bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in surface equivalent potential temperature: A more comprehensive metric for global warming and weather extremes
Authors: Song Fengfei , Zhang Guang J. , Ramanathan V. , Leung L. Ruby
Published: January 2022

Significance

The Earth has warmed by 1.2±0.1 °C since the preindustrial era. The most common metric to measure the ongoing global warming is surface air temperature since it has long and reliable observational records. However, surface air temperature alone does not fully describe the nature of global warming and its impact on climate and weather extremes. Here we show that surface equivalent potential temperature, which combines the surface air temperature and humidity, is a more comprehensive metric not only for the global warming but also for its impact on climate and weather extremes including tropical deep convection and extreme heat waves. We recommend that it should be used more widely in future climate change studies.
Literature and language education
Authors: Bobkina Jelena , Romero Elena Domínguez , Sastre-Merino Susana
Published: January 2022

This study explores the perceptions of English language teachers of the use of literature in the context of bilingual secondary education in the region of Madrid (Spain). An approach was adopted under which eighty-one English teacher participants completed a questionnaire so that a quantitative methodological approach of a descriptive – correlational nature could be adopted for this study. Results unveiled teacher perceptions of the benefits and drawbacks of using literary texts as a teaching and learning tool, their selection of literary texts and their actual implementation of these texts in their English classes, as well as the training needs for the effective use of literary texts as a language teaching and learning tool in the bilingual EFL secondary classroom. The pedagogical implications of the study emphasize the need to redesign and consolidate teacher training programmes containing literature and innovative teaching aspects both in initial teacher training programmes and for continued training.
Shock formation in magnetized plasma under the influence of polarization force and nonadiabaticity of dust charge variation
Authors: Bansal Sona , S Gill Tarsem
Published: January 2022

In this work, we have analyzed the impact of polarization force, angle of obliqueness under the influence of nonadiabatic dust charge fluctuation on shock waves formation in magneto rotating plasma. The present plasma model is consisting of negatively charged dust grains, Maxwellian electrons, nonextensive ions. The dissipation is introduced in the system via nonadiabaticity, a new mechanism for the formation of shock waves. Using standard reductive perturbation method, nonlinear equation namely Korteweg–de Vries Burgers equation is derived and solution is obtained using the Tanh method. It is shown that dust charge fluctuation is the main source of dissipation. We have studied the various parameteric influences on such shock structure and also showed how the gradual variations of these parameter affect the generation and structure of the shocks in their respective domain. Much of experiments on dusty plasma with nonadiabatic dust charge fluctuation will benefit from the parametric study.
Use of Anthropometric Indices to Identify Appropriate Cuff Shapes for Blood Pressure Measurement: Normative Data for Adults
Authors: Palatini Paolo , Fania Claudio , Ermolao Andrea , Battista Francesca , Saladini Francesca
Published: January 2022

Background

Published evidence has shown that troncoconical cuffs improve blood pressure measurement accuracy in subjects with obesity. However, the exact shape of these cuffs according to arm size is unknown. The aim of the present study was to investigate the anthropometric characteristics of the arm in a large population in order to identify the appropriate shape of the cuff for each arm.

Methods

The anthropometric characteristics were assessed in 729 adults with middle arm circumference ranging from 16 to 55 cm. Subjects were divided into classes of arm size and the upper-arm slant angle of the truncated cone was calculated.

Results

In the whole sample, the conical shape of the arm progressively increased with increasing arm circumference (r = 0.61, P < 0.0001). Independent predictors of the conical shape were arm circumference (P < 0.0001) and length (negative relationship, P < 0.0001), and female sex (P = 0.048). Women had a slightly more pronounced conical shape of the arm (P = 0.007) than men. However, the decrease in the slant angle across the arm-size classes showed a similar trend in men and women, and in a 2-way analysis of variance there was no interactive effect between arm size and sex on the conical shape of the arm (P = 0.11). On the basis of the slant angle calculated in each arm-size class, we provide dimensions for bladders that would appropriately fit the arm within a given circumference range.

Conclusions

To properly fit the upper arm in patients with obesity cuffs should have a troncoconical shape. This study provides reference data according to arm size.
Fast and compact matching statistics analytics
Authors: Cunial Fabio , Denas Olgert , Belazzougui Djamal
Published: January 2022

Motivation

Fast, lightweight methods for comparing the sequence of ever larger assembled genomes from ever growing databases are increasingly needed in the era of accurate long reads and pan-genome initiatives. Matching statistics is a popular method for computing whole-genome phylogenies and for detecting structural rearrangements between two genomes, since it is amenable to fast implementations that require a minimal setup of data structures. However, current implementations use a single core, take too much memory to represent the result, and do not provide efficient ways to analyze the output in order to explore local similarities between the sequences.

