Search Results (95)

Past archaeological practices have resulted in a distorted history of Native American cultures based upon western-biased research. This has been especially apparent in the rock art of the Klamath Basin in southern Oregon and northern California. In response to this, Native and non-Native scholars are striving to develop a counter-discourse that both challenges and replaces western constructs in research on Native American communities. The result of this approach is a growing trend within the discipline that has come to be called “Indigenous Archaeology.” Critical to this approach is that Native voices are transported from the margins of the research to its center, where they are intended to replace the Western colonialist narrative. Unfortunately, Native American tribal communities have been the targets of federal assimilation policies for the past few centuries, and as a result, much of their cultural knowledge unwittingly carries forward this distorted past. In this paper I explore a framework built upon ethnographic accounts of shamanism and rock art, along with a robust familiarity with local myth, and how this provides a foundation of traditional cultural knowledge against which to compare and evaluate the interpretive statements made in contemporary tribal members about rock art and other sacred material culture. Full article

Background: The management of difficult airways is one of the most critical and challenging aspects of emergency and ICU care. Despite technological advances, unanticipated airway difficulty can result in serious complications, including hypoxia, brain injury, and death. This comprehensive narrative review aims to consolidate current algorithms and evidence-based strategies to guide clinicians in the assessment and management of difficult airways. Methods: A comprehensive literature review was conducted using PubMed, Embase, and Google Scholar to identify relevant studies, clinical guidelines, and expert consensus documents related to difficult airway management. The focus was placed on both pre-intubation assessment tools and intervention strategies used in various clinical contexts. Results: Airway difficulty is best anticipated through a combination of history, physical examination, and validated tools such as the Mallampati score. Several algorithms, including those from the American Society of Anesthesiologists (ASA) and the Difficult Airway Society (DAS), provide structured approaches that emphasize preoxygenation, preparedness for failed intubation, and the use of adjuncts such as video laryngoscopy, supraglottic airway devices, and awake intubation techniques. Crisis algorithms such as the Vortex approach help simplify decision-making during emergencies. It is important to have adjuncts available in cases of anticipated difficult airways, such as fiberoptic intubation, while surgical airway access is an important component of a stepwise airway management algorithm when critical scenarios are encountered. Conclusions: Effective difficult airway management requires anticipation, a structured plan, familiarity with advanced airway tools, and adherence to validated algorithms. Training in crisis resource management and multidisciplinary rehearsal of airway scenarios are essential to improving outcomes. Full article

Objectives: Pott’s puffy tumor (PPT) is a rare and life-threatening infection of the frontal sinuses, predominantly affecting children but with less frequent reports in adults. Therefore, we present an analysis of one hundred and eighty-one cases of adult patients diagnosed with PPT, along with a description of one of our cases. The purpose of this research is to identify the most common symptoms, predisposing medical history, predominant microorganisms, commonly used antibiotics, treatment options, long-term outcomes, and possible complications in adults. Despite its rarity, PPT has a dynamic course, necessitating familiarization with appropriate treatment methods to improve patient well-being. Methods: Methods involved a systematic search of PubMed, Medline, Google Scholar, Web of Science, EBSCO, and Scopus, following PRISMA guidelines. A total of 122 articles were screened, providing 180 adult patients aged 18 to 86, alongside 1 additional patient treated at our institution, bringing the total to 181 patients. Results: The results showed that the patients ranged from 18 to 86 years of age (mean age of 47 years), with 72.2% being males. The most common symptoms were forehead swelling (74.7%), frontal headache (67%), fever (59.3%), and acute/chronic rhinosinusitis (39.6%). The risk factors associated with its development include sinusitis (49.5%) and previous head trauma (12.6%). Intracranial involvement was found in 38.1% of patients. Streptococcus spp. (19.3%) and Staphylococcus spp. (16.6%) were the most commonly identified pathogens. Surgical intervention was employed in 87.3% of cases, with a mean hospital stay of 23 days. There was no significant difference in hospital stay or rehospitalization rates between those with and without intracranial involvement. Antibiotic therapy was used in 87.3% of cases, with a mean duration of 61 days. A combination of Cephalosporin, Metronidazole, and Nafcillin was the most common empirical antibiotic therapy. The mean follow-up period was 14 months, with a mortality rate of 1.6%. Conclusions: The conclusion highlights the importance of the prompt initiation of empirical antibiotic therapy, followed by targeted treatment based on microbiological cultures. Recognizing that PPT symptoms are not exclusive to pediatric patients but can also affect adults is crucial. PPT warrants further research to optimize its management and outcomes. It is believed that PPT may be more treatable in adults when identified early, which emphasizes the need for PPT recognition among adults. Timely empirical antibiotics based on microbiological results, along with appropriate surgical intervention, are critical for improving outcomes. Multidisciplinary care involving otolaryngologists, neurologists, and infectious disease specialists is essential. Further studies should be developed for the evaluation of diagnostic protocols and long-term management strategies. Full article

