bluuebunny/crossref_metadata_2025 huggingface dataset:
3. Realism
Authors: Sørensen Georg , Møller Jørgen , Jackson Robert
Published: January 2022

This chapter examines the realist tradition in international relations (IR), which is best seen as a research programme with several approaches using a common starting point. It highlights an important dichotomy in realist thought between classical realism and contemporary realism, including strategic and structural approaches. After describing the elements of realism, the chapter discusses the international thought of three outstanding classical realists of the past: Thucydides, Niccolò Machiavelli, and Thomas Hobbes. It then analyses the classical realist thought of Hans J. Morgenthau, along with strategic realism, neorealism, and neoclassical realism. Special attention is devoted to the defensive realism of Kenneth Waltz and the offensive realism of John Mearsheimer. Furthermore, the chapter looks at the recent theoretical debate among realist IR scholars concerning the relevance of the balance of power concept and it shows that realists often disagree among themselves. The chapter concludes with an overview of how the different realist theories treat international and domestic factors.
4. Liberalism
Authors: Sørensen Georg , Møller Jørgen , Jackson Robert
Published: January 2022

This chapter examines the liberal tradition in international relations (IR). It first considers the basic liberal assumptions, including a positive view of human nature and the belief that IR can be cooperative rather than conflictual. In their conceptions of international cooperation, liberal theorists emphasize different features of world politics. The chapter explores the ideas associated with four strands of liberal thought, namely: sociological liberalism, interdependence liberalism, institutional liberalism, and republican liberalism. It also discusses the debate between proponents of liberalism and neorealism, and it identifies a general distinction between weak liberal theories that are close to neorealism and strong liberal theories that challenge neorealism. Finally, it reviews the liberal view of world order and the notion that there is a ‘dark’ side of democracy.
5. International Society
Authors: Sørensen Georg , Møller Jørgen , Jackson Robert
Published: January 2022

This chapter examines the International Society tradition of international relations (IR). International Society, also known as the ‘English School’, is an approach to world politics that places emphasis on international history, ideas, structures, institutions, and values. After providing an overview of International Society’s basic assumptions and claims, the chapter considers the three traditions associated with the leading ideas of the most outstanding classical theorists of IR such as Niccolò Machiavelli and Immanuel Kant: realism, rationalism, and revolutionism. It then explores International Society’s views regarding order and justice, world society, statecraft and responsibility, and humanitarian responsibility and war; as well as how International Society scholars have used a historical approach to understand earlier international systems and the development of international society. It also discusses several major criticisms against the International Society approach to IR and concludes with an overview of the research agenda of International Society after the Cold War.
8. Post-positivist Approaches: Post-structuralism, Postcolonialism, Feminism
Authors: Sørensen Georg , Møller Jørgen , Jackson Robert
Published: January 2022

This chapter examines post-positivist approaches in international relations (IR). Post-positivism rejects any claim of an established truth valid for all. Instead, its focus is on analysing the world from a large variety of political, social, cultural, economic, ethnic, and gendered perspectives. The chapter considers three of the most important issues taken up by post-positivist approaches: post-structuralism, which is concerned with language and discourse; postcolonialism, which adopts a post-structural attitude in order to understand the situation in areas that were conquered by Europe, particularly Africa, Asia, and Latin America; and feminism, which argues that women are a disadvantaged group in the world, in both material terms and in terms of a value system which favours men over women. It also reflects on recent calls for ‘Global IR’, where voices from outside of Western research environments are heard. The chapter concludes with an overview of criticisms against post-positivist approaches and the post-positivist research programme.
11. Major Issues in IR: Climate Change, Terrorism, Religion, Power and Hegemony
Authors: Sørensen Georg , Møller Jørgen , Jackson Robert
Published: January 2022

This chapter examines four of the most important issues in international relations (IR): climate change, international terrorism, religion, and balance and hegemony in world history. It also considers the different ways in which these issues are analysed by the various theories presented in this book. The chapter begins with a discussion of what the issue is about in empirical terms, the problems raised and why they are claimed to be important, and the relative significance of the issue on the agenda of IR. It then explores the nature of the theoretical challenge that the issues present to IR and how classical and contemporary theories handle the analysis of these issues. The chapter addresses how climate change has become a first order challenge of international relations and IR theories, Samuel Huntington’s ‘clash of civilizations’ thesis, the influence of religion on politics, and how throughout history different state systems have come to equilibrate on either balance of power or hegemony.
12. The Big Question: World Order or World Chaos?
Authors: Sørensen Georg , Møller Jørgen , Jackson Robert
Published: January 2022

This final chapter addresses a really big question: are international relations heading towards order or chaos? To answer this question, it interrogates the different IR theories presented in previous chapters. An initial section provides a conceptual map, based on a review of different understandings of the concept of world order. The chapter proceeds by discussing the effect of the rise of authoritarian power such as China, new challenges in established democracies, fragile states in the Global South, and the governance provided by international institutions. The chapter ends by arguing that the glass is at the same time half-full and half-empty: the world faces new and formidable challenges and we are very far from meeting current aspirations for world order; at the same time, global relations are much more ordered than they used to be just a few generations ago—and things are far better than many pessimists claim.
8. The European Commission:
Authors: Mérand Frédéric
Published: January 2022

