Electronic Repositories Research Articles

Upper Gastrointestinal Disease Influences the Occurrence of Inflammatory Bowel Disease.

Compromise of the gastric acid barrier may facilitate bacterial invasion of the lower intestinal tract and influence the occurrence of inflammatory bowel disease (IBD). Our study tested the associations between histopathologic changes in the upper and lower gastrointestinal tract in patients undergoing bidirectional endoscopy. The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the entire USA. A case-control study among 302,061 patients, of whom 13,943 harbored IBD, evaluated whether the occurrence of Crohn's disease or ulcerative colitis was influenced by the presence of various upper gastrointestinal diagnoses associated with lowered gastric acid output. The influence of individual risk factors on the occurrence of colonic disease was expressed as odds ratios with their 95% confidence intervals. The odds ratio for Crohn's disease being associated with gastric H. pylori was 0.30 (0.24-0.37), with intestinal metaplasia 0.30 (0.24-0.39), with fundic gland polyps 0.42 (0.35-0.50), with gastric hyperplastic polyps 0.35 (0.23-0.51), with Barrett's metaplasia 0.19 (0.14-0.24), and with reflux esophagitis 0.46 (0.42-0.51). The odds ratio for ulcerative colitis being associated with gastric H. pylori was 0.58 (0.50-0.67), with intestinal metaplasia 0.39 (0.32-0.47), with fundic gland polyps 0.61 (0.53-0.71), with gastric hyperplastic polyps 0.64 (0.49-0.84), with Barrett's metaplasia 0.50 (0.43-0.59), and with reflux esophagitis 0.77 (0.71-0.84). A diminished gastric acid barrier function, as evidenced by various upper gastrointestinal diseases associated with lowered gastric acid output, may exert a protective influence against the development of inflammatory bowel disease.

Methodological quality of public health guideline recommendations on vitamin D and calcium : a systematic review protocol

IntroductionCurrent recommendations for vitamin D and calcium in dietary guidelines and bone health guidelines vary significantly among countries and professional organisations. It is unknown whether the methods used to develop...

2251. Estimating the Need for Novel Gram-Negative Active Antibiotics in US Hospitals

BackgroundAssessing the unmet need for novel antibiotics could inform appropriate utilization, enrollment in trials and ensure balance in aligning incentives and investments in therapeutic development.MethodsThe Cerner Healthfacts electronic health record repository was queried to identify inpatient treatment opportunities for Gram-negative active agents (GNAA) displaying either difficult-to-treat resistance (DTR; resistance to all β-lactams including carbapenems and fluoroquinolones) or extended-spectrum cephalosporin resistance (ECR). The former was quantified by aggregating episodes of confirmed DTR infection (i.e., DTR strain isolated and concomitant antibiotic(s) received) or suspected (i.e., 1–2 days of empiric colistin/polymyxin-B or aminoglycosides and no DTR pathogen isolated). Aggregate days of therapy (DOT) were reported as a range, multiplying episodes by site-specific or uniform 14-day treatment durations, respectively. Recursive partition and cluster analyses were performed for hospital characteristics and contributions of outbreaks to DTR treatment opportunities, respectively.ResultsBetween 2009 and 2015, across 2,996,271 encounters, 1,352 episodes of potential targeted treatment were identified, which combined with empiric treatment episodes, represent 39–138 DOT/10,000 encounters for a DTR-GNAA. Similarly, 9,535 episodes of potential targeted therapy for an ECR-GNAA were identified (representing 211-466 DOT/10,000 encounters). The most common candidate site and pathogens for DTR-GNAA were lower respiratory and A. baumannii and P. aeruginosa respectively; DTR bloodstream infections displayed the highest crude mortality at 45%. Enterobacteriaceae urinary infections dominated the ECR group. Teaching hospitals with ≥100 beds were the most likely to encounter a DTR infection; potential outbreaks contributed to 10.6% of DTR treatment opportunities.ConclusionThe candidate population for new antibacterials directed against highly resistant GN infections with limited treatment options is small but critical, indicating a role for non-revenue-based strategies to develop more effective antibiotics, as well as mechanisms to support trials that address real-world unmet needs. Disclosures All authors: No reported disclosures.

