bluuebunny/crossref_metadata_2025 huggingface dataset:
Empathy in Psychotherapy for Pregnancy Loss
Authors: Markin Rayna D.
Published: December 2023

This chapter begins with a brief empirical review of empathy in psychotherapy. Evidence-based relationship principles derived from research on empathy in psychotherapy are then applied to the treatment of clients who have specifically suffered a pregnancy loss. Based on theory and research, the author describes how various aspects of empathy in the therapy relationship can help to undo the client’s sense of aloneness, heal narcissistic injuries that resulted from the loss, and process and grow from trauma and grief. Hypothetical therapist–client vignettes are given to demonstrate the application of these concepts. Finally, common challenges to empathy in psychotherapy for pregnancy loss and clinical implications are discussed.
Managing Countertransference in Psychotherapy for Pregnancy Loss
Authors: Markin Rayna D.
Published: December 2023

This chapter begins with a brief theoretical and empirical review of various aspects of countertransference, particularly countertransference management and its relation to psychotherapy outcome. Evidence-based relationship principles derived from research on countertransference in psychotherapy are then applied to the treatment of clients who have suffered a pregnancy loss specifically. Pregnancy loss with and without infertility are examined in this chapter because both represent reproductive traumas that can have a significant impact on an individual’s sense of self and other, which, in turn, can cause powerful transference–countertransference dynamics in the therapy relationship. Based on theory and research, signs of internal countertransference reactions and overt countertransference behaviors are explored, including inappropriate therapist self-disclosure. Common transference–countertransference themes when working with pregnancy loss and infertility are discussed, including when either the therapist or client becomes pregnant. Case examples demonstrate the application of these ideas. Clinical challenges to managing countertransference and clinical implications are offered.
Where Do We Go From Here?
Authors: Markin Rayna D.
Published: December 2023

This concluding chapter offers future research directions, training recommendations, and practice guidelines for psychotherapy for pregnancy loss. It is suggested that future research, practice, and training in this area prioritize the therapy relationship as a vehicle to help clients process and grow from the trauma of loss, grieve, and rebuild healthy self-esteem after the loss of a pregnancy or unborn baby. Future research, practice, and training should address the deeper level wounds left behind by the loss of a pregnancy and go beyond symptom reduction. Psychotherapy research, training, and practice should focus on culturally sensitive treatments for women of color who are at risk for miscarriage and stillbirth and consider the unique psychosocial experiences of LGBTQ + individuals and families coping with pregnancy loss.
Digital Natives
Authors: Arnett Jeffrey Jensen
Published: December 2023

Given the abundance of time they devote to their digital diversions, no account of the lives of emerging adults would be complete without attention to their media uses. This chapter begins with an elucidation of their rates of media use, in areas including listening to music, using social media, watching television, texting, and playing electronic games. Next follows an examination of the role that media play in emerging adults’ lives, especially their identity development. A section then focuses on the question of whether emerging adults’ media uses undermine their social relations. At the end of the chapter is an exploration of the contentious question of whether all this media use is a positive or negative force in their development, concluding that today’s emerging adults integrate their media use into their lives in ways that promote more than undermine their social connectedness and their enjoyment of life.
Becoming Adult
Authors: Arnett Jeffrey Jensen
Published: December 2023

This chapter focuses on the transition from emerging adulthood to the next stage of life. First there is a look at how adulthood has been defined in traditional cultures and in the past in American history. Then research is presented showing how emerging adults today define adulthood and assess their own progress toward adult status. Next, emerging adults reflect on their mixed feelings about leaving adolescence; from the perspective of emerging adulthood, it seems like an easier time. Then they describe their mixed feelings about becoming adults; from the perspective of emerging adulthood, reaching adulthood promises stability but inspires fears of stagnation. Finally, the chapter examines their views of the future, and how they foresee a happy and successful life for themselves even as they believe the world in general is fraught with peril.
Nationwide shutdowns and government offensives
Authors: Gohdes Anita R.
Published: December 2023

This chapter studies the logic and dynamics of Internet shutdowns as they were implemented in Syria between 2011 and 2014. It discusses two central motives for implementing nationwide shutdowns in the context of an armed internal conflict, namely shutting down the Internet as part of a concerted repressive effort or as a reputation-saving measure. The results of the analysis of network outages and daily conflict fatalities in Syria suggest that the government implemented large-scale disruptions selectively and purposely in conjunction with concerted repressive offensives against the opposition. The chapter then goes on to present estimated levels of undocumented violence before and during Internet shutdowns and shows that the shutdowns did not systematically affect the reporting of violence.
Conclusion
Authors: Gohdes Anita R.
Published: December 2023

The final chapter discusses the central findings and reflects on the implications they hold for our understanding of domestic cyber controls, for future research, and for activists faced with the consequences of online controls in their everyday life. The findings suggest that cyber capabilities in the form of online surveillance and censorship have taken a supportive role in a state’s repressive apparatus. The findings expand our understanding of state coercion by studying how the control of digital infrastructure is supercharging states’ abilities to engage in information management. Online monitoring has facilitated state access to previously hard-to-reach sectors of society as it bypasses the need for local in-person intelligence gathering that necessitates long-term investment in trustworthy personnel. Online censorship has accelerated states’ abilities to flexibly stifle or even shut down popular coordination and information exchange for short periods of time, thereby avoiding long-term information vacuums that could prove dangerous for regime stability
Explaining Creativity
Authors: Sawyer R. Keith , Henriksen Danah
Published: December 2023

