bluuebunny/crossref_metadata_2025_split huggingface dataset:
Familial Hyperinsulinism due to HNF4A Deficiency and Benign Premature Adrenarche: A Case Report
Authors: Compton Edward , Geller David , Vidmar Alaina 
Published: May 2021

Background: Familial Hyperinsulinism due to HNF4A deficiency (FHI-HNF4A) is a form of diazoxide-sensitive, diffuse hyperinsulinism, characterized by transient or persistent hyperinsulinemic hypoglycemia, and a propensity to develop Maturity-Onset Diabetes of the Young type 1 (MODY1). The association between FHI-HNF4A deficiency and benign premature adrenarche (BPA) is unknown.
The Case: We report the case of a 5-year-old girl with FHI-HNF4A, controlled on diazoxide, who presented with BPA and Tanner stage III pubic hair associated with body odor and acne. Work-up revealed elevated dehydroepiandrosterone sulfate (DHEAS), elevated free testosterone, and advanced bone age. Insulin levels were elevated in the setting of normal fasting blood glucose. We discuss the possible hormonal underpinnings of hyperandrogenism.
Conclusion: Though the underlying pathophysiology of this phenotype is unclear, a possible synergistic mechanism exists between insulin-induced hyperandrogenism and HNF4A deficiency leading to a transient decrease of SHBG and thus increased free testosterone levels. Further investigation is required to determine the association between HNF4A dysfunction and BPA.
Parceria ensino-serviço na formação em odontologia
Authors: Nunes Maria de Fatima , Oliveira Barbosa Sandra de Cássia 
Published: May 2021

Resumo: A parceria ensino-serviço é fundamental na formação de futuros profissionais, assim como na educação permanente dos profissionais que já atuam nos serviços de saúde. O objetivo deste estudo foi sistematizar e compreender problemas diagnosticados nas unidades básicas de saúde da família (ESF), por estudantes da graduação em Odontologia da Universidade Federal de Goiás (FO/UFG). Foi utilizada a pesquisa documental para levantamento dos dados em projetos acadêmicos elaborados no período de 2006 a 2013, por alunos de graduação do sétimo período no Estágio em Odontologia Coletiva I. Os problemas relatados nos projetos acadêmicos aconteceram em 16 unidades de ESF do Município de Goiânia-Go e foram diagnosticados pelo método da estimativa rápida. Os 80 projetos elaborados pelos acadêmicos foram examinados e apresentou um total de 950 problemas diagnosticados. Os problemas elencados variaram de acordo com o território onde o estágio aconteceu. Após a coleta realizada pelos acadêmicos os problemas foram hierarquizados em função da viabilidade de intervenção. Os problemas priorizados foram aqueles que tiveram soluções a nível local. Após a coleta dos dados, foi realizada a categorização e emergiram sete categorias e 15 subcategorias. Dentre as categorias, as mais citadas foram ‘gestão’ e ‘problema social’ e, das subcategorias foram ‘gestão pública’, ‘gestão dos serviços de saúde’ e ‘organização dos processos de trabalho’. As categorias menos citadas foram ‘trabalho em equipe’ e ‘controle social’. Concluiu-se que as categorias se interligam umas às outras, demonstrando que os problemas de saúde muitas vezes têm diversas causas e necessitam de soluções compartilhadas. Vários destes problemas não têm solução a nível local, relacionam-se aos determinantes sociais de saúde e merecem atenção especial da gestão dos serviços. A categorização dos problemas demonstrou a amplitude das dificuldades vivenciadas pelas equipes de saúde da família, e a necessidade de inserção dos acadêmicos de odontologia precocemente nos serviços de saúde, para vivenciarem a realidade prática, na busca de uma formação que aproxime o futuro profissional de odontologia das reais necessidades da população.

