bluuebunny/crossref_metadata_2025 huggingface dataset:
Refugees or Illegal Immigrants: The Problem of the Group in Refugee Protection
Authors: Innes Alexandria J
Published: September 2021

This research excavates the case of Jewish refugees in Cyprus between 1946 and 1948. I argue that this case is formative of the development not just of the refugee, but—perhaps more interestingly—of the concept of “illegal immigration,” which relies on the constructed impossibility of group-based refugee protection. I contend that there is a paradox residing at the heart of the 1951 Refugee Convention definition of a refugee that produces the refugee as a singular victim while supporting the very conditions that create that victimhood—that is, persecution targeted at an identity group where the persecution is motivated by the shared identity (defined in the Refugee Convention by race, religion, nationality, membership of a particular social group, or political opinion). As the architecture of international human rights was built, the refugee definition was drafted in a way that embedded group-based exclusion in the design of the definition. I exemplify this through the case of Jewish refugees attempting to reach British Mandate Palestine in the 1940s, who were intercepted and detained in Cyprus. The case is worthy of attention because it exposes the absence of group protection in the refugee definition and the effect of that absence: a group is constituted as a threat and cannot be defined collectively as refugees. Instead, they become “illegal immigrants.” This case study of Jewish detention in Cyprus provides a key empirical example of oppression residing inside a historically liberal movement and in the resulting conditions of refugee protection.
Drilling Down in Norm Diffusion: Norm Domestication, “Glocal” Power, and Community-Based Organizations in Global Health
Authors: Restoy Enrique , Elbe Stefan
Published: September 2021

Norm diffusion scholarship analyzes how states come to agree and adopt new international norms. Yet, formal adoption of a new norm does not in itself guarantee that a government will also implement it domestically, and very little international relations scholarship drills down deep enough to examine whether and how new international norms are subsequently integrated, incorporated, and translated at sub-state level. This article initiates a research agenda on norm “domestication” through the first in-depth study of how international norms in the field of global health are locally incorporated by community-based organizations (CBOs). Drawing upon multi-sited international fieldwork in Uganda, Ukraine, and El Salvador, the paper uncovers three norm domestication strategies used by CBOs of people affected by HIV/AIDS: harnessing political divisions within national governments, circumventing government policy with international help, and mounting legal challenges to government policy. The article argues that these CBO strategies represent “glocal” forms of power capable of forging local–global connections through combined practices of norm allying, norm implementation, and norm intertwining. These subtler processes of norm domestication, the article concludes, ultimately require a reconceptualization of norm diffusion not just as a transnational phenomenon, but as a “multi-local” process during which norms are concurrently localized across diverse geographic locales.
Levofloxacin pharmacodynamics against Stenotrophomonas maltophilia in a neutropenic murine thigh infection model: implications for susceptibility breakpoint revision
Authors: Fratoni Andrew J , Nicolau David P , Kuti Joseph L
Published: September 2021

Background

Levofloxacin displays in vitro activity against Stenotrophomonas maltophilia (STM); however, current susceptibility breakpoints are supported by limited data. We employed the murine neutropenic thigh infection model to assess levofloxacin pharmacodynamics against STM.

Methods

Twenty-six clinical STM were studied using the neutropenic murine thigh infection model. Human simulated regimens (HSR) of levofloxacin 750 mg q24h were administered over 24 h. Efficacy was measured as the change in log10 cfu/thigh at 24 h compared with 0 h. Composite cfu data were fitted to an Emax model to determine the fAUC/MIC needed for stasis and 1 log10 reduction at 24 h. Monte Carlo simulation was performed to determine PTA.

Results

Levofloxacin MICs ranged from 0.5–8 mg/L. Mean bacterial burden at 0 h was 6.21 ± 0.20 log10 cfu/thigh. In the 24 h controls, bacterial growth was 1.64 ± 0.66 log10 cfu/thigh. In isolates with levofloxacin MICs ≤1, 2 and ≥4 mg/L, changes in bacterial density following levofloxacin HSR were −1.66 ± 0.89, 0.13 ± 0.97 and 1.54 ± 0.43 log10 cfu/thigh, respectively. The Emax model demonstrated strong agreement between fAUC/MIC and change in bacterial density (R2 = 0.82). The fAUC/MIC exposure needed for stasis and 1 log10 reduction was 39.9 and 54.9, respectively. PTAs for the 1 log10 reduction threshold were 95.8, 72.2, and 26.6% at MICs of 0.5, 1 and 2 mg/L, respectively.

Conclusions

These are the first data to describe fAUC/MIC thresholds predictive of cfu reductions for levofloxacin against STM. Due to poor in vivo efficacy and PTA at MICs ≥2 mg/L, reassessment of the current susceptibility breakpoint is warranted.
Gastric acid suppression, lifestyle factors and intestinal carriage of ESBL and carbapenemase-producing Enterobacterales: a nationwide population-based study
Authors: Willems Roel P J , van Dijk Karin , Dierikx Cindy M , Twisk Jos W R , van der Klis Fiona R M , de Greeff Sabine C , Vandenbroucke-Grauls Christina M J E
Published: September 2021

Background

Gastric acid-suppressive therapy has been suggested to increase the risk for intestinal carriage of MDR Enterobacterales, but there is scarce community-based evidence substantiating this risk.