The use of ileum for ureteral reconstruction was first described in 1906. Since then, its utilization has evolved considerably. Early in the history of ileal ureters, urologists were limited by a lack of familiarity with bowel harvesting and handling. The popularization of ileal conduits for urinary diversions, however, allowed urologists to familiarize themselves with the use of ileum and paved the way for broader applications. With the emergence of laparoscopy and, later, robotic-assisted surgery, the application of ileal ureteral replacement expanded the capabilities of reconstructive urologists. This article describes the historical development of surgical techniques for ileal ureter replacement and the integration of new technologies aiding in improved outcomes, and anticipates potential future directions. In contemporary practice, robotic-assisted ileal ureteral replacement is used in cases of extensive ureteral obstruction or damage. Advantages of the robotic platform include reduced blood loss, shorter recovery time and hospital length of stay, and superior operative ergonomics. Although robotic ileal ureter replacement is a complex and challenging surgery with notable complications, studies have demonstrated the efficacy and safety of this technique in patients with an otherwise end-stage ureter. In addition, the robotic approach has provided urologists the ability to conduct complex reconstructive surgeries including bilateral ureteral replacement in conjunction with bladder augmentation or a urinary diversion. Long-term studies and continued innovation are necessary to further improve the surgical techniques, outcomes, and scope of ileal ureter reconstruction. Full article

Background and Clinical Significance: Pylephlebitis is a suppurative thrombophlebitis of porto-mesenteric veins. It is a rare complication of intraabdominal infection or inflammation. Case Presentation: A 46-year-old female patient presented to the Emergency Department (ED) with a three-day history of subfebrile body temperature (37.5 °C) and dull pain in the right lower abdominal quadrant propagating to the left lower quadrant, with frequent bowel movements and liquid stool consistency. Inflammatory markers were elevated. Following transabdominal ultrasound, possible diagnoses were inflammatory changes of the appendix or sigmoid colon. She was given oral antibiotics and discharged home with a surgical follow-up the next morning. The next day, due to the worsening of the symptoms, surgery was performed with no additional imaging studies. Intraoperative findings were diverticulitis of the sigmoid colon with perforation and peritoneal inflammation, and primary anastomosis with a diverting ileosotomy was performed. The patient was discharged from the hospital after seven days with completed antibiotic treatment. Twelve days later, the patient presented to the ED with a two-day fever (38 °C), elevated inflammatory markers and imaging findings consistent with pylephlebitis: complete left portal vein thrombosis, partial thrombosis of the segmental branch of the right portal vein and thrombosis of the inferior mesenteric vein. The administration of anticoagulants and antibiotics started and after nine days she was discharged home. Conclusions: Timely treatment is a necessity in patients with diverticulitis to prevent complications. Furthermore, clinicians and radiologists should be familiar with vascular complications of diverticulitis because their detection and the following treatment can prevent more extensive disease. Full article

