bluuebunny/crossref_metadata_2025_split huggingface dataset:
Social Structure and Distributive Policies under the PT Governments: A Poverty-Reducing Variety of Neoliberalism
Authors: Loureiro Pedro Mendes 
Published: December 2019

Brazil’s social structure and associated distributive policies during the PT governments did not depart from neoliberalism but rather implemented a poverty-reducing variant of it. Through minimum-wage hikes, conditional cash transfers, legislation driving financial innovation, and the subsidizing of privately provided for-profit services, state power was used to include individuals in ever-expanding formal circuits of commodity production and consumption. Deprivation in multiple dimensions was indeed reduced through these policies, but in the process social mobility came to mean exiting poverty, getting a formal low-skilled job, and accessing credit at lower interest rates to pay for state-subsidized private health and education. A estrutura social do Brasil e as políticas distributivas associadas a ela durante os governos do PT não se afastaram do neoliberalismo, mas sim implementaram uma variante de neoliberalismo redutora da pobreza. Por meio de aumentos do salário mínimo, transferências condicionais de renda, legislação que impulsionava a inovação financeira e o subsídio para serviços privados prestados com fins lucrativos, o poder do Estado foi usado para incluir indivíduos em crescentes circuitos formais de produção e consumo de mercadorias. A privação em múltiplas dimensões foi realmente reduzida por meio dessas políticas, mas neste processo a mobilidade social passou a significar sair da pobreza, conseguir um emprego formal pouco qualificado e obter crédito a taxas de juros mais baixas para pagar pela saúde e educação privadas subsidiadas pelo Estado.
The perception of barriers concerning opioid medicines: A survey examining differences between policy makers, healthcare professionals and other stakeholders
Authors: Vranken Marjolein JM , Linge-Dahl Lisa , Mantel-Teeuwisse Aukje K , Radbruch Lukas , Schutjens Marie-Hélène DB , Scholten Willem , Payne Sheila , Jünger Saskia 
Published: December 2019

Background: In many countries, the consumption of opioid medicines is too low to meet population needs. Discussions within the Access To Opioid Medication in Europe project indicated that there may be significant differences in the perception of barriers for their adequate use, depending on the stakeholders. Aim: The aim of this study was to examine the perception of barriers and their impact concerning opioid medicines, comparing policy makers, healthcare professionals working in the field of pain management, palliative care or harm reduction and other stakeholders. Design: Data were collected using a questionnaire partially constructed from existing surveys, reviewed for content validity by four experts and pilot-tested in Latvia. Setting/participants: Participants of the Access to Opioid Medication in Europe national conferences were invited to complete the questionnaire. Stakeholder groups were compared using non-parametric rank-sum tests. Results: In total, 199 participants (54%) in seven countries completed the questionnaire. Most frequently rated major barriers included lack of financial resources and inadequate knowledge, skills and training among policy makers (55%–66%). Overall, policy makers perceived issues less often as major barriers or having major impact (29% barrier, 32% impact) compared to other stakeholders (36%–42% barrier, 39%–51% impact). Significant differences were seen on several aspects. For example, excessive regulation or bureaucracy for prescribing was rated as having major impact by 55%–57% of healthcare professionals in contrast to only 20% of the policy makers ( p = 0.002). Conclusion: Multiple barriers may play an important role, partly depending on the perspective of the stakeholder involved. Hence, when addressing perceived barriers, it is important to include all relevant stakeholder groups. Only then, effective and widely supported solutions can be implemented.
Variation of the apparent diffusion coefficient of skull bone marrow by age group, pubertal status, and gender in a pediatric population
Authors: Pace Erika , MacKinnon Andrew D , deSouza Nandita M 
Published: December 2019

