bluuebunny/crossref_metadata_2025 huggingface dataset:
God, Purpose, and Reality
Authors: Bishop John , Perszyk Ken
Published: February 2023

Euteleology is a metaphysics according to which reality is inherently purposive and the contingent Universe exists ultimately because reality’s overall telos, the supreme good, is realized within it. This book provides an exposition of euteleology and a defence of its coherence. The main aim is to establish that euteleological metaphysics provides a religiously adequate alternative to the ‘personal-omniGod’ understanding of theism prevalent amongst analytic philosophers. The quest for an alternative to understanding the God of the Abrahamic traditions as an omnipotent, omniscient, morally perfect personal being is motivated by criticizing the religious adequacy of this conception of God. This criticism deploys a ‘normatively relativized’ version of the ‘logical’ Argument from Evil: it is argued that an omnipotent personal agent would unavoidably be responsible for a morally flawed relationship with human beings caught up in horrendous evils. Reasons are given for preferring a ‘non-personalist’ account of theism, and the religious adequacy of a euteleological theism is then defended against two main objections—first, that it faces a problem of evil that threatens its coherence, and, second, that it cannot make good sense of the practices of prayer and worship that are essential to theist religion. An important theme is that, though God is not a personal being, nor any kind of ‘being amongst beings’ in basic euteleological ontology, God-talk may be understood as resting on a radical analogy that is apt for enabling right human responses to ultimate divine reality.
God, the Divine, and the Divine Attributes
Authors: Bishop John , Perszyk Ken
Published: February 2023

This chapter considers the place of God in euteleological theism. It argues that God is not to be identified with any entity in euteleology’s basic ontology—not with the Universe as a whole, or with reality’s principle of unity (its eutelicity), or with the supreme good which is reality’s telos, or with concrete realizations of reality’s telos. Yet euteleology accepts that truths may be conveyed by claims about God’s acting in creating and within creation. It provides an account of creation ex nihilo and of God’s distinctness from creation, as well as of the divine attributes. It generally leaves in place traditional scriptural, liturgical, and creedal personal language about God. Personal language about God is understood by a radical analogous extension or projection from our understanding of personal language as applied to human agents, where the very thought of God as an entity is itself possible only by a process of extending by analogy our ‘thing-property’ schema to apply to the unique case of ultimate reality itself. In ways we cannot fully comprehend, the truth-makers for these analogously constructed claims will be some aspect of ultimate reality itself being the way it is when euteleological theism is true. Despite its account of God-as-a-thing as a cognitive construction, it is argued that a euteleological theism is robustly realist. The chapter concludes by discussing the sense(s) in which euteleology may be regarded as a panentheism.
A Tragic King
Authors: Nicholson Emma
Published: February 2023

Chapter 5 explores the use of a tragic mode in Polybius’ description of Philip’s last years and the implications such a styling has for Polybius’ account of the king, our understanding of his methodology, and our conception of ancient historiography. It revisits old scholarly debates surrounding Philip’s last years, his intentions towards Rome, and Polybius’ views on dramatic elements in history, and asserts that the use of a tragic style was not itself abhorrent in Polybius’ conception of good historiography, but rather the extent to which it distorted the truth. It argues that Polybius deliberately approached the end of Philip’s life with such tragic styling because it was consistent with his overall depiction of the king, offered his readers familiar grounds from which to think about the king, and enabled him to impart what he saw as crucial lessons in politics and moral behaviour.
Election Supervision in Indonesia
Authors: Siregar Fritz
Published: February 2023

After General Election Law (Law 7/2017) was enacted, enormous authority to adjudicate election disputes was given to the General Election Supervisory Agency (Bawaslu). This authority leads to a question: could Bawaslu become a fully functioning election tribunal? In order to adjudicate election disputes and administrative violations, each member of Bawaslu from the regency to provincial level and national level undertakes a role very similar to a judge in a court. This judicial function is core to the work of Bawaslu at all levels of elections. The difference with courts is that Bawaslu must make a decision on disputes or complaints within a short time frame. There are two main questions that need to be answered in regard to Bawaslu’s authority. First, could Bawaslu become an election tribunal and, if so, should it possess authority to adjudicate election result disputes? Second, if so, should Bawaslu remain independent or fall under the authority of the Supreme Court like other specialized courts do? This chapter discusses the merits of these options for reform in the context of comparative literature on electoral accountability.
A Course on Plasticity Theory
Authors: Steigmann David J.
Published: February 2023

This work, concerned with the conceptual foundations of continuum plasticity theory, emphasizes a unifying perspective grounded in the fundamental notion of material symmetry. This affords a systematic framework for the proper understanding of established models of plasticity and for their modern extensions and generalizations. Particular emphasis is placed on the differential-geometric aspects of the subject and their role in illuminating the kinematical basis of plasticity theory. Classical models, together with several alternatives of interest in contemporary research, are developed in a unified format. The book is addressed to graduate students and specialists working in the field of continuum mechanics.
Music and Musicians—and Why the Brain Matters
Authors: Svard Lois
Published: February 2023

