bluuebunny/crossref_metadata_2025 huggingface dataset:
In defence of Islam: How the Islamic State justifies violence
Authors: Aggarwal Neil Krishan
Published: March 2021

This chapter applies a framework for analysing the psychology of persuasion to an Islamic State (IS) video on the fall of its last village. Militant groups such as IS have established media campaigns, but little work to date has examined how such media incites people. Understanding cultural justifications of violence helps psychiatrists to determine whether an individual’s violent behaviours represent abnormal behaviours within a social group and can be classified as those that require social, health, or criminal justice intervention. The mechanisms of psychological persuasion in IS’s Arabic video ‘Meanings of Constancy—Wilāyat Al-Shām, Al-Barakah’ include invoking authority by citing the Quran, drawing contrasts between Muslim believers and non-Muslim disbelievers, casting militants as likeable, and presenting audiovisual footage of IS’s enforcement of morality, the military blockade of its last village, and the suffering of children. This framework facilitates comparisons across militant groups and how mechanisms of persuasion evolve within the same group to generate policy-relevant scholarship.
Terrorism in the context of social capital and community
Authors: Jones Edgar
Published: March 2021

Community cohesion, trust, and participation in networks—or social capital—have been proposed not only as a way of combating the appeal of violent extremism, but also as a way of facilitating radicalization and recruitment. The bonding and bridging processes involved in civic investment are explored to assess both their risk and protective factors. Population research has demonstrated how vulnerable groups, when feeling threatened or marginalized, tend to bond at the expense of bridging, increasing the likelihood of being labelled as suspect communities. A core challenge in an era of terrorist threat is how to balance the need for intelligence about potential acts of extreme violence, while maintaining a positive relationship with communities targeted by recruiters. Although the task of building bridging social capital within a diverse society is more challenging than within a homogenous one, the rewards are potentially greater given the broader range of skills and attributes that can be integrated.
The sharing economy and livestreaming of terror: Co-production of terrorism on social media
Authors: Ibrahim Yasmin
Published: March 2021

In the xenophobic attack on a mosque in New Zealand, the perpetrator filmed the mass murder through a GoPro recording device attached to his head. The attack was streamed live on social networking sites, including a notorious extremist alt-right forum. This livestreaming of the terrorist attack on social media platforms received global condemnation, but it brought renewed scrutiny to the ‘sharing economy’ online and how terrorist attacks can be made for sharing, reposting, and editing of content by users, circumnavigating the removal of such content. This phenomenon widens the co-production of terror through mass audiences’ interaction in real time, positioning terror as mass entertainment. This chapter examines the architecture of the ‘sharing economy’ online and its significance in the production of terror, as well as the moral and ethical considerations it poses for humanity.
Terrorism: Group dynamic and interdisciplinary aspects
Authors: Wenzel Thomas , Alksiri Reem , Chen Anthony F.
Published: March 2021

In this chapter, we offer an interdisciplinary and group-focused model to examine how extreme violence develops, and discuss aspects of interventions for prevention, specifically with regard to terrorism and its many forms. We argue that an analysis of terrorism must be more open, and include research into the perpetrators of extreme violence such as genocide. In general, we see the breakdown of empathy, a group dynamic process that creates the image of ‘the other’ and the violation of basic concepts of humanitarian and human rights laws, as a precondition to terrorism when viewed as a subtype of extreme violence. In recent years, Internet-based and large multinational groups have gained importance, a factor that is insufficiently considered, meaning that more attention is needed on group dynamic processes as drivers of extreme violence. Our interpretation uses models such as that developed by the group analyst Vamik Volkan, and others, including that of chosen trauma. We discuss these factors together with possible strategies to aid transitional justice and contribute to the rehabilitation of victims and perpetrators. The specific impact of each act of terrorism and the needs of victims and society to recover reflect the complex background of each event, and of the contexts in which the crimes were committed.
Terrorism and radicalization: Social factors—a narrative review
Authors: Favale Donato , Ventriglio Antonio
Published: March 2021

Throughout the history of humankind, people have struggled for rights and freedom, and have used different strategies to reach their goals. Furthermore, in recent times, terrorism is overly interpreted to mean a reaction by Muslim populations against Western countries, implying the actions are driven along religious lines and seek to restore freedom. Extreme actions following perceived persecution or extreme distress are well established, not only in the form of terrorism, but also violence more generally and, at times, in the form of suicide. For example, Durkheim postulated a relationship between the degree of social integration and suicide rates. Both religious suicide bombing and apocalyptic suicide represent a final cosmic war in which violence is sanctioned to rid the world of evil forces. In this chapter we describe some the factors that may contribute to acts of violence and terrorism in groups and as lone actors. We explore the reasons why second- and third-generation migrants are much more likely to participate in such activities. These may be related to a sense of alienation, exposure to religious fundamentalism in the absence of religious literacy and connection with orthodox sources, failure to adapt, and a lack of resistance to persuasion into violence. Some preventive strategies are described. We also consider radicalism processes by which an individual or a group carries out violent actions connected to an extremist ideology, and consider modern radical groups, which are now less organized and centralized than previous hierarchical movements such as Al-Qaeda.
The equifinality and multifinality of violent radicalization and mental health
Authors: Gill Paul , Farnham Frank , Clemmow Caitlin
Published: March 2021

