bluuebunny/crossref_metadata_2025 huggingface dataset:
56 EFFICACY OF AN ELECTIVE PERIOD OF IN-PATIENT REHABILITATION FOR PATIENTS LIVING WITH PARKINSON’S DISEASE AND FRAILTY: A PILOT STUDY
Authors: Doyle M , Ryan D , Mello S
Published: February 2023

Background

Frailty and Parkinson’s disease (PD) are more common with increasing age and are associated with syndromes such as falls, immobility, cognitive dysfunction and incontinence. PD may directly cause or co-exist with and compound frailty. A coordinated, multidisciplinary approach to care has been shown to optimize outcomes in both of these conditions. This pilot study aims to examine the short-term effects of an elective two-week in-patient rehabilitation program on frail PD patients’ function, mobility, and self-reported quality of life (QOL).

Methods

This prospective cohort study included all frail PD patients admitted for elective rehabilitation since the program’s conception. Patients included must be able to mobilize independently with or without an aid, or with assistance of one person. They also must be cognitively able to participate in rehabilitation. Patients received consultant-led Comprehensive Geriatric Assessment and attended daily physiotherapy and occupational therapy sessions. Functional outcome and health related QOL measurements were collected on admission and discharge and compared using a paired t-test. Frailty was quantified by the Clinical Frailty Index.

Results

Twelve patients completed the program (58% male). The average age was 79 (range 70–86) and average clinical frailty score was 5.6 indicating mild to moderate frailty. Performance in activities of daily living (Barthel Index: 64 vs 73, p = 0.005), overall mobility (Elderly Mobility Scale: 10.6 vs 12.9, p = 0.004), gait speed (Timed Up and Go: 35 vs 29 seconds, p = 0.05), and balance (Berg Balance Scale: 25 vs 32, p = 0.002) significantly improved from admission to discharge from the program. Health-related QOL also improved (EQ-5D: 44 vs 66, p = 0.004).

Conclusion

Early data suggests that a short elective in-patient rehabilitation program has highly significant benefits for frail PD patients on mobility, performance of activities of daily living, and QOL. Longer term follow-up is required to assess sustainability of these improvements and cost-effectiveness of this intervention.
72 VITAMIN D LEVELS AND SUPPLEMENTATION IN FRAIL OLDER ADULTS PRESENTING TO AN IRISH LEVEL 5 EMERGENCY DEPARTMENT
Authors: Pender C , Dillon L , Byrne C , Magner S , Ryan A , Murphy A , Carribine N , Laguna R , Malomo K
Published: February 2023

Background

The Department of Health published new guidance in November 2020 ‘Vitamin D advice for people aged 65 and older’ which states that all adults >65 years should be supplemented with 15micrograms of Vitamin D daily. TILDA research states that 55.5% of adults >65 years have either insufficient or deficient vitamin D levels in winter (TILDA 2020).

The Frailty Intervention Team (FIT) assess frail adults >65 years in the Emergency Department using medication review and Comprehensive Geriatric Assessment (CGA) to identify vitamin D supplementation.

The audit aim is to determine if the new guideline is being implemented.

Methods

All patients who had a medicine reconciliation completed by the FIT Pharmacist in January 2021 were included in a retrospective audit. Patients were identified from the pharmacists worklist. Data was collected from a Hospital Clinical System using an excel data collection sheet. The data recorded included: Variable Indicative of Placement risk (VIP), Age, Sex, Rockwood Clinical Frailty Score (CFS), serum vitamin D level, date of last serum vitamin D level and vitamin D supplementation.

Results

The FIT Pharmacist completed 60 medicine reconciliations in January 2021.

70% (n = 42) were prescribed vitamin D. Of those 92% (n = 39) were prescribed a supplement containing at least 15micrograms of vitamin D.

85% (n = 51) had a vitamin D level reported in the preceding 6 years. 76% (n = 39) had sufficient vitamin D levels (>50 nmol/L). 21% (n = 11) had insufficient or deficient vitamin D levels (<50 nmol/L).

Conclusion

The new guideline was implemented in 65% (n = 39) of frail patients >65 years. The rate of vitamin D insufficiency in this cohort was lower than TILDA research suggests.
81 LONGER CHAIR-STAND TIME IS ASSOCIATED WITH ORTHOSTATIC INTOLERANCE IN AN OLDER IRISH POPULATION
Authors: Duggan E , Knight S , Rizzo R , David J , Kenny R A , Romero-Ortuño R
Published: February 2023

Background

Hospital admissions for orthostatic hypotension (OH) have risen more than two-fold in the past ten years. OH can lead to orthostatic intolerance (OI), and both OH and OI are common causes of falls and injuries in older persons. Sarcopenia is also common in older persons and associated with adverse health outcomes. The 5-chair stand test (5-CST) can be used as a marker of sarcopenia and a cut-off of 15 s has been proposed. We hypothesized that those with a worse performance on the 5-CST would be at greater risk of OH and sought to investigate this in an older Irish population cohort study.