Music has traditionally been studied as a cultural product, an art form reflecting a specific time and place. However, since making music requires complex auditory processing, memory storage and retrieval, motor programming, and sensory-motor integration, music can also be studied as science, and neuroscientists are increasingly studying musicians and the process of making music to learn more about the structure and function of the human brain. There is no single area in the brain where music is processed. Instead, various elements of music are processed in areas throughout the brain and are connected by vast neural networks. Brain networks that process music have been identified through imaging studies as well as through lesion studies. Research into aphasia, amusia, musical alexia, and musical savants suggest that music and language are processed separately in the brain. Discoveries in neuroscience, behavioral and cognitive psychology, archaeology, biology, and other areas are leading researchers to conclude that music has biological foundations, and that we are hardwired for music just as we are for language.
Does Music Really Make You Smarter?
Authors: Svard Lois
Published: February 2023

There is no evidence that listening to music makes one smarter, but there is considerable evidence that learning to play a musical instrument and making music gives lifelong cognitive advantages in many areas. Neural resources developed while studying music have both a near transfer effect (areas closely related to music) and a far transfer effect (areas unrelated to music). Studying music has a far transfer effect on the study of mathematics; they share spatial-temporal reasoning. Studying music also has a far transfer effect on executive function skills (inhibitory control, working memory, and cognitive flexibility) and on speech processing abilities. Musicians have heightened responses to the acoustic details of speech (pitch, timing, timbre), and because the same auditory pathway is used for both music and speech, the enhancements from studying music transfer to speech processing and language. Because studying music has a transfer effect to speech processing, community or in-school music classes can improve the neural encoding of speech for at-risk children, leading to better language development and reading, and thus to academic success.
Secular Resurrections
Authors: Trigg Christopher
Published: February 2023

Chapter 5 examines secular adaptations of resurrection in the early national and the antebellum eras. It identifies three ways in which writers, thinkers, and politicians used the doctrine to envision the future of the United States. First, they employed resurrection metaphorically, in general political speech or in detailed commentaries that applied the eschatological scriptures to American history. Second, they invoked the concept metonymically, arguing that the democratization of social structures would bring about a corporeal improvement of the citizenry, increasing longevity and enhancing mental capacities. Third, they discussed resurrection literally, with some arguing that belief in the concept needed to be rejected for humanity to reach its full secular potential. In the nineteenth century, sentimentalists, Spiritualists, and materialists all cast doubt on traditional Protestant teachings about resurrection. Nevertheless, their interest in the problems with corporeal life after death demonstrated that the idea still had influence over the American religious imagination.
Introduction
Authors: Peels Rik
Published: February 2023

This first chapter provides a short introduction to the book. First, it sketches a brief history of the study of ignorance. There is a lack of serious investigation into ignorance: apart from the apophatic tradition in the ancient world and the Middle Ages and the more recent fields of agnotology, philosophy of race, and feminist philosophy, ignorance itself has received little philosophical attention. It is then laid out how the field that one would expect to have studied ignorance in detail, namely, epistemology, has failed to do so. The chapter also explores why this could be the case. Subsequently, it is explained what is new about this book and how this fills the important gap in the study of ignorance: it develops and applies an epistemology of ignorance. Finally, it gives a brief overview of the chapters ahead.
Degrees of Ignorance
Authors: Peels Rik
Published: February 2023

This chapter seeks to understand what it is for ignorance to come in degrees. It first provides a short metaphysical exploration of what degrees are. It argues that there are at least three ways in which something can come in degrees: it displays the determinable–determinate relation, it stands in the type–token relation, or it is constituted by stereotypical properties. It then considers whether propositional, objectual, and practical ignorance admit of degrees. It turns out that they do, albeit in somewhat different ways. Finally, this chapter considers whether group ignorance comes in degrees. It argues that it does, partly for the reasons individual propositional, objectual, and practical ignorance come in degrees, but also for reasons that are unique to group ignorance.
White Ignorance
Authors: Peels Rik
Published: February 2023

This chapter zooms in on the concept of white ignorance in the philosophy of race and brings the epistemology of ignorance to bear on this pivotal notion. As some have suggested that the philosophy of race employs a rival notion of ignorance in comparison with the conception of ignorance in epistemology, it first explores whether we need to revise the view on the nature of ignorance that was defended in the first part of this book. After that, it puts the threefold distinction between propositional, objectual, and practical ignorance to work for white ignorance. Next, it explores whether white ignorance can take the shape of each of the six varieties of propositional ignorance: disbelieving, suspending, undecided, unconsidered, deep, and complete ignorance. It then shows how the philosophy of race can benefit from an account of group ignorance, particularly the Dynamic Account developed and defended in chapter 5. Finally, it details how an account of degrees of ignorance can be usefully employed in studying degrees of white ignorance.
Ignorance That Excuses
Authors: Peels Rik
Published: February 2023

