bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction
Authors: Burchardt Tania , Le Grand Julian , Piachaud David
Published: October 2023

Social exclusion has attracted much attention in recent years in Britain and elsewhere. Although the concept originated in continental Europe it is now part of the common currency of British social policy debates. The Lisbon Summit committed EU member states to adopt the promotion of social cohesion and inclusion as a strategic goal, and the concept had already directly entered the British Government’s policy process with the setting up of the interdepartmental Social Exclusion Unit by the Labour Government of Tony Blair in 1997.
Social Exclusion, Social Isolation, and the Distribution of Income
Authors: Barry Brian
Published: October 2023

As discussed in the first chapter, the thought is often expressed that ‘social exclusion’ is no more than a relabelling of what used to be called ‘poverty’. However, although there is no doubt a close association between economic stratification and the phenomenon of exclusion within a society, it seems clear that in principle social exclusion can occur between groups that are not significantly distinguished from one another economically. Thus, while the Jewish immigrants who came to Britain from eastern Europe were poor to begin with, their descendants moved in large numbers over a few generations into the professions and commerce.
The Dynamics of Poverty in Britain
Authors: Burgess Simon , Propper Carol
Published: October 2023

One central aspect of social exclusion under any definition is lack of income. The focus of this chapter is on movements in and out of income below the poverty line: what has come to be called poverty dynamics. Poverty was a major economic and political issue in Britain in the late 1990s. Recent figures show that in 1998/9 about one in five Britons had incomes that put them in poverty by one widely used measure (living in a household in which total income is less than half the national mean). The comparable figure in 1979 was less than one in ten. Poverty has risen among households with children: in 1979, one in twelve children were poor; in 1995/6 one in four were poor. Underlying these snapshots of poverty levels lie movements of people in and out of poverty over their lives.
Optimal regulation
Authors: Allen Franklin , Gale Douglas
Published: October 2023

For the most part, the development of financial regulation has been an empirical process, a matter of trial and error, driven by the exigencies of history rather than by formal theory. An episode that illustrates the character of this process is the Great Depression in the US. The financial collapse in the US was widespread and deeply disruptive. It led to substantial changes in the laws regulating the financial system, many of which shape our current regulatory framework.
Famine in Berar, 1896-7 and 1899-1900: Echoes and Chain Reactions
Authors: Dyson Tim
Published: October 2023

The onetime British India province of Berar corresponds to the combined current jurisdictions of Amraoti, Akola, Buldana and Yavatmal districts in the modern Indian state of Maharashtra. In the eighteenth and early nineteenth centuries the province experienced a fairly turbulent history under the suzerainty of the Nizam of Hyderabad, before in 1853 being taken over by the British. Initially this transference of adminis¬ trative responsibility was theoretically under lease from the Nizam. Therefore, during.
Famine in Nineteenth- and Twentieth-Century Russia: Mortality by Age, Cause, and Gender
Authors: Adamets Serguei
Published: October 2023

During the nineteenth century, famines seemed to strike Russia in a more or less regular pattern. A volume published by the Central Statistics Committee (CSK) in 1871 referred to poor harvests in 1820-1, 1833-4, 1839-40, 1843-6, 1848-51, and 1854. The Report of the Council of Ministers drafted in 1842 implies that food shortages recurred every 6-7 years (Brokgauz and Efron 1893). During the 1860s the worst years were between 1867 and 1869. In the last quarter of the century, there were famines in 1872-3, in 1882-4, and in 1892. At the beginning of the twentieth century, local scarcities affected one or other region of Russia almost annually, and they were particularly serious in 1906 and 1911 (Buxman 1923).
‘Send Us either Food or Coffins’: The 1941-2 Famine on the Aegean Island of Syros
Authors: Hionidou Violetta
Published: October 2023

In economic terms prior to World War II, Greece was predominantly rural, with more than 60 per cent of the population engaged in agricultural occupations generating 35 per cent of the national income. Nevertheless, the country was heavily depen¬ dent upon food imports. In the period 1935-7, 45 per cent of the required wheat was imported, although by 1939, this percentage was reduced to 20.5 (Demathas 1989: 151; Diamond 1947: 5-6). These high figures resulted from a concentration on the production of cash crops such as tobacco and currants (Mazower 1991: 79-81). The primary centres of cereal production in Greece were the northern parts of the mainland, whereas the Peloponnese was the main producer of olive oil and cur¬ rants. Despite wide variations, in genera], the islands were usually producers of a cash crop and they also depended either on remittances and/or cash earned from seasonal/circular migration.
The expansion of Latin Christendom
Authors: Berend Nora
Published: October 2023

Between c.950 and c.1300 Europe emerged through the incorporation of new territories (a process that had started before 950), the consolidation of political systems in the newly integrated areas, and transformations in western Europe itself. By the fourteenth century, Europe became the synonym of Christendom and the geographical area of the two roughly coincided. This chapter focuses on Latin Christendom, as the scope of the book allows only fleeting references to the Balkans, Rus’, and Byzantium. Expansion meant more than the simple addition of new territories and the enlargement of the previously existing western European political and religious system.
Internet marketplaces
Authors: Ramberg Christina
Published: October 2023

