bluuebunny/crossref_metadata_2025 huggingface dataset:
Parasellar Meningiomas
Authors: Graillon Thomas , Regis Jean , Barlier Anne , Brue Thierry , Dufour Henry , Buchfelder Michael
Published: June 2020

Parasellar spaces remain particularly singular, comprising the most important neurovascular structures such as the internal carotid artery and optic, oculomotor, and trigeminal nerves. Meningiomas are one of the most frequent tumors arising from parasellar spaces. In this location, meningiomas remain mostly benign tumors with WHO grade I and a meningothelial subtype. Progestin intake should be investigated and leads mostly to conservative strategies. In the case of benign nonsymptomatic tumors, observation should be proposed. Tumor growth will lead to the proposition of surgery or radiosurgery. In the case of an uncertain diagnosis and an aggressive pattern, a precise diagnosis is required. For cavernous sinus and Meckel’s cave lesions, complete removal is rarely considered, leading to the proposition of an endoscopic endonasal or transcranial biopsy. Optic nerve decompression could also be proposed via these approaches. A case-by-case discussion about the best approach is recommended. A transcranial approach remains necessary for tumor removal in most cases. Vascular injury could lead to severe complications. Cerebrospinal fluid leakage, meningitis, venous sacrifice, visual impairment, and cranial nerve palsies are more frequent complications. Pituitary dysfunctions are rare in preoperative assessment and in postoperative follow-up but should be assessed in the case of meningiomas located close to the pituitary axis. Long-term follow-up is required given the frequent incomplete tumor removal and the risk of delayed recurrence. Radiosurgery is relevant for small and well-limited meningiomas or intra-cavernous sinus postoperative residue, whereas radiation therapy and proton beam therapy are indicated for large, extended, nonoperable meningiomas. The place of the peptide receptor radionuclide therapyneeds to be defined. Targeted therapy should be considered in rare, recurrent, and aggressive parasellar meningiomas.
Allopregnanolone and Pregnanolone Are Reduced in the Hippocampus of Epileptic Rats, but Only Allopregnanolone Correlates with Seizure Frequency
Authors: Lucchi Chiara , Costa Anna Maria , Rustichelli Cecilia , Biagini Giuseppe
Published: June 2020

Background: Neurosteroids modulate epileptic activity by interacting with the γ-aminobutyric acid type A receptor, but their brain levels are still undetermined. Objectives: We aimed to establish neurosteroid levels in the neocortex and hippocampus by liquid chromatography/mass spectrometry in epileptic rats. Methods: Kainic acid-treated rats were continuously monitored up to 9 weeks to determine seizure frequency by video electrocorticography (n = 23) and compared to age-matched controls monitored in the same manner (n = 11). Results: Decreased allopregnanolone (–50%; p < 0.05, Mann-Whitney test) and pregnanolone levels (–64%; p < 0.01) were found in the hippocampus, whereas pregnenolone sulfate, pregnenolone, progesterone, and 5α-dihydroprogesterone were nonsignificantly reduced. No changes were found in the neocortex. Moreover, allopregnanolone (but not pregnanolone) levels were positively correlated with seizure frequency (r2 = 0.4606, p < 0.01). Conclusion: These findings indicate a selective reduction in hippocampal levels of 3α-reduced neurosteroids. This reduction was partially mitigated by seizures in the case of allopregnanolone.
Validation and Disease Risk Assessment of Previously Reported Genome-Wide Genetic Variants Associated With Brugada Syndrome
Authors: Jimmy Juang Jyh-Ming , Liu Yen-Bin , Julius Chen Ching-Yu , Yu Qi-You , Chattopadhyay Amrita , Lin Lian-Yu , Chen Wen-Jone , Yu Chih-Chien , Huang Hui-Chun , Ho Li-Ting , Lai Ling-Ping , Hwang Juey-Jen , Lin Ting-Tse , Liao Min-Tsun , Chen Jien-Jiun , Sherri Yeh Shih-Fan , Chuang Jing-Yuan , Yang Dun-Hui , Lin Jiunn-Lee , Lu Tzu-Pin , Chuang Eric Y. , Ackerman Michael J.
Published: June 2020

Background:

Brugada syndrome (BrS) is an oligogenic arrhythmic disease with increased risk of sudden cardiac arrest. Several BrS or ECG traits-related single-nucleotide polymorphisms (SNPs) were identified through previous genome-wide association studies in white patients. We aimed to validate these SNPs in BrS patients in the Taiwanese population, assessing the cumulative effect of risk alleles and the BrS-polygenic risk score in predicting cardiac events.

Methods:

We genotyped 190 unrelated BrS patients using the TWB Array, and Taiwan Biobank was used as controls. SNPs not included in the array were imputed by IMPUTE2. Cox proportional hazards model was used to evaluate the associations between each particular SNP, the collective BrS-polygenic risk score, and clinical outcomes.

