bluuebunny/crossref_metadata_2025 huggingface dataset:
The Future Car
Authors: Edmonds David
Published: October 2021

This chapter reflects on driverless cars. Real road use of driverless cars poses challenges that engineers and designers are finding difficult to overcome. Some of these are particularly relevant for what might be merely a transition period, when human drivers coexist on the road alongside driverless vehicles. For example, driverless cars are law abiding. This is fine if all cars obey the law, but if human-driven cars are zipping along well above the speed limit, then it may be safer for the driverless car, on occasion, to transgress the law too. However, there are all sorts of problems with programming driverless cars with what has been called “naughty software” — adjusting their behaviour to accommodate dangerous human drivers. There are also technical problems about identifying threats. Humans can easily tell that a brick on the road poses more of a danger than a plastic bag. The driverless car has to learn to distinguish what in its path needs to be avoided and what can be ignored. But this future vehicle also raises ethical challenges — and these may prove even more problematic.
Genome Editing in Livestock
Authors: Devolder Katrien
Published: October 2021

This chapter studies the ethics of genome editing in livestock. At first sight, genome editing in livestock would enable a win-win situation: it would be good for the farmers, as it would prevent enormous financial losses, and good for the animals, because it would prevent them from becoming seriously ill. However, one recurring worry about genome editing is that it oversteps the boundaries of humans' role in scientific research and development. These boundaries are thought to be set by either God or nature. Some may object to the use of genome editing because it is too risky, while some may think that genome editing in livestock would be disrespectful towards the animals. In addition, some may object not because genome editing in itself is wrong, or because this would be disrespectful to the animals, but because it is the wrong kind of solution. The chapter argues that we should support research into applications of genome editing that would be to the benefit of both humans and animals, but that it is important to proceed cautiously. Simultaneously, we should do what we can to transform farming practices in other ways that improve animal lives and reduce environmental damage.
Orthopaedics
Authors: Davies Nev , Vusirikala Anuhya
Published: October 2021

This chapter contains 24 questions that encompass all of the important areas of orthopaedics, with detailed explanations. There is a great deal of knowledge required to be proficient in this field, and it is important that the principles of orthopaedic surgery be studied to ensure thorough understanding. The questions in this section range from neonatal orthopaedic complaints, through to serious pathologies which can be life-changing for patients and career-changing for the clinicians that miss them. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.
“This Enormous Planet”
Authors: Fritzsche Peter
Published: October 2021

This chapter explores how the ascent of National Socialism forever scrambled the associations that people around the world made with Germany. Adolf Hitler's appointment as chancellor on January 30, 1933, generated global headlines, and from then on, the big newspapers' coverage plotted the rise of the Third Reich. Hitler's first hundred days were widely perceived as a sudden tectonic shift in European politics that threatened the very idea of liberal progress. The reverberations of 1933, the nationalist insurgency and the socialist collapse, shook the continent for many years to come. Precisely the transnational nature of the fascist phenomenon, something confirmed by global responses to the Nazi seizure of power in 1933, enhanced its legitimacy and sturdiness. Even France, the historic foe of Germany, registered in profound ways the shock waves of Hitler's revolution. The turbulence of 1933 later shaped both France's resistance to and its collaboration with the German Nazis.
Surā Made from Grains
Authors: McHugh James
Published: October 2021

This chapter focuses on the ancient, prototypical drink of premodern South Asia: surā. The word “surā” means a lot of things and can even be a generic word for alcoholic drinks, but as a named type of drink in ancient texts it often refers to a drink brewed from cereal grains along with special fermentation starters and herbs. The chapter first presents a very early “recipe” for surā from a text on Vedic rituals. Then the chapter examines later discussions of grain-based surā from a variety of textual sources, up through the twelfth century CE. Later surā brewing involved combining cooked grains with a starter called kiṇva, and the chapter also examines the nature and significance of this important substance.
Drink, Health, and Disease in Āyurvedic Texts
Authors: McHugh James
Published: October 2021

Chapter 5 explores at a sample of medical texts that deal with drink and drinking, in order to give the reader a taste of Āyurvedic medical theories on how to drink correctly. These texts no only discuss the medical problems caused by drinking but also give extensive instructions on how to enjoy drinking in a healthy manner. The medical texts also explain exactly how drink affects the mind and body, and how to treat people when drink makes them unwell. The medical condition caused by drink is not the same as modern alcoholism, and indeed a common treatment for intoxication-sickness prescribed in Āyurvedic texts is to drink more liquor of the correct variety.
Drink in Ritual, Myths, and Epic
Authors: McHugh James
Published: October 2021

Many texts—moral, legal, medical, and Tantric—refer to the use of drink in a certain Vedic ritual (the Sautrāmaṇī), as well as to a number of myths and narratives connected to drink. Chapter 6 explores the use and significance of drink in this Vedic ritual and also presents the most common stories associated with drinking, namely, the narrative of the creation of surā at the Churning of the Ocean; the notion of an ocean of surā; the creation of a demonic Intoxication personified; the prohibition of surā for Brahmins by the sage Śukra, as well as discussing Balarāma and drink, and the drunken mutual slaughter of Kṛṣṇa’s kinsmen. These narratives are of intrinsic interest, but it is also essential to know these stories and frameworks in order to understand the remainder of the book.
Firewater and Corpse-Reviver
Authors: McHugh James
Published: October 2021

