bluuebunny/crossref_metadata_2025 huggingface dataset:
29. Multi-Track
Authors: Sime Stuart
Published: July 2021

The multi-track deals with a vast range of cases, from simple contractual disputes involving little more than £25,000, to complex commercial cases involving difficult issues of fact and law with values of several million pounds, to cases where perhaps no money is at stake but which raise points of real public importance. Cases on the multi-track will generally be dealt with either in the Royal Courts of Justice or other civil trial centre. This chapter discusses agreed directions; case management conferences; fixing the date for trial; pre-trial checklists; listing hearings; pre-trial review; directions given at other hearings; and variation of case management timetable.
30. Striking Out, Discontinuance, and Stays
Authors: Sime Stuart
Published: July 2021

This chapter discusses striking-out orders, discontinuance, and stays in civil proceedings. Rule 3.4(2) of the Civil Procedure Rules 1998 (CPR) allows the court to strike out a statement of case if it appears to the court: that the statement of case discloses no reasonable grounds for bringing or defending the claim; that the statement of case is an abuse of the court’s process or is otherwise likely to obstruct the just disposal of the proceedings; or that there has been a failure to comply with a rule, practice direction, or court order. A party who realizes their case is doomed is often best advised to discontinue to prevent the accumulation of further costs, but often has to pay the costs of the other parties to date. Stays are temporary halts in proceedings, and can be granted for a range of reasons. A stay is normally lifted once the reason no longer applies.
31. Disclosure
Authors: Sime Stuart
Published: July 2021

The Civil Procedure Rules 1998 (CPR) require the parties to give advance notice to their opponents of all the material documentation in their control. This is done in two stages. At the first stage the parties send each other lists of documents, a process called ‘disclosure’. The second stage is ‘inspection’, which is the process by which the other side can request copies of documents appearing in the list of documents, typically with photocopies being provided by the disclosing party. This chapter discusses these processes. It covers lawyers’ and clients’ responsibilities; the stage when disclosure takes place; disclosure orders; standard disclosure; menu option disclosure; duty to search; list of documents; privilege; inspection; orders in support of disclosure; documents referred to in statements of case, etc.; admission of authenticity; and collateral use.
33. Hearsay
Authors: Sime Stuart
Published: July 2021

This chapter considers the admissibility of and procedural matters relating to hearsay evidence in civil cases. Hearsay evidence is where a witness gives evidence of facts they have not personally experienced for the purpose of proving the truth of those facts. Hearsay may be written or oral, and may be first-hand, second-hand, etc. Evidence is no longer excluded in civil cases solely on the ground that it is hearsay. However, in practice, trial judges give limited weight to hearsay evidence.
34. Admissions and Documentary Evidence
Authors: Sime Stuart
Published: July 2021

This chapter discusses the rules relating to the proof of admissions and documents at trial. It covers the nature of admissions; pre-action admissions of liability; permission to withdraw an admission; notice to admit facts; and proving documents.
36. Offers to Settle
Authors: Sime Stuart
Published: July 2021

Part 36 of the Civil Procedure Rules 1998 (CPR) provides a means for a party to make a formal offer in settlement of the claim which will be treated as without prejudice for the purposes of liability and remedies, but which can be disclosed to the court on the question of costs. This chapter discusses offers to settle before the commencement of proceedings; making a Part 36 offer; acceptance of a Part 36 offer; rejections, counter-offers, and subsequent offers; withdrawal and amendment of Part 36 offers; failing to obtain judgment more advantageous than a Part 36 offer; advising on Part 36 offers; non-disclosure to judge; and Part 36 offers in appeals.
40. Remote Hearings
Authors: Sime Stuart
Published: July 2021

Traditionally, civil hearings take place in court buildings, with hearings being conducted in public in court rooms in front of a judge. Active case management in accordance with the overriding objective includes dealing with cases without the parties needing to attend court, and by making use of technology (CPR, r 1.4(2)(j) and (k)). There is provision in the CPR for holding hearings by telephone, by video, or by any other means which permits simultaneous communication (r 39.1(1)(a)), and for receiving evidence by telephone or by using any other method of direct oral communication (r 3.1(2)(d)). Increased public proficiency with information technology, combined with the emergency created by the coronavirus outbreak in 2020, have resulted in the courts embracing computer technology for remote hearings for civil proceedings.
43. Freezing Injunctions
Authors: Sime Stuart
Published: July 2021

This chapter discusses the rules on freezing injunctions. A freezing injunction is an interim order restraining a party from removing assets located within the jurisdiction out of the country, or from dealing with assets whether they are located within the jurisdiction or not. The order is usually restricted to assets not exceeding the value of the claim. The main purpose of a freezing injunction is to prevent the injustice of a defendant’s assets being salted away so as to deprive the claimant of the fruits of any judgment that may be obtained.
47. Qualified One-Way Costs Shifting
Authors: Sime Stuart
Published: July 2021

Qualified one-way costs shifting (QOCS) provides costs protection to claimants in personal injuries claims. If the claimant wins, the defendant should be ordered to pay the claimant’s costs in the usual way. However, if the claimant loses, under QOCS, while the claimant remains liable to pay its own lawyers’ costs, and may be ordered to pay the successful defendant’s costs, the claimant will be protected against actually having to pay those costs to the defendant. This chapter discusses cases where QOCS applies; the effects of QOCS; and loss of QOCS protection.
48. Enforcement
Authors: Sime Stuart
Published: July 2021

