bluuebunny/crossref_metadata_2025 huggingface dataset:
The Americas in and before a Century of International Criminal Law
Authors: Quintana Francisco-José , Uriburu Justina
Published: April 2023

Dominant accounts have largely excluded actors from the Americas, other than the United States, from the history of international criminal law. This chapter does not attempt to introduce these exclusions into the established celebratory narrative. Instead, it explores how and why American actors have promoted, resisted, ignored, been affected, or been ignored by different efforts to implement or expand criminal justice in and through international law since the end of World War I until the present. In this way, this chapter presents a counter-history of international criminal law in and from the Americas, unveiling overlooked discontinuities and illuminating the changing political stakes involved in these projects.
Gender, sexuality, and CAT
Authors: Benson Anne , Discepolo Ahmadi Josephine F.
Published: April 2023

This chapter suggests that people inhabit living bodies that are dynamic systems developing in relationship with their social and historical context. There is a live relationship between societal norms and expectations of how our bodies are defined, what we do with them, and how power is exercised. Throughout history different practices have been variously criminalized, pathologized, marginalized, celebrated, and legitimized. Current debate creates a dichotomy between personal relationships based on individual choice rather than on gendered roles. The former risks ignoring societal and political power dynamics, and the latter perpetuates norms established within the heterosexual nuclear family. Meg-John Barker’s reworking of Gayle Rubin’s charmed circle offers a more progressive, less reductionist model. This chapter argues that sexuality and gender have not always attracted the attention and the debate they require within the cognitive analytic therapy (CAT) community. A substantial shift is critical for CAT therapists to develop specific and up-to-date competencies in this field. An approach informed by diversity, and intersectional thinking and adopting affirmative practice provides the foundation. Understanding the relationship to these issues enables the therapist to be consciously aware of what they are bringing to the therapeutic process and of how different factors intersect in shaping the relationships of power in the therapy room. There is a need to promote collaborative, consensual practices that normalize differences without invalidating the unique ways in which people define and express their embodied presence in the world.
Do no harm
Authors: Parry Glenys
Published: April 2023

Although cognitive analytic therapy (CAT) was developed to be a safe first intervention for people with complex mental health problems, like any effective treatment it has the potential to cause harm. The concept of harm is defined and distinguished from a negative therapy experience or ineffective therapy. Research evidence on adverse effects of psychotherapy is summarized to understand what causes harm, and the balance of risk and benefit. I critically examine the CAT model to see how far it lives up to its aspiration to be a safe therapy. Aspects of CAT theory are considered in relation to ways in which the model guards against negative process and outcomes, but also areas where clients can experience negative effects: e.g. the assessment process; the potential for anti-therapeutic or malignant enactments within the therapy relationship; blind spots in reformulation; poor endings. CAT offers clear insights into how therapy fails, so cognitive analytic therapists are well placed to understand these risks and to use CAT to mitigate the risk of harm.
CAT and intellectual disability
Authors: Bork Natalie , Varela Jo
Published: April 2023

People with intellectual disabilities experience many barriers to a good quality of life and are more likely to experience the social, relational, and material precursors to mental ill health. Using case examples, this chapter shows how cognitive analytic therapy (CAT), with its dual focus on supporting cognition and relational understanding, can be used effectively with the person and their care system to empathically understand distress and support change. It offers a relational understanding of behaviour that challenge services and describes adjustments to CAT tools to make them more accessible to people with an intellectual disability. To achieve good outcomes, CAT can support the system to think compassionately about behaviours that challenge and support meaningful change for those that are cared for, through care being more attuned to the individual’s needs and those caring for the individual.
A relational approach to working with medically unexplained symptoms (or not yet explained symptoms)
Authors: Bearman Nadine , Jenaway Alison
Published: April 2023

People suffering medically unexplained symptoms (MUS) or yet to be explained symptoms can be a challenging client group to engage in therapy for a number of reasons. Firstly, MUS is a term used to describe a wide range of presentations from short term, stress-related symptoms to functional neurological disorder (FND) and chronic fatigue syndrome (CFS). Of emerging importance are persisting physiological symptoms post Covid-19 infection. The aetiology of MUS has wide heterogeneity and there is often poor understanding amongst healthcare professionals about MUS and available support. Clients can feel overwhelmed by a lack of clear diagnosis and care pathway, and are often left feeling dismissed when they are referred for therapy. This chapter provides an overview of how psychological models have contributed to our understanding of MUS and the use of therapies in practice. Considering the challenges for clients attending therapy, we describe how the nature of cognitive analytic therapy (CAT)—to be open, curious, and work collaboratively—can provide a helpful approach with this client group. Using case examples, we describe how CAT enables the therapist to explore many aspects of the individual’s experience, including their early life and their relationships with others, themselves, their symptoms, their body, and their experience of the medical professionals. The process of co-constructed reformulation and self-reflection, creates a dynamic person-centred approach that has the openness, curiosity, and flexibility to explore and learn.
CAT in forensic settings part two
Authors: Manson Kerry , Ryan Sue , Lock Peter
Published: April 2023

