bluuebunny/crossref_metadata_2025 huggingface dataset:
Time, Space, and Rationality: Rethinking Political Action through the Example of Montreal's Student Spring
Authors: Boudreau Julie-Anne , Labrie Mathieu
Published: February 2020

Because of a changing relationship with time, space, and affect in a more urbanized world, political actions and social movement practices have transcended the modern, state-oriented logic of action. Following this claim, this paper questions a specifically urban way of acting politically. To answer this question, we need to begin by “looking” for politics in the kinds of places that political scientists generally overlook for political analysis. Understanding the urban logic of political action cannot come solely from an observation of political campaigns, ideologies, political organizations, or interviews with social movement leaders. Using the 2012 student strike in Montreal as our focus, we are taking a different analytical angle that focuses more closely on the personal experience of participation, the personal trajectories of the participating students and the effect of this intense mobilization. This research project uses biometric tools, spatial data and qualitative data to investigate political participation and its relation to the city space.
Asylum in Germany: The Making of the ‘Crisis’ and the Role of Civil Society
Authors: Hinger Sophie
Published: February 2020

In most German cities today, refugees are welcomed and supported by a large and growing number of individuals and collectives whose volunteer work covers almost all aspects of refugee reception. At the same time, the arrival and establishment of refugees has been met with xenophobic protest and violence in many German localities. Focusing especially on the example of a local welcome initiative, but also considering exclusionary civil-society practices, this contribution explores recent civil-society involvement in refugee reception against the legal and political context of asylum in Germany. It will be argued that measures of forced dispersal, deterrence and discomfort, in particular, have materially and discursively produced the framing of current refugee movements as a ‘crisis’ and have triggered the differing actions and reactions among local populations. The fact that the ‘refugee crisis’ has been presented not only as a threat, but also as a ‘humanitarian crisis’ that needs to be tackled by both German state actors and civil society has encouraged the wave of positive reactions. Furthermore, taking into account local negotiation processes of asylum is significant if we want to understand the recent and often contradictory civil-society responses. The paper draws on observations from an ongoing research project on local migration regimes and urban asylum, as well as on other studies dealing with refugee reception in Germany.
Returning and Deporting Irregular Migrants: Not a Solution to the ‘Refugee Crisis’
Authors: DeBono Daniela
Published: February 2020

This article questions whether the presentation of the return and deportation of irregular migrants as a solution to the so-called ‘refugee crisis’ is ethical. Legally, the return of irregular migrants may be a legitimate activity by the state, but the current pressure by the European Commission on member-states to increase the current 40 percent rate of effective returns can lead them to operate returns below minimal human rights standards in a bid to increase the rate. Detailed knowledge of the impact of returns – including deportation from and to different countries – on migrants’ welfare and human rights is scarce. Based on studies on returns from EU member-states to different countries, I make three arguments. First, due to the complexity of the return process, statistics need to be unpacked better. Second, there are key conceptual problems underpinning current EU returns policy. Third, research strongly indicates that returns can render people vulnerable. In the absence of in-depth knowledge on the effects of return on migrants, I conclude with an appeal for returns to be treated with caution and their linking to the refugee crisis to be avoided.
Circuits of Capital, Ground Rent and the Production of the Built Environment: A (New) Framework for Analysis
Authors: Beitel Karl
Published: February 2020

This paper develops prior work on Marxian theories of ground rent and property investment to outline a framework for interpreting the long-term rise in property prices observed in the neoliberal period. Orthodox economists and private developers have consistently maintained that the primary barrier to addressing affordability problems in expensive urban regions is excessive regulation. A diametrically contrasting view is developed in this paper. I argue the affordability crisis expresses the confluence and interaction of three primary factors: widening income and wealth disparities; the fictitious nature of land as a commodity, and the ability of property developers to extract surplus profits. Land is not a genuine commodity; and housing is a heterogeneous economic good whose production is targeted toward particular buyers of this good. Contra the hypothetical constructions of neoclassical economics, there is no “general supply” or “general demand” in urban housing markets. I show why increased production can lead the market toward higher overall levels of rents and prices. The primary counter-tendency to this basic dynamic is recurrent overproduction crises, with some modicum of affordability restored only through a collapse of prices once markets become severely overbuilt. Internal factors within the land market operate to limit the actual fall in prices, so that the longer-term trend in the neoliberal period shows a pronounced inflationary bias.
Livelihoods and Land Uses Produced Together: Evidence from Rural Malawi
Authors: McCusker Brent
Published: February 2020

Land use and livelihood studies rarely engage dialectical thinking to explain how change occurs in rural, peasant economies. In this paper, I employ the dialectical concepts of contradiction and sublation to investigate the ways in which livelihoods and land uses are produced together at the household scale. Using quantitative and qualitative surveys, I demonstrate the degree to which land use and livelihoods are internally related and produced together as a result of households overcoming contradictions facing them in their everyday lives. I conclude by relating these findings back to relevant theoretical concepts.
The Rural Nonfarm Sector in Flexible Capitalism: The Coir Industry in Kerala, India
Authors: Bordoloi Sudarshana
Published: February 2020