Chapter 9 contains some very brief observations on what happened to the drinks, ideas, narratives, and rituals discussed in this book over the later second millennium CE. Although limited to certain narrow sectarian and professional contexts, many of these ancient intellectual resources still formed a repertoire of materials with which to think about drink and drugs in very changed historical circumstances. The chapter first examines what happened to traditional methods of surā brewing, and how distillation was incorporated, practically and conceptually. Then the chapter briefly considers how tobacco was described and classified within the world of Sanskrit texts. Although this period witnessed new technologies and substances, the Sanskritic tradition continued to adapt to these new situations, often by having recourse to ancient ideas and motifs.
Luis Buñuel, Surrealism, and the Politics of Disorder
Authors: Wood Michael
Published: October 2021

Luis Buñuel had his doubts about dogmatic surrealism, but he found in the movement a model of discipline, a form of vigilance against the refluxes of order and reason. This chapter explores some of the ways in which two early films—Un chien andalou and L’Âge d’or—court and confute the idea of interpretation, using the art of cinema to resist all easy recourses to meaning. An examination of questions about montage and the association of ideas, about narrative and the ghosts of dead ambitions, allows us to understand a little better how surrealism can be both a definable historical intervention in the arts and an ongoing practice of skeptical resistance—skeptical even about resistance itself.
Leibniz on the Ideality of Space
Authors: Rutherford Donald
Published: October 2021

This chapter argues for a close connection between Leibniz’s doctrine of the relational character of space and the doctrine that space is ideal. The chapter further explores some of the consequences of the latter doctrine for Leibniz’s philosophy. The approach is anchored in basic principles of Leibniz’s metaphysics that are fixed long before his exchange with Clarke, as well as conclusions he reaches about space through work on the foundations of geometry. Throughout, it is assumed that in his writings on metaphysics, physics, and mathematics Leibniz operates with a single concept of space and a single account of the mode of cognition by which objects are apprehended as spatially related. Finally, the chapter examines the extent to which Leibniz’s doctrine of space anticipates Kant’s conception of space.
Bodies, Matter, Monads, and Things in Themselves
Authors: Stang Nicholas F.
Published: October 2021

There is a tension in Leibniz’s mature metaphysics that has received considerable attention in the last several decades of scholarship. On the one hand, there are texts that support a phenomenalist reading, according to which bodies are simply the coordinated phenomena of minds. On the other hand, there are texts that support a realist reading, according to which bodies are aggregates of the real constituents of the world, monads. Likewise, there is a structurally similar tension in Kant’s metaphysics between “two world” and “one world” interpretations of transcendental idealism. This chapter develops an interpretation of Leibniz’s metaphysics that does justice to both his realism and his phenomenalism, and then shows how that interpretation can be applied to Kant’s transcendental idealism.
Kant and the (Alleged) Leibnizian Misconception of the Difference between Sensible and Intellectual Representations
Authors: Jauernig Anja
Published: October 2021

The chapter focuses on Kant’s central objection to the Leibnizian philosophy, namely, that the Leibnizian conception of the difference between sensible and intellectual representations is a misconception. According to Kant, the Leibnizians regard sensible and intellectual representations to differ logically, with respect to their degrees of confusion or distinctness, whereas they actually differ in kind, with respect to their content and origin. The chapter examines in detail the “misconception objection,” its relation to other Kantian worries about the Leibnizian philosophy, as well as Kant’s underlying concerns that fuel it, and explores whether a central one of these concerns, namely, the worry that the Leibnizians are committed to the view that we could learn something about things in themselves by experience if our senses were acute enough or our powers of disfusing perceptions were strong enough, does apply to Leibniz’s actual position.
Kant’s Amphiboly as Critique of Leibniz
Authors: Bolton Martha Brandt
Published: October 2021

This chapter focuses on the Amphiboly chapter of Kant’s Critique of Pure Reason, where he presents his clearest attack on Leibniz’s philosophy. But, ultimately, it is argued here that the chapter is a disappointment, for it is conspicuously based on mischaracterizations of Leibniz’s account of cognition. The charge that Leibniz intellectualized the phenomena is false and the closely related charge that he confused intelligibilia and sensibilia is also false. There is, however, a direct confrontation over a less well advertised issue abroad in the Amphiboly chapter that takes the form of a problem in Kant’s pre-Critical thinking: finding the epistemic and metaphysical basis of judgments which are not grounded on the law of non-contradiction alone. While Kant’s Critique does not succeed in vitiating Leibniz’s metaphysical doctrines on the basis of a supposedly misguided theory of cognition, it exposes a deep system-wide source of opposition between them.
The Development of Kant’s Conception of Divine Freedom
Authors: Kain Patrick
Published: October 2021

