bluuebunny/crossref_metadata_2025 huggingface dataset:
Preserving the posterior cortex of the sternum during resection of a superficial anterior chest wall sarcoma
Authors: Sakamoto Akio , Tsuge Itaru , Noguchi Takashi , Matsuda Shuichi
Published: September 2021

Following resection of a sternal tumor, respiratory dysfunction can occur and rigid reconstruction is necessary. An 82-year-old woman noted a mass in the anterior chest wall that was increasing in size. The tumor was located on the left aspect of the sternum at the level of the third rib. A radiation-induced malignant spindle cell tumor was diagnosed because of a history of irradiation for hilar lymph node carcinoma. The tumor was resected with the surrounding tissues of the second-to-fourth ribs and sternum. The posterior sternal cortex was preserved by cutting with a curved chisel under fluoroscopy. The chest wall defect was reconstructed with a 2-mm thick Gore-Tex® sheet and a local transpositional flap. Sternal resection with a chisel under fluoroscopy avoids damage to the internal thoracic artery. Preserving the posterior sternal cortex does not require rigid reconstruction. The procedure is minimally invasive.
Kanamycin Supplement for the Disaggregation of Platelet Clumps in EDTA-Dependent Pseudothrombocytopenia Specimens
Authors: Tantanate Chaicharoen , Talabthong Supavat , Lamyai Phenluck
Published: September 2021

Objective

To indicate the ability to disaggregate platelet clumps by vortex mixing and kanamycin supplementation in EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) specimens.

Materials and Methods

For patients with EDTA-PTCP, citrate-anticoagulated, primary EDTA-anticoagulated, vortex-mixed, and kanamycin-treated specimens were tested for complete blood count and platelet-related parameters.

Results

Forty-eight specimens were included. Nineteen (39.6%) of the vortex-mixed specimens and 42 (87.5%) of the kanamycin-treated specimens revealed platelet counts more than those of the primary EDTA specimens, with levels exceeding 100 × 109/L. The platelet count and platelet recovery of the kanamycin-treated specimens were higher than those of the vortex-mixed specimens.

Conclusion

Kanamycin supplementation to EDTA-PTCP blood may be considered as an alternative approach when the recollection of specimens is impractical. Only platelet-related parameters from kanamycin treatment were suitable for guiding patient management. Further studies about the impact of these methods in patients with various conditions, such as in patients with advanced kidney disease, should be conducted.
Individual Criminal Responsibility
Authors: Ambos Kai
Published: September 2021

This chapter starts with the universal recognition of the concept of individual criminal responsibility in ICL as perhaps the most important result of its historic precedents of Nuremberg and Tokyo. It offers a profound analysis of the ‘historic’ case law on individual criminal responsibility, namely the post WW II case law (Nuremberg, Tokyo, the one by the allied powers and Germany), but also relevant case law on other (mainly) State-sponsored criminality (especially in Latin America). It then turns to the ‘modern’ law of individual criminal responsibility and thus analyses the law and jurisprudence of the UN Ad Hoc Tribunals, of the mixed tribunals and, with a particular emphasis, of the ICC. In terms of doctrine a special focus lies on the forms of participation which enable us to hold the masterminds of the international crimes accountable, that is, joint criminal enterprise (JCE) and indirect perpetration by way of an organization (Organisationsherrschaft). In this respect, the chapter deals with what is probably the most important field of the ongoing theoretization of International Criminal Law.
The Subjective Requirements of International Crimes
Authors: Ambos Kai
Published: September 2021

This chapter reviews first Article 30 of the International Criminal Court (ICC) Statute that contains the general mens rea rule for crimes under the Statute (Articles 5-8bis) on the basis of a thorough comparative law inquiry. . After some terminological clarifications (e.g. regarding the meaning of the term ‘intent’), it examines the objects of reference of Article 30 (material elements as well as conduct, consequence and circumstance) in order to be able to apply them to the crimes of the Statute; also, the standard or degrees of the mental element are analysed. In the second section it is inquired whether there are additional or different subjective requirements provided for by the crime definitions, such as most prominently the specific intent (dolus specialis) requirement in genocide; further, the modes of participation (Article 25(3)) going beyond Article 30 are explored.
Grounds Excluding Responsibility (‘Defences’)
Authors: Ambos Kai
Published: September 2021

This chapter provides first the groundwork of any analysis of ‘defences’, namely the broad or narrow meaning of the concept (substantive vs. procedural defences) and the different types or forms of defences, including their effect and procedural implications (standard and burden of proof). This contributes to a better understanding and proper interpretation that suggest major differentiation criteria with regard to ICL. Then, a detailed analysis of the substantive and procedural defences relevant in ICL is offered. This analysis starts with conceptual explanations (e.g. regarding the relevant point in time) and examines, on the basis of a thorough comparative law research, most important and well known defences like mental disease, intoxication, self-defence, duress and necessity, mistake of fact and law, superior order, immunities, but also looks at less prominent ones such as consent, reprisals or abuse of process.
Conceptual Problems
Authors: Hongler Peter
Published: September 2021