The rural nonagricultural/nonfarm sector (RNFS)—which provides employment opportunities for a vast number of people in the global peripheries–is an important arena for policies related to alternative strategies for rural development. The existing literature suggests RNFS as an alternative rural economic sector for employment generation and better wage opportunities that leads to empowerment of the rural workforce. This paper argues instead, that unlike what the present literature suggests, the development of the RNFS in countries like India is essentially the development of market relations, including capitalist market relations, in rural areas, but outside the agricultural sector. The promotion of the RNFS coincides with strategies of promoting an export oriented-flexible mode of capitalist production as part of global neoliberal structural adjustment programs. This paper is based on a study of the export oriented coir industry – an important form of rural nonfarm activity– in Kerala, India. Based on the study of the coir industry, this research adds new insights on how contemporary flexible capitalism re-creates the logic of classical capital-labor relations– through class, gender and caste differentiation– to realize its profit accumulation goals.
Towards An Ethnography of Climate Change Variability: Perceptions and Coping Mechanisms of Women and Men from Lambani Village, Limpopo Province
Authors: Goldin J. , Owen G. , Lebese A. , Botha J.J. , Koatla T. A. B. , Anderson J.J.
Published: February 2020

Attention to gender and equity has lagged behind in climate change research, programming, national policy-making and in the international negotiations. Studies on climate change and gender links with climate change have initially and by necessity been somewhat speculative in nature. While all societies are affected by climate change, the impacts also vary by location, exposure, and context specific social characteristics, identity, power relations and political economy. This draws attention to recognition of difference and sameness and the way in which common, confusing, contradictory results emerge across and within terrains. In its concern for gender-blindness, this paper specifically considers the way in which climate variability impacts on men and women in a given locale and captures the enriched narratives and voices of both rural women and men in two selected villages in Lambani, Limpopo Province, South Africa. To build women's participation in national climate change adaptation planning and to take heed of the multiple entanglements around this topic, participatory processes are required that enable diverse groups of disadvantaged women's as well as men's voices to be heard by policy-makers. We use participatory action research (PAR) to capture people's emotions and perceptions around climate change. In our context, difference is not positioned as the opposition to sameness. It is also incorporated into the self as difference within and is seen as a means of becoming. We consider climatic impacts to be moments where the human and non-human rub up against each other and where human affect becomes tangible. Here our attention to affect is twofold. Not only does it allow for a more realistic reflection of entanglements with nature but also we see affect as being more than emotion as it is a dynamic opening up to possibilities that can effectuate change.
‘The Town is Surrounded:’ From Climate Concerns to life under Wind Turbines in La Ventosa, Mexico
Authors: Dunlap Alexander
Published: February 2020

The Isthmus of Tehuantepec region of southwest Oaxaca, Mexico, known locally as the Istmo, was identified in 2003 as a prime site for wind energy development. Supported by climate change mitigation legislation, a ‘wind rush’ engulfed the Istmo. Now, La Ventosa sits surrounded by high-tension wires and wind turbines, some only 280 meters from homes. This paper argues that new valuations of wind resources based on market mechanisms and anthropogenic climate change laws are intensifying the destructive trajectory of the industrial economy. There are benefits for land owners and political authorities, and what amounts to token civil works projects for the town. But the majority of people interviewed expressed dissatisfaction towards the existence of wind parks surrounding the town. Instead of collective benefits, the wind parks brought different degrees of health concerns, enormous increases in land, rent, food, and electricity prices, as well as insecurity. The findings here demonstrate that wind energy development, encouraged by climate change mitigation policies, is intensifying pre-existing trends towards inequality and poverty in La Ventosa. Meanwhile, the destructive operations of the global industrial economy are renewed, using market-based approaches to mitigating anthropogenic climate change.
Value is Still Labour: Exploitation and the Production of Environmental Rent and Commodities for Nature Tourists in Rural Senegal
Authors: Lopez-Alonso Rocío Hiraldo
Published: February 2020

Monetary incentives such as nature-based tourism and payment for ecosystem service (PES) mechanisms have become increasingly promoted as a means for protecting the environment. Critical scholars are interpreting these developments as forms of accumulation based upon the commodification of nature, prosumption and institutional power that make labour progressively irrelevant in the production of value. Drawing on the case of two Senegalese villages and on Marx's concepts of commodity and value, this paper suggests that such perspectives are inaccurate and that they serve to silence workers’ experiences of exploitation in these contexts. The paper proposes to go beyond generalising conceptualisations of the green economy such as “accumulation by conservation” and to be specific about the ways in which production and therefore working conditions relate to capital accumulation. It distinguishes between nature-based tourism and PES mechanisms: the former a profit-driven commodity production process, the latter a means for depoliticising environmental problems associated to capitalist commodity production through the payment of an environmental or climate rent that does not generate any value. Through this perspective it shows how in rural Senegal villagers’ working day needs to be long, intense and poorly rewarded to reduce PES project costs and facilitate the extraction of surplus value by owners of nature-based tourism businesses as well as how labour hierarchies go hand in hand with relations of exploitation between workers. Capitalists, donors and local intermediaries’ ability to take advantage of workers’ labour is facilitated by the agrarian crises that capital has generated in these Senegalese villages, but it is also contested as workers rise up against exploitation. Capital's ability to survive to its own ecological contradictions therefore rests upon workers’ shoulders and not exclusively on the formation of class hegemonies.
Cuban and Danish Agriculture, The Rochdale Principles, and the Renovation of Socialism
Authors: Marshalek Frank
Published: February 2020

