bluuebunny/crossref_metadata_2025 huggingface dataset:
Stock Corporation Arbitration
Authors: Sester Peter , Azevedo Luis André
Published: November 2020

This chapter assesses stock corporate arbitration. Corporate arbitration has distinct features compared to other segments of Commercial Arbitration. This is particularly true if listed corporations provide mandatory shareholder arbitration in their bylaws. In order to serve as an effective dispute resolution mechanism, one capable of providing consistent decisions and legal certainty, corporate arbitration needs to fulfil two conditions: first, to produce, at least in some cases, an award with erga omnes or extra partes effect; and second, to exclude conflicting awards on identical disputes referring to the same company and identical facts. Developing an effective framework for stock corporation arbitration is one of the biggest challenges for Commercial Arbitration in Brazil today. According to the listing rules of Brazil's sole equity exchange (B3), corporations listed in the market segments Novo Mercado or Level II must adopt arbitration clauses in their corporate bylaws. Hence, over 150 Brazilian stock corporations impose mandatory shareholder arbitration on their shareholders. The Brazilian Corporation Law (BCL) explicitly permits these arbitration clauses. The chapter then explains why the core principles of Commercial Arbitration do not straightforwardly justify the erga omnes effect of arbitral awards, and discusses several proposals aiming to create collective shareholder arbitration in Brazil.
Post M&A Arbitration
Authors: Ferro Marcelo Roberto , de Souza Antonio Pedro Garcia
Published: November 2020

This chapter addresses post-mergers and acquisitions (M&A) arbitration. M&A transactions provide fertile ground for litigation. These complex transactions usually give rise to a significant level of information asymmetry between the parties regarding the target company. Buyer and seller harbour opposing interests concerning the sale value. Representations and warranties, as well as the allocation of risk among parties, although aimed at facilitating the closing of the transaction, also frequently create tension and give rise to dissonant expectations during the post-closing phase. Cross-border M&A transactions add even more layers of complexity given the different business cultures and legal regimes involved. Even though M&A deals have established standard global commercial practices, which follow the common law framework, they still raise a series of challenges for parties, stakeholders, and legal advisors, generating all types of post-closing disputes. Although there are several means of dispute resolution, M&A parties have reliably chosen arbitration as a method for resolving their disputes in Brazil. The chapter then looks at the issues that most frequently feature in the arbitration of international M&A disputes in Brazil.
Construction Contracts between Private Parties
Authors: Tolentino Augusto
Published: November 2020

This chapter describes arbitration involving construction contracts in Brazil. Construction contracts are known for being highly specialized in their form and use of terminology. Among the features of these contracts is the wide use of arbitration as a method of resolving disputes arising in connection with them, especially disputes requiring in-depth technical knowledge. The Brazilian Arbitration Law (BAL) provides that ‘all persons capable of entering into contracts can resort to arbitration to settle disputes referring to transferable property rights and claims. It can be affirmed that almost all construction contracts contemplate these types of rights and claims, which allow the use of arbitration to resolve any disputes arising in connection with those contracts. Moreover, the possibility of having a specialist who knows the subject matter in dispute sitting on the arbitral tribunal is perhaps the greatest advantage of arbitration. With respect to construction claims, this advantage becomes even more salient given the complexity of such claims. The chapter then studies each step of arbitral proceedings concerning construction contracts in Brazil, especially those conducted between private parties.
Oil and Gas Arbitration
Authors: da Fonseca Rodrigo Garcia
Published: November 2020

This chapter discusses oil and gas arbitration in Brazil. The oil and gas sector has undoubtedly played a big role in the evolution of arbitration in Brazil. It is a very international and sophisticated industry, and as such, a very frequent user of arbitration. Nowadays, it does not even make sense anymore to refer to arbitration as an alternative means of dispute resolution in certain areas. When it comes to international contracts, or to certain industries, such as oil and gas, arbitration has become the natural and sometimes almost the only means of dispute resolution. The possibility of having neutral and specialized arbitrators, neutral venues, and confidentiality, among other features of arbitration, make it very appealing for the players in industries like the oil and gas sector. The chapter then looks at some examples of the types of cases that have arisen within the industry of oil and gas. Many of these cases present cutting-edge legal issues that are shaping the evolution of Brazilian arbitration law and practice in general.
The European Court of Human Rights
Authors: Angelika Nussberger
Published: November 2020

After more than thirty years of horror from the outbreak of the Great War in 1914 to the conclusion of Second World War in 1945, the European general population and political leadership thought it absolutely necessary that post-war institutions be created that would make a third European world war less likely. This book introduces us to one such institution, the European Court of Human Rights. The book explores its uniqueness as an international adjudicatory body in the light of its history, structure, and procedure, as well as its key doctrinal usages. It also shows the Court to be an exciting and instructive new development of modern international law and human rights law. The book traces the history of the Court from its political context in the 1940s to the present day, answering pressing questions about its origins and internal workings. What was the best model for such an international organization? How should it evolve within more and more diverse legal cultures? How does a case move among different decision-making bodies? These questions help frame the six parts of the book, whilst the final section reflects on the past successes and failures of the Court, shedding light on possible future directions.
6 Successes, Problems, and Potential
Authors: Angelika Nussberger
Published: November 2020

