bluuebunny/crossref_metadata_2025 huggingface dataset:
Ainu Religion
Authors: Kimura Takeshi
Published: August 2024

The Ainu people are indigenous to Japan (the term Ainu means “human”). They have lived mainly in Hokkaido (called Ainu mosir by the Ainu people) and the Tokyo Metropolitan area. Previously, they also lived in Sakhalin (formerly Karafuto) and the Kuril Islands (including the Chishima Islands). In the early 21st century, aspects of the Ainu people’s social lives were no different from those of other Japanese people because of historical colonization and forced cultural assimilation. However, Ainu religious practices have changed dramatically. The historical influences that have formed the Ainu culture and religion have been debated from various perspectives.

There are two main external influences on the historical formation of the Ainu religion. One is Okhotsk cultural influences, since similar designs are found among the Ainu and some ethnic minorities along the Amur River in the Siberian area, and the other is Japanese cultural influence.

Admittedly, the term religion is not appropriate to describe the Ainu religion and spirituality, which is based on the Ainu people’s close relationship with the kamuy (gods, deities) world through nature and by performing rituals and reciting sacred narratives. Ainu religion and spirituality was the fundamental principle guiding their lives as hunter- gatherers. At any specific historical moment, Ainu religion represents the accumulated social and historical expressions of the Ainu people accommodating and negotiating with traditional, inherited religious symbols and notions.

Aspects of the Ainu religion include domestic rituals of prayer to the goddess of fire, rituals for ancestral spirits, designs of clothes, tattooing, dancing and music, oral narratives, ritual hunting and communal ceremonies, shamanistic practices, and funeral rites. There are gendered aspects of the Ainu life and religion. While the Ainu men were responsible for offering prayers and performing these rituals, the Ainu women were known for shamanism and narrating kamuy-yukar, songs of kamuy, and offering prayers to ancestral spirits.

The Ainu religion is known for its ritual killing of a bear, that is, Iyomante in Ainu language. Iyomantemeans “sending it off,” signifying that the ritual sends the soul of the ritually slain animal back to the world of kamuy (deity or spirit). In order to grasp what it means, it is important to pay close attention to the Ainu’s indigenous religious notions about the relationship between kamuy and animals. Animal bodies or animal flesh are gifts for humans which kamuy embodies or wears in visiting the human world. Iyomante is often translated into “bear ceremony” in English or Japanese, but it is important to grasp the significance of the fact that the Ainu people use the term kamuy for both “bear” and “deity or spirit.” The Ainu people use the term Iyomante not only for the ritual killing of a bear, but also for ritual killings of other animals, such as a fox and an owl.
Mahmoud Ayoub and Christian-Muslim Relations
Authors: Yusuf Imtiyaz
Published: August 2024

Mahmoud Mustafa Ayoub was the foremost North American Muslim scholar of Muslim-Christian relations and interreligious dialogue in the modern age who offered new interpretations concerning the roots of conflict between Islam and Christianity. He also offered a new theological approach for building better Muslim-Christian understanding. Ayoub also made methodologically original contributions to the study of Shi’i Islam, tafsir al-Qur’an—Qur’anic exegesis, and building Taqrib al-Madhahib—Sunni-Shi’i ecumenism.

Ayoub was born in a Shii Muslim family, he converted to Christianity, and then returned to Islam. Such a biographical background and scholarly formation enabled him to address Christological issues based on deep insights into the Qur’an and knowledge of Christianity, its theology, and spirituality. Though Ayoub remained committed to Shiism, for him Islam was an integrated religious tradition whose sectarian trends were not an obstacle to being a holistic Muslim.
Sufism in North America
Authors: Dickson William Rory
Published: August 2024

Sufism in North America is exceptionally diverse, reflecting its heterogenous origins and complex transnational dynamics. It can be found as an essential, if at times subtle, element of Muslim devotional practice, with several North American Muslim networks and organizations integrating Sufism into their teachings. It manifests more explicitly in various Sufi orders, normally led by a lineage-holding shaykh or shaykha, with a spectrum of approaches to Islamic identity and practice. Sufism has further been drawn upon as a niche resource for literature and commodity within the broader spiritual marketplace, intersecting with popular culture. Sufism in North America is thus an integral aspect of Muslim devotional practice, a distinct spiritual path embodied in various lineages and orders, and a literary phenomenon and popular spiritual commodity.
mathematics, Egyptian (relations to Greek)
Authors: Imhausen Annette
Published: August 2024

In the history of mathematics, differences between ancient Egyptian and ancient Greek mathematics have been emphasized while their parallels have often been overlooked. While the source material of the earliest Greek mathematical texts is probably too scarce to trace its beginnings, a comparison of extant Egyptian and Greek sources reveals not only differences but also similarities. It is noteworthy in this respect that specific links to Egyptian and also Mesopotamian mathematical sources can be drawn, which indicates that the mathematical knowledge of both cultures served as the basis for the evolution of Greek mathematics. Instead of contrasting Greek mathematics with its Egyptian predecessors, our understanding of ancient Greek mathematics and its development might benefit from studying the transmission and common features of these mathematical cultures.
Bilingual Language Processing
Authors: Schwieter John W.
Published: August 2024

