bluuebunny/crossref_metadata_2025 huggingface dataset:
The consensus-clarifying role of deliberative mini-publics in constitutional amendment: A reply to Oran Doyle and Rachael Walsh
Authors: Carolan Eoin , Glennon Seána
Published: March 2024

Oran Doyle and Rachael Walsh’s article “Constitutional Amendment and Public Will Formation: Deliberative Mini-Publics as a Tool for Consensus Democracy” is a welcome addition to the literature on Ireland’s efforts to integrate deliberative citizen-involved structures into its constitutional amendment process. We agree that the Citizens’ Assembly on abortion played a role in shaping the legal position that ultimately emerged in Irish law; we disagree, however, with the authors’ account of how that occurred. In particular, we do not believe the Irish experience supports the claim that deliberative mini-publics help to build the consensus for constitutional amendment. On the contrary, on each occasion where amendment processes incorporating a deliberative element have succeeded in Ireland, there has been clear evidence of an enduring pre-existing public consensus over the core of the amendment proposed. We suggest that the potential value of deliberative mini-publics might more accurately be seen as one of consensus-clarifying rather than consensus-building. While a mini-public may be unlikely to create a novel constitutional consensus, it can have a significant—potentially causal—role in converting a general and disparate desire for change into a specific form. That, in our view, is what occurred with the repeal and replacement of Ireland’s constitutional position on abortion. We argue that a careful analysis of the process provides tangible evidence that the Assembly affected the outcome in clear and specific ways: its significant impact was not in creating a constitutional consensus that had previously been absent, but rather, we argue, in putting on the agenda, and coalescing support around, a specific form of legal change.
Dissipativity-based consensus for P-one-sided Lipschitz multi-agent systems via ILC
Authors: Gu Panpan , Zhao Shiji , Chen Liping , Lin Yong , Wang Jiajia , Tian Senping
Published: March 2024

Based on dissipativity theory, the consensus via iterative learning control (ILC) is investigated for P-one-sided Lipschitz (P-OSL) nonlinear multi-agent systems (MASs). This paper only considers the P-OSL condition without using the quadratically inner-bounded constraint. Firstly, the ILC protocol is designed for such nonlinear MASs. Then, the convergence conditions of the consensus algorithm under a connected communication graph are presented from the viewpoint of dissipativity. It is shown that, on a fixed finite-time interval, the proposed algorithm can achieve perfect consensus tracking. Finally, two examples are constructed to show the effectiveness of the proposed method.
How Expert Committees Become Group Agents: Self-Legitimation in the Committee on the Rights of Persons with Disabilities
Authors: Heupel Monika , Joger Marlene
Published: March 2024

The UN human rights treaty bodies—groups of experts tasked with monitoring how states implement international human rights conventions—are increasingly portrayed as powerful collective entities with agency. This article focuses on one mechanism that helps collectives of individuals become group agents, namely internal self-legitimation. By internal self-legitimation, we mean practices such as narratives and rituals enacted by a group that ascribe legitimacy to it in the eyes of its members and are key to building common identification among them. We explore how self-legitimation facilitates group agency on the basis of a case study on the Committee on the Rights of Persons with Disabilities (CRPD), obtaining empirical evidence for the study from content analysis of CRPD documents and interviews with former and present members. We show that specific legitimation narratives—related to the moral value of the committee’s task and the moral integrity of its members, the fairness of the CRPD’s procedures, and the committee’s association with other presumably legitimate institutions—facilitated identity-building and helped the CRPD to develop the characteristics of a group agent and take decisions. Finally, we explore the conditions on which the findings might be applicable to other human rights treaty bodies.
Neoliberalizing Design and the State: The Political Origins of Australian Design Policy and Design Education Reform, 1987–1991
Authors: Stein Jesse Adams , Moore Enya
Published: March 2024

This article draws attention to the state involvement in national design agendas through the example of Australia’s Hawke Government, focusing on 1987 to 1991. It unearths the origins of Australian design policy and reforms to design education within an emerging neoliberal political economy in the 1980s. Drawing on gray literature, the article reveals how this was a period of intensive political rhetoric regarding design and design education, during which the government—led by the Australian Labor Party—specifically promoted the role of design in industry policy. Better design, it was hoped, could enhance the international competitiveness of Australian-made exports, thereby addressing trade imbalances and boosting manufacturing. This increasing emphasis on design occurred in a highly politicized environment and in tandem with the restructuring of Australian tertiary education (known as the “Dawkins revolution”), alongside the discursive notion of Australia as a “clever country.” In essence, this government-led politicization of design meant that Australian design was understood as operating exclusively to “meet the needs of industry,” with industrial design prioritized. While hindsight indicates that this strategy was unsuccessful in enhancing manufacturing, the legacy of this neoliberal framing of design continues to reverberate, particularly in mainstream understandings of design.
In situ stress prediction method for decoupled overburden pressure under tectonic constraints
Authors: Zhou Hao , Zong Zhaoyun , Yang Yaming , Luo Kun
Published: March 2024