The last chapter of the book reviews whether the international tax regime has been a success or a failure and based on these remarks, it is assessed what the reasons are for potential success and potential failure. Afterwards, reference is made to three of the most pressing issues in the current international tax regime. This includes measures against aggressive tax planning, specific issues triggered by the taxation of the digital economy, and a discussion of whether it would better to switch from the arm’s length principle to a formulary system. The chapter will also cover some of the most recent proposals to change the current international tax regime as part of the Pillar 1 and Pillar 2 work of the Inclusive Framework.
Determination of Refugee Status: Analysis and
Application
Authors: Goodwin-Gill Guy S , McAdam Jane , Dunlop Emma
Published: September 2021

This chapter discusses the determination of refugee status. The legal consequences that flow from the formal definition of refugee status are necessarily predicated upon determination by some or other authority that the individual or group in question satisfies the relevant legal criteria. In principle, a person becomes a refugee at the moment when he or she satisfies the definition, so that determination of status is declaratory, rather than constitutive. However, while the question of whether an individual is a refugee may be a matter of fact, whether or not he or she is a refugee within the 1951 Convention, and benefits from refugee status, is a matter of law. Problems arise where States decline to determine refugee status, or where States and the Office of the United Nations High Commissioner for Refugees (UNHCR) reach different determinations.
The Form of Relief in Emergency Arbitration
Authors: Sim Cameron
Published: September 2021

This chapter studies the form of relief in emergency arbitration. In any event, a prospective applicant to an emergency arbitration will almost certainly already have in mind the form of relief they require to preserve their rights pending constitution of the arbitral tribunal. Both for the applicant, and for the respondent, the central issue when considering the form of relief in emergency arbitration will be whether the emergency arbitrator has the power to impose the requested relief. Evidently, the form of relief the emergency arbitrator is empowered to impose is classified differently across the Emergency Arbitration Rules, with no clear majority approach. The forms of relief range from "interim measures" and "interim and conservatory measures"; to "urgent measures", "urgent provisional measures", and "urgent interim and conservatory measures"; and even to "emergency measures". The different terms used to describe the types of relief available under Emergency Arbitration Rules reflects the general approach taken to urgent relief in international arbitration.
The United Kingdom—Gentlemanly Capitalism and the International Markets
Authors: Jordan Cally
Published: September 2021

This chapter focuses on the regulation of international markets in the United Kingdom. Providing investor protection in the United Kingdom has been a fraught and difficult process. Even well into the 1980s, one very popular view in the City of London, openly espoused, was that it was not the role of government, nor was it necessarily either possible or desirable, to ‘protect fools from their own folly’. Rather, the gentlemen of the City, historical evidence to the contrary notwithstanding, insisted that their ‘impeccable’ behaviour provided all the protections necessary. Less than a decade ago, the International Monetary Fund (IMF) identified ‘uncertainty risk’ as the major threat to the City of London. At the time, massive regulatory change in the United Kingdom and a tidal wave of EU regulation in response to the global financial crisis were the immediate concerns. Despite the sea changes in the nature of markets and regulatory upheaval in the United Kingdom, the City sailed on. In hindsight, the uncertainty risks associated with the global financial crisis and the EU's regulatory agenda pale in comparison to those posed by Brexit.
Global South Approaches
Authors: Atapattu Sumudu
Published: September 2021

This chapter details the global South approaches to international environmental law. It first discusses the colonial origins of international law before tracing the evolution of international environmental law and the North-South divide. The chapter then looks at global South perspectives on international environmental law, including principles and frameworks adopted to address the North-South divide. It considers the potential and limits of these perspectives. Ultimately, the chapter argues that unless and until the neoliberal economic model based on capitalism is discarded in favour of a more ecologically friendly model that accommodates the needs of the global South, especially their vulnerable communities, not only will current North-South tensions be exacerbated, the world will also speedily move towards environmental tipping points from which there is no hope of return.
Earth Jurisprudence
Authors: Cullinan Cormac
Published: September 2021

This chapter assesses Earth jurisprudence, which is a philosophical approach to legal and governance systems at every level, rather than a theory of international environmental law. It refers to philosophies of law and governance which seek to guide humans to behave in ways that contribute to the integrity, healthy functioning, beauty, and ongoing evolution of the community of life known as ‘Earth’. This approach seeks to promote the flourishing of the Earth community and a ‘mutually enhancing human-Earth relationship’, rather than its subjugation and exploitation by humankind. The chapter explains the worldview that informs Earth jurisprudence, before looking at the essential concepts and principles that make this approach so distinctive. It then tracks the emergence of Earth jurisprudence and the rights of Nature/Mother Earth within the international sphere, and evaluates how this approach may affect the development of international law.
Freshwater Resources
Authors: Salman Salman M. A.
Published: September 2021