This concluding chapter explores how far the European Court of Human Rights (ECtHR) and the Commission have influenced politics in the forty-seven Member States, created common standards in Europe, and set a model for other parts of the world. The assessment of political success or failure of the Convention model will depend on the expectancies. Undoubtedly, the Court’s jurisprudence reflects the new political tensions and provides answers. Three factors, however, cannot but reduce the direct impact of the Court’s advocacy for ‘bona fide democracy’. First, the Court can only decide on cases brought before it. Second, the Court can only play a subsidiary role. Third, the whole Convention system is dependent on the good will of the Member States. If they do not execute politically important judgments that do not ‘please’ them, the Court's means in forcing them are rather restricted. Despite all these difficulties, whenever it could and within the framework provided by the Convention, the Court has identified the relevant violations and assessed them within the political context. Ultimately, the Court is a ‘European’ court and can speak only for its European Member States. Nevertheless, its voice is not only heard in Europe, but also beyond its borders. This is especially true when the challenges it has to deal with are universal, such as terrorism, migration, and military conflicts.
Young stellar population gradients in central cluster galaxies from NUV and optical spectroscopy
Authors: Salvador-Rusiñol N , Beasley M A , Vazdekis A , Barbera F La
Published: November 2020

Central cluster galaxies are the largest and most massive galaxies in the Universe. Although they host very old stellar populations, several studies found the existence of blue cores in some BCGs indicating ongoing star formation. We analyse VLT/X-Shooter stacked spectra of 6 nearby massive central galaxies with high central velocity dispersions (σ > 300 km s−1) at different galactocentric distances. We quantify the young stellar population out to 4 kpc by fitting near-UV and optical absorption line indices with predictions of composite stellar populations modelled by an old and a young stellar component. We also use IMF-sensitive indices since these galaxies have been found to host a bottom-heavy IMF in their central regions. We derive negative young stellar populations gradients, with mass fractions of stars younger than 1 Gyr decreasing with galactocentric distance, from 0.70 per cent within 0.8 kpc to zero beyond 2 kpc. We also measure the mass fraction in young stars for individual galaxies in the highest S/N central regions. All the galaxies have young components of less than one percent. Our results clearly suggest that the star formation in massive central cluster galaxies takes place in their galaxy cores (<2 kpc), which, with deeper gravitational potential wells, are capable of retaining more gas. Among the possible sources for the gas required to form these young stars, our results are consistent with an in situ origin via stellar evolution, which is sufficient to produce the observed young stellar populations.
Effects of the stellar wind on the Ly α transit of close-in planets
Authors: Carolan S , Vidotto A A , Villarreal D’Angelo C , Hazra G
Published: November 2020

We use 3D hydrodynamics simulations followed by synthetic line profile calculations to examine the effect increasing the strength of the stellar wind has on observed Ly α transits of a hot Jupiter (HJ) and a warm Neptune (WN). We find that increasing the stellar wind mass-loss rate from 0 (no wind) to 100 times the solar mass-loss rate value causes reduced atmospheric escape in both planets (a reduction of 65 per cent and 40 per cent for the HJ and WN, respectively, compared to the ‘no wind’ case). For weaker stellar winds (lower ram pressure), the reduction in planetary escape rate is very small. However, as the stellar wind becomes stronger, the interaction happens deeper in the planetary atmosphere, and, once this interaction occurs below the sonic surface of the planetary outflow, further reduction in evaporation rates is seen. We classify these regimes in terms of the geometry of the planetary sonic surface. ‘Closed’ refers to scenarios where the sonic surface is undisturbed, while ‘open’ refers to those where the surface is disrupted. We find that the change in stellar wind strength affects the Ly α transit in a non-linear way (note that here we do not include charge-exchange processes). Although little change is seen in planetary escape rates (≃ 5.5 × 1011 g s−1) in the closed to partially open regimes, the Ly α absorption (sum of the blue [−300, −40 km s−1] and red [40, 300 km s−1] wings) changes from 21 to 6 per cent as the stellar wind mass-loss rate is increased in the HJ set of simulations. For the WN simulations, escape rates of ≃ 6.5 × 1010 g s−1 can cause transit absorptions that vary from 8.8 to 3.7 per cent, depending on the stellar wind strength. We conclude that the same atmospheric escape rate can produce a range of absorptions depending on the stellar wind and that neglecting this in the interpretation of Ly α transits can lead to underestimation of planetary escape rates.
Quantifying resolution in cosmological N-body simulations using self-similarity
Authors: Joyce Michael , Garrison Lehman , Eisenstein Daniel
Published: November 2020

We demonstrate that testing for self-similarity in scale-free simulations provides an excellent tool to quantify the resolution at small scales of cosmological N-body simulations. Analysing two-point correlation functions measured in simulations using abacus , we show how observed deviations from self-similarity reveal the range of time and distance scales in which convergence is obtained. While the well-converged scales show accuracy below 1 per cent, our results show that, with a small force softening length, the spatial resolution is essentially determined by the mass resolution. At later times, the lower cut-off scale on convergence evolves in comoving units as a−1/2 (a being the scale factor), consistent with a hypothesis that it is set by two-body collisionality. A corollary of our results is that N-body simulations, particularly at high red-shift, contain a significant spatial range in which clustering appears converged with respect to the time-stepping and force softening but has not actually converged to the physical continuum result. The method developed can be applied to determine the resolution of any clustering statistic and extended to infer resolution limits for non-scale-free simulations.
Testing dark matter halo properties using self-similarity
Authors: Leroy M , Garrison L , Eisenstein D , Joyce M , Maleubre S
Published: November 2020