Objectives

To investigate if acid-suppressant use is associated with a risk of intestinal carriage of ESBL and carbapenemase-producing Enterobacterales (ESBL-E) in the open population, and to assess possible modifying factors.

Methods

Within the framework of a nationwide seroprevalence study, we identified a population-based cross-sectional cohort comprising 2746 adults (≥18 years), who provided stool specimens between February 2016 and June 2017. Specimens were tested by phenotypic assays and confirmatory genotype analysis to detect carriage of ESBL-E. Covariate data were extracted from self-administered questionnaires. ORs and 95% CIs were estimated using multivariable multilevel logistic regression, controlling for confounders informed by directed acyclic graphs.

Results

Among 2746 participants, 316 (11.5%) used acid suppressants; the prevalence of ESBL-E carriage was 7.4% (95% CI, 6.1%–8.6%). Current use of acid suppressants was not associated with ESBL-E carriage (adjusted OR [aOR], 1.05; 95% CI, 0.64–1.74); lifestyle and comorbidity did not modify this association. A higher BMI (≥25 kg/m2) (aOR, 1.42 [95% CI, 1.02–1.98]), non-Western ethnic origin (aOR, 1.96 [95% CI, 1.34–2.87]), travel to Eastern-Mediterranean, Western-Pacific or South-East Asia regions (aOR, 3.16 [95% CI, 1.71–5.83]) were associated with ESBL-E carriage. Sensitivity analyses confirmed these results; spline analysis supported a BMI-associated risk.

Conclusions

In this open population study, current use of acid suppressants was not associated with ESBL-E carriage. Travel to high-endemic regions and non-Western ethnicity were confirmed as risk factors, while a higher BMI emerged as a potential new risk for ESBL-E carriage.
Outcome selection in primary care antimicrobial stewardship research
Authors: Gágyor Ildikó , Hay Alastair D
Published: September 2021

Clinical and antimicrobial stewardship (AMS) outcomes are highly relevant to pragmatic primary care trials, reflecting aspects, such as persistent symptoms and relapses, or antibiotic use and antimicrobial resistance. Sometimes both can be equally important. We present evidence demonstrating the wide range of outcome measures used in previous primary care trials and observe that there are no agreed standards for their design. We describe AMS interventions and outcomes in terms of intervention types and targets, and we make recommendations for future research designs. Specifically, we argue that: (i) where co-primary outcomes are considered appropriate, investigators should pre-specify interpretation of conflicting results; (ii) intervention evaluation should ensure prescriptions from sources outside of the usual provider are included in any AMS effectiveness measure; (iii) where possible, outcomes should include antimicrobial resistance; (iv) in some contexts, it may be necessary to include the antibiotics used within the intervention as part of the outcome; and (v) patient involvement is needed to establish the principles investigators should use when deciding whether the AMS or clinical outcomes should be prioritized.
Compliance with the 4Ds of antimicrobial stewardship practice in a tertiary care centre
Authors: Dixit Diksha , Ranka Rajat , Panda Prasan Kumar
Published: September 2021

Background

Antimicrobial stewardship describes the practice of promoting the selection of the right drug, dosage, delivery and duration of antimicrobial therapy (the 4Ds) in order to curtail the emergence of resistant organisms. It is important to quantify the inappropriate use of antimicrobials in terms of percentage adherence to each of the 4Ds mentioned.

Methods

We undertook a prospective review of medical records of patients admitted to the medical wards of a tertiary care centre in North India. All patients on antimicrobials were included and their records reviewed for indication, drug, dose, delivery and duration (or by asking the treating physician if not documented). Adherence to the 4Ds was determined by referring to updated literature-based standard treatment guidelines (STGs) for each specific disease.

Results

Of 304 patients, drugs were appropriate and matched STGs in 218 (72%) patients, with adherence to the right dose in 210 (69%), route of delivery in 216 (71%) and duration in 197 (65%). Full adherence to the 4Ds was observed in 196 (64.5%). Maximum adherence was observed in treating skin and soft tissue infections (100%), while minimum adherence was observed in administering medical prophylaxis (40%). WHO Access, Watch and Reserve categories comprised 29%, 63% and 8.5% of all prescribed antibiotics, respectively.

Conclusions

The right drug, dose, delivery and duration of therapy are prescribed in 72%, 69%, 71%, and 65% of patients, respectively. In order to increase the adherence to 100%, bedside stewardship practices in the form of prospective audits and feedback must be improved. There is a need to integrate WHO AWaRe classification of antibiotics into treatment guidelines.
Autoimmune Encephalitis and Autoantibodies: A Review of Clinical Implications
Authors: Hébert Julien , Muccilli Alexandra , Wennberg Richard A , Tang-Wai David F
Published: September 2021

Background

Autoimmune encephalitis (AE) is a common cause of encephalitis. We review the most recent evidence on this neuroimmune condition and autoantibody testing currently available.