Internet Marketplaces explains and analyses the legal questions and challenges posed by the increased use of online auctions and exchanges for business transactions. Rather than focusing on internet businesses as a whole, the author studies the rules related to closed internet marketplaces where commercial dealings are carried out. The book provides a detailed analysis of the new business models that are being employed, their legal structures, and the extent to which further work is still required to fill in the legal infrastructure. Professor Ramberg is well known for her expertise and involvement in this field, and the book will prove to be useful to fellow practitioners as well as being a key reference for academics working in this area.
French Property And Inheritance Law-Principles And Practice
Authors: Dyson Henry
Published: October 2023

The growing trend for purchasing property in France, either as a main or second home, has led to a corresponding need for a book which explains the French conveyancing system for lawyers trained in other legal systems. French Property and Inheritance Law offers practical guidance to lawyers and other professionals advising clients on property transactions and related matters in France including: buying, selling, and mortgaging land; the ownership of flats and leases; and the establishment of companies to own land as a means of avoiding French inheritance rules and to mitigate French inheritance tax. It unravels the mysteries of many features of the French system such as the marriage régime, the PACS, and sales en viager which can often be advantageous to non-French clients. The book also covers all aspects of French inheritance law, including the rules of intestacy, the making of wills, and the inheritance rights of the surviving spouse and the rights of other members of the family. The author offers advice on how beneficiaries can avoid personal liability for the debts of a deceased and provides practical guidance on the administration of estates. A glossary and relevant legal precedents are also included. The author also writes regular updates on new key developments in French property law - please see the publication Solicitors' Journal for details of his articles on the subject.
Perception Matters: Psychophysics for Economists
Authors: Weber Elke U
Published: October 2023

Experimental economics, behavioral game theory, and behavioral decision research have made great strides in recent years towards their goal of predicting behavior, especially in those cases where it deviates from the predictions of conventional economic rationality. Many, if not most of these advances fall into two categories, both of which assign a causal role to decision-makers” perception, that is, their construal of the decision situation.Category I explanations acknowledge the constructive and hence subjective nature of perception. Category II explanations emphasize the relative nature of perception. Section 1 of this chapter describes these two categories of explanations and the way in which they modify standard theory. Section 2 provides an introduction to the field of psychophysics, an interdisciplinary area of investigation that started psychology as a scientific discipline in the second half of the twentieth century. In psychophysics, the theoretical and empirical investigation of the constructive, subjective, and relative nature of perception and its relation to judgment and choice have had a long history. Broader knowledge of this research tradition and its insights about the modeling of human choice behavior may be helpful for economists and prevent unnecessary duplication of effort, allowing economics to build on (rather than reinvent) psychology. Section 3 describes some recent developments that psychophysics has brought to the modeling of risky choice and provides suggestions for the direction that cumulative theory building across disciplines might take.
Death and Drama in Renaissance England
Authors: Engel William E
Published: October 2023

Drawing on a range of works from the English Renaissance, Death and Drama in Renaissance England offers a novel way to understand, in their original contexts, key aspects of Renaissance mental life and letters. Focusing on the classical Memory Arts, William Engel explores issues of death and decline in exemplary dramas, dictionaries, and histories of the period, and demonstrates the ways in which emblems and memory images were used to communicate special meanings. Special attention is given, initially, to select tragedies by Shakespeare and other contemporary playwrights who stages spectacles of silent death. This is followed by a survey of the end to which foreign language phrase-books crafted highly mannered vignettes of daily life, and a discussion of the ways in which metaphors of the stage were translated into a body of work which portrayed the soul of history in terms of an overriding Aesthetic of Decline. The result is a thought-provoking account of the essentially mnemonic principles of design informing and animating a range of works from the English Renaissance.
Graham and Leslie Scalapino
Authors: Morris Adalaide
Published: October 2023

At moments when change outraces our ability to comprehend it, every system of explanation registers the strain. Oppositions that have long structured thought and guided action slip out of alignment, leaving a culture awash in information it cannot process. If for a while the prefix ‘post’ ‘as in post-Newtonian, postindustrial, poststructural, or postmodern’ stems confusion by pointing to paradigms we no longer trust, its consolations are temporary and largely negative. The purpose of this essay is to engage moments in contemporary poetry and science that test emerging formations.
Edmund Campion
Authors: Miola Robert S
Published: October 2023

The Jesuit Edmund Campion (1540–81) and his companions comprised the Wrst wave of the English Mission, the attempt to support suppressed Catholics and to reclaim the country to Catholicism (see controversies). Months after arriving in Dover on the morning of 25 June 1580, disguised as a jewel merchant, Campion wrote the letter reprinted below. It gives a vivid sense of his life on the run, the solidarity of the 303. angel an English coin. 313. saving . . . honesty preserving your reputation. 316. Charles Charles V (r. 1519–56), Holy Roman Emperor. 317. Thomas Elyot (1490–1546), English diplomat and scholar. 326. John Heywood Catholic playwright and poet (see drama), who married Thomas More’s niece, Joan Rastell.
Margaret Clitherow
Authors: Miola Robert S
Published: October 2023

Still remembered today as ‘the Pearl of York ‘, Margaret Clitherow (1556?–86) converted to Catholicism in 1574 and led a life of joyful devotion and humble service.
Thomas Pounde
Authors: Miola Robert S
Published: October 2023

