bluuebunny/crossref_metadata_2025 huggingface dataset:
P14.66 Re-operation for recurrent meningioma - are we helping patients?
Authors: Richardson G E , Mustafa M A , Gillespie C S , Keshwara S M , Taweel B A , Millward C P , Islim A I , Jenkinson M D
Published: September 2021

BACKGROUND

Meningioma is the commonest primary brain tumour. Despite surgery, meningiomas can recur. Surgery is usually the first line treatment for recurrent meningioma. The aim was to determine the risk factors associated with clinical outcomes (performance status, morbidity, mortality, recurrence) following re-operation for recurrence of intracranial meningioma.

MATERIAL AND METHODS

Retrospective cohort study (1998–2018). Eligible patients had reoperation for local recurrence of a previously operated meningioma. Collected data included baseline clinical and imaging characteristic. Primary outcome measure was performance status after each reoperation. Secondary outcome measures were medical and surgical morbidity, recurrence-free survival (RFS) and overall survival (OS).

RESULTS

Fifty-eight patients were eligible (37 female, mean age at 1st re-operation 56.1 years (SD=11.6)). Eleven patients (19.6%) had 2 re-operations and 3 patients (5.4%) had 3 re-operations. Median follow up was 128.5 months (IQR=73–194.5). Median time to 1st recurrence and 1st re-operation were 36.5 (IQR=24.3–81.0) and 43.8 months (IQR=20.3–103.4), respectively. Fifteen patients (26.8%) had worse performance status after 1st reoperation, compared to 5.4% (n=3) after the primary operation. Complication rate was 32.1% (n=18) after the primary operation compared to 48.2% (n=27) after 1st reoperation. At primary operation, there were 29 (51.8%) grade 1, 24 (42.9%) grade 2, and 1 (1.8%) grade 3 tumours. Median RFS after first re-operation was 36.5 months (95% CI 29.3–43.9). Median OS was 312 months (95 % CI 257.8–366.2). Increased number of post-operative complications were a risk factor for worsened performance status following reoperation (OR 2.2 [95% CI 1.1–4.6], P=0.029).

CONCLUSION

Re-operation is associated with a worse performance status and increased risk of complications. Re-operating meningiomas for radiological recurrence without symptoms increases patient morbidity. Shared-care management decision should be made with patients when considering operating for radiological recurrence only.
P14.85 Impact of the neuro-radiologist and neuro-surgeon in contouring with the neuro-oncologist on local relapse rates for brain metastases treated with stereotactic radiosurgery
Authors: Robinson M , Sayal K , Tunstall C , Padmanaban S , Watson R , Pretorius P , Joseph R , Jeyaretna S , Hobbs C
Published: September 2021

BACKGROUND

The audit evaluates the value of MDT, including neuro-radiologist and neuro-surgeon, review of contouring carried out by a clinical oncologist in stereotactic radiosurgery (SRS).

MATERIAL AND METHODS

A sequential audit was conducted of all patients receiving intracranial SRS at our local institution for the first 22 months of a new SRS service. Lesions were contoured first by clinical oncologist then reviewed/edited by the MDT. The initial contour was compared with final contour using Jaccard conformity and geographical miss indices. The dosimetric impact of a contouring change was assessed using plan metrics to both original and final contour. The impact of the contouring review on local relapse, overall survival and radio necrosis rate was evaluated with at least 24 months follow up (24–46 months).

RESULTS

113 patients and 142 lesions treated over 22 months were identified. Mean JCI was 0.92 (0.32–1.00) and 38% needed significant editing (JCI<0.95). Mean GMI was 0.03 (0.0–0.65) and 17% showed significant miss (GMI>0.05). Resection cavities showed more changes, with lower JCI and higher GMI (p<0.05). There was no significant improvement on JCI or GMI shown over time. Dosimetric analysis indicated a strong association of conformity metrics with PTV dose metrics; a 0.1 change in GTV conformity metric association with 6–17% change in dose to 95% of resulting PTV. Greater association was seen in resection cavity suggesting the geographical nature of a typical contouring error gives rise to greater potential change in dose. Clinical outcomes compared well with published series. Median survival was 20 months and local relapse free rate in the treated areas of 0.89 (0.8–0.94) at 40 months, and 0.9 (0.83–0.95) radio-necrosis free rate at 40 months with a median 17 months to developing radio-necrosis for those that did.

CONCLUSION

This work highlights that a MDT contour review adds significant value to SRS and the approach translates into reduced local recurrence rates at our local institution compared with previously published data. Radio-necrosis rates are below 10%. No improvement in clinical oncologist contouring over time was shown indicating a collaborative approach is needed regardless of experience of clinical oncologist. MDT input is recommended in particular in contouring of resection cavities.
P14.87 Significance of clinical and molecular-genetic factors for prognosis in 574 adult patients with primary glioblastoma
Authors: Zolotova S , Kurmukov A , Dalechina A , Belyashova A , Golanov A
Published: September 2021

BACKGROUND

Despite advances in the characterization of genomic alterations in glioblastoma patient survival remains poor. The aim of this single center retrospective study was to estimate prognostic factors affecting to survival for optimizing personalized treatment strategy in glioblastoma patients.