Focusing on the services and the cabinets, this chapter analyses the European Commission as a complex organizational, political, and social institution. Organizationally, it describes the Commission as a unique international bureaucracy which puts its French administrative tradition, consensus-based, and law-heavy internal procedures under the growing influence of an Anglo-American style of management. Politically, the chapter shows that the Commission increasingly behaves like a political executive that seeks to establish its own legitimacy vis-à-vis public opinion and member states by addressing partisan dynamics in the European Parliament. In terms of social relations, the chapter draws from the author’s ethnographic work to explore the transnational life of Commission civil servants and cabinet staffers who have made the Berlaymont their home.
10. The European Court of Auditors and the European Ombudsman:
Authors: Nǎstase Andreea , Neuhold Christine
Published: January 2022

Both the European Court of Auditors (ECA) and the European Ombudsman (EO) have been coined as European Union (EU) ‘watchdogs’. They have very different mandates: the Court audits the EU’s finances and the Ombudsman investigates complaints of maladministration by EU institutions and bodies. It might then come as a surprise that they have quite a lot in common. Their main EU institution of scrutiny is the European Commission, and they need to preserve their independence as oversight institutions. Neither has the power to impose sanctions on the institutions they investigate. Both the Court and the Ombudsman also cooperate with their national counterparts. In this chapter, we shed light on these EU ‘watchdogs’, which have thus far been under-researched. We do this by examining the key features of their institutional set-up and how they work. We also analyse how they have succeeded in interpreting their role beyond legal provisions and how they have dealt with crisis.
14. The Committee of Permanent Representatives:
Authors: Lewis Jeffrey
Published: January 2022

The Committee of Permanent Representatives (Coreper) originated as a diplomatic forum to meet regularly and prepare meetings of the Council of Ministers. It quickly and quietly evolved into a locus of continuous negotiation and de facto decision-making, gaining a reputation as ‘the place to do the deal’. This reputation is based on insulation from domestic audiences and an unrivalled ability to make deals stick across a range of issue areas and policy subjects. Most importantly, Coreper spotlights the process of integrating interests in a collective decision-making system with its own organizational culture, norms, and style of discourse. In actual operation, the Committee has much to offer institutional theorizing, as multiple ‘logics’ of action are discernible and often complexly entwined.
15. European parties:
Authors: Raunio Tapio
Published: January 2022

The party system of the European Parliament (EP) has been dominated by the two main European party families: centre-right conservatives and Christian democrats, on the one hand, and centre-left social democrats on the other, which controlled the majority of the seats until the 2019 elections. In the early 1950s, members of the European Parliament (MEPs) decided to form party-political groups, instead of national blocs, to counterbalance the dominance of national interests in the Council. Over the decades, the shape of the EP party system has become more stable, and traditional levels of group cohesion and coalition formation have not really been affected by the rise of populism and the increasing politicization of European integration. National parties remain influential within party groups, not least through their control of candidate selection. Outside of the Parliament, Europarties—parties operating at the European level—influence both the broader development of integration and the choice of the Commission president.
17. EU institutional politics:
Authors: Hodson Dermot , Puetter Uwe , Saurugger Sabine
Published: January 2022

The establishment, consolidation, and transformation of EU institutions—in short, EU institutional politics—is the subject of this book. This chapter asks how the different institutions surveyed are situated along the five dimensions of EU institutional politics: (1) intergovernmental vs supranational; (2) international vs transnational; (3) separate vs fused; (4) followers vs leaders; and (5) legitimate vs contested. We show that while tension between supranational and intergovernmental bodies remains a key dimension of EU institutional politics, the four other institutional dimensions have become more pronounced, especially as the crises facing European integration have become more salient over the past twenty years. These crises have not had a homogenous or unidirectional effect on EU institutional politics. The chapter also looks to the future of EU institutions, including institutional tensions over EU–UK relations after Brexit and the Conference on the Future of Europe.
Pathogenic SLC25A26 variants impair SAH transport activity causing mitochondrial disease
Authors: Rosenberger Florian A , Tang Jia Xin , Sergeant Kate , Moedas Marco F , Zierz Charlotte M , Moore David , Smith Conrad , Lewis David , Guha Nishan , Hopton Sila , Falkous Gavin , Lam Amanda , Pyle Angela , Poulton Joanna , Gorman Gráinne S , Taylor Robert W , Freyer Christoph , Wredenberg Anna
Published: January 2022