Content

Clinical criteria, neuroimaging and electroencephalography can facilitate the diagnosis of AE prior to obtaining autoantibody testing results, and lead to a diagnosis of AE even in the absence of a recognized antibody. Early treatment of AE has been found to correlate with improved long-term functional and cognitive outcomes. We suggest a clinical approach to diagnosis based on the predominant area of nervous system involvement and the results of ancillary testing that are widely available. We also propose a 2-tiered approach to the acute management of probable or definite AE. We, finally, provide guidance on the long-term management of AE—a challenging and understudied area.

Much work remains to be done to improve the care of patients with AE. As understanding of the pathophysiology and predisposing factors underlying this condition steadily increases, a more evidence-based, targeted approach to the treatment of AE is still desired. Nonetheless, looking at the progress made over the past 2 decades, since the discovery of the first autoantibodies associated with AE, one cannot help but feel optimistic about the road ahead.
Toward an inclusive digital health system for sexual and gender minorities in Canada
Authors: Antonio Marcy , Lau Francis , Davison Kelly , Devor Aaron , Queen Roz , Courtney Karen
Published: September 2021

Most digital health systems (DHS) are unable to capture gender, sex, and sexual orientation (GSSO) data beyond a single binary attribute with female and male options. This binary system discourages access to preventative screening and gender-affirming care for sexual and gender minority (SGM) people. We conducted this 1-year multi-method project and cocreated an action plan to modernize GSSO information practices in Canadian DHS. The proposed actions are to: (1) Envisage an equity- and SGM-oriented health system; (2) Engage communities and organizations to modernize GSSO information practices in DHS; (3) Establish an inclusive GSSO terminology; (4) Enable DHS to collect, use, exchange, and reuse standardized GSSO data; (5) Integrate GSSO data collection and use within organizations; (6) Educate staff to provide culturally competent care and inform patients on the need for GSSO data; and (7) Establish a central hub to coordinate efforts.
ATLAS: an automated association test using probabilistically linked health records with application to genetic studies
Authors: Zhang Harrison G , Hejblum Boris P , Weber Griffin M , Palmer Nathan P , Churchill Susanne E , Szolovits Peter , Murphy Shawn N , Liao Katherine P , Kohane Isaac S , Cai Tianxi
Published: September 2021

Objective

Large amounts of health data are becoming available for biomedical research. Synthesizing information across databases may capture more comprehensive pictures of patient health and enable novel research studies. When no gold standard mappings between patient records are available, researchers may probabilistically link records from separate databases and analyze the linked data. However, previous linked data inference methods are constrained to certain linkage settings and exhibit low power. Here, we present ATLAS, an automated, flexible, and robust association testing algorithm for probabilistically linked data.

Materials and Methods

Missing variables are imputed at various thresholds using a weighted average method that propagates uncertainty from probabilistic linkage. Next, estimated effect sizes are obtained using a generalized linear model. ATLAS then conducts the threshold combination test by optimally combining P values obtained from data imputed at varying thresholds using Fisher’s method and perturbation resampling.

Results

In simulations, ATLAS controls for type I error and exhibits high power compared to previous methods. In a real-world genetic association study, meta-analysis of ATLAS-enabled analyses on a linked cohort with analyses using an existing cohort yielded additional significant associations between rheumatoid arthritis genetic risk score and laboratory biomarkers.

Discussion

Weighted average imputation weathers false matches and increases contribution of true matches to mitigate linkage error-induced bias. The threshold combination test avoids arbitrarily choosing a threshold to rule a match, thus automating linked data-enabled analyses and preserving power.

Conclusion

ATLAS promises to enable novel and powerful research studies using linked data to capitalize on all available data sources.
It’s like sending a message in a bottle: A qualitative study of the consequences of one-way communication technologies in hospitals
Authors: Lafferty Megan , Harrod Molly , Krein Sarah , Manojlovich Milisa
Published: September 2021

Objective

We examine how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds.

Materials and Methods

We conducted a qualitative study at 4 U.S. hospitals during 2017. Researchers spent 2 weeks at each hospital conducting unit-based observation, shadowing, interviews, and focus groups with nurses and physicians. Using an iterative process, we inductively coded and thematically analyzed data to derive preliminary themes. The theory of workarounds provides an organizational lens on workarounds, consisting of 5 components: antecedents, types, effects, managerial stance, and organizational challenges of workarounds. The first 3 components of the theory helped us to organize and explain our findings.

Results

Communication technologies consisted of pagers and telephones. Antecedents to workarounds included one-way information flow, differential access related to differences in technology types, and technology mismatch. Types of workarounds included bypassing a variety of obstacles and substituting for unavailable resources. Direct effects of workarounds included pager fatigue, interruptions in patient care, and potential errors.

Discussion

One-way communication technologies created an environment where workarounds could flourish. By placing results within the context of the theory of workarounds, we extend what we know about why and how workarounds develop, and offer strategies to minimize workarounds’ adverse effects.

