bluuebunny/crossref_metadata_2025 huggingface dataset:
United Nations Constitutional Assistance
Authors: Sripati Vijayashri
Published: April 2020

United Nations Constitutional Assistance (UNCA) was conceived as colonial/international trusteeship in 1949. This chapter considers how the United Nations (UN) revived UNCA in sovereign states but escaped the colonial tag. Based on the UN’s official explanations, it is argued that the UN has deployed ideas rooted in international law to legitimize tutoring local actors in order that they adopt the Western liberal constitution. The UN’s four arguments therefore concerns this Constitution. The first is this constitution’s universality; the second is the neutrality of the actor producing or internationalizing this constitution which makes such internationalization non-exploitative; the third is the lawful authorization of the constitution’s internationalization which provides a legitimate basis for producing it; and finally, the temporary nature of the UN’s constitutional assistance which makes the internationalization of constitution-making temporary and so, legitimate.
Inlays of Subjectivity
Authors: Govind Nikhil
Published: April 2020

Inlays of Subjectivity is an incisive exposition of the question of subjectivity in modern Indian literature. Seeking to foreground subjectivity through literary expressions of intense emotionality, whether suffering, humiliation, creativity or strife, it also raises the timely question of the relation of justice and speech. This book studies select influential Indian literary texts across the last hundred years in various Indian languages to find overlapping preoccupations with selfhood. As the first chapter on K. R. Meera’s fiction demonstrates, it is the experience of felt injustice that first opens up the realm of subjectivity. Subjectivity is equally opened up by intense negative affect—such as the experience of humiliation—the memoirs of the Dalit writer Urmila Pawar testify to this in the second chapter. The next two chapters trace the historical and literary origins of this question of subjectivity through the novels of canonical writers such as Agyeya, Ismat Chughtai, Saratchandra Chatterjee, and Rabindranath Tagore. The fifth chapter turns to the subtle and powerful writer Krishna Sobti to bring together all these strands of subjectivity, affect and moral agency required in navigating an unequal and harsh world. The book thus hopes to provoke questions of the literary modes for exploring subject positions in a defined Indian literary milieu, and to reflect upon the relationship of literature, subjectivity, and affect.
Second Study
Authors: Govind Nikhil
Published: April 2020

The second chapter takes off from the first in using the affect of humiliation. Humiliation has already been discussed widely in scholarship with relation to caste—see for example Humiliation: Claims and Context (OUP, 2011). This chapter discusses one of the most influential Dalit memoirs—Urmila Pawar’s Aaydan: The Weave of My Life, A Dalit Woman’s Memoirs (2008). Pawar’s powerful work recounts her life from a rural childhood, through education, marriage, and social prominence in the Dalit movement. The book thus demonstrates the evolving subjectivity of the protagonist as she outgrows intense negative affect (such as caste humiliation) to emerge as a full-fledged and respected writer and activist.
Reflections on Indian Political Economy
Authors: Bardhan Pranab
Published: April 2020

In the more-than-three decades since The Political Economy of Development in India (PEDI) appeared, there have been many changes in the Indian economy and polity. But the principal theme of the 1984 book about the enormous difficulty of collective action in taking long-term policy decisions and implementing them in India’s complex heterogeneous society remains valid. This is reflected in governance issues around infrastructural investment, education, public health, and sanitation and environment. The chapter also considers other structural problems that were not discussed in the original book such as the legitimization crises arising out of the various unequalizing forces of capitalist development and the scattered social movements in reaction; the paucity of jobs for the burgeoning unskilled labour force even when the economy is growing relatively fast; the regional asymmetry in job creation; and the tension between rentier and entrepreneurial capitalism exacerbated by the growth process itself.
Covered with Deep Mist
Authors: Rickles Dean
Published: April 2020

The problem of quantum gravity is often viewed as the most pressing unresolved problem of modern physics, the ‘holy grail’: our theories of spacetime and matter, described respectively by general relativity (Einstein’s theory of gravitation and spacetime) and quantum mechanics (our best theory of matter and the other forces of nature) resist unification. Covered in Deep Mist provides the first book-length treatment of the history of quantum gravity, focusing on its origins and earliest stages of development until the mid-1950s. Readers will be guided through the impacts on the problem of quantum gravity resulting from changes in the two ingredient theories, quantum theory and general relativity, which were themselves still under construction in the years studied. We examine how several of the core approaches of today were formed in an era when the field was highly unfashionable. The book aims to be accessible to a broad range of readers and goes beyond a merely technical examination to include social and cultural factors involved in the changing fortunes of the field. Suitable for both newcomers and seasoned quantum gravity professionals, the book will shine new light on this century old, unresolved problem.
Imaginings like desires
Authors: Currie Gregory
Published: April 2020

We commonly contrast imagining with believing. There is, I claim, another kind of imagining: one that contrasts with desire. I call this i-desire. This chapter makes a case for it based on its role in generating our responses to fiction. The argument depends on a distinction between states with different kinds of correctness or appropriateness conditions. Roughly speaking, beliefs and desires are made appropriate by states of the world, while the various kinds of imagining are made appropriate by states of representations of the world. I consider and reject the idea that we can replace talk of i-desires with talk of desires concerning what is fictional.
The varieties of knowing
Authors: Currie Gregory
Published: April 2020