The SLC25A26 gene encodes a mitochondrial inner membrane carrier that transports S-adenosylmethionine (SAM) into the mitochondrial matrix in exchange for S-adenosylhomocysteine (SAH). SAM is the predominant methyl-group donor for most cellular methylation processes, of which SAH is produced as a by-product. Pathogenic, biallelic SLC25A26 variants are a recognized cause of mitochondrial disease in children, with a severe neonatal onset caused by decreased SAM transport activity. Here, we describe two, unrelated adult cases, one of whom presented with recurrent episodes of severe abdominal pain and metabolic decompensation with lactic acidosis. Both patients had exercise intolerance and mitochondrial myopathy associated with biallelic variants in SLC25A26, which led to marked respiratory chain deficiencies and mitochondrial histopathological abnormalities in skeletal muscle that are comparable to those previously described in early-onset cases. We demonstrate using both mouse and fruit fly models that impairment of SAH, rather than SAM, transport across the mitochondrial membrane is likely the cause of this milder, late-onset phenotype. Our findings associate a novel pathomechanism with a known disease-causing protein and highlight the quests of precision medicine in optimizing diagnosis, therapeutic intervention and prognosis.
Ancestry- and sex-specific effects underlying inguinal hernia susceptibility identified in a multiethnic genome-wide association study meta-analysis
Authors: Choquet Hélène , Li Weiyu , Yin Jie , Bradley Rachael , Hoffmann Thomas J , Nandakumar Priyanka ,   23 and Me Research Team, Mostaedi Rouzbeh , Tian Chao , Ahituv Nadav , Jorgenson Eric
Published: January 2022

Inguinal hernias are some of the most frequently diagnosed conditions in clinical practice and inguinal hernia repair is the most common procedure performed by general surgeons. Studies of inguinal hernias in non-European populations are lacking, though it is expected that such studies could identify novel loci. Further, the cumulative lifetime incidence of inguinal hernia is nine times greater in men than women, however, it is not clear why this difference exists. We conducted a genome-wide association meta-analysis of inguinal hernia risk across 513 120 individuals (35 774 cases and 477 346 controls) of Hispanic/Latino, African, Asian and European descent, with replication in 728 418 participants (33 491 cases and 694 927 controls) from the 23andMe, Inc dataset. We identified 63 genome-wide significant loci (P < 5 × 10−8), including 41 novel. Ancestry-specific analyses identified two loci (LYPLAL1-AS1/SLC30A10 and STXBP6-NOVA1) in African ancestry individuals. Sex-stratified analyses identified two loci (MYO1D and ZBTB7C) that are specific to women, and four (EBF2, EMX2/RAB11FIP2, VCL and FAM9A/FAM9B) that are specific to men. Functional experiments demonstrated that several of the associated regions (EFEMP1 and LYPLAL1-SLC30A10) function as enhancers and show differential activity between risk and reference alleles. Our study highlights the importance of large-scale genomic studies in ancestrally diverse populations for identifying ancestry-specific inguinal hernia susceptibility loci and provides novel biological insights into inguinal hernia etiology.
Hsa-miR223-3p circulating level is upregulated in Friedreich’s ataxia and inversely associated with HCLS1 associated protein X-1, HAX-1
Authors: Quatrana Andrea , Morini Elena , Tiano Francesca , Vancheri Chiara , Panarello Luca , Romano Silvia , Marcotulli Christian , Casali Carlo , Mariotti Caterina , Mongelli Alessia , Fichera Mario , Rufini Alessandra , Condò Ivano , Novelli Giuseppe , Testi Roberto , Amati Francesca , Malisan Florence
Published: January 2022

Frataxin (FXN) deficiency is responsible for Friedreich’s ataxia (FRDA) in which, besides the characteristic features of spinocerebellar ataxia, two thirds of patients develop hypertrophic cardiomyopathy that often progresses to heart failure and premature death. Different mechanisms might underlie FRDA pathogenesis. Among them, the role of miRNAs deserves investigations. We carried out an miRNA PCR-array analysis of plasma samples of early-, intermediate- and late-onset FRDA groups, defining a set of 30 differentially expressed miRNAs. Hsa-miR223-3p is the only miRNA shared between the three patient groups and appears upregulated in all of them. The up-regulation of hsa-miR223-3p was further validated in all enrolled patients (n = 37, Fc = +2.3; P < 0.0001). Using a receiver operating characteristic curve analysis, we quantified the predictive value of circulating hsa-miR223-3p for FRDA, obtaining an area under the ROC curve value of 0.835 (P < 0.0001) for all patients. Interestingly, we found a significant positive correlation between hsa-miR223-3p expression and cardiac parameters in typical FRDA patients (onset < 25 years). Moreover, a significant negative correlation between hsa-miR223-3p expression and HAX-1 (HCLS1-associated protein X-1) at mRNA and protein level was observed in all FRDA patients. In silico analyses suggested HAX-1 as a target gene of hsa-miR223-3p. Accordingly, we report that HAX-1 is negatively regulated by hsa-miR223-3p in cardiomyocytes (AC16) and neurons (SH-SY5Y), which are critically affected cell types in FRDA. This study describes for the first time the association between hsa-miR223-3p and HAX-1 expression in FRDA, thus supporting a potential role of this microRNA as non-invasive epigenetic biomarker for FRDA.
Relationship Between Dissociation and Antidepressant Effects of Esketamine Nasal Spray in Patients With Treatment-Resistant Depression
Authors: Chen Guang , Chen Li , Zhang Yun , Li Xiang , Lane Rosanne , Lim Pilar , Daly Ella J , Furey Maura L , Fedgchin Maggie , Popova Vanina , Singh Jaskaran B , Drevets Wayne C
Published: January 2022

Background

In this post-hoc analysis, data from 2 positive, pivotal, phase 3 trials of esketamine nasal spray (ESK) in treatment-resistant depression (TRD)—short-term study (TRANSFORM-2) and maintenance study (SUSTAIN-1)—were analyzed to evaluate the relationship between dissociation and antidepressant effects of ESK.