Methods

5-CST was measured in keeping with a standardised protocol. Beat-to-beat blood pressure was measured with the Finometer device according to the active stand protocol. Multivariable logistic regressions were performed to investigate the associations between OH at 40 seconds after standing (OH40), OI (dizziness after standing), and 5-CST time. Potential confounders were controlled for in the model including age, sex, education, body mass index and medications.

Results

Data from 3,119 participants were available for analysis. Mean age was 63.8 years, 55% were female, 25% took longer than 15s on the 5-CST and mean baseline blood pressure was 141/76 mmHg. Proportion of OH40 was 12.5% and 4.4% reported OI. In the multivariable model, OH40 was not independently associated with 5-CST time after controlling for age (p > 0.05). Worse performance on the chair stands test was however an independent predictor of OI (odds ratio 1.06, p = 0.039).

Conclusion

Longer time taken on the 5-CST, a marker of sarcopenia, was an independent predictor of OI in a large population study. The relationship between sarcopenia and orthostatic blood pressure response is not well elucidated. We plan to further investigate this area in a future clinical cohort.
82 INVESTIGATING LEARNING NEEDS, OUTCOMES, AND CURRICULA IN HEALTHY AND ACTIVE AGEING: A SCOPING REVIEW AND MULTINATIONAL SURVEY
Authors: Wiggin D , Penic B , Sulopuisto O , Setti A , Strockl D E , Timmons S , Consortium E M M A
Published: February 2023

Background

Older people are projected to make up almost one third of the European population by 2060. Healthy and active ageing (HAA) and age-friendly society frameworks offer a method to capitalise on this increasingly older demographic. To inform a new online EU-based taught masters programme, a scoping review and subsequent multinational survey were conducted to identify potential students’ learning needs related to these frameworks.

Methods

The scoping review included a systematic search of four databases. Data were extracted from 32 studies, guiding the development of an anonymous online survey targeting senior undergraduates and recent graduates; future employers; relevant academics; and other key stakeholders (e.g. advocacy groups, policy-makers, and ‘expert’ older people). Participants ranked the importance of 14 broad topics and linked subtopics on a Likert scale, and suggested other key topics. Descriptive data from the first survey wave are presented.

Results

The scoping review revealed a literature focus on intergenerational learning, age-related design, health, attitudes towards ageing, and collaborative learning. Few studies (16%) surveyed students to determine their learning needs. While 72% of studies reported programme evaluations, most were informal/unstructured. From the 473 responses across the initial five survey participation countries (Ireland, Portugal, Greece, Austria, Slovenia), over 90% of potential students, academics, and ‘other’ stakeholders scored psychological aspects of ageing, health promotion, and social inclusion as important topics. In descending order, the workplace/retirement, human rights, physiological and social aspects of ageing, physical environment, technology, and older people in education, were next-ranked. Participants’ suggested other topics included sexual health, oral health, blue zones (regions with marked longevity), and the rights of vulnerable older people.

Conclusion

This study highlights the limited prior investigation into learning needs around HAA and age-friendly society, and demonstrates key stakeholder priorities for education content. The resulting European Masters in Active Ageing will commence student intake in 2023.
90 IMPACT OF AN INTEGRATED CARE MODEL FOR OLDER PERSONS: EVALUATING A PILOT PROGRAMME
Authors: Geoghegan J , Conry M , Mannion E , Shiel E , Flanagan L , McCleane F , Nolan M , Corry M , Chawke M , Coffey K , Costello M , McCarty C E , O'Donnell M , Robinson S , Waters R , Canavan M
Published: February 2023

Background

In September 2019 Sláintecare helped establish an Integrated Care team for Older People. The aim of this service was to provide a Comprehensive Geriatric Assessment (CGA) to older people within a community network. Service user experience/feedback are critically important for development of a team and a service. To give service users a platform to evaluate the service a patient experience survey was conducted.

Methods

The survey was designed by the multidisciplinary team, consisting of 13 closed/3 open questions. A Likert scale was utilised for closed questions and thematic analysis for open questions. A question on impact of COVID-19 was also included.

150 of the 950 service users who received a CGA from June 2020 to June 2021 were selected randomly and invited to participate in the postal survey. All participants received a covering letter, questionnaire and a stamped address envelope to return their completed surveys.

Results

47% response rate (71/150). 77% were aged ≥75. 52% completed the survey themselves, 48% required assistance. 61% attended more than twice and most would prefer to attend a local spoke clinic. 96% agreed/strongly agreed that they were satisfied with the service. 99% felt they were treated with dignity/respect and had confidence in the service. 93% agreed that they were involved in care decisions. 82% reported their carers had the opportunity to discuss concerns. Themes emerging included importance of care close to home, avoiding acute hospital, difficulty parking at tertiary centres. 42% highlighted isolation and loneliness due to COVID-19 as a major issue.

Conclusion

Service users had an overwhelmingly positive experience especially when care was delivered in clinics close to their homes. Development of the hub and spoke model is acceptable and feasible to older people and their carers’ in this region and will be the focus for expansion of this service.
Comparison of sex differences in cognitive function in older adults between high- and middle-income countries and the role of education: a population-based multicohort study
Authors: Bloomberg Mikaela , Dugravot Aline , Sommerlad Andrew , Kivimäki Mika , Singh-Manoux Archana , Sabia Séverine
Published: February 2023

Background

The extent to which education explains variations in sex differences in cognitive function between countries at different levels of economic development is unknown. We examined the role of education in sex differences in four cognitive domains in high- and middle-income countries.