The relationship between violent radicalization and poor mental health is complex and multilayered. We use the principles of equifinality and multifinality to demonstrate this complexity. In terms of equifinality, we draw upon the existing evidence base to demonstrate that the end outcome of violent radicalization has many paths into it. Some individuals will be touched by different aspects related to poor mental health along this path. In terms of multifinality, we demonstrate trajectories to multiple outcomes originating from poor mental health problems, where violent radicalization is a low base rate outcome, of many. To do so, we draw on the evidence base from various systematic reviews and meta-analyses of other public/personal harms. We also draw upon illustrations of different individuals displaying similar symptoms/diagnoses and map the mechanisms through which their end outcome differed (e.g. because of exposure to different influences, opportunity, and so on).
Deradicalization and rehabilitation: A case study of the Quilliam Foundation’s decade-long approach in the UK, the United States, and worldwide
Authors: Fraser-Rahim Muhammad , Khalid Mohammed Hassan
Published: March 2021

Quilliam International is the oldest counter-extremist organization in the world composed of former extremists. Beginning in the early 2000s, the organization is composed of former extremists who occupied leadership roles in al-Qaeda and Hizb ut Tahrir, to name a few. In the aftermath of 9/11 and the fall of the so-called Islamic State, returning foreign fighters are returning to their home nations, requiring Western and developing world nations to respond to effective national and local strategies for prison reform and reintegration. Limited social science research and government data are available on the effectiveness of what techniques actually work. This chapter seeks to provide a case study example of some of the techniques employed by Quilliam as an organization and its approach to aiding individuals in and out of extremism.
Training and certification in intensive and acute cardiovascular care
Authors: Price Susanna , Bonnefoy-Cudraz Eric
Published: March 2021

Acute cardiovascular care consists in a large range of well-defined pathologies and expertise. They are needed to manage these most critically ill cardiovascular patients with evidence suggesting this is associated with improved outcomes. This chapter presents the different levels of training and available curricula in acute cardiovascular care especially the ESC-ACCA certification process.
Out-of-hospital cardiac arrest
Authors: Nolan Jerry P , Hassager Christian
Published: March 2021

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient's final neurological and cardiological outcome. These interventions aim to restore myocardial function and minimize neurological injury.
Renal support therapy
Authors: Ronco Claudio , Romagnoli Stefano , Ricci Zaccaria
Published: March 2021

Renal dysfunction is known to be frequently a component of multiple organ failure, a complex syndrome affecting the most severely ill critical patients. Bidirectional interaction between the kidneys and other organs has always been suspected; evidence suggests that severe kidney injury is an important protagonist in acute illness, even when managed by dialysis. In fact, if it seems that increasing the dose of renal replacement therapy does not reduce mortality, it could be inferred that acute kidney injury influences mortality through means that are not reversed by conventional renal support, either because the putative culprit toxins are not removed by renal replacement therapy or because renal replacement therapy is started too late to prevent these effects. It is known that the kidneys exert effects on other organs, such as the lung, liver, heart, and brain, in a process called 'crosstalk'. This effect means that the kidney is not only a victim, but also a culprit regarding the malfunction of other organs. This chapter will detail some traditional aspects of different renal replacement therapy modalities and prescription schedules, but it will also describe the most recent evidence on the management and support of the kidney during failure of other organs.
The use of biomarkers for acute cardiovascular disease
Authors: Jaffe Allan S
Published: March 2021

Understanding the proper use of biomarkers requires clinicians to appreciate some critical pre-analytic and analytic issues, as well as how to use the markers properly. The benefits of such an approach will not only facilitate the care of patients today, but will also prepare clinicians to understand and embrace the new generation of markers that is coming and that will continue to make this area transformational for cardiology. Two fundamental concepts underlie the clinical use of biomarkers: First, biomarkers should always be used in conjunction with all other clinical information. Second, in order to maximize their diagnostic and prognostic use, biomarkers should be interpreted as quantitative variables. For example, a cardiac troponin level which is 50 times the upper limit of normal has a much higher positive predictive value for the presence of an acute myocardial infarction, compared to a level just above the upper limit of normal.
Biomarkers in acute heart failure
Authors: Choudhary Rajiv , Wettersten Nicholas , Shah Kevin , Maisel Alan
Published: March 2021