Given the heightened complexity and uncertainty of the world we live in, creativity, or the ability to develop new and effective ideas, products, or solutions, has grown in societal interest internationally. There is a recognition of the need for creative problem solving to address complex problems, and thus, new areas of creativity studies and applications have rapidly emerged. Creativity is increasingly recognized as a highly coveted and prized skill for the future of work and life. This book builds on the essential foundations of creativity research and practice that were established in the first and second editions of the book. It provides an up-to-date and exhaustive review of research findings, as well as chapters on new topics were not included in prior books: technology, wellbeing, and self-beliefs. Explaining Creativity takes an interdisciplinary approach that explains concepts, topics and themes related to creativity in ways that are accessible to students and non-experts, yet thorough and detailed enough to be useful to academics or other experts. This broad and practical, yet still detailed, approach covers a broad terrain of the creativity landscape, investigating core aspects of creative cognition, creative practice, and social and cultural contexts for creativity.
Fiscal Barriers in the Internal Market
Authors: Schütze Robert
Published: December 2023

How do the EU Treaties remove fiscal barriers within the internal market; and in particular: what are the constitutional principles under its four fundamental freedoms? This chapter aims to explore these two questions. Section II begins with an analysis of the constitutional principles governing the free movement of goods. We shall see there that the existence of two textual regimes for regulatory and fiscal barriers has translated, over time, into two different constitutional regimes for both types of measures: regulatory measures would be subject to a highly integrationist—federal—regime that significantly cut into the internal sovereignty of each Member State, whereas fiscal barriers would continue to be governed by a traditional international model that focuses on discrimination within and by a national legal order. Would this ‘fiscal affairs exception’, with regard to goods, apply to the other three fundamental freedoms too; or would the Court here assimilate regulatory and fiscal barriers? Section III shows that the European Court has—despite the absence of a textual Treaty distinction—also adopted the non-assimilation solution here by introducing a category approach that implicitly distinguishes between regulatory and fiscal barriers. Are there constitutional reasons for this? Section IV hopes, in a final step, to point to objective differences between regulatory and fiscal national measures.
Tax Powers and the EU State Aid Regime
Authors: de Cecco Francesco
Published: December 2023

The chapter explores the EU state aid regime from the perspective of fiscal powers. It is divided into four sections. The first considers the relevance of state aid law to business taxation. It elucidates the manner in which the EU state aid regime constrains both the internal allocation of tax powers and the exercise of those powers in relation to cross-border economic activities and examines some of the controversies surrounding the interpretation of key elements in the notion of state aid that determine these constraints. The second links the discussion on the reaches of state aid law with the underlying rationale for state aid control and rejects the claims that the Commission’s approach to tax rulings amounts to competence creep and harmonization by stealth. The third section goes on to consider whether the instrumental approach at play in this area represents a threat to the rule of law. The fourth and final section draws the threads together and casts a tentative glance into the future.
The Harmonization of Indirect Taxes
Authors: Traversa Edoardo , Masseglia Elena
Published: December 2023

The harmonization of indirect taxation is inextricably linked to the achievement of the internal market and the Customs Union. Owing to the immediate effects on cross-border trade of national disparities as regards taxes on goods and services, the Commission has been able to convince Member States to adopt common rules in an area where sovereignty concerns are particularly strong. Such a harmonization process has facilitated free movement within the EU. However, it cannot be regarded as mere technical–legal process but has a clear political dimension. In both VAT and excises duties, harmonization slowly started in the 1960s and peaked with the single market and the abolition of fiscal frontiers in the early 1990s. Since then, the legal framework has only undergone minor changes. Despite innovative and potentially far-reaching Commission proposals in various fields, such as CO2 and energy taxation, taxation of financial transactions, or a cross-border VAT, recent reforms concern only relatively marginal aspects of the existing directives—at least as regards the horizontal and vertical division of taxing powers within the EU.
The Harmonization of Direct Taxes
Authors: Panayi Christiana HJI
Published: December 2023

This chapter has examined the extent to which there is harmonization of direct taxes in the European Union. It was shown that, broadly, what could currently be considered as the direct tax legislation of the European Union is a patchwork of minimum rules (enacted through directives) which try to address some of the distortions caused by the co-existence of different and largely unharmonized tax systems of Member States. Most of the rules that exist deal with corporate tax matters. This patchwork of rules is significantly enriched by—but also sometimes in contradiction with—the voluminous case law of the Court of Justice, which establishes how some of the fundamental freedoms are to be interpreted in various increasingly complex tax scenarios.
Epilogue
Authors: Piketty Thomas , Vauchez Antoine
Published: December 2023