In 2011, the Guidelines for Economic and Social Policy of the Party and the Revolution announced Cuba's intentions to decentralize state power and economic decision-making, shift toward a mixed economy, and channel up to one-third of state workers to worker-owned cooperative enterprises and the small business sector. As socialist theory requires movement away from state-centered and toward mixed economies, I examine Danish and Cuban cooperative agricultural movements, evaluating them with respect to the Rochdale Principles of cooperative production, to identify appropriate economic production forms for democratic, participatory socialism within the context of globalization. This study argues first that, to maximize efficiency, cooperative production processes must remain entirely in the hands of cooperative federations. Second, a culture of economic democracy is reinforced by the democratic principles of cooperative work. Third, an income tax would function as a more appropriate way for the Cuban state to obtain a share of returns from agricultural cooperatives than the current production quota system, to avoid disrupting cooperative incentive structures. Fourth, cooperatives can perform well in any industry, at all levels of technological development, and should be considered a dominant model for socialism. Finally, although the Rochdale Principles are based on economic and social justice, these principles and their practical application must be continually refined through further experimentation and research.
Art and the Subject in Revolutionary Cuba
Authors: Gordon-Nesbitt Rebecca
Published: February 2020

This paper explores the ways in which alternatives to capitalist social relations have manifested themselves in the cultural field in Cuba. Its approach is consistent with Don Mitchell's insistence on a “focus on the material development of the idea (or ideology) of culture”(1995: 102), insofar as culture is considered a central part of the ideological development of the Revolution. Cuba's multifaceted conception of culture is not confined to the field in which creative endeavours are undertaken. Creative activity is understood as a process of social production, with human happiness as its end product, which implicates culture in both education and emancipation. While considering the formation of new subjectivities through culture, this paper elaborates the huge effort that was made by the revolutionary government to ensure that both culture and creativity were accessible to all. In the process, it offers a glimpse of ways in which the traditionally discrete categories of artist and audience have been redefined.
Fishing for Justice: England's Inshore Fisheries’ Social Movements and Fixed Quota Allocation
Authors: Anbleyth-Evans Jeremy W. , Williams Chris
Published: February 2020

English inshore fishers have long campaigned through the New Under 10m Fishermen's Association to have a fair share of the UK's fishing opportunities and to be involved in inshore fisheries management. They argue that their allocation of ∼2% of the UK Share of Total Allowable Catch species is unjust, with the inshore fleet contributing 78% of the workforce. Their concern, beyond quota shares, is that Local Ecological Knowledge / real time information from fishing grounds does not feature as information in the determination of the Marine Management Organisation's Fixed Quota Allocation pool. This is thought to be top down, inflexible and having limited potential for adaptive co-management.

At the same time, this entails increased distrust for the Common Fisheries Policy, often through conflated ideas about who is to blame for the allocation of national quota within the UK. Once the overall Total Allowable Catch levels have been agreed on, every December at an EU wide level, fishing opportunities are given out by the member state. Many fishers and the wider public are surprised it is the member state's responsibility to assign access between fleets. Indeed, it is the Fixed Quota Allocation system which has left only 2% of the UK share of TAC species with inshore fishers, a decision which would benefit from a public enquiry. Leasing enough UK, Fixed Quota allocation Units is a barrier to entry for young fishers, as lease costs are high and inshore fisheries are mixed. An ageing knowledge base, with few new recruits to continue practising it, means the intergenerational transmission of fisher LEK is more at risk. Alongside this, the associated cultural value created by fisheries communities is under threat as a result of the inequality in terms of access to fishing opportunities.

The newly recognised Coastal Producer Organisation could manage the 2% of the UK share of Total Allowable Catch, alongside promised ‘uplifts’ and any increases which may occur as a result of leaving the ‘relative stability’ system of EU Total Allowable Catch share. The Coastal Producer Organisation will listen to fishers and manage quota adaptively without permanently gifting fishing rights. Catchapp can be a way for members to integrate their fisher LEK to form the basis for real time updates to changes on fishing grounds. This can support determination in a scientifically robust manner improving on the previous monthly pool allocations for the seasonal mixed inshore fishery. This is an urgent requirement to improve buy in, compliance, confidence in science and foster adaptive co-management.
Science in ‘the storm’: Reflections on politics and plant sciences today
Authors: Mercer Kristin L. , Wainwright Joel D.
Published: February 2020

