Hasil untuk "American literature"

D. Ross, H. Burch, D. Cooper et al.

A. Holland, M. Spruit, T. Troosters et al.

D. Lloyd‐Jones, Yuling Hong, D. Labarthe et al.

M. Nelson, W. Rejeski, S. Blair et al.

A. Davis, J. Carcillo, R. Aneja et al.

M. Gulati, P. Levy, D. Mukherjee et al.

AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.

D. Ferriero, H. Fullerton, T.J. Bernard et al.

Purpose— Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke. Methods— Members of the writing group were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and the American Heart Association’s Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results— Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions— Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field.

A. Towfighi, B. Ovbiagele, Nada El Husseini et al.

Ana Kocić Stanković, Dušan Stamenković

The paper considers Percival Everett’s novel James (2024) and its peculiar technique as an example of resignification and a contemporary reworking of Twain’s Adventures of Huckleberry Finn and American minstrel shows. The theoretical framework is based on Judith Butler’s idea of resignification and Eric Lott’s considerations of the notion of minstrelsy, highlighting the connections between the two. As the key aspect of both Everett’s novel and a minstrel show is performativity/performance, this notion is discussed in detail with a special emphasis on its use in the novel. We argue that Everett’s innovative and subversive use of language, and his decision to tell the story of the birth of a hero from the point of view of Jim/James, the (in)famous stereotypical slave character of Twain’s narrative, represents an instance of anti-minstrel fiction and thus sets new standards in contemporary (African) American literature. We argue that Jim’s/James’ journey from a runaway slave and a comic relief in Twain’s classic to a hero of his own narrative can be interpreted as an example of resignification, i.e., ‘enacted critique’, a deliberate, deviant, mis-performance (Loxley, 2006, 127) which paves the way for new roles and meanings in contemporary (African) American literature.

Jasmine D. Johnson, J. Louis

The burden of preeclampsia, a significant contributor to perinatal morbidity and mortality, is not born equally across the population. While the prevalence of preeclampsia has been reported to be 3-5%, racial and ethnic minority groups such as non-Hispanic Black women and American Indian/Alaskan Native women are widely reported to be disproportionately affected by preeclampsia. However, studies that add clarity to the causes of the racial and ethnic differences in preeclampsia are limited. Race is a social construct, often self-assigned, is variable across settings, and fails to account for subgroups. Studies of the genetic structure of human populations continue to find more variation within racial groups than between them. Efforts to examine the role of race and ethnicity in biomedical research should consider these limitations and not use it as a biological construct. Further, the use of race in decision-making in clinical settings, may worsen the disparity in health outcomes. Most of the existing disparities data examines the differences between White and non-Hispanic Black women. Fewer studies have enough sample size to evaluate outcomes in the Asian, American Indian/Alaska Native, or mixed-race women. Racial differences are noted in the occurrence, presentation, and short term and long-term outcomes of preeclampsia. Well-established clinical risk factors for preeclampsia such as obesity, diabetes, and chronic hypertension disproportionately affect non-Hispanic Black, American Indian/Alaskan Native and Hispanic populations. However, with comparable clinical risk factors for preeclampsia, among women of different race or ethnic groups, addressing modifiable risk factors has not been found to have the same protective effect for all women. Abnormalities of placental formation and development, immunologic factors, vascular changes, and inflammation have all be identified as contributing to the pathophysiology of preeclampsia. Few studies have examined race and the pathophysiology of preeclampsia. Despite attempts, a genetic basis for disease has not been identified. A number of genetic variants, including APOL1, have been identified as possible risk modifiers. Few studies have examined race and prevention of preeclampsia. Although low dose aspirin for the prevention of preeclampsia is recommended by the US Preventive Service Task Force, a population based study found racial/ethnic differences in preeclampsia recurrence after implementation of low dose aspirin supplementation. After implementation, recurrent preeclampsia reduced among Hispanic women (76.4% vs. 49.6%; p <.0001), but there was no difference in recurrent preeclampsia in non-Hispanic Black women, (13.7 vs. 18.1, p=0.252). Future research incorporating the National Institute on Minority Health and Health Disparities (NIMHD) Multilevel Framework, specifically examining the role of racism on the burden of disease, may help in the quest for effective strategies to reduce the disproportionate burden of preeclampsia on a minority population. In this model, a multilevel approach provides a more comprehensive approach and takes into account the influence of behavioral factors, environmental factors, and healthcare systems, not just on the individual.

Carson McKoon BA MS, Paul Pottanat MD, Joshua Morningstar BS et al.