A ‘Hamiltonian turn’ of the European Union would require it to strengthen its ‘metabolic’ capacity by means of both an autonomous fiscal capacity and more autonomous democratic credentials. The T-Dem proposal (Treaty for the Democratization of Europe) provides a possible way forward in this respect. The T-Dem thereby suggests imposing direct taxes on those firms and individuals that have made the most of the opportunities of the Single Market and of the euro (major multinationals, households with high incomes and high assets). Last but not least, it anchors the collective decisions about European solidarity and about European public goods in firm democratic hands with the creation of a transnational Parliament (the European Assembly) composed of delegations from the European and the national parliaments. Among the reasons for the new role given to national parliaments lies the fact that one of the main obstacles to fiscal integration in the past has been the refusal of national parliaments (most often backed by constitutional courts) to lose their monopoly over fiscal prerogatives.
Revelation
Authors: Apetrei Sarah
Published: December 2023

This chapter considers the radical theology of the English Revolution, in its confrontation with speculative knowledge, as a symptom of a wider and deeply gendered epistemological shift which gave newly politicized meaning to mystical theology. I compare the cultural significance of female prophets and preachers in the Revolution (‘silly women’) to that of Catholic female mystics, sought after for their pure, untainted spiritual perception. I focus especially on Augustine Baker and his muse Gertrude More, whose mystical writings published in the 1650s influenced the Restoration reaction against both Catholic mysticism and ‘enthusiasm’ or radical prophecy. The second part of the chapter examines the relationship between the high, even ultimate, status given to experiential knowledge as revelation, and women’s status in the mystical radical milieu, not least among the Fifth Monarchists in the Dublin congregation of John Rogers.
Introduction: History of Topology, Knots, Peter Tait, and Lord Kelvin
Authors: Simon Steven H.
Published: December 2023

How Lord Kelvin and Peter Tait tried to describe atoms with topology and created the field of knot theory.
Aharonov–Bohm Effect and Charge–Flux Composites
Authors: Simon Steven H.
Published: December 2023

We give a basic introduction to the Aharonov-Bohm effect, and use this effect to construct a toy-model of anyons known as the“charge-flux” model. We explore some of the basic properties of this model, including fusion of anyons, antiparticles, and the degeneracy of the ground state on a torus, which is related to the number of species of anyons. This degeneracy can in principle serve as a quantum memory.
Defining Topological Quantum Field Theory
Authors: Simon Steven H.
Published: December 2023

Atiyah systematized the general principles of topological quantum field theories in terms of the mathematics of gluing together manifolds and combining vector spaces. A TQFT roughly is a partition function Z(M) with M a manifold, that returns a number of M has no boundary and a wavefunction on the boundary if M has a boundary. Manifolds can be glued together on their boundaries by taking inner products of wavefunctions. We roughly describe this approach and describe how it relates to the physics of anyons as we have discussed in prior chapters. We also introduce the important notion of the modular S-matrix as a change of basis.
State-Sum TQFTs
Authors: Simon Steven H.
Published: December 2023

Manifolds can be decomposed into simplicies (triangles in 2D or tetrahedra in 3D). TQFTs can be constructed as state sums over discrete quantum numbers on the on these discretized manifolds. Such sums appear like partition functions, statistical mechanics sums of Boltzmann weights. In order to for these sums to yield manifold invariants the sum must be independent on the particular simplicial decomposition (or triangulation) of the manifold. The so-called “Pachner Moves” describe all possible changes of the decomposition, so a sum which is unchanged under Pachner moves gives a manifold invariant. One such state sum is the the Turaev-Viro state sum, which takes as an input a (spherical) fusion category (F matrices satisfying the pentagon equation) and then allows one to assign a (scalar) manifold invariant to a 3D manifold. The corresponding TQFT is known as the quantum double, or Drinfeld double of the fusion category. Much of the study of the Turaev-Viro model has been in the context of so-called spin-network models of quantum gravity. A very similar state sum TQFT is the Dijkgraaf-Witten model, which (in 3D) takes as an input a group and a 3-cocyle (acting as F-matrices). The Dijkgraaf-Witten model is generalizable to any dimension.
Anyon Condensation
Authors: Simon Steven H.
Published: December 2023

A mechanism for constructing one anyon theory from another is anyon condensation, akin to Bose condensation. It is believed that any continuous phase transition between TQFTs must occur by such a condensation transition. We describe the main steps in such a condensation: Identification/Splitting, and Confinement. We give simple examples when the condensing boson is a simple current then describe the more general structure. We explain how the idea of a Chern-Simons coset can be understood under the framework of condensation. Finally we discuss the relationship between condensation and gappable boundaries.
Appendix: Some Mathematical Basics
Authors: Simon Steven H.
Published: December 2023

This chapter is included to introduce some basic mathematical concepts. This includes basic notions about manifolds, basic ideas about groups, group theory, Lie groups, Lie algebras, representations, and the topological idea of a fundamental group.
Learning Latin in the Roman Army
Authors: Speidel Michael A.
Published: December 2023

