bluuebunny/crossref_metadata_2025 huggingface dataset:
Delivery of cardiac resynchronization therapy via the left inferior phrenic vein: a case report
Authors: McIntosh Robert A , Ansari Mohammad I , Moon Joshua , Khan Habib R
Published: September 2019

Background

The successful implantation of cardiac resynchronization therapy (CRT) may be prevented by anatomical variations that preclude the delivery of clinically effective left ventricular (LV) pacing from within the coronary sinus (CS) or its tributaries. Failure of lead delivery, suboptimal LV capture thresholds, or intractable phrenic nerve capture with accompanying diaphragmatic twitch is often encountered. Commonly employed alternative approaches to LV lead delivery, including epicardial, trans-septal, or transapical pacing are associated with significant morbidity.

Case summary

A 74-year-old man with ischaemic heart disease, prior mitral valve repair, long-standing atrial fibrillation, and severe symptomatic LV systolic dysfunction, underwent single chamber pacemaker upgrade to a CRT defibrillator. It was found not to be possible to place a CS lead during the procedure. Biventricular pacing was accomplished by the delivery of a pacing lead through the left inferior phrenic vein (LIPV). Satisfactory LV capture thresholds were obtained with the avoidance of clinically significant diaphragmatic stimulation. Following implantation, a marked clinical response to treatment was observed with improvement in both heart failure symptoms and LV ejection fraction.

Discussion

The LIPV is known to drain into the inferior vena cava in around one-third of examined subjects. In these individuals, LV lead delivery through the LIPV may provide an alternate route for the delivery of resynchronization therapy. This approach to the implantation of CRT may be considered when pacing via the CS or its branches are not achievable.
Adaptive phenotypic plasticity in malaria parasites is not constrained by previous responses to environmental change
Authors: Birget Philip L G , Schneider Petra , O’Donnell Aidan J , Reece Sarah E
Published: September 2019

Background and objectives

Phenotypic plasticity enables organisms to maximize fitness by matching trait values to different environments. Such adaptive phenotypic plasticity is exhibited by parasites, which experience frequent environmental changes during their life cycle, between individual hosts and also in within-host conditions experienced during infections. Life history theory predicts that the evolution of adaptive phenotypic plasticity is limited by costs and constraints, but tests of these concepts are scarce.

Methodology

Here, we induce phenotypic plasticity in malaria parasites to test whether mounting a plastic response to an environmental perturbation constrains subsequent plastic responses to further environmental change. Specifically, we perturb red blood cell resource availability to induce Plasmodium chabaudi to alter the trait values of several phenotypes underpinning within-host replication and between-host transmission. We then transfer parasites to unperturbed hosts to examine whether constraints govern the parasites’ ability to alter these phenotypes in response to their new in-host environment.

Results

Parasites alter trait values in response to the within-host environment they are exposed to. We do not detect negative consequences, for within-host replication or between-host transmission, of previously mounting a plastic response to a perturbed within-host environment.

Conclusions and implications

We suggest that malaria parasites are highly plastic and adapted to adjusting their phenotypes in response to the frequent changes in the within-host conditions they experience during infections. Our findings support the growing body of evidence that medical interventions, such as anti-parasite drugs, induce plastic responses that are adaptive and can facilitate the survival and potentially, drug resistance of parasites.

Lay Summary

Malaria parasites have evolved flexible strategies to cope with the changing conditions they experience during infections. We show that using such flexible strategies does not impact upon the parasites’ ability to grow (resulting in disease symptoms) or transmit (spreading the disease).
The pathway to diagnosis and treatment for surgically managed lung cancer patients
Authors: White Victoria , Bergin Rebecca J , Thomas Robert J , Whitfield Kathryn , Weller David
Published: September 2019

Background

Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis.

Methods

Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or ‘investigation’ of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age.

Results

One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than ‘investigation’ patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant.

Conclusion

Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways.
Spatio-temporal seismic velocity variations associated to the 2016–2017 central Italy seismic sequence from noise cross-correlation
Authors: Soldati Gaia , Zaccarelli Lucia , Faenza Licia
Published: September 2019

We investigate the temporal changes of crustal velocity associated to the seismic sequence of 2016–2017, which struck central Italy with a series of moderate to large earthquakes. We cross-correlate continuous recordings of 2 yr of ambient seismic noise from a network of 28 stations within a radius of 90 km around Amatrice town. We then map the spatio-temporal evolution of the velocity perturbations under the effect of subsequent earthquakes. Coinciding with each of the three main shocks of the sequence we observe a sudden drop of seismic velocity which tends to quickly recover in the short term. After the end of the strongest activity of the sequence, the coseismic velocity changes display gradual healing towards pre-earthquake conditions following a quasi-linear trend, such that by the end of 2017 about 75 per cent of the perturbation is recovered. The spatial distribution of the velocity drop fluctuates with time, and the area that shows the most intense variations beyond the ruptured fault system elongates in the NE direction. This zone roughly corresponds to a region of foredeep sedimentary deposits consisting of highly hydrated and porous sandstones, which respond to the passage of seismic waves with increased pore pressure and crack number, leading to a reduction of the effective relative velocity.
Concentrate Questions and Answers Contract Law
Authors: Devenney James
Published: September 2019