Methods

Analyses were based on 70,846 participants, aged 60 years and older, in cohort studies from a high-income (United States) and four middle-income countries (Mexico, Brazil, China, and India). We used weighted linear models to allow nationally-representative comparisons of sex differences in orientation, memory, attention, and fluency using the United States as the reference, before and after adjustment for education, and after stratification by education.

Results

Females had lower levels of education than males in all countries, particularly in India. Before adjustment for education, sex differences in orientation and attention in all middle-income countries, memory in Brazil, China, and India, and fluency in India were less favourable to females than in the United States (P < 0.010). For example, females outperformed males in memory in the United States (mean difference [male–female scores] = −0.26 standard deviations [95% CI −0.30, −0.22]) but not in China (0.15 [0.09, 0.21]) or India (0.16 [0.13, 0.19]). Adjustment for education attenuated these sex differences. In analyses stratified by education, there were minimal sex differences in the high education group in all countries.

Conclusion

Education contributes to larger female disadvantages in cognitive function at older ages in middle-income countries compared with the United States. Gender equity in education is an important target to reduce sex disparities in cognitive function globally.
New horizons in holistic, person-centred health promotion for hearing healthcare
Authors: Maidment David W , Wallhagen Margaret I , Dowd Kathryn , Mick Paul , Piker Erin , Spankovich Christopher , Urry Emily
Published: February 2023

Over the course of a lifetime, the risk of experiencing multiple chronic conditions (multimorbidity) increases, necessitating complex healthcare regimens. Healthcare that manages these requirements in an integrated way has been shown to be more effective than services that address specific diseases individually. One such chronic condition that often accompanies ageing is hearing loss and related symptoms, such as tinnitus. Hearing loss is not only highly prevalent in older adults but is also a leading cause of disability. Accumulating evidence demonstrates an interplay between auditory function and other aspects of health. For example, poorer cardiometabolic health profiles have been shown to increase the risk of hearing loss, which has been attributed to microvascular disruptions and neural degeneration. Additionally, hearing loss itself is associated with significantly increased odds of falling and is a potentially modifiable risk factor for cognitive decline and dementia. Such evidence warrants consideration of new possibilities—a new horizon—for hearing care to develop a holistic, person-centred approach that promotes the overall health and wellbeing of the individual, as well as for audiology to be part of an interdisciplinary healthcare service. To achieve this holistic goal, audiologists and other hearing healthcare professionals should be aware of the range of conditions associated with hearing loss and be ready to make health promoting recommendations and referrals to the appropriate health practitioners. Likewise, healthcare professionals not trained in audiology should be mindful of their patients’ hearing status, screening for hearing loss or referring them to a hearing specialist as required.
Aesthetic Refinements in Male Chest Lifting
Authors: Austin Ryan E , Milkovich John , Lista Frank , Ahmad Jamil
Published: February 2023

The authors describe aesthetic refinements to the approach for male chest lifting in male patients with grade 3 gynecomastia and/or significant chest skin excess. An inferior pedicle is used to transpose the nipple–areolar complex allowing preservation of pigment and sensation, liposuction and direct excision are used to reduce volume and excess skin, and the resulting curvilinear scar along the inferior and lateral border of the chest provide a more masculine appearance. Early experience with this technique has shown it to be safe and effective. Perioperative management and the detailed steps of the procedure are outlined.

Level of Evidence: 5
The frontoparietal multiple demand network interacts with the dual pathways in auditory working memory
Authors: Leung Ada W S , Moreno Sylvain , Alain Claude
Published: February 2023

The frontoparietal multiple demand (MD) network has been proposed as a control network that regulates processing demands while enabling goal-directed actions. This study tested the MD network account in auditory working memory (AWM) and identified its functional role and relationship with the dual pathways model in AWM, where segregation of function was based on the sound domain. Forty-one healthy young adults performed an n-back task consisting of an orthogonal combination of the sound domain (spatial versus nonspatial) and cognitive operation (low load versus high load). Functional connectivity and correlation analyses were performed to assess the connectivity of the MD network and the dual pathways. Our results confirmed the contribution of the MD network to AWM and identified its interactions with the dual pathways in both sound domains and during high and low load levels. At high loads, the strength of connectivity with the MD network correlated with task accuracy, indicating the key role of the MD network in supporting successful performance as cognitive load increases. This study contributed to the auditory literature by showing that both the MD network and dual pathways collaborate with each other to support AWM, and neither of them alone is adequate to explain auditory cognition.
Additive prognostic value of longitudinal myocardial deformation to SCORE2 in psoriasis
Authors: Makavos George , Ikonomidis Ignatios , Lambadiari Vaia , Koliou Georgia-Angeliki , Pavlidis George , Thymis John , Rafouli-Stergiou Pinelopi , Kostelli Gavriella , Katogiannis Konstantinos , Stamoulis Konstantinos , Kountouri Aikaterini , Korakas Emmanouil , Theodoropoulos Kostas , Frogoudaki Alexandra , Katsimbri Pelagia , Papadavid Evangelia
Published: February 2023

Aims

Psoriasis has been associated with increased cardiovascular (CV) risk. We investigated whether markers of CV function and their change after treatment have a prognostic value for adverse outcomes.

