bluuebunny/crossref_metadata_2025 huggingface dataset:
Conductive liquid metal elastomer thin films with multifunctional electro-mechanical properties
Authors: Tahidul Haque A B M , Tutika Ravi , Gao Meng , Martinez Angel , Mills Julie , Arul Clement J , Gao Junfeng , Tabrizi Mohsen , Ravi Shankar M , Pei Qibing , Bartlett Michael D
Published: September 2020

Wearable electronics, conformable sensors, and soft/micro-robotics require conductive yet stretchable thin films. However, traditional free standing metallic thin films are often brittle, inextensible, and must be processed in strict environments. This limits implementation into soft technologies where high electrical conductivity must be achieved while maintaining high compliance and conformability. Here we show a liquid metal elastomeric thin film (LET) composite with elastomer-like compliance (modulus < 500 kPa) and stretchability (>700%) with metallic conductivity (sheet resistance < 0.1 Ω/□). These 30–70 µm thin films are highly conformable, free standing, and display a unique Janus microstructure, where a fully conductive activated side is accompanied with an opposite insulated face. LETs display exceptional electro-mechanical characteristics, with a highly linear strain-resistance relationship beyond 700% deformation while maintaining a low resistance. We demonstrate the multifunctionality of LETs for soft technologies by leveraging the unique combination of high compliance and electrical conductivity with transfer capabilities for strain sensing on soft materials, as compliant electrodes in a dielectric elastomeric actuator, and as resistive heaters for a liquid crystal elastomer.
The Love of Literature
Authors: Lynch Deidre
Published: September 2020

The notion that theoretical inquiry and the love of literature are at odds is a tenacious one, likewise the related account of the theorist as heartless killjoy. This article, however, challenges the notion that theory is necessarily down on love. It surveys the several strains of theory that since the turn of the 21st century have made it possible for practitioners of theory to acknowledge more readily that concept-driven intellectual work inevitably has an affective undertow. But it also looks further back, to the late 18th-century origins of the literary studies discipline, so as to understand why the love question cannot be confined to the sphere of amateurism but instead hovers persistently around what literature professors do in their classrooms: what does that persistence say about the place of ethical and affective norms in the discipline’s intellectual enterprise? And just why and how does aesthetic receptivity get defined as “love” in the first place?
Literature and Science
Authors: Whitworth Michael H.
Published: September 2020

Though “literature and science” has denoted many distinct cultural debates and critical practices, the historicist investigation of literary-scientific relations is of particular interest because of its ambivalence toward theorization. Some accounts have suggested that the work of Bruno Latour supplies a necessary theoretical framework. An examination of the history of critical practice demonstrates that many concepts presently attributed to or associated with Latour have been longer established in the field. Early critical work, exemplified by Marjorie Hope Nicolson, tended to focus one-sidedly on the impact of science on literature. Later work, drawing on Thomas Kuhn’s idea of paradigm shifts, and on Mary Hesse’s and Max Black’s work on metaphor and analogy in science, identified the scope for a cultural influence on science. It was further bolstered by the “strong program” in the sociology of scientific knowledge, especially the work of Barry Barnes and David Bloor. It found ways of reading scientific texts for the traces of the cultural, and literary texts for traces of science; the method is implicitly modeled on psychoanalysis. Bruno Latour’s accounts of literary inscription, black boxing, and the problem of explanation have precedents in the critical practices of critics in the field of literature and science from the 1980s onward.
Antimicrobial Resistance as a Global Health Crisis
Authors: Baekkeskov Erik , Rubin Olivier , Munkholm Louise , Zaman Wesal
Published: September 2020

Antimicrobial resistance (AMR) is a global health crisis estimated to be responsible for 700,000 yearly deaths worldwide. Since the World Health Assembly adopted a Global Action Plan on AMR in 2015, national governments in more than 120 countries have developed national action plans. Notwithstanding this progress, AMR still has limited political commitment, and existing global efforts may be too slow to counter its rise. The article presents five characteristics of the global AMR health crisis that complicate the translation from global attention to effective global initiatives. AMR is (a) a transboundary crisis that suffers from collective action problems, (b) a super wicked and creeping crisis, (c) the product of trying to solve other global threats, (d) suffering from lack of advocacy, and (e) producing distributional and ethical dilemmas. Applying these five different crisis lenses, the article reviews central global initiatives, including the Global Action Plan on AMR and the recommendations of the Interagency Coordination Group on AMR. It argues that the five crisis lenses offer useful entry points for social science analyses that further nuance the existing global governance debate of AMR as a global health crisis.
Heuristics and Biases in Political Decision Making
Authors: Colombo Céline , Steenbergen Marco R.
Published: September 2020