The Concentrate Questions and Answers series offers the best preparation for tackling exam questions. Each book includes typical questions, answer plans and suggested answers, author commentary and other features. Concentrate Q&A Contract Law provides guidance on answering questions on the law of contract. The book starts with an introduction explaining how to use the book and exploring the skills necessary for success in contract law exams. The book then looks at offer and acceptance, certainty of terms, consideration and intention to create legal relations. After that it examines terms of the contract, exclusion/exemption clauses and unfair terms, misrepresentation, improper pressure, mistake and issues relating to illegality and restraint of trade. The final part of the book looks at frustration, damages, additional remedies, privity of contract and has a short section dealing with mixed questions. The book ends with a chapter containing advice on answering coursework questions.
Introduction to Competition Law
Authors: Jones Alison , Sufrin Brenda , Dunne Niamh
Published: September 2019

This chapter provides an introduction to, and basis for, the material discussed in the subsequent chapters. It introduces some relevant concepts of microeconomics including demand curves, consumer and producer surplus, elasticity of demand, and economies of scale and scope. It discusses the model of perfect competition and the concepts of allocative, productive and dynamic efficiency; the problems in competition terms of monopoly and oligopoly; and the concept of welfare, particularly consumer welfare and total welfare. It considers various schools of competition analysis and theories and concepts relevant to competition law. It discusses the possible objectives of competition law, and particularly considers what objectives are pursued by EU competition law. The chapter also looks at US antitrust law; competition law and the digital economy; competition law and regulation; and at some basic issues in the application of EU competition law.
Competition, the State, and Public Undertakings: Article 106 TFEU
Authors: Jones Alison , Sufrin Brenda , Dunne Niamh
Published: September 2019

This chapter examines how competition law applies to the actions of the State when it intervenes in the market through undertakings which it controls or owns or which it places in a privileged position. The discussion includes the principle of Union loyalty in Article 4(3) TEU; Article 106(1); Article 106(2); and the Commission’s supervisory and policing powers in Article 106(3). Article 106(1) is a prohibition addressed to Member States against enacting or maintaining in force any measure in relation to public undertakings or undertakings to which they have granted special or exclusive rights which are contrary to the Treaty rules. The chapter discusses what is meant by ‘public undertakings’ and ‘special or exclusive rights’ and examines in the light of the case law what measures are forbidden by Article 106(1), including those involving the cumulation of rights, the extension of a dominant position from one market to another, and the creation of situations of inequality of opportunity. Article 106(2) gives a limited derogation from Article 106(2) to undertakings entrusted with the operation of services of general economic interest (SGEIs). The chapter discusses the concept of ‘services of general economic interest’ and examines the cases in which the derogation has been applied or not applied, including the application of Article 106(2) to compensation for the provision of SGEIs which constitutes State aid. The chapter also considers Article 106(3) and the question of the direct effect of Article 106(1) and (2).
Public Enforcement by the Commission and the National Competition Authorities of the Antitrust Provisions
Authors: Jones Alison , Sufrin Brenda , Dunne Niamh
Published: September 2019

This chapter discusses the public enforcement regime for the application of Articles 101 and 102 under Regulation 1/2003. It explains the system that applied previously under Regulation 17, and the reasons for, and salient features of, the ‘modernisation’ introduced by Regulation 1/2003. The chapter then examines: the complaints procedure; the powers of the Commission, including the investigation and inter partes stages of its procedure; the decisions which the Commission may take, including decisions imposing fines and commitments decisions; judicial review by the EU Courts; the European Competition Network (ECN) and enforcement by national competition authorities, including the changes to be introduced by the ECN+ Directive; and the possibility of sanctions against individuals.. The chapter also considers the application of fundamental rights provisions in EU competition proceedings.
8. Contractual impossibility and risk: frustration and common mistake
Authors: Poole Jill , Devenney James , Shaw-Mellors Adam
Published: September 2019

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter examines the law’s response to events that render performance of the contract impossible for reasons beyond the control of the contracting parties, and so provide an excuse for non-performance. The default legal doctrines—common mistake (initial impossibility) and frustration (subsequent impossibility)—may come into play in instances of impossibility of performance only where there is no express or implied allocation of the risk of the event in the contract. These default doctrines determine what is to happen to the existing and future obligations of the parties.
4. Improperly obtained evidence other than confessions
Authors: Spencer Maureen , Spencer John
Published: September 2019

