bluuebunny/crossref_metadata_2025 huggingface dataset:
The Electoral System of Israel
Authors: Shugart Matthew S.
Published: October 2020

The electoral system of Israel is an “extreme” example of proportional representation because of its use of a single nationwide district. This feature has been a constant since 1949, while secondary features, such as legal thresholds and the proportional seat-allocation formula, have changed and had an impact on degrees of proportionality. The party system is highly fragmented, as expected in extreme proportional systems. By applying the Seat Product Model to indices of election outcomes, it is possible to determine whether Israel’s system is more or less fragmented and proportional than expected for its institutional design. This chapter reports that the long-term average outputs are about as expected, but they have fluctuated over time. Some of these fluctuations reflect changes in the secondary features of the system, while others are the results of political factors independent of the institutions.
Parties and the Party System of Israel
Authors: Hazan Reuven Y.
Published: October 2020

Both the parties and the party system of Israel have undergone significant changes during the last seventy years. This chapter begins by delineating the transformation of the political parties in Israel, from classic mass parties to a plethora of types that coexist somewhat uneasily, and from parties focused on domestic socioeconomic issues to ones dominated by foreign policy and security concerns. It then shifts to its main focus, assessing the changes in the party system. The chapter argues two points: first, that while the Israeli parties were extremely volatile, the party blocs were surprisingly stable; and second, that while the Israeli party system exhibited two very stable periods during the first fifty years—albeit with a short, transformative interim phase—during the last twenty-five years it has exhibited accelerated change and instability.
Israel’s Policy in and toward the West Bank and the Gaza Strip
Authors: Barak Oren
Published: October 2020

This chapter discusses Israel’s policy in and toward the West Bank (and East Jerusalem) and the Gaza Strip from the Six-Day War (1967), when Israel occupied these areas, to the present. Although the focus here is on the political-security realm, other spheres (e.g., economic, social, and cultural-discursive) are also addressed. The first part of the chapter discusses Israel’s policy in and vis-à-vis the Territories in the first decade after 1967, which in retrospect was the policy’s formative period. It then examines the four decades that followed, identifying elements of continuity and change in Israel’s policy. This is followed by a discussion of the major challenges to Israel’s policy since 1967: the first Palestinian intifada, the Israeli–Palestinian peace process, the second intifada, and Israel’s withdrawal from the Gaza Strip. The concluding section tries to assess the cumulative impact of Israel’s policy in and toward the Territories.
Israel and the Arab World
Authors: Rabinovich Itamar
Published: October 2020

This chapter traces and analyzes the course of the Arab–Israeli conflict from its early days to the present. What began as a Jewish–Arab conflict in and over Palestine developed in 1948 into a larger conflict between Israel and the Arab world. The conflict festered in the 1950s and culminated in the war of June 1967. That war had two major contradictory results. First, it provided Israel with bargaining chips for negotiating peace with Arab countries that lost territory in the Six-Day War. Most significantly, this led to the signing of the Israeli–Egyptian peace treaty in 1979. But second, it also encumbered Israel with the West Bank, the Gaza Strip, and the lingering control of a large Palestinian population. To a great extent the larger Arab–Israeli conflict was telescoped into the Israeli–Palestinian conflict in its present form. In recent years two other contradictory developments have been shaping the Israeli–Arab landscape. The return of Iran and Turkey into the Middle Eastern arena has added an important Islamic dimension to the conflict. But Iran’s quest for regional hegemony and the exacerbation of Sunni–Shiite tensions in the Middle East have had a moderating effect on the attitude of the Sunni Arab states toward Israel.
Political Culture and Israeli Politics
Authors: Ariely Gal
Published: October 2020

This chapter provides a broad overview of the political culture in Israel. It begins by discussing whether a single Israeli political culture can indeed be identified. It then surveys the principal factors that shape political culture and the key changes from the early days of nation-building attempts to Israel’s current, more multicultural character. Making use of a cultural-value map, the chapter then addresses the question of whether Israel’s political culture is indeed “Western” and compares the principal Israeli political orientations with those of other societies. Finally, it analyzes aspects of system support and democratic norms via the use of national and cross-national survey data. The analysis presented concludes that Israeli political culture is dominated by countervailing forces that create a combination of assertive and allegiant forms of citizenship.
Political History of Israel
Authors: Shapira Anita
Published: October 2020

This chapter discusses the internal political development of the Jewish community in Palestine and, after 1948, of the State of Israel. The rise of popular politics in the early 1930s culminated in the hegemony of the Left, which was the predominant power in Israeli politics from 1933 until 1977. The predominant leader was David Ben Gurion, who retired in 1963. The Left was mostly pragmatic, with a social democratic agenda that emphasized the role of the state in the economy and culture, promoting a narrative that glorified the predominance of the Left in nation- and state-building. In 1977 there was a change of direction: the right-wing opposition won the elections. The government now moved toward a free enterprise economy and a new narrative, which emphasized the question of Greater Israel as the focal point of government and state interest. The clash between Left and Right in Israel was no longer centered on questions of economy and society but rather on external policy. Growing polarization between Left and Right, Ashkenazi Jews and Mizrahim (Middle Eastern Jews), Orthodox and secular, and Israeli Arabs and Israeli Jews has typified Israel politics in the last two decades.
Arab Citizens in the “Jewish” State of Israel
Authors: Galnoor Itzhak
Published: October 2020