Heuristics have rapidly become a core concept in the study of political behavior. The term heuristic stems from the ancient Greek heuriskein, which means “to discover.” In psychology and political science, the term is used to describe cognitive shortcuts in decision making under uncertainty. The key idea is that decision makers with limited time, information, or resources use such shortcuts, thereby bypassing a certain amount of information to reach appropriate decisions. In this sense, heuristics contrast with classical rational choice. Using heuristics allows efficient decision making but can lead to biases, errors, and suboptimal decisions. Heuristics allow decision makers to draw inferences, to fill in information gaps, and to form an impression of the decision at hand. Indeed, they may be the only way to come to grips with uncertainty, especially when a decision is urgent. In political science, the concept of heuristics, originating in mathematics, economics, and psychology, has long been hailed as a possible remedy to citizens’ lack of political knowledge. Citizens participate in democratic decisions, but these decisions often pose high cognitive and informational demands. Ideally, citizens with little information about a political issue or about a candidate could use heuristics in order to reach decisions resembling those of their more well-informed peers. More recently, however, the possible biases introduced by reliance on heuristics, in particular partisan bias and a lack of consideration of different alternatives, has received more attention. Moreover, some studies show that heuristics can be used most efficiently by voters who are relatively well informed and highly interested in politics. The question of whether, or under which circumstances, heuristics can be a useful tool for democratic decision making has not yet been answered conclusively.
Dogmatism and the Need for Closure
Authors: Gaffney Amber M. , La Vogue Natasha
Published: September 2020

Research and both applications of theories of dogmatism and the need for closure implicate the importance of closed belief systems in cognition, social interactions, and decision-making. Research traditionally examines dogmatism as a personality trait wherein people vary in the extent to which they actively justify and maintain their closed belief systems through ideological rigidity. The need for cognitive closure is a related concept, but research and theorizing in this area provides an account of an epistemic motivation to obtain knowledge and answers rapidly—to find information quickly and hold fast to the conclusions drawn from that information. Research on both dogmatism and the need for cognition hold significant implications for and applications to political decision-making and ideology, in-group favoritism and out-group derogation, and resistance to change.
The Drug Wars in Colombia
Authors: Britto Lina
Published: September 2020

From Hollywood movies to binge-worthy TV shows, stories of Colombian narcotraficantes waging war against state agents and civilians are profitable narrative devices of our times. But beyond the screen, the history is not as clear-cut or simple. The drug wars in Colombia began years before the cocaine lords launched a crusade against extradition in the mid-1980s. Building upon a long history of military and intelligence cooperation against communism during the Cold War, the US and Colombian governments engaged in a series of diplomatic exchanges during the 1970s to define the best approach to the growing traffic in marijuana and cocaine between the two countries. By the end of the decade, this long process of political accommodation led to the first drug war in the South American nation. Since then, antinarcotics campaigns against producers of illicit crops and the criminal structures that controlled exportation and distribution to the United States and European markets have constituted essential components in the relationship between the two countries. For the last forty years, prohibitionist drug policies and militarized antinarcotics campaigns have systematically interacted with traffickers’ efforts at survival and their ruthless competition for the accumulation of capital, power, and status. As a result of this dynamic, warfare has become the norm in the functioning of the illicit business as well as in the state’s efforts at drug control and repression, making Colombia one of the main theaters of the drug wars in the world.
Shining Path
Authors: La Serna Miguel
Published: September 2020

Between 1980 and 1999, the Peruvian Communist Party—Shining Path—enveloped the Andean nation of Peru in an armed insurrection designed to topple the state and institute a communist regime. The Maoist insurrection began in the highland department of Ayacucho, quickly spreading throughout the countryside and into the cities. After initially dismissing the insurgency as the work of small-time bandits, the government responded by sending in counterterrorism police and the armed forces into guerrilla-controlled areas. Both Shining Path and government forces targeted civilians as part of their wartime strategies, while some Indigenous peasants took up arms to defend their communities from the bloodshed. In 1992, police captured Shining Path leader Abimael Guzmán, severely weakening the insurgency. By 1999, most remaining guerrilla leaders had been arrested, all but ending the armed phase of the conflict.
Prognostic Assessment of BRAF Mutation in Preoperative Thyroid Fine-Needle Aspiration Specimens
Authors: Abi-Raad Rita , Prasad Manju L , Zheng Jingwei , Hui Pei , Ustun Berrin , Schofield Kevin , Cai Guoping , Adeniran Adebowale J
Published: September 2020

Objectives

We investigate the potential role of BRAF testing in guiding surgical intervention in papillary thyroid carcinoma (PTC).

Methods

Thyroid fine-needle aspiration (FNA) cases with available BRAF result and follow-up thyroidectomy for PTC were included in the study. Cytology and surgical diagnoses were correlated with BRAF status.

Results

There were 151 cases of thyroid FNA specimens with BRAF testing (70 mutant and 81 wild-type BRAF) and histologically confirmed unilateral, unifocal PTCs. There were no differences in age, sex, tumor size, or lymphovascular invasion on thyroidectomy specimens between mutant and wild-type BRAF cases. BRAF mutation was significantly associated with cytology diagnosis (P < .001), PTC subtype (P < .001), extrathyroidal extension (ETE) (P = .006), and higher tumor (T) stage (P = .04). However, an analysis within the histologic subtypes of PTC revealed no significant association between BRAF mutation and ETE or higher T stage. There was also no difference in central (P = .847) or lateral (p = 1) neck lymph node (LN) metastasis.

