number of patients are unable to tolerate its adverse effects, leading to discontinuation of this potentially life-changing therapy. In this study, we present a case of high-grade urothelial carcinoma patient, who experienced neurocomplications during the first pembrolizumab administration. However, we were able to limit the adverse effect by concomitant use of low-dose oral steroids.

Case presentation

A 75-year-old Taiwanese female with high-grade urothelial carcinoma of the left ureter came to the neurology clinic with complaints of acute onset of bilateral ptosis 16 days after her first infusion of pembrolizumab. It was found that she developed complete bilateral ptosis and limited extraocular muscle movements. Myasthenia gravis-related antibodies and repetitive stimulation test were negative. We diagnosed her with pembrolizumab-induced myasthenia gravis-like disorder and myositis based on clinical symptoms and elevation of muscle enzymes. We commenced methylprednisolone pulse therapy followed by oral steroid therapy with gradual resolution of the symptoms. Three months later, the patient received a second cycle of pembrolizumab with low-dose oral steroids without any complications.

Conclusion

Pembrolizumab exerts its antitumor activity by interfering with the binding of programmed death 1 and its ligand, programmed death ligand 1. As a result, enhanced cytotoxic T cells can recognize tumor cells and induce cellular death. However, neurological complications may be severe and require prompt recognition and treatment. Our case demonstrated that concomitant use of low-dose steroids and pembrolizumab might prevent such complications.
Gambling and governmental responsibilities
Authors: Skuse David
Published: April 2021

Human beings seem to be genetically predisposed to take risks in the hope of reward, but in gambling the risks often significantly outweigh the rewards. Should societies and governments attempt to regulate gambling, and how? Two papers in this month's issue ofBJPsych Internationaldiscuss problem gambling in Nigeria and in Malaysia, and how government and society address it.
You are mine. I see now, I'm a have to let you go.
Authors: Moten Fred , Woods Suné , Williams James Gordon
Published: April 2021

Critical Art Encounters offer sustained and at times meditative engagements with contemporary artworks. This Critical Art Encounter is a kind of reprise, a return to a joint performance by visual artist Suné Woods, poet and theorist Fred Moten, and musician and theorist James Gordon Williams. Titled You are mine. I see now, I'm a have to let you go, the piece was performed live at the Hammer Museum during their 2018 biennial event “Made in L.A.” This special section of liquid blackness aims to sample the fully realized collaboration and audiovisual experimentation that took place in the largely improvised art event. This Critical Art Encounter includes the intimate ecological exploration that takes place in Woods's video work; Moten's poem “the general balm,” which was written in part for the performance and later published in his book of poetry and criticism all that beauty (2019); and finally, a conversation with Erin Christovale, an associate curator at the Hammer who helped organize the event. Although not all three artists are featured (Williams's original compositions can be heard in the footage from the performance), we were fortunate to expand this creative dialogue by including a curatorial perspective. Thus we are able to consider how this work expresses liquidity as both a concern of contemporary black art and a call to the congregation.
Moving Between
Authors: Peterson Marina
Published: April 2021

Helium's material form is unstable, moving from gas to liquid under temperature. Lighter than air, it evades the immediacy of perception. Thinking through helium offers an approach to the entanglement of forms of matter that makes movement the locus. Helium shifts an understanding of “between” to one of motion, of phase shifts and plasticity rather than difference, in which the durability of matter—and of the human—withdraws.
Απ-εικονίσεις της Αμερικής
Authors: Ραπατζίκου Τατιανή Γ. , Γενενετζή-Μαλαθούνη Σμάτη , Δέτση Zωή , Μαυρέλος Νικόλαος , Καλογεράς Γιώργος , Θεοδοσιάδου Γιούλη , Κοκκώνης Μιχάλης , Δημακοπούλου Σταματίνα , Γερόλυμπος Γιώργης
Published: April 2021

Επιμελήτριες τόμου: Τατιανή Γ. Ραπατζίκου και Σμάτη Γεμενετζή-Μαλαθούνη

Ο παρών τόμος αποτελεί τη συλλογή ενός εισαγωγικού κειμένου, έξι δοκιμίων και ενός φωτογραφικού οδοιπορικού, τα οποία επιχειρούν να σκιαγραφήσουν την εικόνα της Αμερικής από το 19ο αιώνα μέχρι σήμερα όπως αυτή προσλαμβάνεται μέσω διαφόρων λογοτεχνικών, θεατρικών, κινηματογραφικών, ποιητικών και φωτογραφικών αναζητήσεων.