Psycholinguistic approaches to examining bilingualism are relatively recent applications that have emerged in the 20th century. The fact that there are more than 7,000 current languages in the world, with the majority of the population actively using more than one language, offers the opportunity to examine language and cognitive processes in a way that is more reflective of human nature. While it was once believed that exposing infants and children to more than one language could lead to negative consequences for cognition and overall language competence, current evidence shows that this is not the case. Among the many topics studied in psycholinguistics and bilingualism is whether two language systems share an integrated network and overlap in the brain, and how the mind deals with cross-linguistic activation and competition from one language when processing in another. Innovative behavioral, electrophysiological, and neuroscientific methods have significantly elucidated our understanding of these issues. The current state of the psychology and neuroscience of bilingualism finds itself at the crossroads of uncovering a holistic view of how multiple languages are processed and represented in the mind and brain. Current issues, such as exploring the cognitive and neurological consequences of bilingualism, are at the forefront of these discussions.
Morphological and Syntactical Variation and Change in Brazilian Portuguese
Authors: Clements J. Clancy
Published: August 2024

In the history of Brazil, Africans and their descendants figure prominently. In many of the country’s regions, they represented a majority of the population, especially in the 19th and the first half of the 20th century. The features of Brazilian Portuguese are described and the possible links between the demographic makeup of the country and the presence of the features are explored.
Disaster Through a Feminist Lens: Epistemology, Methodology, and Methods
Authors: Alburo-Cañete Kaira Zoe
Published: August 2024

The foregrounding of gender and, more importantly, the ways in which power produces structures of inequality that shape gendered disaster vulnerabilities have given way to feminist theorizing on disasters. Since the 1990s, feminist works have raised critical questions regarding how conceptualizations of disasters, and the methodologies through which these are studied, have historically privileged androcentric perspectives. Viewing disaster through a feminist lens brings to light other dimensions of living with and responding to risk and disaster that are often elided in gender-blind approaches.

For feminist research, theory and practice are not disconnected. Feminist research is explanatory as well as prescriptive, putting emphasis on the need for transformative change especially in unequal gender relations. This perspective is solidified in the ways that feminist approaches foreground the close connections between epistemology, methodology, and methods and the political/ethical orientations they embody. Applied to disaster studies, feminist research highlights the importance of: (a) placing gender and lived experiences at the center of analysis; (b) recognizing how power operates in these contexts; (c) exploring alternative means to represent lived realities through different methods; (d) embodying reflexivity in the research process; and (e) pursuing social, political, and institutional change.

Applications of feminist methodologies in disaster studies have led to the development of innovative techniques in constructing alternative accounts of disaster experiences. These include but are not limited to feminist participatory action research, photo-based methods, and alternative mapping techniques. These applications have helped reveal often neglected issues such as gendered violence, women’s lack of representation in decision-making, family dynamics affecting access and control, gendering of state and institutional processes, to name a few, in varying contexts of disaster.

In sum, applying a feminist lens offers alternative perspectives on how disasters affect women and other social groups, emphasizing the importance of equitable, inclusive, and ethical research practices. By challenging existing knowledge frameworks and highlighting the relational and intersectional dimensions of disaster experiences, feminist methodologies contribute to a deeper understanding of lived experiences of disasters and the ways in which these are gendered while communicating perspectives of change.
Jakobsson, Harriet
Authors: Aronsson Pia
Published: August 2024

Harriet Jakobsson (1926–2010) was an international social worker was active in three central areas: activities in the voluntary sector (NGOs), training of social workers, and her own practical work in the field. Her driving force has been to work for the best interests of the child and ensure the child’s rights in society. Curiosity, creativity, and perseverance characterized her professional life.
Female Genital Mutilation and Social Work Interventions
Authors: Jungari Suresh
Published: August 2024

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia or other injuries to the female genital organs for non-medical reasons. This coercive practice is prevalent in many parts of the world and is found in developed and developing countries. However, FGM is more prevalent in African countries and some Asian countries. Substantial evidence shows that FGM has no health benefits; it is mainly governed by community traditions and cultures and is carried out on girls before they reach the age of 15. FGM practice has continued because of social, cultural, and religious beliefs and strong norms that produce gender inequality. The practice of FGM can cause severe bleeding, infections, psychological illness, and infertility; most importantly, it can lead to severe consequences during childbirth. FGM is a practice that violates the human and reproductive rights of women. Legal and social interventional efforts should be directed to curb the practice as soon as possible to mitigate the devastating consequences of FGM. Efforts in educating communities and empowering women could be sustainable solutions.
Heterogeneous dynamics of diffusive motion in organic ionic plastic crystal studied using spin–spin relaxation time: N,N-diethylpyrrolidinium bis(fluorosulfonyl)amide
Authors: Nishikawa Keiko , Fujii Kozo , Matsumoto Kazuhiko , Abe Hiroshi , Yoshizawa-Fujita Masahiro
Published: August 2024