We use self-similarity in N-body simulations of scale-free models to test for resolution dependence in the mass function and two-point correlation functions of dark matter haloes. We use 10243 particle simulations performed with abacus , and compare results obtained with two halo finders: friends-of-friends (fof ), and rockstar . The fof  mass functions show a systematic deviation from self-similarity which is explained by resolution dependence of the fof  mass assignment previously reported in the literature. Weak evidence for convergence is observed only starting from haloes of several thousand particles, and mass functions are overestimated by at least as much as $20-25{{\ \rm per\ cent}}$ for haloes of 50 particles. The mass function of the default rockstar  halo catalogue (with bound virial spherical overdensity mass), on the other hand, shows good convergence of the order of 50 to 100 particles per halo, with no detectable evidence at the few percent level of any systematic dependence for larger particle number. Tests show that the mass unbinding procedure in rockstar is the key factor in obtaining this much improved resolution. Applying the same analysis to the halo–halo two point correlation function, we find again strong evidence for convergence only for rockstar  haloes, at separations sufficiently large so that haloes do not overlap. At these separations, we can exclude dependence on resolution at the $5-10{{\ \rm per\ cent}}$ level once haloes have of the order of 50 to 100 particles. At smaller separations results are not converged even at significantly larger particle number, and bigger simulations would be required to establish the resolution required for convergence.
Cosmological model parameter dependence of the matter power spectrum covariance from the DEUS-PUR Cosmo simulations
Authors: Blot Linda , Corasaniti Pier-Stefano , Rasera Yann , Agarwal Shankar
Published: November 2020

Future galaxy surveys will provide accurate measurements of the matter power spectrum across an unprecedented range of scales and redshifts. The analysis of these data will require one to accurately model the imprint of non-linearities of the matter density field. In particular, these induce a non-Gaussian contribution to the data covariance that needs to be properly taken into account to realize unbiased cosmological parameter inference analyses. Here, we study the cosmological dependence of the matter power spectrum covariance using a dedicated suite of N-body simulations, the Dark Energy Universe Simulation–Parallel Universe Runs (DEUS-PUR) Cosmo. These consist of 512 realizations for 10 different cosmologies where we vary the matter density Ωm, the amplitude of density fluctuations σ8, the reduced Hubble parameter h, and a constant dark energy equation of state w by approximately $10{{\ \rm per\ cent}}$. We use these data to evaluate the first and second derivatives of the power spectrum covariance with respect to a fiducial Λ-cold dark matter cosmology. We find that the variations can be as large as $150{{\ \rm per\ cent}}$ depending on the scale, redshift, and model parameter considered. By performing a Fisher matrix analysis we explore the impact of different choices in modelling the cosmological dependence of the covariance. Our results suggest that fixing the covariance to a fiducial cosmology can significantly affect the recovered parameter errors and that modelling the cosmological dependence of the variance while keeping the correlation coefficient fixed can alleviate the impact of this effect.
Dual conformational recognition by Z-DNA binding protein is important for the B–Z transition process
Authors: Park Chaehee , Zheng Xu , Park Chan Yang , Kim Jeesoo , Lee Seul Ki , Won Hyuk , Choi Jinhyuk , Kim Yang-Gyun , Choi Hee-Jung
Published: November 2020

Left-handed Z-DNA is radically different from the most common right-handed B-DNA and can be stabilized by interactions with the Zα domain, which is found in a group of proteins, such as human ADAR1 and viral E3L proteins. It is well-known that most Zα domains bind to Z-DNA in a conformation-specific manner and induce rapid B–Z transition in physiological conditions. Although many structural and biochemical studies have identified the detailed interactions between the Zα domain and Z-DNA, little is known about the molecular basis of the B–Z transition process. In this study, we successfully converted the B–Z transition-defective Zα domain, vvZαE3L, into a B–Z converter by improving B-DNA binding ability, suggesting that B-DNA binding is involved in the B–Z transition. In addition, we engineered the canonical B-DNA binding protein GH5 into a Zα-like protein having both Z-DNA binding and B–Z transition activities by introducing Z-DNA interacting residues. Crystal structures of these mutants of vvZαE3L and GH5 complexed with Z-DNA confirmed the significance of conserved Z-DNA binding interactions. Altogether, our results provide molecular insight into how Zα domains obtain unusual conformational specificity and induce the B–Z transition.
Little Evidence of Modified Genetic Effect of rs16969968 on Heavy Smoking Based on Age of Onset of Smoking
Authors: Adjangba Christine , Border Richard , Romero Villela Pamela N , Ehringer Marissa A , Evans Luke M
Published: November 2020

Introduction

Tobacco smoking is the leading cause of preventable death globally. Smoking quantity, measured in cigarettes per day, is influenced both by the age of onset of regular smoking (AOS) and by genetic factors, including a strong effect of the nonsynonymous single-nucleotide polymorphism rs16969968. A previous study by Hartz et al. reported an interaction between these two factors, whereby rs16969968 risk allele carriers who started smoking earlier showed increased risk for heavy smoking compared with those who started later. This finding has yet to be replicated in a large, independent sample.