This chapter focuses on evidence that is relevant but improperly obtained and thus may be excluded by judicial discretion. It looks at the exclusionary discretion contained within section 78 of the UK’s Police and Criminal Evidence Act 1984 (PACE), and explains how common law and statutory exclusionary discretion may be exercised in relation to other areas of evidence, such as character evidence and hearsay evidence, other than confessions. The chapter also looks at the most common areas of exclusion, other than confession evidence, including breach or evasion of legislation such as PACE and the Codes of Practice. It also reviews when a stay of prosecution might be the appropriate procedure. Finally, it discusses the relevant principles of Article 6 of the European Convention on Human Rights (ECHR) that are enshrined in section 78 of PACE.
5. Character evidence
Authors: Spencer Maureen , Spencer John
Published: September 2019

This chapter, which focuses on the admissibility and evidential worth of character evidence, explains the definition of bad character under the Criminal Justice Act 2003. It examines how bad character evidence of the defendant may be admitted through one of the ‘gateways’ under the Act. It reviews the evidential worth of the character evidence if admitted and explains the difference between propensity and credibility. The law on the admissibility of the bad character of non-defendant witnesses is explained. The chapter concludes with the admissibility of good character evidence, governed by the common law.
8. Identification, care warnings, questioning at trial
Authors: Spencer Maureen , Spencer John
Published: September 2019

This chapter examines a number of procedural matters in criminal trials. It first explains suspect evidence and the erosion of the rules on corroboration under the Criminal Justice and Public Order Act 1994. It then concentrates on identification evidence concerned with the Turnbull directions and the provisions of Code D to PACE 1984. It continues with a review of some procedural aspects of examination and cross examination. The chapter concludes with an examination of the rules on cross examination of complainants in sexual cases on previous sexual history and the case law under section 41 Youth Justice and Criminal Evidence Act 1999.
10. Public interest immunity
Authors: Spencer Maureen , Spencer John
Published: September 2019

This chapter first explains exclusion of evidence on the grounds of the PII doctrine in relation to the public interest in non-disclosure of documents. The chapter examines areas of public interest that are covered by possible PII claims. These include national security, defence and foreign policy, protection of children, the identity of police informers, and confidential records held by public bodies.
3. The law of treaties
Authors: Bantekas Ilias , Papastavridis Efthymios
Published: September 2019

This chapter examines the rules of international law governing the birth, the life, and the death of treaties. Treaties, a formal source of international law, are agreements in written form between States or international organizations that are subject to international law. A treaty falls under the definition of the Vienna Convention on the Law of Treaties (VCLT) no matter what form or title it may have. The most important factor is that it sets out obligations or entitlements under international law. The VCLT enumerates the rules governing the ‘birth’, i.e. the steps from the negotiation until the entry into force of the treaty; the ‘life’, i.e. the interpretation and application of the treaty; and its ‘demise’, i.e. its termination. The two fundamental tenets are, on the one hand, the principle ‘pacta sunt servanda’ and, on the other, the principle of contractual freedom of the parties.
10. Peaceful settlement of disputes
Authors: Bantekas Ilias , Papastavridis Efthymios
Published: September 2019

This chapter examines the means and methods relating to the peaceful settlement of international disputes. The UN Charter obliges States to resolve peacefully their disputes and suggests certain means for such settlement: on the one hand, diplomatic means, like negotiation, mediation, conciliation, or the ‘good offices’ of the UN Secretary-General and, on the other, legal methods, such as arbitration and recourse to the International Court of Justice (ICJ), which are binding. The ICJ exercises its jurisdiction over contentious cases only upon the consent of the parties to the dispute, which may be expressed through various forms (e.g. compromis or optional clause declaration). The ICJ may also render advisory opinions to questions of international law posed by the UN General Assembly, the Security Council, or other competent organs and organizations. The chapter also explains dispute settlement in the context of international investor–State arbitration and in the World Trade Organization.
11. Use of force
Authors: Bantekas Ilias , Papastavridis Efthymios
Published: September 2019

This chapter examines under what circumstances States may use armed force under customary international law and Arts 2(4) and 51 UN Charter. After noting that the use of armed force is generally prohibited and only limited to self-defence, and then only if the target State is under an armed attack, we show that several States have expanded the notion of armed attack. Besides self-defence, the Security Council may authorize the use of armed force through a process of collective security. Several examples of collective security are offered, as well as the ICJ’s position on what constitutes an armed attack. In recent years, the range of actors capable of undertaking an armed attack has included terrorists. Moreover, the development of the doctrine of the responsibility to protect is a significant achievement.
Medico-economic impact of robot-assisted lung segmentectomy: what is the cost of the learning curve?
Authors: Le Gac Constance , Gondé Henri , Gillibert André , Laurent Marc , Selim Jean , Bottet Benjamin , Varin Rémi , Baste Jean-Marc
Published: September 2019

OBJECTIVES

The objective of this study was to assess the learning curve (LC) of robot-assisted lung segmentectomy and to evaluate hospital-related costs.

METHODS

We conducted a retrospective study of Robot-assisted thoracic surgery (RATS) segmentectomies performed by 1 surgeon during 5 years. Perioperative and medical device data were collected. The LC, based on operating time, was assessed by Cumulative SUM analysis and an exponential model. Cost of care was estimated using the French National Cost Study method.