The prediction of in situ stress based on azimuthal seismic data has extensive use in horizon crushability evaluation. Nonetheless, existing in situ stress seismic prediction models do not consider overburden pressure and tectonic strain, which limit the prediction accuracy. To this end, we propose a decoupled overburden pressure in situ stress prediction method under tectonic constraints. The key to this method is to consider that the overburden pressure could act on the rock skeleton and pore fluid, i.e. generating effective pressure and pore pressure; the pore pressure can be estimated using Eaton's method, and then the effective stress can be obtained. The relationship between tectonic strain and effective pressure is constructed based on Hooke's law, where tectonic strain can be calculated from curvature attributes extracted from seismic data. Introducing pore pressure and deriving a model for calculating the maximum and minimum horizontal stresses and the difference in horizontal stress ratio for orthotropic media (OA). When the Thomson anisotropy parameters and the pore pressure are neglected, the proposed model can be degraded to a conventional horizontal transverse isotropy medium in situ stress prediction model, which proves the validity of the model. The results of sensitivity analysis experiments affirm the need to decouple overburden pressure and account for tectonic strain when predicting in situ stress reasonably. Finally, single-well and azimuthal seismic prediction were carried out by using the a priori information from well logging and seismic data.
Euphohelioscopin A enhances NK cell antitumor immunity through GSDME-triggered pyroptosis
Authors: Gong Chenyuan , Mu Hongyan , Luo Jiaojiao , Zhang Rujun , Hu Dan , Chen Zhenhua , Fang Cheng , Chen Zhongxian , Zhu Xinxue , Yao Chao , Wang Lixin , Zhou Yufu , Zhao Weimin , Zhu Shiguo
Published: March 2024

Immune evasion by cancer cells poses a significant challenge for natural killer cell–based immunotherapy. Pyroptosis, a newly discovered form of programmed cell death, has shown great potential for enhancing the antitumor immunity of natural killer cells. Consequently, targeting pyroptosis has become an attractive strategy for boosting natural killer cell activity against cancer. In this study, various assays were conducted, including natural killer cell cytotoxicity assays, flow cytometry, xenograft tumor models, real-time polymerase chain reaction, and enzyme-linked immunosorbent assay, to assess natural killer cell–mediated cell killing, as well as gene and protein expressions. The results indicated that euphohelioscopin A, a potential pyroptosis activator, enhances natural killer cell–mediated lysis of tumor cells, resulting in inhibiting tumor growth that could be reversed by natural killer cell depletion. Furthermore, we found that euphohelioscopin A significantly enhanced IFNγ production in natural killer cells and synergistically upregulated GSDME with IFNγ in cancer cells. Euphohelioscopin A also increased the cleavage of GSDME, promoting granzyme B–induced pyroptosis, which could be reversed by GSDME knockdown and IFNγ blockade. Overall, the findings suggested that euphohelioscopin A enhanced natural killer cell–mediated killing of cancer cells by triggering pyroptosis, making euphohelioscopin A a promising pyroptosis activator with great potential for use in natural killer cell–based cancer immunotherapy.
Impact of risk-based therapy on late morbidity and mortality in neuroblastoma survivors: a report from the Childhood Cancer Survivor Study
Authors: Friedman Danielle Novetsky , Goodman Pamela J , Leisenring Wendy M , Diller Lisa R , Cohn Susan L , Howell Rebecca M , Smith Susan A , Tonorezos Emily S , Wolden Suzanne L , Neglia Joseph P , Ness Kirsten K , Gibson Todd M , Nathan Paul C , Turcotte Lucie M , Weil Brent R , Robison Leslie L , Oeffinger Kevin C , Armstrong Gregory T , Sklar Charles A , Henderson Tara O
Published: March 2024

Background

Early efforts at risk-adapted therapy for neuroblastoma are predicted to result in differential late effects; the magnitude of these differences has not been well described.

Methods

Late mortality, subsequent malignant neoplasms (SMNs), and severe/life-threatening chronic health conditions (CHCs), graded according to CTCAE v4.03, were assessed among 5-year Childhood Cancer Survivor Study (CCSS) survivors of neuroblastoma diagnosed 1987-1999. Using age, stage at diagnosis, and treatment, survivors were classified into risk groups (low [n = 425]; intermediate [n = 252]; high [n = 245]). Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) of SMNs were compared with matched population controls. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals for CHC compared with 1029 CCSS siblings.

Results

Among survivors (49.8% male; median age = 21 years, range = 7-42; median follow-up = 19.3 years, range = 5-29.9), 80% with low-risk disease were treated with surgery alone, whereas 79.1% with high-risk disease received surgery, radiation, chemotherapy ± autologous stem cell transplant (ASCT). All-cause mortality was elevated across risk groups (SMRhigh = 27.7 [21.4-35.8]; SMRintermediate = 3.3 [1.7-6.5]; SMRlow = 2.8 [1.7-4.8]). SMN risk was increased among high- and intermediate-risk survivors (SIRhigh = 28.0 [18.5-42.3]; SIRintermediate = 3.7 [1.2-11.3]) but did not differ from the US population for survivors of low-risk disease. Compared with siblings, survivors had an increased risk of grade 3-5 CHCs, particularly among those with high-risk disease (HRhigh = 16.1 [11.2-23.2]; HRintermediate = 6.3 [3.8-10.5]; HRlow = 1.8 [1.1-3.1]).