Background Bone marrow composition varies with stage of development. Purpose To assess differences in apparent diffusion coefficient (ADC) derived from clivus bone marrow in healthy children by age, pubertal status, and gender as a benchmark when monitoring local and systemic treatment-induced effects. Material and Methods Non-oncological pediatric patients (30 pre-pubertal [15 girls, 15 boys] and 30 post-pubertal [15 girls, 15 boys]) with previous normal magnetic resonance imaging (MRI) of the brain including diffusion-weighted magnetic resonance imaging (DW-MRI; 1.5-T Philips Achieva-Ingenia, b-values 0 and 1000s/mm2) were studied. A 4–6 mm diameter region of interest (ROI), drawn within the clivus on two or three DW-MRI slices, yielded mean and centile ADC values. Pubertal status was recognized from imaging appearances of the pituitary gland and from fusion of the spheno-occipital synchondrosis. Correlations between ADC and age were assessed (Pearson’s coefficient). Mann–Whitney U tests compared ADC by age, pubertal status, and gender. Results Age and ADC were significantly negatively correlated (median ADC r=–0.48, mean ADC r=–0.42, P=0.0001 and 0.0008, respectively) which held true when divided by gender. Mean and median ADC differed significantly before and after puberty for the whole population ( P=0.0001 and 0.0001, respectively). There was a left shift of the ADC histogram after puberty with significant differences in centile values. ADC differences before and after puberty remained when divided by gender (girls: P=0.04 and 0.009, respectively; boys: P=0.005 and 0.0002, respectively). Conclusion ADC of clivus bone marrow correlates with age in children. ADC decreases significantly after puberty, likely due to replacement of hypercellular marrow with fat. There are no gender-related differences in clivus bone-marrow ADC before or after puberty.
Role of spinal adenosine A1 receptors in the analgesic effect of electroacupuncture in a rat model of neuropathic pain
Authors: Dai Qin-xue , Huang Lu-ping , Mo Yun-chang , Yu Li-na , Du Wen-wen , Zhang An-qi , Geng Wu-jun , Wang Jun-lu , Yan Min 
Published: December 2019

Objective The aim of this study was to determine the role of spinal adenosine A1 receptors (A1Rs) in the analgesic effects of electroacupuncture (EA) for neuropathic pain. Methods We performed EA for 30 minutes at the zusanli acupoint in the legs of rats with previously induced chronic constriction injuries and observed the mechanical and thermal pain thresholds 1 hour later. We also examined adenosine levels by high-performance liquid chromatography and A1R expression in the L4–6 spinal cord by western blot analysis. We then injected A1R short interfering RNA (AV-shA1RNA) into the L4–6 spinal cord to downregulate A1R expression and re-examined the mechanical and thermal pain thresholds. Results Adenosine levels and A1R expression in the L4–6 spinal cord were increased at 1 hour after EA. In addition, EA exhibited an analgesic effect that was reversed by AV-shA1RNA. Conclusions Our results suggest that EA at the zusanli acupoint elicits an analgesic effect against neuropathic pain, mediated by A1Rs in the spinal cord.
Effect of low glycaemic diet and structured exercise on quality of life and psychosocial functions in children with epilepsy
Authors: Zhang Hongwei , Yu Liqun , Li Hui , Liu Yong 
Published: December 2019

Objective The study aimed to investigate the combined effects of structured exercise therapy and a low glycaemic diet on quality of life and psychosocial functions in children with epilepsy. Methods Forty-two subjects aged 11 to 17 years and diagnosed with refractory epilepsy were recruited. Structured home-based exercise and a low glycaemic diet designed by exercise and diet specialists were administered for 6 months. The Children’s Depression Inventory (CDI) and the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) were administrated to compare the effects of the combined treatment after 6 months. Results Participants’ mean (±standard deviation) age was 13.1 ± 2.3 years and mean epilepsy duration was 8.9 ± 4.2 years. The seizure frequency was approximately two to four/day per week in 28 cases and five per day/week in 8 cases. After the study period, there was a significant improvement in seizure frequency and in scores on the CDI and QOLCE-55 scales. Conclusion Combined therapy demonstrated a promising improvement in seizure frequency, depression level and quality of life in children with epilepsy.
Drawing Fear of Difference: Race, Gender, and National Identity in Ms. Marvel Comics
Authors: Cooper-Cunningham Dean 
Published: December 2019