Methods

Analysis by responder status, correlation analysis, and mediation analysis were performed to assess the relationships between peak Clinician Administered Dissociative States Scale (CADSS) scores after first (day 1) and last (day 25) ESK dose and change in Montgomery-Åsberg Depression Rating Scale (MADRS) total scores at the first (day 2) and last assessments (day 28) in TRANSFORM-2 and peak CADSS after first maintenance ESK dose and time to relapse in SUSTAIN-1 (only for mediation analysis).

Results

In TRANSFORM-2, the percentage of responders (>50% reduction in MADRS) at day 2 and day 28 did not significantly differ between patients who did vs did not manifest significant dissociation (peak CADSS scores >4 or ≤4, respectively) following the first ESK dose. Spearman correlation coefficients between dissociation and depression improvement were nonsignificant and close to zero. CADSS scores did not significantly mediate the reduction in MADRS at day 2 or 28 in TRANSFORM-2 or the time to depression relapse in SUSTAIN-1. The mean difference in MADRS between ESK and active-control arms persisted beyond day 2 without significant change across time, although the mean peak CADSS scores significantly decreased across consecutive doses and fewer patients experienced significant dissociation after the last ESK dose compared with the first.

Conclusion

Within the dose range tested, the dissociative and antidepressant effects of ESK were not significantly correlated.

Trial registration

NCT02417064 (TRANSFORM-1); NCT02418585(TRANSFORM-2); NCT02493868 (SUSTAIN-1)
Serotonin 1A Receptor Binding of [11C]CUMI-101 in Bipolar Depression Quantified Using Positron Emission Tomography: Relationship to Psychopathology and Antidepressant Response
Authors: Lan Martin J , Zanderigo Francesca , Pantazatos Spiro P , Sublette M Elizabeth , Miller Jeffrey , Ogden R Todd , Mann J John
Published: January 2022

Background

The pathophysiology of bipolar disorder (BD) remains largely unknown despite it causing significant disability and suicide risk. Serotonin signaling may play a role in the pathophysiology, but direct evidence for this is lacking. Treatment of the depressed phase of the disorder is limited. Previous studies have indicated that positron emission tomography (PET) imaging of the serotonin 1A receptor (5HT1AR) may predict antidepressant response.

Methods

A total of 20 participants with BD in a current major depressive episode and 16 healthy volunteers had PET imaging with [11C]CUMI-101, employing a metabolite-corrected input function for quantification of binding potential to the 5HT1AR. Bipolar participants then received an open-labeled, 6-week clinical trial with a selective serotonin reuptake inhibitor (SSRI) in addition to their mood stabilizer. Clinical ratings were obtained at baseline and during SSRI treatment.

Results

Pretreatment binding potential (BPF) of [11C]CUMI-101 was associated with a number of pretreatment clinical variables within BD participants. Within the raphe nucleus, it was inversely associated with the baseline Montgomery Åsberg Rating Scale (P = .026), the Beck Depression Inventory score (P = .0023), and the Buss Durkee Hostility Index (P = .0058), a measure of lifetime aggression. A secondary analysis found [11C]CUMI-101 BPF was higher in bipolar participants compared with healthy volunteers (P = .00275). [11C]CUMI-101 BPF did not differ between SSRI responders and non-responders (P = .907) to treatment and did not predict antidepressant response (P = .580). Voxel-wise analyses confirmed the results obtained in regions of interest analyses.

Conclusions

A disturbance of serotonin system function is associated with both the diagnosis of BD and its severity of depression. Pretreatment 5HT1AR binding did not predict SSRI antidepressant outcome.

The study was listed on clinicaltrials.gov with identifier NCT02473250.
Cohomological Blowups of Graded Artinian Gorenstein Algebras along Surjective Maps
Authors: Iarrobino Anthony , Macias Marques Pedro , McDaniel Chris , Seceleanu Alexandra , Watanabe Junzo
Published: January 2022

We introduce the cohomological blowup of a graded Artinian Gorenstein algebra along a surjective map, which we term BUG (blowup Gorenstein) for short. This is intended to translate to an algebraic context the cohomology ring of a blowup of a projective manifold along a projective submanifold. We show, among other things, that a BUG is a connected sum, that it is the general fiber in a flat family of algebras, and that it preserves the strong Lefschetz property. We also show that standard graded compressed algebras are rarely BUGs, and we classify those BUGs that are complete intersections. We have included many examples throughout this manuscript.
Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review
Authors: Kelter Brian M , Wolfe Audrey E , Kazis Lewis E , Ryan Colleen M , Acton Amy , Slavin Mary D , Schneider Jeffrey C
Published: January 2022

Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social reintegration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: “trajectory curves” or “trajectory models” and “clinic” or “clinical.” Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.
Background of radio photons from primordial black holes
Authors: Mittal Shikhar , Kulkarni Girish
Published: January 2022