Results

We develop practical tools for computing matching statistics between large-scale strings, and for analyzing its values, faster and using less memory than the state-of-the-art. Specifically, we design a parallel algorithm for shared-memory machines that computes matching statistics 30 times faster with 48 cores in the cases that are most difficult to parallelize. We design a lossy compression scheme that shrinks the matching statistics array to a bitvector that takes from 0.8 to 0.2 bits per character, depending on the dataset and on the value of a threshold, and that achieves 0.04 bits per character in some variants. And we provide efficient implementations of range-maximum and range-sum queries that take a few tens of milliseconds while operating on our compact representations, and that allow computing key local statistics about the similarity between two strings. Our toolkit makes construction, storage and analysis of matching statistics arrays practical for multiple pairs of the largest genomes available today, possibly enabling new applications in comparative genomics.

Availability and implementation

Our C/C++ code is available at https://github.com/odenas/indexed_ms under GPL-3.0. The data underlying this article are available in NCBI Genome at https://www.ncbi.nlm.nih.gov/genome and in the International Genome Sample Resource (IGSR) at https://www.internationalgenome.org.

Supplementary information

Supplementary data are available at Bioinformatics online.
Landscape genetics reveal low diversity and adaptive divergence inPortulaca hatschbachii(Portulacaceae): an endangered species endemic to rocky outcrops of the Atlantic Forest
Authors: Feliciano Daniele Cassiano , De Godoy Sara Mataroli , Da Silva João Fernando Marques , Góes Bruna Delgado , Ferraz José Roberto , De Oliveira Santos Patrícia , Da Silva Ribeiro José Eduardo Lahoz , Ruas Paulo Maurício , De Fátima Ruas Claudete
Published: January 2022

Portulaca hatschbachii is endemic to the basaltic rocky outcrops that are distributed, in a discontinuous way, along the Third Plateau of Paraná State, Brazil, composing environments that form the Subtropical Highland Grasslands of the Atlantic Forest Biome. Considering the risk of extinction of the species and the massive anthropization of these outcrops, we applied AFLP, ITS and rps16 molecular markers in ten populations throughout the area of occurrence of the species to generate information about the genetic status of P. hatschbachii and contribute to the development of conservation strategies. Low rates of genetic diversity, high population structure, restricted gene flow and the presence of diversifying selection were observed for the populations. The analysis of variation partitioning (R2adj. = 63.60%) showed that environmental variables have a greater influence on the distribution of variation of loci under selection (R2adj. = 26.70%) than geographical isolation (R2adj. = 1.20%). The strong population structure, for both neutral and selected loci, suggests an isolation by adaptation mechanism (IBA) occurring in populations and highlights the need and urgency for in situ conservation plans for the species and its occurrence on rocky outcrops.
Stopping kidney protection in the elderly following acute kidney injury: think mortality
Authors: Carriazo Sol , Ortiz Alberto
Published: January 2022

Chronic kidney disease (CKD) is projected to become the fifth most common global cause of death by 2040. This illustrates a key consequence of CKD, i.e. premature mortality. Since nephroprotective drugs such as renin–angiotensin system (RAS) blockers and sodium–glucose transport protein 2 (SGLT2) inhibitors decrease glomerular hyperfiltration, they may be stopped following an episode of acute kidney injury (AKI). This may theoretically modify the risks of subsequent events, ranging from hyperkalaemia to CKD progression to cardiovascular events, but the evidence so far has been inconsistent. Roemer et al. have now addressed the shortcomings of prior studies. In a population of mostly elderly (median age 78 years) prevalent users of RAS blockers with an indication for this therapy and who survived for at least 3 months after discharge following a hospitalization characterized by moderate to severe AKI, roughly 50% had stopped RAS blockade at 3 months. Stopping RAS blockade was associated with an increased risk of a primary composite outcome of death, myocardial infarction and stroke, of which a large majority (80%) of events were deaths. In contrast, the risk of hyperkalaemia was reduced and the risk of repeated AKI, CKD progression or heart failure hospitalization was unchanged in patients who stopped RAS blockers. These findings call for a re-evaluation of the practice of stopping RAS blockers in the long-term following AKI and suggest that studies are needed regarding similar practices for SGLT2 inhibitors.
Unexplained syncope in a young athlete: the diagnostic process to find the diagnosis—a case report
Authors: Bergau Leonard , Sohns Christian , Sommer Philipp
Published: January 2022

Background

Differential diagnosis of recurrent syncope is a routine procedure in clinical practice. Most of these syncopes are benign reflex syncopes but identifying patients with cardiac syncope is crucial to prevent fatal outcomes.

Case summary

In this case report, we present the case of a young athlete with recurrent unexplained syncope referred to us for a second opinion. Despite normal resting-electrocardiography and echocardiography, he developed frequent polymorphic and bidirectional premature ventricular contractions during exercise. Genetic testing confirmed a mutation in the RyR2-gene and the diagnosis of catecholaminergic polymorphic ventricular tachycardia was made. A medical therapy with betablockers was initiated but poorly tolerated, so that an implantable cardioverter-defibrillator was implanted. Furthermore, family screening revealed his mother and his sister to be genetic carriers as well. Implantable cardioverter-defibrillator implantation was performed in both family members. The patient did not experience any syncope or arrhythmic episodes during the follow-up period.

