bluuebunny/crossref_metadata_2025 huggingface dataset:
David Charles on Wittgenstein, Aristotle, and Artisans
Authors: Snowdon Paul
Published: May 2024

This chapter reflects critically on some ideas that David Charles has formulated in a comparison between Wittgenstein’s and Aristotle’s views of the unlikely trio of concepts, understanding, and manual workers. The main disagreement with Charles is whether the master craftsperson is a clearcut model of realist thinking, as Charles contends. Charles’ Aristotle holds that the master craftsperson’s grasp of concepts such as ‘elm wood’ consists (inter alia) in understanding part of the nature of the kind elm wood as such and that this explanatory grasp richly informs their various craft practices. The chapter, however, argues that the master craftsperson’s practices are compatible with, and thus fail to undermine, Wittgenstein’s anti-realist account of language learning and concept mastery.
Aristotle on How Essence Grounds Necessity
Authors: Peramatzis Michail
Published: May 2024

A distinctive commitment of Aristotle’s essentialism is that essences are metaphysically basic relative not only to particular substances but also to the substance-kinds that particular substances are essentially the members of. Moreover, they are prior to the characteristic necessary features of particular substances and their kinds. This chapter discusses this issue by engaging with two important themes in Aristotle’s theoretical philosophy, both of which are central to David Charles’ work: (1) What is the relation between our practices of explaining and defining, and what is the correlate underlying bond between cause and essence? (2) What is Aristotle’s view of essence and necessity? The chapter argues that Aristotle does not conceive of necessity as basic. Rather, he maintains that necessary features of things are grounded in things’ essences. In his view, modality is grounded in essence, while the converse is not the case. After sketching the main aspects of this view, the chapter discusses whether and, if so, how Aristotle’s essentialism can sustain this asymmetry. It argues that to underwrite this asymmetry we have to adopt a strong interpretation of Aristotle’s thesis that essence and cause are the same: any essence intrinsically involves not only a thin, formal but also a robust, efficient, final, or material type of cause. Conversely, too, at least in the central cases an Aristotelian cause is sensitive to the nature of the relevant item caused in that it determines (at least partly) that item’s identity.
How Aristotle Understands Change
Authors: Lewis Frank A.
Published: May 2024

In Physics 3.1–3, Aristotle continues his study of notions fundamental to natural philosophy. He begins book 3 by recalling this background, reviewing some familiar distinctions, and explaining change in terms of the active and passive powers constitutive of change, and the activities of each. As he warned (200b22–5), he employs modes of reasoning typical of dialectic: in 3.1, a reductio argument using rules of inference from the Topics and Posterior Analytics, to help explain the use of qua-expressions in the account of change; in 3.2, a review of ‘reputable opinions’ on change; and in 3.3 a constellation of puzzles of varying force, under the title, aporia logikē, and arranged in the form of a dilemma. The puzzles and their resolution (partly by means of an argument by analogy, Top. I.17, 108a7–12) fill in details concerning the location of the activities that jointly comprise a change in the passive rather than the active partner, so that the activity of the teacher is located, not in him, but in the learner. Again, the activities of teacher and learner are in a way the same, as in the analogy with Heraclitus’s road up and road down, the two roads are each accidentally the same as the underlying road between their respective destinations and hence (differently) accidentally the same as each other. Finally, in Aristotle’s ‘two-constituent’ analysis of change, the activities of teaching and learning combine in the change that is the learner’s coming to know what he is being taught.
Why Is Space Discontinuous?
Authors: Karasmanis Vassilis
Published: May 2024

This chapter discusses a question that arises at the intersection of Aristotelian natural science and mathematics: the continuity of magnitude. It deals with this question by focusing on a difficult passage from De Lineis Insecabilibus. This short pseudo-Aristotelian treatise was written to refute the theory of ‘indivisible lines’, according to which lines (and therefore magnitudes) are not continuous but are constituted by small discrete line-atoms. In the Physics (206a17) Aristotle mentions this theory en passant, saying that ‘it is not difficult to refute’ it. De Lineis Insecabilibus opens with five arguments advanced by the supporters of indivisible lines and then seeks to refute them. The chapter focuses on the fifth argument. If correct, this argument would undermine the whole science of geometry. In the author’s view, this argument has been misunderstood not only by the Aristotelian author but also by modern scholars. The first task is to establish which text is to be preferred and how it should be translated. Second, the chapter examines the logical formulation of the argument. Finally, it seeks to show the importance of the argument, and consider plausible ways to escape the difficulties it raises using the Aristotelian theory of the infinite and the continuous.
The Fragmentation of Authoritative Normativity
Authors: McPherson Tristram , Plunkett David
Published: May 2024