Methods

We performed a preregistered, direct replication attempt of the rs16969968 × AOS interaction on smoking quantity in 128 383 unrelated individuals from the UK Biobank, meta-analyzed across ancestry groups. We fit statistical association models mirroring the original publication as well as formal interaction tests on multiple phenotypic and analytical scales.

Results

We replicated the main effects of rs16969968 and AOS on cigarettes per day but failed to replicate the interaction using previous methods. Nominal significance of the rs16969968 × AOS interaction term depended strongly on the scale of analysis and the particular phenotype, as did associations stratified by early/late AOS. No interaction tests passed genome-wide correction (α = 5e-8), and all estimated interaction effect sizes were much smaller in magnitude than previous estimates.

Conclusions

We failed to replicate the strong rs16969968 × AOS interaction effect previously reported. If such gene–moderator interactions influence complex traits, they likely depend on scale of measurement, and current biobanks lack the power to detect significant genome-wide associations given the minute effect sizes expected.

Implications

We failed to replicate the strong rs16969968 × AOS interaction effect on smoking quantity previously reported. If such gene–moderator interactions influence complex traits, current biobanks lack the power to detect significant genome-wide associations given the minute effect sizes expected. Furthermore, many potential interaction effects are likely to depend on the scale of measurement employed.
Neopterin Predicts Disease Severity in Hospitalized Patients With COVID-19
Authors: Bellmann-Weiler Rosa , Lanser Lukas , Burkert Francesco , Seiwald Stefanie , Fritsche Gernot , Wildner Sophie , Schroll Andrea , Koppelstätter Sabine , Kurz Katharina , Griesmacher Andrea , Weiss Günter
Published: November 2020

This study evaluates the predictive value of circulating inflammatory markers, especially neopterin, in patients with coronavirus disease 2019 (COVID-19). Within this retrospective analysis of 115 hospitalized COVID-19 patients, elevated neopterin levels upon admission were significantly associated with disease severity, risk for intensive care unit admission, need for mechanical ventilation, and death. Therefore, neopterin is a reliable predictive marker in patients with COVID-19 and may help to improve the clinical management of patients.
Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE): Protocol for a Multisite Pragmatic Clinical Trial
Authors: Farrokhi Shawn , Russell Esposito Elizabeth , McPherson Danielle , Mazzone Brittney , Condon Rachel , Patterson Charity G , Schneider Michael , Greco Carol M , Delitto Anthony , Highsmith M Jason , Hendershot Brad D , Maikos Jason , Dearth Christopher L
Published: November 2020

Background

Physical therapy (PT) is frequently used for the management of low back pain (LBP) within the US Departments of Defense (DOD) and Veterans Affairs (VA). However, variations in PT practice patterns and use of ineffective interventions lower the quality and increase the cost of care. Although adherence to the clinical practice guidelines (CPGs) can improve the outcomes and cost-effectiveness of LBP care, PT CPG adherence remains below 50%. The Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE) trial will evaluate the effectiveness of an active PT CPG implementation strategy using an education, audit, and feedback model for reducing pain, disability, medication use, and cost of LBP care within the DOD and VA health care systems.

Design

The RESOLVE trial will include 3,300 to 7,260 patients with LBP across three DOD and two VA medical facilities using a stepped-wedge study design. An education, audit, and feedback model will be used to encourage physical therapists to better adhere to the PT CPG recommendations. The Oswestry Disability Index and the Defense and Veterans Pain Rating Scale will be used as primary outcomes. Secondary outcomes will include the LBP-related medication use, medical resource utilization, and biopsychosocial predictors of outcomes. Statistical analyses will be based on the intention-to-treat principle and will use linear mixed models to compare treatment conditions and examine the interactions between treatment and subgrouping status (e.g., limb loss).

The RESOLVE trial will provide a pragmatic approach to evaluate whether better adherence to PT CPGs can reduce pain, disability, medication use, and LBP care cost within the DOD and VA health care systems.
The Night and Day of Amihud’s (2002) Liquidity Measure
Authors: Barardehi Yashar H , Bernhardt Dan , Ruchti Thomas G , Weidenmier Marc
Published: November 2020

Amihud’s stock (il)liquidity measure averages daily ratios of the absolute close-to-close return to dollar volume, including overnight returns. Our modified measure uses open-to-close returns matching return and trading volume measurement windows. It is more strongly correlated with trading-cost measures (by 8%–37%) and better explains cross-sections of returns, doubling estimated liquidity premiums. Using nonsynchronous trading near close, we show overnight returns are primarily information driven: including them in Amihud’s proxy for price impacts of trading magnifies measurement error, understating liquidity premiums. Our modification helps wherever Amihud’s measure is required. Our measures are publicly available for 1964–2019 and can be updated. (JEL G12, G14)