Results:

Of the 88 previously reported SNPs, 22 were validated in Taiwanese BrS patients (
P
<0.05). Of the 22 SNPs, 2 (rs10428132 and rs9388451) were linked with susceptibility to BrS, 10 were SNPs previously reaching genome-wide significance, and 10 were SNPs associated with ECG traits. For the 3 most commonly reported SNPs, disease risk increased consistently with the number of risk alleles (odds ratio, 3.54;
P
trend
=1.38×10
−9
for 5 risk alleles versus 1). Similar patterns were observed in both
SCN5A
mutation+ (odds ratio, 3.66;
P
trend
=0.049) and
SCN5A
mutation− (odds ratio, 3.75;
P
trend
=8.54×10
−9
) subgroups. Furthermore, BrS patients without
SCN5A
mutations had more risk alleles than BrS patients with
SCN5A
mutations regardless of the range of polygenic risk scores. Three SNPs (rs4687718, rs7784776, and rs2968863) showed significant associations with the composite outcome (sudden cardiac arrest plus syncope, hazard ratio, 2.13, 1.48, and 0.41;
P
=0.02, 0.006, and 0.008, respectively).

Conclusions:

Our findings suggested that some SNPs associated with BrS or ECG traits exist across multiple populations. The cumulative risk of the BrS-related SNPs is similar to that in white BrS patients, but it appears to correlate with the absence of
SCN5A
mutations.
Impact of Left Atrial Appendage Exclusion on Short-Term Outcomes in Isolated Coronary Artery Bypass Graft Surgery
Authors: Mahmood Eitezaz , Matyal Robina , Mahmood Feroze , Xu Xinling , Sharkey Aidan , Chaudhary Omar , Karani Sadia , Khabbaz Kamal
Published: June 2020

Background:

The objective of this study was to evaluate the impact of left atrial appendage (LAA) exclusion on short-term outcomes in patients with atrial fibrillation undergoing isolated coronary artery bypass graft surgery.

Methods:

We queried the 2010 to 2014 National Readmissions Database for patients who underwent coronary artery bypass graft repair with and without LAA ligation by using
International Classification of Diseases, Ninth Revision, Clinical Modification
procedure codes (
International Classification of Diseases, Ninth Revision, Clinical Modification
: 36.1xx). Only patients with a history of atrial fibrillation were included in our analysis. The primary outcome of our study was 30-day readmissions following discharge. Secondary outcomes were in-hospital mortality and stroke. To assess the postoperative outcomes, we used multivariate logistic regression models to adjust for clinical and demographic covariates.

Results:

In total, we analyzed 253 287 patients undergoing coronary artery bypass graft surgery, 7.0% of whom received LAA closure. LAA exclusion was associated with a greater risk of postoperative respiratory failure (8.2% versus 6.2%,
P
<0.0001) and acute kidney injury (21.8% versus 18.5%,
P
<0.0001), but it did not significantly change the rate of blood transfusions or occurrence of cardiac tamponade. LAA exclusion was associated with a nonsignificant reduction in stroke (7.9% versus 8.6%,
P
=0.12), no difference in in-hospital mortality (2.2% versus 2.2%
P
=0.99), and a greater risk of 30-day readmission (16.0% versus 9.6%,
P
<0.0001). After covariate adjustment, LAA ligation remained a significant predictor of 30-day readmission (odds ratio, 1.640 [95% CI, 1.603–1.677],
P
<0.0001).

Conclusions:

LAA exclusion during isolated coronary artery bypass graft surgery in patients with atrial fibrillation is associated with a higher rate of 30-day readmission. Postoperative measures to mitigate the loss of the hormonal and hemodynamic effects of the LAA may increase the therapeutic benefit of this procedure.
Efficacy and Safety of Recanalization Therapy for Acute Ischemic Stroke With Large Vessel Occlusion
Authors: Hui Wen , Wu Chuanjie , Zhao Wenbo , Sun Huan , Hao Jun , Liang Hongyan , Wang Xian , Li Ming , Jadhav Ashutosh P. , Han Youli , Ji Xunming
Published: June 2020

Background and Purpose:

The optimal recanalization strategy for acute ischemic stroke with large vessel occlusion continues to be an area of active interest. Network meta-analysis can provide insight when direct comparative evidence is lacking.

Methods:

A systematic review of the literature using PubMed, Embase, the Cochrane Central Register of Controlled Trials, and SinoMed was performed, and a search was conducted for clinical trials on ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and StrokeCenter.org. Four independent reviewers conducted the study selection, data abstraction, and quality assessments.

Results:

The literature review identified 17 trials including 3236 patients and 8 ongoing clinical trials. Sample sizes ranged from 7 to 656 participants. Intravenous thrombolysis (IVT) was the most common intervention, followed by IVT plus mechanical thrombectomy (MT), IVT plus intraarterial thrombolysis, intraarterial thrombolysis alone, and MT alone. In the pooled network meta-analysis, IVT+MT was associated with a higher rate of independent functioning. In contrast, IVT was ranked as the most ineffective treatment strategy with respect to neurological functions, while direct MT was ranked as the least safe intervention with respect to all-cause mortality. Also, irrespective of assessment tools, endovascular treatment plus IVT led to higher successful recanalization rate than thrombolysis alone.