The temperature dependences of the spin–spin relaxation times (T2) of 1H and 19F nuclei were measured for N,N-diethylpyrrolidinium bis(fluorosulfonyl)amide with a plastic crystal phase. In the plastic crystal phase, 2 types of T2 were observed in both 1H and 19F experiments, which were considered to be the appearance of heterogeneous dynamics of diffusive motion. By examining temperature dependences of the T2 values and the existence ratios, the following conclusions were reached. (i) The prepared plastic crystal sample was in a polycrystalline state, and each crystallite comprised 2 phases: the core phase (plastic crystal phase) and the surface phase formed to relieve surface stress. (ii) The 1H-T2 (19F-T2) values of the 2 phases differed, and ions in the surface phase were more mobile. The 1H-T2 (19F-T2) values for the 2 phases increased with temperature rise. In particular, the 1H-T2 (19F-T2) values of the surface phase were smoothly connected to the liquid T2 values. (iii) The cations and anions exhibited a cooperative diffusive motion. (iv) When the temperature was considerably lower than the melting point, the ratio of the surface phase did not significantly differ from when it first formed. However, it rapidly increased near the melting point and became liquid.
Proteome profiling reveals opportunities to investigate biomarkers of oxidative stress and immune responses in blubber biopsies from free-ranging baleen whales
Authors: Kershaw Joanna , Ramp Christian , Sears Richard , Hall Ailsa , Derous Davina
Published: August 2024

Over 25% of cetacean species worldwide are listed as critically endangered, endangered or vulnerable by the International Union for Conservation of Nature. Objective and widely applicable tools to assess cetacean health are therefore vital for population monitoring and to inform conservation initiatives. Novel blubber biomarkers of physiological state are examples of such tools that could be used to assess overall health. Proteins extracted from blubber likely originate from both the circulation and various cell types within the tissue itself, and their expression is responsive to signals originating from other organs and the nervous system. Blubber proteins can therefore capture information on physiological stressors experienced by individuals at the time of sampling. For the first time, we assess the feasibility of applying shotgun proteomics to blubber biopsy samples collected from free-ranging baleen whales. Samples were collected from minke whales (Balaenoptera acutorostrata) (n = 10) in the Gulf of St Lawrence, Canada. Total protein was extracted using a RIPA cell lysis and extraction buffer-based protocol. Extracted proteins were separated and identified using nanoflow Liquid Chromatography Electrospray Ionization in tandem with Mass Spectrometry. We mapped proteins to known biological pathways and determined whether they were significantly enriched based on the proteome profile. A pathway enrichment map was created to visualize overlap in tissue-level biological processes. Amongst the most significantly enriched biological pathways were those involved in immune system function: inflammatory responses, leukocyte-mediated immunity and the humoral immune response. Pathways associated with responses to oxidative stress were also enriched. Using a suite of such protein biomarkers has the potential to better assess the overall health and physiological state of live individuals through remote biopsy sampling. This information is vital for population health assessments to predict population trajectories, and ultimately guide and monitor conservation priorities and initiatives.
The relationship of cardiorespiratory fitness, physical activity, and coronary artery calcification to cardiovascular disease events in CARDIA participants
Authors: Gerber Yariv , Gabriel Kelley Pettee , Jacobs David R , Liu Jennifer Y , Rana Jamal S , Sternfeld Barbara , Carr John Jeffrey , Thompson Paul D , Sidney Stephen
Published: August 2024

Aims

Moderate-to-vigorous-intensity physical activity (MVPA), cardiorespiratory fitness (CRF), and coronary artery calcification (CAC) are associated with cardiovascular disease (CVD) risk. While a U-shaped relationship between CRF or MVPA and CAC has been reported, the presence of CAC among highly fit individuals might be benign. We examined interactive associations of CRF or MVPA and CAC with outcomes and evaluated the relationship of CRF and MVPA to CAC incidence.

Methods and results

CARDIA participants with CAC assessed in 2005–06 were included (n = 3,141, mean age 45). MVPA was assessed by self-report and accelerometer. CRF was estimated with a maximal graded exercise test. Adjudicated CVD events and mortality data were obtained through 2019. CAC was reassessed in 2010–11. Cox models were constructed to assess hazard ratios (HRs) for CVD, coronary heart disease (CHD), and mortality in groups defined by CAC presence/absence and lower/higher CRF or MVPA levels. Logistic models were constructed to assess associations with CAC incidence. Adjustment was made for sociodemographic and CVD risk factors. Relative to participants with no CAC and higher CRF, the adjusted HRs for CVD were 4.68 for CAC and higher CRF, 2.22 for no CAC and lower CRF, and 3.72 for CAC and lower CRF. For CHD, the respective HRs were 9.98, 2.28, and 5.52. For mortality, the HRs were 1.15, 1.58, and 3.14, respectively. Similar findings were observed when MVPA measured either by self-report or accelerometer was substituted for CRF. A robust inverse association of CRF and accelerometer-derived MVPA with CAC incidence was partly accounted for by adjusting for CVD risk factors.