Acute heart failure continues to be a worldwide medical problem, associated with frequent readmissions, high mortality, and a profound economic impact on national health care systems. Biomarkers have shifted the way in which acute heart failure is managed by the cardiologist. The search for the ideal biomarker to aid in the diagnosis, prognosis, and treatment of acute heart failure is ongoing. The natriuretic peptides have come close to an ideal biomarker and prove extremely useful in determining whether acute dyspnoea has a cardiac aetiology. Furthermore, they are useful for prognosis and may have a role in guiding management of heart failure. Additionally, high-sensitivity troponin, sST2, and galectin-3 are increasingly used with mounting clinical evidence for utility. Other emerging acute heart failure biomarkers include mid-regional pro-adrenomedullin, bio-adrenomedulin, mid-regional proatrial natriuretic peptide, and procalcitonin.
ST-segment elevation myocardial infarction
Authors: Ibanez Borja , James Stefan
Published: March 2021

ST-elevation myocardial infarction (STEMI) is a life-threatening conditioning caused by an abrup occlusion of an epicardial coronary artery. Reperfusion (ideally by primary angioplasty, and if not timely available by systemic fibrinolysis) massively improves survival in STEMI patients. Healthcare systems attending STEMI patients in the early phase are critical for a correct triage, reperfusion strategy selection and initial treatment. Besides reperfusion, coadjuvant therapies are critical to improve the success of management and in turn improves long-term mortality and morbidility associated with STEMI. The present chapter presents the state-of-art evidence guiding recommendations for treatment of STEMI with a special focus on the early phases of the process.
Non-pharmacological therapy of acute heart failure: when drugs alone are not enough
Authors: Dauw Jeroen , Mullens Wilfried , Vijgen Johan , Vranckx Pascal
Published: March 2021

Acute heart failure syndrome has been defined as new-onset or a recurrence of worsening signs and symptoms of heart failure, necessitating urgent or emergency management. The management of acute heart failure syndrome is challenging, given the heterogeneity of the patient population, in terms of the clinical presentation, pathophysiology, prognosis, and therapeutic options. The management of acute heart failure syndrome is a dynamic process, requiring ongoing simultaneous diagnosis (monitoring) and treatment. Pharmacological agents remain the mainstay of therapy for acute heart failure syndrome. However, at all time, during the early diagnostic, etiologic, and therapeutic work-up, non-pharmacologic therapy may be indicated and should be considered. The management of the complex cardiac patient with acute heart failure syndrome and/or (potential) haemodynamic compromise has become a special dimension for specialized myocardial intervention centres, providing 24 hours per day and 7 days per week state-of-the-art facilities for (primary) percutaneous coronary intervention and cardiac intensive care, including mechanical ventilation, ultrafiltration, with or without dialysis, and short-term percutaneous mechanical circulatory support. Through the understanding of the underlying pathophysiology and approaches into the problems of acute heart failure syndrome, one should be better prepared to understand and treat its many facets.
Congenital heart disease in adults
Authors: Price Susanna , Keogh Brian F , Swan Lorna
Published: March 2021

The number of patients with congenital heart disease surviving to adulthood is increasing, with many requiring ongoing medical attention. Although recommendations are that these patients should be cared for in specialist centres, the clinical state of the acutely unwell patient may preclude transfer prior to the instigation of lifesaving treatment. Although the principles of resuscitation in this patient population differ little from those with acquired heart disease, the acutely unwell adult congenital heart disease patient presents a challenge, with potential pitfalls in examination, assessment/monitoring, and intervention. Keys to avoiding errors include: knowledge of the primary pathophysiology, any interventions that have been undertaken, residual lesions present (static or dynamic), and the normal physiological status for that patient-to determine the precise cause for the acute deterioration and to appreciate the effects (detrimental or otherwise) that any supportive and/or therapeutic interventions might have. Expert advice should be sought at the earliest opportunity.
Aortic emergencies
Authors: Schepens Marc , Graulus Eric
Published: March 2021

Acute aortic dissection is without any doubt the most feared and life threatening aortic emergency. It is associated with a dreadful mortality rate and an immediate and accurate diagnosis without delay followed by adequate treatment is mandatory. It is important to make a distinction between acute type A, uncomplicated and complicated type B. Acute type A dissection generally requires urgent surgery, complicated type B dissections are treated with endovascular techniques; there is ongoing debate whether uncomplicated type B dissections should also be treated by endografts in its early phase. Surgical repair of acute type A dissection consists of the replacement of the intrapericardial ascending aorta with varying segments of the arch and/or aortic root. The endovascular techniques with stentgrafts deployed into the proximal descending aorta in type B dissections have revolutionized the surgical therapy and the patient�s immediate and medium-term survival. For chronic postdissection aneurysms open surgery still remains the golden standard. Acute traumatic aortic isthmus ruptures are similar life threatening conditions and account for one of the main causes of death at the time of traumatic accidents. In these situations also stentgrafts have changed the outcome of these severe and multiple traumatic patients.
Cardiac emergencies in pregnancy
Authors: Johnson Mark , Roos-Hesselink Jolien
Published: March 2021

