bluuebunny/crossref_metadata_2025 huggingface dataset:
P387 “THE IMPORTANCE OF NEW ADVANCED IMAGING TECHNIQUES IN SINE CAUSA VENTRICULAR ARRHYTHMIAS”
Authors: Pugliesi G , Ravaro S , Rella V , Castelletti S , Meda M , Mariani D , Salerno S , Parati G , Muraru D , Crotti L
Published: May 2023

Case Presentation

A 61–years–old woman was referred to our center after her 33 years old daughter suffered a sudden cardiac death. Cardiovascular risk factors: dyslipidemia and family history of ischemic cardiomyopathy.

Diagnostic and Therapeutic Work Up

Patient’s ECG was normal. Holter ECG showed frequent ventricular extrasystoles (2000/die) isolated and not premature, with LBB morphology, associated with not sustained ventricular tachycardias with LLB and low axis morphology (HR mean 140–170 beats/min). Exercise Stress Test did not show a clear correlation between physical activity and arrhythmias. Beta blocker therapy was started and was only partially effective in reducing ventricular arrhythmias, and a loop recorder was implanted. In 2019 a cardiac MRI with adenosine was performed, showing a mild globular shaped left ventricle with a non–specific linear distribution of LGE in the middle septum. Genetic analysis for channelopathies and cardiomyopathies resulted negative. In the last advanced echocardiogram (2022) with 3D reconstruction and strain analyses, characteristics suspected for arrhythmic mitral valve prolapse (MAD and curling of inferolateral wall) were identified. Accordingly, it has been decided to perform a second cardiac MRI to better characterize the underlying cardiac condition and to define the appropriate risk stratification algorithm.

Conclusions

Arrhythmic mitral valve prolapse is defined by ventricular arrhythmias in the absence of other known causes and it is present in up to 13% of sudden cardiac deaths in female patients. According to the recent consensus document by EHRA, sudden cardiac death risk stratification is complex and based firstly on the evaluation of arrhythmic burden, and secondly on symptoms and additional risk factors (i.e. MAD, left ventricle disfunction, flap redundancy, LGE in specific areas and so on). This case shows the importance of advanced imaging techniques and multimodal approach in ventricular arrhythmias evaluation.
P398 ACUTE PERICARDITIS COMPLICATED BY RAPID DEVELOPMENT OF CONSTRICTION: A CASE REPORT
Authors: Passarelli I , Castelli G , Pirondini M , Lesce A , Luciano R , De Concilio A , Perego C , Chiocca E , Dadone V , Pentiricci S , Ornaghi M , Pierini S
Published: May 2023

A 57–years–old man with no previous cardiovascular history presented with fever, hypotension, dyspnoea at rest and chest pain. The electrocardiogram showed sinus tachycardia, PR–segment depression and diffuse concave–upwards ST–segment elevation. Elevated C–reactive protein and low pro–BNP level were found at lab tests, procalcitonin and troponin were negative. Chest X–ray showed bilateral pleural effusion. Transthoracic echocardiogram (TTE) revealed mild–to–moderate serofibrinous pericardial effusion with initial diastolic collapse of right chambers, suggesting cardiac pre–tamponade. Because of the exiguity of liquid component, pericardiocentesis was not performed, patient was stabilized by fluid–challenge with hypertonic solution. Ibuprofen and colchicine were started. Left thoracentesis was performed removing one liter of fluid overall compatible with transudate. Cytological and microbiological examinations were negative. Despite of initial clinical improvement, the patient showed kidney failure and worsening of lung failure; perianal abscess was detected causing sepsis and requiring surgical drainage and antibiotic therapy with vancomycin and piperacillin/tazobactam. Culture exams were negative. After ibuprofen replacement with indomethacin a repeated TTE showed reduced pericardial effusion, but also respiratory variation in ventricular filling with signs of interventricular dependence. Cardiac magnetic resonance showed thickening and high signal intensity of pericardial layers on T2 weighted imaging and ventricular septal shift on free–breathing cine sequences, suggesting effusive–constrictive pericarditis. Left and right cardiac catheterization demonstrated ventricular “dip and plateau” pattern and ventricular discordance. Considering the lack of clinical improvement on medical therapy, off–bypass pericardiectomy was performed. Incomplete adhesion between the two pericardial layers and thick gelatinous material were found. After surgery patient experienced rapid clinical improvement; cardiac index increased from 1.5 to 3.5 L/min/m2. Effusive–constrictive pericarditis is a rare and dreaded complication of acute pericarditis. Surgery, when appropriated, is crucial for prognosis. In our case initial response to anti–inflammatory therapy with reduced pericardial effusion unmasked constrictive physiology in an effusive–constrictive pericarditis. Clinical management was complicated by sepsis which could have played a role in constriction developing.
P420 A CANCER PATIENT WITH PULMONARY THROMBOEMBOLISM: IS IT RIGHT TO APPLY THE CRITERIA FOR DOSE REDUCTION IN THESE PATIENTS?
Authors: Russo G , Guglielmi A , Cherubini A , Faganello G , Bisceglia I , Canale M , Camilli M , Fiscella D , Paccone A , Gallucci G , Turazza F , Lestuzzi C , Cappelletto C , Mazzone C , Bollini M , Grande E , Ius A , Mattei L , Di Lenarda A
Published: May 2023