Received June 2, 2020; editorial decision September 11, 2020 by Editor Jeffrey Pontiff.
The Costs and Benefits of Shareholder Democracy: Gadflies and Low-Cost Activism
Authors: Gantchev Nickolay , Giannetti Mariassunta
Published: November 2020

We show that there is cross-sectional variation in the quality of shareholder proposals. On average, proposals submitted by the most active individual sponsors are less likely to receive majority support, but they occasionally pass if shareholders mistakenly support them and may even be implemented due to directors’ career concerns. While gadfly proposals destroy shareholder value if they pass, shareholder proposals on average are value enhancing in firms with more informed shareholders. We conclude that more informed voting could increase the benefits associated with shareholder proposals.
Treatment Strategies for Massive Presacral Bleeding
Authors: Mauravičiūtė Sandra , Dulskas Audrius
Published: November 2020

CASE SUMMARY:

An 84-year-old male patient was complaining of constipation and rectal bleeding for 6 months. Colonoscopy and rigid sigmoidoscopy showed a posterior upper rectal mass (13 cm from anus). Histopathology confirmed moderately differentiated adenocarcinoma. A CT scan of the thorax, abdomen, and pelvis, as well as pelvic magnetic nuclear resonance imaging, revealed midrectal cancer cT3N0M0 with clear predicted circumferential margin. The patient underwent anterior resection with tumor-specific total mesorectal excision and end colostomy. During the posterior rectal dissection, dilated fragile varicose presacral veins were damaged, and severe bleeding was observed. Initial pelvic packing was ineffective, as well as bone wax and clips. Internal iliac arteries were ligated, and additional packing was finally successful and the bleeding stopped. The patient was resuscitated with a total blood loss of 4.2 L. The bleeding did not recur, and the packs were removed on postoperative day 2. The postoperative course was uneventful, and the patient was discharged on postoperative day 13 from the initial operation and postoperative day 5 from packing removal.
REPLACEMENT OF LIDOCAINE GEL WITH TOPICAL PROPARACAINE ANESTHESIA FOR ROUTINE INTRAVITREAL INJECTIONS
Authors: Alex Varsha , Singh Sumit R. , Motevasseli Tahmineh , Cavicchini Melina , Jhingan Mahima , Bartsch Dirk-Uwe , Cheng Lingyun , Freeman William R.
Published: November 2020

Purpose:

Lidocaine gel was suggested to be highly effective in providing anesthesia for intravitreal injections but adverse effects include a possibility of making sterilization of the conjunctiva difficult. Hence, we wished to determine the effect of using 0.5% proparacaine drops alone over the use of 3.5% lidocaine hydrochloride gel anesthesia during office-based intravitreal injections.

Methodology:

This was a case–control study in patients who came routinely to the clinic for antivascular endothelial growth factor injections. Eyes were treated with one of two anesthesia modalities. A total of 216 injections in 120 patients were reviewed. One group (N = 107) underwent anesthesia with 0.5% proparacaine drops, and the control group (N = 109) received 3.5% lidocaine gel. The pain perceived after injection was graded using the numerical rating scale, and score was immediately recorded by the “masked” injecting physician.

Results:

The mean pain score (±SD) for the proparacaine-only group versus gel group was 1.97 (±1.17) versus 1.76 (±0.92), P value = 0.3174. There was no statistical difference between the 2 groups.

Conclusion:

3.5% lidocaine gel is not superior to 0.5% proparacaine drops as patients attained good pain control and excellent rates of overall satisfaction with proparacaine drops alone.
Reduced IL-35 in patients with immune thrombocytopenia
Authors: Sun Rui-Jie , Yuan Dai , Liu Shu-Yan , Zhu Jing-Jing , Shan Ning-Ning
Published: November 2020

The occurrence and development of primary immune thrombocytopenia is closely related to autoimmune imbalanced. Thus, we conducted the current study to investigate the modulation of IL-35, a newly identified immunological self-tolerance factor on immune thrombocytopenic purpura (ITP). We were enrolled peripheral blood in 21 adult healthy volunteers, 21 active primary ITP patients and 16 ITP patients in remission. In the same period, bone marrow plasma was drawn from active primary ITP patients and 16 bone marrow donors. Enzyme-linked immunoassay was used to measure IL-35 levels in bone marrow mononuclear cells and peripheral blood mononuclear cells. Real-time quantitative PCR was used to study the mRNA expression levels of p35, Epstein–Barr virus-induced gene 3 in bone marrow mononuclear cells and peripheral blood mononuclear cells. Compared with the normal group, IL-35 levels of in ITP patients were decreased significantly. IL-35 level in bone marrow plasma was decreased more significantly than that in peripheral blood plasma at the same stage. The results showed that plasma IL-35 levels were significantly decreased in patients with active ITP compared with those of control individuals, and IL-35 levels in bone marrow plasma were decreased more significantly compared with those at the same stage. The pathogenesis of ITP is associated with decreased IL-35 levels. Further studies are needed to expand sample content and explore more in-depth investigate a possible role of IL-35 in the pathogenesis and course of ITP.
Can Trans-Syndromal Prototypes (“Types”) Improve Depiction of Complex Psychiatric Cases?
Authors: Yager Joel
Published: November 2020