Personal servant of Queen Elizabeth, Thomas Pounde (1538–1613) left court in 1551 and became a Catholic and active missionary in England. Accepted as a Jesuit lay brother in 1578, Pounde circulated Campion’s A Letter to the Privy Council in manuscript (see controversies), and wrote a challenge of his own. He spent at least thirty years of his life in various prisons for his faith. About 1582 Pounde sent to Francis Tregian a manuscript poem that contrasts true Catholic martyrs with Protestant pseudomartyrs, ‘A Challenge unto Foxe ‘ (for another rebuttal of Foxe, see Persons, histories).
Toby Matthew
Authors: Miola Robert S
Published: October 2023

Toby Matthew (1557–65) converted to Catholicism and experienced subsequent trials and triumphs (see lives and deaths). He wrote a poetic panegyric to the Virgin Mary in Anthony StaVord’s The Female Glory (1635) and twenty-nine sonnets, devotional and personal, which are preserved in a manuscript commonplace book. The sonnet below expresses poignant grief at the common Catholic experience of exile.
Prayers and Hymns
Authors: Miola Robert S
Published: October 2023

Most Catholic prayers and hymns appeared in a prayer book known as the Primer, which derived from the Divine OYce (monastic prayers recited at certain hours of the day) but soon incorporated the Little OYce or Hours of the Virgin Mary, including psalms, the Litany of the Saints, the OYce of the Dead. Richard Verstegan’s translation of the Primer in 1599 (excerpted below) achieved forty-two editions in the following century. There meditations on the Passion envision Jesus as both suVering brother and divine redeemer. The Fifteen Oes (from an earlier text) unites scriptural, liturgical, patristic, and iconic traditions to form a deeply aVective and richly doctrinal plea for salvation.
Consolations
Authors: Miola Robert S
Published: October 2023

Comforting the suVering and dying, ancients like Cicero, Seneca, Pliny, and Plutarch created a genre of philosophical consolation that found late representation in Boethius’s medieval De consolatione philosophiae.
John Heywood
Authors: Miola Robert S
Published: October 2023

Singer, musician, court entertainer, and playwright, John Heywood (1497–1575) belonged to Thomas More’s circle and remained a Roman Catholic through the tumultuous changes of his long life. Both his sons, Ellis and Jasper, became priests: Ellis wrote a prat Nay, deal as thou canst with that elf ! For why, I have enough to do myself. Alas, for pain I am almost dead! The red blood so runneth down about my head!195 Nay, an thou canst, I pray thee, help me! parson Nay, by the mass, fellow, it will not be, I have more tow on my distaV than I can well spin. The cursed friar doth the upper hand win! friar Will ye leave, then, and let us in peace depart? 200 parson and prat Yea, by our Lady, even with all our heart.
Measure for Measure, 1603–4
Authors: Miola Robert S
Published: October 2023

measure for measure Searching the paradoxes of law, justice, and mercy, this play (1604) features centrally Isabella, a novice in the Catholic order of Poor Clares, sister order to the Franciscans. Isabella Wnds herself desired by the corrupt magistrate Angelo, who oVers a pardon for her condemned brother Claudio in exchange for sexual intercourse. The audience admires Isabella’s indignant refusal of the indecent proposal but wonders at her moral logic, ‘More than our brother is our chastity ‘ (109). Shakespeare sympathetically presents this Catholic religious out of cloister and in the midst of the wrenching ethical and emotional conXicts of the fallen world.
Richard Verstegan
Authors: Miola Robert S
Published: October 2023

Richard Verstegan (1548–1636) published poetry, horriWc depictions of Catholic martyr-doms, an inXuential collection of Catholic prayers (see poetry, Figs. 6, 9, instructions and devotions), and an important historical work, A Restitution of Decayed Intelligence in Antiquities (1605). Eschewing the traditional adulation of Brut and primitive Britain, 268. like likely. 269. privy private, intimate. 276. true justice Speaking for many, Lord Burlegh disagreed in The Execution of Justice in England (1584). There he distinguished between Catholics Elizabeth executed for treason and the Protestants Mary executed for heresy: ‘For though they which suVered in Queen Mary’s time continued in the profession of the religion wherein they were christened, and as they were perpetually taught, yet they never at their death denied their lawful queen, nor maintained any of her open and foreign enemies, nor procured any rebellion or civil war, nor did sow any sedition in secret corners, nor withdrew any subjects from their obedience, as these sworn servants of the pope have continually done ‘ (sig. Ciiv ). 285. cast opportunity.
Elizabeth Southwell
Authors: Miola Robert S
Published: October 2023

In 1607 Elizabeth Southwell, a former royal maid who converted to Catholicism, wrote a manuscript account of Queen Elizabeth’s sickness and death. Southwell gives an eyewitness report, rife with sensational incident: the receipt of a magic coin from Wales, supposed to preserve life; the discovery of a playing card nailed to the queen’s chair as part of an evil spell; the appearance and disappearance of Elizabeth’s ghost before her death; the sudden explosion of the dead queen’s body in the coYn. Cecil appears throughout this account as presumptuous, untrustworthy, and menacing. Queen Elizabeth dismisses her Protestant divines as worthless and refuses to name James her successor.
The Publication of Books (Inter sollicitudines), 1515
Authors: Miola Robert S
Published: October 2023