Parties occasionally refuse to comply with the judgments and orders of the court. A range of enforcement procedures is available to ensure compliance. This chapter discusses enforcement of money judgments; enforcement of judgments for the delivery of goods; enforcement of judgments for the possession of land; contempt of court; and enforcement of foreign judgments.
49. Judicial Review
Authors: Sime Stuart
Published: July 2021

This chapter discusses the rules for judicial review. Judicial review lies against public bodies and must be brought by a person with a sufficient interest. There are six remedies available on applications for judicial review (quashing order, mandatory orders, prohibitory order, declaration, injunction, and money awards). Before commencing judicial review proceedings, a claimant should comply with the judicial review pre-action protocol. Permission must be sought to proceed with a claim for judicial review. Defendants must be served with the judicial review claim form, and unless they acknowledge service they cannot appear at the permission hearing unless the court allows them to attend.
50. Appeals
Authors: Sime Stuart
Published: July 2021

This chapter considers the structure of non-family civil appeals. It covers routes of appeal; permission to appeal; time for appealing; procedure on appealing; respondent’s notice; applications within appeals stay; striking out appeal notices and setting aside or imposing conditions; hearing of appeals; appeal court’s powers; appeals by way of case stated; and appeals to the Supreme Court.
Intestinal Biopsies for the Evaluation of Environmental Enteropathy and Environmental Enteric Dysfunction
Authors: Hodges Phoebe , Tembo Mizinga , Kelly Paul
Published: July 2021

Environmental enteric dysfunction (EED) is a syndrome characterized by impairments of digestion and absorption and intestinal barrier failure in people living in insanitary or tropical environments. There is substantial evidence that it contributes to impaired linear growth of millions of children in low- and middle-income countries, to slowed neurocognitive development, and to diminished responses to oral vaccines. It represents the functional consequences of environmental enteropathy, an asymptomatic inflammatory disorder of the mucosa, and there is considerable overlap with the enteropathy observed in severe clinical malnutrition. The majority of studies of EED have employed functional tests based on lactulose permeation to define the presence of abnormal leak in the gut. However, where intestinal biopsies can safely be collected the opportunity then arises to study the underlying enteropathy in cellular and molecular detail, as well as to measure important functional elements such as enzyme expression. The purpose of this narrative review is to summarize the current understanding of environmental enteropathy obtained from small intestinal biopsies, and prospects for future work. We review histology, electron microscopy, transcription and protein expression, physiological measures, and the microbiome. We conclude that while noninvasive biomarkers of enteropathy and intestinal dysfunction permit large-scale studies of unquestionable value, intestinal biopsies are still required to investigate pathophysiology in depth.
Gulliver Unleashed? International Order, Restraint, and The Case of Ancient Athens
Authors: Reiter Dan
Published: July 2021

International relations often include orders of smaller powers led by major powers. Perhaps the most significant aspect of international order is whether the major power leader is restrained or nonrestrained. Restrained major powers respect smaller powers’ preferences, eschew wielding power to impose their preferences, and avoid violating the smaller powers’ sovereignties, often using binding institutions and rules. Nonrestrained major powers violate decision-making rules, seek to impose their preferences, and violate smaller powers’ sovereignties using coercion and force. This article asks, what causes an order to evolve from restrained to nonrestrained? It argues that when a major power grows in strength relative to smaller power order members, the major power becomes more likely to abandon restraint, using coercion and force to impose its preferences on the order. Further, there is a snowball effect, as initial acts of nonrestraint undermine the credibility of the major power's commitment to restraint, encouraging smaller powers to exit the order, fueling further major power nonrestraint. The theory is tested on the fifth-century BCE Athenian order. Athens’ transition from restraint to nonrestraint, what some call a transition from alliance to empire, supports the predictions of the theory. Neither ideology nor rent-seeking theories explain this transition.
Gender, Internal Armed Conflict, and High Court Decision-Making in Transitioning Societies
Authors: Walker Lee Demetrius , Martinez Melissa , Pace Christopher
Published: July 2021

Building on research that applies the policy deference model to high court decision-making during external war, we propose that conflict intensity, political government's preference on liberalization, and the gender of appellant impact the manner in which courts follow policy deference during internal war in transitioning countries. Contextually, we argue that shifts in women's roles and gender relations during internal conflict in transitioning societies condition the manner in which civilian courts make decisions on civil and political rights cases. During external war in advanced democracies, policy deference infers that courts will rule more conservatively on civil and political rights cases. Using habeas corpus cases as a representation of civil and political rights’ protection from El Salvador's civil war period (1980–1992) and two measures of conflict intensity, our findings indicate that the court's decision-making process deviates from conventional expectations derived from the policy deference model in three ways: (1) conflict intensity solely affects the court's decision-making on habeas corpus cases involving men; (2) the political government's choice for political liberalization affects the court's decision-making on both women and men cases; and (3) gender conditions the manner in which policy deference applies in a society that is experiencing societal change.
Impact of a vancomycin loading dose on the achievement of target vancomycin exposure in the first 24 h and on the accompanying risk of nephrotoxicity in critically ill patients
Authors: Hodiamont C J , Juffermans N P , Berends S E , van Vessem D J , Hakkens N , Mathôt R A A , de Jong M D , van Hest R M
Published: July 2021

Background

The advocated pharmacokinetic/pharmacodynamic (PK/PD) target for vancomycin, AUC/MIC ≥ 400 mg·h/L, may not be reached with a conventional fixed starting dose of 1000 mg in critically ill patients, but increasing the dose may cause nephrotoxicity.