This chapter reviews recent work in epistemology and draws a number of distinctions that will be of use in later chapters: between knowledge and learning, between knowledge and understanding, between knowledge and wisdom. It emphasizes the difference between propositional knowledge and the much narrower category of knowledge fully expressible in language. It emphasizes the importance of pathways to learning that are reliable. Most importantly it distinguishes propositional knowledge, knowledge of how to do things, and knowledge of what experiences are like (acquaintance); all these, I argue, are forms of knowing which may be made available by exposure to fiction. Relations of reducibility between these kinds are considered, as is the relation between knowing-how and abilities.
Where we are
Authors: Currie Gregory
Published: April 2020

I began this book by saying that it would be an inquiry into the role of fiction in our lives and in particular into two things we care about a great deal and expend a lot of energy on: imagining and knowing. Fiction, I have argued, has a happier, deeper, and more stable relation to imagination than it does to knowledge. Understanding the concept of fiction (a very stable concept I have argued) depends on appreciating what it is to communicate something with the intention that it be imagined: armed with that and a general sense of the overarching purpose the maker of a text has and the ways that avowedly fictional material can be seen to serve some more important non-fictional purpose (and vice versa) we can often come to reasoned judgements that this work is fiction and that one non-fiction: judgments that don’t deviate much from the judgements of common readers, librarians, and booksellers. Later chapters in ...
The Role and Status of the Prosecutor
Authors: Hodgson Jacqueline S.
Published: April 2020

By situating the crown prosecutor and the French procureur within the broader legal cultural traditions in which they operate, this chapter compares the nature of the prosecutor’s role and functions in the two jurisdictions, their relationship with the investigation, and the different ways in which prosecutors’ independence and accountability are structured and understood. Prosecutors play a pivotal role at the heart of the criminal justice process, preparing and prosecuting criminal matters, managing the flux of cases, and, increasingly, disposing of cases through alternatives to prosecution. The different status of prosecutors in France and England and Wales and their relationship to judicial and political authority are important factors in how we understand and evaluate the functions of the prosecutor, the rights and responsibilities of other legal actors, and the legitimacy of the expanding prosecution role.
The Changing Prosecution Role
Authors: Hodgson Jacqueline S.
Published: April 2020

This chapter analyzes the drivers that are reshaping the prosecution service in both jurisdictions, which rest neither on adversarial nor inquisitorial procedural values, nor on broader concerns with fair trial, but on the processing of large numbers of cases with the minimum of cost and delay in order to demonstrate the effectiveness of criminal justice responses to crime. The center of gravity has shifted further toward the pretrial phase, drawing power away from the judiciary toward the public prosecutor and, in some instances, the police. This has been achieved in part through the routine delegation of work and a process of deprofessionalization, in which procedures for the treatment of cases are standardized and simplified, becoming almost automatic. This recasting of the prosecution function has implications for the independence of the prosecutor, for her autonomy and professional standing, and for the balance of legal and constitutional power in the criminal process.
European Influences on the Pretrial Defense Role
Authors: Hodgson Jacqueline S.
Published: April 2020

This chapter examines the changing ways in which the role of the criminal defense lawyer is structured and understood within different procedural traditions, and the challenges posed to individual legal cultures and practices by the growing influence of the ECtHR and the EU. It focuses on the earliest stages of the pretrial defense role, in part because of the determinative importance for the case of the initial police detention and questioning of the suspect, but also because this is where some of the most radical challenges to procedural values and shifts in role expectations have taken place, especially within inquisitorial-type procedures whose legal tradition centers on a model of judicial investigation rather than party-based argument. Pan-European measures and court decisions have sought to cut through procedural differences, focusing instead on effective defense as a fundamental part of the right to a fair trial and an essential component of the privilege against self-incrimination.
ESTIMATION OF AIRBORNE 106RU ACTIVITY CONCENTRATION FROM TOTAL BETA ACTIVITY OF PM10 PARTICLE FRACTIONS
Authors: Suric Mihic Marija , Beslic Ivan , Davila Silvije , Marovic Gordana , Pavelić Luka , Sencar Jasminka
Published: April 2020

Airborne radioruthenium, as a result of an accidental release, presents a risk for occupational and public exposure. In fall 2017, a detection of 106Ru was reported by the European atmospheric radioactive contamination monitoring networks. We investigated the daily specific total beta activity of PM10 particle fractions samples. The presented method enables indirect determination of airborne 106Ru activity concentration from total beta activity, in case 106Ru was confirmed as single excess radiological pollutant. This allows for daily measurements and time-resolved 106Ru activity concentration data. We estimated the indicative committed effective dose due to 106Ru inhalation for the Croatian population during the exposure period. Although the estimated dose value of ~169.7 nSv, for ~6-d duration of ruthenium air pollution, was very low, it was ~40 times higher than the value for Hinh from inhalation of other radionuclides (90Sr + 137Cs + 40K + 7Be).
Tools of the Trade Multivoxel pattern analysis in fMRI: a practical introduction for social and affective neuroscientists
Authors: Weaverdyck Miriam E , Lieberman Matthew D , Parkinson Carolyn
Published: April 2020

