bluuebunny/crossref_metadata_2025 huggingface dataset:
Academic Condemnation and the Decline of Theology at Oxford
Authors: Larsen Andrew E
Published: November 2023

It has long been clear to scholars that the study of philosophy and theology at Oxford declined in the later fourteenth century. The evidence for this is varied but considerable. Fewer commentaries on the Sentences were being written and those that were written were treating fewer questions, while other types of specialist literature were also becoming less common. Works on logic tended to be more introductory and elementary. Scholars and libraries of this period seem to have shown less interest in collecting the works of contemporaries. By the late fourteenth century, the ratio of theology students to law students was dropping, particularly among students in the secular colleges. Among members of secular colleges, the percentage of students studying theology dropped from 57% in the fourteenth century to 44% in the fifteenth century, while the percentage of students studying law rose from 39% to 52% during that same period. Apart from John Wyclif, Oxford in this period produced no thinkers to rival Parisian luminaries such as Pierre d’Ailly and Jean Gerson, or to rival earlier Oxford scholars like William of Ockham, Walter Chatton, Adam Wodeham, and others. By the fifteenth century, theological innovation had given way to a more conservative approach to theology that emphasized the perpetuation of established theological ideas and gave particular weight to preaching and pastoral instruction.
The Relationships Between Astronomical Observatories and Universities in nineteenth-century France
Authors: Lamy Je´roˆme , Gingras Yves
Published: November 2023

This article proposes an analysis of the process of institutionalization of astronomy in relation to the training of astronomers in nineteenth-century France, with an emphasis on the relations between the observatories and the French Faculties of science as teaching structures. Though many studies have looked at the functions of observatories and how they met national needs, few have raised the question of their relations with universities. We will thus analyze the links between university and observatories in the context of the Humboldtian model of the university as an institution closely connecting teaching and research. This new form of organization was embodied by the University of Berlin, founded in 1809, as a rupture with earlier conceptions, which associated research with academies only. This institution gave birth to the modern university and progressively became the dominant model adopted and adapted in Europe as well as in North America.
Environmental Tax Reform In Europe: Energy Tax Rates And Competitiveness
Authors: Ekins1 Paul , Speck2 Stefan
Published: November 2023

In earlier work,3 we made an initial assessment of the implications for competitiveness of environmental taxes, including those that had been implemented as part of an environmental tax reform (ETR), which we define as an increase in environmental taxes which is accompanied by a corresponding reduction in other taxes, such that the overall tax change is broadly revenue neutral. It was clear in that work that the major environmental tax base in most ETRs is energy use. This chapter updates and extends that work, focusing only on energy (or carbon dioxide) taxes. First, section B discusses how the concept of competitiveness may be defined and understood in the context of ETRs and more generally. Section C then considers the evolution of the ETRs that were included in the earlier chapter and describes the ETRs which have been introduced since the earlier work, especially in the United Kingdom and Germany. This then leads in section D to a detailed presentation of the energy tax rates that have developed over the period 1990 to 2006 in the six European countries (Denmark, Finland, Germany, the Netherlands, Sweden, and the United Kingdom) that introduced major ETRs before 2005, including the component of the rates that was contributed by the ETR. The treatment distinguishes between households and businesses, with a full specification of the rebates and exemptions that have been introduced in different countries for different sectors, especially for energyintensive sectors.
The Need To Shift Canadian Tax Incentives To Reduce The Impact Of The Mineral Industry On The Environment And Local Communities
Authors: Kuyek Joan
Published: November 2023

Mining has a big footprint: acid mine drainage, toxic e uents, air pollution, occupational hazards, enormous consumption of energy and water, road and rail transport hazards, community disruption, and public tax costs. Local communities bear the brunt of these costs, and are often ill-equipped to protect their interests. Most mining and exploration in Canada and around the world takes place on indigenous lands. The shocking cost of the minerals we take for granted must be respected in government policy and industry practice. To the author, this means respecting the minerals that have already been extracted and reducing the need for mining wherever possible. Many more jobs and more sustainable economies can be created in the minerals industry if the focus shifts from mining to the re-use, recycling, and conservation of minerals already taken from the ground and to value-added production in Canada. This chapter begins with a summary of the impacts of mining on the environment and the issue of metals’ depletion. Next, an overview of key components of the tax regime for mining in Canada, including an analysis of the ‘Super Flow-Through Share’ programme, is provided, followed by a short discussion of the limitations for researchers due to the limited data and analysis currently available from governments. The chapter concludes with a number of recommendations for shifting fiscal incentives in order to protect mineral resources for future generations.
The Drafting History of the European Biotechnology Directive
Authors: Porter* Gerard
Published: November 2023