Methods and results

In a prospective study, at baseline and after 6 months of treatment with biological agents, we assessed in 298 psoriasis patients (i) left ventricular global longitudinal strain (GLS) and (ii) carotid-femoral pulse wave velocity (PWV), to evaluate their prognostic value for major adverse cardiovascular events (MACEs), including coronary artery disease, stroke, hospitalization for heart failure, and all-cause death over a 4-year follow-up period. During follow-up, 26 (8.7%) MACEs were recorded. By univariate analysis, decreasing absolute GLS values [hazard ratio (HR): 0.73, P < 0.001], decreasing GLS change after treatment (HR: 0.53, P = 0.008), and increasing PWV values (HR: 1.16, P = 0.049) were associated with adverse outcomes. Baseline GLS and its change post-treatment remained independent predictors of adverse events after adjusting for several confounders (P < 0.05). The addition of baseline GLS and its absolute change post-treatment to SCORE2 increased Harrell’s C from 0.882 to 0.941. By multivariable analysis, for each 1% increase in absolute baseline GLS values, the risk of MACE decreased by 33% and for each 1% absolute increase of GLS post-treatment compared with the baseline value, the risk of MACE decreased by 58%.

Conclusion

Global longitudinal strain has an independent and additive prognostic value to SCORE2 for adverse CV events in psoriasis, providing timely decision-making for intensive anti-inflammatory treatment and aggressive modification of risk factors to reduce CV risk.
The Association of Physical Activity Behaviors and Patterns With Aging Acceleration: Evidence From the UK Biobank
Authors: Zhu Jianwei , Yang Yao , Zeng Yu , Han Xin , Chen Wenwen , Hu Yao , Qu Yuanyuan , Yang Huazhen , Valdimarsdóttir Unnur A , Fang Fang , Song Huan
Published: February 2023

Prior evidence suggests that physical activity may reduce the risk of multiple diseases and mortality. However, whether and how physical activity affects the aging process remains largely unexplored. We included 284 479 UK Biobank participants and computed leukocyte telomere length (LTL) deviation (ie, the difference between genetically determined and observed LTL) and biological age acceleration (defined as the discrepancy between the phenotypic age of a person and the average phenotypic age in the cohort of individuals with the same age and sex) as the indexes for aging acceleration. Linear and logistic models were used to estimate the associations of self-reported physical activity items and patterns (identified by principal component analysis), as well as accelerometer-assessed physical activity, with aging acceleration. Analyses of physical activity patterns indicated, a higher level of adherence to activity patterns predominated by strenuous sports, other exercises, walking for pleasure, heavy and light housework, and public transportation use was associated with a lower risk of aging acceleration, whereas a higher level of adherence to patterns predominated by job-related activities was associated with a higher risk of aging acceleration. Analysis among 62 418 participants with accelerometer-measured physical activity corroborated these results. Physical activity, such as strenuous sports and other exercises in leisure time and the use of public transportation, was associated with reduced biological aging. Besides highlighting the importance of engaging in physical activity for healthy aging, our results provide further evidence for the beneficial effect of physical activity on the telomere attrition process.
Geniposide-RichGardenia jasminoidesEllis Fruit Extract Increases Healthspan inCaenorhabditis elegans
Authors: Choi Pyeong Geun , Park So-Hyun , Nirmala Farida S , Kim Hee Soo , Kim Min Jung , Hahm Jeong-Hoon , Seo Hyo-Deok , Ahn Jiyun , Ha Taeyoul , Jung Chang Hwa
Published: February 2023

The human life span has been markedly extended since the 1900s, but it has not brought healthy aging to everyone. This increase in life expectancy without an increase in healthspan is a major global concern that imposes considerable health care budgets and degrades the quality of life of older adults. Dietary interventions are a promising strategy to increase healthspan. In this study, we evaluated whether a Gardenia jasminoides Ellis fruit ethanol extract (GFE) increases the life span of Caenorhabditis elegans (C. elegans). Treatment with 10 mg/mL GFE increased the life span by 27.1% when compared to the vehicle group. GFE (10 mg/mL) treatment improved healthspan-related markers (pharyngeal pumping, muscle quality, age–pigment, and reactive oxygen species accumulation) and exerted a protective effect against amyloid β 1–42 toxicity. These effects of GFE are related to the inhibition of insulin/IGF-1 signaling and activation of SKN-1/Nrf, thereby promoting the expression of stress resistance-related genes. In addition, treatment with 10 mM geniposide, the most abundant component of GFE, improved healthspan-related markers and increased life span by 18.55% when compared to the vehicle group. Collectively, these findings demonstrate that GFE and its component geniposide increase the life span along with healthspan in C. elegans.
The emerging threat of methicillin-resistantStaphylococcus aureus(MRSA) clone ST22-PT, carrying both Panton–Valentine leucocidin and toxic shock syndrome toxin 1 genes
Authors: Kaneko Hiroshi , Yanagi Yuka , Otake Shogo , Sato Mayu , Saito Takumi , Nakaminami Hidemasa
Published: February 2023

Objectives

Some MRSA strains produce Panton–Valentine leucocidin (PVL) and/or toxic shock syndrome toxin 1 (TSST-1), which are associated with severe infectious diseases. Although PVL- or TSST-1-positive strains have been isolated worldwide, strains carrying both PVL and TSST-1 genes are rare and sporadic. The objective of this study was to characterize these strains from Japan.