Conclusions

BRAF mutation identified in thyroid FNA specimens correlates with histologic subtypes but is not an independent factor for predicting PTC biological behavior and should not be used to guide the extent of LN dissection.
Enhancing Punishment or Repairing Harms? Perceptions of Sentencing Hate Crimes Amongst Members of a Commonly Targeted Victim Group
Authors: Walters Mark A , Paterson Jenny L , Brown Rupert
Published: September 2020

This article investigates the attitudes and emotional reactions of LGBT+ people to enhanced sentencing (ES) and restorative justice (RJ) interventions for hate crime. When forced to choose between interventions, our survey (N = 589) found a preference for the use of RJ over ES, which was perceived to be better at reducing reoffending and supporting victims. Nevertheless, the study found greater average levels of support for the use of ES for hate crime, which was predicted by previous experiences of hate crime, perceptions of threat and feelings of anger. An additional experiment (N = 120) revealed RJ, in response to a hate crime, elicited less anger and sadness and higher levels of satisfaction compared with an ES intervention.
Untargeted SPME–GC–MS Characterization of VOCs Released from Spray Paint
Authors: Tiessen Mitchell , Stock Naomi L , Stotesbury Theresa
Published: September 2020

Paints are a common form of physical evidence encountered at crime scenes. This research presents an optimized method for the untargeted analysis of volatile organic compounds (VOCs) in spray paint using solid-phase microextraction–gas chromatography–mass spectrometry (SPME–GC–MS). The presence and persistence of VOCs were monitored in 30 minute intervals, over a 4 hour period, in a triplicate time study. As predicted, spray paint solvents are lost to the environment readily, whereas few VOCs remained present in the headspace in low concentrations beyond 4 hours. The VOCs that were observed to have the highest persistence in the headspace were aromatic compounds and those with longer hydrocarbon chains. We present this study in a forensic science context and suggest that the interpretation of the results may be useful for forensic applications in establishing a time since deposition of a spray-painted surface.
Paediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 [PIMS-TS] in a Patient Receiving Infliximab Therapy for Inflammatory Bowel Disease
Authors: Meredith Joseph , Khedim Cher-Antonia , Henderson Paul , Wilson David C , Russell Richard K
Published: September 2020

Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 [PIMS-TS] is a newly described condition. It has a spectrum of presentations proposed to occur as part of a post-infectious immune response. We report the first case of PIMS-TS in a child on established anti-tumour necrosis factor alpha [anti-TNFα] therapy; a 10 year-old girl with ulcerative colitis treated with infliximab. The patient had 6 weeks of daily fever with mucocutaneous, gastrointestinal, renal, and haematological involvement. Biomarkers of hyperinflammation were present including: hyperferritinaemia [up to 691 µ/L; normal 15–80 µg/L], C-reactive protein [CRP] [ >100mg/L for  >10 days, normal 0–5 mg/L], erythrocyte sedimentation rate [ESR] consistently  >100mm/h [normal 0–15 mm/h], raised white cell count with neutrophilia, elevated D-dimer and lactate dehydrogenase [LDH], anaemia and Mott cells on bone marrow analysis. Extensive investigations for alternative diagnoses for pyrexia of unknown origin [PUO] were negative. The condition was refractory to treatment with intravenous immunoglobulin [IVIG] but improved within 24 h of high-dose methylprednisolone. Infliximab treatment followed and the patient has remained well at follow-up. Polymerase chain reaction [PCR] and serology for SARS-CoV-2 were negative. Current series report such negative findings in up to half of cases. The patient experienced a milder clinical phenotype without cardiac involvement, shock, or organ failure. Accepting the wide spectrum of PIMS-TS presentations, it is possible that previous anti-TNFα therapy may have attenuated the disease course. Given the uncertainty around therapeutic strategies for PIMS-TS, this case supports the need for further investigation into continuing infliximab as a treatment option for the condition.
Impact of water content and dietary organic carbon richness on gut bacteria in the earthwormLumbricus terrestris
Authors: Zeibich Lydia , Guhl Jennifer , Drake Harold L
Published: September 2020

Many higher and lower animal gut ecosystems have complex resident microbial communities. In contrast, ingested soil is the primary source of the gut microbial diversity of earthworms, invertebrates of fundamental importance to the terrestrial biosphere. Earthworms also harbor a few endemic bacteria including Tenericutes-affiliated Candidatus Lumbricincola of unknown function. Gut microbes are subject to nutrient fluctuations due to dilution effects during gut passage, the nutrient richness of the anoxic gut, and dietary organic carbon, factors that could alter their activity/detection. This study's objective was to assess the potential impact of these factors on the occurrence and activity of ingested and endemic bacteria in gut content of Lumbricus terrestris. Fermentation product profiles of anoxic undiluted and diluted gut content treatments were similar, suggesting that experimental increase in water content and nutrient dilution had marginal impact on fermentation. However, 16S ribosomal Ribonucleic Acid (16S rRNA) sequence abundances indicated that stimulated bacterial taxa were not identical in undiluted and diluted treatments, with dominate potentially functionally redundant phylotypes being affiliated to the Firmicutes, Fusobacteria and Proteobacteria. Although the earthworm-associated Tenericutes were not stimulated in these treatments, the occurrence of three Tenericutes-affiliated phylotypes varied with the organic carbon richness of the earthworm diet, with two phylotypes being associated with high organic carbon richness. 16S rRNA sequence abundances indicated that other dominant gut taxa also varied with dietary organic carbon richness. These findings illustrate that functionally redundant ingested bacteria and earthworm-associated Tenericutes might be influenced by nutrient fluctuations in the gut and organic carbon richness of the earthworm diet.
From Inquilines to Gall Inducers: Genomic Signature of a Life-Style Transition in Synergus Gall Wasps
Authors: Gobbo Erik , Lartillot Nicolas , Hearn Jack , Stone Graham N , Abe Yoshihisa , Wheat Christopher W , Ide Tatsuya , Ronquist Fredrik
Published: September 2020