Directive 98/44/EC of the European Parliament and of the Council of 6 July 1998 on the Legal Protection of Biotechnological Inventions (the Directive) was one of the most heavily lobbied and controversial pieces of legislation ever produced through the European democratic process. Its adoption came after 10 years of difficult negotiations, and followed the Parliament’ s rejection of an earlier draft in March 1995.
Human Embryos, Patents, and Global Trade: Assessing the Scope And Contents of the Trips Morality Exception
Authors: Porter* Gerard
Published: November 2023

The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) is a multilateral agreement on intellectual property that was concluded in 1994 as part of the Uruguay Round of the General Agreement on Tariffs and Trade (GATT).
Particle–Antiparticle Colliders (1961)
Authors: Brandt Siegmund
Published: November 2023

One morning in December 1959, I was taking the final oral exam for my diploma in the office of my advisor Paul in Bonn. One of the topics was particle accelerators. After all, Paul had built a 500-MeV strong-focussing electron synchrotron in Bonn which I had used in my diploma thesis work. We even touched on the new technique of storage rings , of which I had only learnt the day before in a seminar given by Panofsky. While we talked, Panofsky came in to say good-bye to his host. Kindly, he also shook my hand. At that time Panofsky , professor at Stanford University, was director of the Stanford High Energy Physics Laboratory (HEPL) and preparing to found the Stanford Linear Accelerator Center (SLAC). Largely due to him, Stanford developed into a leading centre of particle physics.
Three Quarks – Order in the Wealth of New Particles (1964)
Authors: Brandt Siegmund
Published: November 2023

In the early 1960s an unexpected inflation was observed in the number of strongly interacting elementary particles or hadrons , as they came to be called. Most of these were found with the help of bubble chambers, many by the group of Alvarez in Berkeley, see Episode 72. As an example, we briefly discuss the first observation of a hyperon, which is now called the Σ  ∗ or Σ (1385) [1]. A hydrogen bubble chamber was exposed to a beam of negative K mesons and events were selected in which a Λ hyperon and two pions of opposite charge were produced.
Two Forces of Nature are Only One – Electroweak Interaction (1967)
Authors: Brandt Siegmund
Published: November 2023

The theory of electroweak interaction , also called Glashow–Salam–Weinberg theory , describes the electromagnetic and the weak force in a common framework; the two are no longer separate but two faces of one medal. It has been called a unified theory . The unification was likened to that of electricity and magnetism in the second half of the nineteenth century. Together with the modern theory of strong interactions (Episode 92), it is now usually referred to as the standard model [1], a rather modest name for a theory comprising most of physics and, so far, unchallenged by experiment.
Weak Neutral Currents – A Glimmer of Heavy Light (1973)
Authors: Brandt Siegmund
Published: November 2023

Lagarrigue had entered the École Polytechnique in Paris in 1945, where he studied under Leprince-Ringuet . He did his Ph.D. research on cosmic rays with cloud chambers under the guidance of Peyrou and worked at Berkeley at the time the Bevatron accelerator began operation. On returning to the École Polytechnique in 1955, he began to design and build bubble chambers. His chamber number 3, built at the laboratory of the Centre d’Énergie Atomique in Saclay, was the one used in the first round of CERN neutrino experiments.
Neutrinos Have Mass (1998, 2001)
Authors: Brandt Siegmund
Published: November 2023

In the early times of particle physics, discoveries were made in cosmic rays; but soon accelerators took over as a source of primary particles. The most elusive of particles, the neutrino, was finally observed, because low-energy neutrinos are copiously produced in a nuclear reactor (Episode 76). Accelerators were used for experiments with high-energy neutrinos, which more readily interact with matter (Episodes 85 and 91). But eventually neutrino physics turned to cosmic sources with a surprising result: Neutrinos have mass. In his first printed remarks on the neutrino (quoted on page 202) Pauli stated that its mass had to be small and might be equal to zero. The latter possibility came to be widely accepted, in particular, since it simplified the theoretical description (Episode 79).
Designing Management Information Systems
Authors: Heijden Hans Van Der
Published: November 2023

Management information systems (MIS) produce the information that managers use to make important strategic decisions. This book covers the essential managerial skills that are necessary to design these systems. In contrast to other books on management information systems, this book takes a decidedly managerial perspective. It focuses on how managers perceive and respond to information, and on their need to use this information to make important decisions. The book considers how systems can be designed to combat ‘information overload’ experienced by managers, using such techniques as data aggregation and data visualization. Chapters provide an in-depth and practical consideration of these topics, focusing on the use of information systesms for managerial decision making. Designing Management Information Systems covers the topics of key performance indicator monitoring, and of shortlisting and selecting alternatives from a range of options. These are managerial decisions for which MIS are particularly useful, and which managers face on a daily basis. This is the first book offering practical guidance on how systems should be designed to support these decisions. It is written for managers, those studying business, management, and IT, and those developing MIS on behalf of management.
Statistical Field Theory
Authors: Mussardo Giuseppe
Published: November 2023

