bluuebunny/crossref_metadata_2025 huggingface dataset:
Reception
Authors: Wall Cynthia
Published: January 2025

This chapter will survey the various seventeenth- and early eighteenth-century debates that influenced both the critical and the commercial reception of a variety of genres of prose. The burgeoning of new vehicles for different kinds of prose demonstrates an increasingly literate audience hungry for new kinds of reading material. New kinds of reading meant new ways of reading—as well as new criticisms of both. The shifts from manuscript to print, from reading aloud to reading alone, from the reopening of the theatres to the creation of closets, all these and more were both cause and consequence of new reading practices and prose styles. This bird’s-eye view will track the changing fashions in narrative patterns from the level of syntax and grammar to the alliances between plain prose and cultivated ambiguity. The buying, selling, sharing, reading, and writing of texts all contributed to the changing textures of English prose.
Religious Autobiography
Authors: Conti Brooke
Published: January 2025

This chapter considers the vexed history of the term ‘spiritual autobiography’ and then moves to broaden the definition of religious autobiography. Although scholars now recognize that religious autobiography is a diverse and capacious genre and that not all examples follow the norm of the nonconformist autobiography, that leaves open the question of what unites these works. This chapter contends that, in fact, all works of religious autobiography share certain rhetorical and persuasive goals. Through an analysis of works by writers such as John Bunyan, Richard Baxter, Anna Trapnel, John Lilburne, Joseph Hall, and Thomas Browne, this chapter shows that even those writing in very different modes and from across the Protestant denominational spectrum use autobiography as a tool both to discover and display the truth of their beliefs. Moreover, in an age of religious conflict, religious autobiography is often notably uncontentious, seeking to persuade by example and thus demonstrate the author’s participation in a transhistorical Christian identity.
Sidney and Gardens
Authors: Bushnell Rebecca
Published: January 2025

Through an exploration of later Elizabethan horticulture and landscape design, this chapter analyses two significant moments in Sidney’s works that evoke garden spaces or experiences. The first example is Kalander’s estate in Book 1 of the New Arcadia, which is described as ‘field, garden, and orchard’, making ‘order in confusion’, where art and nature inform each other. The second example is the encounter represented in the country-house entertainment of The Lady of May; there, in the liminal space of the grove, the drama plays out the political and social values of a place where garden and forest intersect. In both examples, the setting of cultivated land, both art and nature, influences the representation of aesthetic, social and political agency.
Authoritarianism in Sub-Saharan Africa
Authors: Cheeseman Nic , Fisher Jonathan , Mwambari David
Published: January 2025

Authoritarianism in Africa takes, and has taken, many different forms including one-party states, military rule, and personal dictatorships. This chapter highlights these variations, the different combinations of co-option and coercion they have given rise to, and how this helps to explain the stability and durability of authoritarian governance. The analysis is organized into three parts. The first explores the history and evolution of authoritarianism in Africa from prior to European colonization to the present. The second presents and assesses different schools of thought concerning why some authoritarian systems in Africa endure and others collapse. Here the focus is not only on the economic, military, and political resources authoritarian governments marshal but also on the ideas and beliefs they draw upon to legitimate themselves, and the claims to authority they make. Finally, the chapter reflects on the current trajectory of authoritarianism in Africa and the growing centrality of developmentalism and global actors beyond the West.
Authoritarian Soft Power
Authors: Bader Julia
Published: January 2025

Despite the intuitive appeal and empirical relevance of Nye’s soft power, the analytical shortcomings of this concept have become particularly salient in the context of authoritarian power wielders. This chapter proposes to conceptualize soft power as a form of influence that is perceived positively by the target. In doing so, the chapter aligns the intuition of soft power with established conceptualizations of power that emphasize audience perceptions. Applicable to democracies and autocracies alike, this approach is analytically useful and allows clarification of the relationship of soft power to related phenomena such as legitimacy and diffusion. The chapter subsequently discusses methodological issues and presents empirical insights into authoritarian soft power as well as audience responses. The conclusion identifies further gaps in the literature and proposes avenues for future research.
Stability and Change in Dutch PoliticsIntroduction to the Handbook
Authors: de Lange Sarah , Louwerse Tom , ’t Hart Paul , van Ham Carolien
Published: January 2025

This introductory chapter to The Oxford Handbook of Dutch Politics offers two ‘snapshots’ of Dutch society and its political system. The first, set in 1963, documents the heyday of the politics of accommodation (as made famous by Arend Lijphart’s classic case study of Dutch political life). The other captures the present moment, 60 years on, and suggests that although there has been great constitutional and institutional stability in the intervening decades, the significant demographic, socio-economic, and cultural changes in Dutch society that have taken place have left their mark on how the Dutch political system operates. In addition, the chapter surveys how the study of Dutch politics—conducted mainly but certainly not exclusively by political scientists—has evolved over this same period. In the final part of the chapter, the design of the Handbook is presented and explained. The chapter ends by briefly showcasing what the six constituent thematic parts offer.
Regional Politics in the Netherlands
Authors: Boogers Marcel , Peters Klaartje
Published: January 2025