Gall wasps (Hymenoptera: Cynipidae) induce complex galls on oaks, roses, and other plants, but the mechanism of gall induction is still unknown. Here, we take a comparative genomic approach to revealing the genetic basis of gall induction. We focus on Synergus itoensis, a species that induces galls inside oak acorns. Previous studies suggested that this species evolved the ability to initiate gall formation recently, as it is deeply nested within the genus Synergus, whose members are mostly inquilines that develop inside the galls of other species. We compared the genome of S. itoensis with that of three related Synergus inquilines to identify genomic changes associated with the origin of gall induction. We used a novel Bayesian selection analysis, which accounts for branch-specific and gene-specific selection effects, to search for signatures of selection in 7,600 single-copy orthologous genes shared by the four Synergus species. We found that the terminal branch leading to S. itoensis had more genes with a significantly elevated dN/dS ratio (positive signature genes) than the other terminal branches in the tree; the S. itoensis branch also had more genes with a significantly decreased dN/dS ratio. Gene set enrichment analysis showed that the positive signature gene set of S. itoensis, unlike those of the inquiline species, is enriched in several biological process Gene Ontology terms, the most prominent of which is “Ovarian Follicle Cell Development.” Our results indicate that the origin of gall induction is associated with distinct genomic changes, and provide a good starting point for further characterization of the genes involved.
“If They Don’t Like You, They Are Not Going to Eat for You”: Individual and Interpersonal Factors Affecting Certified Nursing Assistants’ Ability to Provide Mealtime Assistance to Residents With Dementia
Authors: Douglas Joy W , Jung Seung Eun , Noh Hyunjin , Ellis Amy C , Ferguson Christine C
Published: September 2020

Background and Objectives

In long-term care facilities in the United States, certified nursing assistants (CNAs) provide mealtime assistance to residents with dementia, a task that substantially increases caregiver burden due to the time and attention required. The aim of this qualitative study was to explore the individual and interpersonal barriers and facilitators CNAs experience when providing mealtime assistance to residents with dementia.

Research Design and Methods

Focus group questions were developed based on the corresponding levels of the Social Ecological Model. Using purposive sampling, 9 focus groups were conducted with 53 CNAs who had at least 1 year of experience as a CNA working with older adults. Focus groups were audio-recorded and transcribed verbatim. Data were analyzed using the directed content analysis approach.

Results

CNAs reported individual skills, training, and personal characteristics that affected their ability to provide mealtime assistance. At the interpersonal level, CNAs identified their relationships with residents, residents’ family members, and other health care professionals as factors that affect their ability to provide mealtime assistance.

Discussion and Implications

These findings provide evidence for strategies that administrators can utilize to reduce caregiver burden by improving the mealtime experience. First, CNAs need adequate training, particularly to develop communication skills. Developing verbal communication skills may improve interpersonal relationships between CNAs and residents’ family members and other coworkers. Developing nonverbal communication skills may foster an improved relationship between CNAs and their residents with dementia. Future research should evaluate interventions that seek to improve these skills to determine their impact on the mealtime experience.
Orthotopic heart transplantation and concomitant aortic arch replacement in an adult Fontan patient with hypoplastic left heart syndrome
Authors: Blitzer David , Nguyen Stephanie , Farooqi Kanwal M , Takeda Koji
Published: September 2020

Heart failure and neoaortic dilation are common long-term complications in patients with hypoplastic left heart syndrome after single-ventricle palliation. Orthotopic heart transplantation and concomitant transverse aortic arch replacement can be performed safely and effectively. The addition of preoperative three-dimensional modelling can supplement operative planning, facilitate intraoperative execution, and optimize clinical outcomes.
Swedish snus use is associated with mortality: a pooled analysis of eight prospective studies
Authors: Byhamre Marja Lisa , Araghi Marzieh , Alfredsson Lars , Bellocco Rino , Engström Gunnar , Eriksson Marie , Galanti Maria Rosaria , Jansson Jan-Håkan , Lager Anton , Lundberg Michael , Östergren Per-Olof , Pedersen Nancy L , Trolle Lagerros Ylva , Ye Weimin , Wennberg Patrik , Magnusson Cecilia
Published: September 2020

Background

The health consequences of the use of Swedish snus, including its relationship with mortality, have not been fully established. We investigated the relationship between snus use and all-cause and cause-specific mortality (death due to cardiovascular diseases, cancer diseases and all other reasons, respectively) in a nationwide collaborative pooling project.