Submission Type: Ankle Fractures Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Estimated glomerular filtration rate (eGFR) is commonly used as a preoperative evaluation of kidney function in patients undergoing surgery. To date, there is a paucity of literature investigating the effect of eGFr on outcomes following ankle fracture open reduction and internal fixation (ORIF). As such, this study aims to analyze the effect of kidney function, as measured by eGFR, on short-term adverse outcomes following ankle fracture ORIF procedures. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 – 2019 to identify patients undergoing ankle ORIF. After exclusion of patients missing data for age, race, gender, preoperative creatinine, or with eGFR greater than 3 standard deviations from the mean (91.1 mL/min/1.73 m2), 21,815 patients met criteria for the study. Patients were grouped by eGFR into cohorts: ESRD ( < 15 [1.49%]), moderate to severe kidney function loss (15-60 [17.73%]), mild kidney function loss (60-90 [33.76%]), and normal kidney function (>90 [47.01%]). Results: Nearly half of patients were found to have “normal” eGFR criteria of greater than 90mL/min/1.73m2. As eGFR decreased, indicating poorer kidney function, patient age (p <.001), BMI, rate of female sex, and rate of numerous comorbidities statistically significantly increased. Multivariate regression to control for differences in demographics and comorbidities found that as compared to a normal eGFR, patients with ESRD or moderate to severe loss of kidney function had statistically significantly predicted increased risk of any complication (ESRD: Odds Ratio [OR]=1.505)(15-60:1.261), reoperation (ESRD: OR=1.706)(15-60: 1.314), and readmission (ESRD: OR=1.890)(15-60: 1.649). Conclusion: Low eGFR values, indicative of kidney injury or disease, are significantly predictive of increased risk of postoperative complications, reoperation, and readmission for patients undergoing ankle fracture ORIF. This finding should be considered by surgeons and patients when considering ankle ORIF for patients with decreased kidney function.

A. Guzmán-Holst, R. DeAntonio, D. Prado-Cohrs et al.

Current vaccination coverage rates in Latin America and the Caribbean (LAC) are lower than the region-wide rates set by the Pan American Health Organization. To improve vaccination uptake, it is crucial to identify barriers to vaccination. We conducted a systematic literature review to identify the key barriers to vaccination in the LAC region, and to classify and quantify factors affecting vaccination coverage using the barrier categories outlined by the Strategic Advisory Group of Experts (SAGE) working group. We mapped knowledge gaps in the understanding of region-specific and population-specific vaccine hesitancy. Nine databases (Medline via PubMed, Web of Science, LILACS, MedCarib, SciELO, Scopus, PATH, SAGE Online and Google Scholar) were searched for articles published in English, Spanish and Portuguese up to 15 July 2017. A total of 6867 articles were identified of which 75 were included in the review. Majority of the articles were quantitative in nature and nearly half from Brazil. Many other countries in LAC have limited published evidence on barriers to vaccination. The most commonly investigated target population was parents (of children <8 years of age [yoa] and adolescents 9-10 yoa) but there was a balance in the number of publications that reported on influenza, childhood and human papillomavirus vaccination. There was limited direct evidence which reported insights on the new generation of childhood vaccines (pneumococcal or meningococcal vaccines) or studies targeting adolescents and pregnant women. Among the SAGE barrier categories, 'individual/group influences' were the most frequently reported barrier category (68%) followed by 'contextual influences' (47%). Adverse socioeconomic factors, a low level of education, lack of awareness of diseases and their vaccines, religious and cultural beliefs are commonly cited as obstacles to vaccination acceptance. Additional evidence is needed to fully understand the barriers to vaccination for different target populations, countries in the region and specific vaccine types.

Cecilia Mafla

Archivo histórico de Kipus: Revista Andina de Letras y Estudios Culturales, 2005.

Oliver Sogard MD, John McDonald BS, Michael Elder Waters MD et al.