In high income countries, cardiac disease is the most important indirect cause of maternal mortality and occurs most commonly in women with no cardiac history, but with significant risk factors. The fall in blood pressure and consequent increase in cardiac output induced by pregnancy increases cardiac work significantly, this and other pregnancy-induced changes may unmask undiagnosed heart disease or induce heart disease de novo. Admission to the intensive cardiac care unit is a rare event (0.1-0.9%) during pregnancy but is associated with a significant mortality (3.5 to 21%). The fetus may be adversely affected by the heart disease, either directly through impaired uterine perfusion or indirectly through the need for early delivery, specific therapies or diagnostic tests. In this chapter, we have described the presentation and optimal management of the most common cardiac emergencies that arise during pregnancy.
Pulmonary hypertension
Authors: Palazzini Massimiliano , Galiè Nazzareno , Manes Alessandra
Published: March 2021

Pulmonary hypertension is a haemodynamic and pathophysiological condition defined as an increase in the mean pulmonary arterial pressure of ?25 mmHg at rest, as assessed by right heart catheterization. Recently, a new definition has been proposed as mean pulmonary arterial pressure >20 mmHg combined with pulmonary vascular resistance ? 3 Wood units. While transthoracic echocardiography may provide clues on the presence of pulmonary hypertension, the haemodynamic evaluation offers a more precise and comprehensive assessment. Pulmonary hypertension is heterogeneous from a pathophysiological point of view, and the diversity is reflected in the haemodynamic definitions. The different haemodynamic and clinical forms of pulmonary hypertension can be found in multiple clinical conditions which have been classified into five main groups and at least twenty-six subgroups. Each main clinical group shows specific pathological changes in the lung distal arteries, capillaries, and small veins. If we combine the haemodynamic and clinical heterogeneity, we understand the complexity of an accurate diagnosis in the individual patient which is crucial for the prognostic assessment and treatment strategy. In addition, the concomitant presence of different haemodynamic and clinical mechanisms cannot be excluded in individual cases (e.g. in patients with congestive heart failure and associated lung diseases). The presence of pulmonary hypertension, as defined above, is always an ominous prognostic sign, even if the severity may differ according to the haemodynamic changes and underlying clinical condition. The therapeutic approach also is markedly different, according to the clinical group, and symptomatic and haemodynamic severity. For these reasons, the four more frequent clinical groups are discussed individually, while the classifications are described in the Introduction section.
Acute kidney injury
Authors: Gevaert Sofie A , Hoste Eric , Kellum John A
Published: March 2021

Acute kidney injury is a serious condition, occurring in up to two-thirds of intensive care unit patients, and 8.8-55% of patients with acute cardiac conditions. Renal replacement therapy is used in about 1.5-15% of intensive care unit patients. The term cardiorenal syndrome refers to combined heart and kidney failure; three types of acute cardiorenal syndrome have been described: acute cardiorenal syndrome or cardiorenal syndrome type 1, acute renocardiac syndrome or cardiorenal syndrome type 3, and acute cardiorenal syndrome type 5 (cardiac and renal injury secondary to a third entity such as sepsis). Acute kidney injury replaced the previously used term 'acute renal failure' and comprises the entire spectrum of the disease, from small changes in function to the requirement of renal replacement therapy. Not only failure, but also minor and less severe decreases, in kidney function are of clinical significance both in the short and long-term. The most recent definition for acute kidney injury is proposed by the Kidney Disease: Improving Global Outcomes clinical practice guidelines workgroup. This definition is a modification of the RIFLE and AKIN definitions and staging criteria, and it stages patients according to changes in the urine output and serum creatinine (see Tables 68.1 and 68.2). Acute kidney injury is a heterogeneous syndrome with different and multiple aetiologies, often with several insults occurring in the same individual. The underlying processes include nephrotoxicity, and neurohormonal, haemodynamic, autoimmune, and inflammatory abnormalities. The most frequent cause for acute kidney injury in intensive cardiac care patients are low cardiac output with an impaired kidney perfusion (cardiogenic shock) and/or a marked increase in venous pressure (acute decompensated heart failure). Predictors for acute kidney injury in these patients include: baseline renal dysfunction, diabetes, anaemia, and hypertension, as well as the administration of high doses of diuretics. In the intensive cardiac care unit, attention must be paid to the prevention of acute kidney injury: monitoring of high-risk patients, prompt resuscitation, maintenance of an adequate mean arterial pressure, cardiac output, and intravascular volume (avoidance of both fluid overload and hypovolaemia), as well as the avoidance or protection against nephrotoxic agents. The treatment of acute kidney injury focuses on the treatment of the underlying aetiology, supportive care, and avoiding further injury from nephrotoxic agents. More specific therapies have not yet demonstrated efficacy. Renal replacement therapy is indicated in life-threatening changes in fluid, electrolyte, and acid-base balance, but there are also arguments for more early initiation.
Stress hyperglycaemia and endocrine emergencies
Authors: Gunst Jan , Debaveye Yves , Berghe Greet Van den
Published: March 2021