Discussion

This case report highlights the importance of thorough diagnostic and potential pitfalls in patients with unexplained syncope. Sometimes, the diagnostic steps need to be extended or repeated to detect rare or potential malignant causes of syncope.
A large deletion at the cortex locus eliminates butterfly wing patterning
Authors: Hanly Joseph J , Livraghi Luca , Heryanto Christa , McMillan W Owen , Jiggins Chris D , Gilbert Lawrence E , Martin Arnaud
Published: January 2022

As the genetic basis of natural and domesticated variation has been described in recent years, a number of hotspot genes have been repeatedly identified as the targets of selection, Heliconius butterflies display a spectacular diversity of pattern variants in the wild and the genetic basis of these patterns has been well-described. Here, we sought to identify the mechanism behind an unusual pattern variant that is instead found in captivity, the ivory mutant, in which all scales on both the wings and body become white or yellow. Using a combination of autozygosity mapping and coverage analysis from 37 captive individuals, we identify a 78-kb deletion at the cortex wing patterning locus, a gene which has been associated with wing pattern evolution in H. melpomene and 10 divergent lepidopteran species. This deletion is undetected among 458 wild Heliconius genomes samples, and its dosage explains both homozygous and heterozygous ivory phenotypes found in captivity. The deletion spans a large 5′ region of the cortex gene that includes a facultative 5′UTR exon detected in larval wing disk transcriptomes. CRISPR mutagenesis of this exon replicates the wing phenotypes from coding knock-outs of cortex, consistent with a functional role of ivory-deleted elements in establishing scale color fate. Population demographics reveal that the stock giving rise to the ivory mutant has a mixed origin from across the wild range of H. melpomene, and supports a scenario where the ivory mutation occurred after the introduction of cortex haplotypes from Ecuador. Homozygotes for the ivory deletion are inviable while heterozygotes are the targets of artificial selection, joining 40 other examples of allelic variants that provide heterozygous advantage in animal populations under artificial selection by fanciers and breeders. Finally, our results highlight the promise of autozygosity and association mapping for identifying the genetic basis of aberrant mutations in captive insect populations.
High accuracy of genome-enabled prediction of belowground and physiological traits in barley seedlings
Authors: Puglisi Damiano , Visioni Andrea , Ozkan Hakan , Kara İbrahim , Lo Piero Angela Roberta , Rachdad Fatima Ezzahra , Tondelli Alessandro , Valè Giampiero , Cattivelli Luigi , Fricano Agostino
Published: January 2022

In plants, the study of belowground traits is gaining momentum due to their importance on yield formation and the uptake of water and nutrients. In several cereal crops, seminal root number and seminal root angle are proxy traits of the root system architecture at the mature stages, which in turn contributes to modulating the uptake of water and nutrients. Along with seminal root number and seminal root angle, experimental evidence indicates that the transpiration rate response to evaporative demand or vapor pressure deficit is a key physiological trait that might be targeted to cope with drought tolerance as the reduction of the water flux to leaves for limiting transpiration rate at high levels of vapor pressure deficit allows to better manage soil moisture. In the present study, we examined the phenotypic diversity of seminal root number, seminal root angle, and transpiration rate at the seedling stage in a panel of 8-way Multiparent Advanced Generation Inter-Crosses lines of winter barley and correlated these traits with grain yield measured in different site-by-season combinations. Second, phenotypic and genotypic data of the Multiparent Advanced Generation Inter-Crosses population were combined to fit and cross-validate different genomic prediction models for these belowground and physiological traits. Genomic prediction models for seminal root number were fitted using threshold and log-normal models, considering these data as ordinal discrete variable and as count data, respectively, while for seminal root angle and transpiration rate, genomic prediction was implemented using models based on extended genomic best linear unbiased predictors. The results presented in this study show that genome-enabled prediction models of seminal root number, seminal root angle, and transpiration rate data have high predictive ability and that the best models investigated in the present study include first-order additive × additive epistatic interaction effects. Our analyses indicate that beyond grain yield, genomic prediction models might be used to predict belowground and physiological traits and pave the way to practical applications for barley improvement.
Skin Autofluorescence, a Noninvasive Biomarker of Advanced Glycation End-products, Is Associated With Frailty: The Rotterdam Study
Authors: Waqas Komal , Chen Jinluan , Rivadeneira Fernando , Uitterlinden André G , Voortman Trudy , Zillikens M Carola
Published: January 2022

Background

Accumulation of advanced glycation end-products (AGEs) in tissues has been linked to various age-related disease phenotypes. Therefore, we investigated the potential relationship between skin AGE accumulation and frailty.

Methods

A cross-sectional analysis was performed on 2 521 participants from the Rotterdam Study. Skin AGEs were assessed as skin autofluorescence (SAF) using the AGE reader™. We used 2 approaches to define frailty. Fried’s criteria, including weight loss, weakness, slow gait speed, exhaustion, and low physical activity, were used to define physical frailty (presence of ≥3 components) and prefrailty (presence of ≤2 components). Rockwood’s concept, including 38 deficits from physical and psychosocial health domains, was used to calculate the frailty index (score 0–1). Multinomial logistic and multivariate linear regression were used with SAF as exposure and physical frailty (ordinal) and frailty index (continuous) as outcome adjusting for age, sex, diabetes, renal function, socioeconomic status, and smoking status.