A prominent theme in recent work in metaethics has been an increasingly explicit focus on normativity. Much of this work has been focused on “authoritative” or “robust” normativity: put roughly, the kind of normativity, that, were it to exist, would settle what agents “really and truly” or “genuinely” should do (or think, feel, etc.). This chapter explores the idea that thought and talk about authoritative normativity is discordant in the following sense: (i) there are multiple, equally optimally apt candidate notions of “authoritativeness”, and (ii) the norms picked out by different optimally apt candidates for “authoritativeness” can conflict with each other. We think that this thesis is important, and deserves sustained attention. To encourage such attention, we offer a prima facie argument for it, and explore its significance for work in metaethics, and for metanormative inquiry more broadly construed.
Can We See What’s Wrong with Non-Naturalism?
Authors: Elliott Aaron
Published: May 2024

The Genealogical Debunking Challenge for non-naturalism argues that there’s something epistemically problematic about the origins of our normative beliefs. The strongest version locates the problem in non-naturalism precluding the explanatory connections between the facts and our beliefs necessary to avoid the problematic epistemic luck that drives Gettier cases. Third-factor explanations, where the fact and the belief have a shared explanation, have been popular attempts. But non-naturalist third-factor explanations cannot avoid Gettier-luck. This chapter sketches an account of moral perception that provides non-naturalism with explanatory connections that resolve the problem. Non-naturalism can hold that cognitive permeation allows perceptual access to moral properties, without the implausible commitment that wrongness, for example, causally affects the retina. The most salient objections are epistemological: standard philosophical worries about cognitive permeation, special worries about cognitive permeation in this context, and worries about whether this picture can play the correct dialectical role. These are addressed in turn.
The Logic of Deontic Operators
Authors: Makin Laura Tomlinson
Published: May 2024

According to the consensus, a sentence like “she ought to vote” can be analyzed as being composed of a deontic operator and a proposition—that is, the agential ‘ought’ is a propositional operator. This view is embraced by standard deontic logic, and entailed by the standard semantics for “ought.” This chapter argues against that consensus view. Taking a particular deontic sentence, I consider the candidate propositions that might complete its analysis; I argue that there is no proposition that, when operated on, preserves the sense of the original deontic statement. Thus, I conclude, we must reject this analysis of ‘ought’ sentences. I go on to argue that the difficulties that arise for the propositional analysis of “ought” sentences suggest that “ought” should be understood to operate rather on what we can call “process-forms.” This, in turn, suggests the interesting thesis that deontic logic should be continuous with practical, rather than theoretical, reason.
Blackstones' Handbook of Youths in the Criminal Courts
Authors: Branston Gareth , Redhouse Naomi , Ashford Mark
Published: May 2024