Conclusions:

Compared with other recanalization treatments, IVT+MT seems to be the most effective strategy, without increasing detrimental effects, for thrombolysis-eligible patients with large vessel occlusion-acute ischemic stroke. To improve the current evidentiary basis for recanalization treatment, future trials and real-world studies are warranted and should use unified definitions of symptomatic intracranial hemorrhage and recanalization.
Mesenchymal Behavior of the Endothelium Promoted by SMAD6 Downregulation Is Associated With Brain Arteriovenous Malformation Microhemorrhage
Authors: Fu Weilun , Huo Ran , Yan Zihan , Xu Hongyuan , Li Hao , Jiao Yuming , Wang Linjian , Weng Jiancong , Wang Jie , Wang Shuo , Cao Yong , Zhao Jizong
Published: June 2020

Background and Purpose:

In unruptured brain arteriovenous malformations (bAVMs), microhemorrhage portends a higher risk of future rupture and may represent a transitional state along the continuum of destabilization. Exploration of the molecular and cellular mechanisms of microhemorrhage will provide a possible target for medical treatment to prevent bAVM bleeding.

Methods:

We performed RNA sequencing analysis on 34 unruptured bAVM surgical samples. Functional pathway analysis was performed to identify potential signals associated with the microhemorrhagic phenotype. Candidate gene was then investigated in bAVM specimens by immunohistochemical staining. Several functional assays were used to investigate the effects of candidate genes on the phenotypic properties of cultured human umbilical vein endothelial cells. Then, Masson trichrome staining and immunofluorescence staining were used to evaluate the phenotypic and molecular changes in bAVM tissue.

Results:

Via RNA sequencing, we identified differential gene expression between 18 microhemorrhagic bAVMs and 16 nonmicrohemorrhagic bAVMs. TGFβ (transforming growth factor-beta)/BMP (bone morphogenetic protein) signaling was associated with the bAVM microhemorrhage group when SMAD6 (SMAD family member 6) was downregulated. Immunohistochemical staining showed that the vascular endothelium of microhemorrhagic bAVMs exhibited decreased SMAD6 expression. Functional assays revealed that SMAD6 downregulation promoted the formation of endothelial cell tubes with deficient cell-cell junctions and facilitated the acquisition of mesenchymal behavior by endothelial cells. Masson trichrome and immunofluorescence staining demonstrated that mesenchymal phenotype of endothelial cells is promoted in microhemorrhagic bAVMs.

Conclusions:

TGFβ/BMP signaling mediated by SMAD6 in vascular endothelial cells is associated with microhemorrhagic bAVMs, and mesenchymal behavior of endothelial cells induced by SMAD6 downregulation is related with bAVM microhemorrhage.
The Democracy Dichotomy: Framing the Hong Kong 2019 Street Protests as Legitimacy Counterclaims against an Incoherent Constitutional Morality
Authors: Greenwood-Reeves James
Published: June 2020

This article evaluates the 2019 street protests in Hong Kong following the proposal of the Fugitive Offenders and Mutual Legal Assistance in Criminal Matters Legislation (Amendment) Bill 2019, in light of the constitutional settlement of the region. Firstly, it examines the ‘constitutional morality’ of Hong Kong, that is, the moral principles underlying its foundational claims to moral authority. Secondly it analyses whether the Administration’s ‘legitimacy claims’ – its rational-normative arguments for obedience to law – follow from these constitutional moral principles. Concluding that the legitimacy claims of the Administration pursuant to the Bill proved morally unintelligible, this research finds that protest action by citizens was a logical and rational response to a perceived legitimacy claim failure. It suggests that similar protests are likely to occur for the foreseeable future given the instability of the region’s constitutional morality.
Reforming the International Criminal Court (icc) to Achieve Increased State Cooperation in Investigations and Prosecutions of International Crimes
Authors: Sarkin Jeremy
Published: June 2020

This article examines the issue of state cooperation with the International Criminal Court (icc), and why it is vitally needed to achieve the institution’s mandate, including that of human rights protection. The article examines why state cooperation with the icc is so important and what issues undermine it, including disputes with the African Union, but many other issues as well. It surveys what the icc has done to promote cooperation and what steps ought to be taken to try and enhance state cooperation in the future. This is timely as the icc has set up a review process in 2020 to deal with a range of problems including state non-cooperation. The article therefore examines the practices and procedures of the Court, matters concerning its judges and staff, issues around the appointment of a new prosecutor, as well as and judicial appointments, as well as its jurisprudence. The article examines the issues that ought to be addressed, as well as how a variety of actors could better assist the Court, including the Security Council, the wider United Nations system, and the methodology for doing so. The article also reviews what defensive strategies can be taken up to defend the Court, including against aggressive anti-icc actors, such as the United States of America, who are ramping up their attacks on the Court and its personnel.
Liturgical Theology as a Research Program
Authors: Geldhof Joris
Published: June 2020

This essay is centered around five questions: (i) What is the proper place of liturgical theology? (ii) What past evolutions have there been and what tendencies are there currently in the field of liturgical theology? (iii) What contents should liturgical theologians focus on? (iv) How can liturgical theologians engage in research? And (v): How can liturgical theology appropriately respond to events occurring in Church and society? Each question corresponds to one part. The rationale behind ordering the content this way is the following: starting from a reflection about the non-evident place of liturgical theology, an attempt is made to reposition it on the basis of its genealogy in the Liturgical Movement. It seems that this is a particularly fruitful way to give liturgical theology a proper profile and identity. Correspondingly, liturgical theology can be considered a fully-fledged research program that manifests its usefulness and fruitfulness. In particular, it is shown that liturgical theologians are called to engage in the study of the meaning of Christian worship, and thereby contribute to theology as a whole. They are to employ a variety of methods but should proceed in such a way that directs reflection, research and spirituality always towards the core of liturgy, as established by the history and economy of salvation and culminating in the paschal mystery. If, and inasmuch they do this, they will have a great deal to offer given the complex challenges the Church and theology are confronted with today. The fundamental principle of this entire essay is that liturgical theology does not simply deal with Christian rituals, festivals and sacraments, but with the core of faith itself—God, the world, the Christ event, tradition, Church, and redemption—to the extent that it is embodied and expressed in worship practices.
Facial Muscle Activity Patterns in Clarinet Players: A Key to Understanding Facial Muscle Physiology and Dysfunction in Musicians
Authors: Franz Leonardo , Travan Luciana , Isola Miriam , Marioni Gino , Pozzo Renzo
Published: June 2020