Regional politics as such does not exist in the Netherlands. The national debate about the governance of regional challenges (i.e. between the provincial and the municipal level) has never resulted in the establishment of regional government. The main vehicle for regional governance is intermunicipal cooperation, embodied in intermunicipal cooperatives (IMCs) or more informal cooperation arrangements. Although no reliable figures about the total number of intermunicipal cooperatives and arrangements are available, it is clear that the phenomenon has steadily increased in recent decades. In all of these arrangements, the municipal executives are dominant in the regional decision-making process, but how decisions are made and interests are weighed has not been studied. In the IMCs, based on public law, local councils have limited powers to be informed and consulted about budgets and policy proposals, but all research shows that local councillors experience little influence and a lot of distance to politics on the regional level. This apparent lack of democratic legitimacy of intermunicipal governance has often been mentioned, but no easy solutions exist.
Political Participation at the National and Local Levels in the Netherlands
Authors: den Ridder Josje , van Ostaaijen Julien
Published: January 2025

This chapter deals with political participation in the Netherlands. We show that voting in elections is by far the most common mode of political participation. Turnout at national elections remains high, largely because citizens see politics at the national level as the most relevant to their daily lives. Research demonstrates that there is no overall decline in levels of political participation. However, inequality in who participates remains high and new modes of (online) participation bridge this gap only to a very limited extent. Although many Dutch citizens find it important that citizens can have a say in politics, not everyone wants to participate. Future research into this topic should include new forms of political participation in an increasingly digital and globalized world. It should also focus on the consequences of (non-)participation for representative democracy, policy outcomes, and citizens, and pay (more) attention to how political inequality resulting from unequal political participation can be resolved.
The Politics of the Policymaking Process in the Netherlands
Authors: ’t Hart Paul
Published: January 2025

This chapter provides a general introduction to the politics of public policymaking in the Netherlands. It maps and discusses the cross-cutting institutions and mechanisms that provide rules of the game and structure interactions in the policy process. It presents key recurrent characteristics of Dutch policymaking processes and assesses their strengths and weaknesses. Its arguments include that—although it has become progressively more difficult during the last decade—forging compromises on contentious issues across political divides and with regard for minority viewpoints has continued to be the oil that lubricates the fractured and potentially fractious arenas of Dutch policymaking. The chapter then discusses the evolution of Dutch public policy scholarship. It concludes by arguing the need for rebuilding the country’s once strong policy capacity and by suggesting two avenues for future research.
Economic Policy and Politics in the Netherlands
Authors: van Vliet Olaf , Caminada Koen , Goudswaard Kees
Published: January 2025

This chapter describes the politics of Dutch economic policy. After highlighting the main characteristics of the Dutch economy, the authors provide an overview of the evolution of economic policy since the 1980s. Whereas fiscal policies were politically and economically important in the 1970s and 1980s, structural reforms have gained more ground in economic policy since the end of the twentieth century. The authors zoom in on two such reforms, namely of the housing market and the pension system, which are exemplary for contemporary Dutch economic policy. Building on a review of literature on the politics of economic policy, they conclude the chapter by identifying a number of directions for future research. In particular, they highlight the implications of some recent phenomena in the Netherlands, such as increasing expenditure on health care, the challenges in the housing market, the ageing population, and the green transition.
The Evolving Dutch Welfare State
Authors: van Hooren Franca , Vis Barbara
Published: January 2025

This chapter sketches the development of the Dutch welfare state in the twentieth and twenty-first centuries. It shows how the Dutch welfare state went from being a laggard in comparative perspective in the early twentieth century to one of the frontrunners in the decades after the Second World War. While the welfare state subsequently kept some of its main features, there were also significant reforms characterized by the privatization of risks, the marketization of services, and the activation of benefit recipients. The chapter zooms in on the insights derived from recent scholarship on the politics of welfare reform and gendered critiques of welfare state research. These explain some of the puzzles around the timing and shape of Dutch welfare state development and reform. The chapter highlights how the importance of confessional forces in party politics contributed to a welfare state firmly built on the Christian ideal of a male breadwinner model, explores explanations for reform and retrenchment of popular social policies, and identifies a gap in terms of intersectional and postcolonial welfare state analysis. The final section points at digitalization as a key topic for future welfare state research.
Monarchical Politics in the Netherlands
Authors: Bovend’Eert Paul
Published: January 2025

Coming on the heels of a long republican history, the constitutional monarchy that came into being after the end of French occupation was originally marked by a strong position for the king in government. The first monarch, King William I (1814–1840), conducted a personal, authoritarian regime. Constitutional reforms in 1840 and especially 1848 then opened the way to a parliamentary democracy in the Netherlands. The centre of power gradually moved to the prime minister and cabinet ministers and to parliament. Yet, the position of the king in Dutch government remained relatively strong for a long time, even as the establishment of a parliamentary democracy was completed early in the twentieth century. Queen Wilhelmina (1898–1948) exercised strong influence, particularly over the government in exile during the Second World War. A modern constitutional monarchy within a system of a parliamentary democracy was vested during the reign of Queen Juliana (1948–1980), and confirmed in the 1983 constitution.
Toll/interleukin-1 receptor-only genes contribute to immune responses in maize
Authors: Zhang Qiang , Gao Derong , Tian Lei , Feussner Kirstin , Li Bin , Yang Long , Yang Qin , Zhang Yuelin , Li Xin , Feussner Ivo , Xu Fang
Published: January 2025

