bluuebunny/crossref_metadata_2025 huggingface dataset:
Introducing Suture
Authors: Freudenburg Kirk
Published: December 2022

This chapter seeks to establish connections between the way that film directors and cinematographers stitch their stories together in narrative films, and the way that visual information is parceled out and managed by writers of ancient epic. The visual workings of three passages from Homer’s Iliad and Virgil’s Aeneid are reframed in terms of common practices of cinematic “suture,” that is, seen as versions of what film directors do in stitching one shot to the next in order to establish not only “who sees,” but to produce illusions of spatial wholeness and continuity in the story itself. The main argument throughout is that the poets’ visual evocations do far more than enliven the story-telling by lighting things up and adding splashes of color and sound. Rather, they do serious narrative work of their own by structuring lines of sight, both visual and emotional, and shifting them about. Through these important (but commonly overlooked) means, epic writers tell us not just who is watching, but who is most engaged with what is there to be seen at any given time. In so doing, they tell us things about characters, their interests, emotional states, and motivations, etc., that we would otherwise not know.
The Polish Thaw
Authors: Fidelis Malgorzata
Published: December 2022

This chapter recaptures the cosmopolitan dimension of the Polish Thaw by focusing on young people, who led the movement to create a genuine socialist system based on grassroots ideas and an open international community. A new youth magazine, Around the World, offered its audience a new kind of depoliticized leisure and imaginary transnational interaction through reports and images of the outside world. The Polish Thaw facilitated variety of youth activism, including student clubs, the experimental theater, and critical journalism. Two events helped define the nature of transnational interaction for years to come: the World Youth and Student Festival, held in Warsaw in the summer of 1955, and the Hungarian Revolution in November 1956. The festival accelerated cultural liberalization and youth’s desire for mobility across borders, whereas the Soviet invasion of Hungary, as witnessed by Polish students and young journalists reporting from Budapest, set limits on these newly acquired freedoms.
Bohemians and Discontents
Authors: Fidelis Malgorzata
Published: December 2022

Polish students attempted to insert their voices into the ongoing debates on the meaning of socialist modernity. Student clubs under the patronage of the official student association provided a space where young elites could play or listen to jazz, learn how to dance the twist, and exchange vinyl records. These clubs became symbols of the distinct relationship between students and “freedom” that was more extensive and more transnational than the opportunities granted to other groups. These new spaces, however, created hierarchies and exclusions. Young women and students from rural backgrounds often struggled to be included as equals in urban student milieux. This chapter also introduces students’ political circles, which continued the Thaw-era search for leftist ideas alternative to the ones professed by the socialist regime. Student groups such as the Commandos offered alternative interpretations of leftist politics, while blending political engagement with socializing according to a more relaxed lifestyle of the younger generation.
The World in the Village
Authors: Fidelis Malgorzata
Published: December 2022

This chapter turns to rural youth and the ways the world entered the traditional Polish village. This occurred, to a large extent, through state-supported cultural modernization, which included the spread of schooling, television, and club-cafés. Young women were critical to introducing modern lifestyles to the countryside, including improvements to household technology, dating, and courses on women’s health and reproduction. By claiming the position of “civilizers” in the village, young women defied traditional ways of life and the village community’s control of their destinies. This chapter relies on handwritten memoirs and diaries of rural youth submitted to state-organized competitions. These testimonies offer unique glimpses into the emotional worlds of young villagers. While inspiring global connections, “the world in the village” also helped overcome regional identities and solidified the link between the rural population and the modern Polish nation.
Gods of Thunder
Authors: Pauketat Timothy R.
Published: December 2022

The earth’s climate warmed from the ninth through the thirteenth centuries ce. Named the Medieval Warm Period, these centuries were a time of great historical change in precolonial North America, as evidenced through archaeology. While scholars have previously suggested the existence of long-distance ties between the civilizations of Mesoamerica, the American Southwest, and the Mississippi valley, no one until now has argued that climate change and religion—not trade—were the reasons for these far-flung connections. The book argues that a common supernatural being, the Wind-That-Brings-Rain or Thunderer god, emerged because of climatic factors to drive the development of a series of interrelated religious movements across the continent. These movements were based around a common circular shrine or pyramid in or on which people worshiped the powers of the wind and rain—the essential life-giving forces of global climate.
Wind in the Shell
Authors: Pauketat Timothy R.
Published: December 2022

Cabeza de Vaca and his comrades had seen remnants of the earlier medieval cults of the gods of wind and rain. They had seen how the power to heal the maladies of this world might lead to great centers of spiritual power, such as Tula, Tamtoc, Chaco, Crenshaw, Cahokia, and more. The lesson learned by Cabeza de Vaca can be learned by us today by pilgrimaging across the archaeological landscape of precolonial North America, beginning in the Classic Maya heartland and Teotihuacan, continuing up through the Mexican Altiplano into North Mexico and the American Southwest, and then cutting through Caddo country up the Mississippi River to Cahokia. The lesson is this: there is another way to understand the history of this continent and the world, and it involves an inclusive vision where climatic forces, supernatural beings, and humanity are inextricably intertwined.
Properties and Relations
Authors: Stalnaker Robert
Published: December 2022