A 78 years old woman presented in our cardio–oncology out–patient clinic to renew apixaban treatment plan. In her medical history she was a former smoker, with a chronic kidney disease in IIIb stadium according to KDIGOI guidelines with a creatinine of 1,54 mg/dl, GFR according CKD 32 ml/min/1.73m2 and according Cockcroft e Gault 28 ml/min/1.73m2. In 2010, she had a right lobe pulmonary cancer diagnosis treated in neo–adjuvant with gemcitabine. After chemotherapy, she underwent surgical lobectomy. During hospitalization she had a deep venous thrombosis complicated by pulmonary thromboembolism, heparin sc was given with resolution of the clinical picture. In 2012 she had a recurrence of pulmonary thromboembolism. Heparin and warfarin in a second time was given. In 2016 for cancer disease progression, she underwent various oncological treatments and she found a stability disease with osimertinib and stereotaxic radiotherapy. Warfarin was switched to apixaban low–doses for low weight and chronic kidney disease. In 2021 in osimertinib therapy, cancer was under control. She was continuing low–dose apixaban. One year later, a CT scan demonstrated a disease progression and inferior cava venous thrombosis. A cardiac evaluation in our unit was required: patients was asymptomatic. EKG and Echocardiogram were normal. Apixaban low dose was changed to edoxaban 30 mg. There was a complete vein recanalization. Unfortunately, patient died after 8 months for cancer. It is important, in the direct oral anticoagulation therapy in cancer patient, to consider not only the indication for dose reduction known by the registration studies but also cancer and therapy factors.
P421 INTRA–CARDIAC AND ALL LAYERS CARDIAC INVOLVEMENT BY SQUAMOUS NON–SMALL CELL LUNG CANCER
Authors: Bisceglia I , Mistrulli R , Federico A , Petrolati S , Canale M , Camilli M , Paccone A , Russo G , Veneziano F , De Luca L , Cartoni D
Published: May 2023

A 73 year–old man was referred by his general practitioner to our ambulatory for worsening dyspnea. He also reported substantial weight loss (almost 20 kg during the last three months), new onset dysphonia and dry cough. The patient’s medical history also included a former tobacco addiction, arterial hypertension and dyslipidemia. There was not history of cardiomiopathy. Electrocardiogram, showed: sinus rhythm, 60/min with inferior and anterior–lateral abnormality of repolarization. No laboratory exams were available at the first visit. An echocardiogram was performed, showing: marked septal hypertrophy (IVSd= 23 mm), septal hypokinesia, with an ejection fraction at lower limits of normality (EF= 54%), neither systolic anterior motion of the mitral valve. Minimal pericardial effusion was seen. We required a CT scan of the chest, that showed a large (5x8x11cm) mass in the left upper lobe with ipsilateral mediastinal lymphadenopathy. The mass directly extended into the mediastinum with infiltration of pericardial leaflet, left atrium and the left wall of the aortic arch. A hypodense formation of approximately 4 cm in the interventricular septum in the apical portion was reported. PET–CT with FDG was performed, which documented hypercaptation of the radioactive tracer at the level of the above–mentioned lesions. The patient underwent fine–needle aspiration biopsy of the lung mass and the histological examination led to the diagnosis of squamous cell carcinoma of the lung. Systemic treatment with carboplatin plus placlitaxel and pembrolizumab was subsequently started. A cardiac CMR was performed, which documented an area of 30x17x31 mm located at the septal (mid–apical portion), apex and parapical portion of the free wall of the right ventricle with transmural extension. At this area, extensive late gadolinium enanchement (LGE) at marginal level with a central non–capillary core and hyperintense in T2 sequences (compatible with central necrotic lesion). The pericardium also showed LGE and a mild pericardial effusion (maximum 8 mm); left atrium involvement, seen on CT, was not documented . After he completed the third cycle of CHT, at 5 months from the diagnosis, the echocardiogram showed a substantial disappearance of the mass infiltrating the interventricular septum without evidence of pericardial effusion. The ecg was substantially unchanged. The patient stopped carboplatin and paclitaxel after 3 cycles and kept maintenance pembrolizumab still ongoing.
Soil moisture drives differences in the diversity and trophic complexity of high Arctic tundra soils
Authors: Almela Pablo , Rico Eugenio , Velázquez David , Verleyen Elie , Quesada Antonio
Published: May 2023