Objectives:

Facial muscle activity is crucial to controlling musical performance in wind instrument playing. Facial muscle dysfunctions are common in wind instrument players, dramatically affecting their professional musical activity and potentially leading to disabling symptoms. The aim of this pilot study on a cohort of healthy clarinetists was to use surface electromyography to identify the facial muscle activity patterns involved in stabilizing the mouthpiece, controlling emission and articulation during musical tasks in physiological conditions, also comparing muscle activity between less and more experienced clarinetists (students vs postgraduates/professionals).

Methods:

Surface electromyographic measures of the sternocleidomastoid, masseter, mentalis, mylohyoid and buccinator muscles were obtained from eight healthy clarinet players (four students and four postgraduates/professionals) performing two standardized musical tasks.

Results:

Overall, mean IEMG activity was significantly lower for the sternocleidomastoid than for the other muscles ( P = .000), and for the mouthpiece-stabilizing muscles (masseter and mentalis) than for those directly involved in controlling emission and articulation (buccinator and mylohyoid muscles) ( P = .000). Regardless of the musical task, the mean IEMG values were significantly higher in the students for the masseter ( P = .0007), buccinator ( P = .0001) and mylohyoid (0.000), while they were significantly higher in the postgraduates/professionals for the mentalis ( P = .000). No significant differences emerged between the two groups for the sternocleidomastoid ( P = .207).

Conclusions:

These preliminary data reflect a significantly higher overall facial muscle activity in the less-experienced group, potentially resulting in an overload, whereas the more expert players had more optimized muscle activity patterns.
Pediatric Quality-of-Life Scores Following a Multidisciplinary Aerodigestive Team Approach to Manage Chronic Cough
Authors: Yibrehu Betel A. , Krakovsky Gina M. , Rana Md Sohel , Pillai Dinesh K. , Sehgal Sona , Collins Maura E. , Gatti Meagan L. , Bauman Nancy M.
Published: June 2020

Objectives:

Chronic recalcitrant cough is present in 2/3 of pediatric patients evaluated in our tertiary-care multidisciplinary aerodigestive clinic (ADC). This study aimed to determine the impact of chronic cough and efficacy of ADC treatment using the validated Pediatric-Cough Quality-of-Life-27 tool (PC-QOL-27).

Methods:

The PC-QOL-27 survey was administered to ADC patients with chronic cough at initial clinic visit and 6 to 12 weeks after cough management. Pre and post survey scores, demographic data, treatment and evaluation season were collected over 16 months.

Results:

Twenty parents completed pre and post PC-QOL-27 surveys (mean 12.1 weeks later). Patient median age was 6.04 years (IQR: 2.2-10.44 years). A total of 65% were males and 65% were African American. Management was tailored based on clinical assessment and diagnostic studies, including direct laryngoscopy/bronchoscopy (4), pulmonary function tests (PFT’s 9), esophagogastroduodenoscopy (9), and flexible bronchoscopy/lavage (9). Following ADC management, changes in physical, social and psychological domain scores of the PC-QOL-27 each met the threshold for minimal clinical important difference (MCID) indicating a clinically meaningful improvement. Improvements were most notable in the physical domain where post survey scores significantly improved from pre-survey scores ( P = .009) regardless of age, gender, ethnicity, history of endoscopy and season.

Conclusions:

The physical impact of chronic cough in pediatric patients who failed prior management by a single specialist was lessened by an ADC team approach to management.
Equilibrium Analysis of Vertical Mergers
Authors: Das Varma Gopal , De Stefano Martino
Published: June 2020

Vertical mergers are known to potentially create an incentive for the merged firm to raise the price of inputs it supplies to its rivals (raising rivals’ cost [RRC]). At the same time, vertical mergers are known to create efficiencies in the form of elimination of double marginalization (EDM). Competitive effects of vertical mergers are evaluated as the net effect of RRC and EDM. Conventional antitrust techniques treat the two effects—RRC and EDM—as separable and analyze each in isolation before evaluating their net effect. We show that in an equilibrium treatment, RRC and EDM are not separable; instead, they are inseparably linked because the size of EDM is an important determinant of the strength of the RRC incentive. When the link between EDM and RRC is taken into account, predicted price effects of a vertical merger can turn out to be significantly different relative to those predicted by conventional techniques. Under certain commonly used assumptions, a vertical merger may even create an incentive for the merged firm to lower its rivals’ cost. The precise price effect depends on two things: the shape of demand and the bargaining power of the upstream input supplier in its price negotiations with downstream firms.
Evaluation of a Phenobarbital-Based Protocol for Severe Alcohol Withdrawal in Critically Ill Patients
Authors: Goodberlet Melanie , Dube Kevin , Kovacevic Mary , Szumita Paul , DeGrado Jeremy
Published: June 2020