This chapter traces the evolution of the legal regime for environmental protection of shared watercourses. Codification of international water law began only in 1970, when the International Law Commission (ILC) started to work on a draft convention on the law of the non-navigational uses of international watercourses. After close to a quarter of a century, five rapporteurs, and fifteen reports, the ILC completed its work and adopted the draft United Nations Convention on the Law of the Non-Navigational Uses of International Watercourses (Watercourses Convention). In parallel, the United Nations Economic Commission for Europe (UNECE) Convention on the Protection and Use of Transboundary Watercourses and International Lakes (Water Convention) was adopted in 1992, and entered into force in 1996. The chapter then analyses and compares the environmental provisions of these two global Conventions. It also considers the influence of the two Conventions on the environmental provisions of subsequent regional and bilateral treaties.
Wildlife
Authors: Wiersema Annecoos
Published: September 2021

This chapter details the themes and principles that shape international wildlife law. International wildlife law shares attributes with other fields of international environmental law, but also has certain particular attributes. In particular, the degree to which treaties affecting wildlife conservation impose strict or flexible obligations on their member states is often a product of a variety of factors, for example: how specific the scope of the treaty is, whether the treaty primarily focuses on individual species or on ecosystem and habitat protection, and whether the treaty targets primarily domestic or primarily international activities or species. The chapter then discusses certain international regimes that focus on particular species, before considering examples of ecosystem-based regimes and regimes with a more regional focus. It also looks at the most significant issues facing global wildlife conservation.
Hazardous Substances and Activities
Authors: Wirth David A. , Sachs Noah M.
Published: September 2021

This chapter analyses the enormous scope of international instruments addressing hazardous substances and activities by assessing both the regulatory junctures and the specific strategies that governments rely upon to reduce risk. It begins with the challenge of identifying which substances are hazardous to human health or the environment (risk assessment) and then discusses the major treaties that regulate chemical hazards (risk management). The chapter also examines treaties and other international instruments governing chemical production, use, labelling, and disposal as well as those governing industrial accidents. It concludes with a discussion of instruments designed to promote pollution prevention and toxics use reduction. Presently there is no single, overarching international framework for addressing environmental and public health risks from hazardous substances and activities.
Aviation and Maritime Transport
Authors: Martinez Romera Beatriz
Published: September 2021

This chapter focuses on the main environmental issues relating to aviation and maritime transport, and the key international legal and regulatory frameworks and tools in place to address them. The environmental regulation of aviation and maritime transport activities is orchestrated primarily under the auspices of the International Civil Aviation Organization (ICAO) and the International Maritime Organization (IMO), two United Nations (UN) specialized agencies dealing with all aspects of aviation and maritime transport, respectively. However, the environmental governance of aviation and maritime transport also encompasses actors, processes, and instruments outside these regimes, and interactions with other treaty-based regimes. The chapter then examines the specific regulation of different environmental matters. It also looks at the key issues and pathways for the sustainable future of these sectors.
International Institutions
Authors: Hey Ellen
Published: September 2021

This chapter maps the different roles of international institutions involved in the development of international environmental law by considering the initiating roles that some institutions play, the institutional structure of multilateral environmental agreements (MEAs), and the roles of scientific and financial institutions. It charts how MEAs link to each other substantively by focusing on the relationships between global and regional MEAs and the synergies and contestations between global MEAs. These mapping processes result in the identification of patterns that illustrate the different roles and types of links that exist between international institutions. International institutions, together with non-governmental organizations (NGOs), engage in two types of activities in developing international environmental law. First, they engage in normative development. That is the development of rules and standards that are to regulate human activity. Second, they engage in implementing these rules and standards.
Epistemic Communities
Authors: Haas Peter
Published: September 2021

This chapter begins with a definition and intellectual history of epistemic communities. ‘Epistemic communities’ is a concept developed by ‘soft’ constructivist scholars of international relations concerned with agency. Soft constructivists in general focus on the role of various types of norms, principled beliefs, causal beliefs, and discourses in establishing roles and rules in international relations: that is, determining the identities, interests, and practices that shape the identification of actors in international relations. The chapter then applies this definition to the study of international environmental law and discusses whether or not international lawyers constitute an epistemic community. It concludes with a discussion of some of the recent challenges to the influence of epistemic communities in world politics more broadly, and thus the future of international environmental law.
Trade
Authors: van Asselt Harro
Published: September 2021

This chapter reviews the interactions between international trade law and environmental protection. It begins by explaining how trade and environmental protection are physically interlinked, before offering an account of the evolution of the trade and environment debate. The chapter then examines the relationship between multilateral environmental agreements (MEAs) and trade, followed by an analysis of questions that have arisen in assessing the compatibility of environmental measures with trade law. International trade law may have a ‘chilling effect’ on the adoption or effective implementation of international environmental agreements. Conversely, environmental policies employing trade restrictions can become ‘green protectionism’ and even ‘eco-imperialism’. The chapter explores two emerging developments of relevance for the trade and environment debate, including the rise of regional trade agreements and the growing importance of climate change-related disputes. It concludes with a critical assessment of the prospects for strengthening coherence between international environmental and trade law.
Transparency Procedures
Authors: Sparks Tom , Peters Anne
Published: September 2021

