Introduction: Black Swans and Sinatra Inferences

Public mismanagement as a threat to life and limb is a rare and highly improbable phenomenon—the proverbial Black Swan. Bridges and buildings collapse, claiming the lives of people who had every reason to believe that governmental agencies protect their physical integrity through public oversight and maintenance. Properly analyzed, however, these unlikely events reveal causal mechanisms of a general nature, strong enough to trigger fateful mismanagement even under the restrictive conditions of professional bureaucracies and democratic government. Hence the “Sinatra Inference”: When a mechanism is powerful enough ‘to make it there’—i.e., where causal leverage is supposedly low—it is likely to ‘make it everywhere’ as soon as leverage is enlarged by weaker accountability structures, lower professional standards and lesser values than human safety.

Kształtowanie instrumentów ochrony demokracji w Polsce na przykładzie zakazu zgromadzeń. Perspektywa ideowa

There is no single, universal model for the protection of democracy that sets limits on freedom and tolerance in liberal democracies. In response to political extremism, states apply various measures — from highly repressive ones, such as restrictions on freedom of speech or association, to more liberal ones based on persuasive strategies. Which instruments are adopted and implemented depends on the decisions of public actors. This article deals with the ban on assembly, which is a repressive instrument of democracy protection. Basing on the analysis of selected assembly bans cases, the aim is first to determine which model of democracy protection is closer to the solutions adopted in Poland — militant or procedural democracy, and second to indicate why such solutions were adopted. More precisely, by means of an ideational perspective, the aim is to explain the different positions taken by public actors in the process of implementing the assembly ban. The article uses the method of qualitative content analysis of legal acts and decisions made by public authorities regarding holding assemblies. By means of a purposeful case selection, the analysis was carried out on the assembly bans against extreme right-wing groups in Warsaw and Wrocław. The research has shown that the legal norms adopted in Poland allow the application of assembly bans in accordance with the concept of militant democracy. However, the implementation shows a different approach of public actors in this matter. Municipalities are closer to the model of a militant democracy, as they allow a preventive ban on assembly as an instrument of public order protection in relation to freedom of speech infringements. In doing so, they do not maintain neutrality towards the views public discourse participants. The courts, on the other hand, exclude the subject of assemblies as a basis for their preventive restriction, the premises of the ban being violence or a direct threat to life, health and property. Their position is thus closer to the procedural model of protecting democracy. The adopted ideational perspective points to possible reasons for the different positions of public actors. Their attitude to values which are crucial for the protection of democracy shows differences. This applies, among others, to the different weight ascribed to particular democratic values, the different perception of threats to the society and the democratic state, and the divergence in defining the thresholds of freedom and tolerance. ∗ Artykuł powstał w wyniku realizacji projektu badawczego UMO-2014/15/D/HS5/03272 finansowanego ze środków Narodowego Centrum Nauki. Wyrazy podziękowania kieruję do recenzentów za bardzo wnikliwe i inspirujące komentarze.

Experience of therapy of psoriasis patients with methotrexate in the form of subcutaneous and intramuscularly injections

Псориаз является одним из наиболее распространенных хронических дерматозов, в мире зарегистрировано около 125 млн больных этим заболеванием, причем частота встречаемости в структуре дерматологических заболеваний составляет около 40%. Несмотря на то, что в большинстве случаев псориаз не представляет угрозы для жизни, тем не менее он является непосредственной причиной появления весьма серьезных патологических проблем, социальной дезадаптации. В последнее время все большее число исследователей говорят о псориазе не как об изолированном кожном заболевании, а как о системной псориатической болезни с доминирующими проявлениями на коже. Системность заболевания проявляется в частом вовлечении в процесс не только кожного покрова, но и других систем и органов, в частности опорно-двигательного аппарата при артропатической форме псориаза (псориатическом артрите). Распространенность псориатического артрита у больных псориазом колеблется от 7% до 47%, причем у 15% пациентов артрит развивается до поражения кожи, при обычном псориазе артрит бывает в 6-7% случаев, а при уже выявленной псориатической артропатии у 73,2% больных встречается пустулезный или экссудативный псориаз, а также псориатическая эритродермия. В статье представлены результаты применения в терапии больных среднетяжелым и тяжелым псориазом препарата метотрексат в виде подкожных инъекций в сравнении с аналогичной схемой использования внутримышечных инъекций метотрексата. Показана высокая эффективность курса терапии метотрексатом в лечении псориаза и псориатического артрита. Приведены данные о более высокой безопасности, более значимом позитивном влиянии на качество жизни, о лучшей переносимости и более длительной ремиссии, достигнутых в группе пациентов, получавших подкожные инъекции метотрексата. Psoriasis is one of the most common chronic dermatoses. About 125 million patients with this disease are registered in the world, and the frequency of occurrence in the structure of dermatological diseases is about 40%. Despite the fact that in most cases psoriasis does not pose a threat to life, but, nevertheless, it is the direct cause of the appearance of very serious pathological problems, social maladjustment. Recently, an increasing number of researchers speak of psoriasis not as an isolated skin disease, but as a systemic psoriatic disease with dominant skin manifestations. The systemic nature of the disease is manifested in the frequent involvement in the process of not only the skin, but also other systems and organs, in particular, the musculoskeletal system in the arthropathic form of psoriasis (psoriatic arthritis). The prevalence of psoriatic arthritis in patients with psoriasis ranges from 7 to 47%, and in 15% of patients arthritis develops before skin lesions, with ordinary psoriasis, arthritis occurs in 6-7% of cases, and with already identified psoriatic arthropathy in 73,2%, pustular or exudative psoriasis, as well as psoriatic erythroderma. The article presents the results of the use of methotrexate in the form of subcutaneous injections in clinical practice in the treatment of patients with moderate and severe psoriasis, in comparison with a similar scheme of using intramuscular injections of methotrexate. The course of methotrexate therapy has been shown to be highly effective in the treatment of psoriasis and psoriatic arthritis. The data on higher safety, a more significant positive effect on the quality of life, better tolerability and longer remission of the process achieved in a group of patients receiving subcutaneous injections of methotrexate are presented.