Proteins with Toll/interleukin-1 receptor (TIR) domains are widely distributed in both prokaryotes and eukaryotes, serving as essential components of immune signaling. Although monocots lack the major TIR nucleotide-binding leucine-rich repeat-type (TNL) immune receptors, they possess a small number of TIR-only proteins, the function of which remains largely unknown. In the monocot maize (Zea mays), there are 3 conserved TIR-only genes in the reference genome, namely ZmTIR1 to ZmTIR3. A genome-wide scan for TIR genes and comparative analysis revealed that these genes exhibit low sequence diversity and do not show copy number variation among 26 diverse inbred lines. ZmTIR1 and ZmTIR3, but not ZmTIR2, specifically trigger cell death and defense gene expression when overexpressed in Nicotiana benthamiana leaves. These responses depend on the critical glutamic acid and cysteine residues predicted to be essential for TIR-mediated NADase and 2′,3′-cAMP/cGMP synthetase activity, respectively, as well as the key TIR downstream regulator Enhanced Disease Susceptibility 1 (EDS1). Overexpression of ZmTIR3 in N. benthamiana produces signaling molecules, including 2′cADPR, 2′,3′-cAMP, and 2′,3′-cGMP, a process that requires the enzymatic glutamic acid and cysteine residues of ZmTIR3. ZmTIR expression in maize is barely detectable under normal conditions but is substantially induced by different pathogens. Importantly, the maize Zmtir3 knockout mutant exhibits enhanced susceptibility to the fungal pathogen Cochliobolus heterostrophus, highlighting the role of ZmTIR3 in maize immunity. Overall, our results unveil the function of the maize ZmTIRs. We propose that the pathogen-inducible ZmTIRs play an important role in maize immunity, likely through their enzymatic activity and via EDS1-mediated signaling.
Delusional Themes are More Varied Than Previously Assumed: A Comprehensive Systematic Review and Meta-Analysis
Authors: Pappa Elisavet , Baah Fidelia , Lynch Jessica , Shiel Lisha , Blackman Graham , Raihani Nichola , Bell Vaughan
Published: January 2025

Background and Hypothesis

Delusions are classified into themes but the range of themes reported in the literature has never been examined and the extent to which they differ in prevalence, or relate to clinical characteristics or cultural variation, remains poorly understood.

Study Design

We identified studies reporting delusional theme prevalence in adults with psychosis and completed two multivariate, multilevel, random-effects meta-analyses: one including data from structured assessment scales only and another also including data from ad hoc and clinical assessments to include themes from a wider range of countries and contexts. Sensitivity and meta-regression analyses examined the association with clinical and methodological variables. Analysis code and open data are available online. PROSPERO registration (CRD42019151889).

Study Results

A total of 155 studies from 37 countries met inclusion criteria. The meta-analysis of data from structured assessments included 110 studies and 173 920 patients. A total of 21 themes were identified from “persecutory/paranoid” (57.33%, 53.75-60.88) to “primary” (5.18%, 1.07-11.55). The meta-analysis of all data included 155 studies and 240 901 patients. Thirty-seven themes were identified, from “persecutory/paranoid” (57.39%, 54.38-60.37) to “made impulse” (4.90%, 0.87-11.26). Ad hoc theme classifications were more common in non-Western contexts. Including these did not substantially alter heterogeneity but increased interaction with cultural clusters. There was no evidence of publication bias or association with risk of bias rating.

Conclusions

We report the first comprehensive meta-analysis of delusional themes. Many commonly reported themes are not included in standard classifications. Relationship to culture was modest but more present when not relying solely on established scales.
Apple Genotypes and Soil Properties Shape the Soil Microbiome and Influence the Plant Response to Replant Disease-Affected Soil
Authors: Hauschild Kristin , Orth Nils , Giongo Adriana , Reim Stefanie , Liu Benye , Menssen Max , Beerhues Ludger , Flachowsky Henryk , Smalla Kornelia , Winkelmann Traud
Published: January 2025