Israel’s Declaration of Independence proclaims full equality for all of Israel’s citizens and calls upon members of the Arab nation “to participate in the upbuilding of the State on the basis of full and equal citizenship.” This pledge has not been kept. On the one hand, the government is using its majority to legislate laws that undermine the status and legitimacy of the Arab citizens. On the other, since 2007 the same government has been investing a great deal of money in improving the economic conditions in the Arab localities. The tenuous relationship between Jews and Arabs is under constant pressure. Nonetheless, a change has begun to surface tacitly in the official state policy toward Arab citizens, recognizing the justification of equality, in economic terms. The three subsequent Knesset elections held in 2019–2020 strengthened the political representation and clout of the Arab citizens; however, the discriminating barrier, preventing their recognition as legitimate partners in the government coalition, has not been removed.
Coloniality of Mixed Race and Mixed Language
Authors: Reyes Angela
Published: October 2020

This chapter situates the study of race, language, and mixedness within imperial histories through which notions of racial and linguistic hybridity were and continue to be developed. It argues that questions of “mixed race” and “mixed language” are less about mixing races and languages and more about how evaluations of who and what is regarded as mixed are authorized in the ongoing reproduction of colonial hierarchies. After reviewing past research on mixed race and language, the chapter theoretically situates the concepts of race, language, and hybridity within a framework of coloniality that considers colonial, scientific, and liberal discourses surrounding imperial conquest. The chapter introduces four paradigms of mixedness that have been produced through this history: immiscibility, absorption, blend, and end. The chapter concludes with a case study to illustrate how notions of racial and linguistic hybridity frame a contemporary elite figure in the Philippines.
Race, SIGNS, and the Body
Authors: Smalls Krystal A.
Published: October 2020

This chapter considers the utility of a racial semiotics, or raciosemiotics, to further explore the ways race, language, and the body co-construct one another via multiscalar signification. It begins with a brief overview of semiotic theory, underscoring contemporary scholars’ focus on context and materiality. Drawing from Fanonian phenomenology and from ethnographic research with Black-identified young people in the United States and Liberia, the chapter discusses how antiblackness, as a transhistorical interpretive frame, compounds the semiotic weight of Black bodies and shapes how individuals in such bodies make meaning with others. Finally, by focusing on the racialized body in the construction of meaning, I suggest that attending closely to young people’s raciosemiotic labor—meaning-making about and through race—can move us closer towards developing a theory of racial semiotics.
“You Met My Ambassador”
Authors: Cornelius Brianna R. , Barrett Rusty
Published: October 2020

This chapter focuses on race, sexuality, and self-monitoring by exploring the language practices of black gay men. We show how black gay men use language to creatively navigate the double-bind of homophobia in some black communities and the widespread racism found in predominantly white gay male communities. In our analysis of the speech of one black gay man (Bakari), we examine how he monitors his language and comportment as he constructs a black gay identity. Bakari creates the persona of an “ambassador,” which affords him more acceptance within discriminatory contexts, at least temporarily. We show how individuals who are both sexual and racial minorities use a complex set of linguistic resources in order to navigate the harmful, discriminatory discourses that they face in their daily lives.
Race, Humor, and Politics
Authors: Perrino Sabina
Published: October 2020

From a country of emigrants, Italy has recently become a receiver of migrants. These new, reverse direction migratory flows have triggered strong reactions by Italians, such as nativist discourses about national culture and identity and aggressive, exclusionary, anti-immigration politics. This chapter explores how everyday Italian discursive practices—joke-telling, in particular—operate in relation to these politics, at times totally or partially excluding migrants while simultaneously creating intimate spaces of inclusion for Italians. By codeswitching, for example, from standardized Italian into their local code during joke-telling performances that feature migrants, Northern Italian speech participants address audiences who are presumed to “share” this code while enacting exclusionary stances. This chapter also demonstrates that dichotomies such as exclusion/inclusion are inadequate analytical tools, and it proposes more processual approaches to participation.
“I Don’t Care about London”: Punk in Britain’s Provinces, circa 1976–1984
Authors: Worley Matthew
Published: October 2020

This chapter will look at punk’s impact across Britain’s towns and cities, moving away from the London- and Manchester-centric narratives that tend to dominate most historical accounts. By so doing, it endeavors to offer a provincial view of punk’s dissemination, shedding light on the culture’s transmission and mutation. Punk culture morphed as it was received away from its initial source; its aesthetics, sounds, and performance were filtered through local contexts to be mis- and reinterpreted in about equal measure. By drawing attention to the infrastructure of punk in the provinces, historically mining the traces left by certain spaces, record labels, and fanzines, the chapter recovers the legacy of punk at the grass roots and reveals the deeply engrained stains left on the cultural fabric.
Contracts and Copyright: Contemporary Musician Income Streams
Authors: García Kristelia
Published: October 2020