Interaction Between Ethnicity and Helicobacter pylori Infection in the Occurrence of Reflux Disease.

Few reports are available to reliably assess the ethnic distribution of Barrett metaplasia and reflux esophagitis. The present study served to analyze the joint influence of Helicobacter pylori infection and patient demographics on the diagnoses of Barrett metaplasia and reflux esophagitis. The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the United States. In a case-control study of 52,096 cases with Barrett metaplasia, 189,235 cases with reflux esophagitis, and 152,322 controls without any signs or symptoms suggestive of gastroesophageal reflux disease, we assessed the influence of age, gender, ethnicity, and H. pylori status on occurrence of Barrett metaplasia or reflux esophagitis. Barrett metaplasia was less common among East Asians (with odds ratio, 0.48; 95% confidence interval, 0.44-0.53) and Hispanics (0.60, 0.57-0.63) than other ethnic groups living in the United States. Reflux esophagitis was also less common among East Asians (0.86, 0.82-0.90), but more common among Hispanics (1.18, 1.14-1.21). Both types of esophageal disease were associated with a lower prevalence rates of gastric H. pylori infection than controls, with 0.48, 0.44-0.53 for Barrett metaplasia and 0.60, 0.57-0.63 for reflux esophagitis. The prevalence rates of gastric H. pylori and both esophageal diseases were greater in older than younger and male than female patients in all ethnic groups alike. Gastric H. pylori infection, ethnicity, gender, and age all influence the occurrence of Barrett metaplasia, and reflux esophagitis.

Crafting Critical Echoes in Sport Organizations: Oral Histories of, and Possibilities for, the New Zealand Olympic Committee

Sport organizations’ digital spaces (e.g. organizational websites, fanzines, blogs, electronic repositories and social media) are, potentially, rich empirical terrain in which sport narratives may be (re)presented, mobilised and challenged, and content disseminated to wider audiences. Drawing on New Zealand’s participation in the Olympic movement, and the national Olympic Committee’s efforts to embrace historical thinking, we consider the confluence of oral and digital approaches. More widely, we examine how sport organizations might utilise oral histories and digital spaces to engage audiences more effectively with critical understanding of the past. To note, progressive shifts in museum and heritage studies have advocated ideological and institutional redirection, critical reflection and radical departures from traditional representational practices. In these processes, oral histories have been identified as a key means to these ends. Presenting vignettes constructed from interviews with sport participants, we interrogate connections between oral history, narrative making and public heritage praxis.

Desafios para uma transformação pedagógica: ambientes educativos criativos e inovadores

The accelerated expansion and dissemination of digital technologies has been promotingcreativity and pedagogical innovation. In turn, creativity and innovation are today’s socialcapital. Education plays a key role in this process as it is the engine of economic, social and human development and the future of societies. In addition, the world has evolved with technology, based on two interdependent allies, creativity and innovation. The purpose of this study is to reflect on the importance of creative and innovative environments, which are an enabler of pedagogical transformation and social progress. Methodologically, it was used a bibliographical research collected in electronic repositories of free access from the descriptors educational environments, creativity, innovation and technologies. The results consistent with the literature suggest that the task is required of teachers to design environments that are conducive to the development of skills that reflect openness, coping with risk, critical thinking, flexibility, sensitivity, questioning and nonconformity, whose direct impact is fundamental to the process in the future life of students, in human development and in social progress.

Healthcare utilization in infants and toddlers with asthma-like symptoms.