This chapter brings together practitioner reflections over the past twenty years of the application of cognitive analytic therapy (CAT) to forensic work with individuals within prison and the community. It highlights how CAT can provide a structured yet flexible way to have conversations with individuals that enables hidden and harmful parts of themselves to be explored and reflected upon in a compassionate, containing, and collaborative way. It can enable an individual to be more authentic, less defended and understood as a whole person rather than a fragmented list of risk factors. This chapter brings together different approaches to applying the model, both as a therapy and as a CAT consultation formulation model, which has enabled individuals to reach new awareness and connections that can be shared with the wider systems and staff teams to help enhance relationships and responses. Whilst some individuals have a ‘readiness’ to embark on a CAT, the chapter also considers how some may not feel able to withstand exploration of the past, particularly after release into the community, where increased stressors, expectations, and less external controls can mean that an extended CAT consultation model may be considered.
CAT for long-term health conditions
Authors: Thompson Andrew R. , Fox John R.
Published: April 2023

Long term conditions (LTCs) can be associated with significant psychosocial distress. Psychological distress in LTCs such as diabetes and psoriasis typically not only add to the burden of disease for the individual but also tend to affect the management or even course of the disease itself. This chapter will describe how cognitive analytic therapy (CAT) can be used to assist people living with LTCs with the management of accompanying psychosocial issues. Using CAT in this context requires interprofessional working and some knowledge of the medical aspects of specific diseases. However, a central message within this chapter is to emphasize the value that the reformulatory approach can bring to understanding the complex interplay between the biopsychosocial factors involved in living with a LTC. Further, reformulation that centres on the psychosocial can be a springboard for facilitating a patient’s story to emerge, revealing how reciprocal roles (RRs) shaped by earlier attachments and experiences or by the internalization of wider societal stereotypes might be driving target problem procedures (TPPs) and maintaining target problems (TPs) associated with adjustment. Recognition of this nature can facilitate revision of stuck TPPs and enable the utilization of a range of exit strategies and improve treatment adherence.
The development of the multiple self states model
Authors: Westacott Mark C.
Published: April 2023

The chapter introduces the multiple self states model (MSSM) and describes its elaboration alongside developments in mapping and sequential diagrammatic reformulation (SDRs). It examines early applications of the model to working with people with complex emotional and interpersonal problems and the role of early trauma and dissociation in the development of complex health problems. Reference is made to research studies examining the efficacy of the model with a range of different clinical presentations. The chapter describes cognitive analytic therapy (CAT) concepts of states, self states, state shifts, and metaprocedures and the central role of partial dissociation in many of the difficulties experienced by people with diagnoses of personality disorder, such as borderline and narcissistic personality disorder. It explores different kinds of state shift and the view of the self as comprising a multiplicity of different aspects, selves, or voices. It goes on to highlight the usefulness of CAT tools, such as sequential self state diagrams (SSSDs), the personality structure questionnaire (PSQ), and the state description procedure (SDP) and their application is further explored through a clinical case vignette. The vignette also describes processes of engagement in the therapy, use of the therapeutic relationship and countertransference, mapping and the importance of developing awareness of state shifts and their triggers. Finally, the chapter looks at the application of the model to team work and the reformulation of team processes through contextual reformulation.
Creativity in CAT and the contributions of arts therapies to its theory and practice
Authors: Stevens Yvonne J. , Petratou Vicky
Published: April 2023

Anthony Ryle welcomed many therapists and mental health professionals, like the authors, to cognitive analytic therapy (CAT) with experience and skills from other therapeutic modalities, and he generously encouraged these therapists to creatively integrate these skills and techniques into the CAT processes of recognition, reformulation, and revision. In this chapter we will show how CAT’s practice can be enriched by attending to our clients’ creative potential within their zone of ‘playful’ proximal development, at all stages of therapy. We will demonstrate the use of imaginative and creative therapeutic approaches and how this can encourage the ability of both therapists and clients to contain and express cut-off and fragmented states, trauma, and unexpressed emotion. We will show how the use of the creative therapeutic projective and performative arts experiences and techniques can help in promoting experimentation, playfulness, and improvisation with developing helpful reciprocal roles and expanding flexibility in relating to oneself and others. We will point to particular considerations that therapists need to have in mind when using creative approaches and some thoughts about the place of creativity in mental health services. We will address the following issues: creativity and working with problematic relational procedures; creativity within the CAT framework; offering guidance on creative resources in the therapy room and encouraging self-authoring through reflective writing; the contributions of arts therapies to the theory and practice of CAT including dramatherapy, arts therapy, and cognitive analytic music therapy (CAMT); and reflections on the role of creativity in CAT training.
The asymmetric sunrise effect on Thales’ alleged measurement of the Sun angular size
Authors: Cuadra Jorge
Published: April 2023

Reports from the second and third centuries AD attribute the first measurement of the angular size of the Sun to Thales of Miletus, in the sixth century BC. Cleomedes, also in the second century AD, described a method to perform the measurement based on timing the duration of the sunrise. Several modern authors have suggested that Thales used Cleomedes’ method, but others are skeptical of the connection. Here I present an objection that has not been discussed in the literature, namely, that the proportionality between the size of the Sun and the duration of sunrise is not constant, but changes with latitude and the time of the year, due to what I call the “asymmetric sunrise effect.” I show that this effect is large enough to have prevented Thales from obtaining the roughly accurate recorded value.
Pain Linguistics: A Case for Pluralism
Authors: Coninx Sabrina , Willemsen Pascale , Reuter Kevin
Published: April 2023