RESULTS

One hundred and two RATS segmentectomies were included. The LC was completed at ∼30 procedures according to both models without significant difference in patients’ characteristics before or after the LC. Mean operative time decreased from 136 min [95% confidence intervals (CI) 124–149] for the first 30 procedures to 97 min (95% CI 88–107) for the last 30 procedures. Mean length of stay decreased non-significantly (P = 0.10 for linear trend) from 8.1 days (95% CI 6.1–11.0) to 6.2 days (95% CI 4.9–7.9). The overall costs for the last 30 procedures as compared with the first 30 did not significantly decrease in the primary economic analysis but significantly decreased (P = 0.02) by €1271 (95% CI −2688 to +108, P = 0.02 for linear trend) after exclusion of 1 outlier (hospitalization-related costs > €10 000). After exclusion of this outlier, costs related to EndoWrist® instruments significantly decreased by €−135 (95% CI −220 to −35, P = 0.004), whereas costs related to clips decreased non-significantly (P = 0.28).

CONCLUSIONS

The LC was completed at ∼30 procedures. Inexperienced surgeons may have higher procedure costs, related to consumable medical devices and operating time.
Prospective evaluation of ventricular assist device risk scores’ capacity to predict cardiopulmonary exercise parameters
Authors: Dorken Gallastegi Ander , Öztürk Pelin , Demir Emre , Engin Çağatay , Nalbantgil Sanem , Yağdı Tahir , Özbaran Mustafa
Published: September 2019

OBJECTIVES

Risk scores for left ventricular assist device (LVAD) therapy are known to predict morbidity and adverse events in addition to mortality. This study evaluates the capacity of popular LVAD risk scores to predict cardiopulmonary exercise parameters.

METHODS

Adult patients undergoing continuous flow LVAD implantation were prospectively followed. Five risk scores were calculated before implantation: Model for End-stage Liver Disease (MELD), MELD excluding international normalized ratio (MELD-XI), MELD including sodium (MELD-Na), HeartMate2 Risk Score (HMRS) and Destination Therapy Risk Score (DTRS). Cardiopulmonary exercise tests (CPETs) were performed before and after implantation; peak oxygen consumption (vO2max), the lowest ventilation to carbon dioxide output ratio (vE/vCO2) and exercise time were measured.

RESULTS

Ninety-two patients were implanted during the study period; of these, 30 patients completed preimplantation and postimplantation CPETs (CPET cohort). The mean preimplantation and postimplantation CPET dates were 29 ± 10 days before and 109 ± 5 days following implantation. CPET parameters significantly improved after implantation (P < 0.05). In multivariate analysis, MELD, MELD-XI, MELD-Na and HMRS independently predicted both preimplantation and postimplantation vE/vCO2, while MELD-Na and HMRS were also independent predictors of preimplantation and postimplantation vO2max, respectively.

CONCLUSIONS

Four preimplantation LVAD risk scores (HMRS, MELD, MELD-Na and MELD-XI) independently predict important cardiopulmonary exercise parameters such as vE/vCO2 and vO2 max in LVAD therapy. Out of these 4 risk scores, MELD-Na and HMRS appear to be the best predictors of preimplantation and postimplantation CPET parameters, respectively.
Three-dimensional printing in adult cardiovascular medicine for surgical and transcatheter procedural planning, teaching and technological innovation
Authors: Ferrari Enrico , Gallo Michele , Wang Changtian , Zhang Lei , Taramasso Maurizio , Maisano Francesco , Pirelli Luigi , Berdajs Denis , von Segesser Ludwig Karl
Published: September 2019

Three-dimensional (3D)-printing technologies in cardiovascular surgery have provided a new way to tailor surgical and percutaneous treatments. Digital information from standard cardiac imaging is integrated into physical 3D models for an accurate spatial visualization of anatomical details. We reviewed the available literature and analysed the different printing technologies, the required procedural steps for 3D prototyping, the used cardiac imaging, the available materials and the clinical implications. We have highlighted different materials used to replicate aortic and mitral valves, vessels and myocardial properties. 3D printing allows a heuristic approach to investigate complex cardiovascular diseases, and it is a unique patient-specific technology providing enhanced understanding and tactile representation of cardiovascular anatomies for the procedural planning and decision-making process. 3D printing may also be used for medical education and surgical/transcatheter training. Communication between doctors and patients can also benefit from 3D models by improving the patient understanding of pathologies. Furthermore, medical device development and testing can be performed with rapid 3D prototyping. Additionally, widespread application of 3D printing in the cardiovascular field combined with tissue engineering will pave the way to 3D-bioprinted tissues for regenerative medicinal applications and 3D-printed organs.
IgG immune complexes with Staphylococcus aureus protein A enhance osteoclast differentiation and bone resorption by stimulating Fc receptors and TLR2
Authors: Kamohara Asana , Hirata Hirohito , Xu Xianghe , Shiraki Makoto , Yamada Sakuo , Zhang Jing-Qi , Kukita Toshio , Toyonaga Kenji , Hara Hiromitsu , Urano Yasuteru , Yamashita Yoshio , Miyamoto Hiroshi , Kukita Akiko
Published: September 2019