This chapter explores how information obligations on states—to collect, report, or publish—are an important aspect of most modern multilateral environmental agreements (MEAs). These have developed both alongside and as part of a wider ‘turn to transparency’ in international law, resulting in traditional forms of reporting, monitoring, and verification being incorporated into a more extensive set of transparency relationships. The chapter examines transparency as an increasingly important aspect of international environmental law, both as an end in itself and as a means of achieving other substantive goals. It frames transparency in international environmental law within the wider transparency turn. The chapter then looks at the techniques that are employed in customary and conventional environmental law to realize transparency, focusing on the compliance-centred, emancipatory, and advocative functions it performs.
Market Mechanisms
Authors: Mehling Michael
Published: September 2021

This chapter provides an overview of market mechanisms and their contemporary role in international environmental law. It considers the conceptual foundations and theoretical rationale of market mechanisms when deployed for environmental ends, citing the main arguments levelled on different sides of the debate. As social constructs built on legal rights and obligations, moreover, markets rely on a sound regulatory framework for their efficient operation. With environmental markets, this need for legal parameters is further accentuated by the fact that the article of trade is itself a regulatory artifice. The chapter then looks at legal issues arising in the design and implementation of market mechanisms. It surveys the most important environmental markets currently in place at the international level. The chapter concludes with an outlook on the future role of market mechanisms in international environmental law.
North America
Authors: Affolder Natasha
Published: September 2021

This chapter assesses international environmental law in the courts of North America. In particular, it explores the minimal engagement of US, Canadian, and Mexican courts with international environmental law. Environmental law cases in Canada, Mexico, and the United States are not immune to international law and international norms. However, international environmental lawyers may be forced to look to some unlikely and unusual places to find international environmental law's normative influence. Environmental law cases in North America seem poised to engage most significantly with international law not in the ‘bright lights’ but rather on the side-lines, where environmental law norms interface with climate law, private international law, Indigenous law, and human rights law.
Oceania
Authors: Stephens Tim
Published: September 2021

This chapter addresses international environmental law in the courts of Oceania. The Oceania region stretches across Australasia, Melanesia, Micronesia, and Polynesia, embracing fourteen independent states, two states in free association with New Zealand, and offshore territories of three other states. The states of Oceania have generally been strong advocates for international environmental law and have adopted notable regional environmental treaties. A range of topics of international environmental law has been canvassed in Oceania courts, from sustainable fisheries management to the protection of world heritage. Reflecting the major threat that global warming poses to Oceania, cases addressing climate issues represent a growing proportion of this region's environmental jurisprudence. However, the primary barrier to greater application of international environmental law in Oceania courts is the incomplete implementation of environmental treaty commitments in domestic law.
The Law of Treaties
Authors: Shelton Dinah
Published: September 2021

This chapter discusses how peremptory norms/jus cogens entered positive law with the Vienna treaties on treaties. Jus cogens was first included in the work of the International Law Commission (ILC) with the Third Report of G.G. Fitzmaurice, Special Rapporteur on the Law of Treaties, under the heading ‘legality of the object’. The first two special rapporteurs on the law of treaties supported the notion of peremptory norms in international law. During ILC work on the law of treaties, however, most of the members joined the ILC’s fourth special rapporteur on treaty law, Sir Humphrey Waldock, who sought to reconcile jus cogens with the doctrine of positivism. They spent little time speculating on the origin of jus cogens. The final ILC draft on the law of treaties was produced by Waldock. The work of the ILC on the law of treaties was based essentially on the notion of barring illegal agreements as a general principle of law. The chapter then provides a definition of jus cogens norms.
Jus Cogens in Recent Legal Scholarship
Authors: Shelton Dinah
Published: September 2021

This chapter evaluates recent legal scholarship on jus cogens. Writers continue to discuss and debate the origins and sources of jus cogens. In addition, they devote increasing attention to the specific norms proposed for such status. The prohibition of enforced disappearance, for example, has been recognized in writings as a norm of jus cogens. Other specific norms proposed include the prohibition of torture; the principle of non-refoulement; the prohibition of crimes against humanity; the prohibition of apartheid and racial discrimination; the prohibition of slavery; and the right of self-determination. The jus cogens status of basic rules of humanitarian law is also generally recognized in the literature.
Reading the Materiality of Caste
Authors: Issar Lucky
Published: September 2021

Focusing on the material things in Arundhati Roy’s The God of Small Things, this article examines caste and its connection to sexuality. The brahminic obsession with caste hierarchies is based on controlling women’s bodies and Dalit exclusion. In everyday life, such control over women’s bodies and Dalit subordination is produced via material things. The practice of untouchability becomes real only when certain things/bodies are given touchable/pure status while others are assigned untouchable/abject meanings, which has repercussions for all members of society. Using thing theory and aspects of citizenship theory and brahminic culture, this article studies the ‘materiality’ through which caste is relayed and produced.
Evolution of a Cytoplasmic Determinant: Evidence for the Biochemical Basis of Functional Evolution of the Novel Germ Line Regulator Oskar
Authors: Blondel Leo , Besse Savandara , Rivard Emily L , Ylla Guillem , Extavour Cassandra G
Published: September 2021