The family of neuroimaging analytical techniques known as multivoxel pattern analysis (MVPA) has dramatically increased in popularity over the past decade, particularly in social and affective neuroscience research using functional magnetic resonance imaging (fMRI). MVPA examines patterns of neural responses, rather than analyzing single voxel- or region-based values, as is customary in conventional univariate analyses. Here, we provide a practical introduction to MVPA and its most popular variants (namely, representational similarity analysis (RSA) and decoding analyses, such as classification using machine learning) for social and affective neuroscientists of all levels, particularly those new to such methods. We discuss how MVPA differs from traditional mass-univariate analyses, the benefits MVPA offers to social neuroscientists, experimental design and analysis considerations, step-by-step instructions for how to implement specific analyses in one’s own dataset and issues that are currently facing research using MVPA methods.
Reducing the uncertainty on chilling requirements for endodormancy breaking of temperate fruits by data-based parameter estimation of the dynamic model: a test case in apricot
Authors: Egea Jose A , Egea José , Ruiz David
Published: April 2020

The Dynamic model has been described as one of the most accurate models to quantify chill accumulation based on hourly temperatures in nuts and temperate fruits. This model considers that a dynamic process occurs at a biochemical level that determines the endodormancy breaking through the accumulation of the so-called portions. The kinetic parameters present in the model should reflect how the fruit trees integrate chilling exposure and thus they should be characteristic for each species. However, the original parameter values, reported in the late 1980s, are still being used. Even if the use of such parameter values is useful to compare among chilling requirements (CRs) for different species or cultivars, it is not the optimal choice when one intends to explain the CR variations in different years for a given cultivar. In this work we propose a data-based model calibration that makes use of phenological data for different apricot cultivars within different years to obtain model parameters, which minimize the variations among years and that have, at the same time, physical meaning to characterize the incumbent species. Results reveal that the estimation not only reduces the accumulated portion dispersion within the considered time periods but also allows to improve the CR predictions for subsequent years. We propose a set of model parameter values to predict endodormancy breaking dates in the apricot cultivars studied here.
Spatiotemporal evolution of dengue outbreaks in Brazil
Authors: de Azevedo Thiago S , Lorenz Camila , Chiaravalloti-Neto Francisco
Published: April 2020

Background

Dengue is a mosquito-borne febrile disease infecting millions of people worldwide. Identification of high-risk areas will allow public health services to concentrate their efforts in areas where outbreaks are most likely to occur. The present study focuses on describing the spatiotemporal evolution of dengue outbreaks in Brazil from 2000 to 2018.

Method

To assess the pattern behaviour and spatiotemporal trend of dengue outbreaks, the non-parametric kernel estimator method and the Mann–Kendall test, respectively, were used. Bivariate global Moran's I statistic was used to test the spatial correlation between dengue outbreaks, temperature, precipitation and population data.

Results

Our results revealed that the transmission cycles of dengue outbreaks vary in different spatiotemporal scenarios, with intermittent periods of outbreaks. In the period of study, outbreak clusters were primarily concentrated in the Northeast region and the transmission of dengue extended throughout Brazil until 2018. The probability of occurrence of dengue outbreaks was higher in high temperatures. Further, these space-time fluctuations in the number of outbreaks in the different regions were probably related to the high mobility between the populations of these regions, circulating serotypes and susceptible populations.

Conclusions

The distribution of dengue outbreaks is not random; it can be modified by socioeconomic and climatic moving boundaries.
Evaluating the validity of dengue clinical-epidemiological criteria for diagnosis in patients residing in a Brazilian endemic area
Authors: da Silva Ferreira Elis Regina , de Oliveira Gonçalves Ana Carolina , Tobal Verro Alice , Undurraga Eduardo A , Lacerda Nogueira Maurício , Estofolete Cássia Fernanda , Santos da Silva Natal
Published: April 2020

Background

We evaluated the validity of clinical diagnosis compared with laboratory diagnosis of dengue in a retrospective sample of patients in São José do Rio Preto, Brazil.

Methods

Our sample included 148 299 clinically (56.3%) or laboratory-diagnosed (43.7%) dengue cases. We compared the sensitivity, specificity, positive and negative predictive value (PPV and NPV) of dengue patients’ demographic and clinical characteristics with laboratory-based diagnosis. We used logistic regressions to estimate the correlation between clinical and laboratory diagnosis of dengue and a full set of dengue signs and symptoms.

Results

We found substantial variability in sensitivity and specificity of signs and symptoms ranging from 0.8–81.1 and 21.5–99.6, respectively. Thrombocytopenia exhibited the highest PPV (92.0) and lowest NPV (42.2) and was the only symptom showing agreement with laboratory-confirmed dengue (φ = 0.38). The presence of exanthema and thrombocytopenia led to a greater likelihood of concordant clinical and laboratory diagnoses (exanthema: OR: 4.23; 95% CI: 2.09 to 8.57; thrombocytopenia: OR: 4.02; 95% CI: 1.32 to 12.27).

Conclusions

We found substantial variation in sensitivity, specificity, PPV and NPV of dengue signs and symptoms. For accuracy, clinical and laboratory diagnosis of dengue should be performed concurrently. When laboratory tests are not available, we suggest focusing on the clinical manifestations most associated with dengue.
Pre and postoperative risk management: the role of scores and biomarkers
Authors: Jankovic Radmilo J. , Dinic Vesna , Markovic Danica
Published: April 2020

Purpose of review

The goal of risk prediction is to identify high-risk patients who will benefit from further preoperative evaluation. Clinical scores and biomarkers are very well established tools for risk prediction but their accuracy remains a controversial issue.