This book provides a thorough introduction to the fascinating world of phase transitions as well as many related topics, including random walks, combinatorial problems, quantum field theory and S-matrix. Fundamental concepts of phase transitions, such as order parameters, spontaneous symmetry breaking, scaling transformations, conformal symmetry, and anomalous dimensions, have deeply changed the modern vision of many areas of physics, leading to remarkable developments in statistical mechanics, elementary particle theory, condensed matter physics and string theory. This self-contained book provides an excellent introduction to frontier topics of exactly solved models in statistical mechanics and quantum field theory, renormalization group, conformal models, quantum integrable systems, duality, elastic S-matrix, thermodynamics Bethe ansatz and form factor theory. The clear discussion of physical principles is accompanied by a detailed analysis of several branches of mathematics, distinguished for their elegance and beauty, such as infinite dimensional algebras, conformal mappings, integral equations or modular functions. Besides advanced research themes, the book also covers many basic topics in statistical mechanics, quantum field theory and theoretical physics. Each argument is discussed in great detail, paying attention to an overall coherent understanding of physical phenomena. Mathematical background is provided in supplements at the end of each chapter, when appropriate. The chapters are also followed by problems of different levels of difficulty. Advanced undergraduate and graduate students will find a rich and challenging source for improving their skills and for accomplishing a comprehensive learning of the many facets of the subject.
Space groups
Authors: Bradley C J , Cracknell A P
Published: November 2023

In section 1.5 we gave a descriptive account of the space groups and their labels and we introduced the Seitz notation for the symmetry operations that constitute the space group. In the present chapter we shall be concerned with the details of the identification of the 230 space groups, with the construction of reciprocal lattices and Brillouin zones and with an introduction to the problem of determining the irreducible representations of the space groups.
Remedies for Constitutional Violations
Authors: Yap Po Jen
Published: November 2023

Where courts in Asia are empowered to review the constitutionality of legislation, the standard practice is for the judiciary to invalidate the law, or relevant section of the law, if the court deems it unconstitutional. In common law systems, such invalidation traditionally operates immediately and retrospectively. Tradition also dictates that courts leave it to the legislature to introduce corrective legislation post-invalidation. This practice stems from judicial commitment to the separation of powers principle—a general rule observed in both civil and common law Asia. Courts in Asia are, however, breaking with tradition. They have now devised novel constitutional remedies that complement their invalidation power, usually in the absence of explicit constitutional or statutory authorization. This chapter examines four such constitutional remedies: (i) prospective invalidation, (ii) suspension order, (iii) remedial interpretation, and (iv) judicial directive.
Training police to de-escalate mental health crisis situations: Comparing virtual reality and live-action scenario-based approaches
Authors: Lavoie Jennifer , Álvarez Natalie , Baker Victoria , Kohl Jacqueline
Published: November 2023

Virtual reality is an emerging frontier that offers immersive simulations with the capacity to revolutionize police training. This study evaluated a scenario-based training approach by comparing the delivery of simulations in Virtual Reality (VR) and Live Action (LA). Participation in this mental health crisis response training program in either format led to a significantly greater acquisition of de-escalation competencies compared to a control group. VR format showed comparable effectiveness to the LA format in bringing about improved de-escalation skills through scenario-based training. The training was equally effective across all officer experience levels. The VR group showed a greater reduction in bias towards mental illness compared to the control group. Further, the VR format was found to be no more cognitively demanding than live action. The article discusses the centrality of de-escalation skills in police practice and considers the larger implications of de-escalation training delivered through virtual reality applications for increased consistency, cost-efficiencies, and professionalization.
Do Montreal! A Review Article
Authors: Ruhl J B
Published: November 2023

International climate change diplomacy has tried a rigid top-down approach (the Kyoto Agreement) and a more flexible bottom-up approach (the Paris Agreement). Neither approach has gained sufficient traction on the climate change problem. The authors of Fixing the Climate: Strategies for an Uncertain World propose a new direction. Borrowing from the framework of the Montreal Protocol of 1987, which made great strides in eliminating use of ozone-depleting chemicals, they outline a framework for “experimentalist governance” that relies on public and private organizations to promote a problem-solving approach that is, at the same time, both bottom-up and top-down, market based and institution based, technocratic and democratic. Using case studies and examples across a wide array of contexts—from U.S. coal-fired power-plant sulfur dioxide emissions to dairy farm pollution in Ireland—they build the case for infusing climate change governance with innovation-driven institutions, processes, and instruments. The case studies and examples, however, share several common features that suggest experimentalist governance thrives under ideal conditions, including clearly defined technology challenges and ability to contain the impacts of innovation largely to the incumbent industry. Under the Montreal Protocol, for example, switching chemicals in products did not require consumers to change behavior or make substantial sacrifices. Many of the challenges of climate change policy fit these and the other ideal conditions, but many do not. The full extent of the necessary energy transition, as well as the demands of climate change adaptation, present complex socioeconomic policy issues fraught with political division. Experimentalist governance can go a long way toward fixing the climate, but ultimately, fixing the climate also will require fixing the climate politics.
Magnesium-based alloys with adapted interfaces for bone implants and tissue engineering
Authors: Antoniac Iulian , Manescu (Paltanea) Veronica , Antoniac Aurora , Paltanea Gheorghe
Published: November 2023