The Arctic soil communities play a vital role in stabilizing and decomposing soil carbon, which affects the global carbon cycling. Studying the food web structure is critical for understanding biotic interactions and the functioning of these ecosystems. Here, we studied the trophic relationships of (microscopic) soil biota of two different Arctic spots in Ny-Ålesund, Svalbard, within a natural soil moisture gradient by combining DNA analysis with stable isotopes as trophic tracers. The results of our study suggested that the soil moisture strongly influenced the diversity of soil biota, with the wetter soil, having a higher organic matter content, hosting a more diverse community. Based on a Bayesian mixing model, the community of wet soil formed a more complex food web, in which bacterivorous and detritivorous pathways were important in supplying carbon and energy to the upper trophic levels. In contrast, the drier soil showed a less diverse community, lower trophic complexity, with the green food web (via unicellular green algae and gatherer organisms) playing a more important role in channelling energy to higher trophic levels. These findings are important to better understand the soil communities inhabiting the Arctic, and for predicting how the ecosystem will respond to the forthcoming changes in precipitation regimes.
Regulatory Effect of Ellagic Acid on Immune Function in Burned Rats
Authors: Deng Hong-ao , Chen Yong , Yuan Yuan , Zhang Hong-yan
Published: May 2023

To investigate the effect of ellagic acid (EA) treatment on immune function in burned rats. First, 30 Sprague-Dawley rats were established as a deep second-degree burn model. They were randomly divided into three groups: Model group, EA 50 mg/kg, and EA 100 mg/kg group. The wound area of rats at 0–7 days was measured and the wound healing rate was calculated. The levels of inflammatory factors tumor necrosis factor-α (TNF-α), interferon γ (IFN-γ), interleukin (IL)-1β, IL-6, IL-10, and immunoglobulins IgA, IgG, and IgM in rat serum were evaluated by ELISA. Flow cytometry was used to detect the CD4 +/CD8 + T cell ratio, levels of Foxp3 + Treg cells, and CD4 + CD25 + regulatory T cells (Treg) cells levels in the peripheral blood of rats. On the fourth to seventh day of the burn, EA treatment could significantly promote the decrease of the wound area and the increase of the wound healing rate in burned rats. Further examination revealed that the levels of inflammatory factors in serum were remarkedly decreased and immunoglobulins levels were increased in the EA group, compared with the Model group. Meanwhile, the levels of CD4 + CD25 + Treg cells and Foxp3+ Treg cells were significantly decreased, whereas the CD4+/CD8 + T cell ratio was observably increased in a concentration-dependent manner. Altogether, EA effectively promotes the wound healing of burned rats by regulating the levels of inflammatory factors, immunoglobulin, and T cells in burned rats, and improves the symptoms of burn immunosuppression.
Accumulation conditions and patterns of natural gas hydrate in the Muli permafrost area, northeastern margin of the Qinghai‒Tibet Plateau, NW China
Authors: Pei Fagen , Wang Xuben , Fang Hui , He Dashuang , He Meixing , Du Bingrui , Zhang Penghui , Wang Xiaojiang
Published: May 2023