This new edition of Blackstone's Handbook of Youths in the Criminal Courts reflects major developments in the law and practice relating to youths in the criminal justice system. It has been thoroughly updated to take account of the raft of changes since the previous edition in 2018. The book covers the entire range of issues specific to the treatment of young people in criminal courts. These include the principles and practice of the youth justice system; the issues of jurisdiction, effective participation, and fair trial; the use of special measures; and the complications of sentencing procedure and practice. The book also updates all references to the Criminal Practice Directions to take account of the new 2023 CPD and includes all relevant developments brought about by changes in legislation such as the Sentencing Act 2020, the Judicial Review and Courts Act 2022, and the new, youth-specific sentence and new allocation exception introduced by the Counter-Terrorism and Sentencing Act 2021.
Bladed Articles and Offensive Weapons (Having in Public/Education Premises and Threats)—Sentencing Children and Young People Guideline—effective from 1 June 2018
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter discusses the youth-specific sentencing guidelines for possession of and threatening with bladed articles or offensive weapons. The first step in determining the sentence is to assess the seriousness of the offence. This assessment is made by considering the nature of the offence and any aggravating and mitigating factors relating to the offence itself. When sentencing the offences of possession of or threatening with bladed articles or offensive weapons, a court must impose a sentence of at least four months’ detention and training order. If there are exceptional circumstances that justify not imposing the statutory minimum sentence then the court must impose an alternative sentence. The chapter then looks at referral orders; youth rehabilitation orders (YROs); YROs with intensive supervision and surveillance or YROs with fostering; and custodial sentences.
Sexual Offences—Sentencing Children and Young People Guideline—effective from 1 June 2017
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter focuses on the youth-specific sentencing guidelines for sexual offences. Sentencing a child or young person for sexual offences involves a number of different considerations from adults. The primary difference is the age and level of maturity; children and young people are less emotionally developed than adults. As such, offending can arise through inappropriate sexual experimentation; gang or peer group pressure to engage in sexual activity; or a lack of understanding regarding consent, exploitation, coercion, and appropriate sexual behaviour. If a custodial sentence is imposed, the court must state its reasons for being satisfied that the offence is so serious that no other sanction would be appropriate and, in particular, why a youth rehabilitation order with intensive supervision and surveillance or fostering could not be justified.
Youth Offending Team/Youth Justice Service
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter discusses the Youth Offending Team (YOT). The Crime and Disorder Act 1998, s 39 places a duty on local authorities, in consultation with the police, probation, and health authority to establish one or more YOTs in its area. It is the duty of the YOT to coordinate the provision of the youth justice services ‘for all those in the authority’s area who need them’ and carry out the functions set out in the Youth Justice Plan, which sets out how the local authority intends to fulfil its duties in relation to the provision of youth justice services. The chapter then considers the use of a standardized assessment tool by YOTs. Since 2015, the Youth Justice Board for England and Wales have introduced a new assessment tool to all YOTs, known as AssetPlus, which is said to improve on the Asset and other tools and provide a single tool to be used for assessing the needs of the young person and informing decisions on bail, sentencing, and management of court orders.
Caution
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter describes how the Crime and Disorder Act 1998, ss 66ZA and 66ZB give the police the power to administer a youth caution. The Ministry of Justice and the Youth Justice Board have also issued a document entitled Youth Cautions: Guidance for Police and Youth Offending Teams. The police are permitted to make the decision to offer a simple youth caution for any offence triable summarily or either way in the case of an adult. Authorization from a Crown Prosecutor should be sought before offering a youth caution for an indictable-only offence. Ultimately, the decision whether to give an out-of-court disposal or to charge will depend in part on the seriousness of the offence. The chapter then looks at the Child Gravity Matrix published by the National Police Chiefs’ Council, as well as the CPS Code for Crown Prosecutors. Following a youth caution, the young person must be assessed by the Youth Offending Team, which has a duty to put in place a rehabilitation programme unless deemed inappropriate.
Conditional Caution
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter explores how the Crime and Disorder Act 1998, ss 66A to 66G provide for youth conditional cautions. It looks at the Code of Practice for Youth Conditional Cautions and the Director’s Guidance on Youth Conditional Cautions. A youth conditional caution may be administered whether or not the youth has a previous youth caution, youth conditional caution, or conviction. In any case where an authorized person or prosecutor is considering offering a youth conditional caution, the local Youth Offending Team must be consulted to ensure that the youth understands the nature of the proposed caution, is suitable to undertake the required conditions, and that the conditions are likely to have a positive impact on offending behaviour. The chapter then outlines the requirements that must be satisfied before a youth conditional caution is made.
Code for Crown Prosecutors
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter focuses on the special considerations that apply to the prosecution of youths under the Code for Crown Prosecutors. Where the allegation arises in relation to someone who was under the age of 18 at the time and the prosecutor is considering whether a prosecution is in the public interest, it states that ‘the best interests and welfare of the child or young person must be considered including whether a prosecution is likely to have an adverse impact on his or her future prospects that is disproportionate to the seriousness of the offending’. There are two stages in the decision to prosecute: the evidential stage and the public interest stage. Representations can be made in relation to either or both. When a decision has been made to bring a youth before the court, this can be reviewed, particularly if new information becomes available. Meanwhile, the prosecution of a person who has received a promise, undertaking, or representation from the police that they will not be prosecuted is capable of being an abuse of process.
CPS Legal Guidance
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter highlights the CPS Legal Guidance on Children as Suspects and Defendants. Within that guidance, the Crown Prosecution Service (CPS) has set out principles guiding the decision to prosecute. According to the guidance, ‘a decision to prosecute a child is susceptible to judicial review if it can be shown that the prosecutor has not taken into account all the information about a child’s background and the public interest factors set out in the Code’. The guidance also contains particular reference to the decision whether to prosecute in the following situations: first time entrants; physical and mental health of the child; children looked after; adverse childhood experiences; special educational needs and disabilities; and offence-specific public interest guidance. In response to concerns that young people in the care of local authorities are being unfairly criminalized in relation to their behaviour in children’s homes, the CPS has issued specific guidance on looked after children.
Age
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter focuses on the issue of age of criminal responsibility. Under the Children and Young Persons Act 1933, s 50, it ‘shall be conclusively presumed that no child under the age of ten years can be guilty of an offence’. At common law, there was a rebuttable presumption that a person aged under 14 was incapable of committing a crime. This presumption, often termed doli incapax, required the prosecution to establish not only that the accused had committed the offence but also that they knew what they had done was seriously wrong rather than merely naughty. The presumption of doli incapax was abolished by the Crime and Disorder Act 1998, s 34 for all offences committed on or after 30 November 1998. Ultimately, any dispute in relation to the age of a defendant should be raised at the first hearing, whether in the adult or youth court.