Conclusion

In middle-aged adults, CRF and MVPA demonstrated an inverse association with CAC incidence, but did not mitigate the increased cardiovascular risk associated with CAC, indicating that CAC is not benign in individuals with higher CRF or MVPA levels.
Caterpillar–parasitoid interactions: species-specific influences on host microbiome composition
Authors: Gloder Gabriele , Bourne Mitchel E , Cuny Maximilien A C , Verreth Christel , Crauwels Sam , Dicke Marcel , Poelman Erik H , Jacquemyn Hans , Lievens Bart
Published: August 2024

There is increasing evidence that host–parasitoid interactions can have a pronounced impact on the microbiome of host insects, but it is unclear to what extent this is caused by the host and/or parasitoid. Here, we compared the internal and external microbiome of caterpillars of Pieris brassicae and Pieris rapae parasitized by Cotesia glomerata or Cotesia rubecula with nonparasitized caterpillars. Additionally, we investigated the internal and external microbiome of the parasitoid larvae. Both internal and external bacterial densities were significantly higher for P. brassicae than P. rapae, while no differences were found between parasitized and nonparasitized caterpillars. In contrast, parasitism significantly affected the composition of the internal and external microbiome of the caterpillars and the parasitoid larvae, but the effects were dependent on the host and parasitoid species. Irrespective of host species, a Wolbachia species was exclusively found inside caterpillars parasitized by C. glomerata, as well as in the corresponding developing parasitoid larvae. Similarly, a Nosema species was abundantly present inside parasitized caterpillars and the parasitoid larvae, but this was independent of the host and the parasitoid species. We conclude that parasitism has pronounced effects on host microbiomes, but the effects depend on both the host and parasitoid species.
Why will China and Russia not form an alliance? The balance of beliefs in peacetime
Authors: Feng Huiyun , He Kai
Published: August 2024

The ongoing war in Ukraine has thrust China–Russia relations into the global spotlight, with both nations asserting their stance against forming a military alliance. This article introduces a novel ‘balance-of-beliefs’ framework, positing that the foundation of peacetime alliances lies in leaders' shared beliefs. Using operational code analysis, this study quantifies the philosophical and instrumental beliefs of leaders from the United States (Barack Obama), Australia (Tony Abbott), China (Xi Jinping) and Russia (Vladimir Putin) between 2013 and 2015, and includes additional comparison between Putin and Xi between 2016 and 2022. This research examines the essential role of aligned world-views on ‘the nature of the political universe’ (which we label a P-1 belief) and ‘the strategic approach to achieving political objectives’ (an I-1 belief). The findings reveal that such congruence is crucial for fostering like-minded alliances in peacetime, as evidenced by the US–Australia alliance. In contrast, the divergent P-1 beliefs of Xi and Putin hinder a Sino-Russian military alliance; yet, their aligned I-1 beliefs facilitate pragmatic cooperation on specific issues. This analysis underscores the need for US and European policy-makers to devise nuanced strategies in response to the evolving dynamics of a rising China and a resurgent Russia.
Beyond SIRD models: a novel dynamic model for epidemics, relating infected with entries to health care units and application for identification and restraining policy
Authors: Tsiliyannis Christos
Published: August 2024

Epidemic models of susceptibles, exposed, infected, recovered and deceased (SΕIRD) presume homogeneity, constant rates and fixed, bilinear structure. They produce short-range, single-peak responses, hardly attained under restrictive measures. Tuned via uncertain I,R,D data, they cannot faithfully represent long-range evolution. A robust epidemic model is presented that relates infected with the entry rate to health care units (HCUs) via population averages. Model uncertainty is circumvented by not presuming any specific model structure, or constant rates. The model is tuned via data of low uncertainty, by direct monitoring: (a) of entries to HCUs (accurately known, in contrast to delayed and non-reliable I,R,D data) and (b) of scaled model parameters, representing population averages. The model encompasses random propagation of infections, delayed, randomly distributed entries to HCUs and varying exodus of non-hospitalized, as disease severity subdues. It closely follows multi-pattern growth of epidemics with possible recurrency, viral strains and mutations, varying environmental conditions, immunity levels, control measures and efficacy thereof, including vaccination. The results enable real-time identification of infected and infection rate. They allow design of resilient, cost-effective policy in real time, targeting directly the key variable to be controlled (entries to HCUs) below current HCU capacity. As demonstrated in ex post case studies, the policy can lead to lower overall cost of epidemics, by balancing the trade-off between the social cost of infected and the economic contraction associated with social distancing and mobility restriction measures.
Effects of betaine supplementation on dry matter intake, milk characteristics, plasma non-esterified fatty acids, and β-hydroxybutyric acid in dairy cattle: a meta-analysis
Authors: Malik Muhammad I , Bilal Muhammad , Anwar M Z , Hassan Talal , Rashid Muhammad A , Tarla Divine , Dunshea Frank R , Cheng Long
Published: August 2024