Magnesium and its alloys are one of the most used materials for bone implants and tissue engineering. They are characterized by numerous advantages such as biodegradability, high biocompatibility and mechanical properties with values close to the human bone. Unfortunately, the implant surface must be adequately tuned, or Mg-based alloys must be alloyed with other chemical elements due to their increased corrosion effect in physiological media. This article reviews the clinical challenges related to bone repair and regeneration, classifying bone defects and presenting some of the most used and modern therapies for bone injuries, such as Ilizarov or Masquelet techniques or stem cell treatments. The implant interface challenges are related to new bone formation and fracture healing, implant degradation and hydrogen release. A detailed analysis of mechanical properties during implant degradation is extensively described based on different literature studies that included in vitro and in vivo tests correlated with material properties’ characterization. Mg-based trauma implants such as plates and screws, intramedullary nails, Herbert screws, spine cages, rings for joint treatment and regenerative scaffolds are presented, taking into consideration their manufacturing technology, the implant geometrical dimensions and shape, the type of in vivo or in vitro studies and fracture localization. Modern technologies that modify or adapt the Mg-based implant interfaces are described by presenting the main surface microstructural modifications, physical deposition and chemical conversion coatings. The last part of the article provides some recommendations from a translational perspective, identifies the challenges associated with Mg-based implants and presents some future opportunities. This review outlines the available literature on trauma and regenerative bone implants and describes the main techniques used to control the alloy corrosion rate and the cellular environment of the implant.
NIR-switchable local hydrogen generation by tandem bimetallic MOFs nanocomposites for enhanced chemodynamic therapy
Authors: Zhong Jun , Zheng Xiang , Wen Yuan , Li Yuewei , Zhang Jianting , Kankala Ranjith Kumar , Wang Shibin , Chen Aizheng
Published: November 2023

The inadequate quantity of hydrogen peroxide (H2O2) in cancer cells promptly results in the constrained success of chemodynamic therapy (CDT). Significant efforts made throughout the years; nevertheless, researchers are still facing the great challenge of designing a CDT agent and securing H2O2 supply within the tumor cell. In this study, taking advantage of H2O2 level maintenance mechanism in cancer cells, a nanozyme-based bimetallic metal-organic frameworks (MOFs) tandem reactor is fabricated to elevate intracellular H2O2 levels, thereby enhancing CDT. In addition, under near-infrared excitation, the upconversion nanoparticles (UCNPs) loaded into the MOFs can perform photocatalysis and generate hydrogen, which increases cellular susceptibility to radicals induced from H2O2, inhibits cancer cell energy, causes DNA damages and induces tumor cell apoptosis, thus improving CDT therapeutic efficacy synergistically. The proposed nanozyme-based bimetallic MOFs-mediated CDT and UCNPs-mediated hydrogen therapy act as combined therapy with high efficacy and low toxicity.
A two-process model of Drosophila sleep reveals an inter-dependence between circadian clock speed and the rate of sleep pressure decay
Authors: Abhilash Lakshman , Shafer Orie Thomas
Published: November 2023

Sleep is controlled by two processes—a circadian clock that regulates its timing and a homeostat that regulates the drive to sleep. Drosophila has been an insightful model for understanding both processes. For four decades, Borbély and Daan’s two-process model has provided a powerful framework for understanding sleep regulation. However, the field of fly sleep has not employed such a model as a framework for the investigation of sleep. To this end, we have adapted the two-process model to the fly and established its utility by showing that it can provide empirically testable predictions regarding the circadian and homeostatic control of fly sleep. We show that the ultradian rhythms previously reported for loss-of-function clock mutants in the fly are robustly detectable and a predictable consequence of a functional sleep homeostat in the absence of a functioning circadian system. We find that a model in which the circadian clock speed and homeostatic rates act without influencing each other provides imprecise predictions regarding how clock speed influences the strength of sleep rhythms and the amount of daily sleep. We also find that quantitatively good fits between empirical values and model predictions were achieved only when clock speeds were positively correlated with rates of decay of sleep pressure. Our results indicate that longer sleep bouts better reflect the homeostatic process than the current definition of sleep as any inactivity lasting 5 minutes or more. This two-process model represents a powerful framework for work on the molecular and physiological regulation of fly sleep.
The organization of sleep–wake patterns around daily schedules in college students
Authors: Lu Sinh , Stone Julia E , Klerman Elizabeth B , McHill Andrew W , Barger Laura K , Robbins Rebecca , Fischer Dorothee , Sano Akane , Czeisler Charles A , Rajaratnam Shantha M W , Phillips Andrew J K
Published: November 2023