Recent findings

Current guidelines recommend one of the risk tools for preoperative cardiac risk assessment: American College of Surgeons National Surgical Quality Improvement Program (NSQIP) calculator or Revised Cardiac Risk Index. Although not as easy to use as risk scores, risk models are more accurate and can predict individual patient risk more precisely. A step forward in risk estimation was performed by introducing new risk models developed from the American College of Surgeons NSQIP database – NSQIP surgical risk calculator and Myocardial Infarction or Cardiac Arrest index. Although biomarkers, especially in cardiac risk assessment, are already present in current European and American guidelines, this use is still controversial. Novel biomarkers: microRNAs, heart-type fatty acid-binding protein and mid-regional proadrenomedullin, can be used as new potential biomarkers in clinical practice. Also some of the experimental biomarkers have not yet been introduced into clinical practice, preliminary results are encouraging.

Different risk indices and biomarkers might lead to varying risk estimates. However, the importance of clinical judgment in risk assessment should not be underestimated.
Anesthesia teams managing pacemakers and ICDs for the perioperative period: enhanced patient safety and improved workflows
Authors: Feldman Joshua B. , Stone Marc E.
Published: April 2020

Purpose of review

There have been both technological and philosophical advances over the last decade regarding pacemakers and implanted cardioverter defibrillators (ICDs). Collectively, these devices are currently referred to as cardiac implantable electronic devices (CIEDs). Technological advances include the introduction of leadless pacemakers, subcutaneous defibrillators and cardiac event recorders, enhancements regarding compatibility of CIEDs for MRI scanning, the ability to interrogate devices remotely, and improved programming modes that preserve battery life. Philosophical advances have been mainly in the area of perioperative management of CIED patients.

Recent findings

Current practice recommendations now acknowledge that not every patient requires a formal interrogation of their CIED before and after surgery (as was previously recommended). The response to magnet application is standardized across manufacturer's platforms, and it is known that sources of electromagnetic interference remote from the CIED and its leads do not usually cause any interference with device function.

Educated anesthesia teams can independently manage the vast majority of CIED patients perioperatively with magnet application alone. Furthermore, this portends enhanced patient safety and improved workflows in the perioperative period.
Breast surgery and peripheral blocks. Is it worth it?
Authors: Schwemmer Ulrich
Published: April 2020

Purpose of review

The objective of this review is to identify the potential of peripheral nerve blocks established over the last years for perioperative pain management in breast surgery. These new blocks will be discussed with respect to their clinical effect and necessity.

Recent findings

After case reports and cadaver studies for the Pecs block and its variations sufficient clinical data from randomized controlled trial (RCT) and meta-analyses exist now. The modified Pecs block or Pecs II leads to a reduction of postoperative 24-h opioid consumption. The recently invented Erector spine block addresses the intercostal nerves. The benefits in analgesia of this approach were tested in few RCTs and showed superiority to the control group in terms of requested postoperative morphine. Most studies showed low intraoperative opioid doses and no study more than low to moderate postoperative pain scores.

Taking the pain levels after breast surgery into account, the request of additional nerve blocks has to be pondered against the potential risks and resource requirement. To reduce or avoid intraoperative or postoperative opioids, an ultrasound-guided Pecs II block proves to be the best option for perioperative pain relief.
Potential Neurodevelopmental Effects of Pediatric Intensive Care Sedation and Analgesia: Repetitive Benzodiazepine and Opioid Exposure Alters Expression of Glial and Synaptic Proteins in Juvenile Rats
Authors: Iqbal O’Meara Alia Marie , Miller Ferguson Nikki , Zven Sidney E. , Karam Oliver L. , Meyer Logan C. , Bigbee John W. , Sato-Bigbee Carmen
Published: April 2020

Objectives:

Sedatives are suspected contributors to neurologic dysfunction in PICU patients, to whom they are administered during sensitive neurodevelopment. Relevant preclinical modeling has largely used comparatively brief anesthesia in infant age-approximate animals, with insufficient study of repetitive combined drug administration during childhood. We hypothesized that childhood neurodevelopment is selectively vulnerable to repeated treatment with benzodiazepine and opioid. We report a preclinical model of combined midazolam and morphine in early childhood age-approximate rats.

Design:

Animal model.

Setting:

Basic science laboratory.

Subjects:

Male and female Long-Evans rats.

Interventions:

Injections of morphine + midazolam were administered twice daily from postnatal days 18–22, tapering on postnatal days 23 and 24. Control groups included saline, morphine, or midazolam. To screen for acute neurodevelopmental effects, brain homogenates were analyzed by western blot for synaptophysin, drebrin, glial fibrillary acidic protein, S100 calcium-binding protein B, ionized calcium-binding adaptor molecule 1, and myelin basic proteins. Data analysis used Kruskal-Wallis with Dunn posttest, with a p value of less than 0.05 significance.