Category: Ankle; Trauma Introduction/Purpose: Ankle instability associated with fractures have increased surgical complexity and worse outcomes. Both the deltoid ligament and the syndesmotic ligament complex play pivotal roles in maintaining ankle stability. Medial clear space (MCS) widening serves as an indicator for ankle instability. Trans-syndesmotic fixation following open reduction and internal fixation of distal fibula has been used commonly to restore stability in unstable ankle fractures with MCS widening. Alternatively, anatomic repair of the deltoid ligament offers another approach for addressing MCS widening. However, there is no consensus on the best method for stabilizing the ankle. This study aims to provide a comprehensive analysis of current literature to compare the outcomes of trans-syndesmotic fixation and anatomic deltoid ligament repair in the treatment of unstable ankle fractures with MCS widening. Methods: This comprehensive literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing databases such as PubMed, Embase, Web of Science, and the Cochrane Library. The search was conducted on October 15, 2023. The criteria for including articles in this study were: (1) Patients who had undergone surgical fixation for unstable ankle fractures with medial clear space (MCS) widening, (2) Studies comparing clinical outcomes between trans-syndesmotic fixation and anatomic deltoid ligament repair to address MCS widening, (3) Studies reporting on at least one of the following outcomes: malreduction rates, necessity for hardware removal, wound complications, reoperation rates, and functional outcomes, including AOFAS (American Orthopaedic Foot and Ankle Society) scores and VAS (Visual Analog Scale) pain scores. Exclusion criteria eliminated studies involving: (1) Patients with medial malleolar fractures, (2) Revision surgeries, (3) Non-English publications, and (4) Case reports, systematic reviews, comments, editorials, surveys, or cadaver studies. Results: In this meta-analysis, a total of five studies were included. Medial clear space widening was treated with trans-syndesmotic screw fixation in 165 unstable ankle fractures, while 115 ankles underwent anatomic repair of the deltoid ligament. Anatomic deltoid ligament repair was significantly associated with a reduced risk of syndesmotic malreduction (Risk Ratio (RR)=0.26, 95% Confidence Interval (CI) = [0.10, 0.68]) and a lower likelihood of postoperative hardware removal (RR=0.06, 95% CI = [0.02, 0.14]). No significant differences were found in minor or major wound complications, reoperation rate, AOFAS and VAS scores. These findings highlight the advantages of anatomic deltoid ligament repair, which provides a more precise reduction of unstable ankle injuries with MCS widening and a reduced need for postoperative hardware removal, compared to trans-syndesmotic fixation. Conclusion: This study evaluated postoperative outcomes between trans-syndesmotic fixation and anatomic deltoid ligament repair in addressing MCS widening. Our analysis revealed that anatomic deltoid ligament repair resulted in a significantly lower rate of malreduction and a decreased necessity for postoperative hardware removal compared to trans-syndesmotic screw fixation. Both techniques showed similar rates of wound complications, reoperation, and equivalent functional and pain scores. These results call into question the trans-syndesmotic fixation alone for unstable ankle fractures with MCS widening. Anatomic repair of the deltoid ligament should be considered as a viable option to restore stability in unstable ankle fractures with MCS widening.

Gregory ambrano

Archivo histórico de Kipus: Revista Andina de Letras y Estudios Culturales, 1999.

Maciej Niewada, Maciej Niewada, Tomasz Macioch et al.

Introduction: The combination of immunotherapy and targeted therapy is currently marking a new era in the treatment of renal cancer. The latest clinical guidelines recommend the use of drug combinations for the first-line treatment of advanced renal cancer. The aim of this review is to compare the efficacy of combined cabozantinib + nivolumab therapy with other immune checkpoint inhibitors combined with tyrosine kinase inhibitors or monoclonal antibodies blocking the CTLA-4 (cytotoxic T cell antigen 4) in the first-line treatment of metastatic clear-cell renal cell carcinoma (RCC).Methodology: A systematic literature search was carried out in the PubMed and EMBASE databases. Randomized controlled trials (RCTs) on therapies recommended by the latest EAU and ESMO guidelines for treatment-naïve metastatic RCC (i.e., lenvatinib + pembrolizumab, axitinib + pembrolizumab and nivolumab + ipilimumab) were searched. A network meta-analysis (NMA) was performed for data synthesis. The methodology of included RCTs was assessed using the Cochrane RoB two tool. The data were analyzed in the overall population as well as in risk subgroups defined according to the International Metastatic Database Consortium (IMDC) i.e., patients with a favorable and intermediate or poor prognoses. The most recent cut-off dates from included studies were analyzed.Results: Four RCTs (CheckMate 9 ER, KEYNOTE-426, CLEAR and CheckMate 214) were included in the review. No studies directly comparing cabozantinib + nivolumab with any of the drug combinations included in this review were available. NMA showed that cabozantinib + nivolumab was superior compared to axitinib + pembrolizumab and nivolumab + ipilimumab in all analyzed comparisons (overall population and IMDC risk subgroups), both in terms of overall survival and progression-free survival (PFS). The advantage of cabozantinib + nivolumab was statistically significant only for PFS when compared to nivolumab + ipilimumab in the overall population. The results for the comparison of cabozantinib + nivolumab with lenvatinib + pembrolizumab showed numerical superiority of lenvatinib + pembrolizumab combination in terms of overall survival, but none of the results were statistically significant. The advantage of lenvatinib + pembrolizumab over cabozantinib + nivolumab in terms of PFS was statistically significant in the overall and favorable prognosis population.Conclusion: Inclusion of the most recent cut-off data from CheckMate 9 ER did not affect the role of the cabozantinib + nivolumab combination for treatment-naïve metastatic RCC. Cabozantinib + nivolumab is an effective therapeutic option for the first-line treatment of advanced renal cancer that is recommended both in the latest European and American guidelines for all IMDC risk groups.