The amount of time available in a day is fixed, and consequently, sleep is often sacrificed for waking activities. For college students, daily activities, comprised of scheduled classes, work, study, social, and other extracurricular events, are major contributors to insufficient and poor-quality sleep. We investigated the impact of daily schedules on sleep–wake timing in 223 undergraduate students (age: 18–27 years, 37% females) from a United States university, who were monitored for ~30 days. Sleep–wake timing and daily recorded activities (attendance at academic, studying, exercise-based, and/or extracurricular activities) were captured by a twice-daily internet-based diary. Wrist-worn actigraphy was conducted to confirm sleep–wake timing. Linear mixed models were used to quantify associations between daily schedule and sleep–wake timing at between-person and within-person levels. Later scheduled start time predicted later sleep onset (between and within: p < .001), longer sleep duration on the previous night (within: p < .001), and later wake time (between and within: p < .001). Later schedule end time predicted later sleep onset (within: p < .001) and shorter sleep duration that night (within: p < .001). For every 1 hour that activities extended beyond 10 pm, sleep onset was delayed by 15 minutes at the within-person level and 40 minutes at the between-person level, and sleep duration was shortened by 6 and 23 minutes, respectively. Increased daily documented total activity time predicted earlier wake (between and within: p < .001), later sleep onset that night (within: p < .05), and shorter sleep duration (within: p < .001). These results indicate that daily schedules are an important factor in sleep timing and duration in college students.

Clinical Trial: Multi-scale Modeling of Sleep Behaviors in Social Networks; URL: https://clinicaltrials.gov/study/NCT02846077; Registration:NCT02846077.
U.S. Attending Anesthesiologist Burnout in the Postpandemic Era
Authors: Afonso Anoushka M. , Cadwell Joshua B. , Staffa Steven J. , Sinskey Jina L. , Vinson Amy E.
Published: November 2023

Background

Anesthesiologists are experiencing unprecedented levels of workplace stress and staffing shortages. This analysis aims to assess how U.S. attending anesthesiologist burnout changed since the onset of the COVID-19 pandemic and target well-being efforts.

Methods

The authors surveyed the American Society of Anesthesiologists’ U.S. attending anesthesiologist members in November 2022. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey with additional questions relating to workplace and demographic factors. Burnout was categorized as high risk for burnout (exhibiting emotional exhaustion and/or depersonalization) or burnout syndrome (demonstrating all three burnout dimensions concurrently). The association of burnout with U.S. attending anesthesiologist retention plans was analyzed, and associated factors were identified.

Results

Of 24,680 individuals contacted, 2,698 (10.9%) completed the survey, with 67.7% (1,827 of 2,698) at high risk for burnout and 18.9% (510 of 2,698) with burnout syndrome. Most (78.4%, n = 2,115) respondents have experienced recent staffing shortages, and many (36.0%, n = 970) were likely to leave their job within the next 2 yr. Those likely to leave their job in the next 2 yr had higher prevalence of high risk for burnout (78.5% [760 of 970] vs. 55.7% [651 of 1,169], P < 0.001) and burnout syndrome (24.3% [236 of 970] vs. 13.3% [156 of 1,169], P < 0.001) compared to those unlikely to leave. On multivariable analysis, perceived lack of support at work (odds ratio, 9.2; 95% CI, 7.0 to 12.1), and staffing shortages (odds ratio, 1.96; 95% CI, 1.57 to 2.43) were most strongly associated with high risk for burnout. Perceived lack of support at work (odds ratio, 6.3; 95% CI, 3.81 to 10.4) was the factor most strongly associated with burnout syndrome.

Conclusions

Burnout is more prevalent in anesthesiology since early 2020, with workplace factors of perceived support and staffing being the predominant associated variables. Interventions focused on the drivers of burnout are needed to improve well-being among U.S. attending anesthesiologists.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
CAR-T cell therapy: Where are we now, and where are we heading?
Authors: Wang Jia-Yi , Wang Liang
Published: November 2023

Chimeric antigen receptor (CAR)-T-cell therapies have exhibited remarkable efficacy in the treatment of hematologic malignancies, with 9 CAR-T-cell products currently available. Furthermore, CAR-T cells have shown promising potential for expanding their therapeutic applications to diverse areas, including solid tumors, myocardial fibrosis, and autoimmune and infectious diseases. Despite these advancements, significant challenges pertaining to treatment-related toxic reactions and relapses persist. Consequently, current research efforts are focused on addressing these issues to enhance the safety and efficacy of CAR-T cells and reduce the relapse rate. This article provides a comprehensive overview of the present state of CAR-T-cell therapies, including their achievements, existing challenges, and potential future developments.
Predicting hepatic encephalopathy in patients with cirrhosis: A UK population–based study and validation of risk scores
Authors: Jones Bethan I. , Jenkins Cerys A. , Murphy Daniel , Orr James , Yeoman Andrew , Hubbuck Ellen R. , Heywood Ben R. , Currie Craig J.
Published: November 2023

Background:

HE is a common neurologic complication in cirrhosis associated with substantial disease and economic burden. HE symptoms are nonspecific and there are limited ways of identifying patients with cirrhosis at high risk of later developing HE. A risk score was previously developed to identify patients at risk of developing HE in a predominately male US cohort. Here, we evaluated the performance of the HE risk scores in a UK cohort study.