Feminist scholars have provided important analyses of the gendered and racialised discourses used to justify the Global War on Terror. They show how post-9/11 policies were made possible through particular binary constructions of race, gender, and national identity in official discourse. Turning to popular culture, this article uses a Queer feminist poststructuralist approach to look at the ways that Ms. Marvel comics destabilise and contest those racialised and gendered discourses. Specifically, it explores how Ms. Marvel provides a reading of race, gender, and national identity in post-9/11 USA that challenges gendered-racialised stereotypes. Providing a Queer reading of Ms. Marvel that undermines the coherence of Self/Other binaries, the article concludes that to write, draw, and circulate comics and the politics they depict is a way of intervening in international relations that imbues comics with the power to engage in dialogue with and (re)shape systems of racialised-gendered domination and counter discriminatory legislation. Dibujando miedo a la diferencia: raza, género e identidad nacional en Ms. Marvel Comics
Application of Machine Learning for Predicting Clinically Meaningful Outcome After Arthroscopic Femoroacetabular Impingement Surgery
Authors: Nwachukwu Benedict U. , Beck Edward C. , Lee Elaine K. , Cancienne Jourdan M. , Waterman Brian R. , Paul Katlynn , Nho Shane J. 
Published: December 2019

Background: Hip arthroscopy has become an important tool for surgical treatment of intra-articular hip pathology. Predictive models for clinically meaningful outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) are unknown. Purpose: To apply a machine learning model to determine preoperative variables predictive for achieving the minimal clinically important difference (MCID) at 2 years after hip arthroscopy for FAIS. Study Design: Case-control study; Level of evidence, 3. Methods: Data were analyzed for patients who underwent hip arthroscopy for FAIS by a high-volume fellowship-trained surgeon between January 2012 and July 2016. The MCID cutoffs for the Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) were 9.8, 14.4, and 9.14, respectively. Predictive models for achieving the MCID with respect to each were built with the LASSO algorithm (least absolute shrinkage and selection operator) for feature selection, followed by logistic regression on the selected features. Study data were analyzed with PatientIQ, a cloud-based research and analytics platform for health care. Results: Of 1103 patients who met inclusion criteria, 898 (81.4%) had a minimum of 2-year reported outcomes and were entered into the modeling algorithm. A total of 74.0%, 73.5%, and 79.9% met the HOS-ADL, HOS-SS, and mHHS threshold scores for achieving the MCID. Predictors of not achieving the HOS-ADL MCID included anxiety/depression, symptom duration for >2 years before surgery, higher body mass index, high preoperative HOS-ADL score, and preoperative hip injection (all P < .05). Predictors of not achieving the HOS-SS MCID included anxiety/depression, preoperative symptom duration for >2 years, high preoperative HOS-SS score, and preoperative hip injection, while running at least at the recreational level was a predictor of achieving HOS-SS MCID (all P < .05). Predictors of not achieving the mHHS MCID included history of anxiety or depression, high preoperative mHHS score, and hip injections, while being female was predictive of achieving the MCID (all P < .05). Conclusion: This study identified predictive variables for achieving clinically meaningful outcome after hip arthroscopy for FAIS. Patient factors including anxiety/depression, symptom duration >2 years, preoperative intra-articular injection, and high preoperative outcome scores are most consistently predictive of inability to achieve clinically meaningful outcome. These findings have important implications for shared decision-making algorithms and management of preoperative expectations after hip arthroscopy for FAI.
Rethinking Urban Female Adolescents’ Safety Net: The Role of Family, Peers, and Sexual Partners in Social Support
Authors: Robinson Camille A. , Trent Maria , Ellen Jonathan M. , Matson Pamela A. 
Published: December 2019