Conclusion

Survivors of high-risk disease treated in the early days of risk stratification carry a markedly elevated burden of late recurrence, SMN, and organ-related multimorbidity, whereas survivors of low/intermediate-risk disease have a modest risk of late adverse outcomes.
Do preinjury life events moderate the outcomes of mild traumatic brain injuries in children? An A-CAP Study
Authors: Dharsee Safira , Tang Ken , Beauchamp Miriam H , Craig William , Doan Quynh , Freedman Stephen B , Gravel Jocelyn , Zemek Roger , Yeates Keith Owen
Published: March 2024

Objective

To examine preinjury life events as moderators of postconcussive symptoms (PCS) and quality of life (QoL) in children with pediatric mild traumatic brain injury (mTBI) versus orthopedic injury (OI).

Methods

Participants were 633 children with mTBI and 334 with OI, ages 8–16.99, recruited from 5 pediatric emergency departments and followed for 6 months postinjury as part of a prospective cohort study. Preinjury life events were measured retrospectively using the Child and Adolescent Survey of Experiences, PCS using the Health and Behavior Inventory (HBI) and Post-Concussion Symptom Interview (PCS-I), and QoL using the Pediatric Quality of Life Inventory (PedsQL). Analyses involved longitudinal regression using restricted cubic splines, with group, positive and negative life events, and time as primary predictors. Covariates included age, sex, race, socioeconomic status, preinjury history (i.e., headache, migraine, previous concussion), and parent-rated retrospective PCS-I, HBI, and PedsQL scores.

Results

PCS and QoL were worse after mTBI than OI, but group differences declined with time (all p < .001). Group differences in PCS were larger at higher levels of positive life events, which predicted lower PCS (p= .03 to p < .001) and higher QoL (p = .048) after OI but not after mTBI. Negative life events predicted worse PCS and QoL in both groups (p = .002 to p < .001).

Conclusions

Preinjury positive life events moderate outcomes after pediatric injury, with a protective effect seen in OI but not in mTBI. Negative life events are consistently associated with worse outcomes regardless of injury type.
Automatic Texture Alignment by Optimization Method
Authors: Ott Alois C , Weißensteiner Irmgard , Arnoldt Aurel R , Österreicher Johannes A , Papenberg Nikolaus P
Published: March 2024

Microstructure analysis via electron backscatter diffraction has become an indispensable tool in materials science and engineering. In order to interpret or predict the anisotropy in crystalline materials, the texture is assessed, e.g. via pole figure diagrams. To ensure a correct characterization, it is crucial to align the measured sample axes as closely as possible with the manufacturing process directions. However, deviations are inevitable due to sample preparation and manual measurement setup. Postprocessing is mostly done manually, which is tedious and operator-dependent. In this work, it is shown that the deviation can be calculated using the contour of the crystal orientations. This can also be utilized to define the axis symmetry of pole figure diagrams through an objective function, allowing for symmetric alignment by minimization. Experimental textures of extruded profiles and synthetically generated textures were used to demonstrate the general applicability of the method. It has proven to work excellently for deviations of up to 5∘, which are typical for careful manual sample preparation and mounting. While the performance of the algorithm is reduced with increasing misalignment, good results have also been obtained for deviations up to 15∘.
The FLAMINGO project: baryonic impact on weak gravitational lensing convergence peak counts
Authors: Broxterman Jeger C , Schaller Matthieu , Schaye Joop , Hoekstra Henk , Kuijken Konrad , Helly John C , Kugel Roi , Braspenning Joey , Elbers Willem , Frenk Carlos S , Kwan Juliana , McCarthy Ian G , Salcido Jaime , van Daalen Marcel P , Vandenbroucke Bert
Published: March 2024

Weak gravitational lensing convergence peaks, the local maxima in weak lensing convergence maps, have been shown to contain valuable cosmological information complementary to commonly used two-point statistics. To exploit the full power of weak lensing for cosmology, we must model baryonic feedback processes because these reshape the matter distribution on non-linear and mildly non-linear scales. We study the impact of baryonic physics on the number density of weak lensing peaks using the FLAMINGO cosmological hydrodynamical simulation suite. We generate ray-traced full-sky convergence maps mimicking the characteristics of a Stage IV weak lensing survey. We compare the number densities of peaks in simulations that have been calibrated to reproduce the observed galaxy mass function and cluster gas fraction or to match a shifted version of these, and that use either thermally driven or jet active galactic nucleus feedback. We show that the differences induced by realistic baryonic feedback prescriptions (typically 5–30 per cent for κ = 0.1–0.4) are smaller than those induced by reasonable variations in cosmological parameters (20–60 per cent for κ = 0.1–0.4) but must be modelled carefully to obtain unbiased results. The reasons behind these differences can be understood by considering the impact of feedback on halo masses, or by considering the impact of different cosmological parameters on the halo mass function. Our analysis demonstrates that, for the range of models we investigated, the baryonic suppression is insensitive to changes in cosmology up to κ ≈ 0.4 and that the higher κ regime is dominated by Poisson noise and cosmic variance.
Confronting compositional confusion through the characterisation of the sub-Neptune orbiting HD 77946
Authors: Palethorpe L , John A Anna , Mortier A , Davoult J , Wilson T G , Rice K , Cameron A C , Alibert Y , Buchhave L A , Malavolta L , Cadman J , López-Morales M , Dumusque X , Silva A M , Quinn S N , Van Eylen V , Vissapragada S , Affer L , Charbonneau D , Cosentino R , Ghedina A , Haywood R D , Latham D , Lienhard F , Fiorenzano A F Martínez , Pedani M , Pepe F , Pinamonti M , Sozzetti A , Stalport M , Udry S , Vanderburg A
Published: March 2024