Musicians typically earn revenues from two sources: copyright law and contract. The proportion of revenue derived from each of these sources varies from artist to artist, but an understanding of the general distribution of earnings from each source is useful when considering proposed legislative amendments. Through a series of qualitative interviews with working musicians, this article contributes to the ongoing conversation around copyright’s import to, and impact on, musician revenue at different career stages.
Consequentialism, the Separateness of Persons, and Aggregation
Authors: Brink David O.
Published: October 2020

This essay reconstructs and assesses claims that utilitarianism and, more generally, consequentialism have inadequate conceptions of distributive justice, because their aggregative character ignores the separateness of persons. On this view, the separateness of persons requires a fundamentally anti-aggregative conception of distributive justice. Even if this objection applies to some forms of utilitarianism, it won’t apply to forms of consequentialism that recognize some conception of distributive justice as an important nonderivative good. Moreover, the separateness of persons poses, rather than resolves, questions about the role of aggregation within distributive justice. This essay explores the adequacy of some consequentialist answers to these questions and defends selective, rather than unrestricted, aggregation.
Alternatives
Authors: Smith Holly M.
Published: October 2020

Consequentialists have long debated (as deontologists should) how to define an agent’s alternatives, given that (a) at any particular time an agent performs numerous “versions” of actions, (b) an agent may perform several independent co-temporal actions, and (c) an agent may perform sequences of actions. We need a robust theory of human action to provide an account of alternatives that avoids previously debated problems. After outlining Alvin Goldman’s action theory (which takes a fine-grained approach to act individuation) and showing that the agent’s alternatives must remain invariant across different normative theories, I address issue (a) by arguing that an alternative for an agent at a time is an entire “act tree” performable by her, rather than any individual act token. I argue further that both tokens and trees must possess moral properties, and I suggest principles governing how these are inherited among trees and tokens. These proposals open a path for future work addressing issues (b) and (c).
Comparative Effectiveness Research, Learning Health Systems, and Pragmatic Randomized Controlled Trials
Authors: Kim Scott Y. H.
Published: October 2020

Pragmatic clinical trials (PCTs) comparing interventions “within the standard of care” can efficiently yield important real-world evidence for healthcare practice and policymaking. But since PCTs attempt to mimic real-world procedures, any requirements added to the PCTs—even ethical requirements such as informed consent—can compromise the pragmatic nature of the trials. Many therefore treat such PCTs as ethically exceptional and propose that if PCTs compare two standard interventions, by that mere fact they pose no more than minimal risk—making them candidates for waivers of informed consent. This chapter argues that such an approach misunderstands research risks, is dangerous, and is unnecessary. Using a rigorous research analysis model, the chapter argues that instead of discarding the research–treatment distinction, it is better to pragmatically integrate research and clinical ethics.
Patient Protection and Paternalism in Psychotherapy
Authors: Annoni Marco
Published: October 2020

This chapter provides a synthetic overview of the ethics of paternalism in psychotherapy with a focus on involuntary hospitalization to protect patients from self-harm. Paternalism entails the intentional overriding of someone’s preferences or actions on grounds of beneficence and nonmaleficence. After the emergence of autonomy in medical ethics, paternalism is generally considered prima facie wrong, as it infringes on patient autonomy, trust, and right to informed consent. In particular, the use of paternalism in psychotherapy raises a host of complex and delicate ethical issues due to the nature of the therapeutic relationship and the difficulty to assess the autonomy of the person who will supposedly benefit from the paternalistic intervention.
The Audio-Visual Aesthetics of Music and Dance
Authors: Orgs Guido , Howlin Claire
Published: October 2020

Dance and music appear to belong together: Conventional definitions of dance often conceive it as a rhythmical activity in which a series of steps is performed to musical accompaniment. Indeed, dance and music share many similarities such as rhythm and may have co-evolved as a form of nonverbal communication between groups of people. Despite a rich history of composers and choreographers exploring the aesthetic relationship between dance and music, only a few scientific studies have systematically explored how the visual aesthetics of dance interact with the auditory aesthetics of sound and music. In this chapter we will focus on such interactions; we will explore the common evolutionary origins of dance and music and review existing research on how dance and music influence each other to produce an audio-visual aesthetics of sound and movement. The chapter will explore interactions in both directions: music influences dance perception by altering movement expressiveness, orienting visual attention, and by modulating memory. At the same time music perception strongly depends on groove and danceability and is shaped by the listener’s dance experience. The chapter closes with a review of methodological challenges to studying the audio-visual aesthetics of dance and music and suggestions for future research in this field.
James and Politics
Authors: Throntveit Trygve , Kloppenberg James T.
Published: October 2020