The Muli permafrost area is the only midlatitude permafrost area where natural gas hydrates (NGHs) have been drilled. Although a series of achievements has been made in studies on NGH accumulation conditions in the permafrost area, related studies on gas hydrate stability zones, gas sources and groundwater are still controversial and need further work. Based on geophysical, geological and geochemical data, this paper systematically elaborates the main NGH accumulation conditions in the Muli area in terms of the pressure‒temperature stability conditions, fault structure, gas composition, gas source, reservoir characteristics, groundwater distribution and topographic characteristics. The results show that the thicknesses of the NGH stability zone range from 491.0 to 962.7 m. The fault structure can provide a pathway for hydrocarbon gas migration from deep to NGH stability zones, in which thrust faults can prevent the upwards migration of gas by sealing it below the hanging wall block. Rock fractures in the NGH stability zone can not only be gas migration channels, but also serve as a reservoir space for NGH accumulation. The hydrocarbon gas of NGHs shows multiple origins and is mainly composed of oil-associated gas. The formation of frost mounds related to the overpressured gas ejection caused by NGH decomposition may imply the existence of NGHs. Synthetically, similarities and differences in NGH accumulation conditions between the Muli permafrost area and other high-latitude permafrost areas are proposed, and the ‘regression’ NGH accumulation pattern in the Muli area is constructed. The study results can enrich theoretical knowledge of terrestrial NGH accumulation, and provide scientific guidance for NGH exploration in midlatitude permafrost areas.
Impact of COVID-19 on health care and quality of life in women with breast cancer
Authors: Myers Charlotte , Bennett Kathleen , Kelly Catherine , Walshe Janice , O’Sullivan Nollaig , Quinn Mary , Lyons Therese , Weadick Catherine , Cahir Caitriona
Published: May 2023

Background

The aims of this study were to explore the impact of COVID-19 on health-care services and quality of life (QoL) in women diagnosed with breast cancer (BC) in Ireland and whether the impact varied by social determinants of health (SDH).

Methods

Women diagnosed with BC completed a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during COVID-19 restrictions. The association between COVID-19 impact and disruption to BC services and QoL was assessed using multivariable regression with adjustment for SDH and clinical covariates. An interaction between COVID-19 impact and health insurance status was assessed within the regression models.

Results

A total of 30.5% (n = 109) of women reported high COVID-19 impact, and these women experienced more disruption in BC services (odds ratio = 4.95, 95% confidence interval = 2.28 to 10.7, P < .001) and lower QoL (β = −12.01, SE = 3.37, P < .001) compared with women who reported low COVID-19 impact. Health insurance status moderated the effect of COVID-19 on disruption to BC services and QoL. Women who reported high COVID-19 impact experienced more disruption to BC services and lower QoL compared with women with low COVID-19 impact; however, the magnitude of these unfavorable effects differed by insurance status (Pinteraction  < .05).

Conclusions

There was a large disruption to BC services and decrease in QoL for women with BC in Ireland during the pandemic. However, the impact was not the same for all women. It is important that women with BC are reintegrated into proper care and QoL is addressed through multidisciplinary support services.
The Retention of USUHS Military Physicians: An Exploratory Study
Authors: Jung Eulho , McBee Elexis , Reamy Brian V , Durning Steven J , Zarzuela Geddy , Dong Ting
Published: May 2023

Background

Previously, researchers investigated the career accomplishments of USU medical graduates using the data from a USU alumni survey. To better understand if such accomplishments are related to military retention, the current study investigates the relationship between accomplishments (such as military career milestones and academic achievement) and military retention.

Methods

Utilizing the responses to the alumni survey sent to USU graduates in the Classes of 1980 to 2017, the researchers investigated the relationship between a series of survey items (e.g., military rank, medical specialties, and operation experiences) and military retention.

Results

Among the respondents who had a deployment history in support of an operational mission, 206 (67.1%) stayed longer than their initial active duty service or planned on staying longer than their current active duty service commitment. Fellowship directors (n = 65, 72.3%) showed a higher retention rate than other positions. The PHS alumni had the highest retention rate (n = 39, 69%) of the military branches, whereas physicians in medical specialties with higher demand (e.g., otolaryngology and psychiatry) showed less promising retention.

Conclusions

By conducting future research on underlying reasons as to why full-time clinicians, junior physicians, and physicians in medical specialties with higher demand showed less promising retention, stakeholders will be able to identify what needs to be addressed to retain highly skilled physicians in the military.
Supporting the Transition to Distance Education During the Pandemic and Beyond
Authors: Samuel Anita , Teng Yating , Soh Michael Y , King Beth , Cervero Ronald M , Durning Steven J
Published: May 2023

Introduction

The coronavirus disease 2019 (COVID-19) pandemic affected almost every country around the world, and various forms of lockdown or quarantine measures were implemented. The lockdowns forced medical educators to step beyond traditional educational approaches and adopt distance education technologies to maintain continuity in the curriculum. This article presents selected strategies implemented by the Distance Learning Lab (DLL) at the Uniformed Services University of Health Sciences (USU), School of Medicine (SOM), in transitioning their instruction to an emergency distance education format during the COVID-19 pandemic.

Materials and Methods

When moving programs/courses to a distance education format, it is important to recognize that two primary stakeholders are involved in the process: faculty members and students. Therefore, to be successful in transitioning to distance education, strategies must address the needs of both groups and provide support and resources for both.