Background: Phenobarbital offers several possible advantages to benzodiazepines including a longer half-life and anti-glutamate activity, and is an alternative for the treatment of alcohol withdrawal. The objective of this analysis was to evaluate the safety and efficacy of a phenobarbital protocol for alcohol withdrawal newly implemented at our institution. Methods: This was a single-center, retrospective analysis of adult patients admitted to the medical/surgical/burn/trauma intensive care unit (ICU) with or at risk of severe alcohol withdrawal. Patients who were admitted prior to guideline implementation and received scheduled benzodiazepines (PRE) were compared to those who received phenobarbital post guideline update (POST). The primary outcome was ICU length of stay (LOS). Results: Upon analysis, 68 patients in the PRE and 64 patients in the POST were identified for inclusion. The median APACHE II score was significantly higher in the POST (4.5 [3:9] vs 10 [5:13], P < 0.001). ICU (2 [1:2] vs 2 [2:5], P = 0.002) and hospital (4.5 [3:6] vs 8 [6:12], P < 0.001) LOS were significantly longer in the POST. There was no difference in mortality or duration of mechanical ventilation. More patients required propofol or dexmedetomidine on day one in the POST ( P < 0.001). Conclusion: Patients in the POST had significantly longer ICU and hospital LOS, and had a higher baseline severity of illness. Future research is needed to evaluate the efficacy and safety of phenobarbital compared to benzodiazepines for severe alcohol withdrawal.
A Focus on Evaluating Major Study Limitations in Order to Apply Clinical Trials to Patient Care: Implications for the Healthcare Team
Authors: Ferrill Mary J. , FakhriRavari Alireza , Hong Lisa , Wedret Jody Jacobson
Published: June 2020

Background: With more than a million new biomedical articles published annually, healthcare providers must stay up to date in order to provide optimal evidence-based patient care. The concise ROOTs (relevance, observe validity, obtain clinically significant results, and translate results to clinical practice) format is a valuable tool to assist with literature evaluation. Purpose: To illustrate how major study limitations found in clinical trials might inhibit the ability to adopt the findings of such studies to patient care. Methods: Examples from published clinical trials that contain major study flaws were used to illustrate, if taken at face value, would lead to erroneous assumptions, and if adopted, could potentiallly harm patients. Conclusion: When evaluating the literature, it is crucial to identify limitations in the published literature that might reduce the internal validity, affect the results, or limit the external validity of clinical trials, hence affecting the usability of literature for patient care. This article provides examples of clinical trials that contain major study limitations with potentially erroneous assumptions. These illustrations are meant to show how important it is to delve deeper into an article before conclusions are drawn.
Effects of CYP2C19*17 Genetic Polymorphisms on the Steady-State Concentration of Diazepam in Patients With Alcohol Withdrawal Syndrome
Authors: Skryabin Valentin Yurievich , Zastrozhin Mikhail , Torrado Marco , Grishina Elena , Ryzhikova Kristina , Shipitsyn Valery , Galaktionova Tatiana , Sorokin Alexander , Bryun Evgeny , Sychev Dmitry
Published: June 2020

Background: Diazepam is one of the most widely prescribed tranquilizers for the therapy of alcohol withdrawal syndrome (AWS), which includes the symptoms of anxiety, fear, and emotional tension. However, diazepam therapy often turns out to be ineffective, and some patients experience dose-dependent adverse drug reactions, reducing the efficacy of therapy. Aim: The purpose of our study was to investigate the effects of CYP2C19*17 genetic polymorphisms on the steady-state concentration of diazepam in patients with AWS. Materials and Methods: The study was conducted on 50 Russian male patients suffering from the AWS. For the therapy of psychomotor agitation, anxiety, fear, and emotional tension, patients received diazepam in injections at a dosage of 30.0 mg/day for 5 days. Genotyping was performed by real-time polymerase chain reaction. The efficacy and safety assessment was performed using psychometric scales and scales for assessing the severity of adverse drug reactions. Therapeutic drug monitoring (TDM) was performed using the high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS) method. Results: Based on the results of the study, we revealed the differences in the efficacy of therapy in patients with different CYP2C19 − 806C>T genotypes: (*1/*1) −12.0 [−15.0; −8.0], (*1/*17+*17/*17) −7.0 [−14.0; −5.0], P < .001, as well as the results of TDM: ( CC) 250.70 [213.34; 308.53] ng/mL (*1/*17+*17/*17) 89.12 [53.26; 178.07] ng/mL, P < .001. Conclusion: Thus, our study enrolling 50 patients with AWS, showed the effects of CYP2C19*17 genetic polymorphisms on the efficacy and safety rates of diazepam. Furthermore, we revealed the statistically significant difference in the levels of plasma steady-state concentrations of diazepam in patients carrying different genotypes.
The psychosocial effects of being quarantined following exposure to COVID-19: A qualitative study of Lebanese health care workers
Authors: Fawaz Mirna , Samaha Ali
Published: June 2020

Background:

Since the outbreak of the novel Coronavirus (COVID-19), health care professionals in Lebanon have been diligently serving as the frontline of defense. In the light of challenging economic and political circumstances, putting their community wellbeing as a priority, and abiding by quarantine and strict infection control measures, health care professionals risk both their physical and mental wellbeing.