Prevalence and predictors of post-traumatic stress symptoms in 2200 hospitalised and non-hospitalised injured New Zealanders

Objective: Post-traumatic stress disorder following injuries unrelated to mass casualty events has received little research attention in New Zealand. Internationally, most studies investigating predictors of post-injury post-traumatic stress disorder focus on hospitalised patients although most survivors are not hospitalised. We compared the prevalence and predictors of symptoms suggestive of post-traumatic stress disorder 12 months following injury among hospitalised and non-hospitalised entitlement claimants in New Zealand’s Accident Compensation Corporation. This government-funded universal no-fault insurance scheme replaced tort-based compensation for injuries in 1974 since when civil litigation (which can bias post-traumatic stress disorder estimates) has been rare. Methods: A total of 2220 Accident Compensation Corporation claimants aged 18–64 years recruited to the Prospective Outcomes of Injury Study were interviewed at 12 months post-injury to identify symptoms suggestive of post-traumatic stress disorder using the Impact of Events Scale. Multivariable models examined the extent to which baseline sociodemographic, injury, health status and service interaction factors predicted the risk of post-traumatic stress disorder symptoms among hospitalised and non-hospitalised groups. Results: Symptoms suggestive of post-traumatic stress disorder were reported by 17% of hospitalised and 12% of non-hospitalised participants. Perceived threat to life at the time of the injury doubled this risk among hospitalised (adjusted relative risk: 2.0; 95% confidence interval: 1.2–3.2) and non-hospitalised (relative risk: 1.8; 95% confidence interval: 1.2–2.8) participants. Among hospitalised participants, other predictors included female gender, Pacific and ‘other’ minority ethnic groups, pre-injury depressive symptoms, financial insecurity and perceived inadequacies in healthcare interactions, specifically information and time to discuss problems. Among non-hospitalised survivors, predictors included smoking, hazardous drinking, assault and poor expectations of recovery. Conclusion: One in six hospitalised and one in eight non-hospitalised people reported post-traumatic stress disorder symptoms 12 months following injury. Perceived threat to life was a strong predictor of this risk in both groups. Identifying early predictors of post-traumatic stress disorder, regardless of whether the injury required hospitalisation, could help target tailored interventions that can reduce longer-term psychosocial morbidity.

A threat to life and livelihoods: examining the effects of the first wave of COVID-19 on health and wellbeing in Bengaluru and Patna slums

Taking advantage of our existing dataset of 6,721 slum households in two Indian cities, we undertook six rounds of follow-up phone interviews on the impact of COVID-19 between July and November 2020 with three key informants in each of 40 diverse slums. These cities showed contrasting health effects resulting from the first major wave of the COVID-19 pandemic – no deaths and nearly no illnesses were reported in Patna, while there was widespread low-intensity sickness and a cluster of deaths in Bengaluru. We found no clear pattern in the links between outbreaks and city or neighbourhood characteristics. Livelihood effects, however, were devastating across both cities. All but a few slum dwellers lost their jobs for several months and survived by cutting back on essentials, incurring loans, liquidating assets, and seeking help from neighbours. Government assistance, generous in the early part of the lockdown, dwindled rapidly. Many will likely become chronically poor.

Cell and Cell Free Therapies in Osteoarthritis

Osteoarthritis (OA) is the most common articular disease in adults and has a current prevalence of 12% in the population over 65 years old. This chronic disease causes damage to articular cartilage and synovial joints, causing pain and leading to a negative impact on patients’ function, decreasing quality of life. There are many limitations regarding OA conventional therapies—pharmacological therapy can cause gastrointestinal, renal, and cardiac adverse effects, and some of them could even be a threat to life. On the other hand, surgical options, such as microfracture, have been used for the last 20 years, but hyaline cartilage has a limited regeneration capacity. In recent years, the interest in new therapies, such as cell-based and cell-free therapies, has been considerably increasing. The purpose of this review is to describe and compare bioregenerative therapies’ efficacy for OA, with particular emphasis on the use of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP). In OA, these therapies might be an alternative and less invasive treatment than surgery, and a more effective option than conventional therapies.