Leo, bishop, servant of the servants of God, for an everlasting record, with the approval of the sacred Council. Among the cares weighing upon our shoulders we ponder with constant concern how we may lead back to the path of truth those who err and gain them for God by his grace operating in us. Truly, this is what we earnestly seek, and to this we carefully order the disposition of our mind, and over this we watch with eager diligence. It is surely permissible to obtain a knowledge of the arts and sciences easily through the reading of books. And the art of printing books, chieXy discovered or rather enlarged and perfected in our time by divine favour, has brought many beneWts to mortals, since at small expense a great number of books can be had, in which minds can be exercised very conveniently in the acquisition of knowledge; and men learned in every kind of language, especially those who are Catholics (whom we wish the Church to have in abundance), can easily arise, who can then identify unbelievers, instruct them in holy doctrines, and increase the Xock of the faithful by the wholesome teaching of the Christian faith.
Gender, Labour Market, and Demographic Change: A Case Study of Women’s Entry into the Formal Manufacturing Sector in Bangladesh
Authors: Afsar Rita
Published: October 2023

Bangladesh is one of the few countries which experienced women’s entry into formal manufacturing sector without attaining universal level of primary education, and amidst the prevalent patriarchal values and ideology of sex segregation that govern gender relations in a conservative society. Women have been experiencing some major changes in labour market in terms of nature of jobs and opportunities since last decade. Due to admission of increasing number of female workers to employment predominantly in garment and other small industries, the rate of female participation for all age groups have increased both in rural and urban areas. Moreover the growth rate of female labour force showed a steady increase over that of male labour force since mid-eighties. Among other things, rapid growth of Ready Made Garment (RMG) sector is one of the major contributing factors that causes a shift in women’s predominantly home based to market-oriented economic activities since mid-eighties.
Judicial Deference and Human Rights: A Question of Competence
Authors: Jowell* Jeffrey
Published: October 2023

As our Human Rights Act unfolds, two views are emerging about the extent to which the courts should defer to Parliament and other bodies exercising public powers. The first contends that courts should in principle bow to the decisions of the legislature and those exercising power on its behalf on matters of public interest (sometimes referred to as matters of public policy or expediency).
Real Options: Principles of Valuation and Strategy
Authors: Smit Han T J , Trigeorgis Lenos
Published: October 2023

This chapter provides an overview of the basic principles of quantifying the value of corporate real options and of capturing important strategic dimensions, which are at the core of strategic planning and investing under uncertainty. In the current, highly volatile, and competitive landscape, the horizon over which cash flows can be estimated confidently is shrinking, making it essential for firms to be flexible in their investment programs.
Charles Dickens and His Performing Selves
Authors: Andrews Malcolm
Published: October 2023

Charles Dickens had three professional careers: novelist, journalist and public Reader. That third career has seldom been given the serious attention it deserved. For the last 12 years of his life he toured Britain and America giving 2-hour readings from his work to audiences of over two thousand. These readings were highly dramatic performances in which Dickens's great gift for mimicry enabled him to represent the looks and voices of his characters, to the point where audiences forgot they were watching Charles Dickens. His novels came alive on the platform: at the end of a reading, it seemed to many that a whole society had broken up rather than that a solitary recitalist had concluded. This book tries to recreate, in greater detail than hitherto, the sense of how those readings were performed and how they were received, how Dickens devised his stage set and tailored his books to make them into performance scripts, how he conducted his reading tours all around the country and developed a quite extraordinary rapport with his listeners. No single study of this late career of Dickens has drawn to such an extent on contemporary witnesses to the readings as well as tried to assess in some depth the significance of what Dickens called 'this new expression of the meaning of my books'. 'I shall tear myself to pieces', he said as he waited eagerly to go on stage for his performance, and that is ironically what he did, in ways he perhaps had not quite intended: he fractured into dozens of different characters up there on the platform, and as he thus tore himself to pieces his health collapsed irretrievably under the pressures he put upon himself to achieve these masterly illusions.
Oil and conflict: Lundin Petroleum’s experience in Sudan
Authors: Batruch Christine
Published: October 2023

Lundin Petroleum obtained the rights to explore for and produce oil and gas in concession Block 5A, Unity State, Sudan, in February 1997; it sold these rights in June 2003. During the period in which the company was active in Sudan, it operated in the belief that oil could benefit the economic development of the area and the country as a whole, and that this would have a catalysing effect on the peace process. The problems which it encountered in the area, however, led the company to constantly reassess its activities, role and responsibilities there.
Deciding Whom to Help, Health-Adjusted Life Years and Disabilities
Authors: Kamm Frances M
Published: October 2023

In this chapter, I discuss how to allocate scarce resources related to health. In particular, I am concerned with health care resources. I discuss micro allocation problems, for example, giving a health care resource to one person rather than another, and also macro allocation problems, for example, allocating money to production of one health care service or product rather than another. In Section 11.1, I describe the possible theoretical foundations for assigning weights to some factors and not to others when allocating. Ultimately, I present in outline a decision procedure for allocating. In Section 11.2, I consider several problems that arise in allocating resources using quality- and disability - adjusted life years (QALYs and DALYs) if we take seriously principles of allocation presented in Section 11.1.
The Value of Living Longer
Authors: Broome John
Published: October 2023