Apple replant disease (ARD) is a problem in apple tree and fruit production worldwide and its etiology is not fully understood. This study aimed to evaluate the tolerance of six apple genotypes, including the susceptible rootstock 'M.26', three potentially tolerant rootstocks 'EMR.2', 'G.202' and 'G.935', and two genebank accessions Malus spectabilis MAL0130 and Malus sargentii MAL0739 in ARD soils from six sites. Using a greenhouse biotest, plants were grown for 56 days in ARD or the respective γ-irradiated soil. No genotype showed consistent lack of growth reduction in all ARD soils, indicating that no universal tolerance exists within the tested set of genotypes. Three genotypes ('M.26', MAL0130, MAL0739) were selected for analyses of ARD indicator gene expression and phytoalexin contents in roots as measures of ARD-response. Biphenyl synthase 3 expression and phytoalexin content strongly correlated with highest levels observed in roots of the susceptible rootstock 'M.26'. MAL0739 showed the lowest response, which was not consistently reflected in improved plant growth across all soils. Analysis of the bacterial and fungal communities in three root-affected ARD soils revealed soil- and genotype-specific differences. Bacterial alpha-diversity was higher in MAL0739 compared to 'M.26', while beta-diversity was mainly shaped by the soil. Significant enrichment of Nectria was observed for 'M.26' grown in one ARD soil. Phytoalexin contents and potentially plant beneficial microbial taxa correlated negatively. Our findings highlight that ARD tolerance in apple genotypes is linked to the soil microbiome and other soil properties, indicating the need for an integrated approach to manage ARD.
Outcomes of a PA/APRN grand rounds pilot
Authors: Pinyan Elizabeth C. , Tysinger Elizabeth , Zimmer Rachel , Griffin Kathleen Wetherell , Ronsheim Eileen , McKinnond Andrea , Okoye Chisom , DeTroye Alisha T.
Published: January 2025

This article describes a framework for the development, implementation, and effect of advanced practice provider (APP) grand rounds. A team of certified registered nurse anesthetists (CRNAs), NPs, and physician associates/assistants (PAs) developed and operationalized a grand rounds initiative in 2019. Since January 2020, 34 live monthly learning sessions have been held in person and virtually. Surveys using Likert-scale questions were provided postattendance to attendees to assess educational growth and opportunities for improvement in future programming. Attendees also were offered an opportunity to give open-ended feedback. Recordings of each presentation were analyzed to identify content alignment with stated academic medical center system goals. Most attendees reported increased projected medical competence, performance, and perceived projected effect on patient outcomes after attending grand rounds. Grand rounds are a novel model for increasing PA, NP, certified nurse-midwife, and CRNA engagement; enhancing evidence-based medical knowledge; and advancing stated academic medical center system goals.
Bullying Behaviors in Clinical Settings
Authors: Rutherford Dawna , Gillespie Gordon Lee , Bresler Scott , Johnson Kimberly , Smith Carolyn R.
Published: January 2025

Nursing students exposed to bullying behaviors are at risk for making medication errors. For a quasi-experimental study, 15 prelicensure nursing students at a Midwestern university were exposed to simulated bullying behaviors or common distractions while administering medications in a laboratory setting. Data were analyzed using Kruskal-Wallis tests. There was no significant difference in medication administration rubric score (H[2] = 1.489, p = .475) or time spent in room (H[2] = 1.778, p = .411) between groups. Bullying behaviors and other interruptions distracted nursing students from successfully completing the medication administration simulation.
Evaluation and Management of Congenital Cytomegalovirus Infection
Authors: Coskun Elif , Kakkar Fatima , Riley Laura E. , Ciaranello Andrea L. , Prabhu Malavika
Published: January 2025

The purpose of this review is to serve as an update on congenital cytomegalovirus (CMV) evaluation and management for obstetrician–gynecologists and to provide a framework for counseling birthing people at risk for or diagnosed with a primary CMV infection or reactivation or reinfection during pregnancy. A DNA virus, CMV is the most common congenital viral infection and the most common cause of nongenetic childhood hearing loss in the United States. The risk of congenital CMV infection from transplacental viral transfer depends on the gestational age at the time of maternal infection and whether the infection is primary or nonprimary. Although the risk of congenital CMV infection is lower with infection at earlier gestational ages, clinical sequelae are more severe with maternal infections earlier in gestation. At present, routine screening for maternal CMV infection is not recommended by U.S. guidelines. When maternal primary infection is confirmed in early pregnancy, emerging data support consideration of maternal antiviral therapy to prevent congenital CMV infection. When congenital CMV infection is confirmed, typically after an abnormal prenatal ultrasound result, there are more limited data on the utility of maternal antiviral therapy. Universal newborn screening for congenital CMV infection is not mandatory in most U.S. states at present. Newborns diagnosed with congenital CMV infection undergo an extensive evaluation to determine whether neurologic symptoms are present, which guides postnatal evaluation and management. In this review, we discuss the diagnosis and management of maternal CMV infection, the risk and diagnosis of congenital CMV infection, prevention and potential treatment of congenital CMV infection in utero, and neonatal congenital CMV infection diagnosis and management.
Surgical Approach and Variation in Long-Term Survival Following Colorectal Cancer Surgery Using Instrumental Variable Analysis
Authors: Mullens Cody Lendon , Sheskey Sarah , Norton Edward C. , Thumma Jyothi R. , Nathan Hari , Regenbogen Scott E. , Sheetz Kyle H.
Published: January 2025

Objective:

The study aimed to determine whether increased use of minimally invasive surgical approaches, compared with open, improves long-term survival after colon and rectal cancer resections.

Background:

Existing prospective and observational data comparing surgical approach for colon and rectal cancer are limited by selection bias, necessitating better approaches for causal inference to understand the relationship between surgical approach and long-term survival.