Purpose: To examine how interpersonal factors are associated with family, peer, and partner social support among urban female adolescents in sexual relationships. Design: Secondary data analysis of cross-sectional data. Setting: Two urban health clinics and community sites in Baltimore, Maryland. Participants: One hundred sixteen female adolescents (ages 16-19) with 131 heterosexual relationships from the Perceived Risk of Sexually Transmitted Diseases cohort. Measures: Interpersonal factors included parental monitoring, friend–partner connectedness, and feelings of intimacy for partner. Social support was measured using the Multidimensional Scale of Perceived Social Support with family, peer, and partner subdomains. Analysis: Multivariable linear regression models using baseline data and accounting for clustering of partners. Results: Adolescents perceived high levels of family, peer, and partner support, with the greatest coming from partners (range: 1-5; family mean: 4.0 [95% confidence interval, CI: 3.83-4.18]; peer mean: 4.2 [95% CI: 4.05-4.33]; partner mean: 4.5 [95% CI: 4.36-4.60]). Parental monitoring and friend–partner connectedness were significantly associated with greater family ( b = 0.11, standard error [SE] = 0.03, P = 0.001; b = 0.15, SE = 0.06, P = .02) and peer support ( b = 0.06, SE = 0.02, P = .01; b = 0.29, SE = 0.07, P < .001). Feelings of intimacy for partner was significantly associated with greater partner support ( b = 0.08, SE = 0.03, P = .02). Conclusion: Feeling connected to one’s social network and having a connected network is an important contribution to social support for urban female adolescents in sexual relationships. Future research targeting interpersonal factors is warranted, as it may result in increased social support and promote positive sexual health behaviors in an urban female adolescent population.
Phenytoin Serum Concentrations in Patients With Left Ventricular Support Devices: A Case Series
Authors: Wiebe Amanda Z. , Terry Kimberly , Skaggs John 
Published: December 2019

Purpose: Achieving therapeutic levels of phenytoin is critical to its efficacy and safety. Free serum levels represent pharmacologically active phenytoin due to the high protein binding of the drug. Predicting free serum levels in patients with left ventricular support devices can be challenging, as the pharmacokinetics (PK) can be significantly altered, and equations to correct total levels have not been validated in this population. The aim of this case series was to describe serum phenytoin concentrations in critically ill patients requiring left ventricular support devices. Methods: A retrospective chart review was performed including patients who received phenytoin therapy and had at least 1 set of simultaneously measured free and total serum phenytoin levels during left ventricular support with a mechanical device. Corrected total phenytoin levels were calculated using Sheiner-Tozer equations. Results: Three patients were included in this case series. Patients 1 and 2 required venoarterial extracorporeal membrane oxygenation (ECMO) during phenytoin therapy, and patient 3 had a durable left ventricular assist device (LVAD). Measured phenytoin levels ranged from 4.1 to 11.4 µg/mL, and calculated corrected levels were 6.8 to 18.4. Measured free phenytoin levels ranged from 1.2 to 3.6 µg/mL, which correlated with free fractions of 15.8% to 37.9%. Conclusion: This case series demonstrates a higher percentage of free phenytoin compared to the total serum level than would be predicted and an inability to rely on corrected total phenytoin level to predict whether it is within therapeutic range. Monitoring of free serum phenytoin concentrations should be strongly considered in critically ill patients requiring LVAD or ECMO support.
Efficacy and safety of bortezomib in refractory lupus nephritis: a single-center experience
Authors: Segarra A , Arredondo K V , Jaramillo J , Jatem E , Salcedo M T , Agraz I , Ramos N , Carnicer C , Valtierra N , Ostos E 
Published: December 2019

Background and Objectives Resistant lupus nephritis (LN) has been associated with the persistence of long-lived plasma cells. Preliminary studies identified bortezomib as a potential treatment option for patients with refractory LN. The aim of this study was to analyze the efficacy and safety of bortezomib in the treatment of severe refractory LN. Methods This retrospective study included 12 female patients diagnosed for the first time with class IV or IV/V LN with acute or rapidly progressive kidney injury ( n = 11) and/or severe nephrotic syndrome ( n = 1) who showed resistance to induction therapy with cyclophosphamide, steroids, mycophenolate, and rituximab, and were treated with either intravenous or subcutaneous bortezomib plus intravenous dexamethasone. Results All patients with acute or rapidly progressive kidney injury showed a significant reduction in both biochemical and immunological activity after a mean of 6 (minimum 5, maximum 7) weekly cycles of bortezomib regimen, with a significant increase in C3 levels and a significant decrease of anti-ds DNA antibody titers, Systemic Lupus Erythematosus Disease Activity Index score, serum creatinine, and proteinuria. One patient (8.3%) achieved a complete response, and 10 patients (83.4%) achieved a partial response. During follow-up, all these patients maintained partial responses under treatment with mycophenolate and low-dose glucocorticoids. The patient with refractory nephrotic syndrome showed a partial response but relapsed 11 months after the end of bortezomib treatment and was resistant to treatment. A significant decrease in serum IgG levels after initiation of bortezomib treatment was observed in all patients, five of them (41.6%) showed hypogammaglobulinemia (<500 mg/dl), but no patient suffered from opportunistic infections; in only two patients (16.6%) hypogammaglobulinemia persisted at the end of follow-up. Two patients (16.6%) suffered from sensory neuropathy, which led to bortezomib treatment discontinuation. Conclusions Bortezomib may be an effective option for refractory LN, but close monitoring must be performed for possible adverse events such as peripheral neuropathy and hypogammaglobulinemia.
Using High-Speed Nasopharyngoscopy to Quantify the Bubbling Above the Velopharyngeal Valve in Cases of Nasal Rustle
Authors: Oren Liran , Rollins Michael , Padakanti Srujana , Kummer Ann , Gutmark Ephraim , Boyce Suzanne 
Published: December 2019