Longevity is an important aspect of health. Anyone who wants to measure the health of a population will need to take it into account. But there are special difficulties about doing so. This chapter explains why. Measuring health is one thing and valuing health is another. Which should we aim at? I assume we are interested in a person ‘s health as a component of her well-being. Well-being consists of various different sorts of goods, such as health, comfortable living, freedom from oppression, and so on. So we are interested in health as one good thing to be set alongside others. We are therefore interested in how good it is, which means we are interested in its value. This chapter is about valuing health—measuring the value of health—rather than measuring the quantity of health. Specifically, it is about the value of longevity.
Crime-Related Amnesia
Authors: Christianson Sven Å , Merckelbach Harald , Kopelman Michael
Published: October 2023

Crime-related amnesia refers to a claim raised by offenders that they cannot remember 7.01 essential details of the crime they have committed. There are two obvious legal reasons why it is important to explore crime-related amnesia. To begin with, amnesia raises the issue of automatism, which refers to criminal behaviour that is executed unconsciously and without intent. Second, amnesia bears relevance to the issue of competence to stand trial.
Informing and Consulting Employees
Authors: Squire Nicholas , Healy Kathleen , Broadbent Joanna
Published: October 2023

A comprehensive and practical analysis of the Information and Consultation of Employees Regulations 2004. The Regulations, which come into force on a rolling basis from spring 2005, represent a fundamental and complex change to employee relations in the UK, requesting companies to set up domestic works councils and inform and consult them about a wide range of business issues. This book provides a detailed explanation of the contents of the regulations, as well as offering expert guidance on their implications for employers in practice. The text explains the operation of the new law on a mechanical level and provides expert guidance on its implications. It addresses the practical concerns and questions of those affected - when do the regulations apply; how is the information and consultation process started; how does an employer negotiate; when should a voluntary procedure be considered; what does 'information and consultation' mean; how is confidential information best treated; how will the new be procedure enforced; how does it interact with existing laws on redundancy and TUPE? The Narrative is supported by flowcharts and sample procedures, together with the full text of relevant materials (the Regulations, the Directive, and DTI guidance).
Introduction
Authors: Hamilton Alastair
Published: October 2023

The Copts once formed a vast Christian community which stretched up the Nile deep into Nubia, with churches in the Egyptian towns and monasteries in the Nile Delta, along the great river and in the Eastern and Western Deserts. Part of the far broader movement of ‘Mono- physites’, consisting of Armenians and Syrian Jacobites in the north and Ethiopians, in communion with the Egyptians, in the south, the Church of Alexandria broke away from the main Christian Church after the Council of Chalcedon in 451. Even if the Copts became a minority at some time after the Muslim occupation of Egypt in the seventh century, they have always been an integral part of the Egyptian world.
Gamma-ray emission in the Seyfert galaxy NGC 4151: Investigating the role of jet and coronal activities
Authors: Inoue Yoshiyuki , Khangulyan Dmitry
Published: October 2023

NGC 4151, a nearby Seyfert galaxy, has recently been reported to emit gamma-rays in the GeV range, posing an intriguing astrophysical mystery. The star formation rate of NGC 4151 is too low to explain the observed GeV flux, but the galaxy is known for its coronal activity in X-ray and jet activity in radio. We propose that either the combination of these two activities or the jet activity alone can account for the gamma-ray spectrum. An energy-dependent variability search will allow one to distinguish between the two scenarios, as the coronal component can only contribute at energies of ≲1 GeV. Our analysis also indicates that it might still be difficult to see coronal neutrinos from the apparently X-ray brightest Seyfert NGC 4151 with current-generation neutrino observatories.
Evaluation of the rate and pattern of suicide attempts and deaths by self-poisoning among Egyptians before and during the COVID-19 pandemic
Authors: Elhawary Amira Elsayed , Lashin Heba Ibrahim , Fnoon Noha Fawzy , Sagah Ghada Attia
Published: October 2023

Background

Concerns about increased suicidal attempts, especially by self-poisoning as a consequence of Coronavirus disease 2019 (COVID-19) pandemic have been raised worldwide.

Aim of the study

This study aimed to evaluate the rate and pattern of suicide attempts and deaths by self-poisoning among patients admitted to Tanta University Poisoning Control Center one year before and following COVID-19 pandemic declaration in Egypt. It was conducted on the medical records of 3,200 poisoned patients, from March 2019 to February 2021. Demographic, toxicological data and patients’ outcomes were collected.

Results

During the pandemic year, 63.8% of total admitted patients alleged suicidal self-poisoning. Adults significantly decreased from 59% to 52.3%, while adolescents significantly increased from 34.6% to 41.7%. Monthly numbers of admitted suicidal self-poisoned patients significantly decreased during the lockdown but significantly increased from 7% to 26.5%, during the peak of the second wave of the pandemic as well as suicidal deaths (increased from 1.9% to 21.2%). Suicidal self-poisoning in females increased late in the pandemic year and suicidal self-poisoning deaths were significantly reported from rural areas (P = 0.025). The delay time was significantly longer, length of hospital stay was significantly shorter, intensive care unit admission rates and suicidal deaths were significantly increased during the pandemic year (P < 0.001, 0.026, <0.001, <0.001, respectively). Phosphides were the most commonly used poison for committing suicide and suicidal deaths during this year.