Although endocrine pathology is usually treated in an outpatient clinic, intensive care may be required when endocrinopathies are associated with other medical illnesses or reach a state of decompensation. Although endocrine emergencies are quite rare, they are potentially life-threatening if not recognised promptly and managed effectively. Therefore, every clinician should always be attentive to a possible diagnosis of these complex disorders. The three major diabetic emergencies comprise diabetic ketoacidosis, hyperglycaemic hyperosmolar state, and prolonged hypoglycaemia. Hyperglycaemic crises are characterised by hypovolaemia and electrolyte disturbances, and may be triggered by potentially life-threatening conditions. Hence, airway-breathing-circulation securement, early fluid resuscitation, and adequate diagnosis and treatment of the underlying condition are the cornerstones of acute management. Subsequently, monitoring and correction of electrolyte disturbances and insulin treatment are initiated. Profound hypoglycaemia should be suspected in every patient with coma of unclear etiology, especially if the patient has an indistinct history or was treated with insulin or sulfonylurea/meglitinide. This condition warrants an immediate administration of glucose, followed by regular blood glucose monitoring. Alternatively, glucagon may be injected subcutaneously, or preferably intramuscularly. Hyperglycaemia in critically ill patients is associated with adverse outcome. The optimal blood glucose target for critically ill patients remains unclear, however. In any case, clinicians should prevent severe hyperglycaemia, hypoglycaemia and large glucose fluctuations. The classical non-diabetic endocrine emergencies comprise thyroid storm, myxoedema coma, acute adrenal crisis, and phaeochromocytoma. They all pose diagnostic and therapeutic challenges and require specific treatment such as endocrine replacement or blockage therapy, apart from supportive care and treatment of the inciting event. It is important to note that such conditions are occasionally the first manifestation of an endocrine disorder. This chapter also briefly discusses amiodarone-induced thyroid dysfunction.
Special considerations in the immunosuppressed patient
Authors: Moreau Anne-Sophie , Favory Raphaël
Published: March 2021

Because of improved treatment of haematological malignancies, autoimmune diseases, and HIV infection, an increasing number of patients are being immunocompromised. Immunosuppression varies according to the underlying disease, and different patterns of complications may be encountered. Among the complications of immunosuppressive treatments, infectious diseases are the most frequently encountered, but drug-related toxicities and secondary neoplasms have to be recognized. Making a rapid diagnosis is the most important step in taking these patients in charge. In such setting, cardiac involvement is severe and often leads to admission to intensive care units. This chapter will focus on the cardiac complications of immunosuppression, from heart transplantation to HIV treatment-related toxicity and cardiac infections.
Particle acceleration and radiation reaction in strong spherical electromagnetic waves
Authors: Pétri J
Published: March 2021

Strongly magnetized and fast-rotating neutron stars are known to be efficient particle accelerators within their magnetosphere and wind. They are suspected to accelerate leptons, protons, and maybe ions to extreme relativistic regimes where the radiation reaction significantly feeds back to their motion. In the vicinity of neutron stars, magnetic field strengths are close to the critical value of Bc ∼ 4.4 · 109 T and particle Lorentz factors of the order γ ∼ 109 are expected. In this paper, we investigate the acceleration and radiation reaction feedback in the pulsar wind zone where a large-amplitude low-frequency electromagnetic wave is launched starting from the light cylinder. We design a semi-analytical code solving exactly the particle equation of motion including radiation reaction in the Landau–Lifshits approximation for a null-like electromagnetic wave of arbitrary strength parameter and elliptical polarization. Under conventional pulsar conditions, asymptotic Lorentz factor as high as 108−109 is reached at large distances from the neutron star. However, we demonstrate that in the wind zone, within the spherical wave approximation, radiation reaction feedback remains negligible.
The dynamical structure of broken power-law and double power-law models for dark matter haloes
Authors: Baes Maarten , Camps Peter
Published: March 2021

Galaxy kinematics and gravitational lensing are two complementary ways to constrain the distribution of dark matter on galaxy scales. The typical dark matter density profiles adopted in dynamical studies cannot easily be adopted in lensing studies. Ideally, a mass model should be used that has the global characteristics of realistic dark matter distributions, and that allows for an analytical calculation of the magnifications and deflection angles. A simple model with these properties, the broken power-law (BPL) model, has very recently been introduced. We examine the dynamical structure of the family of BPL models. We derive simple closed expressions for basic dynamical properties, and study the distribution function under the assumption of velocity isotropy. We find that none of the BPL models with realistic parameters has an isotropic distribution function that is positive over the entire phase space, implying that the BPL models cannot be supported by an isotropic velocity distribution, or models with a more radially anisotropic orbital structure. This result limits the attractiveness of the BPL family as a tool for lensing studies to some degree. More generally, we find that not all members of the general family of double power-law or Zhao models, often used to model dark matter haloes, can be supported by an isotropic or radially anisotropic distribution function. In other words, the distribution function may become negative even for spherically symmetric models with a well-behaved density profile.
Differences in Psychosocial Factors and Experimental Pain Sensitivity Between Hispanics and Non-Hispanic Whites from the U.S.-Mexico Border
Authors: Valencia Carolina , Smiley Aaron , Giron Megan , Stacy Johnathan , Rodriguez Isaac , Umucu Emre
Published: March 2021