This chapter explores when ignorance is an excuse. It first spells out what it is to be excused for something: one did something wrong by violating an obligation and one is blameless for that. Next, it is argued that an excuse can be provided by ignorance of four kinds of propositions: ignorance of one’s having the obligation in question, ignorance of one’s having the ability to meet that obligation, ignorance of how to meet that obligation, and lack of foresight regarding that obligation. It follows that normative ignorance can excuse as well as factive ignorance. Moreover, there are important differences between the extents to which varieties of ignorance excuse. Disbelieving, unconsidered, deep, and complete ignorance normally fully excuse, whereas suspending and undecided ignorance provide at most a partial excuse. Practical and objectual ignorance can excuse as well. Finally, it is considered when ignorance counts as an excuse for a group.
Introduction
Authors: McGraw Andrew
Published: February 2023

The introduction describes the author’s reflective experiences of music as ethics, first in Indonesia and later in his community in Virginia. It then outlines the timeline and location of the research for the book and describes the methodologies. Summaries of each chapter are presented, outlining the social scene, musical forms, and the role of music as ethics in each of the four communities. The introduction concludes with a brief summary of the main thesis of this book: Music’s complexity and semantic ambiguity affords our ability to experience it as ethics, and the emotions it evokes can motivate ethical lives, helping us speculate on new forms of the common good.
Conclusion
Authors: McGraw Andrew
Published: February 2023

This chapter concerns a more general discussion of music’s relationship to ethics. Although the principles of traditional normative ethics are sometimes observable in musical interactions, evidence from the communities suggests that they have limited utility for describing the everyday experience of music as ethics. This is because they are optimized for individualistic action, whereas musical interactions emerge from a fundamentally relational ontology encouraging us to constantly shift between egocentric and non-egocentric perspectives. Concepts of situated reasoning and virtue better describe this dynamic. Finally, this chapter argues that the shared experience of music as ethics is uniquely relevant to responding to social crises in modern pluralistic societies because it affords opportunities to imagine new forms of the common good across social–cultural difference.
More Related Than Distinct
Authors: Kampourakis Kostas
Published: February 2023

In this chapter I present evidence that most human DNA variation is found within rather than between populations. This entails that any two humans are more likely to be overall similar than different. In addition, it is not possible to make inferences for individuals from the study of human DNA variation in populations, because there are no DNA markers that are distinctive of any human social group. Whether we predefine populations for these analyses, or we let them emerge through them, the common conclusion is that there are no human populations that are both genetically homogeneous and genetically distinct from others. Whenever we find such differences, they are not clear-cut, as the underlying DNA variation is continuous. As a result, the arguments that races have a biological basis are flawed and not supported at all by DNA evidence.
India’s Internal Security in Comparative Perspective
Authors: Staniland Paul
Published: February 2023

This chapter explores patterns of Indian response to non-state armed actors. It argues that the use of both force and accommodation varies by political context, the type of conflict and violence being faced, and geographic location. Nationalist ideas matter at the macro-level, helping to determine which groups and conflicts are seen as worthy of high-cost repression and sustained efforts at violence monopolization, and which can instead be managed in a fairly loose and flexible way. The goals of violence are also crucial for determining the political threat perceived, with anti-state insurgencies receiving a much different response than the murky world of electoral violence, private armies, and thugs. Border areas receive particular attention, contributing to an interesting blend of hard-line suppression in some areas with the creation of buffer zones and even toleration of cross-border insurgents in others. There is incredible heterogeneity in responses to organized political violence in India.
The Military in Internal Security
Authors: Ahuja Amit , Raghavan Srinath
Published: February 2023

In addition to protecting the state from external threats, militaries in many countries also secure the state internally. This chapter focuses on counterinsurgency, the Indian Army’s most consequential internal security mission. Three arguments emerge from our analysis of the army’s use in internal security. First, the army, which partly inherited its internal security role from its colonial parent, continued its domestic engagement after 1947 to preserve national unity and India’s territorial integrity. Second, tasked to pacify multiple insurgencies simultaneously, the army adopted different approaches for different theatres. To fight the insurgency in Jammu and Kashmir, it raised sixty-five battalions of the Rashtriya Rifles and it oversaw the expansion of the Assam Rifles, a paramilitary force it has administered since 1962 to confront insurgencies in the North East. Third, its successes at controlling violence notwithstanding, the army’s prolonged and substantial engagement with counterinsurgency has possibly distorted civil-military relations, endangered the army’s professionalism, and arguably undermined military effectiveness in confronting external threats and securing India’s foreign policy goals.
Viscoelastic Haemostatic Point-of-Care Assays in the Management of Postpartum Haemorrhage: A Narrative Review
Authors: Dias J.D. , Butwick A.J. , Hartmann J. , Waters J.H.
Published: February 2023

(Anaesthesia. 2022;77:700–711)