The centrality of disruption as a graced moment of awakening social imagination to a new dawn where human flourishing becomes a possibility ought to be the focus of the church’s praxes of sacramental rituals. In fact, Christianity is itself a religion of disruption. The God–human reality that manifests itself in Jesus Christ is itself a graced disruption. God chooses to disrupt the familiar world of fallenness and thus offers God-self as a mediating gift that reorients creation to a new way of being that transcends the familiar orientation towards sin. Disruption, as an existential phenomenon, is not alien to the human condition. In fact, all aspects of human life are saturated with disruption. In fact, grace is itself God’s disruptive intervention in human history. Since creation embodies the goodness of God, creation can be said to be a sacramental symbol of disruption. In a social world where racism and other structures of marginality operate, victims of such marginalities embody in their existence the disruptive grace that can transform such a society. Black bodies are loci for encountering the disruptive grace intended to end the vice of racism. They also serve as the loci for the church to imagine a new way of being a sacrament of disruption in the world because of their existential proximity to the historical realities defining the life of Jesus Christ as a victim of the hegemony of empire. This work shows how black bodies can help foster a new imagination of the human in our contemporary world where systems of marginalization continue to shape human life in general. It attempts to address the following question: how can one conceive of black bodies in a world defined by systems of erasure that directly affect black persons and their embodied agencies? To do this effectively, this work appropriates a constructive theological approach that grounds itself in an interdisciplinary discourse with the intent to argue that to speak of the human person is to instantiate a polyphony of insights: insights that appeal to an ethical consciousness that is defined by altruism. Full article

Electrical machines are at the centre of most engineering processes, with rotating electrical machines, in particular, becoming increasingly important in recent history due to their growing applications in electric vehicles and renewable energy. Although the landscape of condition monitoring in electrical machines has evolved over the past 50 years, the intensification of engineering efforts towards sustainability, reliability, and efficiency, coupled with breakthroughs in computing, has prompted a data-driven paradigm shift. This paper explores the evolution of condition monitoring of rotating electrical machines in the context of maintenance strategy, focusing on the emergence of this data-driven paradigm. Due to the broad and varying nature of condition monitoring practices, a framework is also offered here, along with other essential terms of reference, to provide a concise overview of recent developments and to highlight the modern challenges and opportunities within this area. The paper is purposefully written as a tutorial-style overview for the benefit of practising engineers and researchers who are new to the field or not familiar with the wider intricacies of modern condition monitoring systems. Full article

Single nucleotide polymorphisms (SNPs) found to be associated with Androgenetic Alopecia (AGA) to date, are characterized by an apparent reduced penetrance into the phenotype suggesting a role of other factors in the etiology of AGA. Objective: We conducted a study to investigate the role of specific allelic variants in AGA controlling for nutritional and lifestyle factors. Methods: Individual patterns of SNPs present in the baldness susceptibility locus at 20p11 (rs1160312 and rs6113491) or close to the androgen receptor (AR) gene in chromosome X (rs1041668) were investigated in 212 male subjects. Information on socio-demographic characteristics, medical history, smoking, and diet was also collected. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: After controlling for age, diet, BMI, family history of AGA, and smoking, an increased risk of AGA was found for subjects with [A] alleles for both rs1160312 (OR: 2.97; 95% CI: 1.34–6.62) and rs6113491 (OR: 2.99; 95% CI: 1.37–6.52), and for subjects with the TT genotype for rs1041668 (OR: 4.47; 95% CI: 1.60–12.5). Multivariate logistic regression indicates that diet, familiarity, and BMI, but not smoking, remain statistically significant despite the different SNP genotypes. Conclusions: To our knowledge, this is the first indication that the rs1160312, rs6113491, and rs1041668 polymorphisms are independent risk factors for AGA that can be modulated by diet. Full article

Our understanding of social cognition in brachycephalic dog breeds is limited. This study focused specifically on French Bulldogs and hypothesized that a closer relationship between dog and owner would improve the dogs’ understanding of nonverbal cues, particularly pointing gestures. To investigate this, we tested twenty-six dogs and their owners in a two-way object choice test in which the familiar person pointed to the bowl. As understanding of pointing gestures is influenced by human–animal interaction, we used the Monash Dog Owner Relationship Scale (MDORS) to assess various aspects of the dog–owner relationship, including dog–owner interaction, emotional closeness, and negative aspects of dog ownership and measured salivary oxytocin levels. This study examined the dogs’ correct choices and their straight approach patterns to a reward bowl. Several factors influenced the two measures of social cognition, such as the age and sex of the dog, dog–owner interaction, emotional closeness, and the choice time (time it took the dog to reach the reward bowl), but also that neutered dogs and those with no training history showed better cognitive performance. We found a very high number of correct choices, which could be attributed to the owners’ high scores on the dog–owner interaction scale. Oxytocin showed no direct effect on these measures. To increase the generalizability of the results, we suggest future studies focus on more than one breed to capture the temporal development of the owner–dog relationship and social cognitive abilities. Full article