Objectives

To evaluate the effect of a weight-based loading dose of 25 mg/kg vancomycin on PK/PD target attainment in the first 24 h (AUC0–24) in critically ill patients and to evaluate whether this increases the risk of acute kidney injury (AKI).

Patients and methods

A prospective observational before/after study was performed in ICU patients, comparing the percentage of vancomycin courses with AUC0–24 ≥ 400 mg·h/L and the incidence of AKI, defined as worsening of the risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE) score. The conventional dose group received 1000 mg of vancomycin as initial dose; the loading dose group received a weight-based loading dose of 25 mg/kg. A population PK model developed using non-linear mixed-effects modelling was used to estimate AUC0–24 in all patients.

Results

One hundred and four courses from 82 patients were included. With a loading dose, the percentage of courses achieving AUC0–24 ≥ 400 mg·h/L increased significantly from 53.8% to 88.0% (P = 0.0006). The percentage of patients with new-onset AKI was not significantly higher when receiving a 25 mg/kg loading dose (28.6% versus 37.8%; P = 0.48). However, the risk of AKI was significantly higher in patients achieving AUC0–24 > 400 mg·h/L compared with patients achieving AUC < 400 mg·h/L (39.0% versus 14.8%; P = 0.031).

Conclusions

A weight-based loading dose of 25 mg/kg vancomycin led to significantly more patients achieving AUC0–24 ≥ 400 mg·h/L without increased risk of AKI. However, some harm cannot be ruled out since higher exposure was associated with increased risk of AKI.
The United States and the ICC
Authors: Douglas Lawrence
Published: July 2021

This comment argues that President Biden’s revocation of Trump’s Executive Order 13928, which declared a national emergency and authorized the imposition of various sanctions on officials of the International Criminal Court (ICC), does not represent a fundamental reorientation in the relationship between the United States and the ICC. Offering an overview of this vexed relationship, the author argues that the fundamental sticking point remains the United States’ untenable insistence that the ICC lacks jurisdiction over the personnel of non-State Parties.
A Comprehensive Comparison of Early-Onset and Average-Onset Colorectal Cancers
Authors: Cercek Andrea , Chatila Walid K , Yaeger Rona , Walch Henry , Fernandes Gustavo Dos Santos , Krishnan Asha , Palmaira Lerie , Maio Anna , Kemel Yelena , Srinivasan Preethi , Bandlamudi Chaitanya , Salo-Mullen Erin , Tejada Prince R , Belanfanti Kimeisha , Galle Jesse , Joseph Vijai , Segal Neil , Varghese Anna , Reidy-Lagunes Diane , Shia Jinru , Vakiani Efsevia , Mondaca Sebastian , Mendelsohn Robin , Lumish Melissa A , Steinruecke Felix , Kemeny Nancy , Connell Louise , Ganesh Karuna , Markowitz Arnold , Nash Garrett , Guillem Jose , Smith J Joshua , Paty Phillip B , Zhang Liying , Mandelker Diana , Birsoy Ozge , Robson Mark , Offit Kenneth , Taylor Barry , Berger Michael , Solit David , Weiser Martin , Saltz Leonard B , Aguilar Julio Garcia , Schultz Nikolaus , Diaz Luis A , Stadler Zsofia K
Published: July 2021

Background

The causative factors for the recent increase in early-onset colorectal cancer (EO-CRC) incidence are unknown. We sought to determine if early-onset disease is clinically or genomically distinct from average-onset colorectal cancer (AO-CRC).

Methods

Clinical, histopathologic, and genomic characteristics of EO-CRC patients (2014-2019), divided into age 35 years and younger and 36-49 years at diagnosis, were compared with AO-CRC (50 years and older). Patients with mismatch repair deficient tumors, CRC-related hereditary syndromes, and inflammatory bowel disease were excluded from all but the germline analysis. All statistical tests were 2-sided.

Results

In total, 759 patients with EO-CRC (35 years, n = 151; 36-49 years, n = 608) and AO-CRC (n = 687) were included. Left-sided tumors (35 years and younger = 80.8%; 36-49 years = 83.7%; AO = 63.9%; P < .001 for both comparisons), rectal bleeding (35 years and younger = 41.1%; 36-49 years = 41.0%; AO = 25.9%; P = .001 and P < .001, respectively), and abdominal pain (35 years and younger = 37.1%; 36-49 years = 34.0%; AO = 26.8%; P = .01 and P = .005, respectively) were more common in EO-CRC. Among microsatellite stable tumors, we found no differences in histopathologic tumor characteristics. Initially, differences in TP53 and Receptor Tyrosine Kinase signaling pathway (RTK-RAS)alterations were noted by age. However, on multivariate analysis including somatic gene analysis and tumor sidedness, no statistically significant differences at the gene or pathway level were demonstrated. Among advanced microsatellite stable CRCs, chemotherapy response and survival were equivalent by age cohorts. Pathogenic germline variants were identified in 23.3% of patients 35 years and younger vs 14.1% of AO-CRC (P = .01).