Viscoelastic hemostatic assays (VHA) provide the benefit of real-time information on pregnant women that laboratory hemostatic analysis does not offer. The speed of VHA contributes to its clinical utility as they help diagnose coagulopathy and guide treatment in real-time for maternal patients. This paper investigates current VHA guidelines in postpartum hemorrhage (PPH; defined as blood loss of ≥500 mL within 24 h of delivery) situations, and it reviews recent literature regarding VHA device use when managing postpartum hemostatic competence profiles of women with PPH.
Effect of a Rapid Response Team on the Incidence of In-Hospital Mortality
Authors: Factora F. , Maheshwari K. , Khanna S. , Chahar P. , Ritchey M. , O’Hara J. , Mascha E.J. , Mi J. , Halvorson S. , Turan A. , Ruetzler K.
Published: February 2023

(Anesth Analg. 2022;135:595–604)

Cardiopulmonary arrest in-hospital leads to increased mortality yet is largely preventable with signs of deterioration prior to serious and emergent changes in patients. To intervene early when clinical deterioration is evident prior to adverse effects of cardiopulmonary arrest, rapid response teams (RRTs) were introduced. A nurse-led RRT was introduced in 2009 at a large tertiary medical center, which switched to being anesthesiology-led in 2012. This study primarily aims to compare in-hospital mortality with RRT initiation (2005-2008 vs. 2009-2018). It also aims to compare in-hospital mortality with policy changes following the initiation of an anesthesiology-led RRT.
FIGO Good Practice Recommendations on Modifiable Causes of Iatrogenic Preterm Birth
Authors: Valencia C.M. , Mol B.W. , Jacobsson B. ,   FIGO Working Group for Preterm Birth
Published: February 2023

(Int J Gynaecol Obstet. 2021t;155:8–12)

Iatrogenic preterm delivery, also known as provider-initiated preterm birth, is a planned delivery before 37 weeks of gestation. As the science of obstetrical and neonatal care practice progresses, globally iatrogenic preterm delivery has increased. Now, iatrogenic preterm delivery constitutes nearly 50% of preterm births and is increasing worldwide. Provider-initiated birth may be induction of labor or cesarean delivery without rupture of membranes or spontaneous labor. Reasons for iatrogenic preterm delivery include obstetric complications of both maternal and fetal nature. Maternal conditions include such comorbidities as hypertensive disorders of pregnancy, antepartum hemorrhage, and abnormal placentation conditions. Maternal medical conditions such as heart disease, cancer, nephropathy, and sepsis are increasing in frequency. Fetal causes such as fetal growth restriction, fetal distress, and structural malformations; and nonmedical causes may prompt iatrogenic preterm delivery. Maternal factors and provider behavior may play a role in the increasing rate of iatrogenic preterm delivery, which has led researchers to consider strategies that could decrease preterm birth rates.
FIGO Good Practice Recommendations on Cervical Cerclage for Prevention of Preterm Birth
Authors: Shennan A. , Story L. , Jacobsson B. , Grobman W.A.
Published: February 2023

(Int J Gynaecol Obstet. 2021;155:19–22)

Cervical cerclage, a suture preventing dilation, is an intervention commonly used on women at increased risk of preterm birth and second-trimester fetal loss. Evidence-based recommendations derived from randomized controlled trials (RCTs) and meta-analyses help determine which patients would benefit from cervical cerclage. Pregnant women with obstetric or gynecologic history of increasing preterm birth risk; ultrasound suggesting cervical shortening; and presence of an already open cervix with fetal membrane exposure have the recommendation to undergo cervical cerclage. History-indicated cerclage indications are mid-trimester loss and/or 3 or more preterm deliveries. Ultrasound-indicated cerclage indications are cervical length <25 mm with a history of mid-trimester loss or at least one spontaneous preterm birth. Parturient women with exposed, prolapsed membranes should be offered cervical cerclage on a case-by-case basis. Vaginal cerclage does not increase the risk of preterm labor, rupture of membranes, cesarean section, or chorioamnionitis. Cervical cerclage placement technique and timing of removal should be under the discretion of a trained surgeon, though removal at 36 to 37 weeks is typical. Stitches should be placed as high as realistically possible, and anesthesia use is needed for insertion but may not be necessary for removal.
Quality of Labor Analgesia With Dural Puncture Epidural Versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study
Authors: Tan H.S. , Reed S.E. , Mehdiratta J.E. , Diomede O.I. , Landreth R. , Gatta L.A. , Weikel D. , Habib A.S.
Published: February 2023

(Anesthesiology. 2022;136:678–687)