MATERIAL AND METHODS

574 consecutive patients with primary glioblastoma treated at the Burdenko National Medical Research Center of Neurosurgery from 2014 to 2019 were included in this study (314 male /260 female). Survival data was analyzed using Kaplan-Meier with log-rank tests to assess statistical significance. A linear regression model was built to predict overall survival.

RESULTS

Older patients (> 45 years) had the worse prognosis than patients ≤ 45 (p = 2.37 * 10^-6). Female patients had advantages in overall survival (p = 0.014). Time interval from surgery to the starting of radiotherapy longer than 4 weeks was associated with worse overall survival (p = 0.062). Patients with positive IDH1/2 and MGMT had better prognosis than patients with wild type and MGMT negative (p = 0.000841, p = 0.000138, respectively). We revealed that there were significant differences in overall survival between patients who had progression on the first (p = 0.000312), second (p = 0.001046) and third (p = 0.00223) follow-up MRI after radiotherapy. Median survival times (from the date of surgery) were 17, 20, 23 months, respectively. The feature importance in the linear regression model was patient’s age, IDH1/2 mutation, MGMT promoter methylation status, progression on the first follow-up MRI and sex.

CONCLUSION

Older patient’s age, prolonged time between surgery and RT starting, male sex, negative IDH1/2 and MGMT, progression on the first MRI were associated with poor overall survival in glioblastoma patients. Our results suggested additional clinical, radiomics and molecular-genetic data should be added to improve the overall survival prediction.

The results have been obtained under the support of the RFBR grant 18-29-01054
P14.90 Survival outcomes and prognostic factors in glioblastoma patients treated with radiotherapy plus concomitant and adjuvant temozolomide - real-world study
Authors: Sousa M J , Magalhães J , Basto R , Costa C , Pego A , Sousa G
Published: September 2021

BACKGROUND

Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumour in adults. The current standard of care for newly diagnosed GBM is maximal surgical resection, followed by radiotherapy plus concomitant and adjuvant temozolomide (TMZ). This study aimed to evaluate the survival outcomes and identify predictors of survival among these patients.

MATERIAL AND METHODS

We performed a single-centre retrospective analysis of GBM patients treated with radiotherapy plus concomitant and adjuvant TMZ from 2013 to 2020. The analyses of progression-free survival (PFS) and overall survival (OS), each one evaluated starting from initial diagnosis, were performed. Survival curves were estimated with the Kaplan- Meier method and compared using the log-rank test.

RESULTS

Fifty-eight patients were identified. The median age was 61 years (range 18- 80), 51 (88%) patients were in ECOG-PS 0–1, 6 (10%) patients had isocitrate dehydrogenase (IDH) mutation and 53 (91%) of patients had undergone debulking surgery. At a median follow-up of 21 months, median OS was 12.8 months (95% confidence interval [CI] 9.7–15.9), whereas median PFS was 9.5 months (95% CI 8.5–10.5). The 1-year survival rate was 42% and the 2-year survival rate was 10%. Grade 3 or 4 hematologic toxicity occurred in 11 (19%) patients. Twenty-five (42%) patients completed at least 6 cycles of TMZ monotherapy with statistically significant differences between this sub-group and those who weren’t able to continue TMZ monotherapy [median OS 19.3 months (95% CI 14.4–24.2) vs 10.6 months (95% CI 7.8–13.4) p<0.001]. ECOG-PS = 0 [median OS 16.7 months (95% CI 13.4–20.0, p=0.001)] and patients under 65 years of age [median OS 15.6 months (95% CI 12.3–18.9, p=0.02) were associated with significantly better median OS.

CONCLUSION

The current standard of care treatment for GBM remains poor. An important factor predictor of survival is the completion of the 6 maintenance cycles of TMZ. At baseline, ECOG PS and the patient’s age could be used to define patient prognosis.
P16.08 Inhibition of melanoma brain metastasis by targeting miR-146a
Authors: Wang J , Rigg E K , Lunavat T R , Zhou W , Feng Z , Hoang T , Bjerkvig R , Thorsen F
Published: September 2021

BACKGROUND

Melanoma has the highest propensity of any cancer to metastasize to the brain, with late-stage patients developing brain metastasis (MBM) in 40% of cases. Survival of patients with MBM is around 8 months with current therapies, illustrating the need for new treatments. MBM development is likely caused by molecular interactions between tumor cells and the brain, constituting the brain metastatic niche. miRNAs delivered by exosomes released from the primary tumor cells may play a role in niche establishment, yet the mechanisms are poorly understood. Here, the aim was to identify miRNAs released by exosomes from melanomas, which may be important in niche establishment and MBM progression.

MATERIAL AND METHODS

miRNAs in exosomes collected from human astrocytes, melanocytes, and MBM cell lines were profiled to determine differential expression. Functional in vitro validation was performed by cell growth and migration assays, cytokine arrays, qPCR and Western blots. Functional in vivo studies were performed after miR knockdown in MBM cell lines. An in silico docking study was performed to determine drugs that potentially inhibit transcription of miR-146a to impede MBM development.