Conclusions

Through the theory of workarounds, we see that there is a trajectory to workarounds with potential consequences for clinicians and patients. Two-way communication technologies could minimize workarounds and gaps in information exchange, and reduce unnecessary interruptions and the potential for adverse events.
Guidance for publishing qualitative research in informatics
Authors: Ancker Jessica S , Benda Natalie C , Reddy Madhu , Unertl Kim M , Veinot Tiffany
Published: September 2021

Qualitative research, the analysis of nonquantitative and nonquantifiable data through methods such as interviews and observation, is integral to the field of biomedical and health informatics. To demonstrate the integrity and quality of their qualitative research, authors should report important elements of their work. This perspective article offers guidance about reporting components of the research, including theory, the research question, sampling, data collection methods, data analysis, results, and discussion. Addressing these points in the paper assists peer reviewers and readers in assessing the rigor of the work and its contribution to the literature. Clearer and more detailed reporting will ensure that qualitative research will continue to be published in informatics, helping researchers disseminate their understanding of people, organizations, context, and sociotechnical relationships as they relate to biomedical and health data.
Gender harmony: improved standards to support affirmative care of gender-marginalized people through inclusive gender and sex representation
Authors: McClure Robert C , Macumber Caroline L , Kronk Clair , Grasso Chris , Horn Robert J , Queen Roz , Posnack Steven , Davison Kelly
Published: September 2021

Objective

Accurate representation of clinical sex and gender identity in interoperable clinical systems is a major challenge for organizations intent on improving outcomes for sex- and gender-marginalized people. Improved data collection has been hindered by the historical approach that presumed a single, often binary, datum was sufficient. We describe the Health Level Seven International (HL7) Gender Harmony logical model that proposes an improved approach.

Materials and Methods

The proposed solution was developed via an American National Standards Institute (ANSI)-certified collaborative balloted process. As an HL7 Informative Document, it is an HL7 International-balloted consensus on the subject of representing sex and representing gender in clinical systems based on work of the gender harmony project led by the HL7 Vocabulary Work Group.

Results

The Gender Harmony Model is a logical model that provides a standardized approach that is both backwards-compatible and an improvement to the meaningful capture of gender identity, recorded sex or recorded gender, a sex for clinical use, the name to use, and pronouns that are affirmative and inclusive of gender-marginalized people.

Conclusion

Most clinical systems and current standards in health care do not meaningfully address, nor do they consistently represent, sex and gender diversity, which has impeded interoperability and led to suboptimal health care. The Gender Harmony Project was formed to create more inclusive health information exchange standards to enable a safer, higher-quality, and embracing healthcare experience. The Gender Harmony Model provides the informative guidance for standards developers to implement a more thorough technical design that improves the narrow binary design used in many legacy clinical systems.
Systematic review of prediction models for postacute care destination decision-making
Authors: Kennedy Erin E , Bowles Kathryn H , Aryal Subhash
Published: September 2021

Objective

This article reports a systematic review of studies containing development and validation of models predicting postacute care destination after adult inpatient hospitalization, summarizes clinical populations and variables, evaluates model performance, assesses risk of bias and applicability, and makes recommendations to reduce bias in future models.

Materials and Methods

A systematic literature review was conducted following PRISMA guidelines and the Cochrane Prognosis Methods Group criteria. Online databases were searched in June 2020 to identify all published studies in this area. Data were extracted based on the CHARMS checklist, and studies were evaluated based on predictor variables, validation, performance in validation, risk of bias, and applicability using the Prediction Model Risk of Bias Assessment Tool (PROBAST) tool.

Results

The final sample contained 28 articles with 35 models for evaluation. Models focused on surgical (22), medical (5), or both (8) populations. Eighteen models were internally validated, 10 were externally validated, and 7 models underwent both types. Model performance varied within and across populations. Most models used retrospective data, the median number of predictors was 8.5, and most models demonstrated risk of bias.

Discussion and Conclusion

Prediction modeling studies for postacute care destinations are becoming more prolific in the literature, but model development and validation strategies are inconsistent, and performance is variable. Most models are developed using regression, but machine learning methods are increasing in frequency. Future studies should ensure the rigorous variable selection and follow TRIPOD guidelines. Only 14% of the models have been tested or implemented beyond original studies, so translation into practice requires further investigation.
Transphobia, encoded: an examination of trans-specific terminology in SNOMED CT and ICD-10-CM
Authors: Ram A , Kronk Clair A , Eleazer Jacob R , Goulet Joseph L , Brandt Cynthia A , Wang Karen H
Published: September 2021