Methods:

Health care records from Clinical Practice Research Datalink and linked Hospital Episode Statistics were used to select patients with cirrhosis who were diagnosed with HE, confirmed by a diagnosis code for HE or a rifaximin-α prescription. The index date was the date of incident cirrhosis. The study period was from January 2003 to June 2019.

Results:

A total of 40,809 patients with cirrhosis were selected in the UK cohort, of whom 59% were male. A total of 1561 patients were diagnosed with HE. Applying the UK cohort to the baseline sensitivity risk cutoff (≥−11) from the US cohort provided a sensitivity of 92% and a negative predictive value of 99%. Within a longitudinal model, applying a sensitivity cutoff of ≥−3 to this cohort gave a sensitivity of 89% and a negative predictive value of 99%.

Conclusions:

Using data from the UK, the previously developed HE risk scores were found to be reliable for selecting those most likely to progress to HE in patients with liver cirrhosis. Despite the HE risk scores originally being estimated using the data from a predominately male US cohort, the scores were validated and found to be generalizable to female patients.
Anesthetic considerations in interventional pulmonology
Authors: Sikachi Rutuja R. , Mishra Kelly Louise , Anders Megan
Published: November 2023

Purpose of review

In this review, we highlight the important anesthetic consideration that relate to interventional bronchoscopic procedures for the management of central airway obstruction due to anterior mediastinal masses, endoluminal endobronchial obstruction, peripheral bronchoscopy for diagnosis and treatment of lung nodules, bronchoscopic lung volume reduction and medical pleuroscopy for diagnosis and management of pleural diseases.

Recent findings

The advent of the field of Interventional Pulmonology has allowed for minimally invasive options for patients with a wide range of lung diseases which at times have replaced more invasive surgical procedures. Ongoing research has shed light on advancement in anesthetic techniques and management strategies that have increased the safety during peri-operative management during these complex procedures. Current evidence focusing on the anesthetic techniques is presented here.

The field of Interventional Pulmonology requires a tailored anesthetic approach. Recent advancements and ongoing research have focused on expanding the partnership between the anesthesiologist and interventional pulmonologists which has led to improved outcomes for patients undergoing these procedures.
Laparoscopic transabdominal preperitoneal (TAPP) groin hernia repair using n-butyl-2-cyanoacrylate (LiquiBandFIX8) for mesh fixation and peritoneal closure: case report about extraperitoneal hematoma
Authors: Raab Sandra , Huber Livia , Fortelny René , Shamiyeh Andreas
Published: November 2023

Introduction:

A symptomatic inguinal hernia is a prevalent condition that typically requires surgical intervention. Various surgical approaches have been established for hernia repair, including several techniques for peritoneal closure and mesh fixation in laparoscopic surgery. N-butyl-2-cyanoacrylate, such as LiquiBandFIX8, offers a time-saving alternative to invasive methods for both mesh fixation and peritoneal closure. While n-butyl-2-cyanoacrylate is employed in various closure procedures, LiquiBandFIX8 is specifically designed for mesh fixation in inguinal hernia repair.

Case presentation:

We present a case of a 68-year old man undergoing transabdominal preperitoneal inguinal hernia repair under full heparinization. LiquiBandFIX8 was employed for mesh fixation and peritoneal closure. Upon conducting a revision laparoscopy due to a significant postoperative hematoma, we found that the mesh and peritoneum remained undamaged and fully sealed, indicating an effective fixing technique. Both the initial repair and the subsequent revision surgery were documented and the videos were subsequently analyzed.

Conclusion:

LiquiBandFIX8 provides a reliable adhesive strength and appropriate application for peritoneal closure and mesh fixation. When encountering extraperitoneal fluid collection, there is no anticipation of intraabdominal complications.
Double aneuploidy in a 2-month-old male with Edward syndrome and Klinefelter syndrome: a case report
Authors: Mansour Marah , AlZoubi Ahmed , Zoukar Sham , Aljammal Ghina , Makki Raghad , Khaled Noor Al Huda , Aletesh Yara , Aljundi Rama , Mohammad Deeb Ahmad , Ajlouni Mohammad Obada
Published: November 2023

Introduction and importance:

Edward syndrome is a severe chromosomal defect that occurs as a result of non-disjunction through meiosis. It presents with cardiac septal defects, horseshoe kidneys, patent ductus arteriosus, central nervous system dysgenesis, distinctive craniofacial deformities, and overriding or overlapping fingers. Klinefelter syndrome (47, XXY) is found in 1 in 660 newborn males. It is considered to be one of the most common genetic causes of infertility. It manifests with small firm testes, androgen insufficiency, and azoospermia.