The most common approach to understanding the semantics of the concept of pain is third-person thought experiments. By contrast, the most frequent and most relevant uses of the folk concept of pain are from a first-person perspective in conversational settings. In this paper, we use a set of linguistic tools to systematically explore the semantics of what people communicate when reporting pain from a first-person perspective. Our results suggest that only a pluralistic view can do justice to the way we talk about pain from a first-person perspective: The semantic content of the folk concept of pain consists of information about both an unpleasant feeling and a disruptive bodily state. Pain linguistics thus provides new insights into ordinary pain language and poses an interesting challenge to the dominant unitary views of pain.
Regulation of nerve cells using conductive nanofibrous scaffolds for controlled release of Lycium barbarum polysaccharides and nerve growth factor
Authors: Wang Jing , Liu Yuan , Lv Minmin , Zhao Xiaoli , So Kwok Fai , Li Hui , EL-Newehy Mohamed , EL-Hamshary Hany , Morsi Yosry , Mo Xiumei
Published: April 2023

Currently, more and more patients suffer from peripheral nerve injury due to trauma, tumor and other causes worldwide. Biomaterial-based nerve conduits are increasingly recognized as a potential alternative to nerve autografts for the treatment of peripheral nerve injury. However, an ideal nerve conduit must offer topological guidance and biochemical and electrical signal transduction mechanisms. In this work, aligned conductive nanofibrous scaffolds comprising polylactic-co-glycolic acid and multiwalled carbon nanotubes (MWCNTs) were fabricated via coaxial electrospinning, and nerve growth factor (NGF) and Lycium barbarum polysaccharides (LBP) purified from the wolfberry were loaded on the core and shell layers of the nanofibers, respectively. LBP were confirmed to accelerate long-distance axon regeneration after severe peripheral nerve injury. In addition, the synergistic promotion of LBP and NGF on nerve cell proliferation and neurite outgrowth was demonstrated. MWCNTs were introduced into the aligned fibers to further increase the electrical conductivity, which promoted the directional growth and neurite extension of neurons in vitro. Further, the combination of conductive fibrous scaffolds with electrical stimulation that mimics endogenous electric fields significantly promoted the differentiation of PC12 cells and the axon outgrowth of neurons. Based on robust cell-induced behaviors, conductive composite fibers with optimized fiber alignment may be used for the promotion of nerve recovery.
Macroscale Thalamic Functional Organization Disturbances and Underlying Core Cytoarchitecture in Early-Onset Schizophrenia
Authors: Fan Yun-Shuang , Xu Yong , Bayrak Şeyma , Shine James M , Wan Bin , Li Haoru , Li Liang , Yang Siqi , Meng Yao , Valk Sofie L , Chen Huafu
Published: April 2023

Background and Hypothesis

Schizophrenia is a polygenetic mental disorder with heterogeneous positive and negative symptom constellations, and is associated with abnormal cortical connectivity. The thalamus has a coordinative role in cortical function and is key to the development of the cerebral cortex. Conversely, altered functional organization of the thalamus might relate to overarching cortical disruptions in schizophrenia, anchored in development.

Study Design

Here, we contrasted resting-state fMRI in 86 antipsychotic-naive first-episode early-onset schizophrenia (EOS) patients and 91 typically developing controls to study whether macroscale thalamic organization is altered in EOS. Employing dimensional reduction techniques on thalamocortical functional connectome (FC), we derived lateral–medial and anterior–posterior thalamic functional axes.

Study Results

We observed increased segregation of macroscale thalamic functional organization in EOS patients, which was related to altered thalamocortical interactions both in unimodal and transmodal networks. Using an ex vivo approximation of core-matrix cell distribution, we found that core cells particularly underlie the macroscale abnormalities in EOS patients. Moreover, the disruptions were associated with schizophrenia-related gene expression maps. Behavioral and disorder decoding analyses indicated that the macroscale hierarchy disturbances might perturb both perceptual and abstract cognitive functions and contribute to negative syndromes in patients.

Conclusions

These findings provide mechanistic evidence for disrupted thalamocortical system in schizophrenia, suggesting a unitary pathophysiological framework.
Determinants of zinc utilisation in the management of diarrhoea among under-five children in Nigeria: a population-based, cross-sectional study
Authors: Ogundele Olorunfemi Akinbode , Bello Olufunmilayo E , Ogundele Tolulope , Fagbemi Aderonke T , Fehintola Funmito O , Osunmakinwa Olugbenga O
Published: April 2023

Background

Diarrhoea remains the foremost cause of sickness and death among children aged <5 y (under-five) in low- and middle-income countries. The WHO and UNICEF recommend that any child with diarrhoea signs be given zinc tablets as part of the treatment within 24 h. Therefore, we aimed to assess the prevalence and determinants of zinc utilisation for diarrhoea among under-five children in Nigeria.

Methods

The Nigeria Demographic and Health Survey 2018 was used for this study. Data were analysed using IBM SPSS version 25.0. A multilevel analysis technique employing the generalised linear mixed model was used for analysing the data of 3956 under-five children with diarrhoea.