The DLL used two lenses of adult learning and targeted needs assessment to design faculty and student support during the pandemic. The DLL adopted a learner-centered approach to education, focusing on meeting the faculty members and students where they are. This translated into three specific support strategies for faculty: (1) workshops, (2) individualized support, and (3) just-in-time self-paced support. For students, DLL faculty members conducted orientation sessions and provided just-in-time self-paced support.

Results

The DLL has conducted 440 consultations and 120 workshops for faculty members since March 2020, serving 626 faculty members (above 70% of SOM faculty members locally) at USU. In addition, the faculty support website has had 633 visitors and 3,455 pageviews. Feedback comments provided by faculty members have specifically highlighted the personalized approach and the active, participatory elements of the workshops and consultations.

Evaluations of the student orientation sessions showed that they felt more confident in using the technologies after the orientation. The biggest increase in confidence levels was seen in the topic areas and technology tools unfamiliar to them. However, even for tools that students were familiar with before the orientation, there was an increase in confidence ratings.

Conclusion

Post-pandemic, the potential to use distance education remains. It is important to have support units that recognize and cater to the singular needs of medical faculty members and students as they continue to use distance technologies to facilitate student learning.
Military Medical Students’ Coping With Stress to Maintain Well-being
Authors: Ma Ting-Lan , Bell Kameha , Dong Ting , Durning Steven J , Soh Michael
Published: May 2023

Introduction

Previous studies have shown that medical students experience a great level of burnout and poor well-being during their clinical training periods. In this study, we sought to understand how military medical students cope with stress to prevent burnout and support their well-being. We also investigated if these coping strategies are associated with military medical students’ self-reported well-being, burnout, and depression levels. The findings could help inform programming, resources, and educational strategies to better support students to thrive in their careers long term.

Methods

Using a cross-sectional research design, we surveyed military medical students and conducted content analysis on participant responses to the open-ended item by trained coders. Coding was based on the existing coping theory frameworks as well as categories that emerged inductively to represent the data.

Results

The primary four strategies military medical students utilized included social connection (59.9%), exercise (58.3%), personal relaxation (36%), and work–life balance (15.7%). The use of work–life balance strategy was significantly associated with more positive well-being and lower depression compared to those who did not use this strategy. Three main coping typologies were further extracted, including personal care, connection, and cognitive strategies. Based on the typologies, 62% of students were recognized as multi-type copers (who combined more than two coping typologies), who reported significantly more positive well-being compared to students who relied on a single typology.

Conclusions

The findings demonstrate that certain coping strategies are more positively associated with a good state of well-being and less burnout, and that utilization of multiple types of coping strategies is more supportive. This study amplifies the voice of military medical students concerning the importance of prioritizing self-care and available resources given the unique pressures and demands of their dual military medical curriculum.
Reflecting on LTCOS Scholarship and Implications for Educational Practice
Authors: Dong Ting , Reamy Brian V , Hemmer Col Paul A , Soh Michael , Barry Erin S , Jung Eulho , Durning Steven J
Published: May 2023

The Long Term Career Outcome Study is a central program of research in the Center for Health Professions Education at the Uniformed Services University. The overarching goal of Long Term Career Outcome Study is to perform evidence-based evaluations before, during, and after medical school, and as such, it represents a form of educational epidemiology. In this essay, we highlighted the findings of the investigations published in this special issue. These investigations span from “before” medical school matriculation to “during” medical school and “after” learners go on to graduate training and practice. Furthermore, we discuss how this scholarship might shed light on improving the educational practices at the Uniformed Services University and potentially elsewhere. We hope that this work demonstrates how research can enhance medical education processes and connect research, policy, and practice.
“Primum Non Nocere”—First, Do No Harm: A Retrospective Review of the Impact of Curricular Reform on USUHS Graduates’ Performance During Their PGY-1 Year
Authors: Melton John L , Hemmer Col Paul A , Pock Col Arnyce , Moores COL Lisa K , Pangaro COL Louis N , Durning Steven J , Witkop Col Catherine T , Zapota Ramon , Schreiber-Gregory Deanna N , Dong Ting
Published: May 2023

Purpose

To determine whether medical school curricular change impacted the assessment of graduates in their first year of postgraduate training.