Case presentation:

A 2-month-old male infant with a history of weakness in feeding, frequent convulsions, and an increase in cyanosis two days ago. There were multiple skeletal deformities and a tendency to spasm in the extremities, left ventricular atrophy, mitral atresia, atrial septal defect, ventricular septal defect with dilated right cavities, tricuspid valve regurgitation, pulmonary valve stenosis; and the aorta exits in the right ventricle. There is a widening of the subdural space, which was observed in the left frontal-parietal side with cortical atrophy in that area and a widening of the Sylvian fissure. A karyotype test confirmed the presence of Edward and Klinefelter syndromes.

Clinical discussion:

Aneuploidy is a chromosomal issue characterized by an abnormal number of a chromosome copies. The coexistence of two aneuploidies is called “double aneuploidy” which is a rare occurrence. Herein, we report a case of a 2-month-old male with Edward syndrome and Klinefelter syndrome.

Conclusion:

This publication aims to highlight the challenges in diagnosing and treating a complicated genetic disease.
MDR/XDR/PDR or DTR? Which definition best fits the resistance profile of Pseudomonas aeruginosa?
Authors: Cosentino Federica , Viale Pierluigi , Giannella Maddalena
Published: November 2023

Purpose of review

The aim of this narrative review is to compare the prognostic utility of the new definition of difficult-to-treat resistance (DTR) vs. established definitions in patients with Pseudomonas aeruginosa infection to understand the therapeutic implications of resistance classification and its impact on clinical outcome.

Recent findings

Among Gram-negative bacteria (GNB), P. aeruginosa (PA) is associated with high rates of morbidity and mortality, mostly related to its intrinsic capacity of developing antibiotic resistance. Several classifications of antibiotic resistance have been proposed in the last 15 years. The most common used is that from Magiorakos et al. including multidrug resistance (MDR), extensively drug-resistant (XDR) and pan drug resistance (PDR) according to the number of antibiotic classes showing in vitro activity. A further classification based on the resistance to specific antibiotic classes (i.e. fluoroquinolones, cephalosporins, carbapenem resistance) was also proposed. However, both of them have been criticized because of limited usefulness in clinical practice and for poor correlation with patient outcome, mainly in infections due to PA. More recently the new definition of difficult-to-treat resistance (DTR) has been proposed referring to nonsusceptibility to all first-line agents showing high-efficacy and low-toxicity (i.e. carbapenems, β-lactam-β-lactamase inhibitor combinations, and fluoroquinolones). Studies including large cohorts of patients with GNB bloodstream infections have confirmed the prognostic value of DTR classification and its clinical usefulness mainly in infections due to PA. Indeed, in the recent documents from the Infectious Diseases Society of America (IDSA) on the management of antibiotic resistant GNB infections, the DTR classification was applied to PA.

DTR definition seems to identify better than MDR/XDR/PDR and single class resistant categories the cases of PA with limited treatment options. It requires periodic revision in order to remain up-to-date with the introduction of new antibiotics and the evolving pattern of resistance.
How to treat severe Acinetobacter baumannii infections
Authors: Bouza Emilio , Muñoz Patricia , Burillo Almudena
Published: November 2023

Purpose of review

To update the management of severe Acinetobacter baumannii infections (ABI), particularly those caused by multi-resistant isolates.

Recent findings

The in vitro activity of the various antimicrobial agents potentially helpful in treating ABI is highly variable and has progressively decreased for many of them, limiting current therapeutic options. The combination of more than one drug is still advisable in most circumstances. Ideally, two active first-line drugs should be used. Alternatively, a first-line and a second-line drug and, if this is not possible, two or more second-line drugs in combination. The emergence of new agents such as Cefiderocol, the combination of Sulbactam and Durlobactam, and the new Tetracyclines offer therapeutic options that need to be supported by clinical evidence.

The apparent limitations in treating infections caused by this bacterium, the rapid development of resistance, and the serious underlying situation in most cases invite the search for alternatives to antibiotic treatment, the most promising of which seems to be bacteriophage therapy.
Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains
Authors: Koulenti Despoina , Vandana Kalwaje Eswhara , Rello Jordi
Published: November 2023

Purpose of review

This article aims to review the epidemiology of nonfermenting Gram-negative bacilli (NFGNB) based on recent literature reports, particularly, of the less common, but with emerging clinical significance species.

Recent findings

The reported frequency of multidrug-resistantAcinetobacter baumanniiandPseudomonas aeruginosais increasing, with very significant variability, however, between different countries. Apart from the major NFGNB, that is,A. baumanniiandP. aeruginosa, already recognized as of critical importance healthcare risks, several other NFGNB genera have been increasingly associated with diverse severe infections, such asStenotrophomonas maltophilia,Burkholderiaspp.,Elizabethkingiaspp.,Chryseobacteriumspp.,Achromobacterspp.,Alcaligenesspp.,Sphingomonasspp.,Shewanellaspp. andRalstoniaspp., among others.