Results

Only 29.1% of children who experienced diarrhoea received zinc combined with other forms of treatments during the diarrhoea episode. However, mothers with a secondary or higher level of education had a 40% higher likelihood of zinc utilisation during childhood diarrhoea (AOR, 1.40; 95% CI 1.05 to 2.22). Similarly, children whose mothers were exposed to media were more likely to receive zinc during diarrhoea than those whose mothers were not (AOR, 2.50; 95% CI 1.01 to 3.87).

Conclusions

In this study, the prevalence of zinc use among under-five children with diarrhoea in Nigeria was low. Therefore, appropriate strategies to improve zinc utilisation are needed.
Impact of Infection Timing and Autumnal Fungicide Applications on Perennation of Pseudoperonospora humuli and Severity of Hop Downy Mildew
Authors: Richardson Briana J. , Gent David H.
Published: April 2023

Pseudoperonospora humuli, causal agent of hop downy mildew, is known to survive winter as systemic mycelium in the crown and developing buds of hop (Humulus lupulus). Field studies were conducted over three growing seasons to quantify the association of infection timing to overwintering of P. humuli and development of downy mildew. Cohorts of potted plants were inoculated sequentially from early summer to autumn, overwintered, and then evaluated for symptoms of systemic downy mildew in emerging shoots. Shoots with systemic P. humuli developed after inoculation at any time in the previous year, with the most severe disease typically resulting from inoculation in August. Independent of the timing of inoculation, diseased shoots emerged coincident with the emergence of healthy shoots, beginning as early as late February and continuing through late May to early June. Surface crown buds on inoculated plants exhibited internal necrosis associated with P. humuli at rates ranging from 0.3 to 1.2%, whereas P. humuli was detected by PCR on 7.8 to 17.0% of asymptomatic buds depending on the timing of inoculation and year. Four experiments were conducted to quantify the impact of foliar fungicides applied in autumn on downy mildew the following spring. There was a small reduction of disease in only one study. Together, these studies indicate that infection by P. humuli that leads to overwintering can occur over a broad period of time, but delaying infection until autumn tends to reduce disease levels in the following year. However, in established plantings, postharvest application of foliar fungicides appeared to have little impact on severity of downy mildew in the ensuring year.
Interspecificity of Scab Fungus Isolated from Wild Syrian Pear (Pyrus syriaca)
Authors: Ishii Hideo , Shabi Ezra , Nishimura Kumiko , Yamaoka Yuichi
Published: April 2023

Scab on pear is caused by two pathogens, Venturia pyrina on European pear and V. nashicola on Asian pear. Five races of V. pyrina and seven races of V. nashicola have been reported thus far and pathological specialization occurs in both species. Among them, the five race isolates of V. pyrina were previously found from wild Syrian pear. In this study, mating and morphological characteristics of Venturia isolates from Syrian pear were compared with those of isolates from European and Japanese pear cultivated in Japan. The results from mating experiments showed that Syrian pear isolates were compatible with European pear isolates of V. pyrina to produce ascospores but were sterile with V. nashicola isolates in culture. Interestingly, however, the size and shape of conidia collected from naturally infected leaves of Syrian pear resembled those of V. nashicola. This finding may open the way to study coevolution between pear hosts and Venturia spp. in the future.
A Loop-Mediated Isothermal Amplification Assay for the Identification of Botrytis fragariae in Strawberry
Authors: Vielba-Fernández Alejandra , Dowling Madeline , Schnabel Guido , Fernández-Ortuño Dolores
Published: April 2023

Gray mold in strawberry is caused by multiple species of Botrytis, including Botrytis cinerea, B. pseudocinerea, B. fragariae, and B. mali. The species B. cinerea and B. fragariae are widespread in production regions of the eastern United States and Germany, and their distinction is important for disease management strategies. Currently, the only way to differentiate these species in field samples is by PCR, which is time consuming, labor intensive, and costly. In this study, a loop-mediated isothermal amplification (LAMP) technique was developed based on species-specific NEP2 gene nucleotide sequences. The designed primer set specifically amplified B. fragariae DNA and no other Botrytis spp. (B. cinerea, B. mali, and B. pseudocinerea) or plant pathogens. The LAMP assay was able to amplify fragments from DNA extracted from infected fruit using a rapid DNA extraction protocol, confirming its ability to detect low amounts of B. fragaria DNA from field-infected fruit. In addition, a blind test was performed to identify B. fragariae in 51 samples collected from strawberry fields in the eastern United States using the LAMP technique. The B. fragariae samples were identified with a reliability of 93.5% (29 of 32), and none of the B. cinerea, B. pseudocinerea, or B. mali samples included in the test were amplified in 10 min. Our results show that the LAMP technique is a specific and reliable method for the detection of B. fragariae from infected fruit tissue and can help to control this important disease in the field.
Pitaya Virus X Coat Protein Acts as an RNA Silencing Suppressor and Can Be Used as a Specific Target for Detection Using RT-LAMP
Authors: Zhao Yue , Yang Shutong , Jiang Ling , Yang Qian , Luo Liting , Jiang Junmei , Malichan Srihunsa , Zhao Jin , Xie Xin
Published: April 2023