Methods

We followed 169 103 never-smoking men from eight Swedish cohort studies, recruited in 1978–2010. Shared frailty models with random effects at the study level were used in order to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of mortality associated with snus use.

Results

Exclusive current snus users had an increased risk of all-cause mortality (aHR 1.28, 95% CI 1.20–1.35), cardiovascular mortality (aHR 1.27, 95% CI 1.15–1.41) and other cause mortality (aHR 1.37, 95% CI 1.24–1.52) compared with never-users of tobacco. The risk of cancer mortality was also increased (aHR 1.12, 95% CI 1.00–1.26). These mortality risks increased with duration of snus use, but not with weekly amount.

Conclusions

Snus use among men is associated with increased all-cause mortality, cardiovascular mortality, with death from other causes and possibly with increased cancer mortality.
Legal Expertise: A Critical Resource for Trade Unionists? Insights into the Confédération Française Démocratique du Travail
Authors: Guillaume Cécile
Published: September 2020

Based on in-depth qualitative research conducted in one of the major French trade unions (the CFDT), this article explores to what extent and under what conditions trade unions adopt different legal practices to further their members’ interests. In particular, it investigates how ‘legal framing’ has taken an increasingly pervasive place in trade union work, in increasingly decentralised industrial relations contexts, such as France. This article therefore argues that the use of the law has become a multifaceted and embedded repertoire of action for the CFDT in its attempt to consolidate its institutional power through various strategies, including collective redress and the use of legal expertise in collective bargaining and representation work.
Distal learning of the incremental capacity curve of a LiFePO4 battery
Authors: Sánchez Luciano , Otero José , González Manuela , Anseán David , Zülke Alana A , Couso Inés
Published: September 2020

An intelligent model of the incremental capacity (IC) curve of an automotive lithium-ferrophosphate battery is presented. The relative heights of the two major peaks of the IC curve can be acquired from high-current discharges, thus enabling the state of health estimation of the battery while the vehicle is being operated and in certain cases, aging mechanisms can be suggested. Our model has been validated using a large dataset (number of batteries) representing different degradation scenarios, obtained from a recently available open-source database.
“Anything that Causes Chaos”: The Organizational Behavior of Russia Today (RT)
Authors: Elswah Mona , Howard Philip N
Published: September 2020

RT (formerly, Russia Today) is one of the most important organizations in the global political economy of disinformation. It is the most richly funded, well-staffed, formal organization in the world producing, disseminating, and marketing news in the service of the Kremlin. It is an agency accused of many things, but little is known about all the creative work involved in financing, governing, training, and motivating RT’s activities. To understand more about the production of political news and information by RT, we investigate its organizational behavior through in-depth interviews of current and former staff. Our data show that RT is an opportunist channel that is used as an instrument of state defense policy to meddle in the politics of other states. The channel has been established in the shadows of the Soviet media system and its organizational behavior is characterized by Soviet-style controls.
Latest Thoughts on Treating Pediatric Mucormycosis
Authors: Steinbach William J
Published: September 2020

Mucormycosis is one of the most complicated to diagnose and treat invasive fungal diseases. Diagnostic techniques have not significantly advanced in years, and recent international consensus treatment guidelines offer some insight into the current best approaches to treating this deadly invasive mold.
Differences in Genomic Alterations Between Brain Metastases and Primary Tumors
Authors: Dono Antonio , Takayasu Takeshi , Yan Yuanqing , Bundrant Bethany E , Arevalo Octavio , Lopez-Garcia Carlos A , Esquenazi Yoshua , Ballester Leomar Y
Published: September 2020

BACKGROUND

Brain metastases (BMs) occur in ∼1/3 of cancer patients and are associated with poor prognosis. Genomic alterations contribute to BM development; however, mutations that predispose and promote BM development are poorly understood.

OBJECTIVE

To identify differences in genomic alterations between BM and primary tumors.

METHODS

A retrospective cohort of 144 BM patients were tested for genomic alterations (85 lung, 21 breast, 14 melanoma, 4 renal, 4 colon, 3 prostate, 4 others, and 9 unknown carcinomas) by a next-generation sequencing assay interrogating 315 genes. The differences in genomic alterations between BM and primary tumors from COSMIC and TCGA were evaluated by chi-square or Fisher's exact test. Overall survival curves were plotted using the Kaplan-Meier method.

RESULTS

The comparison of BM and primary tumors revealed genes that were mutated in BM with increased frequency:TP53, ATR, andAPC(lung adenocarcinoma);ARID1AandFGF10(lung small-cell);PIK3CG, NOTCH3, andTET2(lung squamous);ERBB2, BRCA2, andAXL1(breast carcinoma);CDKN2A/B, PTEN, RUNX1T1, AXL, andFLT4(melanoma); andATM, AR, CDKN2A/B, TERT, andTSC1(renal clear-cell carcinoma). Moreover, our results indicate that lung adenocarcinoma BM patients withCREBBP, GPR124, orSPTA1mutations have a worse prognosis. Similarly,ERBB2, CDK12, orTP53mutations are associated with worse prognosis in breast cancer BM patients.