We report on the detailed characterization of the HD 77946 planetary system. HD 77946 is an F5 (M* = 1.17 M⊙, R* = 1.31 R⊙) star, which hosts a transiting planet recently discovered by NASA’s Transiting Exoplanet Survey Satellite (TESS), classified as TOI-1778 b. Using TESS photometry, high-resolution spectroscopic data from HARPS-N, and photometry from CHEOPS, we measure the radius and mass from the transit and RV observations, and find that the planet, HD 77946 b, orbits with period Pb = $6.527282_{-0.000020}^{+0.000015}$ d, has a mass of Mb = 8.38 ± 1.32 M⊕, and a radius of $R_{\rm b} = 2.705_{-0.081}^{+0.086}$R⊕. From the combination of mass and radius measurements, and the stellar chemical composition, the planet properties suggest that HD 77946 b is a sub-Neptune with a ∼1% H/He atmosphere. However, a degeneracy still exists between water-world and silicate/iron-hydrogen models, and even though interior structure modelling of this planet favours a sub-Neptune with a H/He layer that makes up a significant fraction of its radius, a water-world composition cannot be ruled out, as with $T_{\rm eq}~= 1248^{+40}_{-38}~$K, water may be in a supercritical state. The characterisation of HD 77946 b, adding to the small sample of well-characterised sub-Neptunes, is an important step forwards on our journey to understanding planetary formation and evolution pathways. Furthermore, HD 77946 b has one of the highest transmission spectroscopic metrics for small planets orbiting hot stars, thus transmission spectroscopy of this key planet could prove vital for constraining the compositional confusion that currently surrounds small exoplanets.
Universal origin of glassy relaxation as recognized by configuration pattern matching
Authors: Yu Hai-Bin , Gao Liang , Gao Jia-Qi , Samwer Konrad
Published: March 2024

Relaxation processes are crucial for understanding the structural rearrangements of liquids and amorphous materials. However, the overarching principle that governs these processes across vastly different materials remains an open question. Substantial analysis has been carried out based on the motions of individual particles. Here, as an alternative, we propose viewing the global configuration as a single entity. We introduce a global order parameter, namely the inherent structure minimal displacement (IS Dmin), to quantify the variability of configurations by a pattern-matching technique. Through atomic simulations of seven model glass-forming liquids, we unify the influences of temperature, pressure and perturbation time on the relaxation dissipation, via a scaling law between the mechanical damping factor and IS Dmin. Fundamentally, this scaling reflects the curvature of the local potential energy landscape. Our findings uncover a universal origin of glassy relaxation and offer an alternative approach to studying disordered systems.
The super-cycle of the global land-monsoon system
Authors: Hu Yongyun
Published: March 2024

The global land-monsoon system demonstrates super-cycles in both area and precipitation intensity in the Phanerozoic. The cyclicity of the global land-monsoon closely follows the supercontinent cycle, indicating the governance of continental configurations on the global land-monsoon over tectonic timescales.
Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998–2020
Authors: Nomah Daniel K , Jamarkattel Suju , Bruguera Andreu , Moreno-Fornés Sergio , Díaz Yesika , Alonso Lucía , Aceitón Jordi , Llibre Josep M , Domingo Pere , Saumoy Maria , Homar Francesc , Fanjul Francisco , Navarro Jordi , de la Mora Lorena , Knobel Hernando , Orti Amat , Martin-Iguacel Raquel , Miró José M , Casabona Jordi , Reyes-Urueña Juliana
Published: March 2024

Background

Effective antiretroviral therapy (ART) has substantially reduced acquired immunodeficiency syndrome (AIDS)-related deaths, shifting the focus to non-AIDS conditions in people living with human immunodeficiency virus (HIV) (PLWH). We examined mortality trends and predictors of AIDS- and non-AIDS mortality in the Population HIV Cohort from Catalonia and Balearic Islands (PISCIS) cohort of PLWH from 1998 to 2020.

Methods

We used a modified Coding Causes of Death in HIV protocol, which has been widely adopted by various HIV cohorts to classify mortality causes. We applied standardized mortality rates (SMR) to compare with the general population and used competing risks models to determine AIDS-related and non-AIDS-related mortality predictors.

Results

Among 30 394 PLWH (81.5% male, median age at death 47.3), crude mortality was 14.2 per 1000 person-years. All-cause standardized mortality rates dropped from 9.6 (95% confidence interval [CI], 8.45–10.90) in 1998 through 2003 to 3.33 (95% CI, 3.14–3.53) in 2015 through 2020, P for trend = .0001. Major causes were AIDS, non-AIDS cancers, cardiovascular disease, AIDS-defining cancers, viral hepatitis, and nonhepatitis liver disease. Predictors for AIDS-related mortality included being aged ≥40 years, not being a man who have sex with men, history of AIDS-defining illnesses, CD4 < 200 cells/µL, ≥2 comorbidities, and nonreceipt of ART. Non-AIDS mortality increased with age, injection drug use, heterosexual men, socioeconomic deprivation, CD4 200 to 349 cells/µL, nonreceipt of ART, and comorbidities, but migrants had lower risk (adjusted hazard risk, 0.69 [95% CI, .57–.83]).