Measurements and Main Results:

Morphine + midazolam and morphine animals gained less weight than saline or midazolam (p ≤ 0.01). Compared with saline, morphine + midazolam expressed significantly higher drebrin levels (p = 0.01), with numerically but not statistically decreased glial fibrillary acidic protein. Similarly, morphine animals exhibited less glial fibrillary acidic protein and more S100 calcium-binding protein B and synaptophysin. Midazolam animals expressed significantly more S100 calcium-binding protein B (p < 0.001) and 17–18.5 kDa myelin basic protein splicing isoform (p = 0.01), with numerically increased synaptophysin, ionized calcium-binding adaptor molecule 1, and 21.5 kDa myelin basic protein, and decreased glial fibrillary acidic protein.

Conclusions:

Analysis of brain tissue in this novel rodent model of repetitive morphine and midazolam administration showed effects on synaptic, astrocytic, microglial, and myelin proteins. These findings warrant further investigation because they may have implications for critically ill children requiring sedation and analgesia.
Gallbladder disease, cholecystectomy, and pancreatic cancer risk in the International Pancreatic Cancer Case-Control Consortium (PanC4)
Authors: Rosato Valentina , Negri Eva , Bosetti Cristina , Malats Núria , Gomez-Rubio Paulina , Consortium PanGenEU , Maisonneuve Patrick , Miller Anthony B. , Bueno-de-Mesquita H. Bas , Baghurst Peter A. , Zatonski Witold , Petersen Gloria M. , Scelo Ghislaine , Holcatova Ivana , Fabianova Eleonora , Serraino Diego , Olson Sara H. , Vioque Jesús , Lagiou Pagona , Duell Eric J. , Boffetta Paolo , La Vecchia Carlo
Published: April 2020

Background

The association among gallbladder disease, cholecystectomy, and pancreatic cancer is unclear. Moreover, time interval between gallbladder disease or cholecystectomy and pancreatic cancer diagnosis is not considered in most previous studies.

Aim

To quantify the association among gallbladder disease, cholecystectomy, and pancreatic cancer, considering time since first diagnosis of gallbladder disease or cholecystectomy.

Methods

We used data from nine case-control studies within the Pancreatic Cancer Case-Control Consortium, including 5760 cases of adenocarcinoma of the exocrine pancreas and 8437 controls. We estimated pooled odds ratios and the corresponding 95% confidence intervals by estimating study-specific odds ratios through multivariable unconditional logistic regression models, and then pooling the obtained estimates using fixed-effects models.

Results

Compared with patients with no history of gallbladder disease, the pooled odds ratio of pancreatic cancer was 1.69 (95% confidence interval, 1.51–1.88) for patients reporting a history of gallbladder disease. The odds ratio was 4.90 (95% confidence interval, 3.45–6.97) for gallbladder disease diagnosed <2 years before pancreatic cancer diagnosis and 1.11 (95% confidence interval, 0.96–1.29) when ≥2 years elapsed. The pooled odds ratio was 1.64 (95% confidence interval, 1.43–1.89) for patients who underwent cholecystectomy, as compared to those without cholecystectomy. The odds ratio was 7.00 (95% confidence interval, 4.13–11.86) for a surgery <2 years before pancreatic cancer diagnosis and 1.28 (95% confidence interval, 1.08–1.53) for a surgery ≥2 years before.

Conclusions

There appears to be no long-term effect of gallbladder disease on pancreatic cancer risk, and at most a modest one for cholecystectomy. The strong short-term association can be explained by diagnostic bias and reverse causation.
Characterizing Urban-Rural Differences in Colon Cancer Outcomes
Authors: Bosma Nicholas A. , Tilley Derek , Batra Atul , Cheung Winson Y.
Published: April 2020

Objective:

We aimed to explore possible drivers for urban-rural disparities in colon cancer outcomes in a single-payer health care system where all patients had access to universal health care coverage.

Methods:

Patients diagnosed with stage II/III colon cancer between 2004 and 2015 in Alberta, Canada were reviewed. On the basis of postal code, patients were categorized as living in urban, rural, or suburban areas based on travel distance to the cancer center. Kaplan-Meier methods and Cox regression models assessed the associations among the area of residence, receipt of treatment, and overall survival (OS).

Results:

Of 6163 patients identified, there were 3691, 1779, and 693 from urban, rural, and suburban areas, respectively. There was a larger proportion of younger patients (P=0.033) and left-sided colon cancers (P=0.042) in urban areas. Urban patients experienced shorter times from diagnosis to surgery (P<0.001), but longer delays from surgery to adjuvant chemotherapy (P=0.001). A significant difference in outcomes was identified among urban, rural, and suburban populations where median OS were 104, 94, and 83 months, respectively (P<0.001). In multivariate analysis, the location of residence continued to predict for worse OS in suburban (hazard ratio=1.60, 95% confidence interval: 1.24-2.07, P<0.001) and rural areas (hazard ratio=1.24, 95% confidence interval: 1.02-1.50, P=0.042), when compared with urban areas.