Results

The mean SAF was 2.39 ± 0.49 arbitrary units and the median age was 74.2 (14.0) years. Regarding physical frailty, 96 persons (4%) were frail and 1 221 (48%) were prefrail. Skin autofluorescence was associated with both being prefrail (odds ratio [95% confidence interval] = 1.29 [1.07–1.56]) and frail (1.87 [1.20–2.90]) compared with nonfrail. Regarding the frailty index, the median value was 0.14 (0.10–0.19) and higher SAF was also associated with a higher frailty index (coefficient, B = 0.017 (0.011–0.023]).

Conclusions

Higher skin AGEs are associated with both physical frailty and frailty index. Longitudinal studies are needed to evaluate the causality and the potential of SAF as a biomarker to screen frailty.
Peanut oral immunotherapy: current trends in clinical trials
Authors: Reinwald Simone , Rolland Jennifer M , O’Hehir Robyn E , van Zelm Menno C
Published: January 2022

Immunotherapy for allergy has been practiced for over 100 years. Low-dose repeated exposure to specific allergen extracts over several months to years can successfully induce clinical tolerance in patients with allergy to insect venoms, pollen, house dust mite, and domestic animals. Different regimens and routes for immunotherapy include subcutaneous, sublingual, oral, and intralymphatic. Food allergies have been difficult to treat in this way due to high anaphylactic potential and only recently the first immunotherapy for peanut allergy has received regulatory approval. Several clinical trials have indicated high efficacy in desensitisation of peanut-allergic individuals using oral immunotherapy, which allows for safer administration of relatively high allergen concentrations. Still, the risk of adverse events including serious allergic reactions and high anxiety levels for patients remains, demonstrating the need for further optimisation of treatment protocols. Here we discuss the design and outcomes of recent clinical trials with traditional oral immunotherapy, and consider alternative protocols and formulations for safer and more effective oral treatment strategies for peanut allergy.
Mentorship Interest in Breast Imaging: Survey Results From the Society of Breast Imaging
Authors: Weinfurtner R Jared , Lee Amie , Vincenti Kerri , Gundry Kathleen , Hoyt Tamarya , Klein Katherine , Merkulov Alex , Mullen Lisa , O’Brien Sophia , Roubein Daniel , Tseng Joseph , Margolies Laurie
Published: January 2022

Objective

This study assessed mentorship interest within the breast radiologist community to guide development of a mentorship program through the Society of Breast Imaging (SBI).

Methods

A 19-question survey developed by the SBI mentorship committee was distributed electronically to its members March 16, 2021, to May 7, 2021, to gauge interest in forming a society-sponsored mentorship program. Responses were analyzed, with subgroups compared using chi-square analysis.

Results

There was an 18% response rate (598/3277), and 65% (381/588) professed interest in an SBI-sponsored mentorship. Respondents were evenly distributed between academic (241/586, 41%) and private practice (242/586, 41%). Most were breast imaging fellowship-trained (355/593, 60%) and identified as female (420/596, 70%). For practice years, 50% (293/586) were late career (11+ years) with the remainder early-mid career (201/586, 34%) or trainees (92/586, 16%). For mentorship content areas, work/life balance was the most popular choice (275/395, 70%) followed by leadership (234/395, 59%). Most respondents were not currently mentors (279/377, 74%) or mentees (284/337, 84%). Those interested in a mentorship relationship were statistically younger (<45 years old, 234/381, 61% vs 31/207, 15%, P < 0.00001), female (289/381, 76% vs 123/207, 59%, P = 0.00003), academics (189/381, 50% vs 48/207, 23%, P < 0.00001), identified as a racial/ethnic minority (138/381, 64% vs 121/297, 15%, P < 0.00001), and fellowship-trained (262/381, 69% vs 88/207, 43%, P < 0.00001).

Conclusion

There is demand, especially among the society’s young and minority members, for an SBI-sponsored mentorship program. Work/life balance and leadership were the most popular choices for guidance.
The International Criminal Court and Afghanistan
Authors: Wigard Kyra , Jahangiri Guissou
Published: January 2022

The Afghanistan situation at the International Criminal Court (ICC) has been plagued by misunderstandings and misinformation from the moment the Prosecutor announced her request to open an investigation. This article assesses how these phenomena relate in part to the ICC’s own decision-making. First, the ICC has itself been prone to misunderstandings of the situation and its stakeholders, illustrated by the manner in which the Pre-Trial Chamber and the Registry attempted to reach out to victims and the consequences which ensued. Secondly, these misunderstandings led to a vacuum that has been filled by misinformation and competing narratives which undermined victims’ interests and the possible impact of the ICC’s involvement in the situation, such as the ‘peace versus justice’ narrative. These misunderstandings and misinformation have led to disproportionate attention focused on the United States angle of the investigation as opposed to the actual situation in Afghanistan. Yet the ICC’s engagement may still constitute both a positive and substantial avenue if there is an active effort to conduct communication and outreach to victim communities.
Opportunities for and Impediments to Pollinator Conservation in Urban Settings: A Review
Authors: Braman S Kristine , Griffin Becky
Published: January 2022