Abstracts

Germ line specification is essential in sexually reproducing organisms. Despite their critical role, the evolutionary history of the genes that specify animal germ cells is heterogeneous and dynamic. In many insects, the gene oskar is required for the specification of the germ line. However, the germ line role of oskar is thought to be a derived role resulting from co-option from an ancestral somatic role. To address how evolutionary changes in protein sequence could have led to changes in the function of Oskar protein that enabled it to regulate germ line specification, we searched for oskar orthologs in 1,565 publicly available insect genomic and transcriptomic data sets. The earliest-diverging lineage in which we identified an oskar ortholog was the order Zygentoma (silverfish and firebrats), suggesting that oskar originated before the origin of winged insects. We noted some order-specific trends in oskar sequence evolution, including whole gene duplications, clade-specific losses, and rapid divergence. An alignment of all known 379 Oskar sequences revealed new highly conserved residues as candidates that promote dimerization of the LOTUS domain. Moreover, we identified regions of the OSK domain with conserved predicted RNA binding potential. Furthermore, we show that despite a low overall amino acid conservation, the LOTUS domain shows higher conservation of predicted secondary structure than the OSK domain. Finally, we suggest new key amino acids in the LOTUS domain that may be involved in the previously reported Oskar−Vasa physical interaction that is required for its germ line role.
Beyond the Present-Fault Paradigm: Expanding Mens rea Definitions in the General Part
Authors: Child J J , Hunt Adrian
Published: September 2021

This article explores the use of mens rea terms in the criminal general part. We contend the current law fails properly to conceptualise mens rea for a large category of offences, namely bespoke/substantive inchoate offences, attempt, conspiracy, assisting and encouraging, and the general offence of complicity. These offences involve two conduct events: one in the present and one in future. However, current mens rea terms are defined as if applied to the more conventional category of criminal offence which only involves present conduct—a practice which we term the ‘present-fault paradigm’. We explore the limits of current mens rea terms, defined for present-conduct targets (circumstances and results), when applied to future-conduct ulterior targets within inchoate and complicity offences. We contend that current mens rea definitions and analysis within the general part are inappropriate for targeting elements related to future conduct/offending, and we suggest more appropriate bases for conceptualising such mens rea.
Risk Factors for Deliberate Self-harm and Suicide Among Adolescents and Young Adults With First-Episode Psychosis
Authors: Moe Aubrey M , Llamocca Elyse , Wastler Heather M , Steelesmith Danielle L , Brock Guy , Bridge Jeffrey A , Fontanella Cynthia A
Published: September 2021

Little is known about the risk factors for deliberate self-harm (DSH) and suicide among adolescents and young adults with first episode psychosis (FEP) and the longitudinal course of DSH following the initial onset of illness. This study identifies risk factors for DSH and suicide death among Medicaid-covered adolescents and young adults with FEP along with the periods of greatest risk for DSH after diagnosis. A retrospective longitudinal cohort analysis was performed using Medicaid claims data merged with death certificate data for 19 422 adolescents and young adults (aged 15–24 years) diagnosed with the onset of FEP between 2010 and 2017. DSH per 1000 person-years and standardized mortality rates for suicide were determined. Hazard ratios of DSH and suicide were estimated by Cox proportional hazard models. During follow-up, 2148 (11.1%) individuals had at least one self-harm event and 22 (0.1%) died by suicide. The hazards of DSH were significantly higher for those with a previous DSH, suicidal ideation, child abuse and neglect, comorbid medical and psychiatric diagnoses, and prior mental health care. The median follow-up time for those who had DSH was 208.0 days (SD: 526.5 days) in adolescents and 108.0 days (SD: 340.0 days) in young adults. Risk of DSH was highest in the first 3 months following FEP. Individuals with FEP are at high risk for self-harm and suicidal behavior, and recognition of who among these individuals and when following illness onset they are at greatest risk may guide more precise clinical recognition and intervention.
Stock market reactions to downsizing announcements: an analysis through an institutional lens
Authors: Schulz Ann-Christine , Himme Alexander
Published: September 2021

In this study, we examine stock market reactions to corporate downsizing using a neo-institutional perspective. Over the course of the 1990s, a time period in which shareholder value orientation gained momentum, downsizing became an institutionalized management practice. We argue and propose that the growing legitimacy of this practice is displayed in investors’ reactions to downsizing announcements. Using a sample of 391 downsizing announcements of the S&P 100 firms for the period 1990–2006, we show that the announcement year has a positive (diminishing) effect on the abnormal stock market return and that prior downsizings in the focal firm’s institutional field have a positive linear impact on abnormal stock market return. In addition, we provide evidence that these relationships are positively moderated by proactive downsizing motives and firm size. Our results contribute to a deeper understanding of the performance effects of corporate downsizing and investors’ role in legitimizing this prevalent business practice.
Neuroligin-1 Is a Mediator of Methylmercury Neuromuscular Toxicity
Authors: Gunderson Jakob T , Peppriell Ashley E , Krout Ian N , Vorojeikina Daria , Rand Matthew D
Published: September 2021