Staphylococcus aureus is a main pathogen of osteomyelitis and protein A is a virulence factor with high affinity for IgG. In this study, we investigated whether S. aureus affects the differentiation and bone resorption of osteoclasts through the IgG-binding capacity of protein A. Staphylococcus aureus pre-treated with serum or IgG showed marked enhancement in osteoclastogenesis and bone resorption compared to non-treated S. aureus or a protein A-deficient mutant. Blocking of the Fc receptor and deletion of the Fcγ receptor gene in osteoclast precursor cells showed that enhanced osteoclastogenesis stimulated by S. aureus IgG immune complexes (ICs) was mediated by the Fc receptor on osteoclast precursor cells. In addition, osteoclastogenesis stimulated by S. aureus ICs but not the protein A-deficient mutant was markedly reduced in osteoclast precursor cells of Myd88-knockout mice. Moreover, NFATc1, Syk and NF-κB signals were necessary for osteoclastogenesis stimulated by S. aureus ICs. The results suggest the contribution of a of Toll-like receptor 2 (TLR2)-Myd88 signal to the activity of S. aureus ICs. We further examined the expression of pro-inflammatory cytokines that is known to be enhanced by FcγR-TLR cross-talk. Osteoclasts induced by S. aureus ICs showed higher expression of TNF-α and IL-1β, and marked stimulation of proton secretion of osteoclasts activated by pro-inflammatory cytokines. Finally, injection of S. aureus, but not the protein A-deficient mutant, exacerbated bone loss in implantation and intra-peritoneal administration mouse models. Our results provide a novel mechanistic aspect of bone loss induced by S. aureus in which ICs and both Fc receptors and TLR pathways are involved.
Impact of Temperature Storage Conditions of Halyomorpha halys (Hemiptera: Pentatomidae) Eggs on Parasitism by Anastatus reduvii (Hymenoptera: Eupelmidae)
Authors: Ogburn Emily C , Walgenbach James F
Published: September 2019

Brown marmorated stink bug, Halyomorpha halys Stål, is an invasive species of Asian origin that is an important agricultural pest in the eastern United States. Sentinel egg masses are tools used to assess the impact of natural enemies on H. halys populations. To determine the effect of host egg age and storage conditions on their susceptibility to parasitism, H. halys eggs were stored at different temperatures for different lengths of time and then exposed to Anastatus reduvii (Howard), a native natural enemy of H. halys occurring in eastern North America. For eggs stored at 15, 20, and 25°C and then exposed to A. reduvii, the number of host eggs from which parasitoid offspring emerged declined with age of eggs. Control eggs (exposed to parasitoids without being stored) and those eggs stored for only 5.5 degree-days (DD) (=0.5 days) at 25°C yielded the highest percentage of parasitoids at 88.2 and 88.3%, respectively. For eggs stored at 20 and 25°C for 7.3 DD to about 36 DD, offspring emerged from about 58 to 73% of eggs, and total parasitism (emerged + unemerged parasitoids) ranged from about 70 to 80%. Parasitoid emergence was significantly lower for host eggs stored at 15°C for comparable times at 20 and 25°C. Stink bugs nymphs hatched from <0.6% of all eggs. Parasitoid-induced host egg abortion was an important component of egg mortality caused by A. reduvii, with underdeveloped stink bug nymphs, undifferentiated cell contents, and parasitoid host feeding occurring across all storage treatments.
Dreams of Destiny and Omens of Greatness: Exceptionalism in Ottoman Political and Historical Thought
Authors: Menchinger Ethan L
Published: September 2019

This article uses dreams, portents, and prognostications as an entry point into what some scholars have recently called ‘Ottoman exceptionalism’. Drawing on sources in Turkish and Arabic, it traces beliefs about the Ottoman dynasty and empire’s superiority, divine favour, and special role in history from the fifteenth to the eighteenth century. I begin with the ‘seeds’ of the topic in the empire’s early years and myths of origin, including a number of dream stories, before moving to full-scale political exceptionalism. Looking closer, I then identify an eschatological strand in the lead-up to the Islamic millennium that centred on the dynasty’s role in the end time. The millennium’s uneventful passing led to the dissolution of this strand but not of ideas about exceptionalism itself, which in later forms turned inward, depicting the empire as ‘eternal’ and projecting its rule to an undetermined future period.
Assessing the risks to United States and Canadian mammals caused by climate change using a trait-mediated model
Authors: McCain Christy M
Published: September 2019