Urban plants and the design and maintenance of urban landscapes play a critical role in pollinator conservation and the preservation of essential ecosystem services. Effective conservation decisions and planning require careful assessment of the consequences of land use change, and the effects of local and landscape scale factors on bees, butterflies, flies, and other pollinators. Understanding and not under-estimating the needs of the various pollinator functional guilds to inform conservation strategies are critical to success. Research indicates that diverse pollinator assemblages can be enhanced and conserved in urban areas through local and landscape scale efforts. Education and communication are key elements needed to engage policy makers to move conservation forward at the accelerated pace required to address current (rapid urbanization) and impending (climate change and invasive species) challenges. Conservation and protection of urban pollinators and the ecosystem services that they provide require that we move from reactive to proactive activities that tie together regional efforts. Citizen science initiatives can be effective ways to communicate essential information, garner public support, and acquire valuable data concerning pollinators in a cost-effective manner. Improving our knowledge of bee life history, phenology, and nesting sites is essential. Understanding the role and lifecycles of lesser-known pollinators like flies (Diptera) and wasps (Hymenoptera) is vital while there is a critical need to expand our available taxonomic expertise. In this review, we discuss case studies integrating elements of pest and pollinator management through plant selection, landscape and recreational area design, and community engagement with the goal of pollinator conservation. Decision-making resources are included.
The Crowdfunding Regulation in the Context of the Capital Markets Union
Authors: Macchiavello Eugenia
Published: January 2022

This chapter examines the broader EU law context within which the new Crowdfunding Regulation fits. The Crowdfunding Regulation was proposed as part of the Fintech Action Plan, within the broader and pre-existing Capital Markets Union (CMU) Action Plan (September 2015), and eventually adopted in October of 2020. The Crowdfunding Regulation aims to create a single crowdfunding market, improving firms’ financing while protecting investors and ensuring a level-playing field for different operators. Thus, it shares with most CMU actions the difficult task of balancing the goal, on the one hand, of expanding Small and Medium Sized Enterprises’ (SMEs) access to finance through simplification and, on the other, of ensuring investor protection and maintaining stability. The chapter then analyses financial-return crowdfunding (FRC) in comparison with traditional forms of finance and other alternative funding methods touched upon by the CMU Plan, and identifies the related main legal issues raised by the Crowdfunding Regulation.
Collective Redress in Crowdfunding
Authors: Arons Tomas
Published: January 2022

This chapter explores the use of class action procedures to resolve crowdfunding-related disputes. In collective proceedings, associations or foundations will typically act as claimants, representing a constituency of investors that allegedly suffered the same type of harm, and taking decisions with (legal) consequences for the individual members of this groups. In principle, this type of dispute seems to be suitable for class action schemes, e.g. aggregating the claims of a multitude of investors against a project owner, or a service provider. Yet, the availability of this sort of procedures varies largely among European legal systems. The chapter discusses class actions as a method for the resolution of crowdfunding-related disputes, also in light of the new EU Directive on collective redress.
War
Authors: 9780192538451  , Clapham Andrew
Published: January 2022

How relevant is the concept of war today? This book examines how notions about war continue to influence how we conceive legal rights and obligations. It considers situations that recognize the significance of a Declaration of War or a State of War, both domestically and internationally. It outlines how the institution of War was abolished in the 20th century and replaced with a ban on the use of force. At the same time, international criminal law was developed to prosecute wars of aggression and war crimes. The book highlights how states nevertheless continue to claim that they can resort to the use of force, engage in lawful killings in war, imprison law of war detainees and attack objects that are said to be part of a war-sustaining economy. The book provides an overall account of the laws of war and a detailed inquiry into whether states should be able to continue to claim Belligerent Rights over the enemy and neutrals, including those rights connected to booty and blockade. The book claims that while there is general agreement that War has been abolished as a legal institution for settling disputes, the time has come to admit that the Belligerent Rights that states claim flow from being at war are no longer available. Therefore, claiming to be in a war or an armed conflict does not grant anyone a licence to kill people, destroy things, and acquire other people’s property or territory.
The Multiple Meanings of War
Authors: Clapham Andrew
Published: January 2022

This chapter emphasizes the meaning of war as that term is used in different contexts. It illustrates this by considering a selection of decisions from the US courts in three different areas: life insurance claims, military discipline for US military personnel, and environmental liability. The chapter also looks at international law, which abolished war as an acceptable way for states to settle their disputes, but war is still referenced in texts in ways that can trigger rights and obligations. It concludes that national and international law still distinguishes between armed conflicts (often described as wars) and a State of War formally speaking which is defined in the chapter and refers to a situation where two states intend to create a State of War, known thought the book as War with a capital W.
Introduction
Authors: Gabriel Henry Deeb
Published: January 2022