Selenicereus undatus (Haworth) D.R. Hunt (pitaya) is a tropical fruit that has been commonly cultivated in Guizhou Province, China, in recent years due to its good taste and high nutritional value. This planting area currently ranks third in China. Viral diseases have increasingly emerged in pitaya cultivation because of the expansion of the pitaya planting area and the characteristics of asexual propagation. The spread of pitaya virus X (PiVX; a Potexvirus) is among the most severe viruses threatening the quality and yield of pitaya fruit. To investigate the occurrence of PiVX in pitaya cultivations in Guizhou Province, we developed a reverse transcription loop-mediated isothermal amplification (RT-LAMP) method that can detect PiVX with high sensitivity and specificity at a low cost and produce a visualized result. Our best RT-LAMP system was significantly more sensitive than RT-PCR and was highly specific to PiVX. Furthermore, PiVX coat protein (CP) can form a homodimer, and PiVX may use its CP as a plant RNA silencing suppressor to enhance infection. To the best of our knowledge, this is the first report of fast detection of PiVX and functional exploration of CP in a Potexvirus. These findings will provide an opportunity for early diagnosis and prevention of viruses in pitaya.
Barriers to healthcare
Authors: Rodriguez Thureiyya
Published: April 2023

Stigmatization is a deep-rooted problem in US history that has affected generations of Black and Hispanic/Latino patients. By understanding these histories nurses can grow cultural humility in their practice.
Intimate partner violence
Authors: Gary Annette , Kiper Valerie , Geist Rebecca , Rice Louise
Published: April 2023

This manuscript discusses intimate partner violence as it occurs among adults and adolescents. With ongoing support and encouragement, a victim can often find support and strength to leave and live a normal, safe life.
Epinephrine-induced Effects on Cerebral Microcirculation and Oxygenation Dynamics Using Multimodal Monitoring and Functional Photoacoustic Microscopy
Authors: Zhang Dong , Wang Wei , Zhu Xiaoyi , Li Ran , Liu Wei , Chen Maomao , Vu Tri , Jiang Laiming , Zhou Qifa , Evans Cody L. , Turner Dennis A. , Sheng Huaxin , Levy Jerrold H. , Luo Jianwen , Yang Wei , Yao Junjie , Hoffmann Ulrike
Published: April 2023

Background

The administration of epinephrine after severe refractory hypotension, shock, or cardiac arrest restores systemic blood flow and major vessel perfusion but may worsen cerebral microvascular perfusion and oxygen delivery through vasoconstriction. The authors hypothesized that epinephrine induces significant microvascular constriction in the brain, with increased severity after repetitive dosing and in the aged brain, eventually leading to tissue hypoxia.

Methods

The authors investigated the effects of intravenous epinephrine administration in healthy young and aged C57Bl/6 mice on cerebral microvascular blood flow and oxygen delivery using multimodal in vivo imaging, including functional photoacoustic microscopy, brain tissue oxygen sensing, and follow-up histologic assessment.

Results

The authors report three main findings. First, after epinephrine administration, microvessels exhibited severe immediate vasoconstriction (57 ± 6% of baseline at 6 min, P < 0.0001, n = 6) that outlasted the concurrent increase in arterial blood pressure, while larger vessels demonstrated an initial increase in flow (108 ± 6% of baseline at 6 min, P = 0.02, n = 6). Second, oxyhemoglobin decreased significantly within cerebral vessels with a more pronounced effect in smaller vessels (microvessels to 69 ± 8% of baseline at 6 min, P < 0.0001, n = 6). Third, oxyhemoglobin desaturation did not indicate brain hypoxia; on the contrary, brain tissue oxygen increased after epinephrine application (from 31 ± 11 mmHg at baseline to 56 ± 12 mmHg, 80% increase, P = 0.01, n = 12). In the aged brains, microvascular constriction was less prominent yet slower to recover compared to young brains, but tissue oxygenation was increased, confirming relative hyperoxia.

Conclusions

Intravenous application of epinephrine induced marked cerebral microvascular constriction, intravascular hemoglobin desaturation, and paradoxically, an increase in brain tissue oxygen levels, likely due to reduced transit time heterogeneity.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Medicaid and Fulfillment of Postpartum Permanent Contraception Requests
Authors: Arora Kavita Shah , Chua Arzice , Miller Emily , Boozer Margaret , Serna Tania , Bullington Brooke W. , White Kari , Gunzler Douglas D. , Bailit Jennifer L. , Berg Kristen
Published: April 2023

OBJECTIVE:

To evaluate the association between Medicaid insurance and fulfillment of postpartum permanent contraception requests.

METHODS:

We conducted a retrospective cohort study of 43,915 patients across four study sites in four states, of whom 3,013 (7.1%) had a documented contraceptive plan of permanent contraception at the time of postpartum discharge and either Medicaid insurance or private insurance. Our primary outcome was permanent contraception fulfillment before hospital discharge; we compared individuals with private insurance with individuals with Medicaid insurance. Secondary outcomes were permanent contraception fulfillment within 42 and 365 days of delivery, as well as the rate of subsequent pregnancy after nonfulfillment. Bivariable and multivariable logistic regression analyses were used.