Reporting Restrictions in the Youth Court
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter explains how the Children and Young Persons Act 1933, s 49 provides for reporting restrictions in the youth court. Reporting restrictions apply automatically to defendants under the age of 18 appearing in the youth court. Moreover, the CYPA 1933, s 49 does not prevent representatives of the press attending the youth court but merely restricts what can be reported. In rare circumstances, the court may lift reporting restrictions in the youth court before conviction. The court may do so during proceedings if it is appropriate for the purpose of avoiding injustice to the youth defendant or if the defendant is unlawfully at large in order to apprehend them. The youth court may also dispense with reporting restrictions once a youth defendant has been convicted if it is in the public interest to do so. The chapter then considers the applications for post-conviction criminal behaviour orders.
Effective Participation
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter explains that the inability of a defendant to participate effectively in the criminal proceedings against them will be a breach of the right to a fair trial under Article 6(1). It reviews the right of the accused to participate effectively in their criminal trial, which includes the right to hear and follow the proceedings. It also emphasizes how children may be dealt with in a manner that takes account of their age, level of maturity, and intellectual and emotional capacity. The chapter talks about how a child may be at risk of not being able to participate effectively because of their young age or limited intellectual capacity. It looks at the question of fairness of trial in the Crown Court for young defendants that was considered by the European Court of Human Rights in V v UK (2000) 30 EHRR 121.
Detention and Training Order
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter focuses on the detention and training order (DTO), which is the primary custodial sentence that can be imposed in the youth court and Crown Court. It explains how a DTO may be imposed on a defendant who has attained the age of 12 by the date of conviction. It also emphasizes that the court must determine if offenders under the age of 15 are persistent offenders before an order can be imposed. The chapter describes how a DTO cannot be imposed by a youth court or a Crown Court if the offender is not legally represented unless the youth offender has refused to apply for legal aid or the legal aid has been withdrawn. It describes offenders that are deemed to be legally represented if they have a solicitor or barrister to represent them in the court after they are found guilty and before they are sentenced.
Fines
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter looks at the explanatory materials to the Magistrates’ Court Sentencing Guidelines that set out the approach to fines in relation to adult offenders. It cites Sentencing Code, s 123 that provides that the maximum fine in the magistrates’ court for a youth depends on age. It also points out that there is no limit where a youth defendant is convicted on indictment in the Crown Court and that a fine must not exceed the statutory limit. The chapter reviews the amount of the costs that must not exceed the amount of the fine if the court orders costs to be paid by a youth defendant alongside a fine. It highlights the requirement of the court for a defendant to provide details of their financial circumstances, such as youth defendants that are unlikely to have income aside from money provided by their parents or guardians.
Hospital and Guardianship Orders
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter talks about a youth court or a Crown Court that may impose a hospital order or guardianship order upon a youth defendant when the requirements of the MHA 1983, s 37 are satisfied. It emphasizes how a court may authorize the admission and detention of a person convicted by the Crown Court or a magistrates’ court of an offence punishable with imprisonment in a hospital. It also reviews the sentence of an offence that falls under sections 258, 258A, 268A, 273, 274, 274A, 282A, 283, 285, or 285A that will not prevent a court from making an order for the admission of the offender to a hospital. The chapter looks at an order that places an offender under the guardianship of a local social services authority or of any other person if the court is satisfied that that authority or person is willing to receive the offender into guardianship. It considers the restriction order as a hospital order where the court orders that the offender’s release will be subject to special restrictions.
Sentence: Procedure in the Youth Court
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter highlights the fact that the words ‘conviction’ and ‘sentence’ should not be used in relation to a youth defendant dealt with in the youth court or adult magistrates’ court. It cites the Children and Young Persons Act 1933, s 59, which does not apply to youth defendants tried on indictment in the Crown Court. It also outlines the procedure for the sentencing hearing in the youth court that is governed by the Criminal Procedure Rules, r 24.11. The chapter explores the task of the defendant to provide information relevant to a sentence, including details of financial circumstances. It talks about a defendant under 18, which obligates the court to give the defendant’s parents, guardian, or other supporting adult the opportunity to make representations and introduce evidence relevant to the sentence.
Case Management and Effective Participation
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter covers the notion of case management and effective participation. The fair trial guarantee of Article 6 of the European Commission of Human Rights (ECHR) includes the youth defendant's ability to participate effectively in the trial process. The chapter then details the notion of fitness to plead, which involves the procedure under the Criminal Procedure (Insanity) Act 1964. It considers fitness to plead as a measure of last resort. Moreover, the automatic reporting restrictions in the youth court under section 49 of the Children and Young Persons Act 1993 do not apply during proceedings of youth defendants in the Crown Court.
Appeal Cases
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter examines the key concepts surrounding appeal cases. It starts with case management, which involves the hearing of evidence, before elaborating on the rights of appeal to the Crown Court. In the course of hearing any appeal, the Crown Court has the power to, for example, correct any error in the order of judgment. Additionally, the Crown Court may order punishment more severe than that awarded by the lower court. The chapter sets out the reporting restrictions that apply under s 49 of the Children and Young Persons Act 1933 if the Crown Court, acting in its appellate role, was sitting as a youth court.
Reporting Restrictions in Youth Court
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter notes that the provisions within s 49 of the Children and Young Persons Act 1993 no longer apply if the defendant reaches the age of 18 during the proceedings.
Requiring Attendance at Court
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter focuses on requirements to attend court. Section 34A of the Children and Young Persons Act 1933 covers the attendance of parents or guardians at court, as well as the relevance of parental responsibility of a local authority which has a child or young person in their care or accommodation. The Criminal Procedure Rules presents two options for the requirements around summons, warrant, and requisition. The chapter also sets out the Sentencing Children and Young People – Overarching Principles definitive guideline on the statutory requirement relating to parents/guardians for young persons under the age of 16.
Referral Order: Requiring Attendance at Panel
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter provides an overview of the requirement to attend meetings of the youth offender panel when the court makes a referral order, contained in s 90 of the Sentencing Code (SC). When a parent required to attend a meeting is unable to do so, the panel can refer the parent to the youth court for consideration of the making of a parenting order. Further guidance on the failure to comply lies within section 93 of the SC. The chapter also sets out the provision for making a parenting order where the parent or guardian of an offender fails to attend meetings of the youth offender panel.
Addressing the escalating heat index in the Philippines: a call to action
Authors: Rogayan Danilo V
Published: May 2024