Conclusions

EO-CRCs are more commonly left-sided and present with rectal bleeding and abdominal pain but are otherwise clinically and genomically indistinguishable from AO-CRCs. Aggressive treatment regimens based solely on the age at CRC diagnosis are not warranted.
Repercussions of the Degrees of Hearing Loss and Vestibular Dysfunction on the Static Balance of Children With Sensorineural Hearing Loss
Authors: Melo Renato S , Lemos Andrea , Raposo Maria Cristina Falcão , Monteiro Milena Guimarães , Lambertz Daniel , Ferraz Karla Mônica
Published: July 2021

Objective

The purpose of this study was to assess the static balance of children with sensorineural hearing loss (SNHL) according to the degrees of SNHL and the function of the vestibular system.

Methods

This cross-sectional study was conducted in public schools located in Caruaru, Pernambuco state, Brazil, with 130 children (65 with normal hearing and 65 with SNHL as documented by air and bone conduction audiometry) of both sexes between 7 and 11 years old. Static balance was assessed by a stabilometric analysis using a force platform consisting of the circular area of center-of-pressure displacement of the children evaluated in 3 positions: bipedal support with feet together and parallel (PF), tandem feet (TF), and 1 foot (OF), carried out under 2 sensory conditions each, with eyes open and eyes closed. After balance assessments, the children with SNHL received examinations of auditory and vestibular functions—through audiometry and computerized vectoelectronystagmography, respectively—to compose the groups according to degrees of SNHL and vestibular function.

Results

The children with severe and profound SNHL demonstrated more static balance instabilities than the children with normal hearing in 5 positions assessed with eyes open (PF, TF, and OF) and eyes closed (PF and TF). The same phenomenon occurred in children with SNHL and associated vestibular dysfunction in all of the positions assessed with eyes open and eyes closed (PF, TF, and OF).

Conclusion

The larger the degree of SNHL, the greater the balance instability of the children. The children with SNHL and associated vestibular dysfunction showed the highest balance instabilities in this study.

Impact

Children with larger degrees of SNHL and associated vestibular dysfunction might require prolonged periods to rehabilitate their balance.
Insecticide resistance profiles in malaria vector populations from Sud-Kivu in the Democratic Republic of the Congo
Authors: N'Do Sévérin , Bandibabone Janvier B , Soma Dieudonné D , Musaka Bertin Z , Prudhomme Jorian , Habamungu Claude C , Namountougou Moussa , Sangaré Ibrahim , Kientega Mahamadi , Kaboré Didier A P , Bayili Koama , Yerbanga R Serge , Diabate Abdoulaye , Dabire Roch K , Ouedraogo Jean-Bosco , Belem Adrien M G , Boëte Christophe , Guardiola-Claramonte Maite , Chimanuka Bantuzeko
Published: July 2021

Background

Insecticide resistance has become a widespread problem causing a decline in the effectiveness of vector control tools in sub-Saharan Africa. In this situation, ongoing monitoring of vector susceptibility to insecticides is encouraged by the WHO to guide national malaria control programmes. Our study was conducted from April to November 2018 in Tchonka (Sud-Kivu, Democratic Republic of the Congo) and reported primary data on the resistance status of Anopheles funestus and Anopheles gambiae.

Methods

Insecticide susceptibility bioassays were performed on wild populations of A. funestus and A. gambiae using WHO insecticide-impregnated papers at discriminating concentration. In addition, PCR was performed to identify mosquito species and to detect kdr and ace-1R mutations involved in insecticide resistance.

Results

Bioassay results show resistance to all tested insecticides except pirimiphos-methyl, propoxur, fenitrothion and malathion with a mortality rate ranging from 95.48 to 99.86%. The addition of piperonyl butoxide (PBO) increased the susceptibility of vectors to deltamethrin and alpha-cypermethrin by exhibiting a mortality ranging from 91.50 to 95.86%. The kdr mutation was detected at high frequencies (approximately 0.98) within A. gambiae while ace-1R was not detected.

Conclusions

This study provides useful data on the insecticide resistance profiles of malaria vector populations to better manage vector control. Our results highlight that, despite the high level of resistance, organophosphorus compounds and pyrethroids + PBO remain effective against the vectors.
8Postcolonial Theory
Authors: Knudsen Eva Rask , Rahbek Ulla
Published: July 2021

This chapter covers selected research in postcolonial theory published in 2020 and some work delayed and published in early 2021. It begins with a discussion of a new edition of an introduction to postcolonialism and a journal issue with an article cluster devoted to the legacy of Edward Said’s Orientalism (1978) before it focuses on two books that rethink postcolonial studies. The work discussed demonstrates how the ideas in the postcolonial theory and methodology toolbox can still be put to good scholarly use in explorations of bottom-up postcolonialism and activism as well as in top-down postcolonialism and the reading of texts. The book-length studies propose reframing exercises and practical demonstrations that point to new avenues where postcolonial perspectives are still invigorating and, possibly, invaluable.
Three Mycogone Species, Including a New Species, Cause Wet Bubble Disease of Agaricus bisporus in China
Authors: Du Yixin , Shi Niuniu , Ruan Hongchun , Chen Furu
Published: July 2021