RESULTS:

Patients with Medicaid insurance (1,096/2,076, 52.8%), compared with those with private insurance (663/937, 70.8%), were less likely to receive desired permanent contraception before hospital discharge (P≤.001). After adjustment for age, parity, weeks of gestation, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index, private insurance status was associated with higher odds of fulfillment at discharge (adjusted odds ratio [aOR] 1.48, 95% CI 1.17–1.87) and 42 days (aOR 1.43, 95% CI 1.13–1.80) and 365 days (aOR 1.36, 95% CI 1.08–1.71) postpartum. Of the 980 patients with Medicaid insurance who did not receive postpartum permanent contraception, 42.2% had valid Medicaid sterilization consent forms at the time of delivery.

CONCLUSION:

Differences in fulfillment rates of postpartum permanent contraception are observable between patients with Medicaid insurance and patients with private insurance after adjustment for clinical and demographic factors. The disparities associated with the federally mandated Medicaid sterilization consent form and waiting period necessitate policy reassessment to promote reproductive autonomy and to ensure equity.
Continuing Education Evaluations of an Internal Medicine and a Pediatric Podcast
Authors: Kelly Jessica M. , Perseghin Andrea , Dow Alan , Chiu Christopher , Pereira Noah , Posner Jill , Berk Justin
Published: April 2023

Introduction:

This study aimed to characterize practitioners who use podcasts as a form of continuing education (CE), evaluate attitudes regarding podcasting as a medium for CE, and assess intended practice change after listening to podcasts for CE.

Methods:

We examined CE data from a mandatory postpodcast evaluation collected between February 2021 and August 2021 for two free podcasts. We analyzed linked episode data containing podcast downloads.

Results:

Listeners downloaded 972,691 episodes and claimed 8182 CE credits (less than 1% of total downloads) over 7 months. CE credit was claimed by physicians, physician assistants, nurses, and pharmacists. Most listeners claiming CE credit were not affiliated with an academic institution. Motivation for listening to episodes included a topic of interest, relevance to a patient, and a topic of less comfort. Of individuals obtaining CE, 98% intended to implement change after listening.

Discussion:

Although only a small number of podcast listeners claim CE credit, those who claim credit represent a diverse and interprofessional audience. Listeners select podcasts to fill self-identified learning needs. Overwhelmingly, listeners report podcast CE changes intended practice. Podcasts may be an effective modality for CE and practice change; further research should focus on facilitators and barriers to CE uptake and on patient health outcomes.
Haikun Shenxi Capsule for Improving Renal Function in Patients with Chronic Kidney Diseases: A Systematic Review and Meta-analysis
Authors: Geng Yunling , Dong Zhaocheng , Jia Qi , Zhang Pingna , Tang Jingyi , Liu Yu Ning , Liu Wei Jing
Published: April 2023

Haikun Shenxi capsule was widely used for patients with chronic kidney disease (CKD) stages 3–5. This study aimed to systematically evaluate the efficacy and adverse effects of the Haikun Shenxi capsule in the treatment of patients with CKD stages 3–5 (nondialysis-dependent) and provide a reference for clinical application. The Cochrane Library, PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, Chongqing VIP Database, and SinoMed Database were searched for randomized-controlled trials applying Haikun Shenxi capsule to treat CKD from their inception date to February 2022. Data extraction and quality assessment were assigned to two researchers, respectively. The risk of bias was assessed by the Cochrane handbook, and Revman5.3 was used for data statistics and analysis. Heterogeneity tests were conducted, and the mean difference (MD) or relative risk (RR) with a 95% confidence interval (95% CI) of the outcomes was presented. Eight randomized controlled trials with 522 patients diagnosed with CKD stages 3–5 (nondialysis-dependent) treated with Haikun Shenxi capsules were included. Compared with the control group, the Haikun Shenxi capsule group showed lower levels of serum creatinine (Scr; MD = −61.14, 95% CI = −68.13 to −54.16, P < 0.00001) and blood urea nitrogen (BUN; MD = −4.21, 95% CI = −5.59 to −2.84, P < 0.00001) and higher creatinine clearance (Ccr; MD = 3.94, 95% CI = 1.47 to 6.42, P = 0.002). No drug-related adverse effects of Haikun Shenxi were found in these studies. The Haikun Shenxi capsule could reduce Scr and BUN levels and increase the Ccr level, thereby improving renal functions of CKD stages 3–5 (nondialysis-dependent) patients without drug-related adverse effects based on conventional therapy.
Netarsudil-associated reticular epithelial corneal edema after phacoemulsification
Authors: Rodgers Cooper D. , Shah Ankit , Blake Charles R.
Published: April 2023

Introduction:

To the authors' knowledge, this is the first reported case of netarsudil-associated reticular corneal edema noted shortly after phacoemulsification with intraocular lens (IOL) implantation.

Patient and Clinical Findings:

A 68-year-old woman with a history of chronic angle-closure glaucoma with a long-term history of tolerance to netarsudil presented with “honeycomb” epitheliopathy shortly after phacoemulsification with IOL implantation.

Diagnosis, Intervention, and Outcomes:

Netarsudil was discontinued, and the patient's reticular corneal edema resolved shortly thereafter.