Although this chapter, contrary to some recently expressed views, accepts that Latin was the official language of the Roman army, it challenges the common view that soldiers and veterans were key vectors of linguistic change in the provinces of the Roman Empire. The argument is based mainly on the demographic realities in the provinces, in which, numerically, soldiers and veterans made up far too small a proportion of the population to have had a notable impact on the spreading of Latin into non-Latin-speaking communities. Moreover, at the level of the rank and file, service in the army required only a basic knowledge of Latin. Non-native speakers of Latin therefore needed to acquire advanced levels of the language of the Romans only if they intended to advance to higher ranks. Finally, a significant number of auxiliary veterans returned to their former homes after discharge and used their native tongue when communicating with the local population. Hence, such veterans hardly contributed to the diffusion of Latin in the provinces. The Roman army, therefore, does not emerge as a major agent in the spreading of Latin in the Western provinces.
Religion, Language Maintenance, and Language Shift
Authors: Cazanove Olivier De , Tolosa MarÍa JosÍ EstarÁn
Published: December 2023

This chapter explores the role of religious practice in the linguistic changes of Roman-period Gaul, both as a conservative factor in the retention of the local language, Gaulish, and as a Latinizing factor. Epigraphic sources show that domain-based choices linked to religious practices can be a crucial factor for evaluating linguistic shift, generating complex and heterogeneous situations during the period where both local and Roman practices coexisted. We argue that in Gaul this transitional period lasted for longer than is usually assumed. These situations are illustrated with relevant case studies of epigraphic ensembles from Vieille-Toulouse and Alesia framed in their archaeological and sociolinguistic context, and a perspective on the pillar of the nautae, an enigmatic piece in the study of the Latinization of Gaul.
The Attitude of the Roman Emperors towards Language Practices
Authors: Rochette Bruno
Published: December 2023

In this chapter, the focus is on the attitudes of the Roman emperors towards language practices, which sometimes become ideologies mirrored in language usage throughout the Empire, in order to highlight the political aims that lay behind the use they made of Latin and Greek and how languages were used as a political weapon. The first Julio-Claudian emperors understood the importance of the quality of Latin and its use in administration as an element to create a Roman identity in the Imperium Romanum, without making any attempt to impose it in any part of the Empire. After Augustus and Tiberius, who demonstrated an interest in regulating the use of languages in public life, linguistic policy appears to be flexible and adapted to the circumstances. About the situation after Nero’s reign there is less information available. Under the Antonine emperors, a balanced bilingualism is reached. The period from Marcus Aurelius’ death (180) to Constantine’s death (337) is relatively barren in terms of commentary on linguistic attitudes, which can mainly be found in the texts of the classical jurists, which culminated under the Severi. I conclude by briefly taking into account the situation after Constantine until Justinian’s reign (527–65). The documentary sources from the Roman Empire are an important resource for seeing these attitudes and developments possibly reflected in practice and in linking Latin to the Imperium Romanum.
Membership and Congruence
Authors: Martin Shane , Strøm Kaare W.
Published: December 2023

To help us understand better the challenges of legislative capacity and accountability within the three ideal-typical models of legislative assemblies developed in Chapter 1 (the members’ assembly, the leaders’ assembly, and the voters’ assembly), this chapter focuses on the membership and composition of the legislative assembly. As with any multi-person body, the composition of a chamber can be analyzed according to an almost-infinite set of characteristics. Many scholars and voters believe that the partisan, demographic, economic, and professional characteristics of legislators may matter a great deal. In this chapter, we explore in particular two of the most important and commonly studied dimensions by which the membership of legislative chambers has been assessed: (1) the degree to which the membership of the chamber reflects the partisanship of the citizenry and (2) the proportion of assembly members that are female. Both aspects are important to popular representation in any assembly. Specifically, a voters’ assembly will have a membership that broadly reflects the partisanship of the voters and in which both genders are significantly represented. We discuss the importance of such member–voter congruence.
Committees
Authors: Martin Shane , Strøm Kaare W.
Published: December 2023

To help us understand better the challenges of legislative capacity and accountability within the three ideal-typical models of legislative assemblies developed in Chapter 1 (the members’ assembly, the leaders’ assembly, and the voters’ assembly), this chapter focuses on committees. The chapter discusses why a legislative assembly would create and empower a system of committees. The scholarly literature on committees has offered competing explanations of why committees have been such a popular form of legislative organization. This chapter therefore reviews the four most prominent explanations. We describe the primary contours and variation in how real-world legislative committees are designed and relate such organizational design to our concepts of voters’, members’, and leaders’ assemblies. Formal structures and powers define a legislative assembly’s committee system. Our focus is on the number of committees, their membership, and their powers. This will help identify the degree to which committees play a significant role in the life of a legislative assembly. It will also aid our understanding of whom, if anyone, this legislative organization privileges, and how. Having described the components of a legislative committee system, we next examine variation in their structure across different assemblies.
The society project
Authors: Baczko Adam
Published: December 2023