This introductory chapter provides a general comparison of the substantive law of the United Nations Convention on Contracts for the International Sale of Goods (Convention) with the UNIDROIT Principles on International Commercial Contracts (Principles), and the Sales provisions of Article Two of the Uniform Commercial Code (Code). The Convention, the Principles, and the Code are similar in two important aspects: all three are attempts to seek uniformity in the law of sales, and all three are attempts to reflect modern commercial practices. Unlike the Code, the Convention and the Principles are not based on any particular set of underlying established domestic legal principles. Instead, the Convention and the Principles were drafted to be independent of rather than work in conjunction with any particular domestic law or legal tradition. Another significant difference among the Convention, the Principles, and the Code is that the sales provisions of the Code are an integral part of the larger Uniform Commercial Code. Neither the Convention, the Code, nor the Principles cover all aspects of commercial contracts. Unlike the Principles, the Convention and the Code are limited to contracts for the sale of goods.
Ascites at the Border
Authors: Marcelin Jasmine R. , Virk Abinash
Published: January 2022

Coccidioidal infection typically occurs after inhalation of arthroconidia of Coccidioides immitis or Coccidioides posadasii. The most common initial clinical presentation is a self-limited pneumonia, but disseminated disease can occur after hematogenous spread in about 1% of cases, with exposure typically occurring weeks to months before development of symptoms. The most common sites of dissemination include the skin and soft tissue, bones and joints, and the central nervous system. Disseminated coccidioidomycosis can be diagnosed by serologic screening with an enzyme immunoassay. Antifungal therapy is recommended for patients with extrapulmonary coccidioidomycosis.
The Resistance
Authors: Marcelin Jasmine R. , Cummins Nathan W.
Published: January 2022

Mutations in HIV genes that result in drug resistance can be caused by antiretroviral drug selection pressure in treatment-experienced patients or transmission of a resistant HIV strain in treatment-naive patients. Varying genetic barriers to resistance have been observed for some antiretroviral drug classes. Protease inhibitors generally have a high genetic barrier to resistance. Acquired and transmitted resistance to integrase strand transfer inhibitors currently is uncommon. Combination antiretroviral therapy should be selected to maximize use of effective agents and to avoid agents that are expected to be associated with resistance.
Disclosure
Authors: Tan Eugene M. , Marcelin Jasmine R. , Temesgen Zelalem
Published: January 2022

United States state laws vary with regard to notifying partners of persons living with HIV. Some states have expanded confidentiality laws protecting sensitive health information. Other states have HIV-specific criminal laws, which impose penalties on HIV-infected individuals who knowingly expose others to HIV without first disclosing their status. HIV-specific criminal laws may have unintended consequences of increasing HIV-related stigma and may decrease the willingness of persons living with HIV to disclose their status.
Transplant Headaches
Authors: Tan Eugene M. , Marcelin Jasmine R. , Rizza Stacey A.
Published: January 2022

Cryptococcal infections account for approximately 8% of all invasive fungal infections in solid organ transplant recipients and typically occur 16 to 21 months after transplantation. Cryptococcal infection should be considered for any transplant recipient who presents with altered sensorium and fever. Analysis should include opening pressure measurement, cryptococcal antigen testing, cell count with differential, and glucose and protein levels. Initial treatment should consist of a lipid formulation of amphotericin B and flucytosine for at least 2 weeks, followed by high-dose fluconazole for 8 weeks and then lower doses of fluconazole for 6 to 12 months or possibly longer.
Neurologic Lesions Acquired Abroad
Authors: Ball Caroline , Cawcutt Kelly A.
Published: January 2022

Human T-lymphotropic virus 1 (HTLV-1) causes acute T-cell lymphoma (ATL) and is estimated to affect 5 to 20 million individuals worldwide. Transmission of HTLV-1 occurs through sexual intercourse (most commonly from men to women), from mother to child (predominantly through breastfeeding), and through blood transfusions. Most carriers are asymptomatic. Four clinical subtypes of ATL are defined, although the subtypes are generally categorized as aggressive or indolent ATL. Symptoms of all subtypes are diverse and can include generalized lymphadenopathy, skin lesions, hepatosplenomegaly, leukocytosis with abnormal lymphocytes, hypercalcemia, and frequent opportunistic infections. Treatment is determined on the basis of the ATL category.
A Swollen Leg
Authors: O’Horo John C. , Enzler Mark J.
Published: January 2022

Endemic Kaposi sarcoma (KS) is common in Africa and accounts for 2% to 10% of all pediatric cancers and 25% to 50% of soft tissue sarcomas in children. The typical presentation of endemic KS is chronic lymphedema, primarily affecting the feet and legs, and skin changes. Endemic KS is chemosensitive, and several different therapeutic options are available. Local radiotherapy and surgery can be used to treat limited disease. Antiviral therapy directed at human herpesvirus 8 has been tested, but it has not shown a consistent benefit and currently is not part of established treatment guidelines.
The Initial Diagnosis Was Cholecystitis
Authors: Ramanan Poornima
Published: January 2022