While several scholars have suggested that Kant’s early engagement with Leibniz’s philosophical theology led Kant to a conception of the divine will that helped to motivate many of the distinctive features of Kant’s mature moral psychology and moral philosophy, commentators have nevertheless neglected and failed to understand Kant’s account of divine freedom and how it functions in his rejection of substance monism, fatalism, and threats to divine self-sufficiency. This chapter examines the development of Kant’s position in a variety of his early and later published works and in his drafts, Reflexionen, and lecture notes. God is conceived of as the ens realissimum, possessing or exemplifying all fundamental realities or perfections, and it is God’s cognition of his own goodness that gives rise to his volition to create the most perfect world. Divine freedom is understood as a rational and autonomous expression of the divine nature itself, without requiring alternative possibilities.
Leibniz and Kant on Empirical Miracles
Authors: Chignell Andrew
Published: October 2021

Leibniz and Kant were heirs of a biblical theistic tradition which viewed miraculous activity in the world as both possible and actual. But both were also deep explanatory rationalists about the natural world: more committed than your average philosophical theologian to its thoroughgoing intelligibility. These dual sympathies—supernaturalist religion and empirical rationalism—generate a powerful tension across both philosophers’ systems, one that is most palpable in their accounts of empirical miracles—that is, events in nature that violate one or more of the natural laws. The primary goal of this chapter is to exhibit their respective efforts to resolve this tension, and to show how Kant’s noumenal ignorance doctrine allows him to set aside some key difficulties that Leibniz’s model leaves unresolved. The chapter concludes with the unorthodox suggestion that both systems leave conceptual space for the idea that finite free beings, rather than just God, can produce empirical miracles.
Effect of Transcranial Direct Current Brain Stimulation of the Motor Cortex on Chemotherapy-Induced Nausea and Vomiting in Female Patients with Breast Cancer
Authors: Kamal Shereen Mamdouh , Elhusseini Nayria Mahmoud , Sedik Mayada Fawzy , Mohamad Mohamad F , Khedr Eman Mohamed Hussein , Kotb Hassan Ibraheem Mohamed
Published: October 2021

Objective

Chemotherapy-induced nausea and vomiting (CINV) is an adverse outcome associated with chemotherapy and is sometimes difficult to manage. This study aimed to examine the impact of a single session of transcranial direct current brain stimulation (tDCS; 2 mA) over the motor cortex for 20 minutes before chemotherapy in patients receiving a highly emetogenic chemotherapy.

Study Design

Prospective randomized double-blind sham-controlled study.

Setting

Academic medical center.

Method

Sixty patients with breast cancer who were scheduled for chemotherapy treatment were selected and allocated randomly into two equal groups: a stimulation group and a sham group. tDCS was implemented over the primary motor area (M1) (2 mA) for 20 minutes. Patients’ nausea was measured by a cumulative index of nausea, a visual analog scale for nausea (VAS-N), episodes of vomiting, and the Edmonton Symptoms Assessment Scale (ESAS) to assess symptoms like pain, malaise, and sense of well-being. Evaluation was done before stimulation and every 24 hours for 72 hours after the end of infusion of chemotherapy.

Results

The tDCS group showed a reduction in the cumulative index of nausea (P < 0.001, F = 50), the VAS-N (P < 0.001, F = 52), the ESAS malaise score (P < 0.001, F = 37.6), and the sense of well-being score (P < 0.001, F = 25) vs the sham group. Six patients (20%) in the tDCS group required rescue antiemtic therapy vs 14 patients (46.7%) in the sham group (P < 0.028).

Conclusion

A single session of M1 tDCS is suggested as an effective adjuvant therapy to control CINV in female patients suffering from breast cancer and receiving highly emetogenic chemotherapy. Corroboratory studies are needed.
O12 A rare mimic of inflammatory arthritis
Authors: Umair Hafiz Muhammad , Kazmi Muhammad Farooq
Published: October 2021

Case report - Introduction

Melorheostosis is a very rare benign bone disorder involving sclerosing hyperostosis. The name derives from the Greek terms Melos ‘limb’, rheos ‘flow’ and osteon ‘bone’. The incidence of melorheostosis is 0.9 cases per million population, and in the majority of cases is diagnosed before the age of 20 years. It presents with pain, deformities, limitations of a range of motion, contractures, muscle atrophy, and limb swelling. We present a case of a 33-year-old lady who was referred with a history of pain and swelling of the right knee.

Case report - Case description

This 33-year-old lady of Nigerian origin was referred to the rheumatology department with a 7-year history of fluctuating pain and swelling in the right knee with the possibility of inflammatory arthritis. Prior to this, she had been seen by the local orthopaedic team with subsequent input sought from the regional specialist orthopaedic bone unit in Birmingham. The synovial biopsies did not show any evidence of inflammation or pigmented villo-nodular synovitis (PVNS). Prior to moving to the UK, she had been assessed in Germany and Dubai due to knee pain and swelling with a diagnosis of the unclear bone-related condition and fibromyalgia. Clinically the right knee had a chronic cool swelling with reduced range of movement but no synovitis and no signs of inflammatory arthritis in other joints.  There were no features of seronegative inflammatory arthritis or connective tissue diseases.  Investigations showed weak positive ANA with normal CRP, bone profile, FBC, urea and electrolytes, with negative rheumatoid factor and anti-CCP antibody. X-ray knee arranged, showed a flowing periosteal thickening medial cortices of the femur and tibia consistent with ‘melorheostosis’. MRI right knee also confirmed the same diagnosis. Imaging of the upper limbs, spine and pelvis showed no involvement. Input from the metabolic bone health team was arranged who did not deem bisphosphonates useful in her case. Physiotherapy input was arranged to improve her leg posture and movements along with appropriate patient education and analgesia titration.