The exploration of the epidemiology, as well as the pathogenic potential of the of the less frequent, but emerging and increasingly reported NFGNB, is crucial, not only for immunocompromised patients, but also for critically ill patients without overt immunosuppression. As we are heading fast towards a postantibiotic era, such information would contribute to the optimal antimicrobial management, that is, providing prompt, appropriate antimicrobial coverage when needed and, at the same time, avoiding overuse and/or inappropriate use of antimicrobial therapy. Also, it would help to better understand their transmission dynamics and to develop effective prevention strategies.
Analgesia Using Transcutaneous Electric Nerve Stimulation in Office Bladder Chemodenervation, a Randomized Controlled Trial
Authors: Hernandez-Aranda Diego , Panza Joseph , Eigg Marc , Greenstein Marc , Li Dongmei , O’Brien Jeanne , Warren Gareth , Doyle Paula Jaye
Published: November 2023

Importance

Office bladder chemodenervation, performed via cystoscopy with intradetrusor onabotulinumtoxinA (BOTOX) injections, is a common treatment for overactive bladder/urge urinary incontinence. Transcutaneous electric nerve stimulation (TENS) has shown to provide analgesia during office hysteroscopy. Adjuvant analgesia using TENS during bladder chemodenervation has not been studied.

Objective

The primary outcome is a clinically significant (10-mm) difference in pain visual analog scale (VAS) measurements during injections for chemodenervation using active TENS compared with placebo TENS. We hypothesize that active TENS use will significantly change pain VAS scores. Secondary outcomes include 5-point pain Likert scale, satisfaction 10-point scale, and adverse events.

Study Design

This was a double-blind randomized control trial of men and women with urinary urge incontinence undergoing office chemodenervation performed in an academic and private setting. Participants were randomized into 2 groups: chemodenervation with active TENS or placebo TENS. Power calculation determined 100 patients would be required detect a difference of 10 mm on pain VAS.

Results

One hundred one (85 female and 16 male) participants were recruited. No differences were noted in the demographics. Participants in the active TENS group reported a difference of greater than 10 mm in pain VAS scores (48 ± 23 vs 31 ± 23, P = 0.01). Satisfaction index scores were high but no difference was noted between groups (8.6 vs 8.7, P = 0.68).

Conclusions

Most participants were eligible to use TENS units. Transcutaneous electric nerve stimulation is a safe and noninvasive adjuvant analgesia option for patients undergoing this procedure. Lower pain levels and high satisfaction rates suggest that this is an additional analgesic option during outpatient chemodenervation.
Intensive care unit readmission in injured older adults: Modifiable risk factors and implications
Authors: Agoubi Lauren L. , Reimel Beth Ann , Maine Rebecca G. , O'Connell Kathleen M. , Maier Ronald V. , McIntyre Lisa K.
Published: November 2023

BACKGROUND

Prior evaluations of intensive care unit (ICU) readmission among injured older adults have inconsistently identified risk factors, with findings limited by use of subanalyses and small sample sizes. This study aimed to identify risk factors for and implications of ICU readmission in injured older adults.

METHODS

This retrospective, single-center cohort study was conducted at a high-volume Level 1 trauma center and included injured older adult patients (65 years or older) requiring at least one ICU admission during hospitalization between 2013 and 2018. Patients who died <48 hours of admission were excluded. Exposures included patient demographics and clinical factors. The primary outcome was ICU readmission. Multivariable regression was used to identify risk factors for ICU readmission.

RESULTS

A total of 6,691 injured adult trauma patients were admitted from 2013 to 2018, 55.4% (n = 3,709) of whom were admitted to the ICU after excluding early deaths. Of this cohort, 9.1% (n = 339) were readmitted to the ICU during hospitalization. Readmitted ICU patients had a higher median Injury Severity Score (21 [interquartile range, 14–26] vs. 16 [interquartile range, 10–24]), with similar mechanisms of injury between the two groups. Readmitted ICU patients had a significantly higher mortality (19.5%) compared with single ICU admission patients (9.9%) (p < 0.001) and higher rates of developing any complication, including delirium (61% vs. 30%, p < 0.001). On multivariable analysis, the factors associated with the highest risk of readmission were delirium (Relative Risk, 2.6; 95% confidence interval, 2.07–3.26) and aspiration (Relative Risk, 3.04; 95% confidence interval, 1.67–5.54). More patients in the single ICU admission cohort received comfort-focused care at the time of their death as compared with the ICU readmission cohort (93% vs. 85%, p = 0.035).

CONCLUSION

Readmission to the ICU is strongly associated with higher mortality for injured older adults. Efforts targeted at preventing respiratory complications and delirium in the geriatric trauma population may decrease the rates of ICU readmission and related mortality risk.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.