Methods:

We included colon and rectal cancer patients who underwent colon or rectal resection from the American College of Surgeons National Cancer Database between 2011 and 2018. Using an instrumental variable (IV) approach, we accounted for measured and unmeasured differences between patients undergoing colon or rectal cancer resection based on operative approach – robotic, laparoscopic, or open. The IV used in this study was rate of robotic-assisted colon and rectal cancer surgery within 81 different hospital regions based on US Census region and rurality during the 12 months before each patient’s operation. Proportional hazard modeling was used to estimate risk-adjusted mortality rates.

Results:

There were 326,406 colon and 96,979 rectal cancer patients included in this study. The risk-adjusted 5-year cumulative incidence of mortality for colon and rectal cancer was highest for patients who underwent open approaches (35.73 [95% confidence interval {CI}: 35.37–36.1] and 39.27 [95% CI: 28.44–30.13], respectively), compared with lower mortality for those undergoing laparoscopic (28.91 [95% CI: 28.55–29.27] and 22.93 [95% CI: 22.11–23.78], respectively) and robotic approaches (26.39 [95% CI: 24.51–28.42] and 19.77 [95% CI: 17.32–22.43], respectively). Growth in utilization of minimally invasive approaches outpaced improvements in long-term survival.

Conclusions:

Patients undergoing minimally invasive surgical approaches for colon and rectal cancer had improved long-term survival. However, long-term survival changes did not correlate with the large expansion of minimally invasive approaches, which suggests that growing these approaches is not a viable strategy to improve long-term patient outcomes.
Utilizing Image Processing Techniques for Wound Management and Evaluation in Clinical Practice: Establishing the Feasibility of Implementing Artificial Intelligence in Routine Wound Care
Authors: Dabas Mai , Kapp Suzanne , Gefen Amit
Published: January 2025

OBJECTIVE

To develop a generalizable and accurate method for automatically analyzing wound images captured in clinical practice and extracting key wound characteristics such as surface area measurement.

METHODS

The authors used image processing techniques to create a robust algorithm for segmenting pressure injuries from digital images captured by nurses during clinical practice. The algorithm also measured the real-world wound surface area. They used the hue-saturation-value color space to analyze red color values and to detect and segment the wound region within the entire image. To assess the accuracy of the algorithm’s wound segmentation, the authors compared the results against wound image annotations.

RESULTS

The algorithm performed impressively, achieving an intersection-over-union score of up to 0.85 and 100% intersection with the annotations. The algorithm effectively analyzed wound images obtained during clinical practice and accurately extracted the surface area of the documented pressure injuries. These results support the feasibility and applicability of this methodology.

CONCLUSIONS

Accurate determination of wound size and healing supports decision-making regarding treatment and is essential to successful outcomes. This innovative approach for visual assessment of chronic wounds highlights the potential of computerized wound analysis in clinical practice. By leveraging advanced computational techniques, healthcare providers can gain valuable insights into wound progression, enabling more accurate assessments to support their decision-making.
Adjunctive Hyperbaric Oxygen Therapy for Patients with Chronic Refractory Osteomyelitis: A Report of Treatment Outcomes and Risk Factors for Treatment Failure
Authors: Jackson J. Benjamin , Bakaes Yianni , Jacques Ben , Gauthier Chase , Mills William L. , Nguyen Kenny , Gonzalez Tyler , Cone David L.
Published: January 2025

OBJECTIVE

To evaluate the effect of hyperbaric oxygen (HBO) therapy on the outcomes of patients with chronic refractory osteomyelitis (CRO) when combined with modern antibiotics with modern delivery methods and/or surgical treatments.

METHODS

The authors conducted a retrospective review on 58 patients with CRO from a single institution who underwent HBO therapy along with standard treatment between January 2009 and December 2019. To investigate associations with binary outcomes of interest, they estimated logistic regression models. All models were adjusted for sex, smoking status, and pertinent comorbidities. Exponentiated logistic regression model coefficients were interpreted as odds ratios for each outcome of interest. Multivariable logistic regression was used to control for potential confounding variables.

RESULTS

When controlling for multiple confounding factors, patients who completed HBO treatment had 7.76 times the odds of having improvement of their CRO compared with patients who started HBO treatment but did not complete it (P = .015). Further, patients who completed HBO treatment had 7.7 times the odds of experiencing CRO improvement when controlling for CRO stage (P = .006). However, completion of HBO did not statistically significantly impact the resolution of CRO or the odds of further surgery or amputation. Patients with diabetes, peripheral vascular disease, and congestive heart failure had increased odds of having an amputation (Ps = .026, .037, and .024, respectively).