The theory of propositions and the move to a modal logic help to motivate a further ontological commitment to properties and relations, including properties of and relations among individuals, propositions, and properties and relations themselves. This chapter explores the consequences of this further commitment and discusses a framework—higher-order modal logic, or type theory—for representing the structure of relation among individuals, propositions, and properties and relations of the various types. Quine argued that higher-order logic blurred lines between different compositional roles in a way that facilitated equivocation between different kinds of expressions, but it is argued that with care equivocation can be avoided. Some principles governing this complex relational structure are discussed. The last part of the chapter considers whether one might formulate a theory of this structure in a first-order language, and it considers some problems, including a threat of paradox, that such a formulation would face.
Collapse and Resilience
Authors: Seligson Kenneth E.
Published: December 2022

This chapter discusses the period of breakdown and reorganization referred to colloquially as the Classic Maya Collapse. Available data indicate that a series of particularly intense droughts lasting anywhere from three to twenty-plus years affected the Maya lowlands in the ninth and tenth centuries ce. Although scholars continue to refine understandings of the exact timing, intensity, location, and impacts of these droughts, it is now widely accepted that they contributed to the destabilization of the Classic Period order. It is clear, however, that drought was but one of a number of factors that disrupted Classic Maya communities across the lowlands. Other critical factors included environmental exploitation, increasing inter-site warfare, and destabilizing socio-political forces within individual polities. Different combinations of factors affected different sites and subregions at different times and in different ways, resulting in a very complicated picture. One way that communities adapted to the changing circumstances was to adopt new resource-conservation strategies during this tumultuous period. Not all communities succumbed, and numerous cultural practices survived. Viewing this period through the lens of resilience theory highlights how the Classic to Postclassic Period transformation was part of a much longer cyclical trajectory that can be used to characterize all civilizations in human history. We can learn a lot about cultural flexibility from examining the processes that disrupted Classic Maya society during the Terminal Classic Period and the strategies that many communities employed to address them.
Police Scotland and PSNI
Authors: Sinclair Georgina
Published: December 2022

This chapter considers the international policing activities of Police Scotland and PSNI and the development of their own brands by increasing their international footprint strengthened by political devolution and policing reforms. The development of a Police Scotland brand was linked to Scotland’s political trajectory following devolution and then the Scottish independence referendum. The promotion of Scottish interests internationally has seen a slow but steady growth over the past eight years with a particular growth in bilateral projects within the priority countries. The international activities of Police Scotland are examined through case studies in Malawi and Sri Lanka. The PSNI provided a template for post-conflict change management and supporting processes of change and wider lessons learning within international police reform and development which are examined within case studies in Bolivia and the Philippines. As the RUC legacy has faded into memory so a PSNI brand has developed, fostered by public bodies and private companies that have actively promoted brand Northern Ireland which has included policing, justice, and security services. The UK policing brand (re)shaped from the start of the twenty-first century with Police Scotland and PSNI becoming added to the overall international offer. However, with the reforming of the UK policing brand came a fragmentation within the delivery of international policing across the four-nation state.
Ostracism before Ostracism?
Authors: Węcowski Marek
Published: December 2022

Chapter One discusses the ‘prehistory’ of Athenian ostracism by studying both the attested cases of ostracism outside Athens (in Megara, Argos, Tauric Chersonesos, Cyrene, Thourioi, the Sicilian Naxos and possibly in Miletus, as well as the petalismos, or vote using olive leaves, in Syracuse) and conceivable traces of ostracism-like institutions or procedures in Athens of the archaic period. Here, on the one hand, both the famous late Byzantine testimony of the so-called ‘bouleutic ostracism’ (the manuscript Vaticanus Graecus 1144) and that of the archaic ostraca, from the Athenian Agora and the Acropolis, are discounted as unreliable witnesses to the alleged ‘ostracism before ostracism’ in Athens. On the other hand, all extra-Athenian ostracisms seem to post-date the Athenian institution by at least two decades, which bespeaks against the widely held hypothesis that ostracism in Athens was just one local elaboration of a more general Greek practice. More probably, all those institutions in the wider Greek world followed the Athenian model. Additionally, the hypothesis of the ritual origins of ostracism is reassessed and rejected. All in all, it turns out that Athenian ostracism (properly speaking) was an unprecedented Athenian invention.
Aquaculture systems as mesocosms
Authors: Kültz Dietmar
Published: December 2022