We compute the isotropic radiation background due to Hawking emission from primordial black holes (PBHs), and examine if this background is a viable option in explaining the excess radiowave background observed by the Absolute Radiometer for Cosmology, Astrophysics and Diffuse Emission (ARCADE2) and Long Wavelength Array (LWA1) experiments at $\lesssim 1\, {\rm GHz}$. We find that even under the extreme assumption that all of the dark matter is in the form of PBHs, the radio brightness temperature induced by Hawking evaporation of PBHs is $\mathcal {O}(10^{-46})\,$K, highly subdominant compared to the cosmic microwave background. The main reason for this is that for PBHs in the mass range ∼1012–${10^{14}}\, {\rm kg}$, which can be constrained by Hawking emission, the spectrum peaks at 107 to ${10^{5}}\, {\rm eV}$. As the Hawking spectrum is power law suppressed towards lower energies, negligible flux of $\mu \mathrm{eV}$ photons is obtained. The peak of the Hawking spectrum shifts to lower energies for higher masses, but the number density is low and so is the specific intensity. Because Hawking emission from PBHs is thus unable to explain the observed excess radio background, we also consider the alternative possibility of radio emission from gas accretion on to supermassive PBHs. These PBHs can readily produce strong radio emission that could easily explain the ARCADE2/LWA1 excess.
An INTEGRAL/SPI view of reticulum II: particle dark matter and primordial black holes limits in the MeV range
Authors: Siegert Thomas , Boehm Celine , Calore Francesca , Diehl Roland , Krause Martin G H , Serpico Pasquale D , Vincent Aaron C
Published: January 2022

Reticulum II (Ret II) is a satellite galaxy of the Milky Way (MW) and presents a prime target to investigate the nature of dark matter (DM) because of its high mass-to-light ratio. We evaluate a dedicated INTEGRAL observation campaign data set to obtain γ-ray fluxes from Ret II and compare those with expectations from DM. Ret II is not detected in the γ-ray band 25–8000 keV, and we derive a flux limit of ${\lesssim}10^{-8}\, \mathrm{erg\, cm^{-2}\, s^{-1}}$. The previously reported 511 keV line is not seen, and we find a flux limit of ${\lesssim}1.7 \times 10^{-4}\, \mathrm{ph\, cm^{-2}\, s^{-1}}$. We construct spectral models for primordial black hole (PBH) evaporation and annihilation/decay of particle DM, and subsequent annihilation of e+s produced in these processes. We exclude that the totality of DM in Ret II is made of a monochromatic distribution of PBHs of masses ${\lesssim}8 \times 10^{15}\, \mathrm{g}$. Our limits on the velocity-averaged DM annihilation cross section into e+e− are $\langle \sigma v \rangle \lesssim 5 \times 10^{-28} \left(m_{\rm DM} / \mathrm{MeV} \right)^{2.5}\, \mathrm{cm^3\, s^{-1}}$. We conclude that analysing isolated targets in the MeV γ-ray band can set strong bounds on DM properties without multi-year data sets of the entire MW, and encourage follow-up observations of Ret II and other dwarf galaxies.
Risk Factors Associated with Healthcare Utilization for Spine Pain
Authors: Higgins Diana M , Han Ling , Kerns Robert D , Driscoll Mary A , Heapy Alicia A , Skanderson Melissa , Lisi Anthony J , Mattocks Kristin M , Brandt Cynthia , Haskell Sally G
Published: January 2022

Objective

This study examined potential risk factors associated with healthcare utilization among patients with spine (i.e., neck and back) pain.

Methods

A two-stage sampling approach examined spine pain episodes of care among veterans with a yearly outpatient visit for six consecutive years. Descriptive and bivariate statistics, followed by logistic regression analyses, examined baseline characteristics of veterans with new episodes of care who either continued or discontinued spine pain care. A multivariable logistic regression model examined correlates associated with seeking continued spine pain care.

Results

Among 331,908 veterans without spine pain episodes of care during the 2-year baseline observation period, 16.5% (n = 54,852) had a new episode of care during the following 2-year observation period. Of those 54,852 veterans, 37,025 had an outpatient visit data during the final 2-year follow-up period, with 53.7% (n = 19,865) evidencing continued spine pain care. Those with continued care were more likely to be overweight or obese, non-smokers, Army veterans, have higher education, and had higher rates of diagnoses of all medical and mental health conditions examined at baseline. Among several important findings, women had 13% lower odds of continued care during the final 2-year observation period, OR 0.87 (0.81, 0.95).

Conclusions

A number of important demographics and clinical correlates were associated with increased likelihood of seeking new and continued episodes of care for spine pain; however, further examination of risk factors associated with healthcare utilization for spine pain is indicated.
Cognitive difficulties in people with systemic sclerosis: a qualitative study
Authors: Chen Yen T , Lescoat Alain , Devine Anita , Khanna Dinesh , Murphy Susan L
Published: January 2022

Objectives

This study used a qualitative approach to explore how people with SSc experience cognitive changes and how cognitive difficulties impact their functioning.

Methods

Four 90-min focus groups of adults with SSc and self-reported changes in cognition were recruited from a SSc research registry and targeted social media. A focus group guide elicited information from participants via open-ended questions. Content analysis was conducted using grounded theory methodology.