William James never developed a comprehensive political philosophy. The radically pluralist epistemology and metaphysics for which “pragmatism” became his shorthand represented a revolt against all closed systems of thought. Yet James’s very resistance to certainty and finality led him to participate actively in civic life. Varying by context, this activity was consistently guided by James’s pragmatist accounts of individual experience, moral obligation, and social interdependence, which to him implied a collective, ongoing responsibility to balance freedom, justice, and order amid complexity and change. Though providing no detailed blueprint for achieving and maintaining that balance, James’s writings suggest a suite of practices and institutions that, in various forms and degrees, have proven effective in the past and deserve continued trial. These writings also articulate a regulative ideal by which to evaluate all such experiments: an ideal of popular participation in all levels of social ordering that James described, toward the end of his life, as “radical democracy.”
Experiments in the Principia
Authors: Smith George E.
Published: October 2020

Newton carried out four groundbreaking experiments in conjunction with the Principia and proposed a fifth. This chapter reviews his reasons for doing them, their design, and what they achieved. The four include a two-pendulum experiment early in 1685 to establish that the action of gravitational forces on a body is always proportional to its mass and hence that all bodies at any point respond to a gravitational force in the same way. In that same year he conducted a ballistic pendulum experiment to establish that this third law of motion holds for impact of spheres of a wide range of elastic responses, in the process identifying what became known as the coefficient of restitution. He carried out two sets of experiments measuring fluid resistance forces on spheres, the less than successful first relying on pendulum decay and then, for the second edition, vertical-fall. All five experiments were designed to “put the question to nature” in the sense that the three laws of motion enable their results to yield theory-mediated answers to theretofore open questions about forces—and thus parallel the answers to questions about celestial forces drawn from planetary motions that form the core of the Principia.
Exploring the Barriers to Policing Financial Crime in England and Wales
Authors: Gilmour Paul Michael
Published: October 2020

The police service in England and Wales has been subject of much criticism in the past two decades over the policing response to financial crime. Many studies have reported failures in how the police investigate and prosecute financial crime, which have led to many victims being dissatisfied with the service provided by police. Yet, there has been little research into the barriers facing police investigators entrusted with tackling financial crime. This article reports on a study into such barriers, through surveys and interviews with investigators that aimed to better understand the challenges faced by police forces within England and Wales. It demonstrates several overriding practical and cultural issues that inhibit the success of investigations. The article concludes that police need a better appreciation of financial crime, to help improve the service delivered to victims, and to prioritize this often-undervalued field of policing.
Norwich COVID-19 testing initiative pilot: evaluating the feasibility of asymptomatic testing on a university campus
Authors: Gillam T Berger , Cole J , Gharbi K , Angiolini E , Barker T , Bickerton P , Brabbs T , Chin J , Coen E , Cossey S , Davey R , Davidson R , Durrant A , Edwards D , Hall N , Henderson S , Hitchcock M , Irish N , Lipscombe J , Jones G , Parr G , Rushworth S , Shearer N , Smith R , Steel N
Published: October 2020

Background

There is a high prevalence of COVID-19 in university-age students, who are returning to campuses. There is little evidence regarding the feasibility of universal, asymptomatic testing to help control outbreaks in this population. This study aimed to pilot mass COVID-19 testing on a university research park, to assess the feasibility and acceptability of scaling up testing to all staff and students.

Methods

This was a cross-sectional feasibility study on a university research park in the East of England. All staff and students (5625) were eligible to participate. All participants were offered four PCR swabs, which they self-administered over two weeks. Outcome measures included uptake, drop-out rate, positivity rates, participant acceptability measures, laboratory processing measures, data collection and management measures.

Results

798 (76%) of 1053 who registered provided at least one swab; 687 (86%) provided all four; 792 (99%) of 798 who submitted at least one swab had all negative results and 6 participants had one inconclusive result. There were no positive results. 458 (57%) of 798 participants responded to a post-testing survey, demonstrating a mean acceptability score of 4.51/5, with five being the most positive.

Conclusions

Repeated self-testing for COVID-19 using PCR is feasible and acceptable to a university population.
Mutual Fund Trading Style and Bond Market Fragility
Authors: Anand Amber , Jotikasthira Chotibhak , Venkataraman Kumar
Published: October 2020

We explore the link between mutual funds and fragility risk in the corporate bond market. We classify a fund’s trading style based on its responses to signals of large dealer inventories. Trading style is persistent and the majority of funds demand liquidity. Notably, a subset of funds earn positive alpha by intentionally supplying liquidity during periods of sustained customer selling (with transitory price effects). Liquidity-supplying funds maintain their relative trading style when facing large outflows and elevated market stress, thus alleviating fragility risk. Our results add nuance to existing evidence that mutual funds pose a threat to market stability.
Sleep characteristics, cognitive performance, and gray matter volume: findings from the BiDirect Study
Authors: Hermesdorf Marco , Szentkirályi András , Teismann Henning , Teismann Inga , Young Peter , Berger Klaus
Published: October 2020

Study Objectives

Sleep is essential for restorative metabolic changes and its physiological correlates can be examined using overnight polysomnography. However, the association between physiological sleep characteristics and brain structure is not well understood. We aimed to investigate gray matter volume and cognitive performance related to physiological sleep characteristics.