The boundary between aquaculture and capture fisheries is becoming blurred as wild populations of aquatic organisms are ever more impacted (unintended) and managed (intended) by humans who have irreversibly changed the trajectory of the biosphere. Most current aquaculture systems are semi-intensive, open systems that depend to a very high degree on natural ecosystem services. A mismatch between a significant human-induced decline of natural ecosystems on the one hand and increased human demand for ecosystem services on the other hand calls for solutions that minimize the reliance on ecosystem services for all purposes, including aquaculture. Low-yield, extensive aquaculture systems are sustainable in suitable areas, but they are not economical on a global scale unless the human population declines significantly. The most ecologically sustainable aquaculture systems for a growing human population are intensive, closed recirculating aquaculture systems (RAS), which are human-managed mesocosms that require constant balancing of energy and matter in inputs and outputs. Knowledge generated and technologies developed for culture of ornamental organisms in aquaria at microcosm scale have advanced ecologically sustainable aquaculture at larger mesocosm scales. Ecosystem succession must be managed when establishing aquaculture mesocosms to maintain optimal conditions for growth, health, and development of aquaculture organisms. Since trophic level transfer efficiency (TLTE) is only 10–20%, aquaculture systems for top-level carnivores are least energetically efficient and most resource intensive. Balancing trophic levels in closed aquaculture mesocosms requires proportional matching of primary producers, consumers, and decomposers to minimize reliance on ecosystem services.
Introduction
Authors: Keenan Marie , Zinsstag Estelle
Published: December 2022

This chapter sets the scene to the book. It offers definitions of the main concepts sexual violence and restorative justice, it clarifies the wordings used throughout victim/survivors, offenders/perpetrators, the difference between restorative justice and restorative practices, the different types of methods used (VOM, conferencing, circles), and explains the distinction between fully restorative and alternative or quasi restorative justice initiatives. It explores also important concepts for the theme of the book such as truth and choice. It also offers some thoughts on the theoretical framework of the book and the methodology for the research on which this book is based. It ends by explaining the structure of the book.
Historical Background
Authors: Bittelli Marco , Olmi Roberto , Rosa Rodolfo
Published: December 2022

Chapter 2 provides a brief historical background about the origin of random processes theory. The invention of probability theory is commonly referred back to the seventeenth century, where the game of dice was the basis for mathematical development of probability and combinatory laws. Antoine Gambaud and Blaise Pascal were debating about the number of throws necessary to win the game of dice and the theory of probability are starting to be developed.
The Problem of Accuracy
Authors: Bittelli Marco , Olmi Roberto , Rosa Rodolfo
Published: December 2022

The modelling of stochastic processes depends on the accuracy of the estimators derived in the process analysis. The problem of accuracy is discussed in Chapter 10, with examples on averaging of time series, the batch means method, moving bootstrap and other techniques to improve accuracy in random processes modelling.
France and the Rise of China
Authors: Meijer Hugo
Published: December 2022

France’s policy towards the People’s Republic of China (PRC) followed a parallel trajectory to that of its larger regional policy in the Asia-Pacific. China’s increasingly muscular posture in the Indian and Pacific Oceans regions coupled with its concurrent expanding reach into Europe sparked France to harden its ‘China policy’. This chapter examines how France has grappled with China’s rising assertiveness on the European continent. In particular, it examines Paris’s response to Chinese foreign direct investments (FDIs) into sensitive sectors and to its supply of telecommunications (or telecoms) equipment for France’s digital infrastructure. It is shown that, after two decades in which Paris mostly focused on the pursuit of economic opportunities, concerns over China’s inroads into strategic sectors in France and in Europe in the 2010s—coupled with increasingly competitive bilateral economic relations—have been the main driver of change in France’s ‘China policy’. The first two sections delineate the two main drivers of France’s policy towards the PRC, i.e. the evolving French economic interests vis-à-vis China—as its economic imprint in Europe expanded—and Paris’s heightened threat perceptions of the PRC. The chapter then shows how these evolving economic interests and threat assessment, in turn, caused France to harden the goals of its ‘China policy’ and to bolster the policy instruments that it mobilized to achieve such goals.
Conclusions
Authors: Meijer Hugo
Published: December 2022

The Conclusion of the book first synthesizes its core findings on the policies of three major European powers towards China across both continents, the Asia-Pacific and Europe. The central finding of this study is that, whereas growing economic interests have provided the underlying impetus for the three countries’ growing attention to the PRC and the Asia-Pacific, their threat perceptions of China—coupled with increasingly competitive bilateral economic relations—have been the main driver of change in their policies towards Beijing. Europe’s major powers have awakened to security implications of China’s rise. Based upon such findings, this Conclusion then outlines new important avenues for future research at a time when the European Union and NATO have recalibrated their approaches towards the PRC amidst mounting United States–China strategic competition, and the implications of Brexit therefore. In particular, it discusses how future research could broaden the comparative analysis put forward in this book to encompass also the ‘China policies’ of medium and smaller European powers in order to assess the larger trends of convergence (or fragmentation) in the national responses to China’s rise across the whole European Union. Likewise, future research should investigate Washington’s evolving perspective on the role of Europeans in facing China’s rise as well as the main venues through which such cooperation unfolds.
Learning to Live Naturally
Authors: Gill Christopher
Published: December 2022