Betaine supplementation in dairy cattle has gained attention due to its potential benefits to production and health as a methyl donor, which can play a crucial role in the metabolism of dairy cows. The objective of the current meta-analysis was to quantify the effects of betaine supplementation on milk production, composition, β-hydroxybutyric acid (BHBA), and non-esterified fatty acids (NEFA). A systematic literature search was carried out, all relevant studies were retrieved, and the meta-analysis was carried out. The mean difference (MD) for dry matter intake (DMI) using the random-effects model was 0.499 kg/d (P < 0.0001). The subgroup analysis indicated that supplementing betaine in heat-stressed cows increased DMI by 0.584 kg/d (P < 0.001), while in cows not exposed to heat stress, DMI was increased by 0.381 kg/d (P = 0.007). The energy-corrected milk (ECM) increased by 1.36 kg/d (P < 0.0001). The milk fat yield was significantly increased in betaine-supplemented cows (MD = 0.040 kg/d, 95% CI = 0.015 to 0.065). The milk protein yield (kg/d) (MD = 0.014, P = 0.138) was increased (MD = 0.035, P = 0.0005) by betaine supplementation. The lactose yield (kg/d) was also significantly higher (MD = 0.055, P = 0.020) in betaine-supplemented cows. The standardized mean difference (SMD) for NEFA (SMD = − 0.447, 95% CI = − 1.029 to 0.135, P = 0.114) and BHBA (SMD = − 0.130, 95% CI = − 0.491 to 0.234). In conclusion, the findings from this meta-analysis suggest that betaine supplementation positively influences DMI, ECM, milk fat yield, milk lactose yield, and milk protein yield. Subgroup analysis further indicated that the positive effects on DMI are greater in heat-stressed cows compared to those not exposed to heat stress. The analysis did not find significant effects on the levels of NEFA or BHBA, suggesting that betaine supplementation may not directly influence these metabolic parameters.
Presentation and Outcomes of Lassa Fever in Children in Nigeria: A Prospective Cohort Study (LASCOPE)
Authors: Duvignaud Alexandre , Etafo Ijeoma C , Jaspard Marie , Salau Qasim , Serra Béatrice , Kareem Abiodun J , Juchet Sylvain , Jegede Tolulope O , Gabillard Delphine , Abidoye Abiodun T , Le Gal Camille , Abejegah Chukwuyem , Owhin Sampson , Okwaraeke Kevin , Doutchi Mahamadou , Katembo Vihundira Jackson , Besong-Lache Rene-M , Seri Benjamin , Bérerd-Camara Marion , Salam Alex P A , Olayinka Adebola , Horby Peter , Ogbaini-Emovon Ephraim , Duraffour Sophie , Ahmed Liasu A , Günther Stephan , Adedosu Akinola N , Anglaret Xavier , Malvy Denis , Lang Hans J , Ayodeji Oladele O
Published: August 2024

Background

Data on the presentation, management, and outcomes of Lassa fever (LF) in children are limited.

Methods

Description of the clinical and biological features, treatment, and outcomes of reverse transcriptase and polymerase chain reaction (RT-PCR)-confirmed LF in children aged under 15, enrolled in the LASsa fever clinical COurse and Prognostic factors in an Epidemic context (LASCOPE) prospective cohort study in Nigeria between April 2018 and February 2023.

Results

One hundred twenty-four children (aged under 12 months: 19; over 12 months: 105) were hospitalized with RT-PCR-confirmed LF. All received intravenous ribavirin. During follow-up, 99/124 (80%) had fever; 71/124 (57%) had digestive symptoms, vomiting (n = 56/122, 46%) and abdominal pain (n = 34/78 aged ≥5 years, 44%) more often than diarrhea (n = 19/124, 15%); 17/124 (14%) had hemorrhagic signs; 44/112 (39%) had a hematocrit lower than 25%, of whom 32/44 (73%) received transfusions; 44/88 (50%) developed hypotension; 18/112 (16.1%) developed kidney disease improving global outcome (KDIGO) ≥2 acute kidney injury; 10/112 (8.9%) had KDIGO 3 acute kidney failure; 4/124 (3.2%) underwent renal replacement therapy. Seven children died, including 4 aged under 12 months (case fatality rate: under 12 months—22%, 95% confidence interval (CI): 7%–48%; over 12 months—2.9%, 95% CI: 0.7%–8.7%). In univariable analysis, age (P = .003), impaired consciousness (P = .026), and Lassa RT-PCR Ct value (P = .006) were associated with Day 30 mortality.

Conclusions

The fatality rate for children over 12 months hospitalized with LF was lower than that previously reported for adults. Hypotension and acute kidney injury were the most frequent organ dysfunctions. Bleeding was relatively infrequent. Anemia and the need for transfusion were common, the relative contribution of ribavirin-induced hemolysis being unknown.
Pseudohypoxic brain swelling following cerebrospinal fluid leakage: a case report on rapid identification and multidisciplinary management
Authors: Wurm Lennard M , Neuhaus Lukas , Aspargur Golschan , Angemair Stefan , Laue Dominik
Published: August 2024

This report delineates the intricate diagnostic journey and therapeutic conundrum presented by a 61-year-old male who exhibited atypical neurological deterioration shortly after lumbar fusion surgery, manifesting clinical and radiological features suggestive of pseudohypoxic encephalopathy, an entity characterized by symptoms mimicking cerebral hypoxia in the absence of a discernible hypoxic insult. Following an initially unremarkable recovery from an elaborate spinal surgery, the patient’s postoperative condition was confounded by a perplexing decline in consciousness, unresponsive to conventional therapeutic interventions and devoid of clear etiological indicators on standard neuroimaging. The subsequent diagnostic odyssey unraveled a cerebrospinal fluid leak as the putative reason, positing a nuanced clinical paradigm wherein the cerebrospinal fluid leak engendered a state mimicking pseudohypoxic brain swelling. This report underscores the clinical challenges and emphasizes the need for an astute diagnostic approach in postoperative patients with unexplained neurological symptoms advocating for a comprehensive evaluation to identify underlying cerebrospinal fluid leaks and mitigate potential morbidity.
Molecular pathology and computational profiling of Janus kinase 2 (JAK2) mutation in acute lymphoblastic leukemia: insights from a Pakistani cohort
Authors: Maqsood Sidra , Ansari Saqib Hussain , Mushtaq Mamona , Abbas Azhar , Waryah Ali Muhammad , Haq Zaheer Ul-
Published: August 2024