Methylmercury (MeHg) is a developmental toxicant capable of eliciting neurocognitive and neuromuscular deficits in children with in utero exposure. Previous research in Drosophila melanogaster uncovered that developmental MeHg exposure simultaneously targets the developing musculature and innervating motor neuron in the embryo, along with identifying Drosophila neuroligin 1 (nlg1) as a gene associated with developmental MeHg sensitivity. Nlg1 and its transsynaptic partner neurexin 1 (Nrx1) are critical for axonal arborization and NMJ maturation. We investigated the effects of MeHg exposure on indirect flight muscle (IFM) morphogenesis, innervation, and function via flight assays and monitored the expression of NMJ-associated genes to characterize the role of Nlg1 mediating the neuromuscular toxicity of MeHg. Developmental MeHg exposure reduced the innervation of the IFMs, which corresponded with reduced flight ability. In addition, nlg1 expression was selectively reduced during early metamorphosis, whereas a subsequent increase was observed in other NMJ-associated genes, including nrx1, in late metamorphosis. Developmental MeHg exposure also resulted in persistent reduced expression of most nlg and nrx genes during the first 11 days of adulthood. Transgenic modulation of nlg1 and nrx1 revealed that developing muscle is particularly sensitive to nlg1 levels, especially during the 20–36-h window of metamorphosis with reduced nlg1 expression resulting in adult flight deficits. Muscle-specific overexpression of nlg1 partially rescued MeHg-induced deficits in eclosion and flight. We identified Nlg1 as a muscle-specific, NMJ structural component that can mediate MeHg neuromuscular toxicity resulting from early life exposure.
REadmission PREvention in SepSis: Development and Validation of a Prediction Model
Authors: Grek Ami A. , Rogers Emily R. , Peacock Sarah H. , Hartjes Tonja M. , White Launia J. , Li Zhuo , Naessens James M. , Franco Pablo M.
Published: September 2021

Hospital 30-day readmissions remain a major quality and cost indicator. Traditional readmission risk scores, such as LACE (length of stay, acuity of admission, Charlson comorbidity index, and emergency department visits), may be suboptimal in special patient populations, such as those with sepsis. As sepsis survivorship improves, there is a need to determine which variables might be associated with a decrease in 30-day readmission. We completed a retrospective analysis reviewing patients with sepsis who had unplanned 30-day readmissions. Multivariate regression analysis was performed for the REadmission PREvention in SepSis (REPRESS) model, which evaluated age, length of stay, Charlson disease count, Richmond Agitation–Sedation Scale score, discharge to a skilled nursing facility, and mobility for predictive significance in hospital readmission. Our REPRESS model performed better when compared with LACE for predicting readmission risk in a sepsis population.
Hospital value–based purchasing: How acute care advanced practice nurses demonstrate value
Authors: Constable Mark , Mulkey Malissa , Aucoin Julia
Published: September 2021

Hospital value–based purchasing (HVBP) is a budget neutral initiative from the Centers for Medicare & Medicaid Services designed to adjust the hospital payment system based on health care quality data. Hospital value–based purchasing is designed to promote improved clinical outcomes and better patient experience in the acute care setting. Advanced practice registered nurses (APRNs) in the acute care setting are instrumental to the success of health care institutions under the current payer model in the United States health care system. When APRNs use their advanced knowledge and leadership skills to champion quality improvement and patient experience projects, they may increase financial reimbursement within the HVBP system, thus demonstrating value to the health care institution. Four basic steps could help APRNs demonstrate value to the organization, understand the standard, evaluate your performance compared with the standard, identify opportunities, and implement projects or participate in projects. This article provides a broad overview of the HVBP structure and describes how APRNs can positively influence performance measures, thereby potentially increasing hospital reimbursement.
Nonsquamous Lesions of the Vulvar Skin and Subcutaneous Tissue: A Review (Part 1)
Authors: Rastegar Shima , Heller Debra S.
Published: September 2021

Objectives

This article aimed to review “nonsquamous lesions of the vulvar skin and subcutaneous tissue” clinically and pathologically, based on the fifth edition of the World Health Organization tumor classification.

Materials and Methods

A database search of PubMed and Google Scholar was performed between 1970 and 2021, using the search terms “vulva,” “lower genital tract,” and “nonsquamous lesions.” The search was limited to “humans,” “gynecopathology,” and “dermatopathology.” Full article texts were reviewed. Reference lists were screened for additional articles. We excluded articles written in the non-English language and abstracts.

Results

A list of 600 articles was identified. Another screening identified 68 articles for clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue. In the first part of this review, we cover 5 major groups of nonsquamous lesions of the vulvar skin and subcutaneous tissue including (1) glandular tumors and cysts, (2) adenocarcinomas of other types, (3) germ cell tumors of the vulva, (4) neuroendocrine neoplasia, and (5) hematolymphoid hyperplasia and neoplasia. The rest of the major topics including mesenchymal tumors of the lower genital tract, melanocytic lesions, and metastasis will be discussed in the second part of this review.