RESULTS

miR-146a was the most upregulated miRNA in exosomes from MBM cells and was highly expressed in human and animal MBM samples. miR-146a mimics activated human astrocytes, shown by increased proliferation and migration, elevated expression of GFAP in vitro and in mouse brain tumor samples, and increased cytokine production. In animal studies, knockdown of miR-146 in MBM cells injected intracardially into mice reduced BM burden and increased animal survival. Based on the docking studies, deserpidine was found to be an effective inhibitor of MBM growth in vitro and in vivo.

CONCLUSION

miR-146a may play an important role in MBM development, and deserpidine is a promising candidate for clinical use.
P16.09 Regulation of chromatin accessibility in the hypoxic tumor microenvironment of glioblastoma
Authors: Dzwigonska M , Mieczkowski J , Pilanc P , Cyranowski S , Kominek A , Piwocka K , Kaminska B , Leszczynska K B
Published: September 2021

BACKGROUND

Chromatin structure is often dysregulated in cancers, including glioblastoma (GBM), the most aggressive type of primary brain tumor. GBM has the poorest prognosis with no efficient cure to date due to diffusive growth into the brain, resistance to treatments and the immunosuppressive tumor microenvironment (TME). The growth and invasiveness of GBM is supported by the heterogeneous TME including local microglia and bone-marrow-derived macrophages (collectively known as glioma-associated microglia and macrophages, GAMs). In addition, tumor hypoxia is a key factor in the progression of GBM, as it can globally and rapidly alter gene expression, induce cancer cell invasiveness, stemness and lead to therapy resistance. Hypoxia can influence the pro-tumorigenic function of GAMs by inducing the expression of cytokines and cell surface receptors. However, little is known on the hypoxia-imposed chromatin changes of GAMs and GBM cells, which can in turn impact the interaction between these cell populations. Here we analyze these changes using a single-cell method, which preserves in situ hypoxia within the TME of GBM.

MATERIAL AND METHODS

Single-cell Pi-ATAC-seq (Protein-indexed Assay of Transposase Accessible Chromatin with sequencing) method in a GL261 murine glioma model was used to simultaneously assess genome-wide chromatin accessibility and expression of intracellular protein markers in single cells, enabling accurate selection of hypoxic and non-hypoxic tumor cells and GAMs. Pi-ATAC-seq is used on paraformaldehyde-perfused tumors and therefore allows capturing unaltered hypoxia-dependent cellular states, that often become distorted during dissociation and preparation of fresh material in most common single-cell methods.

RESULTS

We optimized Pi-ATAC method in a GL261 GBM mouse model, with specific sorting of GAMs using CD11b+ immunosorting followed by separation of microglia and macrophages, based on intensity of CD45 staining. HIF-1α induction and binding of pimonidazole were used to mark hypoxic populations. Currently, we are investigating the chromatin accessibility profiles of cancer cells and GAMs within the hypoxic tumor microenvironment of GBM. Exploring open chromatin profiles in GAMs and glioma-microglia co-cultures will allow to unravel the mechanisms of chromatin accessibility modulation in the oxygen-dependent manner.

CONCLUSION

In summary, we optimized the Pi-ATAC method in a mouse GBM model to characterize the chromatin openness changes in GAMs and cancer cells in response to hypoxic stress. Further validation of these results will provide the potential to identify novel markers for GAMs/glioma interactions in hypoxic GBMs and develop novel therapeutic targets.
Long COVID and Post-infective Fatigue Syndrome: A Review
Authors: Sandler Carolina X , Wyller Vegard B B , Moss-Morris Rona , Buchwald Dedra , Crawley Esther , Hautvast Jeannine , Katz Ben Z , Knoop Hans , Little Paul , Taylor Renee , Wensaas Knut-Arne , Lloyd Andrew R
Published: September 2021

Fatigue is a dominant feature of both acute and convalescent coronavirus disease 2019 (COVID-19) (sometimes termed “long-COVID”), with up to 46% of patients reporting fatigue that lasts from weeks to months. The investigators of the international Collaborative on Fatigue Following Infection (COFFI) conducted a systematic review of post-COVID fatigue and a narrative review on fatigue after other infections, and made recommendations for clinical and research approaches to assessing fatigue after COVID-19.

In the majority of COVID-19 cohort studies, persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16–20 weeks post-symptom onset. Data from the prospective cohort studies in COFFI and others indicate that fatigue is also a prevalent outcome from many acute systemic infections, notably infectious mononucleosis, with a case rate for clinically significant Post-infective fatigue after exclusion of recognized medical and psychiatric causes, ranging from 10%–35% at 6 months.

To better characterize post-COVID fatigue, the COFFI investigators recommend the following: application of validated screening questionnaires for case detection; standardized interviews encompassing fatigue, mood, and other symptoms; and investigative approaches to identify end-organ damage and mental health conditions.
Retrospective Review on the Safety and Efficacy of Nitrofurantoin for the Treatment of Cystitis in the Veteran Population With or Without Renal Insufficiency
Authors: Welch Elwyn , Sheth Shaila , Ashong Chester N , Pham Caroline
Published: September 2021

Background

The emergence of antimicrobial resistance in uropathogens has generated interest in the use of nitrofurantoin in controversial populations, such as in males and those with renal dysfunction. The purpose of this study was to compare the efficacy and safety of nitrofurantoin for the treatment of cystitis in males and females with variable degrees of renal dysfunction.