A set of 182 populations of 76 mammal species in the United States and Canada, examined in natural conditions with minimized disturbances or management effects, shows that responses to climate change include negative responses, such as elevational range contractions, upward shifts and decreases in abundance, positive responses, such as range expansions, and no detectable responses. Responses vary among and within mammal species but many are correlated with species traits, particularly the responses linked to high extinction risks (= climate change risk: decreases in population sizes, range contractions, local extirpations). The traits showing the strongest links to differential responses to climate change are 1) body size—large mammals respond more often and most negatively to climate change, 2) activity times—few mammals with flexible active times respond to climate change, and 3) spatial distribution—high-latitude and high-elevation mammals responded more often to climate change. Using these traits and two approaches to trait weighting, I modeled the relative climate change risk for all 328 terrestrial, nonvolant mammal species in the United States and Canada across 10 levels of risk (low = 1–2, moderate = 3–4, moderate-high = 5–6, high = 7–8, very high = 9–10). The models predicted that 15% of these mammalian species are in the high- and very high-risk categories, including species from most orders. Many mammal populations and species listed as of conservation concern due to other human impacts by national or international agencies are also predicted by my models to be in the higher categories of climate change risk. My intention for these models is to clarify for managers and researchers which, where, and how mammals are responding to climate change relatively independent of other anthropogenic stressors (e.g., large-scale habitat change, overhunting) and to provide a preliminary assessment of species most in need of careful monitoring for climate change impacts.
Mindfulness for the Next Generation
Authors: Rogers Holly , Maytan Margaret
Published: September 2019

College students and other young adults today are experiencing high levels of stress as they pursue personal, educational, and career goals. In recent years there has been increased awareness of the seriousness of these struggles, which may increase the risk of psychological distress and mental illness among this age group now commonly referred to as “emerging adults.” Scientific research has shown that practicing mindfulness can help manage stress and enhance quality of life, but traditional methods of teaching mindfulness and meditation are not always effective for emerging adults. Mindfulness for the Next Generation is an easy-to-use guide that details Koru Mindfulness, a curriculum developed at Duke University, designed specifically for teaching mindfulness to emerging adults. Koru has been tested and shown to be effective for helping this age group learn the practice of mindfulness. Koru is now used at hundreds of universities in the United States and abroad. In Mindfulness for the Next Generation, authors Holly Rogers and Margaret Maytan, the developers of the Koru program, discuss the unique challenges emerging adults face, review the research on Koru and mindfulness in general for this population, and provide an overview of the Koru curriculum. This book is the primary resource for individuals learning to teach the Koru curriculum.
Incidental Unruptured Arteriovenous Malformation
Authors: Bambakidis Nicholas C. , Nelson Jeffrey T.
Published: September 2019

Abstract: Cerebral arteriovenous malformations are a rare cause of hemorrhage or seizure. They may occur anywhere in the brain and vary considerably in size, arterial and venous drainage, and the degree to which they involve eloquent cortex. Decision-making in terms of treatment depends on an analysis of the expected natural history, the expected number of at risk years, and the anticipated risks and efficacy of treatment. Treatment of unruptured arteriovenous malformations for the prevention of adverse sequelae often requires a multimodality approach, including consideration of the roles of surgical resection, endovascular embolization, and stereotactic radiosurgery. This chapter discusses the diagnosis and management of unruptured cerebral arteriovenous malformations.
Statistics, Ethics, and Management
Authors: Williams George W.
Published: September 2019

While regulatory, management, and statistics concepts are commonly considered pertinent primarily for examinations, the mastery of this skillset allows for effective leadership in an intensive care unit. In the modern multidisciplinary model of critical care, an intensivist needs to be comfortable interpreting quality metrics as well as medical literature. Additionally, an understanding of the regulatory role of government and how such policies affect the care of patients is directly pertinent to interactions with hospital administrators and peers of other specialties. This chapter provides a general overview of these concepts for the examination, but the reader is encouraged to read more into the background of these topics in order to gain a practical mastery of these concepts for practice.
Informed Consent
Authors: Davis Gregory
Published: September 2019

Chapter 2 deals specifically with the topic of informed consent, an essential legal requirement for the general practice of medicine. Some of the cases are specific to mental health treatment, but the most critical to defining the standards of informed consent and related to more purely medical conditions. Cases described here include Natanson v. Kline, Canterbury v. Spence, Kaimowitz v. Michigan Department of Mental Health, Truman v. Thomas, Clites v. Iowa and Zinermon v. Burch.
Civil Commitment
Authors: Ford Elizabeth
Published: September 2019

Chapter 6 covers the major legal cases that have informed the laws governing the civil commitment – involuntary hospitalization – of individuals with mental illness. The cases highlight the evolution of the emphasis on dangerousness as a critical factor in decision-making and very clearly describe the tension between individual autonomy and police power. The cases included in this chapter are Lake v. Cameron, Baxstrom v. Herold, Lessard v. Schmidt, O’Connor v. Donaldson, Addington v. Texas, and a case involving children, Parham v. J.R.
EAHCA (Education for All Handicapped Children Act); IDEA (Individuals with Disabilities Education Act)
Authors: Sidhu Shawn S.
Published: September 2019