Palavras chaves: Ensino na saúde. Ensino-serviço. Odontologia.
Percepção dos idosos sobre as ações de educação em saúde desenvolvidas na atenção básica
Authors: De Lima Pollyana , Sugai Mortoza Andrea , Silva Pereira Edna Regina 
Published: May 2021

O Ministério da Saúde define como porta de entrada a Atenção Básica e como prioridade a realização de ações de educação em saúde para otimizar a saúde da pessoa idosa. Trata-se de uma pesquisa qualitativa exploratória realizada com idosos na Atenção Básica que objetivou verificar o conhecimento dos idosos sobre educação em saúde com ênfase nas facilidades e dificuldades na realização de ações educativas. A técnica de coleta de dados foi o grupo focal. Utilizou-se a Análise de Conteúdo Temática, como proposta por Bardin, para análise de dados. Participaram dos grupos focais 15 idosos. Dos grupos focais emergiram 4 categorias: Educação como comportamento versus educação como ferramenta; O aprendizado e as trocas de experiências dos idosos nas atividades educativas; Características pessoais que interferem na participação de ações de educação em saúde; descobrindo a educação em saúde como mecanismo para alcançar a qualidade de vida. A maioria dos idosos remetem conceito de educação em saúde ao ato do profissional de saúde ser cortês e educado e pouco como ferramenta para aquisição de conhecimento. Atribuem grande importância ao sentimento de acolhimento e pertencimento aos grupos de educação. Apontam como facilitadores no processo de educação em saúde a proximidade das unidades de saúde com suas residências a disponibilidade e tempo. As dificuldades na realização e adesão às atividades educativas relatadas pelos idosos estão vinculadas às barreiras para locomoção, a falta de incentivo por parte de familiares e cuidadores e a não adaptação às atividades propostas
Armuoto betono bažnyčios:
Authors: Deveikienė Vaiva , Deveikis Steponas 
Published: May 2021

Sakralinių pastatų statybai ir architektūrinei raiškai skiriamas didžiulis visuomenės ir architektų dėmesys, naudojamos kokybiškos medžiagos, taikomos naujos statybos technologijos. Architekto Antano Vivulskio (1877–1919) ryžtas statyti Lietuvoje, Vilniuje, bažnyčios pastatą iš armuoto betono (gelžbetonio) sietinas su jo studijų metu Vakarų Europoje, ypač Prancūzijoje, prasidėjusia armuoto betono bažnyčių statyba. Straipsnyje analizuojama A. Vivulskio bažnyčios statybos projekto Vilniuje kontekstas, pateikiama XX a. pradžios armuoto betono bažnyčių statybos Prancūzijoje pavyzdžių.
Da formalidade da docência acadêmica à docência experienciada na escola
Authors: Esteves Rosa Maria Maia Gouvêa , Lemgruber Márcio Silveira 
Published: May 2021

Este artigo objetiva, a partir das pesquisas desenvolvidas por Nóvoa (1992) e Tardiff (2012), e por outros pesquisadores que discutem a formação de professores, compreender que não é somente os saberes formais da academia que determinam o fazer do professor, mas que são essenciais outros saberes, como aqueles construídos ao longo de sua carreira, oriundos de suas práticas, à luz do que ocorre no cotidiano escolar, assim como aspectos de vida pessoal, que trarão novas discussões e avanços nos aspectos teóricos e práticos inerentes à carreira docente. Para tanto é importante que as pesquisas realizadas sobre o fazer dos professores considerem estes como sujeitos e não como meros objetos de investigação. Também propõe-se entender, por meio da metodologia desenvolvida por Nóvoa, por que alguns professores fazem uso da tecnologia da comunicação e da informação e outros não; o que se dá nesse processo que leva alguns professores a diferenciarem seus percursos pegagógicos de seus pares?
Study of Inter-arm Variation of Blood Pressure in Normal and Diabetic In-dividual in Out Patient Department of Nepal Medical College
Authors: Poudyel Pragati , Adhikari Seerina 
Published: May 2021