This correspondence responds to a recently published editorial by highlighting the interconnectedness of science, policy, politics and activism in addressing the escalating heat index in the Philippines. It underlines the importance of a complete strategy that incorporates scientific information into evidence-based policy, navigates the political environment and encourages grassroots activity to address the complex effects of extreme heat on public health. This paper highlights the necessity of multidisciplinary collaboration among stakeholders in developing effective measures for minimizing the negative health consequences of rising temperatures while also promoting climate resilience and health justice in the Philippines.
Deep learning-based liver cyst segmentation in MRI for autosomal dominant polycystic kidney disease
Authors: Chookhachizadeh Moghadam Mina , Aspal Mohit , He Xinzi , Romano Dominick J , Sharbatdaran Arman , Hu Zhongxiu , Teichman Kurt , Ng He Hui Yi , Sattar Usama , Zhu Chenglin , Dev Hreedi , Shimonov Daniil , Chevalier James M , Goel Akshay , Shih George , Blumenfeld Jon D , Sabuncu Mert R , Prince Martin R
Published: May 2024

Background

Autosomal dominant polycystic kidney disease (ADPKD) can lead to polycystic liver disease (PLD), characterized by liver cysts. Although majority of the patients are asymptomatic, massively enlarged liver secondary to PLD can cause discomfort, and compression on adjacent structures requiring cyst aspiration/fenestration, partial liver resection, or liver transplantation. Monitoring PLD by measuring liver volume fails to track the early stages when liver cyst volume is too small to affect liver volume.

Purpose

To improve PLD assessment in the early stages by automating detection and segmentation of liver cysts using deep learning (DL) models.

Materials and Methods

A self-configured UNet-based platform (nnU-Net) was trained with 40 ADPKD subjects with liver cysts annotated by a radiologist. Internal (n = 7), External (n = 10), and test-retest reproducibility (n = 17) validations included macro- and micro-level performance metrics: patient-level Dice scores (PDice), along with voxel-level true positive rates (VTPR), as well as analysis of time saved in a model-assisted scenario. Additionally, we assessed human-level reliability in liver cyst segmentation and evaluated the model’s test-retest reproducibility. We further compared liver volume vs cyst volume for tracking disease in a subject with 16+ years follow-up.

Results

The model achieved an 82% ± 11% PDice and a 75% ± 15% VTPR on the internal test sets (n = 7 patients), and 80% ± 12% Dice score and a 91% ± 7% VTPR on the external test sets (n = 10 patients). It excelled particularly in detecting small liver cysts, a challenging task for manual annotation. This efficiency translated to a median of 91% (IQR: 14%) reduction in annotation time compared to manual labeling. Test-retest assessment demonstrated excellent reproducibility, with coefficients of variation of 94% for liver cyst fraction and 92% for cyst count.

Conclusion

DL automation of liver cyst segmentations demonstrates potential to improve tracking of liver cyst volume in polycystic liver disease.
Who Are the Hand-to-Mouth?
Authors: Aguiar Mark , Bils Mark , Boar Corina
Published: May 2024