What constitutes science? What is the relation between scientific practice and capitalist modernity? What are the responsibilities of scientists in the face of our planetary crisis? In 2016 the Zapatistas of Chiapas organized an event to reflect upon and discuss the practice and politics of science. This paper — based on a script of a presentation at the event — takes up these questions, drawing from radical thought and philosophy of science to consider science in our present conjuncture.
Comment: India's Development Projects, or Hinduism, a Love Story
Authors: Ahmed Waquar
Published: February 2020

Martin J. Haigh's India Abroad is ill-informed and misleading in multiple ways. It presents a romanticized view of ‘Indian’ culture and, what the author calls, Hindu or Hinduism. The article represents misreading of post-colonial praxis, and in turn, post-colonial comradery. Post-colonialism, as an intellectual movement, examines the impact of colonialism on the cultures of colonizing and colonized people. Post-colonialists, sometimes drawing upon Marxian traditions, have mapped exploitative and dependent relations between the metropolitan and colonial societies (Gregory et al. 2009, Blaut 1993). Post-colonial theorists tend to be sensitive to the political implications of the ways the history and cultures of colonial societies are represented. And I bring up post-colonial theory precisely because this post-colonial call to sensitivity, that the author highlights by citing Kumar (2005) has morphed into romanticization and celebration of this category called Hindu, and in turn India, in very problematic ways. In what follows, I highlight how the author's attraction to cultural relativism obfuscates social contradictions and a history of exploitation in India.
Towards a gender sensitive vulnerability assessment for climate change: Lambani, Limpopo Province, South Africa
Authors: Goldin Jacqueline , Botha Cobus , Koatla Thabiso , Anderson Kobus , Owen Germaine , Lebese Ally
Published: February 2020

Women's limited access to resources and decision-making processes increases their vulnerability to impacts of climate change. Despite their own vulnerability, women are often responsible for caring for close relatives, extended families and friends during hazardous and traumatic events (whether its famine, floods, drought or forced displacements). Based on experience and knowledge it is believed that women are more vulnerable to the effects of climate change than men, primarily as they constitute the majority of the world's poor and are more dependent for their livelihood on natural resources that are threatened by climate change. The paper proposes a gender sensitive vulnerable assessment framework that is scaffolded by three key concepts: exposure, temporality and resource base. Because the study is grounded in the Capability Approach Framework it captures multi-dimensionality and intangible goods which are emotions such as fear, anger, shock or shame. It seeks to better understand the differentiated responses of men and women to climate variations and stress such as extreme heat, cold, droughts or floods in a specific site, Lambani, in the Limpopo Province of South Africa. The main aim is to understand different responses of men and women to climate change in order to design and populate a vulnerability assessment (VA) framework. In order to do so the Capability Approach (CA) is applied as a theoretical frame with its lens on diversity and social justice. The CA thus provides an expanded notion of human well-being that taps into the emotional life of women and men in Lambani.
Constructing resilience at three scales: The 100 Resilient Cities programme, Durban's resilience journey and water resilience in the Palmiet Catchment
Authors: Sutherland Catherine , Roberts Debra , Douwes Jo
Published: February 2020

Resilience is a ‘re-emerging concept’ which is being applied to deal with the shocks and stresses facing society and the environment as a result of both human induced and physical hazards. Resilience thinking is shaping policy and practice across the world through global programmes such as the UN Office for Disaster Risk Reduction (UNISDR)'s Making Cities Resilient Campaign; UN Habitat's City Resilience Profiling Programme; and Rockefeller Foundation's 100 Resilient Cities (100 RC). The global post-2015 sustainable development and climate change frameworks and related agreements all have resilience embedded in them. However, the concept of resilience remains contested, with resilience reflecting a continuum of approaches from those that are more deliberative, political, systemic, relational and transformational, to those that are more consultative, post-political, systems based, sectoral and instrumental. Questions of how resilience is being constructed, by whom and for whom therefore need to be explored. This paper focuses on the construction of resilience at three scales: The Rockefeller Foundation's 100 Resilient Cities (100RC) programme (global), Phase 1 of Durban's 100RC journey (city), and the Palmiet Catchment Rehabilitation Project (sub-catchment within a city). It presents the different approaches adopted by global, city-scale and local programmes to build resilience using different framings, approaches and methodologies.
Climate and Societal Interaction in Southwestern Matabeleland, Colonial Zimbabwe: The Drought of 1964–66 and its Antecedents
Authors: Musemwa Muchaparara
Published: February 2020

The drought which afflicted colonial Zimbabwe (then known as Rhodesia until 1980) during the period, 1964–1966, in general and Southwestern (SW) Matabeleland, in particular was perhaps the most debilitating calamity in the colonial era than any other drought, yet it has remained unrecognized and hidden in the opaque shadows of Zimbabwe's colonial history. Despite the occurrence of many droughts and other ecological disasters in Zimbabwe, there have not been, any historical studies dedicated to understanding these calamities, let alone studies that interrogate the ways in which climate and society have interacted to determine how they (disasters) have been historically produced. This paper responds to recent calls by scholars on drought research for more textured histories of environmental disasters that dispense with the practice of treating climate as a mono-causal explanation for disasters and present studies that highlight the intricate interaction between climate variability and society. It argues that the impact of the 1964–66 drought in SW Matabeleland can only be understood by taking a long historical view which examines the complex interaction between colonial policies and practices which violently removed Africans to areas of ‘environmental marginality’ and the effects of climate change such as rainfall variability and droughts.
Social Upgrading as Market Fantasy: The Limits of Global Value Chain Integration
Authors: Fridell Gavin , Walker Chris
Published: February 2020