Methods

The authors examined for differences in the survey of postgraduate year one (PGY-1) program directors for Uniformed Services University (USU) medical school graduates from the Classes of 2011 and 2012 (pre-curriculum reform, pre-CR), Classes of 2015, 2016, and 2017 (curriculum transition), and Classes of 2017, 2018, and 2019 (post-curriculum reform, post-CR). Multivariate analysis of variance was used to explore for differences among the cohorts in the 5 previously identified factors on the PGY-1 survey (Medical Expertise; Professionalism; Military Unique Practice, Deployments and Humanitarian Missions; System-Based Practice and Practiced-Based Learning; Communication and Interpersonal Skills). Nonparametric tests were used when the error variance between cohorts was found to be unequal across samples. Kruskal–Wallis (a rank ordered analysis of variance) and Tamhan’s T2 were used to characterize specific differences.

Results

There were 801 students included: 245 (pre-CR); 298 (curricular transition); and 212 (post-CR). Multivariate analysis of variance demonstrated significant differences in all survey factors among the comparison groups. From pre-CR to the curricular transition, ratings in all factors declined, but none reached the level of a statistical significance. Ratings of all 5 factors showed significant improvement from the curricular transition to post-CR, and scores from pre-CR to post-CR trended in the positive direction with Practice-Based Learning (effect size 0.77), showing significant gains.

Conclusion

Ratings by PGY-1 program directors of USU graduates over time demonstrated a very small decline soon after curriculum reform but later showed a large improvement in domains reflecting areas of emphasis in the curriculum. In the eyes of a key stakeholder, the USU curriculum reform did no harm and led to improved PGY-1 assessments.
Prior Enlisted Medical Students at the Uniformed Services University: Outcomes During Four Years of Medical School
Authors: Green Althea , Dong Ting , Schreiber-Gregory Deanna N , Tilley Laura , Durning Steven J
Published: May 2023

Introduction

The Uniformed Services University (USU) implemented the Enlisted to Medical Degree Preparatory Program (EMDP2) with the goal of enhancing the diversity of the military physician corps. Programs like EMDP2 can assist students in making the social and intellectual transition from undergraduate studies to medical school and beyond. These types of programs are also opportunities to reduce health disparities and prepare students to work in multicultural settings. The purpose of this study was to evaluate whether there was any significant difference in performance between USU medical students who had attended the EMDP2 and those who had not.

Materials and Methods

We compared the results of National Board of Medical Examiners (NBME) Clinical Science Subjects, United States Medical Licensing Examination (USMLE) Step 1, and USMLE Step 2 Clinical Knowledge exams of EMDP2 learners from the School of Medicine classes of 2020 to 2023 to those of four similarly sized cohorts of their peers who varied by age and prior military service.

Results

We found that the performance of EMDP2 graduates was comparable to their peers who followed more traditional and other alternative paths to medical school. For example, regression models showed that EMDP2 status was not a statistically significant predictor of average clerkship NBME exam score, nor of USMLE Step 1 failure.

Conclusion

EMDP2 graduates performed on a par with their medical school peers, and EMDP2 status does not appear to influence NBME or USMLE performance. EMDP2 provides a focused curriculum and addresses the mandate to make medical education opportunities available to a more diverse population.
Veteran Experiences With Suicide Ideation, Suicide Attempt, and Social Support in Safety Planning Within the Department of Veterans Affairs
Authors: Matthieu Monica M , Morissette Sandra B , Clafferty Stephanie , Degutis Linda , Oliver Ciara M , Adkins David A , DeBeer Bryann B
Published: May 2023

Introduction

This evaluation examined the role of safety plans, one of a host of clinical suicide prevention interventions available for veterans through the United States Department of Veterans Affairs’ national network of health care facilities managed by the Veterans Health Administration (VHA).

Materials and Methods

Interviews were conducted with veterans who had experienced suicidal ideation or a suicide attempt since enrolling in the Department of Veterans Affairs health care system (N = 29). Topics included negative life experiences, triggers for suicidal ideation or a suicide attempt, ability to recall and utilize safety plans in crisis, safety plan elements found most and least useful, and improvements to safety planning.

Results

Eighteen (62.07%) of the veterans in the sample had attempted suicide. Drug use was by far the most triggering and overdose was the most negative life event to subsequent ideation or attempt. Although all at-risk veterans should have a safety plan, only 13 (44.38%) created a safety plan, whereas 15 (51.72%) could not recall ever creating a safety plan with their provider. Among those who did recall making a safety plan, identifying warning signs was the most remembered portion. The most useful safety plan elements were: recognizing warning signs, supportive people and distracting social settings, names and numbers of professionals, giving the veteran personal coping strategies, options for using the plan, and keeping their environment safe. For some veterans, safety plans were seen as insufficient, undesirable, not necessary, or lacking a guarantee. The suggested improvements included involving concerned significant others, specific actions to take in a crisis, and potential barriers and alternatives.