Introduction: Growing incidence of hypertension and its significant association with diabetes mellitus are being observed in both developing and developed countries around globe. Scanty literature is available about the comparative study of inter-arm variation of blood pressure in normal individuals and diabetic among Nepalese population. This research was performed to determine extent of inter-arm variation in normal individuals and diabetics.
Methods: A descriptive observational study was carried out from 2013 January to 2014 January in a tertiary level teaching hospital of Nepal. After taking the consent and giving necessary instructions, blood pressures were measured in both the arms one after another in sitting posture using mercurial sphygmomanometer and Littman cardiosonic stethoscope. Arterial blood pressure was measured by palpatory method followed by auscultatory method The cuff pressure at which the tap sound were first perceived was noted as systolic blood pressure (SBP). Similarly, diastolic blood pressure (DBP) was noted at the point where the sound disappeared.
Results: A total of 120 volunteers between ages of 40-80 years were studied. Highly significant inter-arm variation of both SBP and DBP was found in diabetics as compared to normal (p<0.01). Highly significant inter-arm variation was found in diabetic male and female as compared to their normal counter parts (p<0.01).
Conclusion: This study showed that there was significant inter-arm variation of SBP and DBP in diabetic and normal individual. So, this study encourages to measure blood pressure (BP) in both arms for proper treatment planning of an individuals.
A Notorious Mimicker Nasal Melanoma: A Case Report
Authors: Bastakoti Shankar , Kumar Gautam Dej , Raj Upreti Suraj , Jha Nandita , Dhungana Ishan 
Published: May 2021

Melanomas arising in the nasal cavity or paranasal sinus are rare and have a poor prognosis and is more aggressive than cutaneous counter part. The incidence rate reaches its peak when the patients are in the 5th to 8th decades of life, and the disease is slightly more common in males than females; age and sex do not affect the prognosis. We present a case with histologically deceiving features which was proven Malignant Melanoma by application of Immunohistochemistry. On sinoscopic examination, a mass noted of which incisional biopsy was obtained. Histologically, poorly differentiated Sinonasal carcinoma and Malignant Vascular Neoplasm was differential diagnosis.
On immunohistochemistry, strong expression of SOX-10, Melan-A, HMB-45 was observed and p63, CK-7, CK20, Synaptophysin, CD56, CD138, CD45, S100, Desmin, Myogenin were all non-immunoreactive. Thus Malignant Melanoma was final diagnosis.Awareness of melanoma mimickers is very important for clinicians in general, and
A Case Report of Angioplasty and Stenting Experience for Peripheral Arte-rial Disease of the Lower Limbs at Annapurna Neurological Institute
Authors: Raj Pandey Sandeep , Jha Anik , Acharya Sudikchya , Dhakal Sudan 
Published: May 2021

Atherosclerosis leading to stenosis or blockage in the major vessels of lower extremities causes peripheral arterial disease(PAD). PAD may be asymptomatic in early stage. But in late stage PAD present in the form of intermittent claudication (IC) or critical limb ischaemia (CLI) . The Fontaine classification is commonly used to measure the severity of disease which is staged from l-asymtomatic to lV-gangrene. PAD can be treated by medical , endovascular and surgical management
The purpose of this case report is to consider the effectiveness of primary stenting as a treatment management for peripheral artery disease of the lower extremities.
An Autopsy Study of Atherosclerotic Changes in Coronary Arteries at B.P. Koirala Institute of Health Sciences
Authors: Raman Parajuli Sudhir , Yadav Bishwonath , Karki Prahlad , Upadhyaya Paricha , Jha Shivendra 
Published: May 2021

Introduction: Atherosclerosis is a giant killer and the incidence of atherosclerosis in coronary arteries is rapidly increasing. The study was designed to assess the atherosclerotic lesions in coronary artery and to correlate the risk factors related to prevalence of atherosclerosis.
Methods: Heart from 100 medico legal autopsy cases ranging between ages 15 to 35 years which came to BPKIHS Dharan were taken for this study and processed for coronary arteries using conventional technique. They were then studied,and grading was done based on Modified American Heart Association (AHA) classification of atherosclerosis.
Results: Intimal thickening was noted in more than 90% in all three coronary arteries followed by intimal xanthoma whereas intermediate lesion for atherosclerosis was not found. Age, gender, smoking and alcohol in relation to atherosclerosis were found to be of no significance.
Conclusion: The study highlights the impact of atherosclerotic lesions in the Eastern region of Nepal. Meticulous postmortem examination along with histopathological study is the best possible way to study atherosclerotic disease in humans and risk factors associated with it.
Concatenations: On the Works of Olga Tokarczuk
Authors: Czapliński Przemysław , Woźniak Bartosz 
Published: May 2021