This book offers a sustained examination of the core Stoic ethical claims and their significance for modern moral theory. The first part considers the Stoic ideas of happiness as the life according to nature and virtue as expertise in leading a happy life and explores the senses of ‘nature’ (both human and universal) relevant for ethics. It also explains the distinction in value between virtue and ‘indifferents’ and analyses virtuous practical deliberation as selection between ‘indifferents’ directed at leading a happy human life. The second part studies Stoic thinking on ethical development (in their terms, learning to live naturally). It brings out the close interconnections between making progress in ethical understanding, in forming and deepening social relationships, and in emotional responses. The third part discusses how Stoic ethics, as interpreted here, can contribute to contemporary moral theory, especially virtue ethics. It suggests that Stoic thinking on the virtue-happiness relationship offers a cogent alternative to Aristotle, currently the main ancient prototype for virtue ethical theory. It explores ways in which Stoic ideas on human and universal nature can contribute to modern ethical debates, notably on how to respond effectively to the pressing challenge of climate breakdown. It also highlights the potential value of Stoic thinking on development and guidance for modern virtue ethics as well as discussing the powerful impact Stoicism has already had in contemporary ‘life-guidance’.
Partition Times
Authors: Razzack Azra , Siddiqui M. Atyab
Published: December 2022

This chapter discusses the times leading up to the partition, the conflicting identities, the relationship of the institutions—the Anglo Arabic College & Schools with the Muslim League and the infatuation the students had with Jinnah who was soon to become the Quaid e Azam of Pakistan. The closing down of the Anglo Arabic Schools and college in 1947, their opening again as the Anglo Arabic School (only at Ajmeri Gate) and Delhi College in 1948 has been discussed here. The trials and tribulations of that period, the compromise and adjustments made, and the transition of the Anglo Arabic School and its identification into a new and independent country follow.
The Historical Political Economy of Financial Crises
Authors: Weidenmier Marc
Published: December 2022

This chapter examines three important areas of research in the historical political economy of financial crises: the role of political factors in Confederate debt repayment during the American Civil War, the establishment of a central bank in the United States following the San Francisco earthquake of 1906 and the Panic of 1907, and the dramatic expansion of the powers of central banks over the last one hundred years using the Great Depression as a historical case study. These three areas show, among other things, that issues of political economy and financial crises can take very different forms.
Thermo-Sensitive Spikelet Defects 1acclimatizes rice spikelet initiation and development to high temperature
Authors: Cai Zhengzheng , Wang Gang , Li Jieqiong , Kong Lan , Tang Weiqi , Chen Xuequn , Qu Xiaojie , Lin Chenchen , Peng Yulin , Liu Yang , Deng Zhanlin , Ye Yanfang , Wu Weiren , Duan Yuanlin
Published: December 2022

Crop reproductive development is vulnerable to heat stress, and the genetic modulation of thermotolerance during the reproductive phase, especially the early stage, remains poorly understood. We isolated a Poaceae-specific FAR-RED ELONGATED HYPOCOTYLS3 (FHY3)/FAR-RED IMPAIRED RESPONSE1 (FAR1)family transcription factor, Thermo-sensitive Spikelet Defects 1 (TSD1), derived from transposase in rice (Oryza sativa) TSD1 was highly expressed in spikelets, induced by heat, and specifically enhanced the thermotolerance of spikelet morphogenesis. Disrupting TSD1 did not affect vegetative growth but markedly retarded spikelet initiation and development, as well as caused varying degrees of spikelet degeneration, depending on the temperature. Most tsd1 spikelets were normal at low temperature but gradually degenerated as temperature increased, and all disappeared at high temperature, leading to naked branches. TSD1 directly promoted the transcription of YABBY1 and YABBY3 and could physically interact with YABBY1 and three TOB proteins, YABBY5, YABBY4, and YABBY3. These YABBY proteins can form either homodimers or heterodimers and play an important role in spikelet morphogenesis, similar to TSD1. Notably, the knockout mutant yab5-ko and double mutant tsd1 yab5-ko resembled tsd1 in spikelet appearance and response to temperature, indicating that these genes likely participate in spikelet development through the cooperative TSD1–YABBY module. These findings reveal a distinctive function of FHY3/FAR1 family genes and a unique TSD1–YABBY complex to acclimate spikelet development to high temperature in rice, providing insight into the regulating pathway of enhancing thermotolerance in plant reproductive development.
Reversions to consensus are positively selected in HIV-1 and bias substitution rate estimates
Authors: Druelle Valentin , Neher Richard A
Published: December 2022

Human immunodeficiency virus 1 (HIV-1) is a rapidly evolving virus able to evade host immunity through rapid adaptation during chronic infection. The HIV-1 group M has diversified since its zoonosis into several subtypes at a rate of the order of 10−3 changes per site per year. This rate varies between different parts of the genome, and its inference is sensitive to the timescale and diversity spanned by the sequence data used. Higher rates are estimated on short timescales and particularly for within-host evolution, while rate estimates spanning decades or the entire HIV-1 pandemic tend to be lower. The underlying causes of this difference are not well understood. We investigate here the role of rapid reversions toward a preferred evolutionary sequence state on multiple timescales. We show that within-host reversion mutations are under positive selection and contribute substantially to sequence turnover, especially at conserved sites. We then use the rates of reversions and non-reversions estimated from longitudinal within-host data to parameterize a phylogenetic sequence evolution model. Sequence simulation of this model on HIV-1 phylogenies reproduces diversity and apparent evolutionary rates of HIV-1 in gag and pol, suggesting that a tendency to rapidly revert to a consensus-like state can explain much of the time dependence of evolutionary rate estimates in HIV-1.
2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade
Authors: Thilen Stephan R. , Weigel Wade A. , Todd Michael M. , Dutton Richard P. , Lien Cynthia A. , Grant Stuart A. , Szokol Joseph W. , Eriksson Lars I. , Yaster Myron , Grant Mark D. , Agarkar Madhulika , Marbella Anne M. , Blanck Jaime F. , Domino Karen B.
Published: December 2022