Dural puncture epidural technique is a nested needling procedure wherein a spinal needle is passed through the epidural needle and through the dura, without the injection of intrathecal (IT) medications. Delivery of neuraxial analgesia is initiated only through the epidural catheter. Even in the absence of additional medication, dural puncture’s purported advantage over standard epidural placement is the unambiguous return of cerebrospinal fluid (CSF) through the spinal needle, confirming midline placement. Dural puncture may also facilitate the transfer of epidural drugs through the dural breach to help establish onset and quality of analgesia. Evidence for the efficacy of this approach is limited with some mixed data showing no clear clinical advantage. Obese parturients are particularly susceptible to epidural failure, and also at higher risk for emergency cesarean delivery wherein well-initiated neuraxial analgesia would be a further asset to avoid general anesthesia. The ostensible advantage of improved analgesic effect with the use of dural puncture vs standard epidural technique is investigated in obese patients who have the potential to draw strong benefit from an enhanced success rate for quality analgesia given the challenges inherent to this patient population.
The Analgesic Efficacy of Intravenous Dexamethasone for Postcesarean Pain: A Systematic Review With Meta-analysis and Trial Sequential Analysis
Authors: Singh N.P. , Makkar J.K. , Yadav N. , Goudra B.G. , Singh P.M.
Published: February 2023

(Eur J Anaesthesiol. 2022;39:498–510)

Pain management during and following cesarean delivery (CD) has been a topic of interest due to its impact on maternal outcomes, yet the efficacy of intravenous dexamethasone for post-CD analgesia requires more analysis. This systematic review and meta-analysis investigated the association of dexamethasone administration and pain following CD compared with a control group.
Why I Write
Authors: Srivastava Ranjana
Published: February 2023

A practicing physician and oft-published columnist, the author reflects on her journey as a writer. For doctors who like or wish to write, reflections are offered about using writing as a public platform from which to elevate issues important to the doctor–patient relationship. At the same time, the public platform also constitutes a responsibility to be accurate, ethical, and respectful. The author shares guiding questions that writers can ask before or as they write. Attending to these questions will support compassionate, respectful, factually accurate, relevant, and insightful commentary that embodies physician integrity and reflects a thoughtful doctor–patient relationship.
Perspectives on Disparities and Equity in Cancer Outcomes: A Call to Action
Authors: Odunsi Kunle
Published: February 2023

Despite remarkable progress in cancer prevention, treatment, and survivorship in the United States over the past 3 decades, there remain considerable disparities in cancer incidence and mortality among various groups based on race, ethnicity, and other social determinants of health. For most cancer types, African Americans have the highest mortality rate and lowest survival rate of any racial and ethnic group. Here the author highlights some of the factors responsible for cancer health disparities and proposes that cancer health equity is a fundamental human right. These factors include inadequate health insurance coverage, medical mistrust, lack of diversity in the workforce, and social and economic exclusion. Recognizing that health disparities do not exist in isolation but are part of a complex set of problems associated with education, housing, employment, health insurance, and community structures, the author contends that the challenge cannot be solved by public health measures alone but would require a multifaced and coordinated approach involving several sectors of the economy—business, schools, financial institutions, agriculture, and urban planning. Several immediate and medium-term action items are proposed to set the foundation for sustained efforts that would have an impact in the long term. These include developing culturally tailored interventions through community engagement to enhance uptake of cancer screening and clinical trials among racial and ethnic minorities and other medically underserved patients, expanding access to equitable and affordable quality health care by increasing access to health insurance, and prioritizing investment in early-career cancer researchers to enhance diversity and improve equity in the workforce.
To Operate or Not? Balancing Advanced Imaging, Machine Learning, and the Doctor–Patient Relationship in Complex Clinical Decision Making
Authors: Subramanian Tanvi , Pocivavsek Luka , Alverdy John C.
Published: February 2023

Advances in high-resolution, cross-sectional imaging have changed the practice of medicine. These innovations have clearly benefited patient care yet have also led to a decreased dependence on the art of medicine, with its emphasis on obtaining a thoughtful history and thorough physical examination to elicit the same diagnosis that imaging provides.

What remains to be determined is how physicians can balance these technological advances with their own ability to use clinical experience and judgment. This can be seen not only with the use of high-level imaging but also with the increasing use of machine-learning models throughout medicine. The authors contend that these should be seen not as a replacement for the physician, but as another tool in their arsenal in determining management decisions. These issues are salient for surgeons, who, given the serious undertaking required to operate on a person, must develop trust-based relationship with their patients.

Navigating this new field brings with it several ethical conundrums that must be addressed, with the final goal being to provide optimal patient care without sacrificing the human element involved, from either the physician or the patient. The authors examine these less-than-simple challenges, which will continue to develop as physicians use the increasing amount of machine-based knowledge available to them.
Aligning Healthcare's Mission With Corporate Social Responsibility Action
Authors: Dowling Michael J.
Published: February 2023

Amid many challenges, health systems and hospitals are striving to improve the health of their communities with varying degrees of commitment. While many have recognized the importance of the social determinants of health, most have not responded aggressively to the global climate crisis that is sickening and killing millions of people worldwide—and getting worse. As the largest healthcare provider in New York, Northwell Health is committed to keeping our communities well in the most socially responsible way. That means engaging with partners to enhance well-being, expand access to equitable care, and take environmental responsibility.