CONCLUSION

The present study demonstrates significant differences in the frequency of mutations between primary tumors and BM and identifies targetable alterations and genes that correlate with prognosis. Identifying the genomic alterations that are enriched in metastatic central nervous system tumors could help our understanding of BM development and improve patient management.
An Effort Worth Making: A Qualitative Study of How Swedes Respond to Antibiotic Resistance
Authors: Ancillotti Mirko , Eriksson Stefan , Godskesen Tove , Andersson Dan I , Nihlén Fahlquist Jessica
Published: September 2020

Due to the alarming rise of antibiotic resistance, medically unwarranted use of antibiotics has assumed new moral significance. In this paper, a thematic content analysis of focus group discussions was conducted to explore lay people’s views on the moral challenges posed by antibiotic resistance. The most important finding is that lay people are morally sensitive to the problems entailed by antibiotic resistance. Participants saw the decreasing availability of effective antibiotics as a problem of justice. This involves individual as well as collective moral responsibility. Yet, holding agents responsible for their use of antibiotics involves varying degrees of demandingness. In our discussion, these findings are related to the contemporary ethical debate on antibiotic resistance and two proposals for the preservation of antibiotic effectiveness are compared to and evaluated against participants’ views.
NHS Health Check Programme: a qualitative study of prison experience
Authors: Williams Marie , Thomson Louise , Butcher Elizabeth , Morriss Richard , Khunti Kamlesh , Packham Chris
Published: September 2020

Background

NHS Health Checks began in England in 2009 and were subsequently introduced into English prisons. Uptake has been patchy and there is limited understanding about factors that may limit or enhance uptake in prison settings. Uptake of this programme is a key policy in reducing the risk of cardiovascular disease and death in these settings.

Method

Semi-structured focus groups were conducted with groups of prisoners (attendees and non-attendees to the health check), prison healthcare staff, custodial staff and ex-prisoners (n = 50). Participants were asked about their awareness and experiences of the NHS Health Check Programme in prison.

Results

All groups highlighted barriers for not attending a health check appointment, such as poor accessibility to the healthcare department, stigma and fear. The majority of participants expressed a lack of awareness and discussed common misconceptions regarding the health check programme. Methods of increasing the uptake of health checks through group-based approaches and accessibility to healthcare were suggested.

Conclusions

This study reports on prisoner, staff and ex-prisoner perspectives on the implementation of NHS Health Checks within a restrictive prison environment. These findings have potentially substantial implications for successful delivery of care within offender healthcare services.
Different treatment options for Takayasu arteritis patients with moderate-to-severe aortic regurgitation: long-term outcomes
Authors: Cheng Xuesen , Li Zuozhi , Dang Aimin , Lv Naqiang , Chang Qian , Song Yunhu , Liu Guozhang
Published: September 2020

Objectives

To determine the prognosis of Takayasu arteritis (TA) patients with moderate-to-severe aortic regurgitation treated with surgical vs conservative treatment and to identify independent prognostic factors of long-term outcomes.

Methods

Between January 2002 and January 2017, 101 consecutive TA patients with moderate-to-severe aortic regurgitation treated with either surgical (n = 38) or conservative (n = 63) treatments were investigated in this retrospective observational case–control study. The primary end point was all-cause mortality, and the secondary end point comprised the combined end points of death, non-fatal stroke and cardiac events (non-fatal myocardial infarction and congestive heart failure). Propensity score matching was used to reduce the bias of baseline risk factors.

Results

The unadjusted all-cause 10-year mortality in the conservative group was increased compared with the surgical group (28.2% vs 7.4%; log-rank P = 0.036), and the combined end points showed the same trend (52.1% vs 25.3%; log-rank P = 0.005). After an adjustment of baseline risk factors, the conservative treatment was associated with reduced survival rates of both all-cause mortality [hazard ratio (HR): 8.243; 95% CI: 1.069, 63.552; P = 0.007] and combined end points (HR: 6.341; 95% CI: 1.469, 27.375; P = 0.002). Conservative treatment (HR: 3.838, 95% CI: 1.333, 11.053; P = 0.013) and left ventricular end-diastolic diameter (HR: 1.036, 95% CI: 1.001, 1.071; P = 0.042) were risk factors for increased combined end points.

Conclusion

Surgical treatment improves the outcomes of patients with moderate-to-severe aortic regurgitation due to TA. The dilated left ventricle indicated a worse prognosis.
Recommendations for rheumatology ultrasound training and practice in the UK
Authors: Atchia Ismaël , Brown Andrew K , Chitale Sarang , Ciechomska Anna , Estrach Cristina , Karim Zunaid , Wakefield Richard J ,   for the British Society for Rheumatology Ultrasound Special Interest Group (BSRUSSIG), Ahmed Tazeen , Chaudhuri Kaushik , Dasgupta Bhaskar , Dahiya Sandeep , Earl Susie , Filer Andrew , Garood Toby , Hall Alison , Mascarenhas Ravik , Platt Phil , Sahbudin Ilfita , Srinivasan Venkatachelam , Taggart Allister , Thompson Robert , Wong Ernest
Published: September 2020

Objective

The aim of this paper is to present a UK-based consensus of principles and recommendations to guide rheumatology US training and practice.