Conclusions

Mortality rates among PLWH have significantly decreased over the past 2 decades, with a notable shift toward non–AIDS-related causes. Continuous monitoring and effective management of these non-AIDS conditions are essential to enhance overall health outcomes.
Annus Tenebrosus
Authors: Roos Anna Marie
Published: March 2024

Moving out of the Middle Ages, we reach a turning point in European astronomy. The ideas of Nicolaus Copernicus, Johannes Kepler, and, not much later, Isaac Newton would lastingly revolutionize the subject. The changes in religious history, material and technological history, and media all impacted the production and distribution of knowledge about total solar eclipses, as evident in the discussion of the almanac, an annual publication containing calendrical and astronomical information. The interpretation of eclipses then was caught in the same suspension between an understanding of world, life, and human beings ruled by God, or by the confidence and anxieties of the human mind, or by the increasingly measurable scientific knowledge emerging from a proto-enlightened age of observing, categorizing, and theorizing. On the brink of the clockwork universe, the famous total solar eclipse over England in 1652 was surrounded by the political exploitation of popular fear on ‘Black Monday’ in the mid-seventeenth century. Its historical record serves as a reminder that Enlightenment and superstition would remain in conflict for a long time to come.
Signs and Portents
Authors: Hart David Bentley
Published: March 2024

In a certain continuity with both the experience of the twelfth-century ‘Wretched, Horrifying, Black, Remarkable’ eclipse and that of the seventeenth-century ‘Black Monday,’ David Bentley Hart contrasts the terror with which eclipses were greeted in pre-modern times with his own experience of beauty and awe when he witnessed the 2017 event. Revisiting cultural environments that we have explored previously in Chapter 3 (Greco-Roman antiquity), Chapter 5 (early Asia), and Chapter 7 (early modern England), the author takes us on a reading journey through the ancient Chinese tradition to Lucretius and back up to John Milton and William Shakespeare, to the philosophies of René Descartes (1596–1650), Arthur Owen Barfield (1898–1997), and Martin Heidegger (1889–1976), among others — spanning an arch from pasts unknown to the present day.
Lost in translation: a national cross-sectional study on medical interpreter use by pediatric residents
Authors: Peters Sarah , Peebles Erin , Carwana Matthew
Published: March 2024

Background

Lack of communication in a family’s preferred language is inequitable and results in inferior care. Pediatric residents provide care to many families with non-English or French language preferences (NEFLP). There is no data available about how Canadian pediatric residents use interpreters, making it difficult to develop targeted interventions to improve patient experience.

Objectives

Our purpose was to assess translation services in pediatric training centers and evaluate resident perception of their clinical skills when working with NEFLP patients and families. This survey represents the first collection of data from Canadian pediatric residents about interpreter services.

Methods

Eligible participants included all pediatric residents enrolled in an accredited Canadian pediatric training program. An anonymous survey was developed in REDCap© and distributed via email to all pediatric residents across Canada. Descriptive statistics were performed in STATA v15.1.

Results

122 residents responded. Interpreter services were widely available but underused in a variety of clinical situations. Most (85%) residents felt they provided better care to patients who shared their primary language (English or French), compared with families who preferred other languages—even when an interpreter was present. This finding was consistent across four self-assessed clinical skills.

Conclusions

Residents are more confident in their clinical and communication skills when working with families who share their primary language. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Pediatric training programs should develop curriculum content that targets safe and effective interpreter use while reviewing non-spoken aspects of cultural awareness and safety.
The Tragedy of School Desegregation
Authors: Rossell Christine
Published: March 2024

The Crucible of Desegregation: the Uncertain Search for Educational Equality details the legal, social, and political history of school desegregation over the last century and half. The author describes the creation of the civil rights state at the state and federal level, the continuing ambiguity of the term desegregation, the lack of support for mandatory reassignment by Black parents, the reluctance of school officials to apply for a termination of their court order, the effect of terminating school desegregation orders on racial balance and interracial exposure, and the failure of school desegregation to achieve the lofty goals its supporters pursued, of which eliminating the Black-white achievement gap was the most important.
Establishment and utilisation of national diagnostic reference level for adult computed tomography examinations in Ghana
Authors: Issahaku Shiraz , Boadu Mary , Inkoom Stephen , Hasford Francis , Sackey Theophilus A
Published: March 2024