Methods

A total of 6433 MRSA strains isolated in Japan between 2015 and 2021 were analysed. Molecular epidemiological and comparative genomic analyses were conducted on PVL- and TSST-1-positive MRSA strains.

Results

A total of 26 strains from 12 healthcare facilities were PVL positive and TSST-1 positive, and all were classified as clonal complex (CC) 22. These strains exhibited similar genetic features to each other and were named as ST22-PT according to a previous report. Twelve and one of the ST22-PT strains were identified in patients with deep-seated skin infections and toxic shock syndrome-like symptoms, which are typical clinical features of PVL-positive and TSST-1-positive Staphylococcus aureus, respectively. Whole-genome comparative analysis revealed that the ST22-PT strains were highly similar to PVL- and TSST-1-positive CC22 strains isolated in several countries. Evaluation of the genome structure showed that ST22-PT possessed ΦSa2 harbouring PVL genes and a unique S. aureus pathogenicity island harbouring the TSST-1 gene.

Conclusions

ST22-PT strains have recently emerged from several healthcare facilities in Japan, and ST22-PT-like strains have been identified in several countries. Our report highlights that the risk of international spread of PVL- and TSST-1-positive MRSA clone ST22-PT needs to be further investigated.
Patterns of diverse and changing sentiments towards COVID-19 vaccines: a sentiment analysis study integrating 11 million tweets and surveillance data across over 180 countries
Authors: Wang Hanyin , Li Yikuan , Hutch Meghan R , Kline Adrienne S , Otero Sebastian , Mithal Leena B , Miller Emily S , Naidech Andrew , Luo Yuan
Published: February 2023

Objectives

Vaccines are crucial components of pandemic responses. Over 12 billion coronavirus disease 2019 (COVID-19) vaccines were administered at the time of writing. However, public perceptions of vaccines have been complex. We integrated social media and surveillance data to unravel the evolving perceptions of COVID-19 vaccines.

Materials and Methods

Applying human-in-the-loop deep learning models, we analyzed sentiments towards COVID-19 vaccines in 11 211 672 tweets of 2 203 681 users from 2020 to 2022. The diverse sentiment patterns were juxtaposed against user demographics, public health surveillance data of over 180 countries, and worldwide event timelines. A subanalysis was performed targeting the subpopulation of pregnant people. Additional feature analyses based on user-generated content suggested possible sources of vaccine hesitancy.

Results

Our trained deep learning model demonstrated performances comparable to educated humans, yielding an accuracy of 0.92 in sentiment analysis against our manually curated dataset. Albeit fluctuations, sentiments were found more positive over time, followed by a subsequence upswing in population-level vaccine uptake. Distinguishable patterns were revealed among subgroups stratified by demographic variables. Encouraging news or events were detected surrounding positive sentiments crests. Sentiments in pregnancy-related tweets demonstrated a lagged pattern compared with the general population, with delayed vaccine uptake trends. Feature analysis detected hesitancies stemmed from clinical trial logics, risks and complications, and urgency of scientific evidence.

Discussion

Integrating social media and public health surveillance data, we associated the sentiments at individual level with observed populational-level vaccination patterns. By unraveling the distinctive patterns across subpopulations, the findings provided evidence-based strategies for improving vaccine promotion during pandemics.
Towards the in vivo identification of protein–protein interactions
Authors: Suzuki Yuji , Kadomatsu Kenji , Sakamoto Kazuma
Published: February 2023

Protein–protein interactions (PPIs) play crucial roles in biological processes. The conventional methods based on affinity purification of a protein of interest (POI) have been widely used to identify unknown PPIs. Recently, proximity-dependent biotin identification (BioID) has been used increasingly to investigate PPIs. BioID utilizes the proximity-dependent biotinylation, in the presence of biotin, of endogenous proteins that are located within a certain distance of POI-fused biotin ligase, which enables us to reveal the more physiologically relevant PPIs in vivo compared to the conventional methods.

However, there is little information on an appropriate way to administer biotin in vivo. Recent studies reported some biotin supplementations for in vivo BioID. In this commentary, we review the BioID technique as a tool to examine PPIs, and we introduce a potential method to achieve efficient proximity labelling for in vivo BioID.
O Lungo Drom: Legal Mobilization as Counterpower
Authors: Handmaker Jeff , Taekema Sanne
Published: February 2023

Legal mobilization is a contested topic. There is little consensus among scholars regarding what legal mobilization is, let alone how it functions, particularly in relation to the separation or balance of powers doctrine, the latter which concerns the formal mandates of public actors and their interactions in relation to rule of law as a form of governance.