Conclusions:

In this population-based study, urban-rural differences in colon cancer survival persist, even in settings with universal health care coverage. These findings may be partly driven by a younger population with more left-sided colon cancers as well as expedited surgical intervention in urban populations, but these factors do not fully explain the disparities.
Clear Cell Sarcoma With Cutaneous Presentation in a 4-Year-Old Boy
Authors: Westover Clinton , Bacchi Carlos , Gru Alejandro A.
Published: April 2020

We report a case of a 4-year-old Brazilian boy, who presented with an erythematous and painful nodule involving the skin of his left arm. Immunohistochemistry was performed for S100, SOX10, CD34, desmin, SMA, HMB-45, CD1a, and CD163, and fluorescence in situ hybridization for EWSR1 gene rearrangement using a break-apart probe was completed. Immunohistochemistry showed bland spindle cells with “floret-like” appearance simulating a giant cell fibroblastoma; tumor cells were positive for S100 and SOX10; neoplastic cells were negative for CD34, desmin, SMA, HMB-45, CD1a, and CD163; and fluorescence in situ hybridization showed an EWSR1 gene rearrangement. We report the youngest known case of cutaneous involvement of clear cell carcinoma at the age of 4.
Estimating the Size of a COVID-19 Epidemic from Surveillance Systems
Authors: Yue Mu , Clapham Hannah E. , Cook Alex R.
Published: April 2020

Public health policy makers in countries with Coronavirus Disease 2019 (COVID-19) outbreaks face the decision of when to switch from measures that seek to contain and eliminate the outbreak to those designed to mitigate its effects. Estimates of epidemic size are complicated by surveillance systems that cannot capture all cases, and by the need for timely estimates as the epidemic is ongoing. This article provides a Bayesian methodology to estimate outbreak size from one or more surveillance systems such as virologic testing of pneumonia cases or samples from a network of general practitioners.
Comparison of conventional and fibreoptic-guided advance of left-sided double-lumen tube during endobronchial intubation
Authors: Park Jin-Woo , Jo Ji H. , Park Jin H. , Bae Yu K. , Park Seong-Joo , Cho Sung-Woo , Han Sung-Hee , Kim Jin-Hee
Published: April 2020

BACKGROUND

Postoperative sore throat and airway injuries are relatively common after double-lumen tube (DLT) intubation.

OBJECTIVE

The current study aimed to evaluate the effects of fibreoptic-guided advance of DLT on postoperative sore throat and airway injuries associated with intubation.

DESIGN

A randomised controlled study.

SETTING

Tertiary hospital, Seongnam, Korea, from January 2018 to January 2019.

PATIENTS

One hundred twenty three patients undergoing one-lung ventilation with a left-side DLT were randomised into two groups: 62 in the conventional group and 61 in the fibreoptic-guided group.

INTERVENTION

After entering the glottis, the DLT was rotated left 90° and advanced blindly into the left main bronchus in the conventional group. In the fibreoptic-guided group, DLT was advanced into the main bronchus under the guide of fibreoptic bronchoscope, which had been passed through the bronchial lumen and inserted into the left main bronchus.

MAIN OUTCOME MEASURES

The primary outcome was postoperative sore throat at 24 h after operation. The airway injuries were also examined using a bronchoscope during extubation.

RESULTS

At postoperative 24 h, the fibreoptic-guided group showed lower pain score (P = 0.001) and lower incidence (risk ratio [95% CI]: 0.2 [0.1 to 0.5], P < 0.001) of sore throat, compared with the conventional group. Moreover, tracheal injury was more severe in the conventional group than in the fibreoptic group (P = 0.003). Vocal cord injuries also occurred less frequently in the fibreoptic-guided group (risk ratio [95% CI]: 0.4 [0.2 to 1.0], P = 0.036).

CONCLUSION

The fibreoptic-guided advancement seems to reduce irritation to the airway, leading less postoperative complications.

TRIAL REGISTRATION

ClinicalTrials.gov, registration number: NCT03368599.
Coexistence of metabolic syndrome and osteopenia associated with social inequalities and unhealthy lifestyle among postmenopausal women in South Korea: the 2008 to 2011 Korea National Health and Nutritional Examination Survey (KNHANES)
Authors: Lee Hansongyi , Kim Jieun , Lim Hyunjung
Published: April 2020

Objective:

The prevalence of metabolic syndrome (MetS) and osteoporosis (OP) among postmenopausal women has been rapidly increasing. We examined the associations between socioeconomic status-related factors, unhealthy lifestyle, and the coexistence of MetS and osteopenia or OP.

Methods:

One thousand nine hundred ninety-one postmenopausal women aged 45 to 65 years were used to select a representative sample of the civilian, noninstitutionalized South Korean population from the 2008 to 2011 Korea National Health and Nutrition Examination Survey data. Women were grouped as neither MetS nor OP (normal), MetS, OP, and both MetS and OP (MetS + OP). Socioeconomic status (education, household income, place of residence, employment status), health-related behaviors (physical activity, alcohol consumption, smoking), and diet-related factors (intake of nutrients and food groups, eating habits, food insecurity) were obtained. Logistic regression models were used to examine the odds ratio (OR) and 95% confidence interval (CI).

Results:

The prevalence of MetS + OP was 32.5%. The average number of MetS risk factors in MetS + OP was 3.5, higher than that of normal and OP groups (P < 0.001). Bone mineral density at all sites was significantly lower in MetS + OP than normal and MetS groups (P < 0.001). Also, calcium, phosphorus, vitamin A, riboflavin, and niacin levels were lowest in the MetS + OP group compared with the three other groups (P < 0.05). After controlling for covariates, low-income and low-education women were more likely to have MetS + OP (OR 1.97, 95% CI 1.04-3.72); high-income and high-education group was 70% less likely to have MetS + OP (OR 0.30, 95% CI 0.10-0.86) compared with the middle-income and middle-education group.