Methods

A retrospective chart review was conducted in adult patients who received nitrofurantoin for acute cystitis in the outpatient setting. The primary outcome was clinical cure compared between males and females and across various renal function groups (creatinine clearances [CrCl] >60 mL/min, 30–60 mL/min, and <30 mL/min) following nitrofurantoin treatment. The secondary outcome was adverse events.

Results

A total of 446 patients were included, with 278 females and 168 males. The overall clinical cure rate was 86.5% (95% CI, 83.0%–89.4%; n = 386). The clinical cure rate did not vary between genders (odds ratio [OR], 0.6; 95% CI 0.35–1.04; P = .085) or between patients with a CrCl >60 mL/min compared with those with CrCl 30–60 mL/min (OR, 1.01; 95% CI, 0.40–2.44; P = 1). The 1 patient with a CrCl <30 mL/min was not included in the analysis. A history of benign prostatic hyperplasia (OR, 0.5; 95% CI, 0.26–0.99; P = .045) or cirrhosis (OR, 0.21; 95% CI, 0.06–0.82; P = .025) was associated with decreased odds of clinical cure. Adverse events occurred in 2% (n = 9) of patients.

Conclusions

There was no statistically significant difference in clinical cure with nitrofurantoin between genders or various renal functions.
Antifungal Susceptibility Testing: A Primer for Clinicians
Authors: Wiederhold Nathan P
Published: September 2021

Clinicians treating patients with fungal infections may turn to susceptibility testing to obtain information regarding the activity of different antifungals against a specific fungus that has been cultured. These results may then be used to make decisions regarding a patient’s therapy. However, for many fungal species that are capable of causing invasive infections, clinical breakpoints have not been established. Thus, interpretations of susceptible or resistant cannot be provided by clinical laboratories, and this is especially true for many molds capable of causing severe mycoses. The purpose of this review is to provide an overview of susceptibility testing for clinicians, including the methods used to perform these assays, their limitations, how clinical breakpoints are established, and how the results may be put into context in the absence of interpretive criteria. Examples of when susceptibility testing is not warranted are also provided.
One multiplicity
Authors: Clothier Pasha Ian
Published: September 2021

Against an interdisciplinary and intercultural background, this chapter discusses notions of time and sound as they apply to contemporary art projects. Concepts from science, engineering, post-structuralism, and Polynesian philosophy are referenced. A range of artworks are then reviewed in terms of how notions of interconnected systems, time, and audio might map across to creative projects. Eduardo Kac’s Genesis is an exemplar of interconnected systems; Space Time by Karl Heinz Jeron made time discrepancies audible; River Resonations is a GPS and audio project by Trudy Lane; The River Speaks by a collaborative of ten artists utilized live river data, the internet, and audio; and Ko Tātou Te Tangata (We are the people) by Kura Puke, Stuart Foster, and Te Matahiapo deployed sound-carrying laser light. Taken together, all of the creative projects make visible and audible changed concepts of time and sound that characterize awareness in the current era.
A New Materiality Post-Speaker Sound Art
Authors: Bradley Fari
Published: September 2021

How do sound artists function in a ‘post-speaker’ approach to production? Due to the market proliferation of reasonably-priced loudspeakers, rendering them portable and reduced in size on the gallery floor, a standard emerged in which soundworks were formed of prerecorded sounds played back from loudspeakers in gallery spaces. In these instances technology served as the material, shape and form of both sound sculpture and installation, the speaker representing a conveyance of ‘truth’. As a reaction, ‘post-speaker’ soundworks grew gradually as an awareness amongst artists who consciously avoided employing generic loudspeakers, or sought to hide them, perceiving them to be empty vessel conveying artifice. Since even before the loudspeaker was affordable, perhaps as a way of adapting to the loudspeaker’s expense, and later as a reaction to its ubiquity, there has been an ebb and flow towards building on the physical experience of a work, either by generating the sound in the gallery space itself or by using the loudspeaker in innovative ways. The reaction to speakers is a self-conscious continuum created by omission whereby sound sculpture and installation increasingly return to kinetic tendencies, and hand-made and found objects in immersive works that eschew or deconstruct the speaker’s homogeneity altogether.
Inhabiting the Uninhabitable: Encountering Atmospheres as Other Worlds
Authors: Grant Jane
Published: September 2021

In this chapter I discuss a series of site-specific sound art works which are designed to act on our sensory system prior to our intellect. These artworks are created from my fascination with natural phenomena and systems coupled with contemporary and historical scientific ideas and discoveries. The artworks are immersive in that the participant enters into the atmosphere and ‘other worldliness’ of the work. These phenomena include the firing patterns of artificial neurons, the multiverse and the ionosphere; the meeting place between the sun and the earth. In this chapter, I draw on Juhanni Pallasmaa’s writing on sensing and perception where evoking multimodal or cross modal cues are a strategy to create atmospheres where artworks are felt rather than thought.
The Sonic Undercommons: Sound Art in Radical Black Arts Traditions
Authors: Ouzounian Gascia
Published: September 2021