Methods

Polysomnographic recordings from 190 community-dwelling participants were analyzed with a principal component analysis in order to identify and aggregate shared variance into principal components. The relationship between aggregated sleep components and gray matter volume was then analyzed using voxel-based morphometry. In addition, we explored how cognitive flexibility, selective attention, and semantic fluency were related to aggregated sleep components and gray matter volume.

Results

Three principal components were identified from the polysomnographic recordings. The first component, primarily described by apnea events and cortical arousal, was significantly associated with lower gray matter volume in the left frontal pole. This apnea-related component was furthermore associated with lower cognitive flexibility and lower selective attention.

Conclusions

Sleep disrupted by cortical arousal and breathing disturbances is paralleled by lower gray matter volume in the frontal pole, a proposed hub for the integration of cognitive processes. The observed effects provide new insights on the interplay between disrupted sleep, particularly breathing disturbances and arousal, and the brain.
Group mentoring and leadership growth in behavioral medicine
Authors: Sheinfeld Gorin Sherri N , Lee Rebecca E , Knight Sara J
Published: October 2020

Since its inception in 2016, the establishment of learning communities led by senior Society of Behavioral Medicine (SBM) members has been central to the SBM’s Mid-Career Leadership Institute (Institute). At the beginning of an initial two-day intensive workshop, groups of approximately six fellows are placed together, and one or two senior SBM members are asked to lead group mentoring. Senior SBM members serve as mentors during quarterly calls that are conducted over the year in order for group members to develop and present an individual leadership project at the following annual meeting. Group mentoring relies on the social dynamic that emerges from the group’s own social norms and roles; it is designed to advance the careers of group members. To our knowledge, this is the first commentary describing a program of formal group mentoring for mid-career leadership development in a professional association. Based on the authors’ experience as mentors, thematic and descriptive analyses of the initial workshop evaluations, and contemporaneous notes, we discuss the structure, process, and project outcomes of the formal group mentoring in SBM’s Institute. Early process evaluation of the Institute suggests that the Fellows benefitted from the group mentoring experience.
Using a group development framework to maximize leadership strategies in the inaugural session of the Society of Behavioral Medicine Leadership Institute
Authors: Ford Sabrina , Peterson Caryn E , Whiteley Jessica , Kiviniemi Marc T , Martin Michelle Y , Carpenter Kelly M , Whitt-Glover Melicia C , Jacob Arriola Kimberly R
Published: October 2020

The 2016–2017 Inaugural Class of the Society of Behavioral Medicine Leadership Institute (SBM LI) debuted to an eager team of 36 mid-career fellows led by energetic mentors, professional coaches, and career development experts. Fellows were divided into learning communities of eight participants for deeper engagement. Our “Green Team” learning community bonded quickly and actively committed to our collective progress and projects. Upon returning home from the in-person sessions, our activities included monthly team conference calls and consultation with our mentors and selected coaches. The Green Team regularly communicated throughout the year, giving feedback to each other about our projects to be presented at the 2017 SBM Annual Meeting. We also discussed our mentoring and coaching experiences, leadership skills put to use at our institutions, and personal development. Contact continued via social media, email, teleconferencing, and collaborations at other professional meetings. The Green Team utilized the Tuckman and Jensen model of small group development to describe how we developed into a high-functioning group that maximized the resources afforded by the SBM LI to yield successful leadership outcomes. This commentary will offer an example of how a productive SBM LI team works collaboratively to utilize its mentors and resources for professional development.
Rapid vs. Slow Rewarming for Management of Moderate to Severe Hypothermia in Low-Birth-Weight Pre-term Neonates—An Open Label Randomized Controlled Trial
Authors: Jain Prerana , Dalal Jagjit Singh , Gathwala Geeta
Published: October 2020

Background

Evidence is lacking regarding the optimal method of rewarming hypothermic low-birth-weight (LBW) pre-term neonates. We aim to evaluate the effect of rapid vs. slow rewarming in the management of moderate to severe hypothermia in LBW pre-term neonates.

Methods

In this open label, randomized controlled trial, 100 LBW (<2.5 kg), pre-term (<37 weeks) neonates with moderate to severe hypothermia (<36°C) was randomized to two groups of 50 each and received either rapid (at >0.5°C/h) or slow (at ≤0.5°C/h) rewarming rate till normothermia. The primary outcome was stabilization score [TOPS (temperature, oxygenation, perfusion and saturation) and MSNS (modified sick neonatal score)] at baseline, 6 and 24 h and mortality until discharge. Other neonatal morbidities were assessed as secondary outcomes.

Results

Mean TOPS score and MSNS score at baseline, 6 and 24 h of admission as well as change in score from baseline were similar between the two groups. The median rewarming rate [interquartile range (IQR)] was higher in rapid rewarming group than in the slow rewarming group [5.05°C/h (3.54–7.71) vs. 0.71°C/h (0.60–0.90); p < 0.001]. The median rewarming time taken in rapid rewarming group was lesser compared with that in the slow rewarming group [0.31 h (IQR 0.13–0.75) vs. 2.05 h (IQR 1.11–3.03); p < 0.001]. Mortality in rapid rewarming and slow rewarming group was similar [7/50 vs. 5/50; OR 1.46 (0.43–4.97), p = 0.538]

Conclusion

Rapid rewarming was as effective and safe as slow rewarming in the management of moderate to severe hypothermia in LBW pre-term neonates with similar short-term neonatal outcomes.