Conclusions:

Reticular corneal epitheliopathy can be seen in patients being treated with netarsudil after phacoemulsification with IOL implantation. Fortunately, this condition resolves shortly after the drug is discontinued.
Safety and effectiveness comparison of a new cohesive ophthalmic viscosurgical device
Authors: Packer Mark , Shultz Mitchell , Loden James , Lau George
Published: April 2023

Purpose:

To evaluate the safety and effectiveness of a new cohesive ophthalmic viscosurgical device (OVD) (StableVisc) compared with a marketed cohesive OVD (ProVisc) in patients undergoing cataract surgery.

Setting:

22 sites in the United States.

Design:

Prospective multicenter controlled double-masked and randomized 1:1 (StableVisc:ProVisc; stratified by site, age group, and cataract severity).

Methods:

Adults (≥45 years) with age-related noncomplicated cataract considered amenable to treatment with standard phacoemulsification cataract extraction and intraocular lens implantation were included. Patients were randomized to receive either StableVisc or ProVisc during standard cataract surgery. Postoperative visits occurred at 6 hours, 24 hours, 7 days, 1 month, and 3 months. The primary effectiveness outcome was the change in endothelial cell density (ECD) from baseline to 3 months. The primary safety endpoint was the proportion of patients who experienced at least 1 intraocular pressure (IOP) measurement ≥30 mm Hg at any follow-up visit. Noninferiority between the devices was tested. Inflammation and adverse events were evaluated.

Results:

390 patients were randomized; 187 patients with StableVisc and 193 patients with ProVisc completed the study. StableVisc was noninferior to ProVisc in mean ECD loss from baseline to 3 months (17.5% and 16.9%, respectively). StableVisc was noninferior to ProVisc in the proportion of patients with postoperative IOP ≥30 mm Hg at any follow-up visit (5.2% and 8.2%, respectively).

Conclusions:

The StableVisc cohesive OVD, which provides both mechanical and chemical protection, was safe and effective when used in cataract surgery and provides surgeons with a new cohesive OVD.
TRPA1 rare variants in chronic neuropathic and nociplastic pain patients
Authors: Marchi Margherita , Salvi Erika , Andelic Mirna , Mehmeti Elkadia , D'Amato Ilaria , Cazzato Daniele , Chiappori Federica , Lombardi Raffaella , Cartelli Daniele , Devigili Grazia , Dalla Bella Eleonora , Gerrits Monique , Almomani Rowida , Malik Rayaz A. , Ślęczkowska Milena , Mazzeo Anna , Gentile Luca , Dib-Hajj Sulayman , Waxman Stephen G. , Faber Catharina G. , Vecchio Eleonora , de Tommaso Marina , Lauria Giuseppe
Published: April 2023

Missing aspects of the heritability of chronic neuropathic pain, as a complex adult-onset trait, may be hidden within rare variants with low effect on disease risk, unlikely to be resolved by a single-variant approach. To identify new risk genes, we performed a next-generation sequencing of 107 pain genes and collapsed the rare variants through gene-wise aggregation analysis. The optimal unified sequence kernel association test was applied to 169 patients with painful neuropathy, 223 patients with nociplastic pain (82 diagnosed with chronic widespread pain and 141 with fibromyalgia), and 216 healthy controls. Frequency and features of variants in TRPA1, which was the most significant gene, were further validated in 2 independent cohorts of 140 patients with chronic pain (90 with painful neuropathy and 50 with chronic widespread pain) and 34 with painless neuropathy. The effect of aminoacidic changes were modeled in silico according to physicochemical characteristics. TRPA1 was significantly enriched of rare variants which significantly discriminated chronic pain patients from healthy controls after Bonferroni correction (P = 6.7 × 10−4, ρ = 1), giving a risk of 4.8-fold higher based on the simple burden test (P = 0.0015, OR = 4.8). Among the 32 patients harboring TRPA1 variants, 24 (75%) were diagnosed with nociplastic pain, either fibromyalgia (12; 37.5%) or chronic widespread pain (12; 37.5%), whereas 8 (25%) with painful neuropathy. Irrespective of the clinical diagnosis, 12 patients (38%) complained of itch and 10 (31.3%) of cold-induced or cold-accentuated pain, mostly episodic. Our study widens the spectrum of channelopathy-related chronic pain disorders and contributes to bridging the gap between phenotype and targeted therapies based on patients' molecular profile.
Effects of Adalimumab Entering National Reimbursement on Medical Costs for Patients With Psoriasis: A 4-Year Single-Center Retrospective Study in China
Authors: Li Yu , Zhu Bo-Kun , Min Qing-Sheng , Ju Mei , Li Min
Published: April 2023

Objective:

Adalimumab (ADA) is expensive and rarely used among patients. However, its cost for moderate to severe chronic plaque psoriasis can now be reimbursed since its addition to the National Reimbursement Drug List (NRDL) in January 2020. Therefore, we conducted this study to estimate the medical cost of ADA and its influencing factors in patients with psoriasis using ADA and thus gain a better understanding of the effect of the NRDL adjustment in China.

Methods:

This retrospective study evaluated the medical cost of ADA before and after the addition of ADA to the NRDL (2018—2022) among 320 patients in a large professional dermatology specialty hospital. Descriptive analysis, Welch’s analysis of variance, and multiple regression analysis were used to evaluate the medical cost and influencing factors.