During the war, the Taliban judicial system participated in the production of an alternative social order characterized by social conservatism and moral rigour. As a whole, its verdicts show the movement’s plan to preserve—that is, to reproduce—the property structures and social hierarchies of the pre-war period. Thus, as had happened during the 1990s, the judges imposed an identity regime, which followed the main lines of the pre-war regime in favouring the Pashtuns by denying the ethnic question and relegating the Shiites to second-class status. In addition, they guaranteed private property by combating the violent land grabs by 1990s commanders and regime strongmen, but also ensured the reproduction of economic inequalities around land. When it came to gender issues, while the Taliban appeared to be more flexible than in the 1990s with respect to certain practices (music, mobile phones, films, games), quite the opposite was the case. Here, the judges ruled with particular severity: they guaranteed a system of patriarchal domination based on repressing deviance in the public sphere and on delegating the resort to violence in the domestic space to the heads of families. This conservative programme legitimized the social rise of religious elites. Indeed, the judges’ attending to the public good concealed a work of universalizing the special interests of the ulama. By reshaping the state and society through the application of Islamic law, judges promoted an order in which religious status would determine access to positions of power, at the obvious expense of non-religious elites.
Pakistan's Nuclear Exclusion
Authors: Rahim Sana
Published: December 2023

Developed over six chapters, Pakistan’s Nuclear Exclusion offers an account of how Orientalism is a lived experience of post-colonial racism, injustice, and inequality amongst members of the nuclear community in Pakistan. The account is produced through interviews with members of the community consisting of students, academics, and physicists in Pakistan. The book offers unique insights into how Pakistan’s nuclear community is not only perceived/represented but also, therewith, how it seeks to operate in a wider nuclear community dominated by Western nuclear powers. The provision of such highly contextualized insights is enabled by the book setting out to both (a) provide analytical space for and (b) ‘give voice’ to how Orientalism and othering is experienced in their everyday lives. Consequently, the book provides (1) an analysis of how ‘dominant discourses’ of nuclear management and their ‘pictures of reason’ are exclusionary, (2) an analysis of the core features of Orientalism as they pertain to Pakistan’s nuclear weapons and nuclear community, and (3) empirical findings which produce categories of the experience of Orientalism into areas of the everyday—exclusion, making a career, Islamophobia, technology denial, self-reliance, and identity. The book is enormously valuable to the research community as well as extremely well conceived and researched. In addition, much of the methodology chapter offers a level of sophistication and self-reflection that translates well in the interview material and its subsequent analysis.
Birth and Death of Ancient Cities
Authors: Shankar Pratyush
Published: December 2023

This chapter opens with the discussion about cities in the Indian sub-continent right from the time period of Indus Valley civilization. This is amongst the most intriguing period of history especially from the point of view of development of cities as we have very scant evidence on the nature of society and the state. The cities show a level of sophistication that points toward a highly organized state. The cities after this period were predominantly built with wood originated in the North Indian flood plains can only be imagined through textual reference as not much of physical evidence remains on ground anymore.
Temple Towns of South India
Authors: Shankar Pratyush
Published: December 2023

The temple-based settlements in South India might be amongst the oldest surviving examples of cities in India. The origin and evolution of these ‘temple towns’ were intricately connected with the establishment of new irrigation project to make agricultural land more productive and thereby increase surplus. The temple as an institution was absolutely in the centre of the management of these large-scale irrigation projects. This was the single most important reason that led to formation of cities with the temple as its symbolic centre. The temple here works as a proxy to the state and becomes the nuclei of the diagram of the city that signifies power and control.
Aerobic iron-oxidizing bacteria secrete metabolites that markedly impede abiotic iron oxidation
Authors: Baker Isabel R , Matzen Sarick L , Schuler Christopher J , Toner Brandy M , Girguis Peter R
Published: December 2023

Iron is one of the Earth's most abundant elements and is required for essentially all forms of life. Yet, iron's reactivity with oxygen and poor solubility in its oxidized form (Fe3+) mean that it is often a limiting nutrient in oxic, near-neutral pH environments like Earth's ocean. In addition to being a vital nutrient, there is a diversity of aerobic organisms that oxidize ferrous iron (Fe2+) to harness energy for growth and biosynthesis. Accordingly, these organisms rely on access to co-existing Fe2+ and O2 to survive. It is generally presumed that such aerobic iron-oxidizing bacteria (FeOB) are relegated to low-oxygen regimes where abiotic iron oxidation rates are slower, yet some FeOB live in higher oxygen environments where they cannot rely on lower oxygen concentrations to overcome abiotic competition. We hypothesized that FeOB chemically alter their environment to limit abiotic interactions between Fe2+ and O2. To test this, we incubated the secreted metabolites (collectively known as the exometabolome) of the deep-sea iron- and hydrogen-oxidizing bacterium Ghiorsea bivora TAG-1 with ferrous iron and oxygen. We found that this FeOB's iron-oxidizing exometabolome markedly impedes the abiotic oxidation of ferrous iron, increasing the half-life of Fe2+ 100-fold from ∼3 to ∼335 days in the presence of O2, while the exometabolome of TAG-1 grown on hydrogen had no effect. Moreover, the few precipitates that formed in the presence of TAG-1's iron-oxidizing exometabolome were poorly crystalline, compared with the abundant iron particles that mineralized in the absence of abiotic controls. We offer an initial exploration of TAG-1's iron-oxidizing exometabolome and discuss potential key contributors to this process. Overall, our findings demonstrate that the exometabolome as a whole leads to a sustained accumulation of ferrous iron in the presence of oxygen, consequently altering the redox equilibrium. This previously unknown adaptation likely enables these microorganisms to persist in an iron-oxidizing and iron-precipitating world and could have impacts on the bioavailability of iron to FeOB and other life in iron-limiting environments.
Organ damage is a major determinant of work productivity impairment in Behçet’s syndrome: a post hoc analysis of the BODI validation study
Authors: Floris Alberto , Laconi Riccardo , Espinosa Gerard , Lopalco Giuseppe , Serpa Pinto Luisa , Kougkas Nikolaos , Sota Jurgen , Lo Monaco Andrea , Govoni Marcello , Fabiani Claudia , Bertsias George , Correia João , Iannone Florenzo , Cervera Ricard , Vasconcelos Carlos , Mathieu Alessandro , Cauli Alberto , Piga Matteo
Published: December 2023