White button mushroom, Agaricus bisporus (Lange) Imbach, is the most extensively cultivated and edible mushroom worldwide. The production of A. bisporus is commonly affected by wet bubble disease (WBD), imposing a significant economic burden in China. Although studies have shown that this disease is caused by fungi of the Mycogone genus, the pathogen has not been fully characterized. In this study, 802 samples of diseased fruiting bodies of A. bisporus were collected from nine major mushroom-cultivating provinces in China, yielding a total of 586 Mycogone isolates. The morphologic characteristics of these isolates were observed and compared, and multilocus phylogenetic analyses (internal transcribed spacer [ITS], ACT, TEF1-α, TUB, RPB2, and large ribosomal subunit [LSU]) were performed on the selected representative isolates. Three Mycogone species were identified: a new species, M. xinjiangensis; M. perniciosa; and M. rosea. Mycogone rosea was the first ever reported in China. Furthermore, M. rosea was found to be the most prevalent species (54.95% of all isolates) in all the sampled areas, except in Hubei and Xinjiang, followed by M. perniciosa (39.93%) and M. xinjiangensis (5.12%). Pathogenicity tests on the fruiting body and mushroom bed substantiated Koch’s postulates by the development of mildly different symptoms after inoculation with each species. This study, therefore, enhances our knowledge of the species associated with WBD in A. bisporus and provides useful insights for preventing WBD and allied diseases.
Morphopathological and Molecular Morphometric Characterization of Waitea circinata var. prodigus Causing a Novel Sheath Spot Disease of Maize in India
Authors: Singh Vimla , Lakshman Dilip K. , Roberts Daniel P. , Ismaiel Adnan , Hooda K. S. , Gogoi Robin
Published: July 2021

Maize brown sheath spot (MBSS), a new disease of maize, was discovered while surveying for maize leaf and sheath blight diseases in the Indian states of Assam, Jharkhand, Meghalaya, Manipur, and Odisha. Maize is the third most important cereal after rice and wheat in India. Unlike banded leaf and sheath blight disease caused by Rhizoctonia solani, MBSS symptoms on maize were discrete and limited to sheaths only. Symptoms of MBSS in the field were initially water-soaked necrotic lesions of 1 to 2 cm in diameter on the lowermost leaf sheaths, which then progressed to the upper sheaths. Lesions coalesced and covered approximately 2 to 5% of the sheath area. Infected dried lower leaves were shed, whereas infected upper leaves remained on the stem. The pathogen was isolated, characterized morphologically, pathologically, and molecularly, and identified as Waitea circinata var. prodigus, a basidiomycete known to cause basal leaf blight of seashore paspalum. The internal transcribed spacer (ITS) sequence 2 (ITS2) of rDNA from MBSS isolates formed a well supported clade with known W. circinata var. prodigus isolates. Molecular morphometric analysis of the ITS2 regions of the five known varieties of W. circinata detected distinguishing variations in GC content, compensatory base changes (CBCs), hemi- CBCs, indels, and altered base-pairing of helices. Variation in these characteristics may indicate that varieties are distinct biological species within W. circinata sensu lato. The geographical distribution and potential impacts of MBSS on the maize crop in India necessitate further investigations of pathogen identification and disease management.
Preinvasion Assessment of Exotic Bark Beetle-Vectored Fungi to Detect Tree-Killing Pathogens
Authors: Li You , Bateman Craig , Skelton James , Wang Bo , Black Adam , Huang Yin-Tse , Gonzalez Allan , Jusino Michelle A. , Nolen Zachary J. , Freeman Stanley , Mendel Zvi , Kolařík Miroslav , Knížek Miloš , Park Ji-Hyun , Sittichaya Wisut , Pham Thai-Hong , Ito Shin-ichiro , Torii Masato , Gao Lei , Johnson Andrew J. , Lu Min , Sun Jianghua , Zhang Zhen , Adams Damian C. , Hulcr Jiri
Published: July 2021

Exotic diseases and pests of trees have caused continental-scale disturbances in forest ecosystems and industries, and their invasions are considered largely unpredictable. We tested the concept of preinvasion assessment of not yet invasive organisms, which enables empirical risk assessment of potential invasion and impact. Our example assesses fungi associated with Old World bark and ambrosia beetles and their potential to impact North American trees. We selected 55 Asian and European scolytine beetle species using host use, economic, and regulatory criteria. We isolated 111 of their most consistent fungal associates and tested their effect on four important southeastern American pine and oak species. Our test dataset found no highly virulent pathogens that should be classified as an imminent threat. Twenty-two fungal species were minor pathogens, which may require context-dependent response for their vectors at North American borders, while most of the tested fungi displayed no significant impact. Our results are significant in three ways; they ease the concerns over multiple overseas fungus vectors suspected of heightened potential risk, they provide a basis for the focus on the prevention of introduction and establishment of species that may be of consequence, and they demonstrate that preinvasion assessment, if scaled up, can support practical risk assessment of exotic pathogens.
Immunization practices and risk of anaphylaxis: a current update, comprehensive of COVID-19 vaccination data
Authors: Arcolaci Alessandra , Bronte Vincenzo , Zanoni Giovanna
Published: July 2021

Purpose of review

This review aims to provide an updated report in regards to the correlation between vaccines and anaphylaxis and the related risk in the population.

Recent findings

Initial reports showed higher incidence of anaphylaxis following messenger RNA COVID-19 vaccines compared with ‘routine’ vaccinations, likely influenced by the great attention paid to these ‘new’ vaccines. However, anaphylaxis has still to be considered quite rare and its incidence will be systematically reconsidered in the light of additional data collected.