Conclusions

Safety planning is a critical component in suicide prevention within VHA. However, future research is needed to ensure safety plans are accessible, implemented, and useful to veterans when in crisis.
Disparate Risk Factors Among Pregnant Veterans Using Veterans Administration Health Benefits for Community-Based Obstetrical Care
Authors: Hansen Barbara , Picken Lauren K , Gould Sara
Published: May 2023

Introduction

Veterans using the Veterans Administration Health Care System (VAHCS) for obstetrical care experience disparate pregnancy-related risks and health outcomes when compared to their pregnant counterparts. This study examined the prevalence of risk factors associated with pregnancy-related comorbidities among U.S. Veterans receiving obstetrical care using VAHCS benefits in Birmingham, Alabama.

Materials and Methods

A retrospective chart review was conducted of pregnant Veterans receiving care at a large Veterans Administration facility from 2018 to 2021. Using one-sample t-tests, the data from the study charts were compared to the Alabama overall prevalence of tobacco and alcohol use, pregnancy-related hypertension/preeclampsia, and gestational diabetes and, when the Alabama data were unavailable, the U.S. national average prevalence of overweight, obesity, pre-pregnancy hypertension, posttraumatic stress disorder, depression, and anxiety among patients receiving obstetrical care. The institutional review board at the Birmingham VAHCS approved the study, with an exemption for human subjects research.

Results

The study sample (N = 210) experienced higher levels of obesity (42.3% vs. 24.3%, P < .001), tobacco (21.9% vs. 10.8%, P < .001) and alcohol (19.5% vs. 5.4%, P < .001) use, pre-pregnancy hypertension (10.5% vs. 2.1%, P < .001), posttraumatic stress disorder (33.8% vs. 3.3%, P < .001), anxiety (66.7% vs. 15.2%, P < .001), and depression (66.7% vs. 15.0, P < .001). Fewer patients in the study sample were classified as overweight (16.7% vs. 25.5%, P < .001), developed pregnancy-related hypertension/preeclampsia (7.6% vs. 14.4%, P < .001), or were diagnosed with gestational diabetes (7.1% vs. 10.2%, P < .001). The results did not vary by race or age.

Conclusion

The findings highlight the need for further examination of social factors that may be driving disparities among pregnant Veterans, who may benefit from supplemental services to address modifiable comorbidities. Additionally, the implementation of a centralized database to track pregnancy-related outcomes for Veterans would allow these comorbidities to be more closely monitored and addressed. Heightened awareness of a patient’s Veteran status and associated increased risks can alert providers to screen for depression and anxiety more frequently and to familiarize themselves with additional services the VAHCS may offer to patients. These steps could improve referrals to counseling and/or targeted exercise interventions.
Automated evaluation with deep learning of total interstitial inflammation and peritubular capillaritis on kidney biopsies
Authors: Jacq Amélie , Tarris Georges , Jaugey Adrien , Paindavoine Michel , Maréchal Elise , Bard Patrick , Rebibou Jean-Michel , Ansart Manon , Calmo Doris , Bamoulid Jamal , Tinel Claire , Ducloux Didier , Crepin Thomas , Chabannes Melchior , Funes de la Vega Mathilde , Felix Sophie , Martin Laurent , Legendre Mathieu
Published: May 2023

Background

Interstitial inflammation and peritubular capillaritis are observed in many diseases on native and transplant kidney biopsies. A precise and automated evaluation of these histological criteria could help stratify patients’ kidney prognoses and facilitate therapeutic management.

Methods

We used a convolutional neural network to evaluate those criteria on kidney biopsies. A total of 423 kidney samples from various diseases were included; 83 kidney samples were used for the neural network training, 106 for comparing manual annotations on limited areas to automated predictions, and 234 to compare automated and visual gradings.

Results

The precision, recall and F-score for leukocyte detection were, respectively, 81%, 71% and 76%. Regarding peritubular capillaries detection the precision, recall and F-score were, respectively, 82%, 83% and 82%. There was a strong correlation between the predicted and observed grading of total inflammation, as for the grading of capillaritis (r = 0.89 and r = 0.82, respectively, all P < .0001). The areas under the receiver operating characteristics curves for the prediction of pathologists’ Banff total inflammation (ti) and peritubular capillaritis (ptc) scores were respectively all above 0.94 and 0.86. The kappa coefficients between the visual and the neural networks' scores were respectively 0.74, 0.78 and 0.68 for ti ≥1, ti ≥2 and ti ≥3, and 0.62, 0.64 and 0.79 for ptc ≥1, ptc ≥2 and ptc ≥3. In a subgroup of patients with immunoglobulin A nephropathy, the inflammation severity was highly correlated to kidney function at biopsy on univariate and multivariate analyses.