CONCLUSIONS

Patients who completed HBO treatment had increased odds of experiencing improvement of their CRO compared with patients who started HBO treatment but did not complete it. Patients with CRO who had diabetes and congestive heart failure had increased odds of undergoing an amputation.
Scleredema: An Unusual Cutaneous Manifestation of Coronavirus Infection
Authors: Hemrajani Priyanka , Sharma Mona , Gupta Piyush , Dhali Tapan Kumar , D’souza Paschal
Published: January 2025

The global pandemic caused by COVID-19 led to numerous novel cases of autoimmune and rheumatologic disorders that developed postinfection. Along these lines, these authors report an unusual case of scleredema following SARS-CoV-2 infection in an individual who lacked any known risk factors. Given the emergence of newer mutant strains of COVID-19 and steadily rising numbers of people receiving COVID-19 vaccinations, physicians should remain alert for as yet unrecognized manifestations of the disease.
Healthcare Costs of Pressure Injuries among Patients with a Spinal Cord Injury within a Dutch Rehabilitation Center
Authors: Wijker Boas J. , de Groot Sonja , Boertje Anne-Fleur , Adriaansen Jacinthe J. E. , Achterberg-Warmer Wendy J. , Wighman Amber , van Tulder Maurits W. , Janssen Thomas W. J. , van Dongen Johanna M.
Published: January 2025

OBJECTIVE

To assess the healthcare costs of pressure injuries (PIs) among patients with a spinal cord injury (SCI) in a Dutch rehabilitation center and determine if those costs were associated with patients’ age or sex.

METHODS

The direct healthcare costs of PIs were estimated using data from electronic health records of a Dutch rehabilitation center. This dataset contained demographic, clinical, and resource use information of all patients with an SCI or a PI who were treated at the rehabilitation center because of a PI between 2009 and 2022. Standard prices were used to value inpatient rehabilitation, whereas a micro-costing approach was used to value outpatient consultations and material costs. Using ordinary least squares regression analyses, the authors assessed whether the costs were associated with age and sex, after correcting for the patients’ length of PI care.

RESULTS

Between 2009 and 2022, 409 patients with an SCI were treated at the rehabilitation center for a PI. The patients’ mean total length of PI care was 883 ± 1,266 days (median, 137 days; interquartile range, 10–1,620). The mean total rehabilitation cost of PIs among these patients was €15,412 (USD $16,836) per patient with a mean total annual rehabilitation cost of €6,368 (USD $6,956) per patient. Costs were not significantly associated with age and sex.

CONCLUSIONS

The healthcare costs of PIs among patients with an SCI in a Dutch rehabilitation center represent a significant economic burden. Prevention of PIs seems warranted, not only from a clinical perspective, but also from a health economic perspective.
Neuromuscular Electrostimulation Increases Microcirculatory Flux in Mixed Etiology Leg Ulcers
Authors: Harding Keith Gordon , Blow Melissa , Ashton Faye , Bosanquet David C.
Published: January 2025

OBJECTIVE

To determine if intermittent neuromuscular electrostimulation (NMES) of the common peroneal nerve increases microvascular flow and pulsatility in and around the wound bed of patients with combined venous and arterial etiology.

METHODS

Seven consenting participants presenting with mixed etiology leg ulcers participated in this study. Microvascular flow and pulsatility was measured in the wound bed and in the skin surrounding the wound using laser speckle contrast imaging. Measurements were made at baseline and when the venous pumps of the leg were activated by 1 Hz intermittent neuromuscular stimulation of the common peroneal nerve. The nerve was stimulated transdermally at the head of the fibula.

RESULTS

When activated by NMES, wound bed flux increased by 38% (95% CI, 11%–73%; P = .023), and periwound flux increased by 19% (95% CI, 9%–32%; P = .009). Pulsatility increased in the wound bed by 214% (95% CI, 51%–985%; P = .017) and in the periwound by 122% (95% CI, 38%–299%; P = .014).

CONCLUSIONS

The results indicate that NMES is effective in augmenting microvascular flow in leg ulcers with combined venous and arterial etiology.
Managing Calciphylaxis: Insights from Real-World Cases at a Tertiary Academic Center
Authors: Kochhar Kanika , O’Dell Brennen , Torrence Garneisha , Johnson Alton , Spitler Carey , Schmidt Brian
Published: January 2025

Calciphylaxis is a rare and potentially fatal condition involving chronic, nonhealing wounds caused by microvascular calcification. There is currently no approved treatment for calciphylaxis, contributing to its devastating impacts on quality of life. In this case series, the authors highlight instances of potentially misdiagnosed calciphylaxis in a cohort of patients and emphasize the importance of accurate diagnosis through multidisciplinary management approaches.

The authors report on three patients treated at a large tertiary academic center between March 2021 and March 2023. Consent was obtained from all patients, including for the use of patient images. The first and second patients, a 75-year-old man and 62-year-old woman, respectively, both underwent an extensive course of local wound care as well as sodium thiosulfate therapy. The third patient, a 61-year-old woman, was treated with a combination of medication adjustments, lymphedema therapy, pulse lavage treatment, and cadaveric skin substitute. Tissue biopsy was also obtained in two of the three subjects to aid in the diagnosis of calciphylaxis. Unfortunately, these procedures lead to diagnostic challenges and misadventures, highlighting the risks associated with biopsy of calciphylaxis.