Recurrent asthma-like symptoms are common in infants, but few population studies describe diagnostic and treatment practice. Using the electronic data repository of Clalit Health Services, the largest integrated health care provider in Israel, we evaluated children born 2005-2012, who before 3 years of age had >3 episodes of asthma-like symptoms and/or >2 bronchodilator purchases within a year. We described health care utilization and the odds ratio for subsequent utilization after 3 and 12 months' controller therapy. The primary outcome measure was respiratory-related doctor visits. Linear and categorical regression analysis measured overall effectiveness of therapy. Among 689 171 infants, 262 900 (38.1%) had > 3 asthma-like episodes/year during at least 1 year. Of those, 26 108 (10%) purchased controller therapy: 20 316 (77.8%) inhaled corticosteroids (ICS) with or without leukotriene receptor antagonists (LTRA), and 5792 (22.2%) LTRA alone. For these 26 108 over 3 months there were 93 845 respiratory-related doctor visits, 3110 hospital admissions, 5568 diagnoses of pneumonia, 9960 chest X-rays, 37 127 purchases for oral steroids, and 45 142 for antibiotics courses. Healthcare utilization decreased following ICS ± LTRA and LTRA alone, respectively, as follows: doctor visits 7% and 3%, chest X-rays 16% and 17%, bronchodilators 20% and 11%, systemic steroids 17% and 12%, and antibiotics by 35% and 22%, (P < .001 for all). Twelve months' therapy remained effective. Asthma-like symptoms are common in infants. Health care utilization is very high and physician practices should be reassessed. Following controller therapy, health care utilization decreased. Yet controllers were prescribed in only a minority of eligible children.

Quantitative analysis of a rare disease network\u2019s international contact database and E-repository provides insights into biobanking in the electronic consent era

BackgroundCastleman disease (CD) describes a group of rare and poorly understood lymphoproliferative disorders that include unicentric CD (UCD), Human Herpes Virus-8 (HHV8)-associated multicentric CD (HHV8 + MCD), and HHV8-negative/idiopathic MCD (iMCD). Efforts to advance research and drug discovery for CD have been slowed by challenges shared by other rare diseases, such as collecting and centralizing data and biospecimens for research. To collect disease characteristic data and identify individuals interested in contributing biospecimens for research, a global research organization - the Castleman Disease Collaborative Network (CDCN) - established an international Contact Database and electronic repository (E-repository). Herein, we performed analyses of these datasets to further characterize CD and gain insights into research biospecimen acquisition.ResultsDescriptive statistical analyses were performed on 891 participants from the Contact Database and 166 patients in the E-repository. The median age of patients at the time of enrollment in the Contact Database and E-repository was 42 ± 15.7 and 35 ± 14.8, respectively. The E-repository had increased representation from patients with MCD and the iMCD subtype compared to other sub-groups. Though the majority of participants were from the USA, a total of 49 countries on 6 continents were represented. Several patient characteristics in the Contact Database were associated with subsequent enrollment in the E-repository. There were significantly more MCD patients (p < 0.0001) and females (p = 0.002) enrolled in the E-repository compared to the Contact Database. Patient’s year of birth, date of registration, preferred method of communication, and relationship to the patient were also significantly associated with enrollment in the e-Repository.ConclusionsThis study of the largest- dataset of CD patients worldwide provides insights into disease phenotypes, characteristics of patients interested in contributing data and biospecimens for research, and methods for successfully acquiring data and biospecimens. Generally, the factors associated with enrollment in the E-repository represented severity of disease subtype, proximity to the research, and patient motivation. We hope that these findings and the sample documentation (e.g., electronic consent, recruitment materials) provided with this article will assist future rare disease efforts with overcoming hurdles.

Outcomes of Deceased Donor Kidney Transplantation Using Expanded Criteria Donor Kidneys Following Pulsatile Preservation.