Case report - Discussion

We present a rare mimic of inflammatory arthritis. Initially referred by GP to orthopaedic team who considered PVNS which was ruled out by biopsies, then next question was about inflammatory arthritis due to recurrent history of knee pain and swelling which is valid differential for monoarthritis. Rheumatology assessment noted a puffy knee but no effusion to aspirate, x-ray imaging was diagnostic for melorheostosis due to the typical presence of ‘dripping wax appearance’.

As rheumatologists while assessing joints, genetic and metabolic causes need to be considered besides inflammatory and infective causes. A thorough history remains essential along with interaction with radiology colleagues which is the main learning point.

Case report - Key learning points
A Comprehensive Review of the Pathogenesis, Diagnosis, and Management of Diabetic Foot Infections
Authors: Mponponsuo Kwadwo , Sibbald R. Gary , Somayaji Ranjani
Published: October 2021

GENERAL PURPOSE

To review an approach to diabetic foot infections (DFIs), including acute osteomyelitis, while also discussing current practices and the challenges in diagnosis and management.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will

1. Identify the risk factors for developing DFIs.

2. Outline diagnostic techniques for assessing DFIs.

3. Select the assessment techniques that support a diagnosis of osteomyelitis.

4. Choose the appropriate pharmacologic and nonpharmacologic treatment options for patients who have DFIs.

Diabetic foot ulcers result from a combination of peripheral neuropathy, vascular compromise, and repetitive trauma. Approximately 50% of individuals with diabetic foot ulcers will develop a diabetic foot infection (DFI), and 20% of individuals with a DFI will develop osteomyelitis. Herein, the authors review an approach to DFIs including acute osteomyelitis and discuss current practices and challenges in diagnosis and management.

The diagnosis of a skin and soft tissue DFI is based on clinical criteria. A bone biopsy is considered the criterion standard for diagnosis of osteomyelitis; however, biopsy is not always feasible or available. Consequently, diagnosis can be made using a combination of clinical, biochemical, and radiographic findings. X-ray is the recommended imaging modality for initial evaluation; however, because of its lower relative sensitivity, advanced imaging may be used when clinical suspicion remains after negative initial testing.

The microbiology of skin and soft tissue DFIs and osteomyelitis is similar. Staphylococcus aureus and other Gram-positive cocci are the most common pathogens identified. Deep cultures are preferred in both DFI and osteomyelitis to identify the etiologic pathogens implicated for targeted antimicrobial therapy. Management also requires a multidisciplinary approach. Surgical debridement in those with deep or severe infections is necessary, and surgical resection of infected bone is curative in cases of osteomyelitis. Finally, appropriate wound care is critical, and management of predisposing factors, such as peripheral neuropathy, peripheral arterial disease, tinea, and edema, aids in recovery and prevention.
Postoperative Evolution of Sagittal Parameters Over Time Does Not Differ by Upper Instrumented Vertebra
Authors: Steinhaus Michael E. , Lafage Renaud , Alluri Ram K. , Lovecchio Francis , Clark Nicholas J. , Sivaganesan Ahilan , Schwab Frank , Lafage Virginie , Kim Han Jo
Published: October 2021

Study Design.

Retrospective cohort study.

Objectives.

The aim of this study was to examine sagittal alignment over time in adult spinal deformity (ASD) and to understand whether these changes vary by choice of upper instrumented vertebra (UIV).

Summary of Background Data.

Recent ASD literature has focused on specific alignment goals. Less is known about how sagittal parameters evolve over time after surgical correction and whether these changes differ by choice of UIV.

Methods.

This was a retrospective review of ASD patients from a single institution. Routine 36″ sagittal x-rays were obtained preoperatively, before hospital discharge, and at 6 months, 1 year, and 2 years and sagittal parameters were measured. Patients with UIV T6 and above were classified as upper thoracic (UT) and T7 and below as lower thoracic (LT).

Results.

A total of 102 patients with mean age 66.0 years (±7.7) were included in the analysis (49 UT, 53 LT). All sagittal and coronal alignment parameters demonstrated significant improvement from preoperatively to any postoperative time point. Although multiple parameters maintained correction over time, others (TK, TPA, and PT) demonstrated significant increase from discharge to 2 years postoperatively, with changes occurring relatively early after surgery, whereas overall global alignment was maintained. Both UT/LT groups demonstrated significantly greater TK from preoperatively to discharge to 6 months (P 
< 0.05), stabilizing at that time point out to 2 years, whereas TLK preferentially increased in the LT group. There was significant improvement in sagittal vertical axis after surgery, which was maintained out to 2years of follow-up (P > 0.05).

Conclusions.

Our data suggest that although several key parameters are maintained over time out to 2years postopera- tively, TK tends to worsen over time for all patients, whereas TLK preferentially increases in the LT group. Nevertheless, despite these trends, compensatory changes are seen in PT such that global alignment is relatively maintained.