Purpose

Research suggests that ethnicity is a predictor of pain-related outcomes; however, studies comparing the differences in experimental pain sensitivity between Hispanics and non-Hispanic Whites (NHW) are scarce. This study investigated these differences between Hispanics and NHW from the U.S.- Mexico border.

Methods

Fifty-eight healthy participants completed the survey packet, which included a demographic and a psychosocial factors questionnaire. Participants underwent quantitative sensory testing, which included heat pain threshold, heat pain tolerance, Suprathreshold Heat Pain Response (SHPR), and Conditioned Pain Modulation (CPM). SHPR was induced by repeated thermal stimuli in both thenar eminences. CPM was assessed using SHPR as the experimental stimulus and cold pressor task as the conditioning stimulus.

Results

Analyses showed significant differences in experimental pain measures believed to be representative of facilitatory pain processing including SHPR and heat pain threshold, where Hispanics reported significantly higher pain ratings than NHW. Hispanics also reported higher levels of ethnic identity and acculturation. However, these factors were not significantly associated with experimental pain sensitivity.

Conclusion

The experimental pain sensitivity and psychosocial factors included in this study differed by ethnic group, where Hispanics reported significantly higher pain ratings, when compared with NHW. However, ethnic identity and acculturation were not associated with these pain-related outcomes. Overall, enhanced understanding by clinicians of pain sensitivity and disparities in the pain experience between ethnic groups allows for increased cultural sensitivity and can be used to optimize pain treatment on an individual-by-individual basis.
Delayed Adaptive Radiation among New Zealand Stream Fishes: Joint Estimation of Divergence Time and Trait Evolution in a Newly Delineated Island Species Flock
Authors: Thacker Christine E , Shelley James J , McCraney W Tyler , Unmack Peter J , McGee Matthew D
Published: March 2021

Adaptive radiations are generally thought to occur soon after a lineage invades a region offering high levels of ecological opportunity. However, few adaptive radiations beyond a handful of exceptional examples are known, so a comprehensive understanding of their dynamics is still lacking. Here, we present a novel case of an island species flock of freshwater fishes with a radically different tempo of adaptive history than that found in many popular evolutionary model systems. Using a phylogenomic data set combined with simultaneous Bayesian estimation of divergence times and trait-based speciation and extinction models, we show that the New Zealand Gobiomorphus gudgeons comprise a monophyletic assemblage, but surprisingly, the radiation did not fully occupy freshwater habitats and explosively speciate until more than 10 myr after the lineage invaded the islands. This shift in speciation rate was not accompanied by an acceleration in the rate of morphological evolution in the freshwater crown clade relative to the other species, but is correlated with a reduction in head pores and scales as well as an increase in egg size. Our results challenge the notion that clades always rapidly exploit ecological opportunities in the absence of competing lineages. Instead, we demonstrate that adaptive radiation can experience a slow start before undergoing accelerated diversification and that lineage and phenotypic diversification may be uncoupled in young radiations. [Adaptive radiation; Eleotridae; freshwater; Gobiomorphus; New Zealand.]
Combination of Extended Paramedian Forehead Flap and Laser Hair Removal in the Reconstruction of Distal Nasal Defect
Authors: Ding Feixue , Huang Cheng , Sun Di , Zhu Zhu , Yang Jun , Jin Rui , Luo Xusong
Published: March 2021

Aim

The study sought to determine whether extended forehead flap by using part of the scalp combined with laser hair removal is a practical approach when repairing distal nasal defect.

Methods

A retrospective study was conducted with 6 patients who underwent reconstruction of nasal defects with extended forehead flaps (including scalp combined with subsequent laser hair removal) at Shanghai Ninth People's Hospital between June 2016 and December 2018. Surgical data collected included age, causes of defects, sizes of defects, invaded nasal subunits, implantation of tissue expander, time elapsed between the formation of defects and surgical treatments, sessions of laser hair removal, and follow-up results. All patients had nasal defects after removal of a benign nevus (diameter, >1.5 cm), which invaded distal nasal subunits (including the nasal tip, soft triangle, columella, and nasal ala) and could not be repaired using adjacent tissue. Preoperative and postoperative assessments of esthetic outcomes were analyzed, including skin color and texture match, appearance deformity, and scar appearance.