Transgender people experience harassment, denial of services, and physical assault during healthcare visits. Electronic health record (EHR) structure and language can exacerbate the harm they experience by using transphobic terminology, emphasizing binary genders, and pathologizing transness. Here, we investigate the ways in which SNOMED CT and ICD-10-CM record gender-related terminology and explore their shortcomings as they contribute to this EHR-mediated violence. We discuss how this “standardized” gender-related medical terminology pathologizes transness, fails to accommodate nonbinary patients, and uses derogatory and outmoded language. We conclude that there is no easy fix to the transphobia beleaguering healthcare, provide options to reduce harm to patients, and ultimately call for a critical examination of medicine’s role in transphobia. We aim to demonstrate the ways in which the [mis]use and [mis]understanding of gender-specific terminology in healthcare settings has harmed and continues to harm trans people by grounding our discussion in our personal experiences.
Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory
Authors: Richesson Rachel L , Marsolo Keith S , Douthit Brian J , Staman Karen , Ho P Michael , Dailey Dana , Boyd Andrew D , McTigue Kathleen M , Ezenwa Miriam O , Schlaeger Judith M , Patil Crystal L , Faurot Keturah R , Tuzzio Leah , Larson Eric B , O’Brien Emily C , Zigler Christina K , Lakin Joshua R , Pressman Alice R , Braciszewski Jordan M , Grudzen Corita , Fiol Guilherme Del
Published: September 2021

Objective

We identified challenges and solutions to using electronic health record (EHR) systems for the design and conduct of pragmatic research.

Materials and Methods

Since 2012, the Health Care Systems Research Collaboratory has served as the resource coordinating center for 21 pragmatic clinical trial demonstration projects. The EHR Core working group invited these demonstration projects to complete a written semistructured survey and used an inductive approach to review responses and identify EHR-related challenges and suggested EHR enhancements.

Results

We received survey responses from 20 projects and identified 21 challenges that fell into 6 broad themes: (1) inadequate collection of patient-reported outcome data, (2) lack of structured data collection, (3) data standardization, (4) resources to support customization of EHRs, (5) difficulties aggregating data across sites, and (6) accessing EHR data.

Discussion

Based on these findings, we formulated 6 prerequisites for PCTs that would enable the conduct of pragmatic research: (1) integrate the collection of patient-centered data into EHR systems, (2) facilitate structured research data collection by leveraging standard EHR functions, usable interfaces, and standard workflows, (3) support the creation of high-quality research data by using standards, (4) ensure adequate IT staff to support embedded research, (5) create aggregate, multidata type resources for multisite trials, and (6) create re-usable and automated queries.

Conclusion

We are hopeful our collection of specific EHR challenges and research needs will drive health system leaders, policymakers, and EHR designers to support these suggestions to improve our national capacity for generating real-world evidence.
Learning from Law Enforcement
Authors: Dušek Libor , Traxler Christian
Published: September 2021

This paper studies how punishment affects future compliance behavior and isolates deterrence effects mediated by learning. Using administrative data from speed cameras that capture the full driving histories of more than a million cars over several years, we evaluate responses to punishment at the extensive (receiving a speeding ticket) and intensive margins (tickets with higher fines). Two complementary empirical strategies—a regression discontinuity design and an event study—coherently document strong responses to receiving a ticket: The speeding rate drops by a third and re-offense rates fall by 70%. Higher fines produce a small but imprecisely estimated additional effect. All responses occur immediately and are persistent over time, with no backsliding toward speeding even two years after receiving a ticket. Our evidence rejects unlearning and temporary salience effects. Instead, it supports a learning model in which agents update their priors on the expected punishment in a coarse manner.
Social Effects on Annual Fitness in Red Squirrels
Authors: McAdam Andrew G , Webber Quinn M R , Dantzer Ben , Lane Jeffrey E , Boutin Stan
Published: September 2021

When resources are limited, mean fitness is constrained and competition can cause genes and phenotypes to enhance an individual’s own fitness while reducing the fitness of their competitors. Negative social effects on fitness have the potential to constrain adaptation, but the interplay between ecological opportunity and social constraints on adaptation remains poorly studied in nature. Here, we tested for evidence of phenotypic social effects on annual fitness (survival and reproductive success) in a long-term study of wild North American red squirrels (Tamiasciurus hudsonicus) under conditions of both resource limitation and super-abundant food resources. When resources were limited, populations remained stable or declined, and there were strong negative social effects on annual survival and reproductive success. That is, mean fitness was constrained and individuals had lower fitness when other nearby individuals had higher fitness. In contrast, when food resources were super-abundant, populations grew and social constraints on reproductive success were greatly reduced or eliminated. Unlike reproductive success, social constraints on survival were not significantly reduced when food resources were super-abundant. These findings suggest resource-dependent social constraints on a component of fitness, which have important potential implications for evolution and adaptation.
Algorithmic correspondence for hybrid logic with binder
Authors: Zhao Zhiguang
Published: September 2021

In the present paper, we develop the algorithmic correspondence theory for hybrid logic with binder $\mathcal {H}(@, \downarrow )$. We define the class of Sahlqvist inequalities for $\mathcal {H}(@, \downarrow )$, and each inequality of which is shown to have a first-order frame correspondent effectively computable by an algorithm $\textsf {ALBA}^{\downarrow }$.
Clinicopathological features and oncological outcomes of urothelial carcinoma involving the ureterovesical junction
Authors: Oshina Takahiro , Taguchi Satoru , Miyakawa Jimpei , Akiyama Yoshiyuki , Sato Yusuke , Kawai Taketo , Fukuhara Hiroshi , Nakagawa Tohru , Kume Haruki
Published: September 2021

Background

The ureterovesical junction is the boundary between the urinary bladder and upper urinary tract. Because treatment strategies for bladder cancer and upper tract urothelial carcinoma are entirely different, urothelial carcinoma involving the ureterovesical junction requires special attention. Nevertheless, studies focusing on the disease are lacking.