Level of Evidence: 3
Ultrastructural alterations of megakaryocytes in thrombocytopenia: A review of 43 cases
Authors: Eyden Brian , Ru Yong-Xin , Dong Shu-Xu , Liu Jing , Liu Xiao-Fan
Published: October 2021

Thrombocytopenia is a frequent occurrence in a variety of hematopoietic diseases; however, the details of the mechanism leading to low platelet count remain elusive. Megakaryocytes are a series of progenitor cells responsible for the production of platelets. Alterations in megakaryocytes in the bone marrow are a causative factor resulting in thrombocytopenia in varied diseases. Based on ultrastructural analysis of incidentally encountered megakaryocytes in 43 patients with blood diseases marked by low platelet counts, electron micrographs demonstrated that aberrant megakaryocytes predominated in idiopathic thrombocytopenic purpura, aplastic anemia, and myelodysplastic syndrome; autophagy, apoptosis, and cellular damage in megakaryocytes were a prominent feature in aplastic anemia. On the other hand, poorly differentiated megakaryocytes predominated in acute megakaryoblastic leukemia (AMKL) although damaged megakaryocytes were seen in non-AMKL acute leukemia. This paper documents the ultrastructural alterations of megakaryocytes associated with thrombocytopenia and reveals distinctive features for particular blood diseases. A comment is made on future avenues of research emphasizing membrane fusion proteins.
State of the art and future directions in the systemic treatment of medullary thyroid cancer
Authors: Jager Eline C. , Broekman K. Esther , Kruijff Schelto , Links Thera P.
Published: October 2021

Purpose of review

Systemic treatment is the only therapeutic option for patients with progressive, metastatic medullary thyroid cancer (MTC). Since the discovery of the rearranged during transfection (RET) proto-oncogene (100% hereditary, 60–90% sporadic MTC), research has focused on finding effective systemic therapies to target this mutation. This review surveys recent findings.

Recent findings

Multikinase inhibitors are systemic agents targeting angiogenesis, inhibiting growth of tumor cells and cells in the tumor environment and healthy endothelium. In the phase III EXAM and ZETA trials, cabozantinib and vandetanib showed progression-free survival benefit, without evidence of prolonged overall survival. Selpercatinib and pralsetinib are kinase inhibitors with high specificity for RET; phase I and II studies showed overall response rates of 73% and 71% in first line, and 69% and 60% in second line treatment, respectively. Although resistance mechanisms to mutation-driven therapy will be a challenge in the future, phase III studies are ongoing and neo-adjuvant therapy with selpercatinib is being studied.

The development of selective RET-inhibitors has expanded the therapeutic arsenal to control tumor growth in progressive MTC, with fewer adverse effects than multikinase inhibitors. Future studies should confirm their effectiveness, study neo-adjuvant strategies, and tackle resistance to these inhibitors, ultimately to improve patient outcomes.
Emergency Medicine and COVID-19: now and next year
Authors: Christopher Theodore A. , Christopher Adrienne N.
Published: October 2021

The COVID-19 pandemic is responsible for infecting to date more than 93 million people worldwide and causing more than 2 million deaths. That the vast majority of deaths have occurred in the United States (U.S.) can be attributed to nonadherence by Americans to basic public health mitigation strategies that are known to curtail coronavirus spread. Emergency Departments (ED's) throughout the U.S. experienced a dramatic decrease in patient visits during the first surge of COVID-19, followed by an ED patient visit rebound to approximately 80% of pre-COVID-19 numbers, which have remained relatively stable through the current second COVID-19 surge. The pandemic highlighted the significant role that hospital ED's and emergency physicians played in combatting COVID-19 “on the front lines.” Wearing extensive and escalating personal protective equipment (PPE) layers became the norm in seeing emergency patients, and many infrastructure and process changes occurred included evaluating and treating patients in outdoor tents, cohorting confirmed and suspected COVID-19 patients in designated ED and hospital sections, and repeatedly amending COVID-19 evaluation and treatment guidelines as more information became available on a sometimes daily basis. Regarding other clinical venues in which emergency physicians were working during COVID-19 surges, Observation Unit patient visits decreased, although patient acuity increased; urgent care (UC) patient visits decreased dramatically, whereas Telehealth (TH) patient visits to our 24/7 available platform, JeffCONNECT, saw a dramatic increase in activity. Remdesivir, Dexamethazone and more recently, the monoclonal antibody Bamlanivimab, have formed the mainstay of treatment offered to our patients with COVID-19; all these agents are offered to patients in our ED's and Observation Unit. The current second COVID-19 surge, with our ED and hospital patient visits remaining essentially stable, has intensified the public health crisis as record numbers of U.S. patients continue to acquire COVID-19 and die. With ED patient care processes being optimized to treat the influx of COVID-19 patients, and ED geography being adjusted within ED's and expanding maximally to areas outside the ED's but still within the confines of hospital walls, emergency physicians have taken the lead in caring for patients remotely via on demand TH Virtual ED visits. Rather than continuing to request the patients to come to us, emergency physicians are evolving to assess patients remotely and are embracing health care delivery models that bring acute unscheduled medical care to patients at home. This will include also prioritizing health wellness, health care disparities, and health equity, as Emergency Medicine (EM) and emergency physicians begin to collectively address community and patient social determinants of health, especially in vulnerable populations and communities.
Constructed Measures and Causal Inference
Authors: VanderWeele Tyler J.
Published: October 2021