Objective:

The aim of this study is to explore the psychosocial effects of being quarantined following exposure to COVID-19 among Lebanese health care professionals.

Method:

An exploratory qualitative research design was employed, where semi-structured interviews were carried out involving a sample of 13 Lebanese health care providers working at various COVID-19 units.

Results:

The qualitative analysis has revealed four themes namely ‘Fears of contracting and spreading the virus’, ‘Conflict between professional duty and family obligation’, ‘Stigma of being infected’, and ‘Inadequate or inaccurate information’.

Conclusion:

COVID-19 quarantine has been posing intense psychological challenges among Lebanese health care workers which are worsened at times by the economic instability; thus, health care policymakers are urged to take proper action nationwide to alleviate longlisting implications and support the health care providers in fulfilling their mission.
Finding a Point of Observation in the Global South: The C. L. Gerling and J.M. Gilliss Correspondence (1847–1856)
Authors: Sanhueza-Cerda Carlos , Valderrama Lorena B.
Published: June 2020

Historians of science have amply demonstrated the transnational character of science; however, they have not sufficiently attended to how several scientific projects were coordinated as part of global initiatives. Our research – based on the unpublished, written correspondence between Christian Ludwig Gerling in Germany and James M. Gilliss in the United States, from 1847 to 1856 – examines the issues that were being discussed in the search for an observation point in Chile that could be linked to the various astronomical research projects happening in the global north. This article shows that the building of this network had to navigate communicational and language barriers, financial uncertainty, lack of adequate scientific instruments, and the influence of intermediaries. In fact, the intermediaries involved affected the formulation of questions and objectives, as well as the choice of methods and instruments to be used (such as Alexander von Humboldt and Friedrich Gauss), and directly impacted on how these things were brought to bear (for example, instrument manufacturers, diplomats, and translators).
Gross Negligence Manslaughter Revisited: Time for a Change of Direction?
Authors: Crosby Cath
Published: June 2020

This article postulates that the House of Lords took a wrong turn in Adomako, missing the opportunity to revise the Caldwell/Lawrence guidance on recklessness, to produce a more appropriate determinant of criminal liability for inadvertent conduct causing death. It will be advocated that gross negligence manslaughter is replaced with reckless manslaughter utilising an objective capacity–based test. A proposal that encompasses both acts and omissions will be advanced which is theoretically underpinned by a hybrid theory of culpability. It will be contended that this hybrid theory best represents current approaches to criminally reckless conduct in practice and produces a morally apposite method of ascertaining criminal responsibility where the risk of death was not foreseen.
The Positive Effect of Not Following Others on Social Media
Authors: Valsesia Francesca , Proserpio Davide , Nunes Joseph C.
Published: June 2020

Marketers commonly seed information about products and brands through individuals believed to be influential on social media, which often involves enlisting micro influencers, users who have accumulated thousands as opposed to millions of followers (i.e., other users who have subscribed to see that individual’s posts). Given an abundance of micro influencers to choose from, cues that help distinguish more versus less effective influencers on social media are of increasing interest to marketers. The authors identify one such cue: the number of users the prospective influencer is following. Using a combination of real-world data analysis and controlled lab experiments, they show that following fewer others, conditional on having a substantial number of followers, has a positive effect on a social media user’s perceived influence. Further, the authors find greater perceived influence impacts engagement with the content shared in terms of other users exhibiting more favorable attitudes toward it (i.e., likes) and a greater propensity to spread it (i.e., retweets). They identify a theoretically important mechanism underlying the effect: following fewer others conveys greater autonomy, a signal of influence in the eyes of others.
Cutaneous wound metallic residues pattern analysis with SEM-EDX in a forensic case of overkill
Authors: Gentile Guendalina , Boracchi Michele , Gherardi Mirella , Maciocco Francesca , Muccino Enrico , Tambuzzi Stefano , Zoja Riccardo
Published: June 2020

The term overkill identifies the infliction of massive injuries that greatly exceed those needed to kill the victim both in number and intensity. We present the case of a Peruvian transsexual, who was choked and hit by 11 sharp-force wounds all in the facial area. The scanning electron microscopy with energy dispersion X-ray analysis carried out on the skin of the facial wounds proved crucial in proving that two different point-and-edge weapons were used, following the finding of metallic micro-traces of heterogeneous composition. This discovery and the autopsy highlighted the use of two distinct types of injury (mechanical asphyxia and sharp-force trauma) showed that this murder amounted to o verkill.
Coronavirus Act 2020: An overview by a lawyer interested in medico-legal matters
Authors: Samuels Alec
Published: June 2020

The Act and the regulations. How long they might last. The suspension of the renewals. Enforcement and the role of the police. Protection of whistleblowers. The trial scene. The ultimate impact.
Is Covid-19 sowing the seeds for future litigation?
Authors: Riley-Smith QC Toby , Heppinstall Adam , Foster Freya
Published: June 2020

We consider various types of litigation that may follow the Covid-19 pandemic, including: claims against National Health Service (NHS) Trusts by patients who have contracted the coronavirus (or by their bereaved families), claims by NHS staff against their employer for a failure to provide any or adequate personal protective equipment or testing, commercial claims arising from the procurement of medical supplies, the potential liabilities to those who suffer adverse reactions to any vaccine and the guidance issued by the regulators in relation to subsequent disciplinary action.
Childhood Emotional Maltreatment and Post-Traumatic Stress Disorder in the Context of Centrality of the Event and Intrusive Rumination
Authors: Watts Justin , Leeman Michael , O’Sullivan Deirdre , Castleberry Joshua , Baniya Ganesh
Published: June 2020