We argue that the use of law by civic actors to advance social change should be distinguished from the use of law by states and other powerful actors to subvert the rule of law or to suppress critical voices. Thus, in distinguishing legal mobilization from lawfare, we argue that legal mobilization as a legitimate form of counterpower to lawfare has emerged as a viable and important component of governance. Pragmatically speaking, the illegitimate use of law by authoritarian regimes and corporations, the existence of corruption and both substantive and procedural limitations of formal rule of law mechanisms to deliver impartial justice have forced legal advocates to think creatively. In this paper, after conceptualizing legal mobilization and lawfare as opposing uses of law, we analyse the potential of legal mobilization as counterpower in relation to the trias politica doctrine, drawing on a case study of mobilizing Sinti, Roma and Traveller rights in The Netherlands to analyse how law is used to resist lawfare and pursue social justice.
Placenta exosomal miRNA-30d-5p facilitates decidual macrophage polarization by targeting HDAC9
Authors: Bai Kunfeng , Li Jianlin , Lin Leqian , Zhang Qingqing , Zhong Jiangming , Liu Xiaofeng , Cao Dandan , Duan Yong-Gang , Yao Yuanqing , Li Raymond H W , Cheung Ka-Wang , Yeung William S B , Chiu Philip C N , Lee Cheuk-Lun
Published: February 2023

Pregnancy involves a wide range of adaptations in the maternal body. Maternal immune tolerance toward the foreign fetus is critical for a successful pregnancy. Decidual macrophages are the primary antigen-presenting and phagocytic cells responsible for antigen presentation and apoptotic cell removal. Their phenotype changes dynamically during pregnancy. Placenta-derived exosomes are small vesicles carrying active biological molecules such as microRNAs, proteins, and lipids. The placenta-derived exosomes have been implicated in endothelial cell activation, smooth muscle cell migration, and T-cell apoptosis, but it is unknown whether placenta-derived exosomes would affect the development and functions of decidual macrophages. In this study, we reported that placenta-derived exosomes stimulated macrophage polarization into alternatively activated (M2) macrophages. Mechanistically, miRNA-30d-5p from the placenta-derived exosomes induced macrophage polarization to the M2 phenotype by targeting histone deacetylase 9. Furthermore, the conditioned medium of placenta-derived exosome–treated macrophages promoted trophoblast migration and invasion. By contrast, the conditioned medium impaired the ability of endothelial cell tube formation and migration. Placenta-derived exosome–treated macrophages had no impact on T-cell proliferation. Together, we demonstrated that placenta-derived exosomes polarize macrophages to acquire a decidua-like macrophage phenotype to modulate trophoblast and endothelial cell functions.
Floral traits and pollination biology ofEpimedium chlorandrumStearn (Berberidaceae)
Authors: Qian Yi-Fan , Du Wen , Chen Lan-Ying , Quan Qiu-Mei , Li Yun-Xiang
Published: February 2023

The evolution and expression of floral traits are responsive to selection pressure from biotic and abiotic factors. Although floral traits significantly vary among environments, the flower remains unchanged. We aimed to understand the adaptation of Epimedium chlorandrum of floral traits to a frequently nocturnally rainy and wet environments and the roles of floral traits in pollination and reproduction. We observed flowering phenology, measured floral characteristics including the number of pollen grains and ovules per flower, measured pollen viability and stigma receptivity, tested the volume and sugar concentration of nectar and conducted flower-visit observations in this species. Different pollination treatments were performed to characterize the breeding system. The inner sepals and highly curved longer spurs of E. chlorandrum jointly formed an umbrella that shielded the anthers and stigma from rain wash and prevented nectar dilution. Epimedium chlorandrum was visited by six species, while Bombus trifasciatus was the only effective pollinator and fed on the nectar. One flower secreted approximately 17.06 µL of nectar with a 29.19 g/100 mL sugar concentration, and the pollination efficiency of B. trifasciatus was positively associated with the nectar sugar concentration. The self- and open-pollination treatments resulted in fewer fertile seeds than the cross-pollination treatment. In contrast, the autonomous self-pollination treatment failed to yield fertile seeds. In summary, pollen limitation caused by harsh weather and pollinator shortage occurred during the pollination process of E. chlorandrum, which was partially alleviated by self-compatibility.
Seven-decade forest succession reveals how species colonization and extinction drive long-term community structure dynamics
Authors: Rao Shan , Miao Xin-Yu , Fan Shu-Ya , Zhao Yu-Hao , Xu Chi , Li Shao-Peng
Published: February 2023

Understanding how community phylogenetic and functional structures change over succession has gained increasing attention during the last decades, but the lack of long-term time-series data has limited our understanding of the patterns and mechanisms of these changes. This is especially the case for forest communities. Here, we used an exceptionally long-term data over 68 years to analyze the secondary succession dynamics of a subtropical forest in Southeast China. We found that community phylogenetic and functional structures showed opposite temporal trends. The mean pairwise phylogenetic distance between species increased, but the mean nearest taxon distance decreased over succession, indicating both phylogenetically distantly related and sister species co-occurred in late-successional communities. In contrast, both the mean pairwise functional distance and mean nearest functional distance between species decreased over time, and community functional structure switched from overdispersion to clustering. We further distinguished the contributions of species colonization and extinction to community structural changes. We found that the new colonists were generally more distantly related to each other and to the residents than the local extinct species, resulting in increased phylogenetic overdispersion over succession. In contrast, from a functional perspective, we found that species with more similar traits to the resident species had a greater chance to colonize but a lower chance to go locally extinct, which shifted community functional structure toward clustering. Together, our study highlights the critical role of species colonization and extinction in disentangling assembly mechanisms underlying community phylogenetic and functional structures over long-term succession.
Neuropathic Pain
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