Healthcare organizations have a special obligation to broaden their efforts to prevent further damage to the planet and limit the human toll of that damage. For this to happen, their governing boards must support tangible environmental, social, and governance (ESG) strategies and put in place the administrative structures for their C-suites that are necessary to ensure compliance. At Northwell Health, governance is the engine that drives accountability for ESG.
Sustainable Healthcare Depends on Good Governance Practices
Authors: Greenhill Richard G. , Khalil Merette
Published: February 2023

Effective leadership and governance are at the heart of creating and maintaining resilient health systems. COVID-19 exposed a plethora of issues in its wake, most notably the need to plan for resilience. Facing threats that swirl around climate, fiscal solvency, and emerging infectious diseases, healthcare leaders are challenged to think broadly on issues that affect operational viability. The global healthcare community has offered numerous approaches, frameworks, and criteria to assist leaders in creating strategies for better health governance, security, and resilience. As the world exits the worst of the pandemic, now is the time to plan for the sustainability of those strategies. Based on guidance developed by the World Health Organization, good governance is one key to sustainability. Healthcare leaders who develop measures to assess and monitor progress toward strengthening resilience can achieve sustainable development goals.
Same-Day Discharge After Left Bundle Area Pacing
Authors: Kadado Anis John , Gobeil Kyle , Pervaiz Abdullah , Pundlik Shayal , Pritham Ryan , Obeidat Yasin , Fatima Anum , Sawalha Khalid , Chalhoub Fadi
Published: February 2023

Background:

Left bundle area pacing (LBAP) has emerged as an area that appears to be an attractive alternative to other forms of physiological pacing owing to its ease and favorable pacing parameters. Same-day discharge after conventional pacemakers, implantable cardioverter defibrillators, and more recently leadless pacemakers have become routine, especially after the COVID-19 pandemic. With the advent of LBAP, the safety and feasibility of same-day discharge remain unclear.

Methods:

This is a retrospective, observational case series of consecutive, sequential patients undergoing LBAP at Baystate Medical Center, an academic teaching hospital. We included all patients who underwent LBAP and were discharged on the same day of procedure completion. Safety parameters included any procedure-related complications including pneumothorax, cardiac tamponade, septal perforation, and lead dislodgement. Pacemaker parameters included pacing threshold, R-wave amplitude, and lead impedance pre-discharge the following day of implantation and up to 6 months of follow-up.

Results:

A total of 11 patients were included in our analysis, the average age was 70.3 ± 6.74 years. The most common indication for pacemaker insertion was AV block (73%). No complications were seen in any of the patients. The average time between the procedure and discharge was 5.6 hours. Pacemaker and lead parameters were stable after 6 months of follow-up.

Conclusions:

In this case series, we find that same-day discharge after LBAP for any indication is a safe and feasible option. As this mode of pacing becomes increasingly more common, larger prospective studies evaluating the safety and feasibility of early discharge after LBAP will be needed.
Erythrocyte Indices in Patients With Takotsubo Syndrome
Authors: Braschi Annabella , Frasheri Arian , Lombardo Renzo M. , Abrignani Maurizio G. , Lo Presti Rosalia , Vinci Daniele , Traina Marcello
Published: February 2023

Background:

Although the prognosis of patients with Takotsubo syndrome (TTS) is relatively favorable, serious complications may occur. This study aimed to investigate the relationship between blood parameters and the occurrence of in-hospital complications.

Methods:

Clinical charts of 51 patients with TTS were retrospectively evaluated, and data regarding blood parameters assessed during the first 24 hours of hospitalization were studied.

Results:

Levels of hemoglobin less than 13 g/dL in men and 12 g/dL in women (P < 0.01), levels of mean corpuscular hemoglobin concentration (MCHC) less than 33 g/dL (P = 0.01), and levels of red blood cell distribution width-coefficient of variation higher than 14.5% (P = 0.01) were significantly associated to the occurrence of major adverse cardiovascular events (MACE). Markers, such as, platelets to lymphocytes ratio, lymphocytes to monocytes ratio, neutrophils to lymphocytes ratio, and white blood cell count to mean platelet volume, were unable to differentiate patients with and without complications (P > 0.05). MCHC and estimated glomerular filtration rate were independent predictors of MACE.

Conclusions:

Blood parameters may have a role in the stratification risk of patients with TTS. Patients showing low levels of MCHC and decreased estimated glomerular filtration rate were more likely to have in-hospital MACE. This should encourage physicians to closely monitor blood parameters in patients with TTS.
Perioperative versus postoperative calcium and vitamin D supplementation to prevent symptomatic hypocalcemia after total thyroidectomy: a randomized placebo controlled trial
Authors: Sittitrai Pichit , Ruenmarkkaew Donyarat , Klibngern Hanpon , Ariyanon Tapanut , Hanprasertpong Nutthiya , Boonyaprapa Somkamon , Sreesawat Maysayawan
Published: February 2023

Background:

Hypocalcemia is the most common complication following total thyroidectomy. This study aimed to evaluate the efficacy of perioperative combined calcium and vitamin D supplementation compared to postoperative combined calcium and vitamin D supplementation in reducing symptomatic hypocalcemia.