This case series demonstrates how correctly diagnosing calciphylaxis relies heavily on providers maintaining a high index of clinical suspicion based on patient history, presentation, and risk factors. The primary goals of treatment for calciphylaxis include appropriate wound care, management of infection and pain, and close monitoring.
Outcomes of elective total knee arthroplasty in nonagenarians and centenarians
Authors: Plantz Mark A. , Goedderz Cody , Hilow Henry , Peabody Michael , Dooley Jennings , Weissman Joshua P. , Hardt Kevin
Published: January 2025

Introduction:

Among the fastest growing age demographics are individuals in their ninth decade of life. As the population in the United States ages and life expectancy increases, more elderly individuals are pursuing elective orthopaedic procedures, including total knee arthroplasty (TKA).

Methods:

The American College of Surgeons NSQIP database was used to identify patients undergoing elective TKA between January 1st, 2007 and December 31st, 2017. Exact propensity score matching was used to match patients aged 90 years and older to patients between 65-89 years-old based on demographic factors and comorbidities. 30-day outcome measures and complications were compared between the two age groups. Binary logistic regression was used to identify risk factors for adverse events in the matched nonagenarian patients.

Results:

150,326 patients were included in the final cohort (65-89 year-olds: 149,721; 90+ year-olds: 605). 585 patients aged 65-89 years-old were then propensity matched to 585 patients aged 90+ years-old. Statistically similar rates of reoperation (P=0.207), mortality (P>0.999), and overall medical complications (P=0.055) were noted between the two groups; however, nonagenarians and centenarians were more likely to have an unplanned hospital readmission (P=0.049) and non-home discharge (P<0.001). 90+ year-olds were less likely to experience bleeding requiring transfusion (P<0.001). Hypertension, ASA class IV, and a history of bleeding disorder were independent risk factors for adverse outcomes.

Conclusion:

TKA can be a safe and viable treatment option for nonagenarians and centenarians and recommend that comorbidity profiles, rather than age, principally guide shared clinical decision making.
Multiple Model Optimal Sampling Promotes Accurate Vancomycin Area-Under-the-Curve Estimation Using a Single Sample in Critically Ill Children
Authors: Downes Kevin J. , Sharova Anna , Malone Judith , Odom John Audrey R. , Zuppa Athena F. , Neely Michael N.
Published: January 2025

Background:

Area-under-the-curve (AUC)-directed vancomycin therapy is recommended; however, AUC estimation in critically ill children is difficult owing to the need for multiple samples and lack of informative models.

Methods:

The authors prospectively enrolled critically ill children receiving intravenous (IV) vancomycin for suspected infection and evaluated the accuracy of Bayesian estimation of AUC from a single, optimally timed sample. During the dosing interval, when clinical therapeutic drug monitoring was performed, an optimally timed sample was collected, which was determined for each subject using an established population pharmacokinetic model and the multiple model optimal function of Pmetrics, a nonparametric population pharmacokinetic modeling software. The model was embedded in InsightRx NOVA (InsightRx, Inc.) for individual Bayesian estimation of AUC using the optimal sample versus all available samples (optimally timed sample + clinical samples).

Results:

Eighteen children were included. The optimal sampling time to inform Bayesian estimation of vancomycin AUC was highly variable, with trough samples being optimally informative in 32% of children. Optimal samples were collected by clinical nurses within 15 minutes of the goal time in 14 of 18 participants (78%). Compared with all samples, Bayesian AUC estimation with optimal samples had a mean bias of 0.4% (±5.9%) and mean imprecision of 4.6% (±3.6%). Bias of optimal sampling was <10% for 17 of the 18 participants (94%). When estimating AUC using only a peak sample (≤2 hours after dose) or only a trough (≤30 minutes before next dose), bias was <10% for 78% and 86% of participants, respectively.

Conclusions:

Optimal sampling supports accurate Bayesian estimation of vancomycin AUC from a single plasma sample in critically ill children.
Association of Self-Recognition of Hearing Loss With Hospitalizations in Older Adults in the United States
Authors: Bessen Sarah , Zhang Wuyang , Lin Frank R. , Garcia Morales Emmanuel E. , Reed Nicholas S.
Published: January 2025

Background:

Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes.

Objectives:

To investigate the associations between self-recognition of hearing loss and hospitalization outcomes.

Research Design and Subjects:

This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study.

Exposures and Outcomes:

The exposure, recognition of hearing loss, was constructed using participants’ self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss.

Results:

Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26–4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00–4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss.

Conclusions:

In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.
Inflammation in atherosclerosis: a Big Idea that has underperformed so far
Authors: Williams Kevin Jon
Published: January 2025

Purpose of review

For many years, inflammation has been a major concept in basic research on atherosclerosis and in the development of potential diagnostic tools and treatments. The purpose of this review is to assess the performance of this concept with an emphasis on recent clinical trials. In addition, contemporary literature may help identify new therapeutic targets, particularly in the context of the treatment of early, rather than end-stage, arterial disease.