Volume Editors: Tatiani G. Rapatzikou and Smatie Yemenedzi-Malathouni

Each one of the essays contained in the current volume sheds light on America's image with attention paid to particular socio-cultural events and temporalities starting from the nineteenth century till the present day as these are explored via literary practice, theater, poetry, cinema and photography.
La autopercepción de profesores con alemán L1 o LX con respecto a su comportamiento en las lecciones de DaF
Authors: Bracker Philip , Polizio Daniele
Published: April 2021

n der Fremdsprachendidaktik war man lange der Ansicht, dass native speakers im Vergleich zu ihren nichtmuttersprachlichen Kollegen kompetentere Sprachlehrende sind. Allerdings setzt sich die LehrLern-Forschung mit genau dieser Diskussion erst seit den 1990er Jahren auseinander, und fast nur im EFL/ ESL-Bereich. In diesen ersten Studien zeigte sich eine Dichotomie zwischen native und non-native speakers, nach der die zwei «Gruppen» ihren persönlichen Einschätzungen zufolge anders unterrichteten (Medgyes 1994). Der vorliegende Beitrag untersucht die Selbstwahrnehmung von DaF-Lehrer*innen mit Deutsch L1 und LX hinsichtlich ihres Verhaltens im Unterricht, um herauszufinden, ob diese in verschiedenen Studien dargestellte Dichotomie ebenfalls im DaF-Bereich auftritt. 60 Lehrkräfte verschiedener Universitäten und GoetheInstitute in Spanien und Portugal haben an einer Umfrage teilgenommen, deren Auswertung die Ergebnisse anderer Studien der EFL/ESL-Didaktik teilweise bestätigt, allerdings nur als mögliche Tendenzen oder Präferenzen. In den meisten Fällen zeigen die Befragten abgesehen von ihrer Erstsprache nur sehr wenige Unterschiede.
Identifying elements of empowerment and autonomy in food choices in Food and Nutrition Education groups: A qualitative research
Authors: Vincha Kellem Regina Rosendo , Santos Bruna Zillesg Borges dos , Vieira Viviane Laudelino , Cervato-Mancuso Ana Maria
Published: April 2021

Introdução: As políticas públicas de saúde têm reforçado a importância do empoderamento e da autonomia dos indivíduos, mas esses aspectos são desconhecidos na área da Nutrição. Objetivo: Identificar elementos que contribuem para o fortalecimento do empoderamento e autonomia nas escolhas alimentares de participantes de grupos de Educação Alimentar e Nutricional. Métodos: Pesquisa qualitativa na perspectiva das representações sociais realizada na Atenção Primária à Saúde da cidade de São Paulo, Brasil. Foram desenvolvidos dois grupos contendo usuários com doenças crônicas. Esses usuários, com idade de 47 a 78 anos, compareceram em média a seis encontros grupais, em um período de três meses. Para explorar a vivência dos participantes, a fim de compreender como eles atribuem sentidos e significados a suas escolhas alimentares, realizou-se entrevista semiestruturada com 15 usuários, pós-intervenção. Para a análise dos dados, aplicou-se a análise de conteúdo temática. Resultados: Cinco temas emergiram: autopercepção, informação e conhecimento, capacidade pessoal, atitude e adaptação ativa às escolhas. Os quatro primeiros foram identificados como elementos de empoderamento, pois evidenciaram a ampliação da capacidade dos indivíduos de pensar e agir criticamente frente às escolhas alimentares. O último foi formado pelo confronto de determinantes, responsabilização e negociação interna, que se revelaram elementos da autonomia, uma vez que configuraram transformações construídas pelos próprios participantes, pós-intervenção. Conclusão: Os elementos identificados mostraram compor a avaliação da autonomia nas escolhas alimentares dos indivíduos, podendo constituir indicadores de avaliação da Educação Alimentar e Nutricional, bem como avaliar e monitorar as práticas de cuidado preconizadas na promoção da saúde.
COVID-19 insight: winter pressures on urgent and emergency care
Authors: Halliwell Amanda
Published: April 2021

The Care Quality Commission's eighth COVID-19 insight report continues to highlight how providers are coping in the face of the pandemic. This time, the focus is on emergency care services. Amanda Halliwell investigates.