Materials and methods:

A prospective randomized placebo-controlled trial was carried out in patients undergoing total or completion thyroidectomy from June 2017 to May 2022. Eligible patients were assigned to receive either calcium carbonate and alfacalcidol or placebo 3 days before surgery, and both groups were given calcium carbonate and alfacalcidol for 14 days after surgery. Clinical outcomes (signs and symptoms of hypocalcemia, requirement of intravenous calcium, and medication-induced hypercalcemia) and laboratory results (calcium and parathyroid hormone levels) were compared between the two groups.

Results:

One hundred and thirty-four patients were included in the analysis, 68 were in perioperative oral calcium and vitamin D supplementation group, and 66 were in postoperative oral calcium and vitamin D supplementation group. Symptomatic hypocalcemia rates were significantly lower in the perioperative group than in the postoperative group (8.8 and 22.7%, respectively,P=0.033). All symptomatic hypocalcemia cases in the perioperative group occurred in the first 24 hours after surgery. Mean calcium levels were significantly higher in the perioperative group at 24 and 48 hours after surgery. Intravenous calcium requirement rate was lower in the perioperative group but the difference was insignificant (2.9 and 12.1%,P=0.053). Mean parathyroid hormone levels were within the normal range and did not differ between groups. No medication-induced hypercalcemia was detected in either group.

Conclusion:

Perioperative oral calcium and vitamin D supplementation significantly decreased the risks of symptomatic and biochemical hypocalcemia compared to postoperative oral calcium and vitamin D supplementation. The perioperative supplementation also shortened the recovery period of symptomatic hypocalcemia to within 24 hours.
Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors
Authors: Lieber Sarah R. , Baldelli Luke , Kim Hannah P. , Nash Rebekah P. , Noriega Ramirez Alvaro , Magee Gabrielle , Barritt Alfred S. , Evon Donna M. , Singal Amit G.
Published: February 2023

Understanding survivorship experiences at different stages postliver transplantation (poat-LT) is essential to improving care. Patient-reported concepts including coping, resilience, post-traumatic growth (PTG), and anxiety/depression, have been implicated as important predictors of quality of life and health behaviors after LT. We aimed to descriptively characterize these concepts at different post-LT survivorship stages. This cross-sectional study featured self-reported surveys measuring sociodemographic, clinical characteristics, and patient-reported concepts including coping, resilience, PTG, anxiety, and depression. Survivorship periods were categorized as early (1 y or below), mid (1–5 y), late (5–10 y), and advanced (10 y or above). Univariable and multivariable logistic and linear regression modeling examined factors associated with patient-reported concepts. Among 191 adult LT survivors, the median survivorship stage was 7.7 years (interquartile range: 3.1–14.4) and median age was 63 years (range: 28–83); most were male (64.2%) and Caucasian (84.0%). High PTG was more prevalent in the early survivorship period (85.0%) than late survivorship (15.2%). High trait resilience was only reported by 33% of survivors and associated with higher income. Lower resilience was seen among patients with longer LT hospitalization stays and late survivorship stages. About 25% of survivors had clinically significant anxiety and depression, which was more frequent among early survivors and females with pre-LT mental health disorders. In multivariable analysis, factors associated with lower active coping included survivors ≥65 years, non-Caucasian race, lower levels of education, and nonviral liver disease. In a heterogeneous cohort including early and late LT survivors, there was variation in levels of PTG, resilience, anxiety, and depression at different survivorship stages. Factors associated with positive psychological traits were identified. Understanding determinants of LT survivorship has important implications for how we should monitor and support LT survivors.
Complement detection in kidney biopsies – utility and challenges
Authors: Tomaszewski Kristen , Herlitz Leal
Published: February 2023

Purpose of review

This review discusses the important role of staining for components of the complement cascade in both native and transplant kidney biopsies. The use of complement staining as a marker of prognosis, disease activity, and as a potential future tool in identifying patients who may benefit from complement-targeted therapies is discussed.

Recent findings

While staining for C3, C1q and C4d can yield valuable information about complement activation in kidney biopsies, to adequately assess complement activation and potential therapeutic targets, expanded staining panels looking at multiple split products and complement regulatory proteins are needed. Recent progress has been made in identifying markers of disease severity in C3 glomerulonephritis and IgA nephropathy, such as Factor H-related Protein-5, which may serve as future tissue biomarkers. In the transplant setting, the limitation of relying on C4d staining to identify antibody mediated rejection is giving way to molecular diagnostics, including The Banff Human Organ Transplant (B-HOT) panel, which includes numerous complement complement-related transcripts, with the classical, lectin, alternative, and common pathways.