Profile of the in silico secretome of the palm dieback pathogen, a fungus that puts natural oases at risk

Understanding biotic changes that occur alongside climate change constitute a research priority of global significance. Here, we address a plant pathogen that poses a serious threat to life on natural oases, where climate change is already taking a toll and severely impacting human subsistence. Fusarium oxysporum f. sp. albedinis is a pathogen that causes dieback disease on date palms, a tree that provides several critical ecosystem services in natural oases; and consequently, of major importance in this vulnerable habitat. Here, we assess the current state of global pathogen spread, we annotate the genome of a sequenced pathogen strain isolated from the native range and we analyse its in silico secretome. The palm dieback pathogen secretes a large arsenal of effector candidates including a variety of toxins, a distinguished profile of secreted in xylem proteins (SIX) as well as an expanded protein family with an N-terminal conserved motif [SG]PC[KR]P that could be involved in interactions with host membranes. Using agrobiodiversity as a strategy to decrease pathogen infectivity, while providing short term resilient solutions, seems to be widely overcome by the pathogen. Hence, the urgent need for future mechanistic research on the palm dieback disease and a better understanding of pathogen genetic diversity.

Pre-Dialytic SpO2 Measured with a Wearable Device as a Predictor of Mortality in Patients with OSA and Chronic Kidney Disease

Hypoxemia and obstructive sleep apnea (OSA) have been recognized as a threat to life. Nonetheless, information regarding the association between pre-dialytic pulse oximeter saturation (SpO2) level, OSA and mortality risks remains mysterious in patients with maintenance hemodialysis (MHD). Bioclinical characteristics and laboratory features were recorded at baseline. Pre-dialytic SpO2 was detected using a novel microchip LED oximetry, and the Epworth Sleepiness Scale (ESS) score greater than 10 indicated OSA. Non-adjusted and adjusted hazard ratios (aHRs) of all-cause and cardiovascular (CV) mortality were analyzed for pre-dialytic SpO2, OSA and potential risk factors. During 2152.8 patient-months of follow-up, SpO2 was associated with incremental risks of all-cause and CV death (HR: 0.90 (95% CI: 0.82–0.98) and 0.88 (95% CI: 0.80–0.98), respectively). The association between OSA and CV mortality was significant (HR: 3.19 (95% CI: 1.19–9.38). In the multivariate regression analysis, pre-dialytic SpO2 still had an increase in all-cause and CV death risk (HR: 0.88 (95% CI: 0.79–0.98), 0.82 (95% CI: 0.71–0.96), respectively). Considering the high prevalence of silent hypoxia in the post COVID-19 era, a lower pre-dialytic SpO2 level and severe OSA warn clinicians to assess potential CV risks. In light of clinical accessibility, the microchip LED oximetry could be developed as a wearable device within smartphone technologies and used as a routine screen tool for patient safety in the medical system.

Profile of adverse events in toxoplasmosis drug therapy: a review

This study aims to analyze the profile of adverse events (AEs) of drugs for the treatment of Toxoplasmosis. This is a review carried out through a bibliographic search in the electronic databases PubMed, SciELO, Cochrane Digital Library and LILACS. The keywords “Toxoplasmosis” AND “Drug Therapy” AND “Drug-Related Side Effects and Adverse Reactions” were used. The selection was performed by two independent reviewers and the articles were included considering the presence of retrospective studies and case reports published in the literature in Portuguese and English and without time restrictions. In total, 40 articles were found, of which 14 met the inclusion criteria. Cases of cerebral, ocular, gestational and congenital Toxoplasmosis were identified. Among these, we observed a total of 85 patients with reports of AEs due to the use of Pyrimethamine, Sulfadiazine, Spiramycin, Clindamycin, Atovaquone, Trimethoprim and Sulfamethoxazole and Sulfadoxine. Clinical reactions were in the form of skin rash (57.1%), hematological alterations (28.5%), Lyell syndromes (7.1%), Stevens-Johnson (21.4%) and DRESS (21 .4%). The prevalence of AEs related to hematological alterations was seen mainly in treatments based on Pyrimethamine + Sulfadiazine, Trimethoprim and Sulfamethoxazole; on the other hand, those associated with severe syndromes are often related to the use of Pyrimethamine + Sulfadiazine. It is important to establish a standard protocol for drug therapy for Toxoplasmosis, which does not yet exist. In addition, the need to monitor patients after drug administration is highlighted, given the possibility of the occurrence of adverse events that can represent a threat to life.