Adverse reactions to vaccines are commonly reported but most of them are nonspecific mild events, whereas vaccine-related anaphylaxis is considered a rare event, with an incidence rate equal to 1.3 cases per million vaccine doses administered. As anaphylaxis reports usually start to be reported to passive pharmacovigilance during postmarketing surveillance, the first data are used to be influenced by under- and over-reporting and lack of denominators and following studies are needed to confirm the causal relationship. This might create an initial overcautiously approach to new immunization practices but, being anaphylaxis a potential life-threatening event, every suspected contraindication has to be deepened to maximize effectiveness and safety profile and constantly redefined not to exclude an overestimated population group who could receive the vaccine uneventfully.
Autologous serum eye drops for ocular surface disorders
Authors: Cui David , Li Gavin , Akpek Esen K.
Published: July 2021

Purpose of review

Ocular surface disease is a prevalent, diverse group of conditions that cause patient discomfort and decreased visual acuity and present considerable expense to both patients and healthcare systems. Autologous serum eye drops are a topical treatment modality derived from the patient's own blood. Use of serum eye drops for ocular surface disease has been promising due to biochemical similarities to endogenous tears.

Recent findings

Use of serum eye drops for moderate to severe ocular surface diseases such as dry eye, corneal epithelial defects, and inflammatory conditions has become more prevalent. Recent studies have demonstrated that the use of serum eye drops is well-tolerated by patients and associated with improvement in patient-reported outcomes and objective dry eye parameters. Production of serum eye drops may vary, treatment costs can be significant, and the quality of evidence for serum eye drop use published from randomized controlled trials is modest, particularly for long-term treatment. Accessibility remains an area for improvement and may be complemented by allogeneic serum eye drops.

Serum eye drops are frequently used as a safe, well-tolerated, and effective treatment for ocular surface disease. Further research is needed to assess long-term outcomes and improve accessibility.
Differences in Health Care Access and Satisfaction Across Intersections of Race/Ethnicity and Sexual Identity
Authors: Turpin Rodman E. , Akré Ellesse-Roselee L. , Williams Natasha D. , Boekeloo Bradley O. , Fish Jessica N.
Published: July 2021

Purpose

Racial/ethnic and sexual minorities experience numerous health disparities compared with their White and heterosexual counterparts, which may be exacerbated when these social identities intersect. The authors tested for differences in health care access and satisfaction across intersections of sexual identity and race/ethnicity.

Method

A cross-sectional secondary data analysis of the 2012–2018 waves of the Association of American Medical Colleges biannual online Consumer Survey of Health Care Access was conducted. This survey captures a national sample of U.S. adults who reported needing health care in the past 12 months. The analytic sample included 29,628 participants. Sixteen possible combinations of sexual identity and race/ethnicity were examined. Health care access and satisfaction were measured with 10 items and an index created from these items. Cumulative prevalence ratios (PRs) for the index and PRs across sexual identity, both individually and in combination with race/ethnicity, for each health care access and satisfaction item were generated.

Results

Compared with White heterosexuals, all other groups had significantly more barriers to care before adjustment. The greatest barriers were observed among non-Hispanic Asian/Pacific Islander/Hawaiian gay/lesbian (unadjusted PR = 3.08; 95% confidence interval [CI]: 2.45, 3.88; adjusted PR = 2.01; 95% CI: 1.59, 2.53), non-Hispanic Black bisexual (unadjusted PR = 2.73; 95% CI: 2.28, 3.27; adjusted PR = 1.83; 95% CI: 1.52, 2.20), non-Hispanic Black other sexual identity (unadjusted PR = 2.27; 95% CI: 1.69, 3.06; adjusted PR = 2.07; 95% CI: 1.53, 2.78), and Hispanic/Latino other sexual identity (unadjusted PR = 2.06; 95% CI: 1.60, 2.65; adjusted PR = 1.39; 95% CI: 1.08, 1.79) participants.

Conclusions

Persons of both racial/ethnic and sexual minority status generally had less health care access and satisfaction than White heterosexuals. An intersectional perspective is critical to achieving equity in quality health care access.
Effects of posterior hemivertebra resection and short segment fusion on the evolution of sagittal balance in children with congenital scoliosis
Authors: Xu Fulong , Canavese Federico , Liang Feng , Li Yiqiang , Xun Fuxing , Shi Weizhe , Xu Hongwen
Published: July 2021

There is a paucity of data describing sagittal alignment changes in children with congenital scoliosis (CS) treated by hemivertebra (HV) resection. This study aimed to evaluate the effects of posterior HV resection on spine sagittal alignment in children with CS. This is a retrospective analysis of 31 children with CS (mean age at surgery: 49.61 ± 10.21 months; range, 39–72; mean follow-up time: 5.16 ± 1.21 years; range: 3–7) treated at our Institution. Only patients with single thoracic or single lumbar, fully segmented HV managed by posterior HV resection and two segments fusion with four screws and two robs were included. According to the anatomical location of the HV, patients were divided into two groups: thoracic (group A) and lumbar (group B). Thoracic kyphosis (T1–T12; TK) and lumbar lordosis (L1–S1; LL) were measured pre- and postoperatively at 6 months interval. Postoperative TK and LL were 30.3 ± 11.47 and 28.8 ± 9.47, and were 31.98 ± 9.66 and 46.7 ± 11.37 at the last follow-up visit, respectively. The incidence of thoracic hypokyphosis in group B was 53.3%, and it was significantly higher compared to group A (12.5%, P = 0.04). During follow-up, TK changes were comparable between the two groups of patients while LL improved in all patients 6 months after surgery, and continued to improve thereafter. Posterior HV resection and short segment fusion have limited impact on the evolution of TK; in particular, children with lumbar HV were more likely to be hypokyphotic preoperatively, but less likely postoperatively with an increase in LL and a stabilization of TK.
Comparison of Surgical Outcomes for Distal Rectus Femoris Transfer and Resection Surgeries in Children With Cerebral Palsy With Stiff Knee Gait
Authors: Salazar-Torres Jose J. , Church Chris , Shields Thomas , Lennon Nancy , Shrader M. Wade , Sees Julieanne P. , Miller Freeman
Published: July 2021