Tularemia is a rare but potentially fatal zoonotic infection that is most often caused by Francisella tularensis, a fastidious, aerobic, gram-negative coccobacillus. This facultative intracellular pathogen evades the host immune response by surviving in host macrophages. The major reservoirs of F tularensis are various terrestrial and aquatic small mammals such as rabbits, hares, ground squirrels, muskrats, and water rats. In humans, F tularensis causes 6 distinct clinical syndromes that are dictated by its mode of transmission: ulceroglandular, glandular, oculoglandular, typhoidal, oropharyngeal, and pneumonic tularemia. Aminoglycosides are bactericidal to F tularensis and are the first-line treatments for tularemia in humans.
Fever in a Returning Traveler
Authors: Fida Madiha , Elbadawi Lina I. , Enzler Mark J.
Published: January 2022

A common patient presentation in the travel clinic is fever in the returning traveler. Brucellosis is an uncommon reportable disease in the United States. Domestically acquired cases are typically associated with ingestion of unpasteurized dairy products. Brucellosis is a zoonotic infection that may be transmitted through direct inoculation, inhalation of infected aerosols, or ingestion of food products derived from infected animals. The microbiologic diagnosis is established by culture, serology, or polymerase chain reaction. Treatment of brucellosis requires combination antibiotic therapy with agents that are active intracellularly; with this therapy, cure rates are up to 92%.
A 60-Year-Old Man With Multiple Falls
Authors: Fida Madiha , Cook Sara L. , Abu Saleh Omar M.
Published: January 2022

Creutzfeldt-Jakob disease (CJD) is one of the most common forms of human prion disease. Clinical symptoms are characterized by rapidly progressive mental deterioration that may include dementia, behavioral changes, and impairment of memory and judgment. Myoclonus is a cardinal manifestation of CJD and is especially provoked by startling the patient. Diagnosis is made by considering a combination of clinical features, imaging findings, and cerebrospinal fluid analysis, but the definitive diagnosis requires histopathologic analysis of brain tissue. No effective treatment for CJD exists, and most individuals die within a year of diagnosis.
The Furuncle Keeps Getting Worse
Authors: Cano Cevallos Edison J. , DeSimone Daniel C.
Published: January 2022

Actinomycosis represents an invasive infection by an Actinomyces organism, characterized by continuous and progressive spread, often across tissue planes. The classic and most common presentation is cervicofacial actinomycosis, characterized by slow progression of a painless, indurated abscess that forms deep sinus tracts and most commonly originates from odontogenic infections. Surgical intervention is paramount in the management of patients with actinomycosis. A combination of surgical débridement plus intravenous antibiotics is widely recommended, followed by 3 to 6 months of treatment with oral antimicrobial agents, provided that the patient has improvement after surgical intervention and no evidence of recurrence.
Oral Ulcers in an Immunocompromised Patient
Authors: Azam Tariq , Enzler Mark J.
Published: January 2022

Although most Histoplasma capsulatum infections (>90%) are asymptomatic and self-limited, 1 in 2,000 acute infections may result in severe, progressive disseminated histoplasmosis (DH). DH is associated with the spread of infection to extrapulmonary organs such as lymph nodes, skin, adrenal glands, brain, wrist tendons or synovium, gastrointestinal tract, liver, bone marrow, oral mucosa, and heart valves (rare). Diagnosis of DH requires a clinical suspicion of histoplasmosis for patients residing in Histoplasma-endemic regions and patients who have been exposed to birds or bird guano. DH is confirmed by H capsulatum cultured from bodily fluids or tissue biopsies.
HIV and Its Myriad Opportunistic Infections
Authors: Gurram Pooja R. , Wright Alan J.
Published: January 2022

Opportunistic infections and coinfections of HIV/AIDS include Pneumocystis pneumonia, hepatitis B virus (HBV), and disseminated Mycobacterium avium complex (MAC). Symptoms of Pneumocystis pneumonia are progressive shortness of breath, dry cough, fever, and chest discomfort. First-line medication for treating Pneumocystis pneumonia is trimethoprim-sulfamethoxazole. For patients with HIV-HBV coinfection, a combination of either lamivudine or emtricitabine plus either tenofovir alafenamide or tenofovir disoproxil fumarate must be used as the nucleoside reverse-transcriptase inhibitor combination. Common treatment regimens for MAC infection include a 2- or 3-drug regimen with a macrolide (azithromycin or clarithromycin), ethambutol, and possibly rifabutin.
Stuck Between a Foot and a Soft Place
Authors: Thoendel Matthew J. , Tande Aaron J.
Published: January 2022

The potentially increased risk of hemolytic uremic syndrome (HUS) developing with antibiotic treatment of Shiga toxin−producing Escherichia coli (STEC) infections has been reported since STEC was identified as a cause of HUS. HUS is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. The increased risk of HUS development with antibiotic use remains a subject of investigation. The relative severity of HUS (compared with a typical postoperative infection) must be factored into the decision to use prophylactic antibiotics. The risk of HUS developing with antibiotic use also likely depends on the causative STEC strain.
The Language of Pediatric Palliative Care
Authors: Wolfe Joanne , Hinds Pamela S. , Sourkes Barbara M.
Published: January 2022