Results

All 6 female patients (ages 4 to 24 years) accepted the extended forehead flap technique and subsequent laser hair removal treatments. Among the 6 patients, 2 had nasal tip defects, 1 had a columella nasi defect, one had an alar defect, and 2 had multiunit defects. All transferred forehead flaps survived with no necrosis and underwent 2 to 5 subsequent laser hair removal treatments. The color and texture of the transferred flaps was similar to the adjacent skin in all patients. All patients were satisfied with the final outcome of the reconstructed nose with no obvious scarring during follow-up.

Conclusions

Extending the forehead flap using the scalp is a practical and safe approach for the repair of large and distal nasal defects. Subsequent laser hair removal can eliminate the hair follicles of the scalp and improve the appearance and color of the flap.
A Comparison of Cell-Based and Cell-Cultured as Appropriate Common or Usual Names to Label Products Made from the Cells of Fish
Authors: Hallman William K. , Hallman William K.
Published: March 2021

Using an online experiment with a nationally representative sample of 1200 adult American consumers, two “common or usual names,” “Cell-Based Seafood” and “Cell-Cultured Seafood,” were assessed using five criteria. Displayed on packages of frozen Atlantic Salmon, the names were evaluated on their ability to differentiate the novel products from conventionally-produced fish, to identify their potential allergenicity, and after learning its meaning, to be seen by participants as an appropriate term for describing the process for creating the product. In addition, the names were evaluated as to whether they would be interpreted as disparaging of new or existing products, and whether they elicited reactions contrary to the assertion that the products are nutritious, healthy and safe. The results confirmed earlier research showing that “Cell-Based Seafood” slightly outperformed “Cell-Cultured Seafood” as a common or usual name. Labeling products with the term “Cell-Based Seafood” meets important regulatory criteria by enabling consumers to distinguish such products from conventional seafood products, and by indicating the presence of allergens. From a marketing perspective, “Cell-Based” is also viewed as an appropriate term for describing the process for producing the products, meeting the criteria for transparency. Consumers also had more positive reactions to “Cell-Based Seafood” and were slightly more inclined to want to taste and purchase “Cell-Based” products both before and after learning the meaning of “Cell-Based” and “Cell-Cultured.” Therefore, “Cell-Based Seafood” should be adopted as the best common or usual name to label cell-based seafood products.

Practical Application

Widespread adoption and consistent use of a single “common or usual name” for “Cell-Based” seafood, meat, poultry and other products by the food industry, regulators, journalists, marketers, environmental, consumer, and animal rights advocates, and other key stakeholders would help shape public perceptions and understanding of this rapidly advancing technology and its products. This study confirms that “Cell-Based Seafood” is the best performing term to label seafood products made from the cells of fish. It meets relevant FDA regulatory requirements and slightly outperforms “Cell-Cultured Seafood” with regard to positive consumer perceptions, interest in tasting and likelihood of purchasing these novel products.
Trends in Thoracic Impedance and Arrhythmia Burden Among Patients with Implanted Cardiac Defibrillators During the COVID-19 Pandemic
Authors: Lu Yuan , Murugiah Karthik , Jones Paul W , Caraballo César , Mahajan Shiwani , Massey Daisy S , Ahmed Rezwan , Bader Eric M , Krumholz Harlan M
Published: March 2021

Hospitalizations for acute cardiac conditions have markedly declined during the coronavirus disease 2019 (COVID-19) pandemic, yet the cause of this decline is not clear. Using remote monitoring data of 4,029 patients with implantable cardiac defibrillators (ICDs) living in New York City and Minneapolis/Saint Paul, we assessed changes in markers of cardiac status among these patients and compared thoracic impedance and arrhythmia burden in 2019 and 2020 from January through August. We found no change in several key disease decompensation markers among patients with implanted ICD devices during the first phase of COVID-19 pandemic, suggesting that the decrease in cardiovascular hospitalizations in this period is not reflective of a true population-level improvement in cardiovascular health.
COVID-19 Related Chemosensory Changes in Individuals with Self-Reported Obesity
Authors: Bhutani Surabhi , Coppin Géraldine , Veldhuizen Maria Geraldine , Parma Valentina , Joseph Paule Valery
Published: March 2021

Background/objectives

Individuals with obesity show alterations in smell and taste abilities. Smell and taste loss are also the most prominent neurological symptoms of COVID-19, yet how chemosensory ability present in individuals with obesity with a positive COVID-19 diagnosis is unknown.

Subjects/Methods

In this secondary analysis of a cross-sectional global dataset, we compared self-reported chemosensory ability in participants with a respiratory illness reporting a positive (C19+; n = 5156) or a negative (C19−; n = 659) COVID-19 laboratory test outcome, who also self-reported to be obese (C19+; n = 433, C19−; n = 86) or non-obese.