Results

There were 20 participants (mean age = 55.5 (11.4) years) comprising 16 (80%) females, 14 (70%) Caucasians, and 11 (55%) people with diffuse cutaneous SSc. Study themes included cognitive difficulties as part of daily life experience, impact of cognitive difficulties on daily life functioning, coping strategies and information seeking. Participants used different terms to describe their experience of cognitive difficulties, and most encountered deficits in short-term memory, language difficulties, decreased executive function, difficulties with concentration and focus, and slow processing speed. Participants expressed frustration with their cognitive difficulties and used coping strategies to lessen their impact. Participants were uncertain about the causes and wanted to understand factors contributing to cognitive difficulties as well as how to manage them.

Conclusion

Participants with SSc reported cognitive difficulties that had a substantial negative impact on their lives. Improved understanding of cognitive changes could subsequently facilitate development of relevant therapeutic interventions or educational programmes for symptom self-management to reduce impact of cognitive difficulties in people with SSc.
The impact of depression on mothers’ neural processing of their adolescents’ affective behavior
Authors: Barendse Marjolein E A , Allen Nicholas B , Sheeber Lisa , Pfeifer Jennifer H
Published: January 2022

Depression affects neural processing of emotional stimuli and could, therefore, impact parent–child interactions. However, the neural processes with which mothers with depression process their adolescents’ affective interpersonal signals and how this relates to mothers’ parenting behavior are poorly understood. Mothers with and without depression (N = 64 and N = 51, respectively; Mage = 40 years) from low-income families completed an interaction task with their adolescents (Mage = 12.8 years), which was coded for both individuals’ aggressive, dysphoric, positive and neutral affective behavior. While undergoing fMRI, mothers viewed video clips from this task of affective behavior from their own and an unfamiliar adolescent. Relative to non-depressed mothers, those with depression showed more aggressive and less positive affective behavior during the interaction task and more activation in the bilateral insula, superior temporal gyrus and striatum but less in the lateral prefrontal cortex while viewing aggressive and neutral affect. Findings were comparable for own and unfamiliar adolescents’ affect. Heightened limbic, striatal and sensory responses were associated with more aggressive and dysphoric parenting behavior during the interactions, while reduced lateral prefrontal activation was associated with less positive parenting behavior. These results highlight the importance of depressed mothers’ affective information processing for understanding mothers’ behavior during interactions with their adolescents.
Body-focused repetitive behaviors
Authors: Najera Deanna Bridge
Published: January 2022

Body-focused repetitive behavior (BFRB) is a significantly underrecognized phenomenon that can cause physical complications and marked mental distress. Understanding the condition and offering patients pharmacologic as well as psychotherapeutic support may effectively reduce adverse health outcomes. This article reviews BFRBs, which can present clinically in multiple settings.
The Associations of Hearing Sensitivity and Different Cognitive Functions with Perception of Speech-in-Noise
Authors: Merten Natascha , Boenniger Meta M. , Herholz Sibylle C. , Breteler Monique M.B.
Published: January 2022

Objectives:

Impaired speech-in-noise perception affects individuals’ daily lives and is a frequent symptom of age-related hearing loss, which is a common disabling condition and a health concern in aging populations. The relative impact of hearing sensitivity loss and different cognitive functions on speech-in-noise perception is not well understood. We aimed to assess to what extent hearing sensitivity and different cognitive functions were associated with sentence-in-noise performance across the adult lifespan.

Design:

This study is based on data of 2585 participants of the Rhineland Study, which is a German community-based cohort study of persons of age 30 years and older. We assessed speech-in-noise with a sentence-in-noise test (Göttinger Satztest), hearing sensitivity thresholds (air conduction pure-tone audiometry [PTA] average of 0.5, 1, 2, and 4 kHz), and the following cognitive domains: crystallized intelligence (German Mehrfachwahl-Wortschatz-Intelligenztest, MWT-B), executive functioning (Trail Making Test B, TMT), working memory (Digit Span forward, DS), and long-term memory (Verbal Learning and Memory Test delayed recall; VLMT). We examined the association between hearing sensitivity and cognitive functions with sentence-in-noise perception using a multivariable linear regression model adjusted for age, sex, and multiple potential confounders.

Results:

Better hearing sensitivity was associated with better speech-in-noise perception (0.25 signal noise ratio [SNR] dB HL decrease per 5 dB HL decrease in PTA; 95% confidence interval [CI]: 0.20 to 0.25; p < 0.001). Better cognitive performance was also associated with better speech-in-noise perception, but to a lesser extent. Crystallized intelligence (MWT-B) showed an effect size of –0.10 SNR dB HL decrease per SD (95% CI: –0.14 to –0.06; p < 0.001), executive functioning (TMT) of –0.08 SNR dB HL decrease per SD (95% CI: –0.13 to –0.03; p = 0.002), working memory (DS) of –0.04 SNR dB HL decrease per SD (95% CI: –0.08 to –0.003; p = 0.03), and long-term memory (VLMT) of –0.03 SNR dB HL decrease per SD (95% CI: –0.07 to 0.01; p = 0.12). The standardized effect of hearing sensitivity (ß = 0.34) on speech-in-noise perception was four to five times larger than the effects of crystallized intelligence (ß = –0.08) and executive functioning (ß = –0.06).