Recent findings

Newly reported clinical trials cast doubt on the efficacy of colchicine, the sole anti-inflammatory agent currently approved for use in patients with atherosclerotic cardiovascular disease (ASCVD). New analyses also challenge the hypothesis that residual ASCVD event risk after optimal management of lipids, blood pressure, and smoking arises primarily from residual inflammatory risk. Current clinical practice to initiate interventions so late in the course of atherosclerotic arterial disease may be a better explanation. Lipid-lowering therapy in early atherosclerosis, possibly combined with novel add-on agents to specifically accelerate resolution of maladaptive inflammation, may be more fruitful than the conventional approach of testing immunosuppressive strategies in end-stage arterial disease. Also discussed is the ongoing revolution in noninvasive technologies to image the arterial wall. These technologies are changing screening, diagnosis, and treatment of atherosclerosis, including early and possibly reversable disease.

The burden of proof that the Big Idea of inflammation in atherosclerosis has clinical value remains the responsibility of its advocates. This responsibility requires convincing trial data but still seems largely unmet. Unfortunately, the focus on inflammation as the source of residual ASCVD event risk has distracted us from the need to screen and treat earlier.
Technical Note
Authors: Shinkawa Norihiro , Sonoda Ai , Kakizaki Eiji , Yukawa Nobuhiro
Published: January 2025

Wischnewsky spots are disseminated, dark lesions in gastric mucosa reflecting hemorrhage associated with fatal hypothermia, and are a phenomenon well known to forensic pathologists. We applied luminol and leucomalachite green tests to formalin-fixed gastric mucosa with Wischnewsky spots in autopsy cases of hypothermia. Both luminol and leucomalachite green tests showed positive reactions. We describe the technical significance of these tests in forensic diagnosis, in that luminol and leucomalachite green tests may be useful in forensic autopsy cases, and may also be useful for formalin-fixed organs.
Free-Breathing Respiratory Triggered High-Pitch Lung CT
Authors: Schwarz Annette , Hofmann Christian , Dickmann Jannis , Simon Arndt , Maier Andreas , Wacker Frank K. , Raatschen Hans-Jürgen , Gleitz Stephan , Schmidbauer Martina
Published: January 2025

Objective

Respiratory motion can affect image quality and thus affect the diagnostic accuracy of CT images by masking or mimicking relevant lung pathologies. CT examinations are often performed during deep inspiration and breath-hold to achieve optimal image quality. However, this can be challenging for certain patient groups, such as children, the elderly, or sedated patients. The study aimed to validate a dedicated triggering algorithm for initiating respiratory-triggered high-pitch computed tomography (RT-HPCT) scans in end inspiration and end expiration in complex and irregular respiratory patterns using an anthropomorphic dynamic chest phantom. Additionally, a patient study was conducted to compare the image quality and lung expansion between RT-HPCT and standard HPCT.

Materials and Methods

The study utilized an algorithm that processes the patient's breathing motion in real-time to determine the appropriate time to initiate a scan. This algorithm was tested on a dynamic, tissue-equivalent chest motion phantom to replicate and simulate 3-dimensional target motion using 28 breathing motion patterns taken from patient with irregular breathing. To evaluate the performance on human patients, prospective RT-HPCT was performed in 18 free-breathing patients. As a reference, unenhanced HPCT of the chest was performed in 20 patients without respiratory triggering during free-breathing. The mean CTDI was 1.73 mGy ± 0.1 mGy for HPCT and 1.68 mGy ± 0.1 mGy for RT-HPCT. For phantom tests, the deviation from the target position of the phantom inlay is known. Image quality is approximated by evaluating stationary versus moving acquisitions. For patient scans, respiratory motion artifacts and inspiration depth were analyzed using expert knowledge of lung anatomy and automated lung volume estimation. Statistical analysis was performed to compare image quality and lung volumes between conventional HPCT and RT-HPCT.

Results

In phantom scans, the average deviation from the desired excursion phase was 1.6 mm ± 4.7 mm or 15% ± 24% of the phantom movement range. In patients, the overall image quality significantly improved with respiratory triggering compared with conventional HPCT (P < 0.001). Quantitative average lung volume was 4.0 L ± 1.1 L in the RT group and 3.6 L ± 1.0 L in the control group.

Conclusions

This study demonstrated the feasibility of using a patient-adaptive respiratory triggering algorithm for high-pitch lung CT in both phantom and patients. Respiratory-triggered high-pitch CT scanning significantly reduces breathing artifacts compared with conventional nontriggered free-breathing scans.
Skull Base Metastasis of Uterine Carcinosarcoma Mimicking Primary Carcinoma of the Middle Ear
Authors: Wang Yuxiang , Cui Yan , Du Bulin , Li Xuena , Li Yaming
Published: January 2025

Uterine carcinosarcoma is a rare type of endometrial carcinoma with poor prognosis. A bone metastasis to the skull base is extremely scarce in uterine carcinosarcoma. A 54-year-old woman with uterine carcinosarcoma complained of right ear otorrhea and otalgia. 18F-FDG PET/CT presented an increased FDG uptake at the right middle ear involving the mastoid process and external acoustic meatus. Primary carcinoma of the middle ear was considered according to clinical symptoms and PET manifestation. However, the skull base metastasis from uterine carcinosarcoma was pathologically confirmed. The rare metastasis from uterine carcinosarcoma should be differentiated from primary carcinoma of the middle ear.