CTRI number

CTRI/2018/01/011187.
An Additional Threat to ‘Cavendish’ Banana Growers and Traders: The Infection of Banana Peduncles by Fusarium oxysporum f. sp. cubense Tropical Race 4 (Foc TR4)
Authors: Bai Tingting , Qin Meng , Li Xundong , Fan Huacai , Xu Shengtao , Zeng Li , Zheng Si-Jun
Published: October 2020

Fusarium oxysporum f. sp. cubense tropical race 4 (Foc TR4) is one of the most destructive banana pathogens worldwide. Until now, it has been generally accepted that Foc TR4 mainly colonizes the roots, rhizomes, pseudostems, and leaves of banana plants and spreads among plantations with infected planting material, soil residues, and water. Because banana Fusarium wilt is a typical vascular bundle disease, the pathogen is accepted to possess the ability to enter the peduncle. However, no scientific proof has been presented. Recently, more and more signs of peduncle Foc TR4 in ‘Cavendish’ plants in different banana production provinces of China suggest that further investigations ought to be made regarding fungal colonization. We observed discoloration inside some peduncles from the Foc TR4-infected plants. The fungus isolated from these symptoms was identified using Foc TR4-specific PCR, sequencing, and a host inoculation assay. In a greenhouse bioassay, the Foc TR4 isolates from the peduncle showed the capacity for reinfecting Brazilian plants (Cavendish, AAA) up into the leaves. Collectively, we isolated the Foc TR4 from the peduncle and directly testified that this pathogen can invade the peduncle via xylem vascular bundle.
Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology
Authors: van Wijk Jan J. , Weber Frank , Stolker Robert J. , Staals Lonneke M.
Published: October 2020

Purpose of review

The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is challenging, due to lack of evidence, validity and size constraints. Most measured parameters are proxies for end organ function, in which an anesthesiologist is actually interested. Ideally, monitoring should be continuous, noninvasive and accurate. This present review summarizes the current literature on noninvasive monitoring in noncardiac pediatric anesthesia.

Recent findings

For cardiac output (CO) monitoring, bolus thermodilution is still considered the gold standard. New noninvasive techniques based on bioimpedance and pulse contour analysis are promising, but require more refining in accuracy of CO values in children. Near-infrared spectroscopy is most commonly used in cardiac surgery despite there being no consensus on safety margins. Its place in noncardiac anesthesia has yet to be determined. Transcutaneous measurements of blood gases are used mainly in the neonatal intensive care unit, and is finding its way to the pediatric operation theatre. Especially CO2 measurements are accurate and useful.

New techniques are available to assess a child's hemodynamic and respiratory status while under anesthesia. These new monitors can be used as complementary tools together with standard monitoring in children, to further improve perioperative safety.
Clinical Presentation of Coronavirus Disease 2019 (COVID-19) in Pregnant and Recently Pregnant People
Authors: Afshar Yalda , Gaw Stephanie L. , Flaherman Valerie J. , Chambers Brittany D. , Krakow Deborah , Berghella Vincenzo , Shamshirsaz Alireza A. , Boatin Adeline A. , Aldrovandi Grace , Greiner Andrea , Riley Laura , Boscardin W. John , Jamieson Denise J. , Jacoby Vanessa L. ,   on behalf of the Pregnancy CoRonavIrus Outcomes RegIsTrY (PRIORITY) Study
Published: October 2020

OBJECTIVE:

To describe the clinical presentation, symptomology, and disease course of coronavirus disease 2019 (COVID-19) in pregnancy.

METHODS:

The PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) study is an ongoing nationwide prospective cohort study of people in the United States who are pregnant or up to 6 weeks postpregnancy with known or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed the clinical presentation and disease course of COVID-19 in participants who tested positive for SARS-CoV-2 infection and reported symptoms at the time of testing.

RESULTS:

Of 991 participants enrolled from March 22, 2020, until July 10, 2020, 736 had symptoms of COVID-19 at the time of testing; 594 tested positive for SARS-CoV-2 infection and 142 tested negative in this symptomatic group. Mean age was 31.3 years (SD 5.1), and 37% will nulliparous. Ninety-five percent were outpatients. Participants who tested positive for SARS-CoV-2-infection were a geographically diverse cohort: 34% from the Northeast, 25% from the West, 21% from the South, and 18% from the Midwest. Thirty-one percent of study participants were Latina, and 9% were Black. The average gestational age at enrollment was 24.1 weeks, and 13% of participants were enrolled after pregnancy. The most prevalent first symptoms in the cohort of patients who tested positive for SARS-CoV-2 infection were cough (20%), sore throat (16%), body aches (12%), and fever (12%). Median time to symptom resolution was 37 days (95% CI 35–39). One quarter (25%) of participants who tested positive for SARS-CoV-2 infection had persistent symptoms 8 or more weeks after symptom onset.