Chapter 14 includes two cases involving the EAHCA, now called the Individuals with Disabilities Education Act (IDEA), that have heavily influenced the way public education is provided to school children with disabilities. Hendrick Hudson Board of Education v. Rowley helped to establish the requirements and limits of Individual Education Plans (IEP), a free academic service for any school child with a learning disability. Irving Independent School District v. Tatro, although specific to a child with spina bifida, helped to establish the medical care accommodations that a school must provide for a child with a physical disability.
ADA and Disability Rights
Authors: Forman Howard , Cucolo Heather Ellis , Rotter Merrill
Published: September 2019

Chapter 16 includes a group of cases that relate to the Americans with Disabilities Act (ADA) of 1990. Most of the cases involve Title II of the Act, specifically that no individual with a disability can be denied services by public entities. The disabilities claimed in the cases vary broadly, from HIV to carpal tunnel syndrome to schizophrenia, but they are all critical in defining accommodations for individuals with disabilities. Settings of alleged discrimination highlighted include workplace, housing, involuntary treatment, hospitalization and police encounters. Olmstead v. Zimring is particularly relevant to psychiatry because it addressed the concern about institutional warehousing of mentally disabled individuals. Other cases in this section include City of Cleburne, Texas v. Leburne Living Center, Carter v. General Motors, Bragdon v. Abbott, Pennsylvania v. Yeskey, Toyota v. Williams, Hargrave v. Vermont, U.S. v. Georgia, Disability Rights of New Jersey, Inc. v. Commissioner, New Jersey, and Sheehan v. City of San Francisco.
Prisoners’ Rights
Authors: Khan Omar , Lewis Rebecca , Subedi Bipin , Cucolo Heather Ellis
Published: September 2019

Chapter 26 includes a broad range of cases that relate to the rights of individuals detained in jails or prisons. Because the U.S. Constitution considers deprivation of liberty a significant harm, efforts are made to protect the rights, as much as possible, of those who are incarcerated. As related to mental health, those rights include medical and psychiatric care, right to refuse treatment, and due process rights related to psychiatric hospitalization. The cases in this chapter are Estelle v. Gamble, Vitek v. Jones, Washington v. Harper, Riggins v. Nevada, Farmer v. Brennan, Sell v. U.S. and Brown v. Plata. The newest case (Taylor v. Barkes) looks at whether inadequate suicide prevention policies represent a potential 8th amendment violation.
Improving the accuracy of simulated chaotic N-body orbits using smoothness
Authors: Hernandez David M
Published: September 2019

Symplectic integrators are a foundation to the study of dynamical N-body phenomena, at scales ranging from planetary to cosmological. These integrators preserve the Poincaré invariants of Hamiltonian dynamics. The N-body Hamiltonian has another, perhaps overlooked, symmetry: it is smooth, or, in other words, it has infinite differentiability class order (DCO) for particle separations greater than 0. Popular symplectic integrators, such as hybrid methods or block adaptive stepping methods do not come from smooth Hamiltonians and it is perhaps unclear whether they should. We investigate the importance of this symmetry by considering hybrid integrators, whose DCO can be tuned easily. Hybrid methods are smooth, except at a finite number of phase space points. We study chaotic planetary orbits in a test considered by Wisdom. We find that increasing smoothness, at negligible extra computational cost in particular tests, improves the Jacobi constant error of the orbits by about 5 orders of magnitude in long-term simulations. The results from this work suggest that smoothness of the N-body Hamiltonian is a property worth preserving in simulations.
Clocking the formation of today’s largest galaxies: wide field integral spectroscopy of brightest cluster galaxies and their surroundings
Authors: Edwards Louise O V , Salinas Matthew , Stanley Steffanie , Holguin West Priscilla E , Trierweiler Isabella , Alpert Hannah , Coelho Paula , Koppaka Saisneha , Tremblay Grant R , Martel Hugo , Li Yuan
Published: September 2019

The formation and evolution of local brightest cluster galaxies (BCGs) is investigated by determining the stellar populations and dynamics from the galaxy core, through the outskirts and into the intracluster light (ICL). Integral spectroscopy of 23 BCGs observed out to $4\, r_{e}$ is collected and high signal-to-noise regions are identified. Stellar population synthesis codes are used to determine the age, metallicity, velocity, and velocity dispersion of stars within each region. The ICL spectra are best modelled with populations that are younger and less metal-rich than those of the BCG cores. The average BCG core age of the sample is $\rm 13.3\pm 2.8\, Gyr$ and the average metallicity is $\rm [Fe/H] = 0.30\pm 0.09$, whereas for the ICL the average age is $\rm 9.2\pm 3.5\, Gyr$ and the average metallicity is $\rm [Fe/H] = 0.18\pm 0.16$. The velocity dispersion profile is seen to be rising or flat in most of the sample (17/23), and those with rising values reach the value of the host cluster’s velocity dispersion in several cases. The most extended BCGs are closest to the peak of the cluster’s X-ray luminosity. The results are consistent with the idea that the BCG cores and inner regions formed quickly and long ago, with the outer regions and ICL forming more recently, and continuing to assemble through minor merging. Any recent star formation in the BCGs is a minor component, and is associated with the cluster cool core status.
Tolerance to Selenoprotein Loss Differs between Human and Mouse
Authors: Santesmasses Didac , Mariotti Marco , Gladyshev Vadim N
Published: September 2019