Neuropathic pain is a much more common pain disorder than usually thought, affecting up 10% of the general population worldwide. It encompasses a large number of conditions, such as sciatica, postsurgical pain, painful neuropathies, postherpetic neuralgia, multiple sclerosis, spinal cord injury, and stroke. However, neuropathic pain is still considered by many doctors as difficult to detect and extremely complex to manage. This book provides essential skills for the management of neuropathic pain. Each chapter presents case vignettes inspired by real patients, covering distinct aspects of neuropathic pain from common conditions such as sciatica to rare disorders such as erythromelalgia, but clinical cases sharing similarities with neuropathic pain, such as fibromyalgia or orofacial pain, are also covered. This book will help train unfamiliar physicians to use screening questionnaires; assess neuropathic pain and its causes; and manage patients with non-opioid analgesics, complementary medicine, psychotherapies, neuromodulation, or invasive techniques. To help readers gradually increase their skills, the book is arranged in three sections: Section 1 covers clinical cases often encountered in primary care, Section 2 addresses best therapeutic management, and Section 3 presents assessment and management of more complex cases. Medical students and doctors interested in pain management, from primary care physicians to specialists, should find this book practical, easy to read, and useful for everyday practice.
Introduction
Authors: Varvinskiy Andrey
Published: February 2023

This chapter sets out the rationale for writing a book on how to pass the European Diploma in Anaesthesiology and Intensive Care (EDAIC), a brief history of the formation of the exam, and what the reader can expect from the rest of the book. The EDAIC has a long history that goes as far back as the days of the European Academy of Anaesthesiology (EAA), an organization that was established on 5 September 1978 and held its first General Assembly in Paris after two years of preparatory work. This preparatory work began in 1976 after a group of anaesthesiologists met during the World Congress in Mexico City to discuss the consequences of the Medical Directives of the European Economic Community (EEC) that were adopted by the Council of Ministers in June 1975.
Pharmacology
Authors: Hill Sue
Published: February 2023

This chapter provides 45 practice multiple-choice questions (MCQs) about pharmacology along with answers, explanations, and references for further reading to increase your in-depth understanding. Drugs used in anaesthetic practice, as well as those affecting the respiratory and cardiovascular systems feature prominently in the examination. Principles of drug action and interaction should not be omitted from your preparation. As far as possible, these questions appear as they would on an actual EDAIC Part I paper. However, there are some publisher-defined style differences that should not affect your understanding of the questions presented here. The main differences include certain spelling conventions, when and where abbreviations are explained and then used in a question, and the presence of Oxford commas, which are present through this book but used only for clarification on an examination paper.
Statistics
Authors: Hill Sue
Published: February 2023

This chapter provides ten practice multiple-choice questions (MCQs) about statistics along with answers, explanations, and references for further reading to increase your in-depth understanding. In Paper A of the Part I examination there are usually just two questions on statistics. The most important topics to understand for Part I are summary statistics, the Normal distribution and its properties, basic principles of clinical trial design and errors in interpretation of statistical analysis. There are many statistical tests available, but you need only a basic understanding of the simpler tests used. The questions here are presented as they would be seen on an actual Part I paper, although there are some publisher-defined style differences that should not affect your understanding of the questions. These differences have been alluded to in previous chapters.
Emergency medicine
Authors: Hamilton Duncan Lee
Published: February 2023

This chapter provides 20 practice multiple-choice questions (MCQs) about emergency medicine and the associated model answers, alongside references for more in-depth understanding. The questions in this chapter mainly cover the critical incidence situations that anaesthetist need to be able to manage swiftly and efficiently with the background knowledge of their national and international protocols and guidelines that are referred to in the Answer section.
Applied pharmacology
Authors: Varvinskiy Andrey , Cortis Petramay Attard
Published: February 2023

This chapter provides five examples of structured oral examination questions (SOEs) on applied pharmacology along with model answers and references to help you increase your knowledge and depth of understanding. In the practice of anaesthesiology and intensive care, a good knowledge of pharmacology is essential and has to be very broad especially with regard to the general principles of pharmacodynamics and pharmacokinetics, and has to be quite detailed with regard to those classes of drugs which are the mainstay of daily anaesthetic practice. Consequently questions about drug bioavailability, interactions, metabolism and elimination mechanisms are to be expected. The commonly used classes of anaesthetic drugs such as inhalational agents, intravenous hypnotic agents, muscle relaxants, analgesics and local anaesthetic agents will always feature to an appreciable degree in the EDAIC Part II examination.
Clinical measurement
Authors: Varvinskiy Andrey
Published: February 2023