Family history for CAD (coronary artery disease) is an established cardiovascular (CV) risk factor and it is progressively acquiring importance in patients’ CV risk stratification. Numerous studies have demonstrated that individuals with a first-degree relative affected by CAD have a significantly higher risk of developing the condition themselves; in particular, when CAD occurs at an early age in relatives. Indeed, recently published CCS (chronic coronary syndrome) ESC (European Society of Cardiology) guidelines include family history (FH) as a risk factor to consider when calculating pre-test risk for CAD. ESC guidelines on preventive cardiology (2021) only suggested CV risk assessment in the presence of a positive FH for CV disease, not considering it in the actual risk scores. Evidence suggests that positive anamnesis for relatives affected by CAD correlates with ACS (acute coronary syndrome) and CAD, with slight differences in relative risk as far as the degree of kinship is concerned. Genetic factors contribute to this correlation by influencing key processes that affect heart health, such as cholesterol metabolism, blood pressure regulation, and inflammatory responses. New technologies in the genetics field are increasing the availability of genome sequencing, and new polymorphism panels are being tested as predictive for CAD, objectifying familiarity. Advances in imaging techniques allow the assessment of coronary atherosclerosis and its composition, and these are acquiring strength in evidence and recommendations in ESC guidelines as a way to define coronary disease in low and low-to-intermediate risk patients and to guide medical therapy and interventional procedures. Use of these emerging tools to guide screening is likely to be extended, beyond high CV risk patients, to individuals with FH for early CAD and/or specific genetic profiles, as recent evidence in the literature is suggesting. Full article

The extant texts of Enochic Judaism present accounts about the early history of humankind, which use the motifs familiar from the ancient Mesopotamian historiography. The different versions of the Jewish story of the Watchers originate as counter narratives about the antediluvian sages, or apkallus, which are known from the cuneiform literature. The myth of Adapa in Akkadian offers a version of the narrative in which the sage was promoted in heaven to a god-like status, which concept is corroborated with an entry in the cuneiform compendium Tintir and the Chronicle of the Esagila. This tradition also associated Adapa with the immortalized flood survivor. In the form of a counter narrative, the Enochic texts of Judaism attributed the heavenly assumption to Enoch and presented the Watchers as the demonic entities subordinated to him. The fall of the Watchers, the promotion of Enoch, and the primordial battle against evil forces are depicted in the Animal Apocalypse of 1 Enoch 85–90. A very similar scenario is found in the Chronicle of Esagila, which describes the early history of humankind from the Babylonian perspective. It can be demonstrated that the Animal Apocalypse uses this or a similar cuneiform historiographic source as the basis of its counter narrative. Full article

Dilated cardiomyopathy (DCM) is a common cause of heart failure (HF) and heart transplantation (HTx), with genetic factors playing a significant role. In recent years, the RNA-binding protein motif 20 (RBM20), which affects the gene splicing of various proteins with different cellular functions, was identified as the first DCM gene with regulatory properties. Variants of RBM20 have been associated with severe forms of DCM. The aim of this critical systematic review was to analyse RBM20 cardiomyopathy clinical features and outcomes. According to PRISMA guidelines, a search was run in the PubMed, Scopus and Web of Science electronic databases using the following keywords: “RBM20”; “cardiomyopathy”; “arrhythmias”; “heart failure”. A total of 181 records were screened, of which 27 studies were potentially relevant to the topic. Through the application of inclusion and exclusion criteria, eight papers reporting 398 patients with RBM20 pathogenic variants were analysed. The mean age at presentation was 41 years. Familiarity with cardiomyopathy was available in 59% of cases, with 55% of probands reporting a positive family history. Imaging data indicated a mild reduction of left ventricular ejection fraction (mean LVEF 40%), while tissue characterization was reported in 24.3% of cases, showing late gadolinium enhancement in 33% of patients. Composite outcomes of sustained monomorphic ventricular tachycardia or ventricular fibrillation occurred in 19.4% of patients, with 12% undergoing HTx. There were no gender differences in arrhythmic outcomes, while 96.4% of patients who underwent HTx were male. In conclusion, RBM20 cardiomyopathy exhibits a severe phenotypic expression, both in terms of arrhythmic burden and HF progression. Full article