Conclusion

Psychological support should be directed to females and adolescents, especially from rural areas in Egypt to help reduce suicidal attempts and deaths by self-poisoning during any future pandemics and lockdowns.
Real-time Three-dimensional Echocardiography: A Feasible and Accurate Method for Measuring Right Ventricular Function in Pulmonary Hypertension
Authors: Ahmad Ashfaq , Zou Yifan , Zhang Peng , Li Lingling , Wang Xiaoyu , Mohsen Ahmed Ali , Wang Yousen , Fan Fenling
Published: October 2023

Right ventricular function is independently associated with poor clinical outcomes in patients with various cardiovascular diseases including pulmonary hypertension (PH). The complex geometry and mode of contractility means the right ventricle (RV) inlet and outlet are not in line; hence, 2-dimensional echocardiography fails to accurately quantify RV volumes and function in such patients. Three-dimensional echocardiography (3DE) allows for reliable and reproducible quantification of RV volumes and function by overcoming these limitations of conventional echocardiography. This review focuses on the 3DE assessment of RV function in patients with PH and discusses the following points: (1) acquiring an RV data set for 3DE imaging, including details of all available 3DE systems and software utilized in daily practice; (2) the reliability and feasibility of RV remodeling measured with 3DE with different modalities in patients with PH; and (3) the prognostic value of 3DE-derived RV function in such patients.
Durvalumab-induced Pure White Cell Aplasia
Authors: Lin Ji , Rodriguez-Martinez Paola , Oo Thein Hlaing , E Shuyu , Jorgensen Jeffrey , Rojas-Hernandez Cristhiam M.
Published: October 2023

Immune checkpoint inhibitors (ICI) have gained approval as a treatment for a wide array of cancers. Their mechanism of action prevents the inactivation of cytotoxic T-cells, allowing for its cytotoxic response. However, the upregulation of the immune system by ICI also leads to many undesired adverse events known as immune-related adverse events (irAEs), ranging from dermatologic manifestations, such as rashes, to inflammation of mucous membranes, to hematologic toxicities. Here, we report a case of ICI-induced pure white cell aplasia, secondary to the agent durvalumab, which responded to treatment with filgrastim, prednisone, and cyclosporine. ICI-neutropenia accounts for 0.6% of all irAEs or 17% of hematologic irAEs. Given the rarity of hematologic irAEs, the available treatment guidelines are based on expert consensus. As ICI becomes more widely used, we can expect an increase in the prevalence of rare irAEs as well. This case report aims to present a rare side effect of ICI and demonstrate its response to immunosuppressive therapy while providing guidance for future clinicians and further elucidating the mechanism behind these irAEs.
EUS-guided radiofrequency ablation plus chemotherapy versus chemotherapy alone for pancreatic cancer (ERAP): An observational open-label pilot study
Authors: Kongkam Pradermchai , Tiankanon Kasenee , Seo Dong Wan , Luangsukrerk Thanawat , Sriuranpong Virote , Nantavithya Chonnipa , Jantarattana Trirat , Cañones Arlyn , Kerr Stephen J. , Tantitanawat Kittithat , Angsuwatcharakon Phonthep , Ridtitid Wiriyaporn , Kullavanijaya Pinit , Rerknimitr Rungsun
Published: October 2023

Background

No study has compared EUS-guided radiofrequency ablation (EUS-RFA) plus systemic chemotherapy (CMT) with CMT alone for unresectable pancreatic ductal adenocarcinoma.

Methods

This study compared the results of treatment in patients receiving EUS-RFA plus concomitant CMT (group A; n = 14) with those receiving CMT (group B; n = 14) as a pilot study.

Results

From July 2017 to August 2018, 4 and 2 patients from groups A and B, respectively, withdrew from the study because of progression of the disease. In total, 10 and 12 patients from groups A and B, respectively, completed the study. All 30 EUS-RFA procedures were successful. Mean maximal tumor diameter before treatment of group A (n = 10) versus B (n = 12) was 62.2 ± 21.0 versus 50.5 ± 22.0 mm, respectively (P = not significant). After treatment, no statistically significant difference in mean maximal tumor diameter was found between both groups. However, in group B, mean maximal tumor diameter was significantly increased from 50.5 ± 22.0 to 56.3 ± 18.7 mm, respectively (P = 0.017). Tumor necrosis occurred in group A versus B at 10 of 10 (100%) versus 6 of 12 (50%) patients, respectively (P = 0.014). After treatment, group A patients could reduce the mean narcotic pain drug dosage at 26.5 mg of morphine equivalent per day (from 63.6 to 37.1 mg, P = 0.022), whereas group B patients could not reduce the dosage of pain-controlled medication. No statistically significant difference in 6-month mortality rate was found. In group A, 1 procedure-related nonsevere adverse event (n = 1 of 30 [3.3%]) occurred in 1 patient (n = 1 of 14 [7.1%]).