This chapter responds to Sara Ahmed’s powerful assertion that ‘to account for racism is to offer a different account of the world’ (Ahmed, 2012). Its premise is that artists of colour have been largely neglected within existing accounts of sound art, and that sound art discourses would change substantially if they accounted for the work of such artists as Terry Adkins, Charles Gaines, Jennie C. Jones, George Lewis, Mendi + Keith Obadike, Clifford Owens, Benjamin Patterson, and Adrian Piper, among many others. Focusing in particular on the sound works of African American artists, this article investigates what Lock and Murray (2009) have described as a racially biased ‘selective hearing’ in relation to emerging canons of sound art. It puts under pressure sound art histories—purported traditions, genres, aesthetic lineages, genealogies—and, equally, confronts the philosophical and intellectual paucity that has resulted from the lack of critical and scholarly attention to the work of black artists. What is missing from ‘whiteness-imbued histories’ (Lewis, 2012) of sound art? How does selective hearing limit what we know and understand about sound art, and how we come to know it?
Felt Spaces
Authors: Böhme Gernot
Published: September 2021

The chapter deals with the atmospheric space provided by music or sound art. The main point is that this is not Euclidian space, that is, the space of geometry, but felt space. Starting from the two classical concepts of space—topos (Aristotle) and spatium (Descartes)—the article introduces with the help of New Phenomenology—the concept of felt space (leiblicher Raum). Turning to music, in particular to Sound-Scapes (Murray Schafer) and sound art, Böhme shows that sound is tuning the felt space or better—producing a certain atmosphere. Atmospheres are spaces with a certain mood.
Chthonic: 72 hours below Earth day
Authors: Wilson Louise K.
Published: September 2021

This chapter takes as its starting point a durational project in which three artists and an engineer spent seventy-two hours dwelling underground, in a disused lead mine in the North Pennines (in the north of England) They took up residence in the cavernous ‘Ballroom’, spending time engaging in audio experimentation and the production of drawings, writings and video making. The text reflects on the works made (both individual and collaborative) and the perceptual, epistemological and ontological observations arising from this unique performance. One of the key aspects of the experience was the impact of this specific acoustic environment in shaping awareness of processes of listening and in generating a productive resonance with place.
The Art that is Made Out of Time
Authors: Kennedy Stephen
Published: September 2021

This chapter asks, how do rhythm, temporality, and noise work through a range of media practices from painting, writing, music, and film? Artists have long employed an array of media to create what might be referred to as ‘sound art’, when that term is expanded, as it is here, to include all work that is prefaced on a temporal flow and set against the figure of noise. What is sound art? This question seems to have been asked a lot in recent times. The intention here is not to pose it again but to offer instead some concrete reflections on what happens when other artistic practices work through sound and noise?
Parenting and Culture
Authors: Coe Kathryn , Clark Kyle J.
Published: September 2021

This chapter examines the role of culture in parenting. Although successful parenting involves the use of many skills, cultural and otherwise, rituals provide a blueprint that parents, generation after generation, can and have used to influence their children to emulate proper social behavior. Rituals are used to teach children not only what the behavioral codes are, but how to interpret and respond appropriately to social cues. These parental tactics, to the extent they remain traditional, also teach children why they should transmit the same strategies to their own offspring and thus how to perpetuate the behavior into future generations. After discussing parenting in more detail, the chapter focuses on language, which is central to teaching and learning and the foundation on which parents influence their children.
Maternal Relationships With Adolescents
Authors: Gajos Jamie M. , Beaver Kevin M.
Published: September 2021

This chapter studies a number of theoretical frameworks which seek to explain the reciprocal relationships between mothers and adolescents. In particular, it discusses two primary explanations for the onset of mother–adolescent conflict during puberty. The first explanation is informed by an evolutionary perspective and contains two different hypotheses of the relationship between familial conflict and puberty. The first hypothesis applies a general evolutionary theory framework to explain the relationship between maternal–adolescent conflict and puberty by suggesting that the onset of conflict during the pubescent years functions to increase (ancestral) offspring reproductive fitness. The second evolutionary hypothesis for the familial conflict–puberty relationship is informed by a life history theory perspective. Meanwhile, the second explanation for mother–adolescent conflict is informed by an area of research devoted to examining person-directed effects, which are commonly referred to as gene–environment correlations. The chapter then offers a number of recommendations for future research on the relationships between mothers and adolescents.
Aunts and Uncles
Authors: Tanskanen Antti O. , Danielsbacka Mirkka
Published: September 2021