These practice guidelines provide evidence-based recommendations on the management of neuromuscular monitoring and antagonism of neuromuscular blocking agents during and after general anesthesia. The guidance focuses primarily on the type and site of monitoring and the process of antagonizing neuromuscular blockade to reduce residual neuromuscular blockade.
Performance of Noninvasive Airway Occlusion Maneuvers to Assess Lung Stress and Diaphragm Effort in Mechanically Ventilated Critically Ill Patients
Authors: de Vries Heder J. , Tuinman Pieter R. , Jonkman Annemijn H. , Liu Ling , Qiu Haibo , Girbes Armand R. J. , Zhang YingRui , de Man Angelique M. E. , de Grooth Harm-Jan , Heunks Leo
Published: December 2022

Background

Monitoring and controlling lung stress and diaphragm effort has been hypothesized to limit lung injury and diaphragm injury. The occluded inspiratory airway pressure (Pocc) and the airway occlusion pressure at 100 ms (P0.1) have been used as noninvasive methods to assess lung stress and respiratory muscle effort, but comparative performance of these measures and their correlation to diaphragm effort is unknown. The authors hypothesized that Pocc and P0.1 correlate with diaphragm effort and lung stress and would have strong discriminative performance in identifying extremes of lung stress and diaphragm effort.

Methods

Change in transdiaphragmatic pressure and transpulmonary pressure was obtained with double-balloon nasogastric catheters in critically ill patients (n = 38). Pocc and P0.1 were measured every 1 to 3 h. Correlations between Pocc and P0.1 with change in transdiaphragmatic pressure and transpulmonary pressure were computed from patients from the first cohort. Accuracy of Pocc and P0.1 to identify patients with extremes of lung stress (change in transpulmonary pressure > 20 cm H2O) and diaphragm effort (change in transdiaphragmatic pressure < 3 cm H2O and >12 cm H2O) in the preceding hour was assessed with area under receiver operating characteristic curves. Cutoffs were validated in patients from the second cohort (n = 13).

Results

Pocc and P0.1 correlate with change in transpulmonary pressure (R
2 = 0.62 and 0.51, respectively) and change in transdiaphragmatic pressure (R
2 = 0.53 and 0.22, respectively). Area under receiver operating characteristic curves to detect high lung stress is 0.90 (0.86 to 0.94) for Pocc and 0.88 (0.84 to 0.92) for P0.1. Area under receiver operating characteristic curves to detect low diaphragm effort is 0.97 (0.87 to 1.00) for Pocc and 0.93 (0.81 to 0.99) for P0.1. Area under receiver operating characteristic curves to detect high diaphragm effort is 0.86 (0.81 to 0.91) for Pocc and 0.73 (0.66 to 0.79) for P0.1. Performance was similar in the external dataset.

Conclusions

Pocc and P0.1 correlate with lung stress and diaphragm effort in the preceding hour. Diagnostic performance of Pocc and P0.1 to detect extremes in these parameters is reasonable to excellent. Pocc is more accurate in detecting high diaphragm effort.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Trends in Attempted and Successful Trial of Labor After Cesarean Delivery in the United States From 2010 to 2020
Authors: Bruno Ann M. , Allshouse Amanda A. , Metz Torri D.
Published: December 2022

The vaginal birth after cesarean (VBAC) delivery rate was last reported as 13.8% in 2019. However, contemporary trends in attempted and successful trial of labor after cesarean (TOLAC) delivery among individuals with prior cesarean delivery have not been evaluated. We performed a repeated cross-sectional analysis of singleton, cephalic, term deliveries in individuals with a history of one or two cesarean deliveries in the National Vital Statistics System from 2010 to 2020. Temporal trends in attempted and successful TOLAC, as well as VBAC, were characterized using joinpoint regression. Overall, 4,277,800 deliveries were included. Attempted TOLAC increased from 15.3% in 2010 to 21.7% in 2020, with an annual percent increase (relative) of 4.25% (95% CI 2.9–5.6%). Successful TOLAC increased from 69.8% to 74.7%, with an annual percent change (relative) of 0.91% (95% CI 0.7–1.2%). The VBAC rate similarly increased such that, by 2020, it was 16.2%.
Association of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection With Maternal Mortality and Neonatal Birth Outcomes in Botswana by Human Immunodeficiency Virus Status
Authors: Jackson-Gibson Maya , Diseko Modiegi , Caniglia Ellen C. , Mayondi Gloria K. , Mabuta Judith , Luckett Rebecca , Moyo Sikhulile , Lawrence Pamela , Matshaba Mogomotsi , Mosepele Mosepele , Mmalane Mompati , Banga Jaspreet , Lockman Shahin , Makhema Joseph , Zash Rebecca , Shapiro Roger L.
Published: December 2022

OBJECTIVE:

To evaluate the combined association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) infection on adverse birth outcomes in an HIV-endemic region.