Words, phrases, and sentences convey intended and unintended meanings. Basic words such as “palliative care,” “end-of life care” and “terminal care,” while often used interchangeably, vary in definition. Patients, families, and clinicians may interpret them differently and consequently experience unintentional and harmful consequences. A primary focus of the second edition of Interdisciplinary Pediatric Palliative Care is the use of pre-defined and consistent terminology to exemplify the critical importance of precise language. The definitions in this chapter – and the rationale for each - were derived by consensus from the original authors and the three editors. Time given to understanding the intended meaning and reaching agreement about the use of certain words, phrases and sentences helps health care professionals to express themselves more accurately, clearly, and empathetically throughout the child and family illness experience. When language is used with thoughtful care, it is an invaluable tool in providing clear and compassionate communication.
Settings of Care
Authors: Cohn Moshe , Johnston Emily , McBee Julia
Published: January 2022

Pediatric palliative care (PPC) is provided wherever the children who receive it may be found. Settings include the emergency room, inpatient floor and intensive care units, outpatient clinics, and hospice, as well as at home and at school. Each setting is characterized by a different combination of patients and families, palliative care needs, interdisciplinary team members, and medical and psychosocial environments. A successful PPC team adapts to the unique demands of each setting in providing high-quality PPC. To this end, new models of care delivery and team integration are needed, such as telehealth and tiered expertise, and research efforts must be expanded to guide PPC clinicians and healthcare leaders in keeping pace with the rapidly changing landscape of PPC in different settings.
Witness to Suffering
Authors: Sourkes Barbara M. , Liben Stephen , Papadatou Danai
Published: January 2022

Clinicians in pediatric palliative care enter the world of children living with life-threatening conditions and their families. These clinicians come face to face with the relentlessness of illness, the uncertainty of prognosis, and, at times, the inevitability of death. Through repeated cycles of attachment and loss, their core challenge is to learn how to preserve themselves while at the same time sustain the ability to be effective and empathic. This chapter examines relationship-centered care with a focus on the complex reciprocal influences among children, families, and clinicians. It describes the nature of clinicians’ suffering, including the impact of a child’s death. Building resilience and engaging in self-care are discussed as critical practices, both for the integration of clinicians’ own experience and for the provision of optimal care of children and their families.
Dermatologic Conditions and Symptom Control
Authors: Bower Kimberly A. , Good Julie , Reineke Anke , Gordon Cristina , Burdette-Taylor Michele R.
Published: January 2022

Skin disorders are often encountered in seriously ill patients and they can have significant physical, emotional, social, and spiritual impact. The skin provides protection from the external environment and allows intimacy through the ability to touch and be touched. It is visible to the external world, thus strongly affecting appearance, which in turn impacts social interactions, self-image, and perception of health and well-being. Caring for skin conditions such as wounds may require a significant time commitment and may detract from the time that caregivers are able to devote to other relationships and activities. To improve the quality of life for both children with skin conditions and their families, it is critical to use an interdisciplinary team to take a whole-person approach to the treatment of both the child and the family.
The Use of Risk Assessment Instruments for Sex Offenders
Authors: Mamak Mini , Prosser Aaron , Vincent Gina M. , Maney Shannon M. , Hart Stephen D.
Published: January 2022

This chapter investigates the use of risk assessment instruments for sex offenders. Over the past 20 years, numerous risk assessment strategies and processes have been developed to assist clinicians in evaluating an individual’s risk to reoffend. Currently, actuarial and structured professional judgment are the competing and leading approaches in the risk assessment literature. Actuarial approaches are often described as mechanical, mathematically driven algorithms. Risk factors are explicit and fixed, and there is no professional or clinical input into what risk factors are selected or how they are weighed. Structured professional judgment (SPJ) approaches, however, are a guide rather than a formula. SPJ tools not only guide an assessor to consider empirically identified risk factors but also allow clinical flexibility with respect to how specific risk factors are weighed and how risk is ultimately determined. Despite the empirical strength of actuarial risk measures, SPJ tools have been broadly adopted, given their utility in risk management planning and clinical decision-making.
Laboratory Measurement of Penile Response in the Assessment of Sexual Interest
Authors: Murphy Lisa , Bradford John M. , Fedoroff J. Paul
Published: January 2022

This chapter focuses on the laboratory measurement of penile response in the assessment of sexual arousal. Changes in penile tumescence, as measured by penile plethysmography (PPG), is a widely recognized means of measuring male sexual arousal in response to the presentation of various stimuli. Although not part of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or International Classification of Diseases (ICD) criteria for any paraphilias, PPG is widely considered by researchers and clinicians to be an important contributor in the assessment and treatment of males with paraphilic interests and/or males who have committed sex crimes. PPG, also referred to as phallometry, phallometrics, or penile tumescence testing (PTT), contributes to clinical assessment of paraphilic interests, appraisal of risk of recidivism, and provides an objective measurement of changes in sexual arousal in response to treatment. Before the development of PPG techniques, clinicians assessing individuals to learn their sexual arousal patterns relied primarily on self-report for the evaluation of treatment needs and outcomes.