This chapter studies the behavior of one specific group of extended family members, namely aunts and uncles. Aunts and uncles typically belong to the same generation as the children’s parents, but obviously the relations between aunts and uncles and their nieces and nephews are very different compared to parent–child relations. This is due to the fact that aunts and uncles are seldom the main caregivers of their nieces and nephews, and in contemporary Western societies, they rarely live in the same household as them. That said, however, noncoresiding aunts and uncles can serve as important alloparents for children and are often highly committed to the lives of their nieces and nephews, providing, for instance, social support, friendship, mentoring, and role models. The chapter then outlines key evolutionary theories of intergenerational family relations explaining the behavior of aunts and uncles. It also considers the investment of aunts and uncles in contemporary affluent societies.
Developmental Perspectives on Parenting
Authors: Hentges Rochelle F. , Martin Meredith J.
Published: September 2021

This chapter discusses two leading middle-level theories within evolutionary psychology, which attempt to explain both how and why parenting influences child development across the life span. First, it presents an overview of one of the most influential evolutionary theories in developmental psychology: John Bowlby’s attachment theory. Attachment theory revolutionized the way people understand the nature of the parent–child bond, framing the parent as not just a provider of physical needs but also as a secure base for emotional and psychological needs. These early-life bonds between the caregiver and infant are further proposed to form the basis for relationship attachments across the life span. Next, the chapter addresses how competing strategies toward resource allocation can influence individual differences in parental investment and sensitivity. According to life history theory, differences in the caregiving environment, in turn, promote the formation of distinct reproductive strategies, resulting in behavioral, social, and physiological differences across child development.
Inferences of Parental Abilities Through Facial and Bodily Features
Authors: Brown Mitch , Sacco Donald F. , Boykin Kaitlyn , Drea Kelsey , Macchione Alicia
Published: September 2021

This chapter explains that within the corpus of research showing the extent to which cues to physical attractiveness connote individuals’ specific value as a mate, findings have begun to recognize how these cues specifically apply to inferring parental abilities. Namely, this research suggests some physical features that were likely selected due to their connotations of heritable fitness may dually implicate a person as an especially effective parent. Such work additionally demonstrates the instances in which features not selected for their connotation of what we typically consider heritable fitness (i.e., adiposity) become desirable while providing additional evidence for the trade-offs in selecting short- and long-term mates. This selection of adiposity further clarified what is actually meant when researchers discuss selecting for good genes. That is, individuals could be inferring parental abilities through adiposity, thus leading individuals to select mates with higher levels for a long-term context given that connotation.
Social and Personality Perspectives on Parenting in an Evolutionary Context
Authors: Yong Jose C. , Li Norman P.
Published: September 2021

This chapter evaluates the dominant social-personality theories of parenting. It highlights the limitations inherent in the literature, particularly the lack of integration between the domains of parenting and attachment as well as the inability to make claims about the specific causes and effects of parent–child dynamics. The chapter then explains how an evolutionary life history perspective allows for a better understanding of parenting and attachment patterns and overcomes these limitations by grounding parent–child dynamics in a functional context. An evolutionary perspective stresses that different parenting styles and attachment types represent facultative responses to environmental demands, thereby facilitating adaptive responses to anticipated interpersonal interactions in the interest of individual fitness. Ultimately, parenting and attachment behaviors reflect life strategies on a fast–slow continuum that aim to maximize ancestral reproductive success in response to environmental harshness and unpredictability.
Intuitive Sensory Presentiation and Recollection
Authors: Simonett Helena
Published: September 2021

Based on ethnographic work among Indigenous people of northwestern Mexico and on Martin Heidegger’s philosophical writings on being and time, this chapter addresses the phenomenon of human-animal transformation as practiced by the Yoreme. Music and song evoke memories of other temporalities and experiences of transcendence and, thus, help skilled deer dancers to become the animal, a transformation that is perceived as real, not as symbolic. By opening themselves up to juyia annia (the enchanted world of the deer), the dancers are able to re-enactively engage with the mythological past. For Yoreme, this past is not what Robert Torrance would call an “inertial inheritance”; rather, it is constitutive of the future. For the community members present in the ceremonial fiesta, the dancer’s presentiation and remembrance of the deer world opens up a new possibility for human existence and allows them to understand themselves as a distinct people.
The Aesthetics of Proximity and the Ethics of Empathy
Authors: Kapchan Deborah
Published: September 2021

Where does affect reside in a phenomenology of perception? How should we understand ethics when bodies are close? What changes when we are distant? In this chapter, the author illustrates the “aesthetics of proximity,” degrees of spatio-temporal as well as spatio-tactile closeness between sounds and bodies, and the implications for an embodied ethics of response. Using Merleau-Ponty’s notion of the “flesh,” which he defines as an element (like water or fire), the author explores the relation of feeling and matter in close encounters, evoking Sufi sounds of worship in Morocco and France, as well as the Black Lives Matter movement during a global pandemic.
Scrape, Brush, Flick
Authors: Young Katharine
Published: September 2021

No thing makes a sound. All sounds are made by two things. They touch; they speak; they sing. We hear that most intimate connection between two entities rubbing up against each other. It is the things talking to themselves. We eavesdrop on the world. As we listen, we attune to our surroundings, sounding out what we do not see: the insides of things, things hidden behind other things, hidden things inside our own bodies. For the ear, things are no longer stuck to their physical locations: intimations of them arrive by air, running all the way around our bodies and passing right though them. These auditory communiques animate us from within even as they animate the world without. Hearing participates with the other senses in the sensuous epistemology that grants us knowledge of our world and ourselves.
Intelligence and Grand Strategy
Authors: Rovner Joshua
Published: September 2021