METHODS:

The Tsepamo Study abstracts data from antenatal and obstetric records in government maternity wards across Botswana. We assessed maternal mortality and adverse birth outcomes for all singleton pregnancies from September 2020 to mid-November 2021 at 13 Tsepamo sites among individuals with documented SARS-CoV-2 screening tests and known HIV status.

RESULTS:

Of 20,410 individuals who gave birth, 11,483 (56.3%) were screened for SARS-CoV-2 infection; 4.7% tested positive. People living with HIV were more likely to test positive (144/2,421, 5.9%) than those without HIV (392/9,030, 4.3%) (P=.001). Maternal deaths occurred in 3.7% of those who had a positive SARS-CoV-2 test result compared with 0.1% of those who tested negative (adjusted relative risk [aRR] 31.6, 95% CI 15.4–64.7). Maternal mortality did not differ by HIV status. The offspring of individuals with SARS-CoV-2 infection experienced more overall adverse birth outcomes (34.5% vs 26.6%; aRR 1.2, 95% CI 1.1–1.4), severe adverse birth outcomes (13.6% vs 9.8%; aRR 1.2, 95% CI 1.0–1.5), preterm delivery (21.4% vs 13.4%; aRR 1.4, 95% CI 1.2–1.7), and stillbirth (5.6% vs 2.7%; aRR 1.7 95% CI 1.2–2.5). Neonates exposed to SARS-CoV-2 and HIV infection had the highest prevalence of adverse birth outcomes (43.1% vs 22.6%; aRR 1.7, 95% CI 1.4–2.0).

CONCLUSION:

Infection with SARS-CoV-2 at the time of delivery was associated with 3.7% maternal mortality and 5.6% stillbirth in Botswana. Most adverse birth outcomes were worse among neonates exposed to both SARS-CoV-2 and HIV infection.
Postmatch perceptions of virtual interviews among orthopaedic surgery program directors and candidates: results of an online survey
Authors: Brueggeman David A. , Via Garrhett G. , Lyons Joseph G. , Froehle Andrew W. , Krishnamurthy Anil B.
Published: December 2022

Background:

Interviews are considered fundamental to the residency application. Universal implementation of virtual interviews (VIs) caused substantial modifications to the 2020/2021 residency application cycle. Previous work elucidated the expectations and perceptions of candidates and program directors (PDs) prior to the match. The authors aimed to assess whether the match results affected perceptions of VIs.

Methods:

An online survey was distributed to candidates and PDs of the 2020/2021 orthopaedic surgery residency application cycle. Questions assessed match results, the perceived impact of VIs, and interview format preferences for upcoming application cycles.

Results:

Responses included 39 PDs (20% response rate) and 71 candidates (14% response rate). PDs in the sample reported filling all positions. Of the 71 candidates, 19 went unmatched. Candidates had significantly higher prematch expectations of the impact of VIs than PDs (P=0.039). PDs reported significantly different changes in perception of VIs after the match compared with candidates, with more positive views of VIs reported (P=0.009). Compared with matched candidates, unmatched candidates expressed significantly greater dissatisfaction with the match result (P<0.001).

Conclusions:

PDs reported higher satisfaction with VIs than expected after the match compared with prematch expectations. Candidates’ opinions of VIs postmatch were polarized. Unmatched candidates expressed a high level of dissatisfaction with the match and overwhelmingly felt VIs negatively affected their chances of matching. A large majority of PDs and matched candidates were satisfied with the outcomes of the match and VIs; nevertheless, this did not confer broad support for continuing VIs in the future.

Level of Evidence:

Level IV
Immune therapy: a new therapy for acute myeloid leukemia
Authors: Tian Chen , Chen Zehui
Published: December 2022

Although complete remission could be achieved in about 60%–70% of acute myeloid leukemia (AML) patients after conventional chemotherapy, relapse and the state of being refractory to treatment remain the main cause of death. In addition, there is a great need for less intensive regimens for all medically frail patients (both due to age/comorbidity and treatment-related). Immune therapy anticipates improved prognosis and reduced toxicities, which may offer novel therapeutic rationales. However, one of the major difficulties in developing immune therapies against AML is that the target antigens are also significantly expressed on healthy hematopoietic stem cells; B-cell malignancies are different because CD20/CD19/healthy B-cells are readily replaceable. Only the anti-CD33 antibody-drug conjugate gemtuzumab-ozogamicin is approved by the FDA for AML. Thus, drug development remains extremely active, although it is still in its infancy. This review summarizes the clinical results of immune therapeutic agents for AML, such as antibody-based drugs, chimeric antigen receptor therapy, checkpoint inhibitors, and vaccines.
Alveolar Biomarker Profiles in Subphenotypes of the Acute Respiratory Distress Syndrome
Authors: Sathe Neha A. , Morrell Eric D. , Bhatraju Pavan K. , Fessler Michael B. , Stapleton Renee D. , Wurfel Mark M. , Mikacenic Carmen
Published: December 2022

OBJECTIVES:

We sought to determine whether hyperinflammatory acute respiratory distress syndrome (ARDS) and hypoinflammatory ARDS, which have been associated with differences in plasma biomarkers and mortality risk, also display differences in bronchoalveolar lavage (BALF) biomarker profiles. We then described the relationship between hyperinflammatory ARDS and hypoinflammatory ARDS to novel subphenotypes derived using BALF biomarkers.