The International Atomic Energy Agency, as part of the new regional project (RAF/9/059), recommend the establishment of diagnostic reference levels (DRLs) in Africa. In response to this recommendation, this project was designed to establish and utilise national DRLs of routine computed tomography (CT) examinations. These were done by estimating CT dose index and dose length product (DLP) from a minimum of 20 patient dose report of the most frequently used procedures using 75th percentile distribution of the median values. In all, 22 centres that formed 54% of all CT equipment in the country took part in this study. Additionally, a total of 2156 adult patients dose report were randomly selected, with a percentage distribution of 60, 12, 21 and 7% for head, chest, abdomen–pelvis and lumber spine, respectively. The established DRL for volume CT dose index were 60.0, 15.7, 20.5 and 23.8 mGy for head, chest, abdomen–pelvis and lumber spine, respectively. While the established DRL for DLP were 962.9, 1102.8, 1393.5 and 824.6 mGy-cm for head, chest, abdomen–pelvis, and lumber spine, respectively. These preliminary results were comparable with data from 16 other African countries, European Commission and the International Commission on Radiological Protection. Hence, this study would serve as a baseline for the establishment of a more generalised regional and national adult DRLs for Africa and other developing countries.
Long-standing Nonunited Fracture Lateral Humeral Condyle in Children. Evaluating a Two-stage Surgical Treatment Strategy With Critical Review
Authors: Khanfour Ashraf A.
Published: March 2024

Objective:

This work aimed to evaluate the results of using a 2-stage surgical treatment strategy without doing anterior transposition of the ulnar nerve (ATUN) for cases with long-standing nonunited fracture lateral humeral condyle (LHC) in children, accompanied by a critical review.

Methods:

A consecutive 12 children with a long-standing “>2 years” nonunited LHC with evident radiologic gross anatomic distortion of the elbow were included in this study. A 2-stage surgical treatment strategy was applied, wherein the first stage, open functional reduction, osteosynthesis, and iliac bone graft were done. Then after 6 months, the second stage surgery was carried out in the form of supracondylar humeral corrective osteotomy if the cubitus valgus angle was ≥20 degrees. ATUN was not done for any of the cases even with those having ulnar nerve dysfunction.

Results:

Union took place in 11 out of the 12 cases after a mean follow-up period of 11 weeks (range: 8 to 14 wk; SD: 1.6). All the 7 cases showed preoperative ulnar nerve dysfunction and reported clinical recovery at the end of their follow-up.

Conclusions:

Two-stage surgical treatment strategy without ATUN is a convenient, reproducible, and successful line of treatment for children presented with longstanding nonunited LHC with anatomically distorted elbow.

Level of Evidence:

Level IV—case series.
Delayed cardiotoxicity following osimertinib therapy in non-small cell lung cancer: a unique case report
Authors: Xu Zhanwen , Jia Haiyan , Yin Xiaoping
Published: March 2024

This case report features a 62-year-old male with stage IB lung adenocarcinoma harboring an epidermal growth factor receptor exon 19 deletion, who underwent treatment with osimertinib following a left upper lobectomy and lymph node dissection. Despite a history of smoking and well-managed type 2 diabetes, the patient developed heart failure 18 months post-initiation of osimertinib therapy, marking one of the latest occurrences of heart failure following osimertinib treatment documented in limited literature. Cardiac MRI revealed significant left ventricular enlargement, lateral wall myocardial thinning, and localized myocardial fibrosis without perfusion defects, a finding not previously reported in literature. This case underscores the severe and unusual cardiac effects of osimertinib in patients with latent risk factors, highlighting the importance of vigilant cardiac monitoring and a multidisciplinary management approach.
Diagnostically Challenging Multifocal Penile Epithelioid Hemangioma Successfully Treated With Doxorubicin Hydrochloride
Authors: Fawzi Marwa M. , El Anany Galal , Abdelraouf Mohamed M. , Elbendary Amira
Published: March 2024

Epithelioid hemangioma (EH), also known as angiolymphoid hyperplasia with eosinophilia, is an unusual vascular proliferation that tends to manifest in the head and neck region. Its occurrence on the penis is rare, with only scarce reported cases in the literature. The histopathological examination of this condition poses a challenge because it shares similarities with other entities, such as epithelioid hemangioendothelioma, epithelioid angiosarcoma, cutaneous epithelioid angiomatous nodule, or Kaposi sarcoma (KS). The infrequency of EH in penile locations underscores the need for accurate diagnostic differentiation and tailored treatment strategies for this atypical presentation. This case report highlights a rare instance of multifocal penile EH. The patient's lesions exhibited distinctive histopathologic features, with extensive eosinophilic infiltration, presence of necrosis, and infiltration to subcutaneous fat. The patient was treated with doxorubicin, a chemotherapy drug, with a very good response. This successful therapeutic outcome underscores the potential efficacy of doxorubicin in the management of multifocal penile EH. The comprehensive analysis of this case contributes to our understanding of the clinical presentation, histopathologic features, and treatment modalities for this rare penile tumor, providing valuable insights for future clinical considerations.
Diagnostic Validation of Anti-TOX Antibody for Early-Stage Mycosis Fungoides Through Digital Analysis of Tissue Samples
Authors: Pinilla-Pagnon Ignacio , Rojo-López Rosa , Coll-Orduña Ignacio , Nogales-Moro Adrián , Chao-Crecente Montserrat
Published: March 2024