AimWe compared the outcomes of transplanting expanded criteria donor (ECD) kidneys undergoing machine perfusion (MP) versus cold storage (CS).Material and methodsData on all expanded criteria deceased donor kidney transplants performed at the University of Pittsburgh Medical Center from January 2003 through December 2012 were collected from an in-house electronic repository. There were 78 patients in the MP group and 101 patients in the CS group. The majority of the ECD kidneys were imported from other organ procurement organizations: 69 of 73 in the MP group (94.5%, 5 from unknown sources); and 90 of 99 in the CS group (91%), 2 from an unknown source). Most of the patients in the MP group (77 of 78) received a combination of MP and static CS. MP was performed just prior to transplantation in all MP patients. We used descriptive statistics to characterize our sample. We used logistic regression analysis to model the binary outcome of delayed graft function (DGF; i.e., “yes/no”) and Cox (proportional hazard) regression to model time until graft failure. The Kaplan-Meier product-limit method was used to estimate survival curves for graft and patient survival.ResultsA total of 179 transplants were done from ECD donors (MP, 78; CS, 101). The mean static cold storage time was 14 ± 4.1 hours and the mean machine perfusion time was 11.2 ± 6.3 hours in the MP group. The donor creatinine was higher (1.3 ± 0.6 mg/dl vs. 1.2 ± 0.4 mg/dl, p = 0.01) and the cold ischemia time was longer (28.9 ± 10 hours vs. 24 ± 7.9 hours, p = 0.0003) in the MP patients. There were no differences between the two groups in DGF rate (20.8% [MP] vs. 25.8% [CS], p = 0.46), six-year patient survival (74% [MP] vs. 63.2% [CS], p = 0.11), graft survival (64.3% [MP] vs. 51.5% [CS], p = 0.22), and serum creatinine levels (1.5 mg/dl vs. 1.5 mg/dl) on univariate analysis. On unadjusted analysis, MP subjects without DGF had longer graft survival compared to CS subjects with DGF (p < 0.0032) and MP subjects with DGF (p < 0.0005). MP subjects without DGF had longer death-censored graft survival compared to CS subjects with DGF (p < 0.0077) and MP subjects with DGF (p < 0.0016). However, on regression analysis, MP subjects had longer graft survival than CS subjects when DGF was not present. MP subjects without DGF had longer patient survival compared to CS subjects with DGF (p < 0.0289), on unadjusted analysis. MP subjects had a reduced risk of graft failure (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.17, 0.68) and death-censored graft failure (HR, 0.44; 95% CI, 0.19, 1.00), compared to CS subjects when DGF was not present.ConclusionsReduction of DGF rates for imported ECD kidneys is vital to optimize outcomes and increase their utilization. One strategy to decrease DGF rates may be to reduce static CS time during transportation, by utilizing a portable kidney perfusion machine.

OPEN ACCESS TO SCIENTIFIC INFORMATION AS A FORM OF INFORMATION AND ANALYTICAL SUPPORT OF SCIENTIFIC ACTIVITIES AND COMMUNICATION

The article analyzes the issue of open access to scientific information, which is currently being discussed in national and foreign studies (V. Bykov, N. Veretennikova, L. Holovko, S. Ivanova, N. Kunanets, L. Luparenko, O. Novitsky, O. Spirin, T. Yaroshenko, A. Yatsyshyn, D. Salo, L. Thomas, F. Manista, et al.). The relevance of the issue is associated with the massive publication of scientific research results in the network, the creation of electronic scientific repositories, and building a specific informational scientific environment. Interpretations of the concepts “open access”, “open educational resources” (OER), “open knowledge”, “electronic open access journal systems” are given. The advantages of using open access to scientific information, features of the “green” and “golden” ways are determined, as well as the electronic platforms that host Ukrainian scientific open access e-journals are analyzed, which constitute the purpose of the article. It is emphasized that the key factors in the emergence of the movement to open access are intensive informatization of society, the emergence and rapid spread of the Internet, as well as the relatively high and ever-increasing price of a subscription to scientific journals. As a result, at the beginning of the 21st century, several international documents appeared, they declared free online access to scientific literature and introduced the concept of open access. Examples of information projects and portals that provide open access to Ukrainian scientific sources: “Scientific periodicals of Ukraine at OJS”, “Science of Ukraine: Access to Knowledge” are given. It is noted that the legal framework for open access is provided by Creative Commons licenses. Examples of open electronic journaling systems used in national scientific institutions are given: Open Journal System (OJS), Joomla! The conclusions prove that awareness of the policy of open access to scientific information and the study of the work principles of the open access scientific electronic publications are important parts of the scientific activity of higher education institution teachers, employees of scientific institutions, doctoral students, and post-graduate students.