Background and aims: In many psychiatric settings, patients with complex cases are the rule rather than the exception. These cases are characterized by multidiagnostic conditions, often complicated with distressed social contexts, for which few if any evidence-based practice guidelines exist. The aim of this hypothesis-generating article is to consider whether and how these cases might comprise trans-syndromal prototypes (“types”), coherent units that could serve as the basis for further study, assessment, and treatment planning. Methods: For context, psychiatric and medical visit diagnoses and problem lists noted among principle visit diagnoses and “snapshot” portions of electronic medical records were tabulated for 293 psychiatric outpatients seen consecutively during a 1-week period at a university psychiatric clinic. By considering resulting comorbidity patterns in these records from the perspectives of clinicians caring for these patients, several commonly encountered diagnostic-problem sets emerged as candidate types. Results: Of 293 patients, only 18% had a single diagnosis, 43% had two, 29% had three, and 7% had four or more noted. Occurring in assorted combinations, specific diagnostic areas noted included depressive disorders (68%, the large majority major depressive disorder recurrent), anxiety disorders (60%, the large majority generalized anxiety disorder, with or without panic disorder and/or social anxiety disorder), posttraumatic stress disorder (22%), attention deficit hyperactivity disorder (ADHD) (17%), alcohol and substance abuse disorders (16%), personality disorders (11%), and bipolar disorders (18%). Several illustrative candidate types emerging from this population are described including major anxious depressive disorder, anxiety disorder secondary to ADHD, complex emotional instability disorder, multi-impulsive eating disorder, substance-dependent impoverished personality disorder, painful mood disorder, and complex personal and cultural trauma disorder. Other potential types are identified as well. Conclusions and implications: The types described here are but a small selection, because other settings including community mental health centers, private practices, public and private hospitals, and forensic facilities see a variety of other types as well. The study of types might provide important findings about pathogenesis, course, outcome, and treatment to augment information obtained from examination of individual diagnostic components.
Developing a Framework for Designing and Deploying Technology-Assisted Rehabilitation After Stroke
Authors: Jayasree-Krishnan Veena , Ghosh Shramana , Palumbo Anna , Kapila Vikram , Raghavan Preeti
Published: November 2020

Objective

Many unmet rehabilitation needs of patients with stroke can be addressed effectively using technology. However, technological solutions have not yet been seamlessly incorporated into clinical care. The purpose of this pilot study was to examine how to bridge the gaps between the recovery process, technology, and clinical practice to impact stroke rehabilitation meaningfully.

Design

Semistructured interviews were performed using a grounded theory approach with purposive sampling of 17 diverse expert providers in acute care, inpatient, and outpatient stroke rehabilitation settings. Common themes were identified from qualitative analyses of the transcribed conversations to develop a guiding framework from the emerging concepts.

Results

Four core themes emerged that addressed major barriers in stroke rehabilitation and technology-assisted solutions to overcome these barriers: (1) accessibility to quality rehabilitation, (2) adaptability to patient differences, (3) accountability or compliance with rehabilitation, and (4) engagement with rehabilitation.

Conclusions

The results suggest a four-pronged framework, the A3E framework that stands for Accessibility, Adaptability, Accountability, and Engagement, to comprehensively address existing barriers in providing rehabilitation services. This framework can guide technology developers and clinicians in designing and deploying technology-assisted rehabilitation solutions for poststroke rehabilitation, particularly using telerehabilitation.
Developmental Pattern of Diurnal Cortisol Rhythm and Sex-Specific Associations With Psychopathological Symptoms During Pubertal Transition
Authors: Zhang Dan-dan , Duan Xiao-nan , Wan Yu-hui , Zhang Zhi-hua , Su Pu-yu , Tao Fang-biao , Sun Ying
Published: November 2020

Objective

This study aimed to examine the developmental pattern of diurnal cortisol rhythm during pubertal transition and its prospective association with psychopathological symptoms.

Methods

A cohort of 1158 children consisting of 608 boys and 550 girls aged 7 to 9 years (mean [standard deviation] age = 8.04 [0.61] years) were recruited in the Anhui Province of China in 2015 (wave 1). A single awakening sample was collected at baseline, and three additional samples were collected at one weekday in wave 2 to wave 4. Four indices of cortisol activity were evaluated and calculated across the day: awakening cortisol level, cortisol awakening response, the area under the curve with respect to ground (AUC), and the diurnal cortisol slope. In each wave, pubertal development was assessed by testicular size in boys and Tanner scales in girls. Psychopathological symptoms were ascertained in waves 2 to 4.

Results

Multilevel mixed models revealed no significant pubertal changes in diurnal cortisol activity in girls. In boys, awakening cortisol (β = −0.005, p = .004) and total cortisol output (lnAUC, β = −0.005, p = .040) significantly decreased across pubertal transition. Higher awakening cortisol and total cortisol output (lnAUC) were associated with higher scores on internalizing symptoms in girls (β = 0.82, p < .001; β = 0.62, p = .012) and externalizing symptoms in boys (β = 0.73, p = .001; β = 0.55, p = .019) during the 3-year follow-up. In contrast, no associations were found between cortisol awakening response and diurnal cortisol slope with psychopathological symptom scores in boys or girls.