CONCLUSION:

COVID-19 has a prolonged and nonspecific disease course during pregnancy and in the 6 weeks after pregnancy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04323839.
Why Irrigate for the Same Contamination Rate: Wound Contamination in Pediatric Spinal Surgery Using Betadine Versus Saline
Authors: Cohen Lara L. , Schwend Richard M. , Flynn John M. , Hedequist Daniel J. , Karlin Lawrence I. , Emans John B. , Snyder Brian D. , Hresko Michael T. , Anderson John T. , Leamon Julia , Talwar Divya , Glotzbecker Michael P.
Published: October 2020

Background:

The risk of surgical site infection in pediatric posterior spine fusion (PSF) is up to 4.3% in idiopathic populations and 24% in patients with neuromuscular disease. Twenty-three percent of pediatric PSF tissue cultures are positive before closure, with a higher rate in neuromuscular patients. Our primary aim was to evaluate the feasibility of a complete randomized controlled trial to study the efficacy of surgical site irrigation with povidone-iodine (PVP-I) compared with sterile saline (SS) to reduce the bacterial contamination rate before closure in children undergoing PSF.

Methods:

One hundred seventy-five subjects undergoing PSF were enrolled in a multicenter, single-blind, pilot randomized controlled trial. We recruited patients at low-risk (LR) and high-risk (HR) for infection 3:1, respectively. Before closure, a wound culture was collected. Nonviable tissues were debrided and the wound was soaked with 0.35% PVP-I or SS for 3 minutes. The wound was then irrigated with 2 L of saline and a second sample was collected.

Results:

One hundred fifty-three subjects completed the protocol. Seventy-seven subjects were allocated to PVP-I (18 HR, 59 LR) and 76 to SS (19 HR, 57 LR). Cultures were positive in 18% (14/77) of PVP-I samples (2 HR, 12 LR) and in 17% (13/76) of SS samples (3 HR, 10 LR) preirrigation and in 16% (12/77) of PVP-I samples (5 HR, 7 LR) and in 18% (14/76) of SS samples (4 HR, 10 LR) postirrigation. Eight percent (3/37) HR subjects (1 PVP-I, 2 SS) experienced infection at 30 days postoperative. No LR subjects experienced infection.

Conclusions:

Positive cultures were similar across treatment and risk groups. The bacterial contamination of wounds before closure remains high regardless of irrigation type. A complete randomized controlled trial would be challenging to adequately power given the similarity of tissue positivity across groups.

Level of Evidence:

Level II—pilot randomized controlled trial.
The Interaction of Acute and Chronic Glycemia on the Relationship of Hyperglycemia, Hypoglycemia, and Glucose Variability to Mortality in the Critically Ill*
Authors: Krinsley James S. , Rule Peter , Pappy Lovin , Ahmed Afshan , Huley-Rodrigues Camilla , Prevedello Danielle , Preiser Jean-Charles
Published: October 2020

Objectives:

To determine the relationship between preadmission glycemia, reflected by hemoglobin A1c level, glucose metrics, and mortality in critically ill patients.

Design:

Retrospective cohort investigation.

Setting:

University affiliated adult medical-surgical ICU.

Patients:

The investigation included 5,567 critically ill patients with four or more blood glucose tests and hemoglobin A1c level admitted between October 11, 2011 and November 30, 2019. The target blood glucose level was 90–120 mg/dL for patients admitted before September 14, 2014 (n = 1,614) and 80–140 mg/dL or 110–160 mg/dL for patients with hemoglobin A1c less than 7% or greater than or equal to 7% (n = 3,953), respectively, subsequently.

Interventions:

None.

Measurements and Main Results:

Patients were stratified by hemoglobin A1c: less than 6.5.(n = 4,406), 6.5–7.9% (n = 711), and greater than or equal to 8.0% (n = 450). Increasing hemoglobin A1c levels were associated with significant increases in mean glycemia, glucose variability, as measured by coefficient of variation, and hypoglycemia (p for trend < 0.0001, < 0.0001, and 0.0010, respectively). Among patients with hemoglobin A1c less than 6.5%, mortality increased as mean glycemia increased; however, among patients with hemoglobin A1c greater than or equal to 8.0%, the opposite relationship was observed (p for trend < 0.0001 and 0.0027, respectively). Increasing glucose variability was independently associated with increasing mortality only among patients with hemoglobin A1c less than 6.5%. Hypoglycemia was independently associated with higher mortality among patients with hemoglobin A1c less than 6.5% and 6.5–7.9% but not among those with hemoglobin A1c greater than or equal to 8.0%. Mean blood glucose 140–180 and greater than or equal to 180 mg/dL were independently associated with higher mortality among patients with hemoglobin A1c less than 6.5% (p < 0.0001 for each). Among patients with hemoglobin A1c greater than or equal to 8.0% treated in the second era, mean blood glucose greater than or equal to 180 mg/dL was independently associated with decreased risk of mortality (p = 0.0358).