Information Needs and Challenges of Agricultural Researchers and Extension Workers in Edo State, Nigeria

This study investigated information needs and challenges of agricultural researchers and extension workers in Edo State, Nigeria. Proportionate sampling technique was used to select 106 respondents. Descriptive and inferential statistics were used to analyse the data. The majority (71.6 %) of respondents indicated their need for information with respect to climate change and adaptation measures (71.6 %). Extension workers communicated more with agricultural researchers monthly (77.5 %). Lack of office-wide internet connectivity (2.06±1.08), unstable power supply (2.05±1.07), and non-subscription to relevant online resources by employer (2.05±1.07) inhibited respondents from meeting their information needs. The study recommends that to enhance knowledge sharing among researchers and extension workers, there is need for research institutes and state government to develop electronic repositories for their research outputs as this will further help other agricultural stakeholders to access local contents immediately.

P072: Comparing met vs. unmet palliative care needs in patients with end-stage conditions presenting to two Canadian emergency departments

Introduction: Patients with end-stage conditions require integrated physical, spiritual, psychological and social care. Despite efforts to provide comprehensive community care, those with severe symptoms often present to emergency departments (EDs) with palliative care (PC) needs. The objective of this study was to identify patients with end-stage diagnoses presenting to EDs, and to document and compare their PC needs. Methods: A four-month prospective cohort study was conducted in two Canadian EDs. Using a modified PC screening tool, volunteer emergency physicians identified adult patients with end-stage illnesses and documented their PC needs. This tool has the ability to classify patients as having met vs. unmet PC needs based on the documentation of risk factors. Research assistants documented demographic information, severity at presentation (Canadian Triage and Acuity Scale {CTAS}), disposition and revisits from an electronic repository. Bivariate comparisons between patients with met vs. unmet PC needs were completed. Results: Overall, 663 patients were enrolled, of which 78% (n = 518/663) were identified as having unmet PC needs according to the screening tool. Cancer was the most prevalent condition in each group (43% unmet needs, 37% met needs). There was no significant difference between the two groups in terms of age, sex or CTAS score. The unmet PC needs group was more likely to be admitted (68% vs. 50%; p = 0.0001) when compared to patients with PC needs assessed as being met. No significant difference was noted in terms of time to physician assessment or ED length of stay. The two groups did not significantly differ in the proportion of return visits within 30 days (34% vs. 32%) or the average number of return visits (3 vs. 2 visits). A higher proportion of patients with unmet PC needs made at least one visit to the ED in the 6 months prior to their index visit compared to patients with met PC needs (74% vs. 51%, p &amp;lt; 0.001); yet, the average number of ED visits was similar between the groups (3 visits). Conclusion: This study revealed that patients with end-stage diagnoses, especially cancer, commonly have unmet PC needs. They are also more likely to present to the ED and to require hospitalization than patients in whom PC needs have been met. Further investigations into their clinical profile and health care utilization may clarify the impact of their unmet PC needs on the healthcare system.

Study of the effectiveness of combinatorial protection algorithms based on the hardware and software of the electronic storage of corporate information systems

The paper presents experimental studies of combinatorial algorithms designed to calculate the composition and order of application of vulnerability parry tools, conducted on the basis of a typical electronic repository of the cultural institution information system. Experimental studies of data protection algorithms with the use of a neural network composition calculation unit and the order of application of vulnerability parry tools have been carried out. The proposed approach makes it possible to obtain a gain in time and efficiency (reliability) by using standard means of protecting software tools of large-scale electronic repositories, typical for large cultural institutions.