Background

JAK2 mutation plays a clinically significant role in the pathogenesis of acute lymphoblastic leukemia (ALL) by enhancing its oncogenicity. The study aimed to characterize the molecular pathology and computational profile of the JAK2 mutation in an ALL cohort of Pakistani origin.

Methods

Ninety-three patients were enrolled in the current study. The disease diagnosis was confirmed via flow cytometry and karyotyping of bone marrow aspirate/blood. For the identification of causative gene variations and assessment of their potential impact, the JAK2 gene underwent direct sequencing and predictive computational and in silico structural analysis, respectively.

Results

JAK2 mutations were detected in 10 (11%) patients. All mutations were missense with 1 being frameshift. Most mutations showed a similar pattern to the wild type but p.N673H+p.V674L+p.C675W (AAD699), p.V674F (AAD704), and p.V674L (AAD705) exhibited statistically significant stability loss. The triple mutation displayed reduced stability both globally and locally.

Conclusion

The pattern of gene defects in JAK2 in the studied cohort showed a disruption in proper folding behavior, evident from increased gyration values, resulting in the hypothesis that these mutations may cause structural alterations in the JAK2 protein that lead to disease progression.
Discrimination in Investment Treaty Arbitration
Authors: Risvas Michail
Published: August 2024

This book provides an original and comprehensive treatment of the non-discrimination standards at the heart of many investment treaty cases. Drawing insights from US law, EU law, and international human rights courts, the book supplies key insights into arbitration tribunals' decisions on the interpretation and application of a wide scope of standards, including Most Favoured Nation (MFN) Treatment; National Treatment (NT); non-impairment clauses prohibiting arbitrary and/or discriminatory measures; Fair and Equitable Treatment (FET); and non-discrimination in the context of the Expropriation standard. Advancing normative suggestions for the application of non-discrimination standards, the book proposes a template for practitioners, policymakers, and adjudicators involved in investment treaty negotiations. The book is also a valuable resource for legal scholars, as it clarifies inconsistent arbitral practice and distils the key traits of discrimination claims.
The Legal Test for Establishing Violations of Non-discrimination Obligations
Authors: Risvas Michail
Published: August 2024

This chapter explores the case law of investment treaty tribunals in relation to different non-discrimination obligations. It discusses how investment treaty tribunals determine likeness and less favourable treatment respectively before considering the tribunals' perspective on the absence of discriminatory intent or the existence of legitimate public policy justifications. Since discrimination obligations in international investment law prohibit discrimination based on nationality, it requires a comparison between individual investors not groups, as in the case of disparate treatment discrimination. The chapter details the non-discrimination obligations in correlation with the case of relevant jurisprudence and scholarship. It then looks into the inconsistencies of case law in line with normative arguments.
Exposome Signatures of Gastrointestinal Disorders Among Active Duty Service Members
Authors: Maldonado Carlos J , White-Phillip Jessica A , Liu Yuliang , Choi Y Sammy
Published: August 2024

Introduction

We evaluated the risk factors associated with gastrointestinal disorders (GD) among the soldiers of the Army and Marine Aviation community (AMAC) using an exposomic approach. Specifically, we aimed to determine the medical and operational factors associated with reported GD in the Military Health System.

Methods

Longitudinal data were obtained from the Medical Assessment and Readiness System (MARS) housed at Womack Army Medical Center, Fort Liberty, NC, for a retrospective cohort study that included 79,249 active duty United States AMAC active duty service members (ADSMs) from October 2015 to December 2019. Multivariable mixed-effects logistic regression was used to assess the relationship between the incidence occurrence of GD and variables including rank, service time, deployment, Armed Forces Qualification Test score, education, tobacco use, alcohol use, age, gender, race, ethnicity, body mass index (BMI), and marital status.

Results

The incidence of GD included 22,813 person-years of observations with a rate of 2.2 per 100 person-years and a period prevalence of 3.2%. GD was independently associated with rank, service time, and deployment (all P < 0.05).