Psychosocial constructs can only be assessed indirectly, and measures are typically formed by a combination of indicators that are thought to relate to the construct. Reflective and formative measurement models offer different conceptualizations of the relation between the indicators and what is sometimes conceived of as a univariate latent variable supposed to correspond in some way to the construct. I argue that the empirical implications of reflective and formative models will often be violated by data since the causally relevant constituents will generally be multivariate, not univariate. These empirical implications can be formally tested but factor analysis is not adequate to do so. I argue that formative models misconstrue the relation between the constructed measures and the underlying reality by which causal processes operate, but that reflective models misconstrue the nature of the underlying reality itself by typically presuming that the constituents of it that are causally efficacious are unidimensional. I discuss the ensuing problems arising from these misconstruals. I propose a causal interpretation of associations between constructed measures and various outcomes that is applicable to both reflective and formative models and is applicable even if the usual assumptions of these models are violated. I put forward an outline for a new model of the process of measure construction and discuss the practical implications of these observations and proposals for the provision of definitions, the selection of items, item-by-item analyses, the construction of measures, and the interpretation of the associations of these measures with subsequent outcomes.
Self-report Versus Measured Physical Activity Levels During Outpatient Cardiac Rehabilitation
Authors: Groothuis Rutger J. , van Keeken Helco G. , de Vries Arjen E. , Dijkstra Pieter U.
Published: October 2021

Purpose:

Many patients with coronary artery disease (CAD) do not achieve the recommended physical activity (PA) levels during and after cardiac rehabilitation (CR). The aim of this study was to analyze moderate to vigorous physical activity (MVPA) levels and the differences between perceived (self-reported) and measured (activity monitor) MVPA in CAD patients during CR. The second aim was to analyze which patient characteristics were associated with this difference.

Methods:

A two-center observational-sectional study was conducted within the Department of Rehabilitation Medicine of the University Medical Center Groningen between January and April 2018. Adults with CAD, following an outpatient CR program, were included. Perceived MVPA was assessed with the Short Questionnaire to Assess Health-enhancing Physical Activity and compared with ActivPAL3 activity monitor outcomes over a period of 7 d.

Results:

Fifty-one patients with CAD (age 59.4 ± 7.1 yr, eight females) were recruited. Four patients (8%) did not achieve the recommended guideline level of ≥150 min/wk of MVPA. Patients spent ≥80% of the week in sedentary activities. Patients overestimated MVPA with a median of 805 (218, 1363) min/wk (P< .001). The selected patient characteristics (age, body mass index, type of CAD, type of CR, social support, and self-efficacy) were not associated with this overestimation.

Conclusions:

Most patients with CAD, participating in an outpatient CR program, do achieve MVPA exercise recommendations but spend simultaneously too much time in sedentary activities.
Development and Validity Testing of the Workplace Parent Index
Authors: Yun Young Ho , Choi Yeani , Chae Minjin
Published: October 2021

Objective:

We aimed to develop the Workplace Parent Index (WPI) as an assessment tool of family-friendly practice in the workplace and validate its psychometric properties.

Methods:

The development of the WPI included three phases: item generation, scale construction, and field testing. Participants were 1000 parents, aged 18 or more years old, who completed the WPI online and measures of competency of parentship, life satisfaction, and positive growth after experiencing a traumatic event.

Results:

The WPI comprised 80 items and five domains: Governance and Infrastructure, Planning and Communications, Action-Pregnancy and Childbirth, Action-Childrearing, and Monitoring and Feedback. All subscales of the WPI demonstrated high internal consistency reliability and correlated with other scales as expected in support of concurrent and predictive validity.

Conclusions:

The WPI demonstrated excellent psychometric properties that can be used to assess comprehensive family-friendly practices in the workplace when addressing the need and prioritizing the allocation of resources for workplace parentship program initiatives.
Evaluation of Possible Effects of the COVID-19 Pandemic on Febrile Neutropenia Episodes in Children With Acute Leukemia
Authors: Erbaş İrem Ceren , Tüfekçi Özlem , Akyol Şefika , Asrak Hatice Karaoğlu , Güzin Ayşe Çakil , Alataş Şilem Özdem , Yilmaz Şebnem , Ören Hale , Belet Nurşen
Published: October 2021

With the rapid spread of coronavirus disease 2019 (COVID-19) around the globe, concerns about the management of patients with malignancy have risen significantly. This study aimed to investigate the possible impact of the COVID-19 pandemic and prevention policies on the incidence and etiology of febrile neutropenia (FN) episodes in children with acute leukemia. Children who had acute leukemia and were diagnosed as FN in a tertiary center from March 2018 to March 2021 were included in the study. FN episodes were grouped as prepandemic and postpandemic based on the date that pandemic was declared. Relevant data were collected retrospectively. We evaluated 113 FN episodes (75.2% were prepandemic) of 46 patients, a median of 4.7 (2.6 to 12.6) years of age. The number of FN episodes per patient did not differ between prepandemic and postpandemic periods (P=0.476). There was no significant difference among the 2 groups regarding the microbiologic causes, focus of fever, and clinical outcomes in FN episodes. Two of the patients were diagnosed as COVID-19 and recovered without any complications. In conclusion, we showed that the incidence and etiology of FN episodes were similar before and during the COVID-19 pandemic in children with acute leukemia.
18F-Choline PET Detected the Third Ventricle Craniopharyngioma
Authors: Zhu Yunqi , Zhao Kui , Wang Zhen , Zhang Yafei , Lu Xiaoya
Published: October 2021