Confronted with mixed evidence linking economic upgrading in global value chains to improved social outcomes, proponents have called for a new emphasis on “social upgrading” to promote better employment, gender equality, and poverty reduction. Originally focused on a central role for states, unions, and social movements, the discourse on social upgrading has shifted, emphasizing the benefits of corporate social responsibility and global markets. Drawing on political economic, critical theory, and psychoanalytic paradigms, we explore the politics of this shift and argue that social upgrading is gradually being deployed as a neoliberal market fantasy, designed not to challenge the limits of market integration, but to obscure and deny them. The strength of the social upgrading discourse emerges less from its pretense toward objective, data-driven analysis, than its effectiveness as an ideological fantasy in meeting the contradictory, non-rational desires of experts and non-experts.
No Right to Share the City: Being Homeless in Rio de Janeiro during the FIFA World Cup
Authors: Kassens-Noor Eva , Ladd Joshua
Published: February 2020

To stage a successful mega-event, hosts believe they must present their city as safe and clean. Thus, policy-makers create and enforce spatial rules to hide the homeless from public view. Spatial conflicts peak when the homeless use public places selected for mega-event staging. We analyze these space conflicts from the perspective of the homeless before and during the 2014 FIFA World Cup in Rio de Janeiro. We propose a framework of clean streets policies that are regularly used based on a spectrum of high- to low-conflict zones. Furthermore, we contribute to current knowledge suggesting there are invisible spatial barriers in no-conflict zones that violently enable new codes of behaviors for and among the homeless.
A Mixed Methods Study of K–12 Influences on College Participation for Students With Disabilities
Authors: Kutscher Elisabeth L. , Tuckwiller Elizabeth D.
Published: February 2020

This study investigated K–12 experiences individuals with disabilities perceived as influencing their transition to and participation in postsecondary education. Using a convergent transformative mixed methods research design, the study integrated findings from interviews and surveys ( n = 13) using multiple correspondence analysis. Qualitative analyses yielded eight K–12 facilitators of postsecondary education participation. Quantitative results showed participants reported access to at least one previously identified high school predictor, high levels of self-determination, and neutral identification with a disability community. Finally, integrated findings revealed that endorsement of facilitators was associated with experiencing a challenging transition to postsecondary education. Research and practice implications are discussed.
Revascularization in Ischemic Heart Failure: A Review
Authors: Lakshman H V V S S , Rao V. Dayasagar
Published: February 2020

Ischemic heart disease as a cause of heart failure is common in India, ranging from 48% to 71%. The pathoanatomic basis of LV dysfunction is not only due to infarcted myocardium, but also due to viable but dysfunctional myocardium (hibernating/stunned myocardium) and structural abnormalities (mitral regurgitation/ventricular septal defect aneurysm) consequent to obstructive coronary artery disease. Evaluation of dysfunctional but viable myocardium is a key determinant of recovery of LV function, and magnitude of recovery is proportional to the amount of dysfunctional viable myocardium which if more than 25% LV (4 segments out of 17 segments model) results in improvement in function and size (reverse remodeling). Most of the data regarding therapy come from observational, registry data showing better outcomes with coronary artery bypass graft than percutaneous coronary intervention and medical therapy. The need for more multicentric, randomized controlled trials regarding recovery of LV function by various therapies is more than ever now.
Angioplasty of Iatrogenic Circumflex Coronary Stenosis Following Mitral Valve Surgery: Two Case Reports
Authors: R. Katyayini , A.N. Patnaik , P.V.R.C. Raju , K.V.S.S. Saikiran
Published: February 2020

There are only a few case reports of iatrogenic compression of left circumflex during mitral valve surgery. We encountered 2 such incidences which were successfully managed with timely percutaneous intervention. The possible mechanisms causing this tricky complication and tips to avoid it are discussed in this report.
PET vs MRI for Myocardial Viability
Authors: Christopher Johann
Published: February 2020

Myocardial viability is an important concept that though conceptualy inituitive however has eluded any positive benefit in a randomised trial situation . The two techniques that are cutting edge and also the most accurate are the PET and CMR . In this review we will try to address the fundamentals and the pros and cons of each technique to enable clinical cardiologists to have an understanding on which technique will be the most optimum in a given clinical situation.
Exome Sequencing Identifies Glycosylation Defects As a Probable Cause of Immune Thrombotic Thrombocytopenic Purpura
Authors: Massicano Felipe , Staley Elizabeth M. , Halkidis Konstantine , Kocher Nicole K. , Williams Lance A. , Marques Marisa B. , Guillory Bryan K. , Cao Wenjing , Basu Malay K. , Zheng X. Long
Published: February 2020

Background: Immune thrombotic thrombocytopenic purpura (iTTP) is a potentially fatal syndrome, resulting primarily from autoantibodies against ADAMTS13. However, the mechanism underlying the autoantibody formation and the contribution of other genomic alterations to the pathogenesis of iTTP are largely unknown.