Psychiatric disorders, such as post-traumatic stress disorder (PTSD), are significantly more likely among those exposed to child maltreatment. Not all who are exposed to maltreatment develop PTSD; while many contributing factors are understood, more research is needed to understand why some develop this disorder. The purpose of this study was to examine relationships among an understudied form of maltreatment: childhood emotional maltreatment (CEM) and cognitive processes that may directly or indirectly explain development of PTSD among CEM survivors. A sample of college students ( N = 396) completed surveys related to childhood trauma history, cognitive processing, and PTSD. Mediation analyses revealed that CEM had a significant direct effect on PTSD, and that centrality of the event and intrusive rumination significantly mediated this relationship. Recommendations are provided for identifying maladaptive cognitive processes with the aim of facilitating adaptive cognitive processing related to prior trauma exposure and current PTSD symptoms.
Mapping the invisibles: Using non-conventional point-level data to analyse residential patterns of deprived people in a mid-sized city
Authors: Balducci Francesco
Published: June 2020

In urban geography it is a common practice to refer to censuses and other official sources of data to analyse residential segregation. However, there are limitations to those data, especially where particular groups of people are concerned. Often, official sources of data do not allow micro-level analysis of the characteristics, needs and residential patterns of socially disadvantaged residents. At the same time, measures based on income thresholds fail to fully take into account the complexity of multidimensional deprivation. This work uses the unconventional information coming from a voluntary organisation to investigate and understand the residential patterns of disadvantaged residents living in a mid-sized Italian city. The factors associated with the relative presence of deprived residents in city neighbourhoods are tested with a GLM/Poisson regression model. The results are differentiated among the sub-groups: the disadvantaged people pertaining to the Asian community are more residentially clustered than others. Their distribution, unlike that of other ethnic groups, is not significantly related to the economic characteristics at area level but to the presence of other Asian residents in an area.
An unusual case of tropical pyomyositis: cryptococcal pyomyositis
Authors: Ramesh Venkat , Polati Vishnu R , Prakasham P Swathi , Narreddy Suneetha , Saidulu Ganta , Varahala Sneha
Published: June 2020

The more common manifestations of cryptococcal infections are restricted to the central nervous system and lungs. A young man, suffering from idiopathic dilated cardiomyopathy with a left ventricular ejection fraction of 20%, presented with subacute, painful tender swelling in both legs initially attributed to congestive cardiac failure. No response to diuretics was achieved. Metabolically active lesions in the muscles of both lower limbs suggestive of muscle abscesses were found. A diagnosis of tropical pyomyositis was therefore made, but aspiration surprisingly revealed gram-positive yeast cells, staining of which on India ink and culture confirmed Cryptococcus. A good response to a combination of liposomal amphotericin B and flucytosine was obtained, but nevertheless the patient died from heart failure after induction of antifungal therapy.
Conscription or constriction: Military policing of urban youth
Authors: Matallana-Villarreal Jairo
Published: June 2020

Policing—order-making practices to discipline society and tackle crime—goes beyond the typical work of constabulary forces. There is a plurality of policing actors, rationales, and interests within a larger security assemblage, and multiple configurations of those elements according to specific contexts. This paper presents the phenomenon of batidas militares—military raids with the purpose of enforced conscription—carried out by the Colombian army as an informal policing practice. Through a combination of spatial analysis and fieldwork, including interviews with policing operators and young people involved in documented cases, I explain how the systematic execution of batidas created invisible, yet identifiable, urban borders, and how batidas operated as complementary preemptive security devices imposing a militarist order on the city.
Simulating renewal: Postwar technopolitics and technological urbanism
Authors: Elrick John W
Published: June 2020

This article traces the terms and practices underwriting emergent forms of urban government to technical efforts to simulate markets after the Second World War. With an eye toward contemporary techno-utopian schemes and city-building initiatives, I argue that the basis of technological approaches to urban rule today—a conception of cities as complex socio-economic systems amenable to market-driven optimization—was forged by postwar administrators and technicians in response to the vicissitudes of uneven development. To advance this claim, I examine the history of San Francisco’s Community Renewal Program, an early modeling initiative sponsored in the US by the federal government. After situating it in the context of racialized housing markets and policies, I probe the Community Renewal Program’s attempt to build a computer model capable of forecasting the effects of redevelopment on housing markets. Though the Community Renewal Program model ultimately proved unviable as a planning tool, expert appraisals of it at the time simultaneously confirmed the characterization of cities as systems of market signals and affirmed in principle the ability to model and thus manage them given an appropriate technological infrastructure. In this light, current municipal design and development projects premised on interactive and remote-sensing technologies express something of the technocratic politics and optimism of the mid-20th century.
Protecting a whale in a sea of phish
Authors: Pienta Daniel , Thatcher Jason Bennett , Johnston Allen
Published: June 2020