Methods

We reviewed consecutive patients with urothelial carcinoma treated via either transurethral resection of bladder tumor (n = 2791) or radical nephroureterectomy (n = 292) between 2000 and 2020 and identified those with bladder cancer involving the ureteral orifice (n = 64) and those with upper tract urothelial carcinoma involving the intramural ureter (≤2 cm) (n = 41). After excluding overlapping cases (n = 24), 80 patients with urothelial carcinoma involving the ureterovesical junction were analyzed.

Results

The initial symptoms or reasons for diagnosing urothelial carcinoma involving the ureterovesical junction were hematuria (n = 30), hydronephrosis (n = 21), follow-up examinations for prior urothelial carcinoma (n = 13), screening examinations (n = 7), frequent urination (n = 6) and unknown causes (n = 3). During a median follow-up period of 42 months, 18 patients died of urothelial carcinoma. The definitive surgical treatments for urothelial carcinoma involving the ureterovesical junction were transurethral resection of bladder tumor alone (n = 26), radical nephroureterectomy (n = 41) and radical cystectomy (n = 13), with different treatments having different cancer-specific survivals. Multivariate analyses identified T stage (≥T2) as an independent predictor of shorter cancer-specific survival.

Conclusions

Given the positional property of urothelial carcinoma involving the ureterovesical junction, the profiles of patients with the disease were highly heterogeneous. Further optimization of treatment strategies for urothelial carcinoma involving the ureterovesical junction is urgently warranted for better clinical outcomes.
Ki-67 index of 5% could better predict the clinical prognosis of well-differentiated pancreatic neuroendocrine tumours
Authors: Yuan Bing , Shi Yanfen , Li Yuanliang , Tan Haidong , Jiao Peipei , Su Wenting , Liu Meng , Qi Zhirong , Tan Huangying , Luo Jie
Published: September 2021

Background

The pathological classification of well-differentiated pancreatic neuroendocrine tumour (pNET) is based largely upon Ki-67 index. However, current controversies abound about the classification of pNETG1/pNETG2.

Patients and methods

Clinicopathological data were retrospectively analysed for 153 pNETG1/pNETG2 patients hospitalized at China-Japan Friendship Hospital. The critical values of pNETG1/pNETG2 were examined by using the area under the receiver operating characteristic curve and survival analysis was used to compare the clinical prognosis of pNETG1/G2.

Results

Among them, 52.3% were males. The median age was 49 (18–81) years and the clinical types were pNETG1 (n = 38) and pNETG2 (n = 115). According to the receiver operating characteristic curve, the optimal cut-off value was 5.5% for classifying pNETG1/pNETG2. Significant differences between pNETG1 (n = 101) and pNETG2 (n = 52) existed in overall survival (P = 0.001) and disease-free survival (P = 0.013) when Ki-67 index was 5%. Yet no significant differences existed in overall survival (P = 0.378) or disease-free survival (P = 0.091) between pNETG1 and pNETG2 when Ki-67 index was 3%. Furthermore, multivariate analysis indicated that the revised pathological grade was an independent risk factor for mortality and post-operative recurrence of pNET patients (P = 0.003 and 0.014; hazard ratio (HR) = 4.005 and 2.553).

Conclusion

Thus, differentiating pNETG1/pNETG2 with Ki-67 index (5%) is proposed as the cut-off value and a new Ki-67 index (5%) is a better predictor of pNET mortality and post-operative recurrence than Ki-67 index (3%).
Trends in diagnostic and therapeutic strategies for extra-abdominal desmoid-type fibromatosis: Japanese musculoskeletal oncology group questionnaire survey
Authors: Murase Fuminori , Nishida Yoshihiro , Hamada Shunsuke , Sakai Tomohisa , Shimizu Koki , Ueda Takafumi
Published: September 2021

Objective

The mainstay of treatment modality for extra-abdominal desmoid-type fibromatosis (DF) has shifted from surgery, which often impairs ADL/QOL, to conservative treatment including active surveillance. In the present study, we conducted a longitudinal survey on the diagnosis and treatment of DF at facilities belonging to the Japanese Musculoskeletal Oncology Group, which is a research group of facilities specializing in the treatment of bone and soft tissue tumors in Japan to clarify the transition of medical care for extra-abdominal DF.

Methods

The same questionnaire was administered in 2015 and 2018, and responses were obtained from 46 (69%) of 67 facilities and 42 (53%) of 80 facilities in 2015 and 2018, respectively.

Results

Although immunostaining for β-catenin was often used for the pathological diagnosis in both 2015 and 2018, CTNNB1 mutation analysis was not performed either in 2015 or in 2018. As for the treatment strategy for resectable cases, surgical treatment including wide resection was selected at 11 facilities (24% of respondents) in 2015, and further decreased to 5 facilities (12%) in 2018. Conservative treatment with active surveillance or medical treatment was the most common treatment for both resectable and difficult-to-resect cases. COX-2 inhibitors and tranilast were often used in the drug treatment of both resectable and difficult-to-resect cases. Few facilities provided radiotherapy, methotrexate and vinblastine, or DOX-based chemotherapy for refractory cases in both 2015 and 2018.