Mouse has emerged as the most common model organism in biomedicine. Here, we analyzed the tolerance to the loss-of-function (LoF) of selenoprotein genes, estimated from mouse knockouts and the frequency of LoF variants in humans. We found not only a general correspondence in tolerance (e.g., GPX1, GPX2) and intolerance (TXNRD1, SELENOT) to gene LoF between humans and mice but also important differences. Notably, humans are intolerant to the loss of iodothyronine deiodinases, whereas their deletion in mice leads to mild phenotypes, and this is consistent with phenotype differences in selenocysteine machinery loss between these species. In contrast, loss of TXNRD2 and GPX4 is lethal in mice but may be tolerated in humans. We further identified the first human SELENOP variants coding for proteins varying in selenocysteine content. Finally, our analyses suggested that premature termination codons in selenoprotein genes trigger nonsense-mediated decay, but do this inefficiently when UGA codon is gained. Overall, our study highlights differences in the physiological importance of selenoproteins between human and mouse.
TSPO deficiency induces mitochondrial dysfunction, leading to hypoxia, angiogenesis, and a growth-promoting metabolic shift toward glycolysis in glioblastoma
Authors: Fu Yi , Wang Dongdong , Wang Huaishan , Cai Menghua , Li Chao , Zhang Xue , Chen Hui , Hu Yu , Zhang Xuan , Ying Mingyao , He Wei , Zhang Jianmin
Published: September 2019

Background

The ligands of mitochondrial translocator protein (TSPO) have been widely used as diagnostic biomarkers for glioma. However, the true biological actions of TSPO in vivo and its role in glioma tumorigenesis remain elusive.

Methods

TSPO knockout xenograft and spontaneous mouse glioma models were employed to assess the roles of TSPO in the pathogenesis of glioma. A Seahorse Extracellular Flux Analyzer was used to evaluate mitochondrial oxidative phosphorylation and glycolysis in TSPO knockout and wild-type glioma cells.

Results

TSPO deficiency promoted glioma cell proliferation in vitro in mouse GL261 cells and patient-derived stem cell–like GBM1B cells. TSPO knockout increased glioma growth and angiogenesis in intracranial xenografts and a mouse spontaneous glioma model. Loss of TSPO resulted in a greater number of fragmented mitochondria, increased glucose uptake and lactic acid conversion, decreased oxidative phosphorylation, and increased glycolysis.

Conclusion

TSPO serves as a key regulator of glioma growth and malignancy by controlling the metabolic balance between mitochondrial oxidative phosphorylation and glycolysis.

1. TSPO deficiency promotes glioma growth and angiogenesis.

2. TSPO regulates the balance between mitochondrial oxidative phosphorylation and glycolysis.
Acquired Personality Disturbances After Meningioma Resection Are Strongly Associated With Impaired Quality of Life
Authors: Barrash Joseph , Abel Taylor J , Okerstrom-Jezewski Katrina L , Zanaty Mario , Bruss Joel E , Manzel Kenneth , Howard Matthew , Tranel Daniel
Published: September 2019

BACKGROUND

Some patients experience long-term declines in quality of life following meningioma resection, but associated factors are not well understood.

OBJECTIVE

To investigate whether long-term declines in quality of life (specifically impaired adaptive functioning) after meningioma resection are associated with specific personality disturbances that often develop with lesions in ventromedial prefrontal cortex (vmPFC).

METHODS

 We studied 38 patients who underwent resection of meningioma, 18 of whom had vmPFC lesions and 20 with lesions elsewhere (non-vmPFC). A total of 30 personality characteristics were rated by spouse or family, and a neuropsychologist blindly rated adaptive functioning an average of 3.8 yr postresection. Relevant personality disturbance was defined by a priori process: the presence of “conjoint personality disturbance” required specific disturbances in at least 2 of 4 types of disturbance: executive disorders, disturbed social behavior, emotional dysregulation, and hypoemotionality.

RESULTS

Fourteen patients had impaired adaptive functioning: 12 had vmPFC lesions and 2 had non-vmPFC lesions. Fourteen patients had conjoint personality disturbance, and 12 of them had impaired adaptive functioning. By contrast, among the 24 patients who did not have conjoint personality disturbance, only 2 had impaired adaptive functioning. Mediation analysis showed that the association between vmPFC lesions and impaired adaptive functioning was mediated by the negative impact of acquired personality disturbance on adaptive functioning.

CONCLUSION

Anterior skull base meningiomas plus resection surgery may result in specific personality disturbances that are highly associated with impaired adaptive functioning at long-term follow-up. These patients may benefit from early counseling regarding potential personality changes and their implications for adaptive functioning.