Conclusions

Clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue as categorized by the updated World Health Organization classification are presented.
Prevalence of Positive Cervical Cancer Screening Tests Past the Age of 65 Years With Prior Adequate Negative Screening
Authors: Sheu Joanne , Field Alessia , Viswanathan Radhika , Minkowitz Jeremy , Calixte Rose , Lee Yi-Chun
Published: September 2021

Objectives

Cervical cancer screening recommendations suggest that cessation can be offered above the age of 65 years if specific prior negative screening criteria are met. We investigated the prevalence of abnormal results in individuals who continue screening despite satisfying the American Society for Colposcopy and Cervical Pathology guidelines for cessation.

Materials and Methods

In this retrospective study, medical records 2008–2019 from a single urban hospital-based clinic were queried. Charts were manually reviewed to determine which patients met the American Society for Colposcopy and Cervical Pathology exit criteria but continued screening. Findings detected during the extended surveillance period beyond the age of 65 years were analyzed.

Results

Two hundred ninety-six patients met the criteria of additional screening despite meeting guidelines for cessation. Length of the continued additional surveillance period ranged from 1 to 15 years with a mean of 3.98 years and median of 3 years. Thirty-nine individuals had abnormalities during additional surveillance: 25 high-risk human papillomavirus (HR-HPV) positive only with negative cytology, 8 atypical squamous cells of undetermined significance, 3 low-grade squamous intraepithelial lesions, 2 atypical glandular cells of undetermined significance, and 1 high-grade squamous intraepithelial lesion. No cases of cervical cancer were detected. Total rate of abnormalities including HR-HPV positive only was 332.20 per 10,000 person-years, and cytologic abnormalities alone at 119.25 per 10,000 person-years.

Conclusions

Most findings were HR-HPV positive with negative cytology, which studies suggest may confer low risk of progression in older individuals. In addition, no patient was found to develop cervical malignancy. Despite controversy regarding this recommendation, our data suggest screening cessation may be appropriate with adequate negative screening history.
Outcome and Toxicity of Proton Therapy for Vestibular Schwannoma: A Cohort Study
Authors: Koetsier Kimberley S. , Hensen Erik F. , Niemierko Andrzej , Dewyer Nicholas A. , Chapman Paul H. , Lamba Nayan , Bussière Marc R. , van Vulpen Marco , McKenna Michael J. , Loeffler Jay S. , Shih Helen A.
Published: September 2021

Objective:

To assess the efficacy and toxicity of proton radiotherapy in vestibular schwannoma.

Study Design:

Retrospective chart review and volumetric MRI-analyses.

Setting:

Tertiary referral center.

Patients:

Vestibular schwannoma patients treated with protons between 2003 and 2018.

Intervention:

Proton radiotherapy.

Main Outcome Measures:

Tumor control was defined as not requiring salvage treatment. Progressive hearing loss was defined as a decrease in maximum speech discrimination score below the 95% critical difference in reference to the pretreatment score. Hearing assessment includes contralateral hearing and duration of follow-up. Dizziness and/or unsteadiness and facial and trigeminal nerve function were scored. Patients who had surgery prior to proton radiotherapy were separately assessed.

Results:

Of 221 included patients, 136 received single fraction and 85 fractionated proton radiotherapy. Actuarial 5-year local control rate was 96% (95% CI 90–98%). The median radiological follow-up was 4.5 years. Progressive postirradiation speech discrimination score loss occurred in 42% of patients with audiometric follow-up within a year. Facial paresis was found in 5% (usually mild), severe dizziness in 5%, and trigeminal neuralgia in 5% of patients receiving protons as primary treatment.

Conclusions:

Proton radiotherapy achieves high tumor control with modest side effects aside from hearing loss in vestibular schwannoma patients. Limited and heterogeneous outcome reporting hamper comparisons to the literature. Potential sequelae of radiation therapy impacting vestibular function, cognitive function, and quality of life warrant further evaluation. Subgroups that benefit most from proton radiotherapy should be identified to optimize allocation and counterbalance its costs.
Correlation Between Cochlear Length, Insertion Angle, and Tonotopic Mismatch for MED-EL FLEX28 Electrode Arrays
Authors: Dutrieux Noémie , Quatre Raphaële , Péan Vincent , Schmerber Sébastien
Published: September 2021

Objective:

To investigate the relationship between cochlear length, insertion angle, and tonotopic mismatch and to compare the tonotopic mismatches with respect to the spiral ganglion and the organ of Corti.

Study Design:

Retrospective.

Setting:

Tertiary referral center with cochlear implant program.

Patients:

Analyses of patients’ computed tomography images after cochlear implant surgery.

Intervention:

Cochlear implantation with 28-mm-long straight lateral wall electrode arrays.

Main Outcome Measure:

Cochlear length, insertion angle, and insertion depth were assessed using the OTOPLAN software. Tonotopic mismatch for each electrode contact was estimated using the Greenwood (organ of Corti) and the Stakhovskaya (spiral ganglion) maps and compared.