Background:

Children with cerebral palsy (CP) often present with a stiff knee gait pattern because of rectus femoris (RF) spasticity and/or contracture. Rectus femoris transfers (RFTs) and resections are surgical procedures aimed at reducing muscle stiffness, thereby improving knee flexion during the swing phase of gait. Previous research has consistently demonstrated objective benefits of rectus transfer using instrumented gait analysis (IGA). Rectus femoris resection (RFR), a relatively simpler procedure, shows similar improvement in knee range of motion during gait. The objective of this study was to compare surgical outcomes between rectus transfers and resections using 3-dimensional IGA.

Methods:

Children with spastic CP who had RFTs or resections were retrospectively matched by walking speed and preoperative knee kinematics from 3-dimensional IGA (peak and timing of peak knee flexion in swing). Secondary outcomes included knee range of motion and maximum knee extension during gait.

Results:

Twenty-eight children were included in both the transfer group [age 9.4±2 y; Gross Motor Function Classification System (GMFCS) I (3 children), II (15 children), III (8 children), and IV (2 children)] and the resection group [age 10.6±2.5 y; GMFCS I (1 child), II (14 children), and III (13 children)]. Both surgical groups showed statistically significant short-term postsurgical improvements in peak knee flexion during swing (P<0.001 for the transfer group and P=0.003 for the resection group) and Duncan-Ely test (P=0.004 for the transfer group and P<0.001 for the resection group). Further analysis by GMFCS level showed children at GMFCS levels III/IV had a greater tendency to crouch after RFT when compared with children at GMFCS levels I/II. This tendency was not observed in the RFR group.

Conclusions:

Both transfer and resection surgeries significantly improved gait kinematics short-term outcomes in children with spastic CP who present with stiff knee gait pattern. Further studies are required to compare long-term outcomes of both surgeries.

Level of Evidence:

Level III—retrospective matched-cohort study.
Texture Analysis of Magnetic Resonance Images Enables Phenotyping of Potentially Painful Annular Fissures
Authors: Eriksson Stefanie , Waldenberg Christian , Torén Leif , Grimby-Ekman Anna , Brisby Helena , Hebelka Hanna , Lagerstrand Kerstin
Published: July 2021

Study Design.

Retrospective analysis of prospectively collected data.

Objective.

To investigate whether intervertebral disc (IVD) image features, extracted from magnetic resonance (MR) images, can depict the extension and width of annular fissures and associate them to pain.

Summary of Background Data.

Annular fissures are suggested to be associated with low back pain (LBP). Magnetic resonance imaging (MRI) is a sensitive method, yet fissures are sometimes unobservable in T2-weighted MR-images, even though fissure information is present in the image. Image features can mathematically be calculated from MR-images and might reveal fissure characteristics.

Methods.

Forty four LBP patients who underwent MRI, low-pressure discography (<50 psi), and computed tomography (CT) sequentially in 1 day, were reviewed. After semi-automated segmentation of 126 discs, image features were extracted from the T2-weighted images. The number of image features was reduced with principle component analysis (PCA). CT-discograms were graded and dichotomized regarding extension and width of fissures. IVDs were divided into fissures extending to outer annulus versus short/no fissures. Fissure width was dichotomized into narrow (<10%) versus broad fissures (>10%), and into moderately broad (10%–50%) versus very broad fissures (>50%). Logistic regression was performed to investigate if image features could depict fissure extension to outer annulus and fissure width. As a sub-analysis, the association between image features used to depict fissure characteristics and discography-provoked pain–response were investigated.

Results.

Fissure extension could be depicted with sensitivity/specificity = 0.97/0.77 and area under curve (AUC) = 0.97. Corresponding results for width depiction were sensitivity/specificity = 0.94/0.39 and 0.85/0.62, and AUC = 0.86 and 0.81 for narrow versus broad and moderately broad versus very broad fissures respectively. Pain prediction with image features used for depicting fissure characteristics showed sensitivity/specificity = 0.90/0.36, 0.88/0.4, 0.93/0.33; AUC = 0.69, 0.75, and 0.73 respectively.

Conclusion.

Standard MR-images contains fissure information associated to pain that can be depicted with image features, enabling non-invasive phenotyping of potentially painful annular fissures.

Level of Evidence: 2
A Matched Cohort Analysis of Drain Usage in Elective Anterior Cervical Discectomy and Fusion
Authors: Lim Seokchun , Bazydlo Michael , Macki Mohamed , Haider Sameah , Schultz Lonni , Nerenz David , Fadel Hassan , Pawloski Jacob , Yeh Hsueh-Han , Park Paul , Aleem Ilyas , Khalil Jad , Easton Richard , Schwalb Jason M. , Abdulhak Muwaffak , Chang Victor
Published: July 2021

Study Design.