Craniopharyngiomas are rare tumors of low histological malignancy (World Health Organization grade I) in the sellar and suprasellar region of the brain. We report a case of the third ventricular craniopharyngioma detected using 18F-choline PET/CT in a 43-year-old man. MRI of the brain revealed an intense gadolinium enhancement focus in the same area. Histology revealed characteristics of papillary craniopharyngioma. Our findings suggest that craniopharyngioma should be included in the differential diagnosis of 18F-choline–avid brain lesions.
Hanstruepera crassostreae He et al. 2018 is a later heterotypic synonym of Pseudobizionia ponticola Park et al. 2018
Authors: Pei Jiahao , Wu Yong , Gao Yuxin , Li Sicong , Fang Jiasong , Wei Yuli
Published: October 2021

Hanstruepera crassostreae

L53T was compared with

Pseudobizionia ponticola

MM-14T to examine the taxonomic relationship between the two type strains. The 16S rRNA gene sequence of

H. crassostreae

L53T had complete similarity (100.0%) to that of

P. ponticola

MM-14T. The results of phylogenetic analyses based on 16S rRNA gene sequences indicated that the two strains formed a tight cluster within the genus

Pseudobizionia

. Draft genomic comparison between the two strains revealed an average nucleotide identity of 96.9 % and a digital DNA–DNA hybridization estimate of 75.3±2.8 %, strongly indicating that the two strains represented a single species. In addition, neither strain displayed any striking difference in metabolic, physiological or chemotaxonomic features. Therefore, we propose that

Hanstruepera crassostreae

is a later heterotypic synonym of

Pseudobizionia ponticola

.
Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: An observational cohort study
Authors: Marincowitz Carl , Stone Tony , Hasan Madina , Campbell Richard , Bath Peter A. , Turner Janette , Pilbery Richard , Thomas Benjamin , Sutton Laura , Bell Fiona , Biggs Katie , Hopfgartner Frank , Mazumdar Suvodeep , Petrie Jennifer , Goodacre Steve
Published: October 2021

Background

Emergency Medical Services (EMS) have experienced surges in demand as the COVID-19 pandemic has progressed with ambulances services in the UK declaring major incidents due to the risk of care being compromised. COVID-19 specific EMS telephone triage tools have been introduced to help manage demand. There has been no previous evaluation of the accuracy of EMS telephone triage in identifying patients with suspected COVID-19 at risk of serious adverse outcome.

We aimed to assess accuracy of EMS telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy.

Method

Patients who made an emergency call to Yorkshire Ambulance Service between 2ndApril and 29thJune 2020 and were assessed using an AMPDS pandemic pathway for suspected COVID-19 were linked to Office for National Statistics death registration data, hospital and general practice electronic health care data collected by NHS Digital.

Accuracy of decision to dispatch an ambulance was assessed in terms of death or need for organ support at 30 days from the first 999 call. Multivariable logistic regression was used to identify factors associated with false negative and false positive triage.

Results

Of 12, 653 callers included in the study population, 11.1% experienced the primary composite adverse outcome. Using the triage pathway, 16% of callers did not receive an emergency response and they had a lower risk (3.5%) of the primary outcome. Ambulances were dispatched to 4, 230 callers (33.4%) who were not subsequently conveyed to hospital and did not experience the primary outcome (false positive triage). Multivariable modelling found older age and presence of pre-existing respiratory disease were significant predictors of false positive triage.

Conclusion

EMS telephone triage avoided 16% of calls receiving an emergency ambulance, of whom 3.5% died or needed organ support by 30 days. Telephone triage can therefore reduce the burden of EMS responses but with the cost of a small proportion of patients who do not receive an initial emergency response deteriorating. Research is needed to identify the appropriate balance between over- and under-triage
SARS-COV-2 δ variant drives the pandemic in India and Europe via two subvariants
Authors: Yang Xiang-Jiao
Published: October 2021

SARS-COV-2 evolution generates different variants and drives the pandemic. As the current main driver, δ variant bears little resemblance to the other three variants of concern, raising the question what features future variants of concern may possess. To address this important question, I compared different variant genomes and specifically analyzed δ genomes in the GISAID database for potential clues. The analysis revealed that δ genomes identified in India by April 2021 form four different groups (referred to as δ1, δ2, δ3 and δ4) with signature spike, nucleocapsid and NSP3 substitutions defining each group. Since May 2021, δ1 has gradually overtaken all other subvariants and become the dominant pandemic driver, whereas δ2 has played a less prominent role and the remaining two (δ3 and δ4) are insignificant. This group composition and variant transition are also apparent across Europe. In the United Kingdom, δ1 has quickly become predominant and is the sole pandemic driver underlying the current wave of COVID-19 cases. Alarmingly, δ1 subvariant has evolved further in the country and yielded a sublineage encoding spike V36F, A222V and V1264L. These substitutions may make the sublineage more virulent than δ1 itself. In the rest of Europe, δ1 is also the main pandemic driver, but δ2 still plays a role. In many European countries, there is a δ1 sublineage encoding spike T29A, T250I and Q613H. This sublineage originated from Morocco and has been a key pandemic driver there. Therefore, δ variant drives the pandemic in India and across Europe mainly through δ1 and δ2, with the former acquiring additional substitutions and yielding sublineages with the potential to drive the pandemic further. These results suggest a continuously branching model by which δ variant evolves and generates more virulent subvariants.
Survey of Direct and Indirect Effects of COVID-19 on Eyes and the Common Ocular Manifestations
Authors: Rabi Dianeh , Rabi Razan , Jarrar Arkan , Mharma Sarah , Jaradat Aya , Bzoor Shatha
Published: October 2021