Mycosis fungoides (MF) has become one of the most difficult diagnostic challenges for both dermatologists and dermatopathologists because its clinical presentation and microscopic findings may mimic benign reactive processes, specifically those displaying histopathological features of interface dermatitis. The goal of our study was to prove with digital scanning and automated sample methodology through algorithmic analysis, combined with the utility of TOX marker a more precise, faster, and objective evaluation of each sample. Moreover, this would offer high levels of reproducibility with the possibility of establishing cut-off points, allowing us to distinguish between inflammatory dermatoses (ID) and MF. A retrospective longitudinal-descriptive and observational study was conducted to compare the diagnostic criteria (immunohistochemical studies of anti-TOX stain) in patients with clinical suspicion of MF by dividing them into 2 groups: samples with a positive biopsy for MF (MF group) and those with a negative biopsy, therefore diagnosed as an ID (control group). The algorithm assessed 5 selected areas with lymphocytic representative cellularity, and based on the intensity, nuclear staining was classified as 0 (negative), 1+ (weak/yellow), 2+ (moderate/orange), and 3+ (strong/scarlet red) nuclei. The results showed statistically significant differences (P = 0.040) between the mean number of (2+) nuclei in the positive final diagnosis group (MF group) and the negative final diagnosis group (ID group).
Repair of an Occipital Meningocele and Scalp Soft-tissue Reconstruction in a Newborn Patient
Authors: Freedman Jonathan D. , Gehring Michael B. , O’Neill Brent R. , French Brooke , Khechoyan David
Published: March 2024

The differential diagnosis of large congenital scalp defects includes aplasia cutis and encephalocele, among others. Treatment includes conservative management with dressings or operative management with dermal substitutes, skin grafting, local flaps, and free flaps. This case report discusses the technical considerations and reconstructive strategies for repair of a meningocele in a newborn with a large 5.5-cm scalp defect. The key strategies include preemptive cerebrospinal fluid (CSF) diversion with external ventricular drain to reduce the risk of CSF leak and mitigate wound-healing complications; careful identification and avoidance of key anatomic structures, such as the superior sagittal sinus, as anatomy may be significantly distorted due to the presence of a meningocele and after CSF diversion; and careful, thoughtful design of the local scalp flaps to maximize blood supply and to avoid tension on the final reconstruction.
Resistant hypertension
Authors: Shariati Farnoosh , Tandan Nitin , Lavie Carl J.
Published: March 2024

Purpose of review

Resistant hypertension (RH) is characterized by persistently elevated blood pressure despite the concurrent use of three antihypertensive medications, including a diuretic, at optimal doses. This clinical phenomenon poses a significant burden on healthcare systems worldwide due to its association with increased cardiovascular disease morbidity and mortality.

Recent findings

Ongoing studies on device-based treatment of RH, with aim to reduce sympathetic nervous system outflow, have shown promising evidence in management of RH which may in turn decrease the incidence of composite cardiovascular outcome faced by the affected population.

This paper aims to provide a comprehensive overview of RH, and review some of the diagnostic and therapeutic approaches in management of RH.
Establishment and validation of a predictive nomogram for severe pleural effusion in liver cancer patients after hepatectomy
Authors: Zhao Jun-Yu , Lin Hang-Yu , Gong Cai-Fang , Zhang Hong , Huang Xu-Jian , Xie Meng-Yi , You Chuan
Published: March 2024

This study aims to develop and validate a predictive nomogram for severe postoperative pleural effusion (SPOPE) in patients undergoing hepatectomy for liver cancer. A total of 536 liver cancer patients who underwent hepatectomy at the Department of Hepatobiliary Surgery I of the Affiliated Hospital of North Sichuan Medical College from January 1, 2018, to December 31, 2022, were enrolled in a retrospective observational study and comprised the training dataset. Lasso regression and logistic regression analyses were employed to construct a predictive nomogram. The nomogram was internally validated using Bootstrapping and externally validated with a dataset of 203 patients who underwent liver cancer resection at the Department of General Surgery III of the same hospital from January 1, 2020, to December 31, 2022. We evaluated the nomogram using the receiver operating characteristic curve, calibration curve, and decision curve analysis. Variables such as drinking history, postoperative serum albumin, postoperative total bilirubin, right hepatectomy, diaphragm incision, and intraoperative blood loss were observed to be associated with SPOPE. These factors were integrated into our nomogram. The C-index of the nomogram was 0.736 (95% CI: 0.692–0.781) in the training set and 0.916 (95% CI: 0.872–0.961) in the validation set. The nomogram was then evaluated using sensitivity, specificity, positive predictive value, negative predictive value, calibration curve, and decision curve analysis. The nomogram demonstrates good discriminative ability, calibration, and clinical utility.
Quantitative evaluation of gut microbiota composition in pancreatic cancer: A pooled study
Authors: Jin Dachuan , Jin Shunqin , Zhou Tao , Cui Zhongfeng , Guo Baoqiang , Li Guangming , Zhang Chunming
Published: March 2024

Background:

Prior research has demonstrated a positive association between the composition of gut microbiota and the incidence of pancreatic cancer. Nevertheless, a thorough quantitative and systematic evaluation of the distinct properties of gut microbiota in individuals diagnosed with pancreatic cancer has yet to be conducted. The objective of this study is to examine alterations in the diversity of intestinal microbiota in individuals diagnosed with pancreatic cancer.

Methods:

Search for relevant literature published before July 2023 in 4 databases: PubMed, Embase, Web of Science, and Cochrane Library, without any language restrictions.