Methods: Whole exome sequencing (WES) and bioinformatic analyses were performed to determine the genetic variations in 40 patients with iTTP who had ADAMTS13 activity <10 IU/dL and a positive inhibitor or an elevated anti-ADAMTS13 IgG in concordance with clinical presentations of severe thrombocytopenia and microangiopathic hemolytic anemia with various degrees of organ injury. WES was also performed at the same time in fifteen age-, gender-, and ethnicity- matched individuals who did not have a history of iTTP or other hematological disorders as controls.

Results: WES identified variants or mutations in the genes involving in glycosylation, including O-linked glycosylation, to be the major pathway affected in patients with iTTP. We propose that the altered glycosylation may be responsible for the development of autoantibodies against ADAMTS13 which impair the proteolytic cleavage of von Willebrand factor, accelerate the clearance of ADAMTS13 from circulation, and result in severe thrombocytopenia platelets in patients with iTTP. We also identified defects in ankyrin repeat containing protein ANKRD36C, a protein with hitherto unknown function, as the most statistically significant genomic alterations associated with iTTP (p < 10-5). Moreover, candidate gene analysis revealed that various genes involving in hemostasis, complement activation, platelet function and signaling pathway, and inflammation were all affected in patients with iTTP, which may contribute to the onset, progress, severity, and long-term outcome of iTTP. Finally, we also identified two patient subgroups where the disease mechanism might be different.

Conclusion: Our findings provide novel insight into the pathogenic mechanism underlying ADAMTS13 autoantibody production and the potential contribution of other genetic abnormalities in modifying the iTTP clinical presentations in the individuals with severe deficiency of plasma ADAMTS13 activity.

Disclosures

Zheng: Alexion: Speakers Bureau; Ablynx/Sanofi: Consultancy, Speakers Bureau; Shire/Takeda: Research Funding; Clotsolution: Other: Co-Founder.
Eosinophils, basophils and type 2 immune microenvironments in COPD-affected lung tissue
Authors: Jogdand Prajakta , Siddhuraj Premkumar , Mori Michiko , Sanden Caroline , Jönsson Jimmie , Walls Andrew F. , Kearley Jennifer , Humbles Alison A. , Kolbeck Roland , Bjermer Leif , Newbold Paul , Erjefält Jonas S.
Published: February 2020

Although elevated blood or sputum eosinophils are present in many patients with COPD, uncertainties remain regarding the anatomical distribution pattern of lung-infiltrating eosinophils. Basophils have remained virtually unexplored in COPD. This study mapped tissue-infiltrating eosinophils, basophils and eosinophil-promoting immune mechanisms in COPD-affected lungs.

Surgical lung tissue and biopsies from major anatomical compartments were obtained from COPD patients with severity grades Global Initiative for Chronic Obstructive Lung Disease stages I–IV; never-smokers/smokers served as controls. Automated immunohistochemistry andin situhybridisation identified immune cells, the type 2 immunity marker GATA3 and eotaxins (CCL11, CCL24).

Eosinophils and basophils were present in all anatomical compartments of COPD-affected lungs and increased significantly in very severe COPD. The eosinophilia was strikingly patchy, and focal eosinophil-rich microenvironments were spatially linked with GATA3+cells, including type 2 helper T-cell lymphocytes and type 2 innate lymphoid cells. A similarly localised and interleukin-33/ST2-dependent eosinophilia was demonstrated in influenza-infected mice. Both mice and patients displayed spatially confined eotaxin signatures with CCL11+fibroblasts and CCL24+macrophages.

In addition to identifying tissue basophilia as a novel feature of advanced COPD, the identification of spatially confined eosinophil-rich type 2 microenvironments represents a novel type of heterogeneity in the immunopathology of COPD that is likely to have implications for personalised treatment.
Blood eosinophil count in the general population: typical values and potential confounders
Authors: Hartl Sylvia , Breyer Marie-Kathrin , Burghuber Otto C. , Ofenheimer Alina , Schrott Andrea , Urban Matthias H. , Agusti Alvar , Studnicka Michael , Wouters Emiel F.M. , Breyer-Kohansal Robab
Published: February 2020

There is growing interest in blood eosinophil counts in the management of chronic respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Despite this, typical blood eosinophil levels in the general population, and the impact of potential confounders on these levels have not been clearly defined.

We measured blood eosinophil counts in a random sample of 11 042 subjects recruited from the general population in Austria. We then: 1) identified factors associated with high blood eosinophil counts (>75th percentile); and 2) excluded subjects with these factors to estimate median blood eosinophil counts in a “healthy” sub-population (n=3641).