Handedness, a complex human aspect that reflects the functional lateralization of the hemispheres, also interacts with the immune system. This study aimed to expand the knowledge of the lateralization of hand, foot, and eye activities in patients with immune-mediated (IM) or other (noIM) neurological diseases and to clarify the properties of the Edinburgh Handedness Inventory (EHI) in an Italian population. Three hundred thirty-four patients with IM or noIM diseases affecting the brain or spine and peripheral nervous system were interviewed about stressful events preceding the disease, subjective handedness, and familiarity for left-handedness or ambidexterity. The patients and 40 healthy subjects underwent EHI examination. In the whole group of participants, 24 items of the EHI were classified into five factors (Hand Transitive, Hand Refined, Hand Median, Foot, Eye), demonstrating good reliability and validity. Chronological age had a significant influence on hand and foot EHI factors and the laterality quotient (LQ), particularly on writing and painting. In the patient groups, EHI factors and the LQ were also predicted by age of disease onset, duration of disease, and family history of left-handedness or ambidexterity. No differences were found between patients and healthy subjects, but pencil use scored significantly lower in patients with IM diseases than in those with noIM brain diseases. These results demonstrate that the lateralization of hand and foot activities is not a fixed human aspect, but that it can change throughout life, especially for abstract and symbolic activities. Chronic neurological diseases can cause changes in handedness. This may explain why, unlike systemic immunological diseases, IM neurological diseases are not closely associated with left-handedness. In these patients, the long version of the EHI is appropriate for determining the lateralization of body activities to contextualize the neurological picture; therefore, these findings extend the Italian normative data sets. Full article

(1) Background: Psoriasis is a common chronic inflammatory skin disease with different manifestations, affecting the quality of life at social, emotional, and professional dimensions and requiring long-term treatment. This study aimed to investigate the effect of psychosocial and clinical factors on adherence to topical treatment in psoriasis. (2) Methods: Self-reported measures and weighing the medicines were used to assess adherence. Psychopathological symptoms were measured using the Brief Symptoms Inventory (BSI). Social and clinical factors were assessed by a sociodemographic and clinical questionnaire. Adherence to treatment with topical medication was assessed using a sample of 102 psoriasis patients. (3) Results: The explanatory models of adherence to topical treatment in psoriasis translated into positive associations between adherence and the education level (higher education) (p = 0.03; φ = 0.23), the single-family household (p = 0.01; φ = 0.44), active employment status (p = 0.05; φ = −0.19), familiar history of psoriasis (p = 0.04; φ = −0.21), and the presence of obsessive-compulsive symptoms (p = 0.01; d = 0.29). (4) Conclusions: In patients who present the characteristics identified that influence non-adherence, instructions should be reinforced to increase adherence. The experimental mortality (39.6%) reduced the sample size, representing a limitation of the study. Full article

Background: Meniere’s disease (MD) is a disabling disease, especially in patients who are refractory to medical therapy. Moreover, selective vestibular neurectomy (VN), in these selected cases, can be considered a surgical alternative which preserves hearing function and facial nerve. Methods: We retrospectively studied 23 patients with MD diagnosis and history of failed extradural endolymphatic sac surgery (ELSS) who underwent combined micro-endoscopic selective VN, between January 2019 and August 2023, via a presigmoid retrolabyrinthine approach. All patients were stratified according to clinical features, assessing preoperative and postoperative hearing levels and quality of life. Results: At the maximum present follow-up of 2 years, this procedure is characterized by a low rate of complications and about 90% vertigo control after surgery. No definitive facial palsy or hearing loss was described in this series. One patient required reintervention for a CSF fistula. Statistically significant (p = 0.001) difference was found between the preoperative and the postoperative performance in terms of physical, functional, and emotive scales assessed via the DHI questionnaire. Conclusions: Selective VN via a presigmoid retrolabyrinthine approach is a safe procedure for intractable vertigo associated with MD, when residual hearing function still exists. The use of the endoscope and intraoperative neuromonitoring guaranteed a precise result, saving the cochlear fibers and facial nerve. The approach for VN is a familiar procedure to the otolaryngologist, as is lateral skull base anatomy to the neurosurgeon; therefore, the best results are obtained with multidisciplinary teamwork. Full article