Whaling is one of the most financially damaging, well-known, effective cyberattacks employed by sophisticated cybercriminals. Although whaling largely consists of sending a simplistic email message to a whale (i.e. a high-value target in an organization), it can result in large payoffs for cybercriminals, in terms of money or data stolen from organizations. While a legitimate cybersecurity threat, little information security research has directed attention toward whaling. In this study, we begin to provide an initial understanding of what makes whaling such a pernicious problem for organizations, executives, or celebrities (e.g. whales), and those charged with protecting them. We do this by defining whaling, delineating it from general phishing and spear phishing, presenting real-world cases of whaling, and provide guidance on future information security research on whaling. We find that whaling is far more complex than general phishing and spear phishing, spans multiple domains (e.g. work and personal), and potentially results in spillover effects that ripple across the organization. We conclude with a discussion of promising future directions for whaling and information security research.
A drive for structure: A longitudinal qualitative study of the implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention during hospital discharge at end of life
Authors: Hall Alex , Ewing Gail , Rowland Christine , Grande Gunn
Published: June 2020

Background:

Informal carers are essential in enabling discharge home from hospital at end of life and supporting palliative patients at home, but are often ill-prepared for the role. Carers’ support needs are rarely considered at discharge. If carers are less able to cope with home care, patient care may suffer and readmission may become more likely.

Aim:

To investigate the implementation of an evidence-based Carer Support Needs Assessment Tool (CSNAT) intervention to support carers during hospital discharge at end of life.

Design:

Longitudinal qualitative study with thematic analysis.

Setting/participants:

One National Health Service Trust in England: 12 hospital practitioners, one hospital administrator and four community practitioners. We provided training in CSNAT intervention use and implementation. Practitioners delivered the intervention for 6 months. Data collection was conducted in three phases: (1) pre-implementation interviews exploring understandings, anticipated benefits and challenges of the intervention; (2) observations of team meetings and review of intervention procedures and (3) follow-up interviews exploring experiences of working with the intervention.

Results:

Despite efforts from practitioners, implementation was challenging. Three main themes captured facilitators and barriers to implementation: (1) structure and focus within carer support; (2) the ‘right’ people to implement the intervention and (3) practical implementation challenges.

Conclusions:

Structure and focus may facilitate implementation, but the dominance of outcomes measurement and performance metrics in health systems may powerfully frame perceptions of the intervention and implementation decisions. There is uncertainty over who is best-placed or responsible for supporting carers around hospital discharge, and challenges in connecting with carers prior to discharge.
Pre-exposure of adolescent mice to morphine results in stronger sensitization and reinstatement of conditioned place preference than pre-exposure to hydrocodone
Authors: Madison Caitlin A , Wellman Paul J , Eitan Shoshana
Published: June 2020

Background:

Opioids are commonly prescribed to treat moderate-to-severe pain. However, their use can trigger the development of opioid use disorder. A major problem in treating opioid use disorder remains the high rate of relapse.

Aim:

The purpose of this study was to determine whether there are differences among opioids in their ability to trigger relapse after pre-exposure during adolescence.

Methods:

On postnatal day 33, mice were examined for the acute locomotor response to saline, morphine, or hydrocodone (5 mg/kg). They were administered with the corresponding opioid or saline during postnatal days 34–38 (20 mg/kg) and 40–44 (40 mg/kg). On postnatal day 45, they were recorded for the development of locomotor sensitization (5 mg/kg). Starting on postnatal day 55, mice were examined for the acquisition (1, 5, 10, 20, and 40 mg/kg), extinction, and drug-induced reinstatement (1, 2.5, and 5 mg/kg) of conditioned place preference.

Results:

There were no significant differences in the acute locomotor response to morphine and hydrocodone. Morphine induced significantly stronger locomotor sensitization as compared to hydrocodone. Pre-exposure to morphine, but not hydrocodone, sensitized the acquisition of conditioned place preference. There were no significant differences in extinction rates. Mice pre-exposed to morphine reinstate conditioned place preference after priming with a 1 mg/kg dose. In contrast, higher priming doses were required for reinstatement in all other experimental groups.

Conclusions:

Adolescent mice administered with morphine develop greater sensitization to its effects and subsequently reinstate conditioned place preference more readily than mice administered with hydrocodone. This suggests higher risk for relapse after pre-exposure to morphine during adolescence as compared to hydrocodone.
Heroin-induced headache in female heroin addicts
Authors: Li Li , Yu Shengyuan
Published: June 2020

Objective

To investigate the manifestations and incidence of headaches caused by heroin in Chinese women.

Methods

This was a survey study conducted from 29 June to 3 July 2015 with women attending the Shanxi Drug Rehabilitation Centre for Women (China). All study subjects were newly admitted and had not begun their drug rehabilitation. Demographic characteristics, heroin usage and headache episodes within the previous 3 months were surveyed, especially the presence of a headache within 2 hours of heroin use. Details of the severity, location, premonitory symptoms and characteristics of headaches were recorded.

Results

Of the 90 heroin-dependent patients, 74 experienced headache attacks within 2 hours of heroin use, and the headaches subsided within 72 hours of discontinuation of heroin use. Most heroin-induced headaches were similar to migraines and manifested as pulsating pain in 54 patients (51/74, 68.9%); bilateral pain was reported by 46 patients (46/74, 62.2%). Approximately half of the patients with heroin-induced headaches also reported accompanying symptoms of nausea, vomiting, and light and sound sensitivity.

Conclusions

Heroin-induced headache may eventually be listed as a new class of headache in the International Classification of Headache Disorders.