We found that: 1) in the entire cohort, age ≤18 years (OR 2.41), asthma (OR 2.05), current smoking (OR 1.72), positive skin prick test (OR 1.64), COPD (OR 1.56), metabolic syndrome (OR 1.41), male sex (OR 1.36) and obesity (OR 1.16) were significantly (p<0.05) associated with high blood eosinophil counts (binary multivariable logistic regression analysis), and had an additive effect; and 2) after excluding these factors, in those older than 18 years, blood eosinophil counts were higher in males than in females (median 120 (5%–95% CI: 30–330)versus100 (30–310) cells·µL−1, respectively) and did not change with age.

Median blood eosinophil counts in adults are considerably lower than those currently regarded as normal, do not change with age beyond puberty, but are significantly influenced by a variety of factors which have an additive effect. These observations will contribute to the interpretation of blood eosinophil levels in clinical practice.
Adherence to inhaled corticosteroids and clinical outcomes in mepolizumab therapy for severe asthma
Authors: d'Ancona Gráinne , Kavanagh Joanne , Roxas Cris , Green Linda , Fernandes Mariana , Thomson Louise , Dhariwal Jaideep , Nanzer Alexandra M. , Jackson David J. , Kent Brian D.
Published: February 2020

Introduction

Inhaled corticosteroids (ICS) achieve disease control in the majority of asthmatic patients, although adherence to prescribed ICS is often poor. Patients with severe eosinophilic asthma may require treatment with oral corticosteroids (OCS) and/or biologic agents such as mepolizumab. It is unknown if ICS adherence changes on, or alters clinical response to, biologic therapy.

Methods

We examined ICS adherence and clinical outcomes in OCS-dependent severe eosinophilic asthma patients who completed 1 year of mepolizumab therapy. The ICS medicines possession ratio (MPR) was calculated (the number of doses of ICS issued on prescription/expected number) for the year before and the year after biologic initiation. Good adherence was defined as MPR >0.75, intermediate 0.74–0.51 and poor <0.5. We examined outcomes after 12 months of biologic therapy, including OCS reduction and annualised exacerbation rate (AER), stratified by adherence to ICS on mepolizumab.

Results

Out of 109 patients commencing mepolizumab, 91 who had completed 12 months of treatment were included in the final analysis. While receiving mepolizumab, 68% had good ICS adherence, with 16 (18%) having poor ICS adherence. ICS use within the cohort remained similar before (MPR 0.81±0.32) and during mepolizumab treatment (0.82±0.32; p=0.78). Patients with good adherence had greater reductions in OCS dose (median (interquartile range) OCS reduction 100 (74–100)%versus60 (27–100)%; p=0.031) and exacerbations (AER change −2.1±3.1versus0.3±2.5; p=0.011) than those with poor adherence. Good ICS adherence predicted the likelihood of stopping maintenance OCS (adjusted OR 3.19, 95% CI 1.02–9.94; p=0.045).

Conclusion

ICS nonadherence is common in severe eosinophilic asthma patients receiving mepolizumab, and is associated with a lesser reduction in OCS requirements and AER.
Antibacterial activities of the extracts, fractions and isolated compounds from Canarium patentinervium Miq. against bacterial clinical isolates
Authors: Mogana R. , Adhikari A. , Tzar M. N. , Ramliza R. , Wiart C.
Published: February 2020

Background

Canarium patentinerviumleaves are used by the local indigenous people of Malaysia for wound healing. The current study is undertaken to screen the comprehensive antibacterial activity of the leaves and barks extracts, fractions and isolated compounds from this plant. Bioassay guided fractionation was also undertaken to deeply evaluate the antibacterial activity of the water fraction of the leaves extract. This is to provide preliminary scientific evidence to the ethnopharmacology usage of this plant by investigating antibacterial properties of the plant and its isolated constituents.

Methods

Bio-assay guided fractionation and subsequent isolation of compounds using open column chromatography. The antibacterial activity against gram positive and gram negative ATCC strain and resistant clinical strains were evaluated using microtiter broth dilution method to determine minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and time-kill assay. The chemical structure of the isolated compounds from the water fraction of the ethanol extract of leaves was elucidated using Nuclear Magnetic Resonance (NMR).

Results

The ethanol extract of the leaves and barks showed antimicrobial activity against all four ATCC and eight clinical isolates. The ethanol extract of the leaves and the corresponding water fraction had good activity against MRSAS. aureus.(MIC: 250 μg/ml) and had bactericidal effect on eight of the clinical strains (MSSA,MRSA, oxacillin-resistant CONS, oxacillin-sensitive CONS,Enterococcus faecalis,Klebsielaspecies, Kleb pneumoniaeESBL andCandida parapsilosis). Further phytochemical investigation of the water fraction of the crude ethanol extract of leaves afforded compound 7 (hyperin) and compound 8 (cynaroside) that had bactericidal activity against tested bacterial species (MIC 50 μg/ml and 100 μg/ml). The two compounds were isolated from this genus for the first time.