Conclusions:

Preadmission glycemia, reflected by hemoglobin A1c obtained at the onset of ICU admission, has a significant effect on the relationship of ICU glycemia to mortality. The different responses to increasing mean glycemia support a personalized approach to glucose control practices in the ICU.
IPACK block: emerging complementary analgesic technique for total knee arthroplasty
Authors: Caballero-Lozada Andrés Fabricio , Gómez Juan Manuel , Ramírez Jorge A , Posso Mónica , Zorrilla-Vaca Andrés , Lasso Luis Fernando
Published: October 2020

Introduction:

Pain control in total knee arthroplasty (TKA) is a determining factor in the patient's rehabilitation process. With conventional peripheral blocking techniques for the posterior compartment, foot drop, and distal motor deficit have been reported. The infiltration between popliteal artery and capsule of the knee (IPACK) block is a promising emerging analgesic technique.

Objective:

To describe analgesic control, opioid consumption, and mobility of patients scheduled for TKA using IPACK block as adjunct analgesic to the femoral block.

Methods:

We conducted a prospective observational cohort study over a 6-month period in adults taken to TKA. Sociodemographic and anthropometric characteristics, laterality, postoperative pain, and opioid consumption, patient and surgeon satisfaction (Likert), postoperative nausea and vomiting, and walk in the first 24hours, were evaluated and reported with a descriptive analysis.

Results:

Twenty-seven patients taken to TKA received an IPACK block. The pain score remained in a mild level during the 48 hours of evaluation. In 73% of the cases, an opioid rescue dose was not required; 81% of the patients managed to walk in the first 24 hours.

Conclusion:

The IPACK block, combined with femoral block and neuraxial anesthesia, turn out to be an excellent analgesic strategy for TKA, achieving adequate pain management, prompt rehabilitation, and early ambulation of the patient.
Firibastat: An Oral First-in-Class Brain Aminopeptidase A Inhibitor for Systemic Hypertension
Authors: Khosla Jagjit , Aronow Wilbert S. , Frishman William H.
Published: October 2020

Systemic hypertension is the leading cause of death and disability worldwide. The management of hypertension is challenging in the high-risk patient population with high salt-sensitivity and low serum renin levels. The renin-angiotensin system (RAS) plays a central role in blood pressure (BP) regulation. While we have effective medications to act on peripheral RAS, our understanding of brain RAS and its effect on BP regulation is still in an evolving stage. Brain RAS hyperactivity is associated with the development and maintenance of hypertension. In comparison to peripheral RAS, where angiotensin II is the most crucial component responsible for BP regulation, angiotensin III is likely the main active peptide in the brain RAS. Angiotensin II is metabolized by aminopeptidase A into angiotensin III in the brain. EC33 is a potent inhibitor of brain aminopeptidase A tested in animal models. The use of EC33 in conscious spontaneously hypertensive rats, hypertensive deoxycorticosterone acetate-salt rats, and conscious normotensive rat models leads to a reduction in BP. In order to facilitate the passage of EC33 through the blood-brain barrier, the 2 molecules of EC33 were linked by a disulfide bridge to form a prodrug called RB150. RB150, later renamed as QGC001 or firibastat, was found to be effective in animal models and well-tolerated when used in healthy participants. Firibastat was found to be safe and effective in phase 2 trials, and is now planned to undergo a phase 3 trial. Firibastat has the potential to be groundbreaking in the management of resistant hypertension.
Interventional Cardiology and Catheter-Based Interventions in Pregnancy
Authors: Gupta Rahul , Alcantara Ryan , Mahajan Sugandhi , Malik Aaqib H. , Mehta Sanjay S. , Frishman William H. , Aronow Wilbert S.
Published: October 2020

Cardiovascular disease is the leading cause of maternal mortality worldwide and has been increasing in prevalence over the last several decades. Pregnancy is associated with significant hemodynamic changes that can overwhelm the maternal cardiovascular reserve, and may exacerbate previously asymptomatic cardiovascular disease. Complications associated with these may cause substantial harm to both the mother and the fetus, and the management of these conditions is often challenging. Numerous novel treatments and interventions have demonstrated the safety and efficacy of managing these conditions outside of pregnancy. However, there are little data regarding their use in the pregnant population. In this review, we describe the common cardiovascular diseases encountered during pregnancy and discuss their management strategies, with a particular focus on the role of percutaneous, catheter-based therapeutic interventions.
Endometriosis of the Bowel
Authors: Kim Tae David
Published: October 2020

CASE SUMMARY:

A 31-year-old woman with a history of endometriosis was referred to the outpatient colorectal surgery office for evaluation of rectal bleeding. Colonoscopy was recommended because of the ongoing symptoms, and a polyp was discovered in the colon (Fig. 1A). Pathology was consistent with endometriosis (Fig. 1B). The patient was previously scheduled for laparoscopic endometriosis resection and underwent laparoscopic colon resection at the same time. She recovered and continued to do well postoperatively with no additional signs of rectal bleeding.