Conclusion

The high-risk categories associated with GD in the AMAC included age, BMI, race (not ethnicity), marital status, and service time. Our data also show that deployment time, not geographical location, was associated with a higher risk of GD. Together, these analyses suggest that White ADSMs older than 33 years of age who have experienced marriage, longer service time, and deployments appear to have a higher risk of GDs. Our assessment shows the utility of using an exposomic approach to create a member-specific, big data-informed personalized clinical algorithm of health outcomes.
Multivitamin Compliance Reduces Injuries of Female Recruits at Air Force Basic Training: A Randomized Controlled Cohort Study
Authors: Kasper Korey B , Cockerell Meredith , Escamilla Clarissa , Gonzalez Richard
Published: August 2024

Introduction

Department of the Air Force basic military training (BMT) is the 7.5-week initial entry training for all enlisting U.S. Air Force and Space Force recruits. Overuse musculoskeletal injuries (MSKI) during training threaten success in BMT, and trainees with nutritional deficiencies are at higher risk. Several efforts are made at BMT to mitigate these issues to help trainees graduate on time, such as the distribution of multivitamins (MVI) to female recruits. However, trainee compliance with the prescribed MVI has been reported to be low, calling into question the effectiveness of this intervention. This study evaluated the effect of briefing modality offered to these trainees at the time of distribution on educational effectiveness, MVI compliance, and injury rates.

Materials and Methods

This was a randomized controlled cohort study of BMT female trainees. Subjects included all female trainees of a single iteration of BMT concurrently completing training within the same squadron. At the outset of training, cohorts were randomly educated in one of two ways regarding the provided MVI. The control cohort (n = 80) was presented with the standard educational video created by BMT-registered dietitians, while the test cohort (n = 79) was presented the video and then also briefed in-person by a group of subject matter experts. At the end of BMT, the trainees completed a questionnaire regarding their knowledge, confidence, and compliance with the MVI. Additionally, a routinely collected training database was queried and analyzed for differences in injuries and training outcomes using the chi-squared test with significance set to α ≤ 0.05.

Results

Although both cohorts found their educational presentation useful, the “in-person” cohort reported significantly higher compliance rates and were found to be diagnosed with MSKI and bone stress injuries at significantly lower rates (43% and 66% relative risk reductions, respectively).

Conclusions

Education to female BMT trainees regarding the MVI, which included a face-to-face discussion with subject matter experts, resulted in greater compliance and reduced incidence of MSKI and bone stress injury, compared to a video prepared by registered dietitians alone. Such educational approaches should continue to be strived for in this and other military population health measures. This study’s implication of MVI efficacy for injury risk reduction in female trainees should be further studied, verified, and improved upon in this and other populations.
Engineering Features From Advanced Medical Technology Initiative Submissions to Enable Predictive Modeling for Proposal Success
Authors: Pavliscsak Holly , Knisely Benjamin
Published: August 2024

Introduction

The U.S. Army Telemedicine and Advanced Technology Research Center Advanced Medical Technology Initiative (AMTI) demonstrate key emerging technologies related to military medicine. AMTI invites researchers to submit proposals for short-term funding opportunities that support this goal. AMTI proposal selection is guided by a time-intensive peer review process, where proposals are rated on innovation, military relevance, metrics for success, and return on investment. Utilizing machine learning (ML) could assist in proposal evaluations by learning relationships between proposal performance and proposal features. This research explores the viability of artificial intelligence/ML for predicting proposal ratings given content-based proposal features. Although not meant to replace experts, a model-based approach to evaluating proposal quality could work alongside experts to provide a fast, minimally biased estimate of proposal performance. This article presents initial stages of a project aiming to use ML to prioritize research proposals.

Materials and Methods

The initial steps included a literature review to identify potential features. Then, these features were extracted from a dataset consisting of past proposals submissions. The dataset includes 824 proposals submitted to the AMTI program from 2010 to 2022. The analysis will inform a discussion of anticipated next steps toward developing a ML model. The following features were created for future modeling: requested funds; word count by section; readability by section; citations and partners identified; and term frequency—inverse document frequency word vectors.

Results

This initial process identified the top ranked words (data, health, injury, device, treatment, technology, etc.) among the abstract, problem to be solved, military relevance, and metrics/outcomes text proposal fields. The analysis also evaluated the text fields for readability using the Flesch readability scale. Most proposals text fields were categorized as “college graduate,” indicating a challenging readability level. Finally, citations and partners were reviewed as an indicator of proposal successfulness.

Conclusions

This research was the first stage of a larger project to explore the use of ML to predict proposal ratings for the purpose of providing automated support to proposal reviewers and to reveal the preferences and values of AMTI proposal reviewers and other decision-makers. The result of this work will provide practical insights regarding the review process for the AMTI program. This will facilitate reduction in bias for AMTI innovators and a streamlined and subjective process for AMTI administrators, which benefits the military health system overall.
Evaluation of Self-collected Saliva Samples Without Viral Transport Media for SARS-CoV-2 Testing via RT-PCR and Comparison of Amplicon Sequences Against Commonly Used Primers in Diagnostic Assays
Authors: Ramos Benjamin D , Hudson N Ryan , Gonzales Diane E , Brown Ashleigh N , White Matthew G , Browde Ryan J , McNeary-Garvin Antoinette M , Knight Celynn E , Pham Kevin C , Sweatt Robert J , Phan Liem Minh , Ly Eileen , Garcia Andrew R
Published: August 2024

Introduction

Mass screening for SARS-CoV-2 using nasopharyngeal swabs (NPS) is costly, uncomfortable for patients, and increases the chance of virus exposure to health care workers. Therefore, this study focused on determining if self-collected unpreserved saliva can be an effective alternative to NPS collection in COVID-19 surveillance.