This chapter explores the relationship between intelligence and grand strategy. The first section discusses how intelligence informs grand strategy, and describes several factors that limit its influence. The second section introduces the concept of an intelligence posture, which describes how states build and operate their intelligence services. A state’s intelligence posture reflects its choices about how to collect information, how to prioritize what it collects, and whether to employ covert action abroad. These choices depend on the state’s broader approach to national security. Grand strategy guides key decisions about spying and sabotage, just as it provides the logical basis for the use of force. The chapter illustrates this idea by sketching intelligence postures for three grand strategies: restraint, liberal internationalism, and primacy.
Strategy on the Upward Slope
Authors: Shifrinson Joshua
Published: September 2021

When a great power rises, what strategies does it adopt and why? Despite substantial interest in these questions due to concerns surrounding the rise of China and concomitant decline of the United States, research on rising state grand strategy remains underdeveloped. Not only do analysts lack a consistent way of describing how risers’ grand strategies vary, but insight into the drivers of rising state strategy remains inchoate. Accordingly, this chapter analyzes existing research, highlights the problems rising states confront in crafting grand strategy, advances a new framework for discussing strategy, and suggests avenues for future research.
The Grand Strategies of Violent Rebel Groups
Authors: Byman Daniel
Published: September 2021

This chapter examines a range of strategic options violent nonstate actors such as terrorist groups and insurgencies have used over the years with varying degrees of success. These include trying to wear down government forces, attracting significant foreign help, winning over the local population, and intimidating a range of foes in the hope of undermining the government. In many cases, strategies focus on organizational survival, trying to endure and attract resources and recruits while making an area ungovernable or inhospitable for regime forces. The chapter weighs the requirements, strengths, and weaknesses of each approach and how the enemy government shapes the best strategy for the group. It illustrates its arguments with examples from history and a longer description of the Palestinian experience. The chapter concludes by discussing how states might disrupt violent rebel group strategies through diplomacy, political reform, better intelligence, and effective military operations.
Grand Strategy and the Challenge of Change
Authors: James William D.
Published: September 2021

Why do some states persist with grand strategies that have become excessively burdensome? Generations of great powers have become overstretched by squandering resources in areas of peripheral importance, instead of cutting their losses and focusing on core interests. This chapter explores the incentives, barriers, and enablers of grand-strategic change. It first offers a definition of grand strategy, before outlining a two-tiered framework for measuring change. The chapter then examines the structural incentives for altering a state’ grand strategy, as well as the psychological, cultural, organizational, and domestic impediments. Short of a catastrophic strategic shock, grand-strategic change is rare. It is possible, however, given the right systemic conditions, as well as the presence of change agents and a viable alternative to the status quo.
Alternatives to Grand Strategy
Authors: Dombrowski Peter
Published: September 2021

The other contributions in this volume take seriously the proposition that having a universal grand strategy is essential for a great power. This chapter considers three alternative propositions: (1) that in many cases grand strategy in a classic sense is not achievable given bureaucratic and political impediments, (2) that all great powers do not require a grand strategy, and, (3) that under some circumstances, the great power can thrive by pursuing calibrated grand strategies depending on both region and threats. The first proposition will build upon the work of scholars (Jervis 1998; Metz 1997) who have argued that the United States and other countries often “muddle through” both strategic formulation and implementation. The second considers arguments about the process of developing grand strategies, such as those advanced by Ionut Popescu (2017) who advocate focusing on “emergent strategies” as understood by scholars studying business corporations. The final proposal builds upon my own research (Reich and Dombrowski 2018) that argues that it is impossible to implement one coherent grand strategy: there are six variants and the United States has inevitably pursued many if not all of them simultaneously in the post–Cold War era. Inverting top-down formulations, the choice of any one strategy in a theater of (potential) conflict is contingent upon the nature of the threat, the actors, and the potential conflicts as interpreted by senior political and military leaders, and the bureaucratic environment in which they operate. In the end, this chapter offers both conceptual and substantive challenges to traditional understandings of grand strategy.
Making Grand Strategy in Practice
Authors: Bueger Christian , Gadinger Frank
Published: September 2021

Theories of practice are widely seen as the most innovative recent research program in international relations. They also provide important avenues to understand how grand strategy is made and why and how it has effects. Strategy is understood as the outcome of practical activities and struggles between actors. This chapter presents an overview of how practice theories have productively revisited concepts such as “strategic culture” or “security communities.” It also demonstrates how frameworks derived from field theories, actor-network theory, and narrative theories illuminate grand strategies and the processes that produce them. Theories of practice provide a major innovative point of departure for understanding strategy differently.
Safety of Dry Needling of the Pronator Teres Muscle in Cadavers: A Potential Treatment for Pronator Syndrome
Authors: Fernández-de-las-Peñas César , López-de-Celis Carlos , Rodríguez-Sanz Jacobo , Hidalgo-García César , Donelly Joseph M , Cedeño-Bermúdez Simón A , Pérez-Bellmunt Albert
Published: September 2021

Background

Entrapment of the median nerve at the pronator teres muscle can contribute to symptoms in the forearm and wrist. The pronator teres is also involved in patterns of spasticity observed in people who had suffered a stroke. Research on treatment efficacy with dry needling is scarce.