Conclusions

These results may provide a rational support for the traditional use ofCanarium patentinerviumMiq. in infections and wound healing, since the antimicrobial compounds isolated were also present in the leaves extract.
Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis
Authors: Axson Eleanor L. , Ragutheeswaran Kishan , Sundaram Varun , Bloom Chloe I. , Bottle Alex , Cowie Martin R. , Quint Jennifer K.
Published: February 2020

Background

Discrepancy exists amongst studies investigating the effect of comorbid heart failure (HF) on the morbidity and mortality of chronic obstructive pulmonary disease (COPD) patients.

Methods

MEDLINE and Embase were searched using a pre-specified search strategy for studies comparing hospitalisation, rehospitalisation, and mortality of COPD patients with and without HF. Studies must have reported crude and/or adjusted rate ratios, risk ratios, odds ratios (OR), or hazard ratios (HR).

Results

Twenty-eight publications, reporting 55 effect estimates, were identified that compared COPD patients with HF with those without HF. One study reported on all-cause hospitalisation (1 rate ratio). Two studies reported on COPD-related hospitalisation (1 rate ratio, 2 OR). One study reported on COPD- or cardiovascular-related hospitalisation (4 HR). One study reported on 90-day all-cause rehospitalisation (1 risk ratio). One study reported on 3-year all-cause rehospitalisation (2 HR). Four studies reported on 30-day COPD-related rehospitalisation (1 risk ratio; 5 OR). Two studies reported on 1-year COPD-related rehospitalisation (1 risk ratio; 1 HR). One study reported on 3-year COPD-related rehospitalisation (2 HR). Eighteen studies reported on all-cause mortality (1 risk ratio; 4 OR; 24 HR). Five studies reported on all-cause inpatient mortality (1 risk ratio; 4 OR). Meta-analyses of hospitalisation and rehospitalisation were not possible due to insufficient data for all individual effect measures. Meta-analysis of studies requiring spirometry for the diagnosis of COPD found that risk of all-cause mortality was 1.61 (pooled HR; 95%CI: 1.38, 1.83) higher in patients with HF than in those without HF.

Conclusions

In this systematic review, we investigated the effect of HF comorbidity on hospitalisation and mortality of COPD patients. There is substantial evidence that HF comorbidity increases COPD-related rehospitalisation and all-cause mortality of COPD patients. The effect of HF comorbidity may differ depending on COPD phenotype, HF type, or HF severity and should be the topic of future research.
Taking the ‘I’ out of LLINs: using insecticides in vector control tools other than long-lasting nets to fight malaria
Authors: Paaijmans Krijn P. , Huijben Silvie
Published: February 2020

Long-lasting insecticidal nets, or LLINs, have significantly reduced malaria morbidity and mortality over the past two decades. The net provides a physical barrier that decreases human-mosquito contact and the impregnated insecticide kills susceptible mosquito vectors upon contact and may repel them. However, the future of LLINs is threatened as resistance to pyrethroids is now widespread, the chemical arsenal for LLINs is very limited, time from discovery of next-generation insecticides to market is long, and persistent transmission is frequently caused by vector populations avoiding contact with LLINs. Here we ask the question whether, given these challenges, insecticides should be incorporated in nets at all. We argue that developing long-lasting nets without insecticide(s) can still reduce vector populations and provide both personal and community protection, if combined with other approaches or technologies. Taking the insecticide out of the equation (i) allows for a faster response to the current pyrethroid resistance crisis, (ii) avoids an LLIN-treadmill aimed at replacing failing bed nets due to insecticide resistance, and (iii) permits the utilization of our current and future insecticidal arsenal for other vector control tools to target persistent malaria transmission.
The challenge of describing the epidemiology of HTLV in the Amazon region of Brazil
Authors: Ishak Ricardo , de Oliveira Guimarães Ishak Marluísa , Vallinoto Antonio Carlos R.
Published: February 2020

HTLV-1 was the first described human retrovirus and was soon found to be associated with severe clinical diseases, including a devastating lymphoma/leukemia and other inflammatory diseases. Although HTLV-2 is not usually pathogenic, it is widely distributed among native Indian populations in Brazil, particularly in the Amazon region of the country. Presently, HTLV spreads mainly by the sexual route and from mother to child, and virus persistence is an active biological factor aiding its transmission. Recently, the use of illicit drugs has been shown to be an additional risk factor, showing the influence of new habits on the epidemiology of HTLV in the region. Despite the detection of the virus in several different populations in the Amazon region of Brazil for almost 30 years, the exact prevalence of HTLV-1/2 is not well defined. The original biases in sampling and the selection of epidemiologically unsuitable populations were commonly repeated in most prevalence studies, generating unreliable and conflicting figures that do not represent the actual prevalence of HTLV. The improvements in clinical and laboratory facilities have resulted in the description of several clinical manifestations that were previously unknown in the region. The extent of the spread of the virus must be defined in this region, which is the largest geographical area of the country. As prophylaxis advances toward the use of vaccines against HTLV-1, it is important to determine who is at risk of being infected and developing a disease to successfully implement preventive measures, particularly as proposals are made to eradicate the virus among humans.