Abstract
This paper is a micro-synthesis of Olga Tokarczuk’s prose works. The initial assumption is that the main driving force in the author’s prose narratives is desire which determines the actions of her protagonists and influences the genre of said works. This assumption allows for discovery of discrete stages in Tokarczuk’s prose fiction. In the first stage from Podróż ludzi Księgi [The journey of the people of the book, 1993] to Prawiek i inne czasy [Primeval and other times, 1996], the strongest driving force is the desire for knowledge. In the second period from Dom dzienny, dom nocny [House of day, house of night,1998] to Bieguni [Flights, 2007] the desire is to focus on the Other, taking the form of solidarity. Finally, in the third period from the novel Prowadź twój pług przez kości umarłych [Drive your plow over the bones of the dead, 2009] to Księgi Jakubowe [The books of Jacob, 2014], the desire is directed against unjust laws, presupposing a recognition of the world order, and defining obligations towards other lives.
Time of Microhistory and Time of Micro-theater in Olga Tokarczuk’s Novels
Authors: Świerkosz Monika , Kowalcze-Pawlik Anna 
Published: May 2021

Abstract
This article details two ways of conceptualizing the experience of the past by the characters in Olga Tokarczuk’s prose fiction, which assume the form of a personal micronarration and the form of a microtheater. Utilizing Frank Ankersmit’s categorization of symbolic (metaphorical) signs and indexical (metonymic) signs, the article draws attention to the coexistence of different orders of speaking and staging (theatricalizing) history in the works under discussion. What is emphasized is the fundamental but ambivalent role of the body that as the vehicle of memory and an object of various processes of appropriation and reification. Such an ambiguous status of the body is underlined by the usage of the motifs often present in Olga Tokarczuk’s writing: those of the doll/puppet and of miniaturization. These speak to the desire to go beyond the anthropocentric vision of the human and the world, life and death, agency, and passivity.
Madwoman at Large: Prophetic Anger and Just Revenge in Olga Tokarczuk’s Drive Your Plow over the Bones of the Dead
Authors: Kowalcze-Pawlik Anna 
Published: May 2021

Abstract
This article explores the use of anger as a modus operandi of the protagonist in Olga Tokarczuk’s Prowadź twój pług przez kości umarłych [Drive your plow over the bones of the dead, 2009] and discusses the significance of intertextual indebtedness of the novel to William Blake’s poetry and the Romantic approach to anger for the construction of the plot and the main character. In order to achieve these ends, it elaborates on the generic provenance of Tokaruczk’s novel and provides a brief overview of Western approaches to anger. Attention to gendered aspects of noir fiction and the construction of anger in the Western tradition brings to light cultural presuppositions which affect the assessment of the vengeful impulse of the protagonist and which have possibly influenced the reception of the novel in Poland and abroad.
Transitievergoeding verschuldigd, en nu?
Authors: van Loon Thirza , Westland Lieke 
Published: May 2021

Transitievergoeding verschuldigd, en nu?
In dit artikel wordt ingegaan op de situatie dat een transitievergoeding verschuldigd is en alles wat daarbij komt kijken. De auteurs leggen uit welke looncomponenten wel of niet onder de transitievergoeding vallen en hoe de transitievergoeding berekend wordt. Verder wordt aandacht besteed aan de fiscale behandeling van de transitievergoeding en (gelijkwaardige) ontslagvoorzieningen.
Stereotactic Body Radiation Therapy (SBRT) for Liver Oligometastases: Outcomes and Safety
Authors: Cazic Dejan , Marosevic Goran 
Published: May 2021