Objective: The loud and severely distorting form of audible nasal emission (commonly known as nasal turbulence or nasal rustle) typically occurs with a small velopharyngeal opening during production of pressure-sensitive consonants. The purpose of this study was to determine whether bubbling of the secretions, which commonly occurs on the superior aspect of the velopharyngeal port when there is a small opening, is a periodic process that can generate sound in the nasal cavity. Participants: Ten pediatric patients were included in the study. All participants had normal articulation and resonance but exhibited audible nasal emission characterized as nasal rustle. Measures: For each participant, high-speed video (HSV) nasopharyngoscopy and acoustic signals were recorded simultaneously. The acoustic recordings were captured in a manner similar to nasometry using nasal and oral microphones connected to a separation plate. Spectral analysis of the audio recordings and the HSV images was used to determine correlation between the acoustic and visual measurements. Results: This study showed that secretion bubbling is a periodic process and its frequency, measured from the HSV data, was also captured by the acoustic measurements. The nasal acoustic signal correlated more strongly with the video of bubbling than the oral acoustic signal in the majority of the cases where bubbling occurred. Conclusion: These findings are strong evidence that secretion bubbling plays a significant role in the mechanism that generates undesired sound in the nasal cavity. Further work is needed to determine whether this sound is perceived as nasal rustle.
Eustachian Tube Dysfunction in Children With Unilateral Cleft Lip and Palate: Differences Between Ipsilateral and Contralateral Ears
Authors: Hu Allen , Shaffer Amber D. , Jabbour Noel 
Published: December 2019

Objective: To evaluate Eustachian tube dysfunction in the ipsilateral and contralateral ears, in children with unilateral cleft lip and palate (UCLP). Design: Retrospective chart review. Setting: Tertiary care children’s hospital. Patients: Seventy-four consecutive patients with UCLP born between 2005 and 2011 and treated at UPMC Children’s Hospital of Pittsburgh Cleft-Craniofacial Center were included. Main Outcome Measures: Conductive hearing loss, tympanogram type, number of middle ear effusions, tympanostomy tubes, and complications. Hypothesis was formulated prior to data collection. Results: Conductive hearing loss was nearly twice as common in the ipsilateral ear (43.2%) compared with contralateral (23.0%; P = .001, McNemar test). There were no significant differences in the frequency of each type of tympanogram between the contralateral and ipsilateral ears. The proportions of ipsilateral (90.5%) and contralateral (91.9%) ears with effusion were not significantly different. The total number of tubes received was not significantly different between the 2 ears (median of 2 bilaterally). When combined, complications (retractions, perforations, and cholesteatomas) were significantly more common in the ipsilateral ear (29.7%) compared with the contralateral ear (18.9%; P = .039, McNemar test). Conclusion: In children with UCLP, there were significantly more instances of conductive hearing loss and complications on the cleft side compared to the noncleft side. This suggests that Eustachian tube dysfunction may indeed be more severe on the cleft side. Considering this information, clinicians may need to be especially observant of the ipsilateral ear.