Conclusions

Development of diurnal cortisol activity during pubertal transition occurs in a sex-specific manner. Awakening cortisol level and daily total cortisol output may serve as markers for psychopathology during pubertal transition.
Current choices of antibiotic treatment for Pseudomonas aeruginosa infections
Authors: Ibrahim Dima , Jabbour Jean-Francois , Kanj Souha S.
Published: November 2020

Purpose of review

Pseudomonas aeruginosa is one of the most feared nosocomial pathogens. Treatment of P. aeruginosa infections is challenging because of the limited choices of antibiotics and the emergent resistance of the pathogen. The present review aims at addressing the management of P. aeruginosa infections and highlighting the novel antibiotics that show a future promising role.

Recent findings

Novel fluoroquinolones have been recently introduced and show favorable activity. New combinations of β-lactams/β-lactamase inhibitors have been studied in various indications of infections because of P. aeruginosa. Cefiderocol, a new cephalosporin, shows very promising results against P. aeruginosa. Currently, combination therapy is only recommended in limited scenarios. Extended-infusion of β-lactams exhibit clinical benefit. Bacteriophage therapy is a growing field of interest and may have an impactful effect on the treatment of resistant P. aeruginosa.

Factors that guide clinical decisions for empiric and directed P. aeruginosa therapy include the epidemiology, the patient's risk factors, the site of infection, and the available treatment options. Conventional antipseudomonal antibiotics have been used successfully for a long time, but the increase in worldwide resistance necessitates the need for newer agents. Antimicrobial stewardship is essential to preserve the new drugs and prevent future development of resistance.
Antibiotic treatment of common infections: more evidence to support shorter durations
Authors: Smith Benjamin J. , Heriot George , Buising Kirsty
Published: November 2020

Purpose of review

Although there is increasing recognition of the link between antibiotic overuse and antimicrobial resistance, clinician prescribing is often unnecessarily long and motivated by fear of clinical relapse. High-quality evidence supporting shorter treatment durations is needed to give clinicians confidence to change prescribing habits. Here we summarize recent randomized controlled trials investigating antibiotic short courses for common infections in adult patients.

Recent findings

Randomized trials in the last five years have demonstrated noninferiority of short-course therapy for a range of conditions including community acquired pneumonia, intraabdominal sepsis, gram-negative bacteraemia and vertebral osteomyelitis.

Treatment durations for many common infections have been based on expert opinion rather than randomized trials. There is now evidence to support shorter courses of antibiotic therapy for many conditions.
Advocating the Development of Next-Generation, Advanced-Design Low-Field Magnetic Resonance Systems
Authors: Runge Val M. , Heverhagen Johannes T.
Published: November 2020

New next-generation low-field magnetic resonance imaging systems (operating in the range of 0.5 T) hold great potential for increasing access to clinical diagnosis and needed health care both in developed countries and worldwide. The relevant history concerning the choice of field strength, which resulted in 1.5 T still dominating today the number of installed systems, is considered, together with design advances possible because of interval developments, since low field was considered for clinical use in the 1980s, and current research. The potential impact of low-cost, advanced-generation low-field magnetic resonance imaging systems, properly designed, is high in terms of further dissemination of health care—across the gamut from industrial to developing countries—regardless of disease entity and anatomic region of involvement, with major niche applications likely as well.
HLA and AB0 Polymorphisms May Influence SARS-CoV-2 Infection and COVID-19 Severity
Authors: Amoroso Antonio , Magistroni Paola , Vespasiano Francesca , Bella Antonino , Bellino Stefania , Puoti Francesca , Alizzi Silvia , Vaisitti Tiziana , Boros Stefano , Grossi Paolo Antonio , Trapani Silvia , Lombardini Letizia , Pezzotti Patrizio , Deaglio Silvia , Brusaferro Silvio , Cardillo Massimo ,   on behalf of the Italian Network of Regional Transplant Coordinating Centers
Published: November 2020

Background.

SARS-CoV-2 infection is heterogeneous in clinical presentation and disease evolution. To investigate whether immune response to the virus can be influenced by genetic factors, we compared HLA and AB0 frequencies in organ transplant recipients and waitlisted patients according to presence or absence of SARS-CoV-2 infection.

Methods.

A retrospective analysis was performed on an Italian cohort composed by transplanted and waitlisted patients in a January 2002 to March 2020 time frame. Data from this cohort were merged with the Italian registry of COVID+ subjects, evaluating infection status of transplanted and waitlisted patients. A total of 56 304 cases were studied with the aim of comparing HLA and AB0 frequencies according to the presence (n = 265, COVID+) or absence (n = 56 039, COVID–) of SARS-CoV-2 infection.

Results.

The cumulative incidence rate of COVID-19 was 0.112% in the Italian population and 0.462% in waitlisted/transplanted patients (OR = 4.2; 95% CI, 3.7-4.7; P < 0.0001). HLA-DRB1*08 was more frequent in COVID+ (9.7% and 5.2%: OR = 1.9, 95% CI, 1.2-3.1; P = 0.003; P
c = 0.036). In COVID+ patients, HLA-DRB1*08 was correlated to mortality (6.9% in living versus 17.5% in deceased: OR = 2.9, 95% CI, 1.15-7.21; P = 0.023). Peptide binding prediction analyses showed that these DRB1*08 alleles were unable to bind any of the viral peptides with high affinity. Finally, blood group A was more frequent in COVID+ (45.5%) than COVID– patients (39.0%; OR = 1.3; 95% CI, 1.02-1.66; P = 0.03).