Results:

Before ADA was added to the NRDL, patients’ mean total cost and ADA cost were ¥24,243.56 ± 16,346.53 and ¥20,391.11 ± 14,440.69, respectively. After ADA became covered by the NRDL, the above 2 expenses decreased to ¥10,461.19 ± 7,554.66 and ¥8,775.27 ± 7,092.16, respectively. This significant decrease in the cost of ADA resulted in a significant 110.5-times increase in ADA use. Statistically significant differences were found in the total cost, patient type (outpatient/inpatient), insurance status (yes/no), reimbursement status (before/after), and age. Medical insurance reimbursement (P < 0.001, β = -0.468, before reimbursement = 1, after reimbursement = 2) was the most significant influencing factor, followed by patient type (P = 0.018, β = -0.215, outpatient = 1, inpatient = 2) and age (P = 0.0046, β = -0.174).

Conclusion:

Medical insurance reimbursement is the most important factor affecting patients’ total cost of ADA by reducing the economic burden, enhancing the availability of ADA, and stimulating the need for treatment.
Brain imaging after cardiac arrest
Authors: Beekman Rachel , Hirsch Karen G.
Published: April 2023

Purpose of review

Many patients who survive a cardiac arrest have a disorder of consciousness in the period after resuscitation, and prediction of long-term neurologic outcome requires multimodal assessments. Brain imaging with computed tomography (CT) and MRI is a key component. We aim to provide an overview of the types of neuroimaging available and their uses and limitations.

Recent findings

Recent studies have evaluated qualitative and quantitative techniques to analyze and interpret CT and MRI to predict both good and poor outcomes. Qualitative interpretation of CT and MRI is widely available but is limited by low inter-rater reliability and lack of specificity around which findings have the highest correlation with outcome. Quantitative analysis of CT (gray–white ratio) and MRI (amount of brain tissue with an apparent diffusion coefficient below certain thresholds) hold promise, though additional research is needed to standardize the approach.

Brain imaging is important for evaluating the extent of neurologic injury after cardiac arrest. Future work should focus on addressing previous methodological limitations and standardizing approaches to qualitative and quantitative imaging analysis. Novel imaging techniques are being developed and new analytical methods are being applied to advance the field.
Airway management during cardiac arrest
Authors: Penketh James , Nolan Jerry P.
Published: April 2023

Purpose of review

Despite improvements over time, cardiac arrest continues to be associated with high rates of mortality and morbidity. Several methods can be used to achieve airway patency during cardiac arrest, and the optimal strategy continues to be debated. This review will explore and summarize the latest published evidence for airway management during cardiac arrest.

Recent findings

A large meta-analysis of out-of-hospital cardiac arrest (OHCA) patients found no difference in survival between those receiving tracheal intubation and those treated with a supraglottic airway (SGA). Observational studies of registry data have reported higher survival to hospital discharge in patients receiving tracheal intubation or an SGA but another showed no difference. Rates of intubation during in-hospital cardiac arrest have decreased in the United States, and different airway strategies appear to be used in different centres.

Observational studies continue to dominate the evidence base relating to cardiac arrest airway management. Cardiac arrest registries enable these observational studies to include many patients; however, the design of such studies introduces considerable bias. Further randomized clinical trials are underway. The current evidence does not indicate a substantial improvement in outcome from any single airway strategy.
Perspectives on peripheral perfusion assessment
Authors: Kattan Eduardo , Ibarra-Estrada Miguel , Ospina-Tascón Gustavo , Hernández Glenn
Published: April 2023

Purpose of review

The ANDROMEDA-SHOCK trial positioned capillary refill time (CRT) assessment as a novel resuscitation target for septic shock.

The purpose of this article is to summarize pathophysiological determinants of CRT, review new technical developments on peripheral perfusion assessment, and explore recent evidence on the role of CRT monitoring in septic shock and other critical conditions.

Recent findings

A growing body of evidence supports the role of peripheral perfusion assessment as a warning and prognostic signal in a variety of clinical conditions among severely ill patients. Recent physiological studies demonstrated a rapid improvement of CRT after a single fluid bolus or a passive leg raising maneuver, a fact which may have diagnostic and therapeutic implications. Moreover, a couple of posthoc analyses of ANDROMEDA-SHOCK trial, reinforce that a normal CRT at the start of septic shock resuscitation, or its rapid normalization, thereafter may be associated with significant better outcomes.

Recent data confirm the relevance of peripheral perfusion assessment in septic shock and other conditions in critically ill patients. Future studies should confirm these findings, and test the potential contribution of technological devices to assess peripheral perfusion.
The pulmonary artery catheter
Authors: Arias-Ortiz Julian , Vincent Jean-Louis
Published: April 2023

Purpose of review

To review recently published data on pulmonary artery catheter (PAC) use in critically ill patients and consider optimal use of the PAC in personalized clinical practice.

Recent findings

Although PAC use has decreased considerably since the mid-1990s, PAC-derived variables can still have an important role in elucidating hemodynamic status and directing management in complex patients. Recent studies have suggested benefit, notably in patients having cardiac surgery.

Only a small number of acutely ill patients require a PAC and insertion should be individualized based on clinical context, availability of trained staff, and the possibility that measured variables will be able to help guide therapy.