Conclusions:

Social inequalities might be powerful contributors in Korean postmenopausal women with coexistence of MetS and OP. Therefore, social and political perspective approaches are required in this population for prevention and treatment of MetS and OP. Future studies should explore to find controllable factors and thereby improve health status in postmenopausal women.
Leadership Quality and Risk of Long-term Sickness Absence Among 53,157 Employees of the Danish Workforce
Authors: Sørensen Jeppe Karl , Framke Elisabeth , Clausen Thomas , Garde Anne Helene , Johnsen Nina Føns , Kristiansen Jesper , Madsen Ida E.H. , Nordentoft Mads , Rugulies Reiner
Published: April 2020

Objective:

To examine whether low leadership quality predicts long-term sickness absence (LTSA) in Denmark.

Methods:

Using Cox models, we estimated the association between exposure to low leadership quality and onset of register based LTSA (more than or equal to 6 weeks) during 12-months follow-up among 53,157 employees without previous LTSA.

Results:

During 51,155 person-years, we identified 2270 cases of LTSA. Low leadership quality predicted LTSA with a dose–respone pattern after adjustment for confounders. The hazard ratio (HR) of LTSA in the lowest compared with the highest quartile of leadership quality was 1.61 (95% CI: 1.43 to 1.82). Further, change from high to low leadership quality over time predicted risk of LTSA (HR = 1.42, 95% CI: 1.02 to 1.97) compared with persistent high leadership quality.

Conclusions:

Exposure to low leadership quality is a risk factor of LTSA in the Danish workforce.
P16/Ki-67 Immunostaining in the Triage of Postmenopausal Women With Low-Grade Cytology Results
Authors: Dovnik Andraž , Repše Fokter Alenka
Published: April 2020

Objective

The interpretation of postmenopausal smears and the gynecological treatment of these patients can often be difficult. The objective of this study was to assess the performance of p16/Ki-67 dual-stained cytology as a triage of atypical squamous cells of undetermined significance and low-grade intraepithelial lesion cytology results in postmenopausal women.

Methods

All consecutive atypical squamous cells of undetermined significance and low-grade intraepithelial lesion smears in 1-year period were collected and p16/Ki-67 immunostaining was performed retrospectively. The results were compared with histology results or long-term cytology follow-up in cases with no biopsy.

Results

The sensitivity of p16/Ki-67 immunostaining for the detection of cervical intraepithelial neoplasia (CIN) 2 and CIN 3 was 57.1% and 85.0%, respectively. The specificity for the detection of CIN 2 was 94.3% and CIN 3 92.4%. Negative predictive values for the detection of CIN 2 and CIN 3 were 96.3% and 99.6%, respectively.

Conclusions

Dual p16/Ki-67 immunostaining is a useful additional method in postmenopausal patients with low-grade cytology. Considering the high specificity and negative predictive value in our study, we believe that it could be helpful in avoiding unnecessary referrals to colposcopy and thus reduce the cost of the program.
Measurement of the Pediatric and Adult Osseous External Auditory Canal: Implications for Transcanal Endoscopic Ear Surgery
Authors: Ito Tsukasa , Kubota Toshinori , Furukawa Takatoshi , Kakehata Seiji
Published: April 2020

Objective:

To develop a method for measuring the diameter of the osseous external auditory canal (OEAC) in pediatric and adult patients.

Study Design:

Retrospective analysis of imaging data from patients with a cholesteatoma who underwent transcanal endoscopic ear surgery (TEES) to remove the cholesteatoma by analyzing preoperative sagittal cone beam computed tomography (CBCT) images using ImageJ.

Methods:

Pediatric and adult patients were included who underwent TEES for a cholesteatoma between December 2011 and March 2015 and had available preoperative CBCT scans. Sagittal CT imaging data were analyzed by ImageJ to measure the maximum and minimum Feret diameters along the OEAC. The output data were then analyzed to determine the smallest maximum and smallest minimum Feret diameters for each patient.

Results:

Fifty-one patients ranging in age from 3 to 83 years old were included in this study. The smallest maximum Feret diameter ranged from 6.5 to 10.1 mm (mean: 8.0 mm) for pediatric patients (<16 years of age) and 6.9 to 15.0 mm (mean: 8.9 mm) for adult patients, while the smallest minimum Feret diameter ranged from 3.6 to 5.9 mm (mean: 5.1 mm) for pediatric patients and 3.4 to 6.4 mm (mean: 5.4 mm) for adult patients. Moreover, the smallest maximum Feret diameters of children were significantly smaller than those of adults.

Conclusion:

We have developed a novel method for measuring the diameter along the OEAC and determining its narrowest site. This method can be incorporated into the preoperative evaluation of patients who are candidates for TEES.
100 Years on: Politzer's Greatest Historical Legacy
Authors: Mudry Albert , Young John Riddington
Published: April 2020

Objective:

To mark the centenary of Adam Politzer's death by investigating and celebrating the legacy he left to otology. Politzer is arguably one of the greatest otologists of the last 200 years and his textbook on otological history is undoubtedly the seminal work on the subject. The aim of this paper is twofold. Not only do the authors hope to find out if he is still remembered by otolaryngologists, but also what has been the greatest legacy which he has bequeathed to them.