Method

A Delphi process was conducted involving 19 US experts representing each of the 14 regions of the UK. A working group of experienced British Society for Rheumatology Ultrasound Special Interest Group (BSRUSSIG) members made seven proposals that were presented to the whole group for further discussion. This resulted in minor modifications and seven preliminary recommendations. Members were then asked to anonymously agree or disagree with each recommendation using an electronic ballot. A threshold of 75% was used to determine consensus agreement. Results were collated by an independent chairperson and presented to the BSRUSSIG in a face to face meeting where agreement for each recommendation was ratified and an action plan agreed for dissemination of the results and future development work.

Results

Using a validated process, experts in rheumatology US have worked through an iterative process and have unanimously agreed seven recommendations for rheumatology training and practice. These cover a hierarchy of practice indications, education and training, including the need for practitioners to demonstrate lifelong learning, as well as a commitment to support mentors and trainers through the BSRUSSIG.

Conclusion

These are the first specific education and practice recommendations for rheumatology US in the UK and have been developed and endorsed by the BSRUSSIG. We intend that these proposals will help to support and validate rheumatology US practice and inform the development of future rheumatology training curricula and education programmes.
PsART-ID inception cohort: clinical characteristics, treatment choices and outcomes of patients with psoriatic arthritis
Authors: Ayan Gizem , Aydin Sibel Zehra , Kimyon Gezmis , Ozisler Cem , Tinazzi Ilaria , Dogru Atalay , Omma Ahmet , Kilic Levent , Yılmaz Sema , Kucuksahin Orhan , Gönüllü Emel , Yıldız Fatih , Can Meryem , Balkarlı Ayşe , Solmaz Dilek , Dalkılıc Ediz , Bayindir Ozun , Yıldırım Çetin Gözde , Ergulu Esmen Serpil , Ersozlu Emine Duygu , Duruoz Mehmet Tuncay , Akyol Lütfi , Kucuk Adem , Bes Cemal , Cınar Muhammet , Erden Abdulsamet , Mercan Rıdvan , Bakirci Sibel , Kasifoglu Timucin , Yazısız Veli , Kalyoncu Umut
Published: September 2020

Objectives

Our aim is to understand clinical characteristics, real-life treatment strategies, outcomes of early PsA patients and determine the differences between the inception and established PsA cohorts.

Methods

PsArt-ID (Psoriatic Arthritis- International Database) is a multicentre registry. From that registry, patients with a diagnosis of PsA up to 6 months were classified as the inception cohort (n==388). Two periods were identified for the established cohort: Patients with PsA diagnosis within 5–10 years (n = 328), ≥10 years (n = 326). Demographic, clinical characteristics, treatment strategies, outcomes were determined for the inception cohort and compared with the established cohorts.

Results

The mean (s.d.) age of the inception cohort was 44.7 (13.3) and 167/388 (43.0%) of the patients were male. Polyarticular and mono-oligoarticular presentations were comparable in the inception and established cohorts. Axial involvement rate was higher in the cohort of patients with PsA ≥10 years compared with the inception cohort (34.8% vs 27.7%). As well as dactylitis and nail involvement (P = 0.004, P = 0.001 respectively). Both enthesitis, deformity rates were lower in the inception cohort. Overall, 13% of patients in the inception group had a deformity. MTX was the most commonly prescribed treatment for all cohorts with 10.7% of the early PsA patients were given anti-TNF agents after 16 months.

Conclusion

The real-life experience in PsA patients showed no significant differences in the disease pattern rates except for the axial involvement. The dactylitis, nail involvement rates had increased significantly after 10 years from the diagnosis and the enthesitis, deformity had an increasing trend over time.
Disrupted Intersubject Variability Architecture in Functional Connectomes in Schizophrenia
Authors: Sun Xiaoyi , Liu Jin , Ma Qing , Duan Jia , Wang Xindi , Xu Yuehua , Xu Zhilei , Xu Ke , Wang Fei , Tang Yanqing , He Yong , Xia Mingrui
Published: September 2020

Schizophrenia (SCZ) is a highly heterogeneous disorder with remarkable intersubject variability in clinical presentations. Previous neuroimaging studies in SCZ have primarily focused on identifying group-averaged differences in the brain connectome between patients and healthy controls (HCs), largely neglecting the intersubject differences among patients. We acquired whole-brain resting-state functional MRI data from 121 SCZ patients and 183 HCs and examined the intersubject variability of the functional connectome (IVFC) in SCZ patients and HCs. Between-group differences were determined using permutation analysis. Then, we evaluated the relationship between IVFC and clinical variables in SCZ. Finally, we used datasets of patients with bipolar disorder (BD) and major depressive disorder (MDD) to assess the specificity of IVFC alteration in SCZ. The whole-brain IVFC pattern in the SCZ group was generally similar to that in HCs. Compared with the HC group, the SCZ group exhibited higher IVFC in the bilateral sensorimotor, visual, auditory, and subcortical regions. Moreover, altered IVFC was negatively correlated with age of onset, illness duration, and Brief Psychiatric Rating Scale scores and positively correlated with clinical heterogeneity. Although the SCZ shared altered IVFC in the visual cortex with BD and MDD, the alterations of IVFC in the sensorimotor, auditory, and subcortical cortices were specific to SCZ. The alterations of whole-brain IVFC in SCZ have potential implications for the understanding of the high clinical heterogeneity of SCZ and the future individualized clinical diagnosis and treatment of this disease.
CE: From the CDC: Understanding Autism Spectrum Disorder
Authors: Christensen Deborah , Zubler Jennifer
Published: September 2020