Staining for complement components in kidney biopsies to understand how complement is activated in individual cases may help to identify patients who may benefit from complement-targeted therapies.
Management of antineutrophil cytoplasmic antibody-associated vasculitis: a changing tide
Authors: Krishnan Anoushka , Walsh Michael , Collister David
Published: February 2023

Purpose of review

Antineutrophil cytoplasmic antibody associated vasculitis (AAV) is a group of autoimmune disorders of small blood vessels. While outcomes in AAV have improved with the use of glucocorticoids (GC) and other immunosuppressants, these treatments are associated with significant toxicities. Infections are the major cause of mortality within the first year of treatment. There is a move towards newer treatments with better safety profiles. This review reflects on recent advances in the treatment of AAV.

Recent findings

The role of plasma exchange (PLEX) in AAV with kidney involvement has been clarified with new BMJ guideline recommendations following the publication of PEXIVAS and an updated meta-analysis. Lower dose GC regimens are now standard of care. Avacopan (C5a receptor antagonist) was noninferior to a regimen of GC therapy and is a potential steroid-sparing agent. Lastly, rituximab-based regimens were noninferior to cyclophosphamide in two trials for induction of remission and superior to azathioprine in one trial of maintenance of remission.

AAV treatments have changed tremendously over the past decade with a drive towards targeted PLEX use, increased rituximab use and lower GC dosing. Striking a crucial balance between morbidity from relapses and toxicities from immunosuppression remains a challenging path to navigate.
Recent updates in kidney risk prediction modeling: novel approaches and earlier outcomes
Authors: Hundemer Gregory L. , Sood Manish M. , Canney Mark
Published: February 2023

Purpose of review

Recent years have witnessed the development of kidney risk prediction models which diverge from traditional model designs to incorporate novel approaches along with a focus on earlier outcomes. This review summarizes these recent advances, evaluates their pros and cons, and discusses their potential implications.

Recent findings

Several kidney risk prediction models have recently been developed utilizing machine learning rather than traditional Cox regression. These models have demonstrated accurate prediction of kidney disease progression, often beyond that of traditional models, in both internal and external validation. On the opposite end of the spectrum, a simplified kidney risk prediction model was recently developed which minimized the need for laboratory data and instead relies primarily on self-reported data. While internal testing showed good overall predictive performance, the generalizability of this model remains uncertain. Finally, there is a growing trend toward prediction of earlier kidney outcomes (e.g., incident chronic kidney disease [CKD]) and away from a sole focus on kidney failure.

Newer approaches and outcomes now being incorporated into kidney risk prediction modeling may enhance prediction and benefit a broader patient population. However, future work should address how best to implement these models into practice and assess their long-term clinical effectiveness.
Arterialized Vein Bypass Graft Recipient Vessel in Free Tissue Transfer Covering Diabetic Foot Ulcers Complicated by Critical Limb Ischemia
Authors: Tran Ryu , Haffner Zoė K. , Slamin Robert P. , Akbari Cameron M. , Evans Karen K.
Published: February 2023

Limb salvage options are limited in diabetic patients with critical limb ischemia. Soft tissue coverage remains technically demanding with limited recipient vessels for free tissue transfer. These factors make revascularization alone challenging. When open bypass revascularization is possible, venous bypass graft is optimal and functions as a recipient vessel for staged free tissue transfer.

The authors present 2 cases using a combination approach of staged venous bypass graft revascularization followed by free tissue transfer with anastomosis to the venous bypass graft resulting in successful limb preservation.

Free tissue transfer to a native vessel has limited application in severe peripheral vascular disease patients because early vascular compromise threatens flap survival. In both presented cases, venous bypass graft alone was insufficient to treat their nonhealing wounds, and preoperative angiogram revealed dismal options for free tissue transfer reconstruction. However, previous venous bypass graft provided an operable vessel for free tissue transfer anastomosis. The combination of venous bypass graft and free tissue transfer proved to be ideal for successful limb preservation by providing vascularized tissue to previously ischemic angiosomes, ensuring optimal wound healing capacity. Venous bypass graft is advantageous to native arterial grafts, and its combination with free tissue transfer likely increases graft patency and flap survival. We demonstrate that end-to-side anastomosis to a venous bypass graft is a viable option in these highly comorbid patients with favorable flap outcomes.
Coronavirus disease 2019 infection and cerebrovascular diseases: an update on the pathophysiology and management
Authors: May Brandon , Wang David Z.
Published: February 2023

Purpose of review

COVID-19 is an ongoing global pandemic since it was first discovered in 2020. Cerebral vascular disease and stroke are among the most common and devastating neurological manifestations of COVID-19. This review offers an up-to-date information on the possible underlying mechanism of COVID-19-related stroke, its diagnosis, and management.

Recent findings

The thromboembolism associated with COVID-19 infection is likely related to the cytokine storm with innate immune activation, pulmonary disease leading to hypoxia-induced ischemia, thrombotic microangiopathy, endothelial damage and multifactorial activation of the coagulation cascade. Currently, there is no clear guidelines on the use of antithrombotics for the prevention and treatment of this phenomenon.

COVID-19 infection can directly cause a stroke or facilitate the formation of thromboembolism in the presence of other medical conditions. Physicians treating patients with COVID-19 should stay vigilant about the signs and symptoms of stroke, detect and treat early.