Many households hold little wealth. In standard precautionary savings models, these households should not only display higher marginal propensities to consume (MPCs) but also higher future consumption growth. In contrast, we see from the Panel Study of Income Dynamics that such “hand-to-mouth” households do not display higher growth in spending. They also exhibit greater volatility of spending and adjust their spending to a greater extent through the number of categories consumed. Consistent with a role for preference heterogeneity, the panel data show that it is persistent differences across households, not current assets, that predict low consumption growth and other spending differences for the hand-to-mouth households. To identify the extent of preference heterogeneity, we consider the model of Kaplan and Violante with both liquid and illiquid assets, but allow heterogeneity in preferences. To match the data, many poor hand-to-mouth must be relatively impatient and have a high inter-temporal elasticity of substitution. The model shows that preferences predominantly explain the higher MPCs for low-asset households. Preference heterogeneity notably increases the spending impact of fiscal transfers, but only if targeted, while reducing that from interest rate cuts.
Demystifying the virtualization process: A call for standard reporting of virtual modifications to evidence-based psychotherapies, using the FRAME model
Authors: Boykin Derrecka M , Smith Tracey L , Rakel Barbara , Rodrigues Merlyn , Embree Jennie , Woods Ken , Chaison Angelic D , Dindo Lilian
Published: May 2024

The sudden onset of the coronavirus disease led to a rapid expansion of video telehealth to deliver mental healthcare. Although video telehealth was not a new clinical practice, there was limited guidance on how best to modify evidence-based psychotherapies (EBPs) for virtual delivery (a process also referred to as virtualization). The virtualization process for EBPs remains unclear as newly emerging reports on this topic do not consistently report modification decisions. This commentary calls attention to the need to improve documentation practices to allow a greater understanding of modifications needed to maximize the positive effects of EBPs transported to a virtual format. We used the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to capture details about the nature, process, and outcomes of intervention modifications across a given clinical setting or population. To illustrate the use of the FRAME, we present a case example describing our experiences with transporting a 1-day in-person Acceptance and Commitment Therapy group workshop to a virtual format. Workshop modifications primarily involved changes to the delivery format, administration procedures, and content. The case example walks through how, why, and by whom specific modifications were made as well as the degree to which fidelity was maintained. In the wake of the telemedicine revolution, further investigation into the virtualization process for EBPs is warranted. Improving reporting practices by using the FRAME or a similar adaptation framework will promote a more rigorous study of virtual modifications to EBPs that inform future guidelines and best practices.
Say the Words: Using Words to Confront Injustices in Health Care
Authors: Showalter Darlene A. , Foster Melissa M.
Published: May 2024

A guide for speaking out and taking action
Designing a Mentorship Program for APRNs in Specialty Palliative Care Practice
Authors: Fedel Patrice
Published: May 2024

As advanced practice registered nurses (APRNs) enter practice, support is crucial for success. Formal mentorship has been shown to improve employee turnover, job satisfaction, and clinical competence. In the wake of the COVID-19 pandemic, an APRN team specializing in palliative care experienced an unprecedented rate of staff turnover. As a result, the team decided to create a formal mentorship program to support newly hired colleagues and assist their transition to practice. A subcommittee of APRNs within the palliative care practice met to establish a mentorship practice framework, expectations for the program, and a methodology for matching mentors and mentees. The mentorship program was implemented with two cohorts comprising a total of five mentors and six mentees. It was evaluated by participants using surveys asking open-ended, qualitative questions. Both mentors and mentees reported finding the program valuable. Mentees felt the program helped their transition to practice, created a forum for peer support, and improved their clinical competence. Mentors said the program furthered their own professional development, advanced their clinical growth, and fostered a connection to colleagues. Employee engagement and alignment improved, and staff turnover decreased. Further work is needed to improve on the program framework and analyze the outcomes of mentorship.
Letters of Reference in the Current Era
Authors: Gottlieb Michael , Boatright Dowin , Landry Adaira
Published: May 2024

Letters of reference (LORs) are a common component of the application process for residency training programs. With the United States Medical Licensing Examination Step 1 transitioning to pass/fail grading and with the increasing use of holistic review, the potential role of LORs is rising in importance. Among some key benefits are the ability to provide a broader and more holistic view of applicants, which can include highlighting elements of experiences or skills that could be missed in their application, as well as providing a third-party assessment of the applicant external to their rotation experiences. However, LORs also face issues, including variation in quality, challenges with comparability, and risk of bias. In this article, the authors discuss the unique benefits, limitations, and best practice recommendations for LORs in academic medicine. The authors also discuss future directions, including the role of artificial intelligence, unblinded, and co-created LORs.
Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study
Authors: Chu Sheng-En , Huang Chun-Yen , Cheng Chiao-Yin , Chan Chun-Hsiang , Chen Hsuan-An , Chang Chin-Ho , Tsai Kuang-Chau , Chiu Kuan-Ming , Ma Matthew Huei-Ming , Chiang Wen-Chu , Sun Jen-Tang
Published: May 2024

OBJECTIVES:

Following current cardiopulmonary resuscitation (CPR) guidelines, which recommend chest compressions at “the center of the chest,” ~50% of patients experiencing out-of-hospital cardiac arrest (OHCA) undergo aortic valve (AV) compression, obstructing blood flow. We used resuscitative transesophageal echocardiography (TEE) to elucidate the impact of uncompressed vs. compressed AV on outcomes of adult patients experiencing OHCA.

DESIGN:

Prospective observational cohort study.