This chapter provides five examples of structured oral examination questions (SOEs) relating to physics and clinical measurement together with model answers and references for further reading to increase your in-depth knowledge and understanding. Each Part II examination will have one SOE on physics and clinical measurement as part of one of the Basic Science oral examinations. This type of SOE will not be the first question for this particular oral examination, so you will not be given time to prepare your answer. As with all SOEs, you should practice answering questions about your anaesthetic equipment and monitors in preparation for Part II. Diagrams are particularly useful for demonstrating your understanding of the principles of clinical monitoring and types of waveforms encountered during clinical practice.
Infections
Authors: Dewar Donald
Published: February 2023

Despite progress with antimicrobial drug therapy, critical care, and interventional radiology, there remain some skin, soft tissue, and bone infections which can only be treated effectively with surgery. These include abscesses, infected prosthetic material, most cases of osteomyelitis, and necrotizing infections, such as necrotizing fasciitis and gas gangrene.
Structure and function of the skin
Authors: Goodfield Mark
Published: February 2023

The skin is the body’s largest organ, and its structure and function are both essential to life. This chapter discusses these issues, outlining the relative simplicity of structure, allied to a most complex and interactive function. It discusses the structure, related to function, and the interaction of structural elements to provide protection and flexible responses to environmental stimuli. The involvement of the structural elements of the skin in the development of skin cancers as well as in protection of the body from the causative agents of cancer is included. The functions of the skin include elements of immunology, demonstrating the role of the skin as the home of the innate immune system, as well as its involvement in the activation of distant immune responses. Homeostatic control of temperature including vascular shunting and sweat gland control are discussed, as well as the role of hormonal factors in the control of sebaceous function and hair growth, and the consequences of dysfunction in this system. Additional endocrinological functions with body-wide effects are discussed, with particular reference to vitamin D metabolism. Finally, the psychosocial role of the skin is considered.
Benign skin conditions and tumours
Authors: Rahim Rajib , Stables Graeme
Published: February 2023

Benign lesions of the skin can be classified according to their nature (cystic lesions or solid neoplasms) and their tissue of origin. Clinical characteristics assist in diagnosis and distinguishing these benign lesions from more aggressive lesions. Treatment is dictated by this assessment.
Macroscopic and microscopic anatomy of the peripheral nervous system
Authors: Novikov Lev N. , Wiberg Mikael
Published: February 2023

The spinal and cranial nerves (CNs) of the peripheral nervous system allow the spinal cord and brainstem to communicate with the rest of the body. The majority are mixed nerves, whose somatosensory and motor axons innervate skeletal muscles, joints, and skin, and whose autonomic axons innervate smooth muscles, blood vessels, and glands. Not all CNs are mixed nerves, some are more functionally specialized types of nerves containing only somatosensory axons (CNs I, II, and VIII), somatic motor axons (CNs IV, VI, XI, and XII), or a combination of somatic and visceral axons (CN III). This chapter presents the clinical anatomy of the spinal nerves and CNs and their peripheral targets, and describes the microscopic anatomy of a typical peripheral nerve.
Mass lesions of the peripheral nervous system
Authors: Wilson Thomas J. , Restrepo Carlos E. , Spinner Robert J.
Published: February 2023

Mass lesions of the peripheral nervous system present an interesting diagnostic challenge as well as a number of obstacles to their management. The range of pathology of these lesions spans from completely benign to aggressively malignant, while optimal management of these lesions ranges from non-operative to radical resection. Operative management is complicated by their frequent involvement in major mixed nerves, as well as their potential location in close proximity to major blood vessels and the spinal cord. Operative resection that results in a major postoperative deficit is unacceptable for the benign lesions. Thus, understanding the principles for diagnosing and managing these relatively rare lesions is vitally important despite there being little guidance on their management in the literature. Optimal management requires a thorough understanding of the breadth of potential pathologies, of the operative anatomy, and comfort with the principles of resection of these lesions. Because management often requires adjuvant physical, pain management, chemo-, or radiation therapies, a multidisciplinary approach is often necessary. The differential diagnosis of mass lesions of the peripheral nervous system includes but is not limited to schwannoma, neurofibroma, perineurioma, malignant peripheral nerve sheath tumour, intraneural lipoma, fibrolipomatous hamartoma (lipomatosis of nerve), ganglion cyst, desmoid tumour, sarcoidosis, and metastatic disease. This chapter reviews the evaluation and management principles of these mass lesions.
The devascularized limb
Authors: Rahman Kaz M.A. , Hettiaratchy Shehan
Published: February 2023

Injury to the axial vessels of the lower limb after high-energy trauma is common. When the vascular injury leads to sudden and irreversible loss of perfusion of the distal part, time becomes an important factor. Prompt diagnosis (with or without imaging) and treatment is the cornerstone of effective management.
Management of soft tissue loss without microsurgery
Authors: Wright Thomas C.
Published: February 2023

This chapter describes the treatment options for lower limb defects when free tissue transfer techniques are not used. The aetiology and management of pretibial injuries is discussed, along with their associated morbidity. The decision-making process for more complex defects is explored and various local, regional, and distant flap options are described.