Conclusions

A good trend was found in the questionnaire survey. It will be further necessary to disseminate clinical practice guidelines to physicians more widely, and to have them understand and implement the most up-to-date medical practice strategies for this rare disease.
Evaluating the legacy of multiple introductions of American martens on spatiotemporal patterns of genetic diversity
Authors: Day Casey C , Gilbert Jonathan H , Manlick Philip J , Grauer Jennifer A , Pauli Jonathan N , Scribner Kim T , Williams Bronwyn W , Zollner Patrick A
Published: September 2021

Species reintroductions are successful when established populations maintain both demographic stability and genetic diversity. Such a result may be obtained by ensuring both structural habitat connectivity and genetic connectivity among reintroduced and remnant populations. Nevertheless, prezygotic barriers such as assortative mating can prevent the flow of genetic material between populations, even when migration between populations is high. Limited gene flow may be particularly relevant for reintroductions that were sourced either from captive-bred populations or from disparate locations in the wild. American martens (Martes americana) have been reintroduced repeatedly in the Upper Midwestern United States in an effort to establish self-sustaining populations. We quantified levels of genetic diversity within and spatial genetic variance among four marten populations during two time periods separated by 10 years. Spatially informed and naïve discriminant analysis of principal components were used to assign individuals to populations. Results indicate that heterozygosity declined and inbreeding coefficients increased between the two collection periods, while genetic structure among populations also increased. Data are consistent with assortative mating contributing to reapportioning of genetic variation. Population assignment tests show that migration among populations is apparent, but admixture (based on cluster membership probabilities) is low and declined over time. Specifically, martens may be successfully dispersing between populations but a lack of admixture indicates a lack of reproductive contributions to genetic diversity by migrants. Because marten reintroductions in this region are well-documented and well-monitored, lessons can be derived from results to inform future reintroductions. We encourage a careful balance of supplementing genetic diversity via augmentation while avoiding translocation of animals from disparate populations that may result in reproductive isolation of migrants. In combination with the maintenance of a functionally connected landscape, this strategy would maximize the likelihood of a successful reintroduction in terms both of demography and genetics.
Are bat mist nets ideal for capturing bats? From ultrathin to bird nets, a field test
Authors: Ferreira Diogo F , Jarrett Crinan , Atagana Patrick Jules , Powell Luke L , Rebelo Hugo
Published: September 2021

The use of mist nets is the most widespread technique to capture bats; however, no study has compared if the type of ground-level mist net used during sampling affects bat captures. We sampled bats using three different types of mist nets that varied in mesh (16, 18, and 20 mm) and denier/ply (45/1 and 75/2) sizes over 76 half-night surveys. We used 17–20 mist nets and checked them at intervals of 15–20 min. Capture rate for echolocating bats was higher in the two mist nets with the biggest denier/ply and smaller mesh sizes. “Ultrathin bat mist nets” showed the lowest capture rates (1.5 times less than “Regular bat mist nets”), whereas “Bird mist nets” had capture rates only 1.2 times smaller than “Regular bat mist nets.” Our results showed that “Bird mist nets” can sample echolocating bats almost as well as “Regular bat mist nets,” and that thinner mist nets may not be the best solution to capture bats that echolocate at high frequencies in this type of surveys. We highlight the importance of considering the efficiency, durability, and longevity of mist nets when choosing the ideal mist-net type for a bat survey.
The ‘It’ Arbitrator: Why Do Corporations Not Act as Arbitrators?
Authors: Moreira João Ilhão , Vecellio Segate Riccardo
Published: September 2021

The international arbitrators’ service market is diverse, with arbitrators operating out of different structures, varying from multinational law firms to small arbitral boutiques. Yet, despite this heterogeneity, this market is dominated by individuals in the sense that legal persons are rarely, if ever, selected to act as arbitrators directly. Albeit the idea that an arbitrator must be a natural person appears to be deeply ingrained in the dominant understandings of arbitration, this is, in fact, an exception to the way knowledge-intensive services are usually provided. This brings to the forefront a largely unexplored topic: why legal entities are not selected as arbitrators. Through a survey of 60 jurisdictions, we explore to what extent may legal persons be appointed to act as arbitrators and conclude that stand-alone legal reasons do not fully explicate this state of affairs. Against this background, we advance a further set of explanations for relating to conflict of interest rules, insulation from civil liability, as well as the peculiar price formation and power competition dynamics within the arbitration market. Culturally and socially shaped expectations on how arbitrations should be managed play a role too.
Designing Remedies for Digital Markets: The Interplay Between Antitrust and Regulation
Authors: Lancieri Filippo , Pereira Neto Caio Mario S
Published: September 2021