Objectives

To evaluate the prevalence, magnitude and potential determinants of work productivity impairment in patients with Behçet’s syndrome (BS), focusing on the role of irreversible organ damage.

Methods

A post hoc analysis of the BS Overall Damage Index (BODI) prospective validation study was performed. Demographics and clinical features were recorded in all patients. The Work Productivity and Activity Impairment: General Health (WPAI:GH) questionnaire was administered to assess the work limitation and the BODI to measure organ damage. The independent effect of BS features on WPAI:GH outcomes was evaluated by regression analysis.

Results

Of 148 patients, 34.5% were unemployed, with age [odds ratio (OR) 1.035] and BODI score (OR 1.313 for a 1-unit increase) as the only factors significantly (P < 0.05) associated with the unemployment state. Overall work impairment was reported in ≈64.2% of the employed patients. Indeed, 22.7% reported missing work hours due to their health (absenteeism), with a mean time loss of 34.4%, whereas 60.2% declared reduced performance at work because of their health (presenteeism), with a mean productivity impairment of 45.4%. Ocular damage was associated with absenteeism (β = 0.225); female sex (β = 0.260), physician global assessment of disease activity (β = 0.502) and an increased BODI score (β = 0.166 for 1-point increase) with presenteeism; and fibromyalgia (β = 0.246), Physician Global Assessment (β = 0.469) and musculoskeletal damage (β = 0.325) with overall work impairment.

Conclusions

Disease activity and organ damage accrual remarkably affect work productivity in BS patients. Achieving remission and preventing damage accrual are crucial and complementary objectives.
Decoding the diagnostic potential of T cell repertoires in peripheral blood of patients from amnestic mild cognitive impairment to Alzheimer's disease
Authors: Du Yansheng , Zhang Yichen , Diao Jiuzhou , Fu Pengrui , Jiang Runze , Wang Ping , Yang Hui , Zheng Xiaolei , Zhang Leisheng , Bi Jianzhong , Zhou Qingbo
Published: December 2023

Alzheimer's disease (AD) is currently an incurable neurodegenerative disorder and is the most common etiological cause of dementia. Consequently, it has severe burden on its patients and on their caregivers and represents a global health concern. Clinical investigations have indicated that a dysregulation of peripheral T cell immune homeostasis may be involved in the pathogenesis of AD, as well as in the early stages of AD, characterized by mild cognitive impairment (MCI). However, the characteristics and concomitant feasibility of the use of T‐cell receptor (TCR) typing for disease diagnosis remains largely unknown. We employed a high‐throughput sequencing and multidimensional bioinformatics analyses for the identification of TCR repertoires present in peripheral blood samples of 10 patients with amnestic MCI (aMCI), 10 patients with AD, and 10 healthy controls (HCs). Based on the characteristics of the TCR repertoires in the amount and diversity of combinations of V–J, the spectrum of immune defense, and differentially expressed genes (DEGs), single and specific TCR profiles were observed in the patient samples of aMCI and AD compared to profiles of HCs. In particular, the diversity of TCR clonotypes manifested a pattern of “decreased first and then increased” pattern during the progression from aMCI to AD, a pattern that was not observed in HC samples. Additionally, a total of 46 and 35 amino acid CDR3 sequences with consistent and reverse expressive abundance with diversity of TCR clonotypes were identified, respectively. Taken together, we provide novel and essential preliminary evidence demonstrating the presence of diversity of T cell repertoires from differentially expressed V–J gene segments and amino acid clonotypes using peripheral blood samples from patients with AD, aMCI, and from HC. Such findings have the potential to reveal potential mechanisms through which aMCI progresses to AD and provide a reference for the future development of immune‐related diagnoses and therapies for AD.
Orthopaedic Trauma and Anemia: Conservative versus Liberal Transfusion Strategy: A Prospective Randomized Study
Authors: Mullis Brian H. , Mullis Leilani S. , Kempton Laurence B. , Virkus Walter , Slaven James E. , Bruggers Jennifer
Published: December 2023

OBJECTIVES:

To determine whether it is safe to use a conservative packed red blood cell transfusion hemoglobin (Hgb) threshold (5.5 g/dL) compared with a liberal transfusion threshold (7.0 g/dL) for asymptomatic musculoskeletal injured trauma patients who are no longer in the initial resuscitative period.