<p class="Default"><strong>Objective. </strong>The aim of this study was to investigate adverse effects, progression free survival (PFS), one-year local control (LC) and one-year overall survival (OS) of patients with liver oligometastases treated with stereotactic body radiotherapy (SBRT), and whether there was a significant difference in these parameters in patients with primary colorectal cancer compared to other tumor localizations.</p><p class="Default"> <strong>Patients and Methods. </strong>Patients were simulated using four-dimensional computed tomography (4DCT). Using volumetric modulated arc therapy (VMAT) technique, SBRT was performed on 16 patients with &lt;3 liver metastases. The prescribed dose was 60 Gy in 8 fractions (BED 105 Gy). Cone beam CT (CBCT) was used for image guidance before each frac­tion with online correction.</p><p class="Default"><strong>Results. </strong>There were no adverse effects. Median PFS for all patients, patients with primary colorectal cancer, and patients with primary non-colorectal cancer was 11 months (SE 2.1), 16 months (SE 2.8), 6 months (SE 2.4), re­spectively. There was no significant difference in the PFS for these two observed groups (P=0.09). The one-year LC was 62.5%. Patients with primary colorectal cancer had one-year LC of 87.5%, while the group of patients with primary non-colorectal cancer had one-year LC of 37.5% (P=0.063). The total one-year OS was 87.5%. In the group of patients with primary colorectal cancer, the one-year OS was 100%, while in the group of patients with primary non-colorectal cancer, the one-year OS was 75% (P=0.317).</p><p class="Default"><strong>Conclusion. </strong>SBRT with 8 × 7.5 Gy can be safely delivered and is effective method of treating liver oligometastases.</p>
Independent Assessment of Current Floater Concepts for Floating Wind Application
Authors: Singhal Gaurav , Connolly Aengus , Laranjinha Manuel , McKinnon Colin , Mortimer Alan 
Published: May 2021

Most of the offshore wind developments to date, globally, have been bottom-fixed foundations located in shallow waters (&lt;30m water depth) and in close proximity to shore. However, as technology improves and as space for near-shore sites decreases, offshore wind development is projected to trend towards deeper waters. Floating wind is thus expected to become one of the leading renewable energy sources over the next decade or so. Notably, the success of pilot projects in Europe has confirmed the viability of floating wind technology, drawing in additional developers to the market. In the United States, there is a significant potential for floating offshore wind off the coast of California, Maine, and Hawaii. While the majority of current floating wind activity is concentrated in &lt;200m water depth, further technology improvement coupled with experience from floating oil and gas developments will lead to even deeper floating wind projects in the future.
One key aspect for floating wind technology is the floater foundation that will support the wind turbine assembly. The entire unit will be moored to the seabed and be subject to challenging environment conditions throughout its service life (akin to a floating oil and gas production facility). There are several floating wind concepts currently in the market - a handful are field-proven at pilot project scale but the majority are still in development phase, each with their own unique offering. The purpose of this paper is to perform an independent qualitative assessment of the current floating wind concepts. The assessment will focus on aspects related to technology readiness, design complexity and scalability, material selection, constructability, installation, operations, and maintenance. This paper provides the offshore wind industry with an unbiased opinion on available designs as well as an insight into perceived challenges for future developments. As a disclaimer, it is noted that Wood has utilized public-domain information for this study and has no preference towards any existing floating wind concepts or designs.
Patterns of torture among forcibly displaced Eritreans in California: A cross-sectional study
Authors: Portnoy P. Suzanne , Diaz Alejandro , Kupa Jenna , Rocroi Isabelle , Tatel Emily , Mehta Kala , Nelson Nicholas 
Published: May 2021

Abstract
Introduction: Unprecedented global increases in involuntary migration have created large populations of forcibly displaced people, who are disproportionately likely to have experienced abuse and torture. We undertook this study to better understand the frequency and consequences of specific types of torture and abuse within an immigrant population in our community, San Francisco, East Bay.
Methods and Results: We conducted a cross-sectional study of 59 Eritreans seeking asylum in the United States presenting to a human rights clinic for forensic medical and psychological evaluations. Demographic features of individuals, reported history and specific types of torture, and physical and psychological sequelae were analyzed. Over 300 instances of torture were reported, an average of about 6 per person. The primary forms of torture reported were beating and forced positioning, and many others were reported sporadically. 90% of asylum seekers examined had clinical findings which were consistent with the torture they reported, and some physical findings had clinical as well as forensic significance. 86% met diagnostic criteria for post-traumatic stress disorder.
Discussion: Forcibly displaced people are likely to have witnessed and experience violence, deprivation, and abuse, and for this reason bear a disproportionate burden of physical, psychological, and social morbidity. Our study describes the epidemiology of torture and its consequences in a specific population, and demonstrates why understanding local and general epidemiology of torture and other forms of abuse is necessary to provide excellent biopsychosocial care to forcibly displaced people.