Cloud-Based Architecture to Implement Electronic Health Record (EHR) System in Pakistan

Electronic health record (EHR) systems are being used in several developed countries to minimize the problems and limitations of the conventional paper-based approach. However, several developing countries like Pakistan have not advanced significantly in adopting the new healthcare standards due to socioeconomic and technological constraints. Although there are some healthcare providers that are using their own EHRs, there is no electronic repository of patients’ electronic health data maintained at Government level. In this paper, a cloud-based architecture for the implementation of the EHR system for the hospitals of Pakistan is proposed. Adopting the proposed cloud-based architecture will be helpful in improving patient care, diagnostics, disease presentation, and round the clock availability of electronic health information. Moreover, the EHR system will help in reducing the cost of maintaining paper-based records. The development of such a system will not only enable the doctors and hospitals to exchange patients’ information with each other but will also establish electronic health data repository that subsequently can be used for diverse purposes, such as predictive diagnostics and personalized medicine.

A federated EHR network data completeness tracking system.

ObjectiveThe study sought to design, pilot, and evaluate a federated data completeness tracking system (CTX) for assessing completeness in research data extracted from electronic health record data across the Accessible Research Commons for Health (ARCH) Clinical Data Research Network.Materials and MethodsThe CTX applies a systems-based approach to design workflow and technology for assessing completeness across distributed electronic health record data repositories participating in a queryable, federated network. The CTX invokes 2 positive feedback loops that utilize open source tools (DQe-c and Vue) to integrate technology and human actors in a system geared for increasing capacity and taking action. A pilot implementation of the system involved 6 ARCH partner sites between January 2017 and May 2018.ResultsThe ARCH CTX has enabled the network to monitor and, if needed, adjust its data management processes to maintain complete datasets for secondary use. The system allows the network and its partner sites to profile data completeness both at the network and partner site levels. Interactive visualizations presenting the current state of completeness in the context of the entire network as well as changes in completeness across time were valued among the CTX user base.DiscussionDistributed clinical data networks are complex systems. Top-down approaches that solely rely on technology to report data completeness may be necessary but not sufficient for improving completeness (and quality) of data in large-scale clinical data networks. Improving and maintaining complete (high-quality) data in such complex environments entails sociotechnical systems that exploit technology and empower human actors to engage in the process of high-quality data curating.ConclusionsThe CTX has increased the network’s capacity to rapidly identify data completeness issues and empowered ARCH partner sites to get involved in improving the completeness of respective data in their repositories.

Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care.

To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. Retrospective cohort study. A 544-bed academic tertiary care hospital in Portland, Oregon. A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. Data were collected from an electronic repository of medical record data and a manual review of patients' discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients' discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication-related decisions. Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.

Экономические журналы: специализация против наукометрии

The article discusses the prospect of conserving the scientific journals in an environment where new technologies for scientific publications, informing about research projects and their results are used more and more. SSRN electronic repository, ResearchGate social network can serve as examples of such technologies. The Institute for Mandatory Peer Review of incoming materials stands out as a fundamental advantage of scientific journals. He takes the activities of a scientific journal beyond simple mediation between authors and readers, turns the journal into a link in the research process. The difficulties of obtaining a high place in a general ranking table by a specialized magazine are presented. The relationship between the average value of the Hirsch index of the authors of the journal and its impact factor is considered. The formation of separate ratings for journals of similar specialization is proposed. The increased sensitivity of specialized journals to the volatile dynamics of scientific publications is noted. Fluctuations in the share of basic research funding in total research and development funding is one factor in this variability.

Portuguese-speaking countries and the challenge of a technological circumnavigation