Results

Compared to the C19− group, C19+ exhibited a greater decline in smell, taste, and chemesthesis during illness, though these symptoms did not differ between participants with obesity and without obesity. In 68% of participants who reported recovery from respiratory illness symptoms (n=3431 C19+ and n= 539 C19−), post-recovery chemosensory perception did not differ in C19+ and C19− diagnosis, and by self-reported obesity. Finally, we found that all chemosensory and other symptoms combined predicted the C19+ diagnosis in participants with obesity with a moderately good estimate (63% accuracy). However, in C19+ participants with obesity, we observed a greater relative prevalence of non-chemosensory symptoms, including respiratory as respiratory and GI symptoms.

Conclusions

We conclude that despite a presumed lower sensitivity to chemosensory stimuli, COVID-19 respondents with obesity experience a similar self-reported chemosensory loss as those without obesity, and in both groups self-reported chemosensory symptoms are similarly predictive of COVID-19.
Registration, Publication, and Outcome Reporting among Pivotal Clinical Trials that Supported FDA Approval of High-Risk Medical Devices Before and After FDAAA
Authors: Swanson Matthew J. , Johnston James L. , Ross Joseph S.
Published: March 2021

Background

Selective registration, publication, and outcome reporting of clinical trials distorts the primary clinical evidence that is available to patients and clinicians regarding the safety and efficacy of FDA-approved medical devices. The purpose of this study is to compare registration, publication, and outcome reporting among pivotal clinical trials that supported FDA approval of high-risk (Class III) medical devices before and after the U.S. Food and Drug Administration (FDA) Amendment Act (FDAAA) was enacted in 2007.

Methods

Using publicly available data from ClinicalTrials.gov, FDA summaries, and PubMed, we determined registration, publication, and reporting of findings for all pivotal clinical studies supporting FDA approval of new high-risk cardiovascular devices between 2005 and 2020, before and after FDAAA. For published studies, we compared both the primary efficacy outcome with the PMA primary efficacy outcome and the published interpretation of findings with the FDA reviewer’s interpretation (positive, equivocal, or negative).

Results

Between 2005 and 2020, the FDA approved 156 high-risk cardiovascular devices on the basis of 165 pivotal trials, 48 (29%) of which were categorized as pre-FDAAA and 117 (71%) as post-FDAAA. Post-FDAAA, pivotal clinical trials were more likely to be registered (115 of 117 (98%) vs 24 of 48 (50%); p < 0.001), to report results (98 of 115 (85%) vs 7 of 24 (29%); p < 0.001) on ClinicalTrials.gov, and to be published (100 or 117 (85%) vs 28 of 48 (58%); p < 0.001) in peer-reviewed literature when compared to pre-FDAAA. Among published trials, rates of concordant primary efficacy outcome reporting were not significantly different between pre-FDAAA trials and post-FDAAA trials (24 of 28 (86%) vs 96 of 100 (96%); p = 0.07), nor were rates of concordant trial interpretation (27 of 28 (96%) vs 93 of 100 (93%); p = 0.44).

Conclusions

FDAAA was associated with increased registration, results reporting, and publication for trials supporting FDA approval of high-risk medical devices. Among published trials, rates of accurate primary efficacy outcome reporting and trial interpretation were high and no different post-FDAAA.
Benchmarking saliency methods for chest X-ray interpretation
Authors: Saporta Adriel , Gui Xiaotong , Agrawal Ashwin , Pareek Anuj , Truong Steven QH , Nguyen Chanh DT , Ngo Van-Doan , Seekins Jayne , Blankenberg Francis G. , Ng Andrew Y. , Lungren Matthew P. , Rajpurkar Pranav
Published: March 2021

Saliency methods, which “explain” deep neural networks by producing heat maps that highlight the areas of the medical image that influence model prediction, are often presented to clinicians as an aid in diagnostic decision-making. Although many saliency methods have been proposed for medical imaging interpretation, rigorous investigation of the accuracy and reliability of these strategies is necessary before they are integrated into the clinical setting. In this work, we quantitatively evaluate seven saliency methods—including Grad-CAM, Grad-CAM++, and Integrated Gradients—across multiple neural network architectures using two evaluation metrics. We establish the first human benchmark for chest X-ray segmentation in a multilabel classification set up, and examine under what clinical conditions saliency maps might be more prone to failure in localizing important pathologies compared to a human expert benchmark. We find that (i) while Grad-CAM generally localized pathologies better than the other evaluated saliency methods, all seven performed significantly worse compared with the human benchmark; (ii) the gap in localization performance between Grad-CAM and the human benchmark was largest for pathologies that were smaller in size and had shapes that were more complex; (iii) model confidence was positively correlated with Grad-CAM localization performance. While it is difficult to know whether poor localization performance is attributable to the model or to the saliency method, our work demonstrates that several important limitations of saliency methods must be addressed before we can rely on them for deep learning explainability in medical imaging.