Objective

To determine if a solid filiform needle safely penetrates the pronator teres muscle during the clinical application of dry needling.

Design

A cadaveric descriptive study.

Methods

Needle insertion of the pronator teres was conducted in ten cryopreserved forearms with a 30 ×0.32 mm filiform needle. With the forearm supinated, the needle was inserted 3 cm distal to the mid-point between the biceps tendon insertion and the medial epicondyle. The needle was advanced in a cranial and medial direction to a depth clinically judged to be in the pronator teres muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles.

Results

Accurate needle penetration of the pronator teres was observed in 100% of the specimens (mean needle penetration: 16.7 ± 4.3 mm, 95% confidence interval [CI] 13.6 to 19.7 mm). No neurovascular bundles were pierced in any of the specimen’s forearms. The distances from the tip of the needle to the surrounding neurovascular bundles were 16.4 ± 3.9 mm (95% CI 13.6 to 19.2 mm) to the ulnar nerve (A), 9.0 ± 2.2 mm (95% CI 7.3 to 19.5 mm) to the median nerve (B), and 12.8 ± 4.0 mm (95% CI 10.0 to 15.7 mm) to brachial artery (C).

Conclusions

The results from this cadaveric study support the assumption that needling of the pronator teres using described anatomical landmarks can be accurately and safely conducted by an experienced clinician.
Use of disease-modifying antirheumatic drugs and the subsequent risk of herpes zoster in older adults
Authors: Qian Jiahui , Lassere Marissa Nichole , Heywood Anita Elizabeth , Liu Bette
Published: September 2021

Objectives

To examine the association between DMARD use and subsequent risk of herpes zoster in a large, heterogeneous and prospective population-based cohort.

Methods

Using data from a cohort of adults (45 and Up Study) recruited between 2006 and 2009 and linked to pharmaceutical, hospital and death data (2004–2015), the effect of DMARD use on zoster risk was analysed using Cox proportional hazards models, adjusting for sociodemographic characteristics, comorbidities and corticosteroid use.

Results

Among 254 065 eligible participants, over 1 826 311 person-years follow-up, there were 6295 new DMARD users and 17 024 incident herpes zoster events. Compared with non-users, the risk of zoster was higher in those who used biologic (b)DMARDs, either alone or in combination with conventional synthetic (cs)DMARDs than in those who only used csDMARDs (adjusted hazard ratio [aHR] 2.53 [95% CI: 2.03, 3.16]) for bDMARDs vs 1.48 [95% CI: 1.33, 1.66] for csDMARDs, P-heterogeneity < 0.001; reference: non-users). Among users of csDMARDs, compared with non-users, zoster risks were highest in those using exclusively cyclophosphamide (aHR 2.69 [95% CI: 1.89, 3.83]), more moderate in those using azathioprine (aHR 1.57 [95% CI: 1.07, 2.30]) and hydroxychloroquine (aHR 1.43 [95%CI: 1.11, 1.83]) and not elevated in users of methotrexate (aHR 1.24 [95% CI: 0.98, 1.57]), sulfasalazine (aHR 1.00 [95% CI: 0.71, 1.42]) and leflunomide (aHR 0.41 [95% CI: 0.06, 2.88]).

Conclusions

The risk of zoster was high among bDMARD and cyclophosphamide users. Also, the risk was increased in those using hydroxychloroquine alone and in combination with methotrexate but not methotrexate alone. Preventative strategies such as zoster vaccination or antiviral therapies should be considered in these populations if not contraindicated.
Clinical and Radiological Features of Intramuscular Orbital Amyloidosis: A Case Series and Literature Review
Authors: Tong Jessica Y. , Juniat Valerie , McKelvie Penelope A. , O’Donnell Brett A. , Hardy Thomas G. , McNab Alan A. , Selva Dinesh
Published: September 2021

Purpose:

Orbital amyloidosis of the extraocular muscles (EOMs) is a rare condition, and its clinicoradiological features are not well elucidated. This study describes the characteristic clinical signs, MRI features, and potential treatment options.

Methods:

Retrospective multicenter case series and literature review of EOM amyloidosis.

Results:

Five cases were identified for inclusion. Common clinical findings were diplopia, ophthalmoplegia, and proptosis. Systemic amyloidosis was more likely to present with multiple muscle involvement, but no particular pattern was observed with localized disease. On MRI, amyloid deposition was characterized as a heterogeneous intramuscular mass with T2 hypointensity and post contrast enhancement. Management is dependent on the extent of disease and functional impairment; options include surgical debulking and radiation therapy.

Conclusion:

EOM amyloidosis is uncommon. The combination of clinical and radiologic findings described in this study should lead to its clinical suspicion.