DESIGN:

Secondary analysis of a randomized control trial testing omega-3 fatty acids for the treatment of ARDS.

SETTING:

Five North American intensive care units.

PATIENTS:

Adults (n = 88) on invasive mechanical ventilation within 48 hours of ARDS onset.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We classified 57 patients as hypoinflammatory and 31 patients as hyperinflammatory using a previously validated logistic regression model. Of 14 BALF biomarkers analyzed, interleukin-6 and granulocyte colony stimulating factor were higher among patients with hyperinflammatory ARDS compared with hypoinflammatory ARDS, though the differences were not robust to multiple hypothesis testing. We then performed a de novo latent class analysis of the 14 BALF biomarkers to identify two classes well separated by alveolar profiles. Class 2 (n = 63) displayed significantly higher interleukin-6, von Willebrand factor, soluble programmed cell death receptor-1, % neutrophils, and other biomarkers of inflammation compared with class 1 (n = 25). These BALF-derived classes had minimal overlap with the plasma-derived hyperinflammatory and hypoinflammatory classes, and the majority of both plasma-derived classes were in BALF-derived class 2 and characterized by high BALF biomarkers. Additionally, the BALF-derived classes were associated with clinical severity of pulmonary disease, with class 2 exhibiting lower Pao
2 to Fio
2 and distinct ventilatory parameters, unlike the plasma-derived classes, which were only related to nonpulmonary organ dysfunction.

CONCLUSIONS:

Hyperinflammatory and hypoinflammatory ARDS subphenotypes did not display significant differences in alveolar biologic profiles. Identifying ARDS subgroups using BALF measurements is a unique approach that complements information obtained from plasma, with potential to inform enrichment strategies in trials of lung-targeted therapies.
Safety Outcomes of Direct Discharge Home From ICUs: An Updated Systematic Review and Meta-Analysis (Direct From ICU Sent Home Study)*
Authors: Lau Vincent I. , Donnelly Ryan , Parvez Sehar , Gill Jivanjot , Bagshaw Sean M. , Ball Ian M. , Basmaji John , Cook Deborah J. , Fiest Kirsten M. , Fowler Robert A. , Mailman Jonathan F. , Martin Claudio M. , Rochwerg Bram , Scales Damon C. , Stelfox Henry T. , Iansavichene Alla , Sy Eric J.
Published: December 2022

Objective:

To evaluate the impact of direct discharge home (DDH) from ICUs compared with ward transfer on safety outcomes of readmissions, emergency department (ED) visits, and mortality.

Data Sources:

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature from inception until March 28, 2022.

Study Selection:

Randomized and nonrandomized studies of DDH patients compared with ward transfer were eligible.

Data Extraction:

We screened and extracted studies independently and in duplicate. We assessed risk of bias using the Newcastle-Ottawa Scale for observational studies. A random-effects meta-analysis model and heterogeneity assessment was performed using pooled data (inverse variance) for propensity-matched and unadjusted cohorts. We assessed the overall certainty of evidence for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach.

Data Synthesis:

Of 10,228 citations identified, we included six studies. Of these, three high-quality studies, which enrolled 49,376 patients in propensity-matched cohorts, could be pooled using meta-analysis. For DDH from ICU, compared with ward transfers, there was no difference in the risk of ED visits at 30-day (22.4% vs 22.7%; relative risk [RR], 0.99; 95% CI, 0.95–1.02; p = 0.39; low certainty); hospital readmissions at 30-day (9.8% vs 9.6%; RR, 1.02; 95% CI, 0.91–1.15; p = 0.71; very low-to-low certainty); or 90-day mortality (2.8% vs 2.6%; RR, 1.06; 95% CI, 0.95–1.18; p = 0.29; very low-to-low certainty). There were no important differences in the unmatched cohorts or across subgroup analyses.

CONCLUSIONS:

Very low-to-low certainty evidence from observational studies suggests that DDH from ICU may have no difference in safety outcomes compared with ward transfer of selected ICU patients. In the future, this research question could be further examined by randomized control trials to provide higher certainty data.
Concept of older person autonomy: phenomenological study of the opinion of specialist nurses
Authors: Lima Andreia Maria Novo , da Silva Martins Maria Manuela Ferreira , Ferreira Maria Salomé Martins , Fernandes Carla Sílvia , Schoeller Soraia Dornelles , Coelho Adriana Raquel Neves , Parola Vítor Sérgio Oliveira
Published: December 2022

Background: The concept of autonomy is composed of several components, making it a multidimensional concept. This includes cognitive ability, intellectual ability, emotional intelligence, social situation, and physical ability skills. This study aimed to describe the experiences attributed to the meaning of the concept of autonomy, by specialist nurses.