SETTING:

Single center.

PATIENTS:

This study included adult OHCA patients undergoing resuscitative TEE in the emergency department. Patients were categorized into AV uncompressed or AV compressed groups based on TEE findings.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was sustained return of spontaneous circulation (ROSC). The secondary outcomes included end-tidal co
2 (Etco
2) during CPR, any ROSC, survival to ICU and hospital discharge, post-resuscitation withdrawal, and favorable neurologic outcomes at discharge. Additional analyses on intra-arrest arterial blood pressure (ABP) were also conducted. The sample size was pre-estimated at 37 patients/group. From October 2020 to January 2023, 76 patients were enrolled, 39 and 37 in the AV uncompressed and AV compressed groups, respectively. Intergroup baseline characteristics were similar. Compared with the AV compressed group, the AV uncompressed group had a higher probability of sustained ROSC (53.8% vs. 24.3%; adjusted odds ratio [aOR], 4.72; p = 0.010), any ROSC (56.4% vs. 32.4%; aOR, 3.30; p = 0.033), and survival to ICU (33.3% vs. 8.1%; aOR, 6.74; p = 0.010), and recorded higher initial diastolic ABP (33.4 vs. 11.5 mm Hg; p = 0.002) and a larger proportion achieving diastolic ABP greater than 20 mm Hg during CPR (93.8% vs. 33.3%; p < 0.001). The Etco
2, post-resuscitation withdrawal, and survival to discharge revealed no significant intergroup differences. No patients were discharged with favorable neurologic outcomes. Uncompressed AV seemed critical for sustained ROSC across all subgroups.

CONCLUSIONS:

Absence of AV compression during OHCA resuscitation is associated with an increased chance of ROSC and survival to ICU. However, its effect on long-term outcomes remains unclear.
The Impact of Common Variations in Sequential Organ Failure Assessment Score Calculation on Sepsis Measurement Using Sepsis-3 Criteria: A Retrospective Analysis Using Electronic Health Record Data
Authors: Alrawashdeh Mohammad , Klompas Michael , Rhee Chanu
Published: May 2024

OBJECTIVES:

To assess the impact of different methods of calculating Sequential Organ Failure Assessment (SOFA) scores using electronic health record data on the incidence, outcomes, agreement, and predictive validity of Sepsis-3 criteria.

DESIGN:

Retrospective observational study.

SETTING:

Five Massachusetts hospitals.

PATIENTS:

Hospitalized adults, 2015 to 2022.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We defined sepsis as a suspected infection (culture obtained and antibiotic administered) with a concurrent increase in SOFA score by greater than or equal to 2 points (Sepsis-3 criteria). Our reference SOFA implementation strategy imputed normal values for missing data, used Pao
2/Fio
2 ratios for respiratory scores, and assumed normal baseline SOFA scores for community-onset sepsis. We then implemented SOFA scores using different missing data imputation strategies (averaging worst values from preceding and following days vs. carrying forward nonmissing values), imputing respiratory scores using Spo
2/Fio
2 ratios, and incorporating comorbidities and prehospital laboratory data into baseline SOFA scores. Among 1,064,459 hospitalizations, 297,512 (27.9%) had suspected infection and 141,052 (13.3%) had sepsis with an in-hospital mortality rate of 10.3% using the reference SOFA method. The percentage of patients missing SOFA components for at least 1 day in the infection window was highest for Pao
2/Fio
2 ratios (98.6%), followed by Spo
2/Fio
2 ratios (73.5%), bilirubin (68.5%), and Glasgow Coma Scale scores (57.2%). Different missing data imputation strategies yielded near-perfect agreement in identifying sepsis (kappa 0.99). However, using Spo
2/Fio
2 imputations yielded higher sepsis incidence (18.3%), lower mortality (8.1%), and slightly lower predictive validity for mortality (area under the receiver operating curves [AUROC] 0.76 vs. 0.78). For community-onset sepsis, incorporating comorbidities and historical laboratory data into baseline SOFA score estimates yielded lower sepsis incidence (6.9% vs. 11.6%), higher mortality (13.4% vs. 9.6%), and higher predictive validity (AUROC 0.79 vs. 0.75) relative to the reference SOFA implementation.

CONCLUSIONS:

Common variations in calculating respiratory and baseline SOFA scores, but not in handling missing data, lead to substantial differences in observed incidence, mortality, agreement, and predictive validity of Sepsis-3 criteria.
Frequently asked questions about adverse drug reactions of methylphenidate
Authors: Heerfordt Ida M. , Horwitz Henrik
Published: May 2024

This article addresses frequently asked questions about the adverse drug reactions associated with methylphenidate treatment. Methylphenidate is a central nervous system stimulant used primarily for the treatment of attention-deficit/hyperactivity disorder. It utilizes insights from the combined knowledge of pharmacists and physicians who advise healthcare professionals in the Capital Region of Denmark on patient-specific medication queries. The article provides an overview of the clinical challenges and safety considerations associated with methylphenidate use, integrating empirical data and clinical expertise to facilitate informed decision-making by practitioners.
A New Technique for Harvesting Limbal Stem Cell Tissue for Transplantation Using an Automated Microkeratome and a Novel Globe-Fixation System
Authors: Bibak-Bejandi Zahra , Mohammadi Seyed-Farzad , Davoudi Mehdi , Bahmanpour Amirhossein , Asadi-Amoli Fahimeh
Published: May 2024

Purpose:

To introduce an unprecedented technique, instrumentation, and setup for the superficial limbus harvest from the human cadaver donor whole globe.