Conclusions:

Hearing sensitivity was the strongest determinant of sentence-in-noise perception in adults above the age of 30. We determined the relative effect of different cognitive functions on sentence-in-noise perception. Crystallized intelligence and executive functions showed stronger associations while working and long-term memory functions had much smaller independent effects. Our results contribute to the understanding of determinants of speech-in-noise perception in aging adults.
Is Having Hearing Loss Fundamentally Different? Multigroup Structural Equation Modeling of the Effect of Cognitive Functioning on Speech Identification
Authors: Marsja Erik , Stenbäck Victoria , Moradi Shahram , Danielsson Henrik , Rönnberg Jerker
Published: January 2022

Objectives:

Previous research suggests that there is a robust relationship between cognitive functioning and speech-in-noise performance for older adults with age-related hearing loss. For normal-hearing adults, on the other hand, the research is not entirely clear. Therefore, the current study aimed to examine the relationship between cognitive functioning, aging, and speech-in-noise, in a group of older normal-hearing persons and older persons with hearing loss who wear hearing aids.

Design:

We analyzed data from 199 older normal-hearing individuals (mean age = 61.2) and 200 older individuals with hearing loss (mean age = 60.9) using multigroup structural equation modeling. Four cognitively related tasks were used to create a cognitive functioning construct: the reading span task, a visuospatial working memory task, the semantic word-pairs task, and Raven’s progressive matrices. Speech-in-noise, on the other hand, was measured using Hagerman sentences. The Hagerman sentences were presented via an experimental hearing aid to both normal hearing and hearing-impaired groups. Furthermore, the sentences were presented with one of the two background noise conditions: the Hagerman original speech-shaped noise or four-talker babble. Each noise condition was also presented with three different hearing processing settings: linear processing, fast compression, and noise reduction.

Results:

Cognitive functioning was significantly related to speech-in-noise identification. Moreover, aging had a significant effect on both speech-in-noise and cognitive functioning. With regression weights constrained to be equal for the two groups, the final model had the best fit to the data. Importantly, the results showed that the relationship between cognitive functioning and speech-in-noise was not different for the two groups. Furthermore, the same pattern was evident for aging: the effects of aging on cognitive functioning and aging on speech-in-noise were not different between groups.

Conclusion:

Our findings revealed similar cognitive functioning and aging effects on speech-in-noise performance in older normal-hearing and aided hearing-impaired listeners. In conclusion, the findings support the Ease of Language Understanding model as cognitive processes play a critical role in speech-in-noise independent from the hearing status of elderly individuals.
Evolving perceptions regarding receiving orthopaedic care during the Coronavirus 2019 (COVID-19) pandemic: a follow-up survey
Authors: Only Arthur J. , Reams Megan , Comadoll Shea , Cunningham Brian P.
Published: January 2022

Background:

As the Coronavirus 2019 (COVID-19) pandemic evolves, it is critical to understand how patients’ feelings and perceptions have changed. The aim of this study was to understand current feelings and concerns about seeking and receiving orthopaedic care 9 mo into the global pandemic.

Methods:

Utilizing a survey developed to evaluate the attitudes and beliefs from healthcare respondents about receiving care during the COVID-19 pandemic, an updated and revised version, evaluating changes in perception of respondents 9 mo into the pandemic, was distributed to a group of panelists by email.

Results:

Out of 1200 individuals, 197 (16%) completed the survey. A majority of respondents reported high level of comfort in the immediate or near-term receiving care in an orthopaedic clinic, urgent care clinic specifically for orthopaedics, or in an emergency room. Six percent of respondents reported a delay in seeking orthopaedic care despite COVID-19 concerns that occurred between studies. Respondents reported their primary reason for delaying care was because of concerns for risk of COVID-19 exposure from other patients (83%). More than 75% of respondents stated they are “extremely” or “very” likely to get the COVID-19 vaccine when it becomes available to the public. Respondents had a generally negative outlook on pandemic efforts locally to globally.

Conclusions:

Despite dismal overall perceptions regarding the outlook of the pandemic; consumers are becoming increasingly comfortable obtaining orthopaedic care. The ability of healthcare providers and practices to adherence to safety protocols will remain essential to maintaining consumer trust and confidence.

Level of Evidence:

Level IV.
Brief Report: Rapid Clinical Recovery From Critical Coronavirus Disease 2019 With Respiratory Failure in a Pregnant Patient Treated With IV Vasoactive Intestinal Peptide
Authors: Youssef Jihad Georges , Bitar Mohammad Z. , Zahiruddin Faisal , Al-Saadi Mukhtar , Elshawwaf Mahmoud , Yau Simon , Goodarzi Ahmad , Javitt Jonathan C.
Published: January 2022

BACKGROUND:

Aviptadil, a synthetic form of human vasoactive intestinal peptide, has entered clinical trials to treat critical coronavirus disease 2019 pneumonia with respiratory failure. Vasoactive intestinal peptide protects the lung against a broad array of injuries by binding to the vasoactive intestinal peptide receptor 1 receptor of alveolar type II cells, the cells that severe acute respiratory syndrome coronavirus 2 binds to. As the role of Aviptadil in treating pregnant patients with critical coronavirus disease 2019 pneumonia is unknown, the authors report successful treatment in such a patient who is ineligible for phase 3 trials of Aviptadil.