Methodology:

Extensive review of available academic literature mentioning the name Politzer.

Results:

Politzer's celebrated tome, History of Otology was not only the first comprehensive book on the subject, but it has stood the test of time and still remains unsurpassed as the “Gold Standard” reference work.

Conclusion:

The considered opinion of the authors (both otolaryngologists and academic historians) is that the name of Politzer certainly lives on and that this book is probably his most enduring legacy to posterity. It can justifiably be said that Adam Politzer was the first otologist to prove the concept that the past is the key of the present, which opens the future.
Apolipoprotein C-II: the re-emergence of a forgotten factor
Authors: Wolska Anna , Reimund Mart , Remaley Alan T.
Published: April 2020

Purpose of review

Apolipoprotein C-II (apoC-II) is a critical cofactor for the activation of lipoprotein lipase (LPL), a plasma enzyme that hydrolyzes triglycerides (TG) on TG-rich lipoproteins (TRL). Although apoC-II was first discovered nearly 50 years ago, there is renewed interest in it because of the recent efforts to develop new drugs for the treatment of hypertriglyceridemia (HTG). The main topic of this review will be the development of apoC-II mimetic peptides as a possible new therapy for cardiovascular disease.

Recent findings

We first describe the biochemistry of apoC-II and its role in TRL metabolism. We then review the clinical findings of HTG, particularly those related to apoC-II deficiency, and how TG metabolism relates to the development of atherosclerosis. We next summarize the current efforts to develop new drugs for HTG. Finally, we describe recent efforts to make small synthetic apoC-II mimetic peptides for activation of LPL and how these peptides unexpectedly have other mechanisms of action mostly related to the antagonism of the TG-raising effects of apoC-III.

The role of apoC-II in TG metabolism is reviewed, as well as recent efforts to develop apoC-II mimetic peptides into a novel therapy for HTG.
Remnant lipoproteins: are they equal to or more atherogenic than LDL?
Authors: Salinas Carlos A. Aguilar , Chapman M. John
Published: April 2020

Purpose of review

To critically appraise new insights into the biology of remnant lipoproteins and their putative role in the pathophysiology of atherosclerotic cardiovascular disease, and to compare the atherogenicity of remnant particles with that of low-density lipoproteins (LDL).

Recent findings

New in-vivo stable isotope tracer studies of the kinetics of apoB48 and apoB100-containing lipoproteins in postprandial conditions have revealed that apoB48-containing very low-density lipoproteins (VLDL) accumulated markedly in hypertriglyceridemic patients. These intestinally-derived particles were cleared slowly, and represented up to 25% of circulating VLDL; as part of the remnant particle population, they may increase cardiovascular risk. Importantly, the PCSK9 inhibitor, evolocumab, was shown to reduce remnant levels (−29%) during the postprandial period in diabetic patients on statin therapy – an effect which may be additive to that of LDL-cholesterol reduction in conferring cardiovascular benefit. In recent Mendelian randomization studies, the effect of lowering triglyceride-rich lipoproteins or LDL-cholesterol translated to similar clinical benefit per unit of apoB. Finally, in randomized trials involving statin-treated patients with atherosclerotic cardiovascular disease, remnant cholesterol levels were associated with coronary atheroma progression independently of LDL-cholesterol.

Overall, data from observational studies in large cohorts, Mendelian randomization studies, meta-regression analyses, and post-hoc analyses of randomized trials are consistent with the contention that remnants are highly atherogenic particles and contribute to the atherosclerotic burden in an equivalent manner to that of LDL.
Prediction of Cognitive Ability With Social Determinants in Children of Low Birth Weight
Authors: Blair Lisa M. , Ford Jodi L. , Gugiu P. Cristian , Pickler Rita H. , Munro Cindy L. , Anderson Cindy M.
Published: April 2020

Background

Despite strong prevention efforts and advances in neonatal care in recent decades, low birth weight remains a serious public health problem in the United States, and survivors remain at increased risk for lifelong problems including cognitive deficits. Current regional and local strategies for referral often rely on variable thresholds for birth weight and gestational age that may be poor analogues to cognitive risk. Improving early referral criteria offers many benefits, including improved cognitive outcomes for children and improved cost-effectiveness and resource utilization in resource-limited communities.

Objectives

We hypothesized that social determinants measurable at birth or at birth hospital discharge, when combined with birth weight and gestational age, would offer an improvement over birth weight and gestational age alone in predicting cognitive test scores in school-aged children with low birth weight.

Methods

We conducted a secondary analysis using a birth cohort of children from the Fragile Families and Child Wellbeing Study. We created a panel of maternal, familial, and community-level social determinant indicators from the data and examined associations with cognitive measures assessed at age of 9 years.

Results

The final social determinant model was statistically significant and explained 35% of the total variance in composite test scores. The “standard care” model (birth weight and gestational age) only explained 9% of the variance.

Discussion

Assessment of social determinants may offer improvement over traditional referral criteria to identify children most at risk of cognitive deficits after low birth weight.