Autism spectrum disorder (ASD) is a condition characterized by impaired social communication as well as restricted and repetitive behaviors. It is considered a neurodevelopmental disorder because it is associated with neurologic changes that may begin in prenatal or early postnatal life, alters the typical pattern of child development, and produces chronic signs and symptoms that usually manifest in early childhood and have potential long-term consequences. In past decades, autism was conceptualized as a strictly defined set of behaviors, usually accompanied by intellectual impairment. Today, it is recognized as a spectrum, ranging from mild to severe, in which behaviors vary substantially and the majority of children who fall on the spectrum have average to above average intellectual ability. Here, the authors discuss the risk factors for ASD, its epidemiology, common concurrent conditions, evaluation, diagnosis, treatments, and outcomes.
Treatment of distal humeral fractures in elderly patients: where are we in 2020? A review article
Authors: Christiano Anthony V. , Dieterich James D. , Frechette Gregory M. , Lovy Andrew J. , Kim Jaehon M. , Hausman Michael R.
Published: September 2020

Distal humeral fractures are increasing in the elderly population and pose a difficult clinical problem as orthopaedic surgeons attempt to maximize return of function and avoid complications. Many treatments have been suggested for distal humeral fractures in the elderly, with operative intervention becoming a mainstay of treatment for active patients. Open reduction internal fixation (ORIF) and total elbow arthroplasty (TEA) have been utilized with both success and complications. The available literature appears to be equivocal on the ideal treatment of geriatric distal humeral fractures, with well-done TEA and ORIF demonstrating similar outcomes. Failed fixation of geriatric distal humeral fractures can be reliably converted to TEA without worsened outcomes but requires a second surgery. TEA demonstrates equivalent outcomes, but with activity limitations for the lifespan of the patient that may inhibit the use of walking aids. There also may be decreased hardware survivorship when TEA is employed for acute fracture. Surgeons and patients must weigh the risks and benefits of treatment with TEA associated with functional restrictions and possible decreased hardware survivorship. TEA does not have the reliable fallback option, but ORIF requiring a second surgery can be converted to TEA.
New reduction technique for posterior prosthetic hip dislocation: a case report demonstrating ease of reduction with this technique in larger patients
Authors: Vajapey Sravya P. , Phieffer Laura S.
Published: September 2020

The authors describe a new technique for posterior prosthetic hip dislocation. This technique is unique because it requires only one assistant and is suitable for smaller physicians who are performing the reduction on much larger patients. This technique uses the first-order lever created by the knee and extensor mechanism, which acts as a fulcrum, to convert the applied force necessary to perform the reduction from a pulling force into a pushing force. This case report presents an obese patient with a posterior prosthetic hip dislocation that was reduced with this new technique after two failed attempts with conventional methods.
Diagnostic Role of Flexion-extension Central Motor Conduction Time in Cervical Spondylotic Myelopathy
Authors: Park Dougho , Kim Byung Hee , Cho Jae Man , Yang Joong Won , Yang Dong Hoon , Kim Man Su , Kwon Heum Dai , Lee Sang-Eok
Published: September 2020

Study Design.

Retrospective study

Objective.

The purpose of this study was to assess the diagnostic usefulness of flexion-extension central motor conduction time

(CMCT) for patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data.

Previous reports have suggested that cervical cord compression can be aggravated by neck motions. Thus, the importance of dynamic magnetic resonance imaging (MRI) has been emphasized. However, authors of this study found no reports conducted at the time of this research on whether flexion-extension CMCT was useful for detecting myelopathy.

Methods.

We enrolled 227 patients with CSM for this study. We acquired CMCT recorded from the abductor pollicis brevis muscle. All patients underwent a dynamic CMCT study during neck flexion and extension as well as a static study during neutral neck. Static and dynamic MRIs were also scanned. We read all MR images using Muhle classification (MC).

Results.

CMCT was significantly delayed with flexion (P < 0.01) and extension (P < 0.01) compared to neutral neck position. Patients with MC grade 1 and 2 showed significant lag in CMCT during flexion and extension. No significant lag by neck motion was observed for those in the MC grade 3. We also evaluated the amount of CMCT variation according to MC grade change (G0, G1, G2) by neck motion. Delta-CMCT of both G1 and G2 were significantly larger than those of G0 in both flexion and extension. In neutral neck, the CMCT showed significant difference between MC grades 1 and 3. They also displayed significant delay with delay with high signal intensity on T2 MRI. More than one-third of the patients whose CMCT was within normal range in neutral neck presented abnormal CMCT in neck flexion (35.3%) and extension (37.8%).

Conclusion.

CMCT is significantly slower in both neck flexion and neck extension than in the neutral neck position. These findings reflect the dynamic cervical cord impingement.

Level of Evidence: 4