Results:

106 cochleae were analyzed. 99% of the electrode arrays were located in the tympanic ramp. The insertion was complete in 96% of cases. The mean cochlear length was 34.5 mm and the mean insertion angle of the apical electrode was 545°. Cochlear length was negatively correlated with the insertion angle of the contacts E1 to E9 (all p < 0.004). The tonotopic mismatch was greater at the organ of Corti than at the spiral ganglion. It was also greater at the organ of Corti in larger cochleae (correlation with mismatch for E1 r = 0.421, p < 0.0001) and in the apical than in the middle and basal regions of the cochlea.

Conclusion:

Small cochlea size corresponded to higher insertion angle and reduction of tonotopic mismatch on a 28-mm-long straight lateral wall electrode array. Tonotopic mismatch could be minimized preoperatively by choosing electrode arrays according to the individual cochlear morphology and postoperatively by appropriate frequency fitting.
Hearing Loss and Incident Dementia: Claims Data From the New York SPARCS Database
Authors: Chern Alexander , Sharma Rahul K. , Golub Justin S.
Published: September 2021

Objective:

Age-related hearing loss (HL) may be a risk factor for incident dementia. The objective was to use population-based claims data from the New York Statewide Planning and Research Cooperative System (SPARCS) to establish if HL is associated with incident dementia.

Study Design:

Retrospective cohort study.

Setting:

Comprehensive all-payer data reporting system (2007–2017).

Patients:

Two hundred six thousand eight hundred one subjects more than 60 years (56,523 with HL, random sample of 150,278 without HL).

Interventions:

None.

Main Outcome Measures:

The main outcome was incident dementia, measured by initial dementia diagnosis (ICD-9/ICD-10 code) associated with a patient visit/insurance claim. The main exposure was HL, measured by at least two separate HL diagnoses associated with claims before dementia diagnosis. Cox proportional-hazards models were used to examine the relationship of baseline HL with incident dementia, adjusting for age, sex, cardiovascular disease, cerebrovascular disease, diabetes, and smoking.

Results:

Dementia incidence rates per 1,000 person-years were 10.16 (95% confidence interval [CI] = 9.81–10.51; subjects with HL) and 5.43 (5.28–5.57; subjects without HL). Fewer (2–10) HL claims (n = 56,523), compared with no (0) HL claims, was associated with 1.10 (95% CI = 1.05–1.15, p < 0.001) times the hazard of incident dementia, adjusting for covariates. Greater (>10) HL claims (n = 3,414), compared with no (0) HL claims, was associated with 1.63 (95% CI = 1.42, 1.86, p < 0.001) times the hazard of incident dementia, adjusting for covariates.

Conclusions:

HL diagnosis was associated with increased risk of incident dementia based on a comprehensive all-payer data reporting system. Individuals with a more established diagnosis of HL (more HL claims) demonstrated an increased hazard ratio.
Audiological Features in 63 Patients With Cochlear Nerve Deficiency
Authors: Matsuura Kazuki , Yoshimura Hidekane , Shinagawa Jun , Kurozumi Masahiro , Takumi Yutaka
Published: September 2021

Objective:

We aimed to investigate the clinical features of cochlear nerve deficiency (CND), and in particular, the long-term course of hearing disability and audiogram shapes.

Study Design:

Retrospective observational nonrandomized group study.

Setting:

Academic medical center.

Patients/Interventions:

The subjects were 63 children with congenital hearing loss who visited our hospital between 2009 and 2019 and underwent MRI, based on which they were diagnosed with CND. There were 61 cases of unilateral CND and two cases of bilateral CND.

Main Outcome Measures:

Imaging tests by MRI and CT and audiometric assessments by pure-tone audiometry and distortion product otoacoustic emission were performed.

Results:

Among the cases of CND diagnosed by assessing the cochlear nerve on MRI, approximately 20% of the bony cochlear nerve canals that could be assessed on CT were normal. Of the 61 cases diagnosed with unilateral CND, 55 cases had cochlear nerve aplasia (90.2%), and six had cochlear nerve hypoplasia (9.8%), with a mean hearing ability of 92.2 and 94.6 dB HL, respectively. Thus, the majority of cases had severe-to-profound hearing loss. The overall audiometric patterns were 78.7% flat, 9.8% cookie-bite, and 9.8% high-frequency. Six of 61 cases (9.8%) had a distortion product otoacoustic emission (DPOAE) response based on the affected side, and none of the cases lost the response during follow-up.

Conclusions:

Herein, we report the largest study on CND and performed CND image and audiometric assessments. Accurately in diagnosing CND requires not only CT but also MRI assessment. Hearing loss is often severe to profound; however, various audiometric patterns have been observed. CND includes a small number of cases that respond to DPOAE, indicating that some CND cases are clinically diagnosed with auditory neuropathy spectrum disorder (ANSD). A sustained DPOAE response might help in differentiating CND from other ANSDs. Children with congenital deafness who have passed the newborn hearing screening by DPOAE should be examined by MRI to rule out CND.