METHODS:

Design:Prospective, randomized, multicenter trial.

Setting:

Three level 1 trauma centers.

Patient Selection Criteria:

Patients aged 18–50 with an associated musculoskeletal injury with Hgb less than 9 g/dL or expected drop below 9 g/dL with planned surgery who were stable and no longer being actively resuscitated were randomized once their Hgb dropped below 7 g/dL to a conservative transfusion threshold of 5.5 g/dL versus a liberal threshold of 7.0 g/dL.

Outcome Measures and Comparisons:

Postoperative infection, other post-operative complications and Musculoskeletal Functional Assessment scores obtained at baseline, 6 months, and 1 year were compared for liberal and conservative transfusion thresholds.

RESULTS:

Sixty-five patients completed 1 year follow-up. There was a significant association between a liberal transfusion strategy and higher rate of infection (P= 0.01), with no difference in functional outcomes at 6 months or 1 year. This study was adequately powered at 92% to detect a difference in superficial infection (7% for liberal group, 0% for conservative,P< 0.01) but underpowered to detect a difference for deep infection (14% for liberal group, 6% for conservative group,P= 0.2).

CONCLUSIONS:

A conservative transfusion threshold of 5.5 g/dL in an asymptomatic young trauma patient with associated musculoskeletal injuries leads to a lower infection rate without an increase in adverse outcomes and no difference in functional outcomes at 6 months or 1 year.

LEVEL OF EVIDENCE:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Strain on Scarce Intensive Care Beds Drives Reduced Patient Volumes, Patient Selection, and Worse Outcome: A National Cohort Study*
Authors: Brinkman Sylvia , de Keizer Nicolette F. , de Lange Dylan W. , Dongelmans Dave A. , Termorshuizen Fabian , van Bussel Bas C.T.
Published: December 2023

OBJECTIVES:

Strain on ICUs during the COVID-19 pandemic required stringent triage at the ICU to distribute resources appropriately. This could have resulted in reduced patient volumes, patient selection, and worse outcome of non-COVID-19 patients, especially during the pandemic peaks when the strain on ICUs was extreme. We analyzed this potential impact on the non-COVID-19 patients.

DESIGN:

A national cohort study.

SETTING:

Data of 71 Dutch ICUs

PARTICIPANTS:

A total of 120,393 patients in the pandemic non-COVID-19 cohort (from March 1, 2020 to February 28, 2022) and 164,737 patients in the prepandemic cohort (from January 1, 2018 to December 31, 2019).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Volume, patient characteristics, and mortality were compared between the pandemic non-COVID-19 cohort and the prepandemic cohort, focusing on the pandemic period and its peaks, with attention to strata of specific admission types, diagnoses, and severity. The number of admitted non-COVID-19 patients during the pandemic period and its peaks were, respectively, 26.9% and 34.2% lower compared with the prepandemic cohort. The pandemic non-COVID-19 cohort consisted of fewer medical patients (48.1% vs. 50.7%), fewer patients with comorbidities (36.5% vs. 40.6%), and more patients on mechanical ventilation (45.3% vs. 42.4%) and vasoactive medication (44.7% vs. 38.4%) compared with the prepandemic cohort. Case-mix adjusted mortality during the pandemic period and its peaks was higher compared with the prepandemic period, odds ratios were, respectively, 1.08 (95% CI, 1.05–1.11) and 1.10 (95% CI, 1.07–1.13).

CONCLUSIONS:

In non-COVID-19 patients the strain on healthcare has driven lower patient volume, selection of fewer comorbid patients who required more intensive support, and a modest increase in the case-mix adjusted mortality.
Dabrafenib plus trametinib in unselected advanced BRAF V600–mut melanoma: a non-interventional, multicenter, prospective trial
Authors: Richtig Erika , Nguyen Van A. , Koelblinger Peter , Wolf Ingrid , Kehrer Helmut , Saxinger Werner , Ressler Julia M. , Weinlich Georg , Meyersburg Damian , Hafner Christine , Jecel-Grill Elisabeth , Kofler Julian , Lange-Asschenfeldt Bernhard , Weihsengruber Felix , Rappersberger Klemens , Svastics Nina , Gasser Klaus , Seeber Arno , Kratochvill Franz , Nagler Sophie , Mraz Bernhard , Hoeller Christoph
Published: December 2023

Objective

The efficacy of combined BRAF and MEK inhibition for BRAF V600–mutant melanoma in a broad patient population, including subgroups excluded from phase 3 trials, remains unanswered. This noninterventional study (DATUM-NIS) assessed the real-world efficacy, safety and tolerability of dabrafenib plus trametinib in Austrian patients with unresectable/metastatic melanoma.

Methods

This multicenter, open-label, non-interventional, post-approval, observational study investigated the effectiveness of dabrafenib plus trametinib prescribed in day-to-day clinical practice to patients (N = 79) with BRAF V600–mutant unresectable/metastatic melanoma with M1c disease (American Joint Committee on Cancer staging manual version 7), ECOG > 1, and elevated serum lactate dehydrogenase (LDH). The primary endpoint was 6-, 12- and 18-month progression-free survival (PFS) rates. Secondary endpoints were median PFS, disease control rate and overall survival (OS).