Results:

A total of 12 studies were included, including 535 patients with pancreatic cancer and 677 healthy controls. Analysis was conducted on 6 phyla, 16 genera, and 6 species. The study found significant and distinctive changes in the α-diversity of gut microbiota, as well as in the relative abundance of multiple gut bacterial groups at the phylum, genus, and species levels in pancreatic cancer patients.

Conclusion:

Overall, there are certain characteristic changes in the gut microbiota of pancreatic cancer patients. However, further research is warranted to elucidate the specific mechanism of action and the potential for treatment.
Hantavirus infection-related acute inflammatory demyelinative polyradiculoneuropathy: A case report and literature review
Authors: Zhou Ying , Yang Jun , Hai Hong , Dong Jun , Wen Ying
Published: March 2024

Rationale:

Hemorrhagic fever with renal syndrome (HFRS) is a common infectious disease in China. As a complication of post-Hantavirus infection, Guillain–Barre syndrome (GBS) was rarely previously reported. Here, we described a case of acute inflammatory demyelinative polyradiculoneuropathy secondary to Hantavirus infection in spring of 2023. We also made a summary of the clinical features from previous reported cases.

Patient concerns:

A young male patient complained a fever with headache, who was subsequently diagnosed with HFRS with positive serum Hantavirus antibody IgM. Two weeks later, he presented sustained back pain, obvious numbness located in 4 extremities, chest and abdomen, facial dyskinesia and 4 extremities muscle weakness.

Diagnosis, Interventions, and Outcomes:

He was rapidly diagnosed with GBS by typical cerebrospinal fluid change and the electromyography examination presentation, which was verified associated with hantavirus infection. He was treated with intravenous immunoglobulin infusion followed by rehabilitation treatment. He got a complete recovery within 4 months after disease onset.

Lessons:

GBS was an uncommon manifestation of Hantavirus infection. GBS should be considered when acute limb weakness happens in cases with HFRS. A multidisciplinary team could make a rapid diagnosis and optimal treatment when nervous system disorders occurred.
Effect of antinuclear antibody positivity on antineutrophil cytoplasmic antibody results by indirect immunofluorescence assay
Authors: Gür Vural Demet , Usta Büşra , Tanriverdi Çayci Yeliz , Bilgin Kemal , Birinci Asuman
Published: March 2024

Background:

The indirect immunofluorescence assay (IIFA) utilizing antineutrophil cytoplasmic antibodies (ANCA) is widely used as a diagnostic test for autoimmune vasculitis. The presence of antinuclear antibodies (ANA) might lead to a misleading interpretation of ANCA. This study aims to explore the impact of the presence of ANA on the interpretation of ANCA.

Methods:

This retrospective research examined samples negative for antiMPO and antiPR3 ANCA by IIFA and explored correlations between the ANA–IIFA results and the ANCA interpretation frequencies. Our analysis involved the use of suitable statistical methods, including Chi-square and kappa statistics.

Results:

Up to 75.2% of the ANCA–IIFA-positive samples exhibited a positive p-ANCA pattern when using the ethanol-fixed substrate, with c-ANCA positivity at 24.8%. In the ANA–IIFA-positive samples, ~77.3% displayed p-ANCA patterns on ethanol-fixed substrates. A comparison between the ANA–IIFA titers and the p-ANCA results revealed that p-ANCA positivity was notably more common in samples with higher titers, and this correlation was found to be statistically significant.

Conclusion:

Positive ANA results by IIFA tests are linked to a higher incidence of p-ANCA interpretation, particularly in cases with higher titer patterns. This insight aids laboratories in establishing effective workflows to investigate potential p-ANCA interference.
The CT-guided percutaneous drainage of pancreatic pseudocyst accompanied by pseudoaneurysm: A case report
Authors: Yang Qimin , Li Bing , Sun Bai Jin Tao , Zhong Xiangkai , Qiu Zhiqiang , Yang Hanfeng
Published: March 2024

Rationale:

This case report discusses the CT-guided percutaneous drainage of a pancreatic pseudocyst accompanied by a pseudoaneurysm. Pancreatic pseudocysts can erode the peripancreatic artery and produce pseudoaneurysms. This is rare, but it can be life-threatening.

Patient concerns:

The case presented involves a 58-year-old female who was diagnosed with pancreatic cancer and underwent surgical treatment. She presented with hematochezia, dizziness, and hypodynamic findings with no obvious cause. Imaging revealed a pancreatic pseudocyst and small arterial aneurysms. To reduce the risk of aneurysm rupture, the patient underwent transcatheter arterial coil embolization. Three days later, CT-guided catheter drainage was performed to reduce the erosion of the arterial wall caused by pancreatic fluid.

Diagnoses:

The contrast-enhanced-CT imaging showed a round, slightly high-density lesion in the cyst, suggesting the presence of a pseudoaneurysm.

Interventions:

The patient was sent for another transcatheter arterial embolization with coils and n-butyl-2-cyanoacrylate.

Outcomes:

After receiving the transcatheter arterial embolization, the patient had no serious bleeding or other complications.

Lessons:

Early detection and accurate assessment of pseudoaneurysms are essential for appropriate management. This case shows that contrast-enhanced CT is necessary before CT-guided percutaneous drainage of pancreatic pseudocysts. It also shows that, due to the many complications that pancreatic pseudocysts may cause, appropriate treatment of pseudocysts complicated with pseudoaneurysm has important clinical significance.