Conclusions

In this study, the mean tumor diameter of group B was significantly increased after the treatment. Group A had a significantly higher rate of necrosis of tumor and required less narcotic.
Device malfunctions with use of EUS–guided fine-needle biopsy devices: Analysis of the MAUDE database
Authors: Singh Achintya D. , Madhu Deepak , Pathiyil Mythili Menon , Ramai Daryl , Mohan Babu P. , Shah Bhavesh , Adler Douglas G.
Published: October 2023

Background

The safety of endoscopic ultrasound–guided tissue acquisition through fine-needle biopsy devices is well-established in clinical trials. The real-world experience of using these devices is not known. The authors analyzed the postmarketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to answer this question.

Methods

The Food and Drug Administration MAUDE database from January 2012 to June 2022 was accessed to evaluate for device malfunctions and patient-related adverse consequences of these malfunctions.

Results

There were 344 device-related issues. Most issues were due to detachment or breakage of the device (n = 185 [53.7%]). Seventy-six of the breakages (40.8%) occurred during the procedure, whereas 89 cases (47.8%) occurred while removing the needle from the endoscope. The most common site of tissue biopsy at the time of needle breakage was the pancreas (44 [23.8%]).

The common patient-related adverse events were retained foreign body (n = 50 [14.5%]) followed by bleeding (16, 4.6%). Six patients (3.4%) required a second intervention for removal of the retained foreign bodies including surgery in 2 cases. The device breakage damaged the endoscope in 3 cases (1.7%), and there was 1 case of needlestick injury to the nurse.

Conclusion

The fine-needle biopsy devices can be associated with needle breakage and bending; these adverse events were not previously reported. Needle breakages can result in a retained foreign body that may require additional procedures including surgery. These real-world findings from the MAUDE database may inform clinical decisions and help improve clinical outcomes.
Mishaps with EUS–guided lumen-apposing metal stents in therapeutic pancreatic EUS: management and prevention
Authors: Braden Barbara , Hocke Michael , Selvaraj Emmanuel , Kaushal Kanav , Möller Kathleen , Ignee Andrè , Vanella Giuseppe , Arcidiacono Paolo Giorgio , Teoh Anthony , Larghi Alberto , Rimbas Mihai , Hollerbach Stefan , Napoleon Bertrand , Dong Yi , Dietrich Christoph F.
Published: October 2023

EUS–guided interventions have become widely accepted therapeutic management options for drainage of peripancreatic fluid collections. Apart from endosonographic skills, EUS interventions require knowledge of the endoscopic stenting techniques and familiarity with the available stents and deployment systems. Although generally safe and effective, technical failure of correct stent positioning or serious adverse events can occur, even in experts' hands.

In this article, we address common and rare adverse events in transmural EUS-guided stenting, ways to prevent them, and management options when they occur. Knowing the risks of what can go wrong combined with clinical expertise, high levels of technical skills, and adequate training allows for the safe performance of EUS-guided drainage procedures. Discussing the procedural risks and their likelihood with the patient is a fundamental part of the consenting process.
Triage method for endometrial biopsy in postmenopausal women: a multicenter retrospective cohort study
Authors: Shen Yufei , Li Lucia , Wang Hailong , Hu Yi , Deng Xi , Lian Xiaoling , Tan Yanlin , Liang Liling , Zhang Yu , Yang Wenqing
Published: October 2023

Objective

To identify the optimal triage procedure for endometrial biopsies in postmenopausal women.

Methods

The clinical information of 470 postmenopausal women with endometrial biopsy results and postmenopausal bleeding (PMB) and/or transvaginal ultrasonography (TVU) abnormalities were collected at the gynecology departments of four general hospitals from March 2021 to March 2022. In the validation cohort, 112 women with TVU abnormalities who underwent endometrial biopsy at Xiangya hospital between May 2022 and May 2023 were enrolled. The endpoint was the final diagnosis based on hysteroscopy reports and biopsy pathology results. The sensitivity, specificity, positive predictive value, and negative predictive value were compared among the three triage methods. A nomogram prediction model was developed and validated.

Results

Referring women with TVU abnormalities for endometrial biopsy identified 100% malignant/premalignant lesions despite low specificity (19.7%). Among women with measurable endometrial thickness (ET), we suggest that the ET cutoff value for biopsy referral should be ≥4 mm. The PMB (odds ratio [OR], 3.241; 95% confidence interval [CI], 1.073-9.789), diabetes (OR, 10.915; 95% CI, 3.389-35.156), and endometrial thickness (OR, 1.277; 95% CI, 1.156-1.409) were independent predictive factors for endometrial (pre)malignancy. A nomogram prediction model was constructed (area under curve [AUC] = 0.802, 95% CI: 0.715 to 0.889). The ideal cutoff point was 22.5, with a sensitivity of 100.0% and a specificity of 15.7%. The external validation achieved an AUC of 0.798 (95% CI, 0.685-0.911).