In this article, I propose the assumption that we are making a technological journey, analogous in many respects to European ocean voyages of the 15th and 16th centuries (Martins, 2015a, 2017, 2018a, 2018b). Thus, I confront the technological nature of the current financial globalization and the commercial nature of European maritime expansion. Whereas the first journey resulted in the colonization of peoples and nations, in the second journey we moved, in a century and a half, to that which Edgar Morin called the “colonization of the spirit” of the entire human community (Morin, 1962). Within this context, I took into consideration the consequences, for culture, of the acceleration of the time via technology, which has mobilized human beings, “totally” (Jünger, 1930) and “infinitely” (Sloterdijk, 2010), in view of the urgencies of the present (Martins, 2010). On the other hand, I will use post-colonial studies to situate transnational and transcultural identities, by examining Portuguese-speaking communities within the context of the “battle of languages,” to use an expression coined by Mozambican linguist Armando Jorge Lopes (2004). This is why I will consider “technological circumnavigation” (Martins, 2015a, 2017, 2018a, 2018b), to be undertaken by every Portuguese-speaking country, like a fight for the world’s symbolic ordering (Bourdieu, 1977, 1979, 1982), where we raise hegemony language-related problems and those pertaining to political, scientific, cultural and artistic subordination (Martins, 2015b). This is, therefore an electronic journey, using sites, portals, social media, digital repositories and archives, as well as virtual museums. What’s more, the viewpoint adopted is that which states a great language of cultures and thinking, such as Portuguese, likewise cannot avoid being a great language of human and scientific knowledge.

Varied presentations and outcomes of Charcot neuroarthropathy in patients with diabetes mellitus

Charcot neuroarthropathy (CN) of the foot is uncommon and CN of atypical sites like wrist is sparingly described. CN is grossly under-diagnosed or misdiagnosed by primary care physicians. CN may present in acute phase with classical signs of inflammation or with deformities in chronic phase. The present study describes varied presentations, diagnostic dilemmas, and outcomes of CN in patients with diabetes. Data from the electronic repository of patients with diabetes and foot complications was obtained. The repository has a pre-designed structured format for information pertaining to the patients’ anthropometry, presentation, neurological, vascular and foot examination details, treatment offered, and outcomes on follow-up. In addition, literature search for prior reported cases of atypical site (wrist) of CN was conducted. Data of 206 subjects with foot CN and two cases of atypical joint amongst 1297 patients with diabetes mellitus was screened. The particulars of patients with varied presentation viz. acute phase (case 1), stable foot deformities in chronic phase (case 2), and unstable foot with destruction of ankle joint in hindfoot CN (case 3) are presented along with the differential diagnosis and their outcomes on follow-up at 36 months of presentation. A literature search for atypical site of CN revealed only nine cases of wrist CN. The diagnosis of wrist CN was not initially considered and misdiagnosed. Patient with CN may present in active phase or more commonly with deformities and destroyed joints. The acute CN is misdiagnosed as cellulitis and inadvertently treated with antibiotics. Wrist and MCP joint CN is extremely rare and the diagnosis of CN requires a high index of suspicion supported by radiography findings.

OjO Latino: A Photovoice Project in Recognition of the Latino Presence in Pittsburgh, PA

In recent years, the Latino population has increased rapidly in areas with traditionally low concentration of Latinos. In these emerging communities, Latinos often live scattered, confronting social isolation and social services not tailored to serve their cultural and linguistic needs. Latinos’ invisibility in Pittsburgh is evidenced by the absence of records of the Latino presence in the city’s museums and public archives. OjO Latino, a community engaged project, sought to advance the inclusion of the Latino community in Pittsburgh through Photovoice. This participatory expression methodology enables individuals to share their stories with the larger public through cultural and artistic expression. The intentional organization of the project as a group activity facilitated the transfer of power over the project to participants, creating solidarity and fomenting trust. During four meetings participants took part in a short photography training, discussed their photographs addressing the meaning of being Latino in Pittsburgh, and selected 34 photographs for exhibition organizing them in four themes: Work, Costumes, Family and Landscape and climate. OjO Latino held one exhibit in a community venue and another one at the university. In addition, the photographs are available in an electronic public repository. OjO Latino served a dual purpose of expanding the visibility of Latinos in and educating the larger community. The OjO Latino team got closer to the ways Latino immigrants see and experience the city. Their gaze challenged our own views and experiences and also spoke the saliency of nostalgia and social networks in their lives. The open discussion of what it means to be Latino in an emerging community and the opportunity to produce a visual account of it, along with the acknowledgment of the presence of this diverse population promote human rights, ethnic identity as well as mental and social health.