Purpose

Ocular manifestations were reported in many recent observations that studied either the effect of COVID-19 directly on eyes or of face mask use. Hence, this study aimed to investigate the effect of COVID-19 on the eyes and make a clear comparison of its direct and indirect effect from face mask-wearing.

Methods

This was a cross-sectional study of both written and web-based questionnaires, distributed among a group of COVID-19 patients and a matched control group, the questionnaire consisted of common demographic data, COVID-19 infection history and its symptoms, focusing on ocular symptoms and the presence of conditions related to or cause eye symptoms. As well as the use of face masks that were assessed in terms of the complained ocular manifestation

Results

Of 618 participants, 252 had COVID-19 and 366 never had COVID-19. Ocular manifestation among COVID-19 incidence was 44%, significantly higher than non-infected participants’ incidence (35.8%), adjusted odds ratio, 95% confidence interval (AOR, 95%CI); 1.45 (1.02-2.06)). Eye discharges (p-value = 0.033) and photosensitivity (p-value = 0.003) were noted more commonly among COVID-19 participants compared to healthy control. When comparing long periods of face mask use with each ocular symptom; dry eye based on OSDI, forging body sensation, eye pain and eye discharges, were found significantly common among extended periods of face mask use.

Conclusion

COVID-19 pandemic affected eyes, both directly from the virus or from its preventive measure of face mask use.
Slower Learning Rates from Negative Outcomes in Substance Use Disorder over a 1-Year Period and their Potential Predictive Utility
Authors: Smith Ryan , Taylor Samuel , Stewart Jennifer L. , Guinjoan Salvador M. , Ironside Maria , Kirlic Namik , Ekhtiari Hamed , White Evan J. , Zheng Haixia , Kuplicki Rayus ,   Tulsa 1000 Investigators, Paulus Martin P.
Published: October 2021

Computational modelling is a promising approach to parse dysfunctional cognitive processes in substance use disorders (SUDs), but it is unclear how much these processes change during the recovery period. We assessed 1-year follow-up data on a sample of treatment-seeking individuals with one or more SUDs (alcohol, cannabis, sedatives, stimulants, hallucinogens, and/or opioids; N = 83) that were previously assessed at baseline within a prior computational modelling study. Relative to healthy controls (HCs; N = 48), these participants were found at baseline to show altered learning rates and less precise action selection while completing an explore-exploit decision-making task. Here we replicate these analyses when these individuals returned and re-performed the task 1 year later to assess the stability of these baseline differences. We also examine whether baseline modelling measures can predict symptoms at follow-up. Bayesian analyses indicate that: (a) group differences in learning rates were stable over time (posterior probability = 1); (b) intra-class correlations (ICCs) between model parameters at baseline and follow-up were significant and ranged from small to moderate (.25 ≤ ICCs ≤ .54); and (c) learning rates and/or information-seeking values at baseline were associated with substance use severity at 1-year follow-up in stimulant and opioid users (.36 ≤ rs ≤ .43, .002 ≤ ps ≤ .02). These findings suggest that learning dysfunctions are moderately stable during recovery and could correspond to trait-like vulnerability factors. In addition, computational measures at baseline had some predictive value for changes in substance use severity over time and could be clinically informative.
Mod3D: A Low-Cost, Flexible Modular System of Live-Cell Microscopy Chambers and Holders
Authors: Barba Bazan C. , Goss S. , Peng C. , Begeja N. , Suart CE. , Neuman K. , Truant Ray
Published: October 2021

Live-cell microscopy imaging typically involves the use of high-quality glass-bottom chambers that allow cell culture, gaseous buffer exchange and optical properties suitable for microscopy applications. However, commercial sources of these chambers can add significant annual costs to cell biology laboratories. Consumer products in three-dimensional printing technology, for both Filament Deposition Modeling (FDM) and Masked Stereo Lithography (MSLA), have resulted in more biomedical research labs adopting the use of these devices for prototyping and manufacturing of lab plastic-based items, but rarely consumables. Here we describe a modular, live-cell chamber with multiple design options that can be mixed per experiment. Single reusable carriers and the use of biodegradable plastics, in a hybrid of FDM and MSLA manufacturing methods, reduce plastic waste. The system is easy to adapt to bespoke designs, with concept-to-prototype in a single day, offers significant cost savings to the users over commercial sources, and no loss in dimensional quality or reliability.