Conclusions

It was possible to refer all postmenopausal women with TVU abnormity (ET ≥ 4 mm or other abnormal findings) for endometrial biopsy. Among women with TVU abnormalities, a nomogram was constructed, and a score greater than 22.5 suggested the need for referral for endometrial biopsy, while a score less than 22.5 suggested that regular follow-up was required, further improving the triage procedure.
Discontinuation of hormone therapy and bone mineral density: does physical activity modify that relationship?
Authors: Sheedy Alyssa N. , Wactawski-Wende Jean , Hovey Kathleen M. , LaMonte Michael J.
Published: October 2023

Objective

Hormone therapy can positively impact bone mineral density after menopause. We explored bone mineral density change in postmenopausal women who discontinued hormone therapy after the Women's Health Initiative landmark 2002 trial results were published. We secondarily explored whether usual physical activity modified the results.

Methods

Postmenopausal women participating in the Buffalo OsteoPerio study with information on hip bone density, hormone therapy use, and self-reported physical activity at two time points (1997-2001; 2002-2007) were included (N = 961). Hormone therapy included three groups according to use at baseline and year 5 (non/non; current/non; current/current).

Results

At baseline (mean age, 65.9 years; SD, 6.7 years), 480 women were not using hormone therapy, while 481 were current users. Between the baseline and 5-year visits, 336 women using hormone therapy discontinued. Baseline total hip bone density was highest in current users. After 5 years, those who continued hormone therapy exhibited no bone loss; those who discontinued exhibited the greatest loss at the total hip of −0.021 gm/cm2. Women who never used hormone therapy exhibited some loss of −0.012 gm/cm2. Usual physical activity did not appreciably impact change in bone density in any group.

Conclusions

This prospective observational study explored the 5-year change in bone mineral density among older postmenopausal women after the landmark 2002 hormone therapy trial findings were released. We found bone density decreased in never-users and in women who discontinued use. Bone density was maintained in current users. Although usual physical activity did not mitigate bone loss, targeted physical activity regimens should be investigated.
Prevalence and Economic Burden of Fuchs Endothelial Corneal Dystrophy in the Medicare Population in the United States
Authors: Singh Rohan Bir , Parmar Uday Pratap Singh , Kahale Francesca , Jeng Bennie H. , Jhanji Vishal
Published: October 2023

Purpose:

The aim of this study was to assess the prevalence and economic burden of Fuchs endothelial corneal dystrophy (FECD) in patients older than 65 years in the United States.

Methods:

A retrospective analysis of the Medicare data reported to the Vision and Eye Health Surveillance System including patients diagnosed with FECD between 2014 and 2019 was performed. The crude prevalence rate of FECD was assessed and extrapolated to estimate the total case burden in the United States. The prevalence data were further compared between men and women and different racial groups. In addition, the economic burden was computed using inflation-adjusted direct costs of treatment to patients.

Results:

The Medicare database included 25,432,700 patients older than 65 years. The national prevalence of FECD in this population cohort was calculated to be 1.12% in 2019. In 2019, FECD case burden in Medicare patients older than 65 years was 284,846 and total estimated FECD case count in the country in this age group was 591,226. FECD prevalence was significantly higher in women as compared to men during the 6-year period evaluated in this study. The intergroup comparison revealed that FECD prevalence in the White population was significantly higher than all other racial groups (P < 0.0001). The total inflation-adjusted economic burden of FECD in the United States in 2019 was USD 291.648 million and has increased from USD 243.998 million over the 6-year study period.

Conclusions:

The estimated prevalence of FECD in the individuals older than 65 years is 1.12% in the United States. FECD prevalence is significantly higher in women and White population compared with other ethnicities.
Platelet lifespan and mechanisms for clearance
Authors: An Olga , Deppermann Carsten
Published: October 2023

Purpose of review

Activated or aged platelets are removed from circulation under (patho)physiologic conditions, the exact mechanism of platelet clearance under such conditions remains unclear and are currently being investigated. This review focuses on recent findings and controversies regarding platelet clearance and the disruption of platelet life cycle.

Recent findings

The platelet life span is determined by glycosylation of platelet surface receptors with sialic acid. Recently, it was shown that platelet activation and granule release leads to desialylation of glycans and accelerated clearance of platelets under pathological conditions. This phenomenon was demonstrated to be a main reason for thrombocytopenia being a complication in several infections and immune disorders.

Although we have recently gained some insight into how aged platelets are cleared from circulation, we are still not seeing the full picture. Further investigations of the platelet clearance pathways under pathophysiologic conditions are needed as well as studies to unravel the connection between platelet clearance and platelet production.
Liver Biopsy Leads to Serendipitous Diagnosis of Glycogen Storage Disease Type IX in a Patient With Fontan-Associated Liver Disease
Authors: Hyer Erin , Alexander Caitlin , Rand Elizabeth B. , Diamond Tamir
Published: October 2023

Fontan-associated liver disease (FALD) is a form of congestive hepatopathy resulting from Fontan palliation procedures in patients with single ventricle physiology. Although there is variation between pediatric centers, the surveillance for FALD may include liver biopsies for assessment of degree of fibrosis. Our report describes a 7-year-old girl with hypoplastic left heart syndrome who underwent Fontan palliation at age 2, and presented with disproportionate hepatomegaly, elevated liver enzymes, and increased stiffness on liver elastography. Liver biopsy showed diffuse hepatocellular cytoplasmic glycogenation, leading to the diagnosis of glycogen storage disease IX. This case demonstrates the importance of investigating unexpected physical exam findings and the potential for serendipitous benefit of liver biopsy in FALD.