Jimena Victoria Torres Marco

En el presente artículo se analiza la relación sentimental planteada por Andrea Jeftanovic en su novela Geografía de la lengua (2007). Esta relación surge en un no lugar, se construye a través del medio tecnológico y genera en sus protagonistas una confusión entre la realidad y la ficción. Estos rasgos, que la crítica ha adscrito a la narrativa del simulacro, constituyen los vectores principales de este análisis. El objetivo de este artículo es subrayar el tratamiento literario de los distintos condicionantes que atraviesa una relación sentimental sometida a la distancia física y a la tecnología.

Scott A. MacLeod, Philip W. S. Newall

International research has shown that live sports commentary exhibits racial bias. Specifically, non-White players are more likely to be praised in terms of their physicality, while White players are more likely to be praised in terms of their intellect and character. The current study, which utilised a quantitative content analysis design, examined whether the speech of AFL commentators exhibited racial bias. The study randomly selected 50 men’s AFL game quarters from the 2019 AFL season and analysed 1368 applicable statements directed at 382 unique players. Based on prior research, a coding instrument was developed that incorporated three main categories (physical, cognitive, and character attributes), and six subcategories (physical ability, appearance, cognitive ability, intelligence, general character, and hard work). In contrast to the international literature, findings revealed that there were no significant between-race differences for each main attribute category. However, non-White players received a higher proportion of statements related to their physical ability, and a lower proportion of statements related to their appearance compared to White players. Non-White players also received a higher proportion of negative statements related to their cognitive ability compared to White players. There was no evidence found to suggest that players of any race were discussed in terms of their physical ability being innate, natural, or instinctual. Given the strong, but also dated, evidence showing racial bias within both American and European sports commentary, the current study provides only weak evidence for the existence of racial bias within contemporary AFL live commentary.

Anna Pawlikowska-Gorzelańczyk, Ewa Szuster, Paulina Kostrzewska et al.

Introduction and purpose Nowadays obesity has become a main problem in the world’s population and it is beginning to replace undernutrition and infectious diseases. Over the years perception of obesity has diametrically changed. Obesity is no longer the result of bad choices but serious medical problem. The aim of this study is to show how changes in perception of obesity affect the obesity pandemic. Review methods The literature review included articles available on the websites of health-related organizations and databasis on PubMed. As a part of analysis systematic search of current scientific data was performed. Description of the state of knowledge Obesity is defined as an abnormal or excessive fat accumulation and in adults BMI ≥30 is necessary to recognize it. Obesity has plenty of consequences such as diabetes, hypertension, cancers etc. In June 2013 the American Medical Association made a decision to recognize obesity as a disease. That changed the perception of obesity by the public and caused many actions in prevention and treatment. Management of obese patient consists of diagnosis the obesity-causing diseases, recognition of eating and physicall activity habits. Surgical as well pharmacological treatment is available and should be individually considered. Summary Recognition of obesity as a disease requires health organisations to build special prevention and treatment programs. Nowadays there is an array of treatment methods for obesity. However the most important method to stop the pandemic is education and promotion of a healthy lifestyle, according to the motto, prevention is better than cure.

Amjad Ashoorioon, Kazem Rezazadeh, Abasalt Rostami

Releasing the 12.5-year pulsar timing array data, the North American Nanohertz Observatory for Gravitational Waves (NANOGrav) has recently reported the evidence for a stochastic common-spectrum which would herald the detection of a stochastic gravitational wave background (SGWB) for the first time. We investigate if the signal could be generated from the end of a ∼10 MeV but still phenomenologically viable double-field inflation when the field configuration settles to its true vacuum. During the double-field inflation at such scales, bubbles of true vacuum that can collapse to LIGO mass, and heavier primordial black holes form. We show that only when this process happens with a first-order phase transition, the produced gravitational wave spectrum can match with the NANOGrav acclaimed SGWB signal. We show that the produced gravitational wave spectrum matches the NANOGrav SGWB signal only when this process happens through a first-order phase transition. Using LATTICEEASY, we also examine the previous observation in the literature that by lowering the scale of preheating, despite the shift of the peak frequency of the gravitational wave profile to smaller values, the amplitude of the SGWB could be kept almost constant. We notice that this observation breaks down at the preheating scale, M≲10−14mPl.