Results

The 6-, 12- and 18-month PFS rates were 76%, 30.6% and 16.2%, respectively. Subgroup analysis showed a significant PFS benefit in the absence of lung metastasis. The median PFS and OS were 9.1 (95% CI, 7.1–10.3) months and 17.9 (95% CI, 12.7–27.8) months, respectively. The 12- and 24-month OS rates were 62.7% and 26.8%, respectively. Subgroup analyses showed significant OS benefits in the absence of bone or lung metastasis and the presence of other metastases (excluding bone, lung, brain, liver and lymph nodes). Furthermore, S100 and Eastern Cooperative Oncology Group performance status (ECOG PS) showed a significant impact on survival. No new safety signals were observed.

Conclusion

Despite an unselected population of melanoma patients with higher M1c disease, ECOG PS > 1 and elevated LDH, this real-world study demonstrated comparable efficacy and safety with the pivotal phase 3 clinical trials for dabrafenib–trametinib.
A specialized health camp (Orthopedics) in rural set up: an experience from a tertiary care institution in Nepal
Authors: Maharjan Sagar , Shrestha Rohit , Shrestha Pramit R. , Acharya Suyash , Khadka Sushant K. , Thapa Sangharsha , Chaudhary Aashutosh
Published: December 2023

Background:

A health camp is a stationary or mobile short-term medical intervention done for target communities in order to provide medical check-ups and medications to the people in the community. A specialized health camp focuses on a certain group of people for detailed workup and hence better results. Such specialized health camps have not been conducted for orthopedics in Nepal yet.

Methods:

This is a retrospective cross-sectional study conducted from 2016 to 2019. Data recorded on a proforma were stored on an Excel spreadsheet and later analyzed using SPSS 16.0. Chief complaints and other relevant demographic data were analyzed.

Results:

A total of 1554 patients were seen with a mean age group of 49.9 years. The most common complaints were knee pain 544 (35.00%) followed by back pain 513 (33.01%).

Conclusion:

A specialized health camp is beneficial to a community as it results in early diagnosis and prompt management of a disease. It also leads to increased awareness among people belonging to a rural community.
Enhanced Recovery after Surgery Protocol Decreases Length of Stay and Postoperative Narcotic Use in Microvascular Breast Reconstruction
Authors: Muetterties Corbin E. , Taylor Jeremiah M. , Kaeding Diana E. , Morales Ricardo R. , Nguyen Anissa V. , Kwan Lorna , Tseng Charles Y. , Delong Michael R. , Festekjian Jaco H.
Published: December 2023

Background:

Enhanced recovery after surgery (ERAS) protocols have demonstrated efficacy following microvascular breast reconstruction. This study assesses the impact of an ERAS protocol following microvascular breast reconstruction at a high-volume center.

Methods:

The ERAS protocol introduced preoperative counseling, multimodal analgesia, early diet resumption, and early mobilization to our microvascular breast reconstruction procedures. Data, including length of stay, body mass index, inpatient narcotic use, outpatient narcotic prescriptions, inpatient pain scores, and complications, were prospectively collected for all patients undergoing microvascular breast reconstruction between April 2019 and July 2021. Traditional pathway patients who underwent reconstruction immediately before ERAS implementation were retrospectively reviewed as controls.

Results:

The study included 200 patients, 99 in traditional versus 101 in ERAS. Groups were similar in body mass index, age (median age: traditional, 54.0 versus ERAS, 50.0) and bilateral reconstruction rates (59.6% versus 61.4%). ERAS patients had significantly shorter lengths of stay, with 96.0% being discharged by postoperative day (POD) 3, and 88.9% of the traditional cohort were discharged on POD 4 (P< 0.0001). Inpatient milligram morphine equivalents (MMEs) were smaller by 54.3% in the ERAS cohort (median MME: 154.2 versus 70.4,P< 0.0001). Additionally, ERAS patients were prescribed significantly fewer narcotics upon discharge (median MME: 337.5 versus 150.0,P< 0.0001). ERAS had a lower pain average on POD 0–3; however, this finding was not statistically significant.

Conclusion:

Implementing an ERAS protocol at a high-volume microvascular breast reconstruction center reduced length of stay and postoperative narcotic usage, without increasing pain or perioperative complications.
A Practical Guide to Implementing Holistic Review during Surgery Resident Selection
Authors: Reghunathan Meera , Thompson Noelle , Sendek Gabriela , Butler Paris D. , Reid Chris M. , Gosman Amanda A.
Published: December 2023

Provider workforce diversity is a key component of improving healthcare quality and addressing healthcare disparities. Furthermore, the traditional approach of “score-centered” application metrics do not consistently correlate with meeting milestones in surgery, nor do they adequately predict a surgical resident’s clinical strength and operative abilities. We present here an adaptable process by which surgical residency programs can identify their values and incorporate holistic review into their resident selection process to improve resident selection and physician workforce diversity.