Materials and Methods

In this study, patients being tested for SARS-CoV-2 using NPS were asked to provide a saliva sample to compare their results. NPS samples were evaluated for SARS-CoV-2 using BioFire® FilmArray® Torch® or Cepheid® GeneXpert® systems while saliva samples were evaluated using an in-house developed reverse transcriptase polymerase chain reaction (RT-PCR) which targeted the Envelope (E) and Nucleocapsid (N) genes.

Results

Detection of SARS-CoV-2 using self-collected saliva was found to be only slightly less accurate (<5%) than testing using NPS. In addition, initial saliva RT-PCR identified 27 positive subjects, 18 of which provided amplicons sufficient for confirmatory sequencing. The sequencing data showed a genetic shift in the virus within our population sometime between 22 June and July 8, 2021 from Alpha to Delta variant.

Conclusions

The saliva sample collection method identifies the E gene in SARS COVID-2 samples which provides an alternative specimen source to the NPS. This identifies the S gene and ORF1ab. Saliva collection is more convenient to the patient, yields comparable results to NPS collection, and potentially increases Covid-19 surveillance.
Enhancing Mission Wellness: Iterative Optimization and Stakeholder Engagement to Promote Sexual and Reproductive Health in the United States Military
Authors: Vargas Sara , Landoll Ryan , Guthrie Kate M , Quinlan Jeffrey , Clark Madison F , Obuseh Francis , Ozemoya Amelia
Published: August 2024

Introduction

Sexual and reproductive health is critical for the readiness of the warfighter, as costs of sexually transmitted infections and unintended pregnancy result in added health care costs, lost mission time, and impact on morale. The Multiphase Optimization Strategy (MOST) is an engineering-inspired framework used to optimize biobehavioral interventions. The Military Active-Duty Reproductive and Sexual Health (MARSH) research team applied the MOST framework to develop “Mission Wellness”—an electronic health intervention to promote sexual and reproductive health within the U.S. Military.

Materials and Methods

From 2017 to 2022, the MARSH team implemented the first and second phases of MOST to develop and optimize “Mission Wellness.” All phases received institutional review board approval. The first phase consisted of expert and literature review, qualitative interviews, and beta testing to identify intervention components and the optimization objective and to inform study design. The second phase consisted of a factorial trial.

Results

Figures 1–4 outline the research program approach, demographics of the sample, and format of the app. Service members who used the application found it to be acceptable and, overall, reported that it would be easier to talk to a sexual partner about risk behaviors and history at the post-intervention assessment compared to baseline. This iterative optimization approach using both local and strategic engagement enhanced program development and set the stage for dissemination and implementation efforts.

Conclusions

In line with the iterative nature of MOST, the lessons learned during the optimization trial led the MARSH team to return “Mission Wellness” to the preparation phase. The utilization of mixed (i.e., qualitative and quantitative) research methods and engagement with stakeholders at multiple levels of the military enterprise provided the information necessary to further optimize “Mission Wellness.” This programmatic approach also provides a blueprint for the development of research design and testing in military health care balancing rigor and agility.
Designing the Prolonged Field Care Kit (PFAK) to Address the Logistical Challenges of Future Combat Casualty Care
Authors: Dawood Zaiba Shafik , Keeney-Bonthrone Toby P , Russo Rachel M , Ho Jessie W , Liggett Marjorie R , Gurney Jennifer , Greenberg Allyson , Tobin Joshua M , Clark Walter , Shaikh Aleezeh , Alam Hasan B
Published: August 2024

Introduction

Prolonged Casualty Care (PCC) is a military adaptation aimed at providing pre-hospital care in austere settings when evacuation is delayed or even impossible. Current lack of standardized medical equipment and size/weight restrictions of military packs during dismounted operations hinder effective PCC. We sought to design a standardized, practical, and effective prolonged field care kit (PFAK) to enable widespread implementation of PCC.

Materials and Methods

We reviewed Joint Trauma System Clinical Practice Guidelines to generate a list of potential contents of the PFAK. We obtained Institutional Review Board (IRB) exemption and then conducted stakeholder surveys of combat casualty care experts across the Joint Trauma System using a modified Delphi survey approach. We established a civil–military working group that provided in-depth qualitative feedback on the PFAK contents and provided an initial design of a long-range medical rucksack (LMR) to house it. Responses were analyzed using mean rank scores to help determine initial components of the PFAK. Tactical subject-matter experts tested and evaluated the PFAK and LMR prototype in austere conditions to refine the design.

Results

Review of the PCC Clinical Practice Guidelines generated 49 medications and 301 potential supplies as potential PFAK contents. The first Delphi survey was sent to 100 stakeholders (overall response rate of 60%). After the first survey, contents were narrowed to a list of the most essential 27 medications and 105 other components. Iterative prototypes of the PFAK and LMR were tested to determine ergonomics, portability, flexibility, and equipment compartmentalization to facilitate use in emergencies. The prototype was optimized to address the clinical, logistical, and tactical requirements of PCC across a variety of platforms and environmental conditions.

Conclusions

Given the changing battlefield environment, efficient and effective PCC will play an increasingly important role in the management of combat trauma. The PFAK can meet this need by providing a practical and standardized resuscitation kit generated by expert military and trauma personnel consensus, carried conveniently in the LMR.