Conclusions.

Although preliminary, these results suggest that HLA antigens may influence SARS-CoV-2 infection and clinical evolution of COVID-19 and confirm that blood group A individuals are at greater risk of infection, providing clues on the spread of the disease and indications about infection prognosis and vaccination strategies.
Race, Education, and Gender Disparities in Transplantation of Kidneys From Hepatitis C Viremic Donors
Authors: Nguyen Tiffany , Sise Meghan E. , Delgado Cindy , Williams Winfred , Reese Peter , Goldberg David
Published: November 2020

Background.

Transplantation of kidneys from hepatitis C virus (HCV)-viremic donors into HCV-negative patients followed by direct-acting antiviral therapy was an important breakthrough to increase the number of life-saving kidney transplants. Data suggest that these transplants offer several benefits; however, it is unknown whether adoption of this practice has been shared equitably, especially among disadvantaged groups.

Methods.

We evaluated United Network for Organ Sharing data on HCV-seronegative adult deceased-donor kidney transplant recipients from January 1, 2017, to June 12, 2020. We compared recipients of a kidney from an HCV antibody− (Ab−)/nucleic acid test− (NAT−), HCV Ab+/NAT−, and HCV NAT+ donor. The primary covariates were as follows: (1) race/ethnicity; (2) female sex; and (3) highest level of education. Models included variables associated with being offered an HCV NAT+ kidney. We fit mixed-effects multinomial logistic regression models with the center as a random effect to account for patient clustering.

Results.

Of 48 255 adult kidney-alone deceased-donor kidney transplant HCV-seronegative recipients, 1641 (3.4%) donors were HCV NAT+−, increasing from 0.3% (January 2017–June 2017) to 6.9% (January 2020–June 2020). In multivariable models, racial/ethnic minorities, women, and those with less education were significantly less likely to receive a kidney from an HCV NAT+ donor relative to an HCV Ab−/NAT− and HCV Ab+/NAT− donor. The disparities were most pronounced among Hispanic and Asian patients with less educational attainment (grade school, high school, or some college/tech school).

Conclusions.

Despite an increase in transplants from HCV NAT+ donors, we found substantial racial/ethnic disparities in transplantation of these kidneys. These data highlight how the benefits of a scientific breakthrough are often made less available to disadvantaged patients.
Evaluation of GENECUBE Mycoplasma for the detection of macrolide-resistant Mycoplasma pneumoniae
Authors: Morinaga Yoshitomo , Suzuki Hiromichi , Notake Shigeyuki , Mizusaka Takashi , Uemura Keiichi , Otomo Shinobu , Oi Yuka , Ushiki Akihito , Kawabata Naoki , Kameyama Kazuaki , Morishita Eri , Uekura Yoshiko , Sugiyama Akio , Kawashima Yosuke , Yanagihara Katsunori
Published: November 2020

Introduction. Resistance against macrolide antibiotics in

Mycoplasma pneumoniae

is becoming non-negligible in terms of both appropriate therapy and diagnostic stewardship. Molecular methods have attractive features for the identification of

Mycoplasma pneumoniae

as well as its resistance-associated mutations of 23S ribosomal RNA (rRNA).

Hypothesis/Gap Statement. The automated molecular diagnostic sytem can identify macrolide-resistant

M. pneumoniae

.

Aim. To assess the performance of an automated molecular diagnostic system, GENECUBE Mycoplasma, in the detection of macrolide resistance-associated mutations.

Methodology. To evaluate whether the system can distinguish mutant from wild-type 23S rRNA, synthetic oligonucleotides mimicking known mutations (high-level macrolide resistance, mutation in positions 2063 and 2064; low-level macrolide resistance, mutation in position 2067) were assayed. To evaluate clinical oropharyngeal samples, purified nucleic acids were obtained from

M. pneumoniae

-positive samples by using the GENECUBE system from nine hospitals. After confirmation by re-evaluation of

M. pneumoniae

positivity, Sanger-based sequencing of 23S rRNA and mutant typing using GENECUBE Mycoplasma were performed.

Results. The system reproducibly identified all synthetic oligonucleotides associated with high-level macrolide resistance. Detection errors were only observed for A2067G (in 2 of the 10 measurements). The point mutation in 23S rRNA was detected in 67 (26.9 %) of 249 confirmed

M. pneumoniae

-positive clinical samples. The mutations at positions 2063, 2064 and 2617 were observed in 65 (97.0 %), 2 (3.0 %) and 0 (0.0 %) of the 67 samples, respectively. The mutations at positions 2063 and 2064 were A2063G and A2064G, respectively. The results from mutant typing using GENECUBE Mycoplasma were in full agreement with the results from sequence-based typing.

Conclusion. GENECUBE Mycoplasma is a reliable test for the identification of clinically significant macrolide-resistant

M. pneumoniae

.