Methods: A descriptive phenomenological study was carried out, according to the Giorgi method. Eighteen nurses were recruited at a hospital in Portugal. Data were collected through individual interviews.

Results: The 18 specialist nurses work on average as nurses for 16years and are specialist nurses; for an average of 5.9years, most are specialist nurses in rehabilitation nursing. From the data analysis, six themes emerged: ability to do, ability to resolve, decision ability, cognitive ability, social integration, and emotional intelligence.

Conclusions: Most professionals perceive the concept as the ability to perform activities of daily living and the ability to make decisions, especially concerning informed consent. It is necessary to raise awareness of the breadth of this concept since the quality of life and dignity of the elderly person depends on autonomy.
Impact of perioperative chemotherapy in the treatment of patients with gastric cancer
Authors: Fonseca Telma , Coimbra Mariana , Santos-Sousa Hugo , Barbosa Elisabete , Barbosa José
Published: December 2022

Background:

Perioperative chemotherapy (PeriCh) is the current standard of care for stage II/III gastric cancer tumors in Europe. However, when it concerns patients who endure complications during PeriCh it is unclear if it increases the risk of postoperative complications and other poorer surgical outcomes. We aim to demonstrate if there is an association between having complications during PeriCh and postoperative complications and histopathological response.

Methods:

We conducted a retrospective, transversal, and observational study, including all patients with diagnosed gastric cancer who underwent PeriCh followed by surgical resection during the period of eight years.

Results:

We included 80 patients with a median age of 64.0years (min 24, max 78). Eighty-eight-point eight percent ended the chemotherapy regime proposed, with a median duration of 42 days, and were also submitted to gastric resection: 58.8% total gastrectomy and 41.2% distal gastrectomy. Twelve-point five percent of the patients had no complications during the PeriCh period and 16.3% had >2 complications. Twenty-five percent of patients had a histological response of <10% of tumor burden, but in 41.3% only regression of <50% could be obtained. No significant association was found between complications during PeriCh and adverse surgical outcomes (P = .497). Patients with complications during PeriCh had slightly higher median time difference from end of PeriCh until surgery, but with no statistical significance (P = .575).

Conclusions:

In our sample, the existence of association between complications during PeriCh and postoperative complications or histological response was not demonstrated.
Diagnosis of pathological conditions through electronic nose analysis of urine samples: a systematic review and meta-analysis
Authors: Afonso Helga A.S. , Farraia Mariana V. , Vieira Mónica A. , Cavaleiro Rufo João
Published: December 2022

Currently available urinalysis methods are often applied for screening and monitoring of several pathologies. However, traditionally analyzed biomarkers in urinalysis still lack sensitivity and specificity to accurately diagnose some diseases. Several studies have proposed the use of electronic noses (eNoses) for the analysis of volatile organic compounds in urine samples that may, directly or indirectly, correlate with certain pathologies. Hence, the aim of this study was to perform a systematic review and meta-analysis of studies concerning the use of portable electronic noses for diagnosis or monitoring of pathologies through analysis of urine samples. A systematic review of the literature was held according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-four articles met the inclusion criteria and were included in the analysis. The results of the revised studies showed that there are various volatile organic compound profiles, identified through eNose analysis, that may be applied for diagnosis or monitoring of several diseases, such as diabetes, urinary tract infection, inflammatory bowel disease, and kidney disease. A meta-analysis was conducted taking into consideration the data of 10 of the initial 24 articles. The pooled sensitivity, specificity, and diagnostic odds ratio were 84% (95% CI, 0.72–0.92), 85% (95% CI, 0.75–0.91), and 24.17 (95% CI: 7.85–74.41), respectively. The area under the receiver operating characteristic curve was 0.897. These results suggest that eNose technology has adequate diagnostic accuracy for several pathologies and could be a promising screening tool for clinical settings. However, more studies are needed to reduce heterogeneity between results.
Improving Time to Defibrillation Following Ventricular Tachycardia (VTach) and Ventricular Fibrillation (VFib) Cardiac Arrest: A Multicenter Retrospective and Prospective Quality Improvement Study
Authors: Bodempudi Sairamya , Wus Lisa , Kloo Juergen , Zeniecki Patrick , Coromilas James , West Frances Mae , Lev Yair
Published: December 2022

The goal of this study was to identify how often 2 independent centers defibrillated patients within the American Heart Association recommended 2-minute time interval following ventricular fibrillation/ventricular tachycardia arrest. A retrospective chart review revealed significant delays in defibrillation. Simulation sessions and modules were implemented to train nursing staff in a single nursing unit at a Philadelphia teaching hospital. Recruited nurses completed a code blue simulation session to establish a baseline time to defibrillation. They were then given 2 weeks to complete an online educational module. Upon completion, they participated in a second set of simulation sessions to assess improvement. First round simulations resulted in 33% with delayed defibrillation and 27% no defibrillation. Following the module, 77% of the second round of simulations ended in timely defibrillation, a statistically significant improvement (P < 0.00001). Next steps involve prospective collection of the code blue data to analyze improvement in real code blue events.