CASE SUMMARY:

Under an open-label Food and Drug Administration-approved Expanded Access Protocol NCT04453839, a 32-year-old female patient Gravida 6 Para 4 at 27-week gestation, body mass index 42.5 kg/m2, admitted to the ICU of a quaternary care hospital with critical coronavirus disease 2019 was treated in January 2021 and followed for 4 months post-ICU admission. Standard of care included remdesivir, methylprednisolone, enoxaparin, and inhaled epoprostenol. In addition, the patient received three successive 12-hour IV infusions of Aviptadil at 50/100/150 pmol/kg/hr escalating doses, per randomized clinical trial NCT04311697. Human subjects’ protection was overseen by the Institutional Review Board of the Houston Methodist Hospital. The patient was enrolled in the treatment and was given informed consent approved by the Food and Drug Administration and the Institutional Review Board. Data on the patient was incorporated based on her consent for de-identified data to be used in research given at the time of hospital admission in a manner approved by the Institutional Review Board (PRO00025607). Baseline inflammatory markers, arterial blood gases, radiologic imaging, oxygen requirements, Pao
2/Fio
2, continuous fetal monitoring at baseline, throughout the patient’s treatment with the investigational drug, and throughout the patient’s hospital course.

CONCLUSION:

The rapid clinical improvement seen in this patient treated with IV vasoactive intestinal peptide is consistent with the theory that vasoactive intestinal peptide protects the alveolar type II cell, ameliorates cytokine storm, and improves oxygenation in acute lung injury. This specific role of vasoactive intestinal peptide in the lung may be vital to combating the lethal effects of severe acute respiratory syndrome coronavirus 2 infection. In addition, the role of vasoactive intestinal peptide in the human maternal-fetal interface suggests that vasoactive intestinal peptide is a safe treatment of severe coronavirus disease 2019 respiratory failure during pregnancy.
Describing Nonfatal Intimate Partner Strangulation Presentation and Evaluation in a Community-Based Hospital: Partnerships Between the Emergency Department and In-House Advocates
Authors: Bergin Audrey , Blumenfeld Elizabeth , Anderson Jocelyn C. , Campbell Jacquelyn C. , Patch Michelle
Published: January 2022

Objective:

To describe characteristics of strangulation, and associated medical care, documentation, and injuries of women after nonfatal intimate partner strangulation (NF-IPS) who present for care to a community-based emergency department (ED) with an associated intimate partner violence (IPV) advocacy program between 2008 and 2016.

Setting, Design, and Participants:

A retrospective review of 345 female ED patients' medical records who sought care at a community hospital ED following a physical assault including strangulation by an intimate partner was conducted. Demographics, characteristics related to reported signs and symptoms, injuries, and subsequent imaging, diagnoses, and discharge information were abstracted.

Results:

Commonly reported symptoms were neck pain (67.2%) and headache (45.8%), with fewer patients reporting more severe symptoms such as loss of consciousness (22.6%), dysphagia (25.0%), or dysphonia (26.7%). Rates of patients disclosing strangulation to the entire multidisciplinary team and dedicated neck imaging appeared to improve between 2008 and 2014. Among the 45 patients with noted head and neck findings, 2 patients were found to have an internal carotid artery dissection, 2 patients were found to have strokes, and 1 patient was found to have an intracranial hemorrhage.

Conclusions:

Survivors of NF-IPS may present to community-based hospitals, and existing imaging guidelines can support clinicians in identifying serious internal injury such as carotid artery dissection and stroke. Further research is needed to better discern symptoms previously attributed to psychological trauma from poststrangulation brain injury. This study contributes to the growing literature on NF-IPS with data specific to community-based ED visits.
STATIN USE AND THE INCIDENCE OF AGE-RELATED MACULAR DEGENERATION
Authors: Eshtiaghi Arshia , Popovic Marko M. , Sothivannan Amirthan , Muni Rajeev H. , Kertes Peter J.
Published: January 2022

Purpose:

Age-related macular degeneration (AMD) shares many of the same risk factors with atherosclerosis. There is a postulated role of lipid-lowering agents in preventing AMD. This meta-analysis investigates the possible role of statins in the prevention of AMD onset and progression.

Methods:

MEDLINE, EMBASE, Cochrane CENTRAL, and the reference lists of included studies were systematically searched from inception to September 2020. Studies were included if they measured the risk of AMD development or progression with statin use. The primary outcomes assessed were AMD incidence and progression. Secondary outcomes were the incidence of early AMD, late AMD, choroidal neovascularization, and geographic atrophy.

Results:

Twenty-one articles (1 randomized control trial and 20 observational studies) collectively reporting on 1,460,989 participants were included. The pooled risk ratios (95% confidence interval) for statin use on any, early, and late AMD incidence were 1.05 (0.85–1.29) (P = 0.44), 0.99 (0.88–1.11) (P = 0.86), and 1.15 (0.90–1.47) (P = 0.27), respectively. In patients with existing AMD, the respective risk ratios for statin use on incidence of AMD progression, choroidal neovascularization, and geographic atrophy were 1.04 (0.70–1.53) (P = 0.85), 0.99 (0.66–1.48) (P = 0.95), and 0.84 (0.58–1.22) (P = 0.36).

Conclusion:

This meta-analysis found that there was no significant difference in the incidence or progression of AMD based on statin use.