This is a retrospective, cohort analysis of multi-institutional database.

Objective.

This study was designed to analyze the impact of drain use following elective anterior cervical discectomy and fusion (ACDF) surgeries.

Summary of Background Data.

After ACDF, a drain is often placed to prevent postoperative hematoma. However, there has been no high quality evidence to support its use with ACDF despite the theoretical benefits and risks of drain placement.

Methods.

The Michigan Spine Surgery Improvement Collaborative database was queried to identify all patients undergoing elective ACDF between February 2014 and October 2019. Cases were divided into two cohorts based on drain use. Propensity-score matching was utilized to adjust for inherent differences between the two cohorts. Measured outcomes included surgical site hematoma, length of stay, surgical site infection, dysphagia, home discharge, readmission within 30 days, and unplanned reoperation.

Results.

We identified 7943 patients during the study period. Propensity-score matching yielded 3206 pairs. On univariate analysis of matched cohorts, there were no differences in rate of postoperative hematoma requiring either return to OR or readmission. We noted patients with drains had a higher rate of dysphagia (4.6% vs. 6.3%; P = 0.003) and had longer hospital stay (P < 0.001). On multivariate analysis, drain use was associated with significantly increased length of stay (relative risk 1.23, 95% confidence interval [CI] 1.13–1.34; P < 0.001). There were no significant differences in other outcomes measured.

Conclusion.

Our analysis demonstrated that drain use is associated with significant longer hospital stay.

Level of Evidence: 3
Cauda Equina Syndrome
Authors: Planty-Bonjour Alexia , Kerdiles Gaelle , François Patrick , Destrieux Christophe , Velut Stephane , Zemmoura Ilyess , Cook Ann-Rose , Terrier Louis-Marie , Amelot Aymeric
Published: July 2021

Study Design.

A prospective patient's database operated on a cauda equina syndrome (CES).

Objective.

The aim of our study was to identify prognosis factors for favorable functional recovery after CES.

Summary of Background Data.

CES is a neurologic impairment of variable symptoms associating urinary, bowel, and sexual dysfunctions with or without motor or sensitive deficits caused by nerve root compression of the cauda equina. The definition of CES remains debated, as well as the prognosis factors for favorable functional recovery and the benefit of early surgery.

Methods.

One hundred forty patients were included between January 2010 and 2019. Univariate and multivariate cox proportional hazard regression models were conducted.

Results.

The patients were young with a median age of 46.8 years (range 18–86 yrs). At presentation, 60% were affected by a motor deficit, 42.8% a sensitive deficit, 70% urinary dysfunctions, and 44% bowel dysfunctions. The mean follow-up was 15.5 months. Bilateral motor deficit (P = 0.017) and an initial deficit severity of 0 to 2 (P = 0.001) represented prognosis factors of poor motor recovery. Initial anal incontinence (P = 0.007) was associated with poor bowel recovery. Only 32.8% of the patients went back to work. Initial motor deficit (P = 0.015), motor sequelae (P = 0.001), sphincter dysfunctions sequelae (P = 0.02), and long LOS (P = 0.02) were poor return-to-work prognosis factors. Time to surgery within an early timing < 24 or 48 hours or later did not represent a prognosis factor of recovery in CES. Incomplete versus complete CES did not show better recovery.

Conclusion.

CES remains a profound disabling syndrome with poor functional prognosis: in the long run, few patients go back to work. The main prognosis factors established in our series regarded the initial severity of deficits whether motor or sphincteral. Early or later surgical cauda equina decompression did not show to represent a prognosis factor for functional recovery.

Level of Evidence: 4
A Simple Versatile Technique to Retrieve Polyaxial Tulip-head Spinal Pedicle Screws Following Failed Pedicle Screw Removal: A Technical Note With Analysis of Efficacy and Outcomes
Authors: Uvaraj Nalli R. , Bosco Aju
Published: July 2021

Introduction:

With increase in the number of thoracolumbar spine surgeries using pedicle screw instrumentation, there is a proportionate increase in the number of revision surgeries requiring implant removal. Lack of standardization in manufacturing spinal pedicle screws has led to diverse variations in their design and dimensions. Removal of polyaxial pedicle screws becomes extremely difficult when there is a mismatch between their tulip-head and the screwdriver. With the rapidly changing concepts and designs of spinal pedicle screws this problem may arise when the appropriate pedicle screw instrumentation is out of production. There may be a need for special instruments or an array of screwdrivers of various dimensions/designs to overcome this problem. We describe a simple yet versatile technique to remove polyaxial tulip-head pedicle screws using commonly available instruments in the spinal instrumentation set.

Materials and Methods:

Polyaxial screws were removed after converting them into monoblock screws using the appropriate set-screw screwdriver, a 25-mm long 5.5 mm rod, and a counter torque wrench.

Results:

Using this technique we have successfully removed 167 screws in 53 revision surgeries [instrumented fusions for lumbar degenerative diseases (n=21), thoracolumbar fractures (n=15), and scoliosis (n=17)]. No failed retrievals or complications like pedicle breach or neurological deficit were observed.

Discussion:

The described technique is simple to execute, effective, quick, and safe. It is versatile and can be used to remove polyaxial pedicle screws of any design in the thoracic and lumbar spine using the commonly available instruments in the routine spinal instrumentation set (appropriate set-screw screwdriver, a 25-mm long 5.5 mm rod, a counter torque wrench).