Methods:

We studied several superficial limbus harvest alternatives, developed a preferred approach with our available instruments, and optimized it on a handful of (seropositive) cadaver donors of whole globes.

Results/Technique:

The globe was pressurized to about normal intraocular pressure by viscoelastic injection through the optic nerve stump. The globe was then mounted on a dynamic globe fixator that maintained a negative pressure in its stabilizing socket. Exertion of the negative pressure effectively elevated globe intraocular pressure (to over 40 mm Hg) and made the corneoscleral wall tight. The socket was then held tilted to the left side for about 35 to 40 degrees to put the limbal zone horizontally and mildly “chin-up.” Next, the microkeratome was put on the uppermost and exposed limbus of the globe and activated, and the socket was rotated clockwise under the microkeratome head and its oscillating blade, allowing an effective 360-degree revolution of the microkeratome head around the limbal belt (for a right-handed operator and a counterclockwise cut).

Conclusions:

We consistently succeeded in peeling intact 360-degree strips of the smooth superficial limbus by using blades with varying depths. Our method can be further equipped and optimized and be used by the eye banks and the surgeons for keratolimbal grafting as a more efficient limbal stem cell tissue harvest technique.
Collagen-Based Artificial Cornea for Lamellar Keratoplasty: An Early Case Report
Authors: Andreev Andrey Yurevich , Yusef Yusef Naim , Avetisov Sergey Eduardovich , Osipyan Grigory Albertovich , Domogatsky Sergey Petrovich , Osidak Egor Olegovich
Published: May 2024

Purpose:

The aim of this study was to evaluate Viscoll collagen membrane (VCM) for lamellar keratoplasty.

Methods:

A 54-year-old man with grade 4 recurrent pterygium underwent lamellar keratoplasty using VCM as the graft material. Standard keratoplasty postoperative treatments, including topical antibiotic-corticosteroid and artificial tears, were administered.

Results:

Complete graft epithelialization was achieved after 4 days of the surgery. Follow-up at 9 months showed no pterygium recurrence as well as good integration of the VCM graft into the surrounding tissues with preserved transparency.

Conclusions:

This case demonstrated that VCM possesses great potential as an alternative to the human donor cornea for lamellar keratoplasty; however, the application of VCM for lamellar keratoplasty still needs additional evaluation.
Study on the bioactive ingredients and mechanism of Huangqi against diabetic retinopathy based on network pharmacology and experimental verification
Authors: Lin Xiaohui , Bao Min , Zhang Xiaohui , Qirula Sa , Jiao Chenxu , Zhang Dingyi , Han Jing
Published: May 2024

Background:

Diabetic retinopathy (DR) is one of the most well-known microvascular complications of diabetes mellitus. As a traditional Chinese medicine, Huangqi (HQ), has been used for treating DR for a long time. However, its anti-DR active ingredients and mechanism are still unknown. Therefore, we designed this study to explore the active components and mechanism of HQ against DR via network pharmacology analysis.

Methods:

The ingredients of HQ, and potential targets of HQ and DR were obtained from public databases. We used the protein-protein interaction (PPI) network, Kyoto Encyclopedia of Genes and Genomes (KEGGs) pathway enrichment, and Gene Ontology (GO) analysis to identify core targets and pathways of HQ against DR. Finally, molecular docking and vitro experiments were applied to validate our results.

Results:

A total of 34 potential targets of HQ against DR were obtained. Based on PPI network, VEGFA, PTGS2, Interleukin-6 (IL-6), and CCL2 were considered as core targets. GO analysis involved 692 biological processes, 21 cellular components, and 35 molecular functions. KEGG enrichment analysis manifested that the anti-DR effect of HQ was mainly mediated via the AGE-RAGE signaling pathway in diabetic complications. The molecular docking results indicated that kaempferol had higher affinity with CCL2, IL-6, VEGFA, and PTGS2. The vitro experiments showed that the mRNA expressions of CCL2, IL-6, VEGFA, and PTGS2 in ARPE-19 cells were differentially decreased after kaempferol treatment.

Conclusion:

This study preliminarily unveiled that the therapeutic efficacy of HQ against DR might be attributed to the reduced expression of CCL2, IL-6, VEGFA, and PTGS2.