Regulatory interventions aimed at promoting competition in digital markets face a challenge: How to design remedies that actually improve welfare? This article helps provide an answer to this question. First, it maps out the frontier of remedy design: Part II.A summarizes antitrust and regulatory remedies imposed on digital companies over the past decades, while Part II.B reviews nineteen reports on competition in digital markets to identify proposals to advance antitrust or regulatory interventions. Part III, the core of the article, builds on this review to propose a new, two-level framework for remedy design that integrates pro-competition antitrust and regulatory interventions as part of a single policy. First, at the substantive level, it develops a compounded error-cost framework that helps authorities to choose between different remedies applicableto a given conduct: when policymakers accept higher risks of over-enforcement in deciding to intervene, they should compensate by taking lower risks of over-enforcement in remedy design and vice-versa. Second, at the institutional level, the article proposes that authorities consider separating three connected but different key activities in remedy design: (i) identifying harmful behavior, (ii) designing interventions, and (iii) monitoring and adapting remedies. It also outlines four criteria (legal mandate, need for technical expertise, relative risks of regulatory capture, and overall administrative costs) that can help authorities allocate these tasks among different regulators. Part IV concludes by applying this framework to seven types of conduct that Part II identified as potentially problematic: (i) discrimination, unfair treatment, and self-preferencing; (ii) exclusivity contracts; (iii) tying or bundling; (iv) MFNs and other price parity clauses; (v) refusals to deal, limited interoperability, and lack of data portability; (vi) exploitative or exclusionary terms of service; and (vii) nudges, sludges, and other concerns around user interfaces.
Common Ownership Patterns in the European Banking Sector—The Impact of the Financial Crisis1
Authors: Banal-Estañol Albert , Boot Nuria , Seldeslachts Jo
Published: September 2021

We provide a description of ownership patterns in the top 25 European banks for the period 2003–2015, where we especially focus on the global financial crisis. Investment managers, such as Blackrock, are dominant in terms of number of blockholdings in different banks, maintaining fairly stable “common ownership” networks throughout our sample. However, the financial crisis led to capital injections by governments in several banks in trouble, which in turn led to a jump in holdings by governments, which typically are “non-common owners” (i.e., they hold only shares in only one bank). This jump translated into these investors temporarily being the top investor with a large share, and non-common owners being the majority among large shareholders. A brief comparison with US banks uncovers large ownership differences between the European and US banking sectors. We briefly discuss what these ownership patterns might imply for competition, stability and performance in the banking industry.
Notes on Iterated Rationality Models of Scalar Implicatures
Authors: Fox Danny , Katzir Roni
Published: September 2021

In the linguistics literature, the derivation of scalar implicatures has often been handled in a relatively modular way, using computations that are sensitive to logical relations among alternatives such as entailment but are blind to other notions such as the probabilities that participants in a conversation might associate with these alternatives (or with related propositions). In recent years, a family of models that we refer to as iterated rationality models (IRMs) have offered an interestingly different perspective on such alternative-sensitive processes in terms of multiple iterations of (typically probabilistic) reasoning. Our paper investigates what at first sight seems like a very interesting argument for the adequacy of IRMs as models of scalar implicatures, coming from the conjunctive interpretation of disjunctive sentences. We then outline challenges for the argument based on a theoretical comparison with the grammatical theory of scalar implicatures. The comparison focuses on the full distribution of conjunctive interpretation, on the question of sensitivity to priors, and on other results achieved within the grammatical theory that the IRM literature has yet to engage with.
Psychometric Properties of the Hypoglycemia Fear Survey in a Clinical Sample of Adolescents with Type 1 Diabetes and Their Caregivers
Authors: O’Donnell Holly K , Bennett Johnson Suzanne , Sileo Deseray , Majidi Shideh , Gonder-Frederick Linda , Driscoll Kimberly A
Published: September 2021

Objective

A previously published exploratory factor analysis suggested that the Hypoglycemia Fear Survey—Child and Parent Versions, is comprised of three subscales: Maintain High Blood Glucose, Helplessness/Worry About Low Blood Glucose, and Worry About Negative Social Consequences. The primary aim of this study was to confirm this three-factor model with a clinical population of adolescents with type 1 diabetes (T1D) and their caregivers.

Methods

Participants included N = 1,035 youth ages 10–17.99 years with T1D, and their female (N = 835) and/or male (N = 326) caregivers who completed the Hypoglycemia Fear Survey independently during a routine medical appointment. We conducted confirmatory factor analysis and examined reliability of the Hypoglycemia Fear Survey and its associations with demographics and clinical outcomes (e.g., mean blood glucose, glycemic control).

Results

Confirmatory factor analysis supported the three-factor model in youth and female and male caregivers. The internal consistencies for Maintain High Blood Glucose, Helplessness/Worry About Low Blood Glucose, and Worry About Negative Social Consequences were acceptable. The majority of demographic and clinical outcome variables correlated as hypothesized with the three subscales.

Conclusions

Using a large clinical sample of adolescents with T1D and their caretakers, we confirmed the three-factor model for the Hypoglycemia Fear Survey, which is sufficiently reliable to be used in a clinical setting. Important areas of future research include examining moderators for the effect of fear of hypoglycemia on clinical outcomes, and possible inclusion of items related to modern diabetes devices.