Conclusion

We developed a tool using deep learning that scores the total inflammation and capillaritis, demonstrating the potential of artificial intelligence in kidney pathology.
On the Road with Louis
Authors: Crease Stephanie Stein
Published: May 2023

In 1932, Webb’s band was heard on WMCA four times a week, and played for “breakfast dances” at the Savoy and the Alhambra Ballroom. That summer, it toured white resorts and dance halls along the Susquehanna River in Pennsylvania. In late fall, Webb’s band was chosen to accompany Louis Armstrong, then a huge national star, for the latest version of the show Hot Chocolates at Connie’s Inn, then on an East Coast tour. Armstrong, with Chick Webb’s Orchestra, made his debut record for RCA Victor. The session took place at RCA Victor’s famous Camden Studio, a converted church. Webb and Armstrong reunited for the tour back at the Howard Theater in Washington, DC, the week before Christmas, then at the Royal in Baltimore for Christmas week. They played a midnight dance on Christmas night, when Louis was in extraordinary pain but still stole the show, as Webb would through his own health struggles a few years later.
Reordering Adivasi Worlds
Authors: Dasgupta Sangeeta
Published: May 2023

Recounting the story of the Oraons and Tana Bhagats of Chhotanagpur in the present-day state of Jharkhand, this book questions postcolonial understandings of the category of ‘tribe’ and unravels the threads of a hierarchical adivasi world. It unpacks colonial ethnography, missionary narratives, and anthropological writings; explores issues of adivasi identity and resistance; and demonstrates how contemporary adivasi protest draws upon memories of the past. Dasgupta argues that nineteenth- and early twentieth-century ideas of ‘tribe’ were not abstract imaginaries but structured colonial interventions. These affected the shaping of customary rights; the understanding of the rural world; and the perception of customs and practices. She analyses the ways in which Tana Bhagats questioned hierarchies among the Oraons; opposed landlords, moneylenders, and the colonial state; and engaged with Gandhi and the Congress. Dasgupta delineates how Tanas allude to their diverse experiences and distinctive memories to negotiate with the sarkar even today.
Forms of Scripture in Early Judaism
Authors: Elledge C.D.
Published: May 2023

Early Jewish writings pose important implications for understanding the nature of scripture in ancient times, prior to the later formation of biblical canons. A review of early noncanonical literary collections unveils the diverse assumptions about scripture that existed within ancient Judaism. In their formative contexts, many of these writings present their religious claims as extensions of divine revelation, not merely as secondary, postbiblical compositions. Others endeavor to present themselves as essential complements to earlier scriptural books. Such high esteem for their authority appears to have been shared among some of their earliest audiences. Carefully studying the literature of this era thus reveals the extended horizon of authoritative traditions prevalent during the period of Christian origins. This realization arises from the modern study of literary collections known as Apocrypha (Deuterocanonical Books), Pseudepigrapha, Dead Sea Scrolls, and the writings of Philo and Josephus.
In the Wilderness
Authors: Elledge C.D.
Published: May 2023

New insights into Early Judaism have flourished over the past generation due to the modern discovery of the Dead Sea Scrolls. The scrolls revealed a previously unknown literary collection attesting to the religious beliefs and practices of a sectarian Jewish community. The community voluntarily separated from other Jews, forming a highly structured society with a strong priestly self-understanding and dualistic, apocalyptic beliefs. Their vast literary collection includes (1) scriptural manuscripts and their interpretation, (2) communal rules, (3) legal writings, (4) psalms, hymns, and prayers, and (5) wisdom and apocalyptic writings. Aspects of the collection have been especially important for understanding how Palestinian Jewish traditions informed Christian origins, even as the church adapted to its broader Mediterranean contexts. New Testament traditions surrounding John the Baptist, the communal structures of the early church, and messianic beliefs strike remarkable continuities and differences with the literature of the Dead Sea Scrolls.
The Overlap of Intellectual Property and Traditional Knowledge
Authors: Frankel Susy
Published: May 2023

This chapter elaborates on the overlap of intellectual property and traditional knowledge. The increase in global trade and the consequent cross-border flows of cultural and intellectual property-related goods and services resulted in an increased market in the developed world for new sources of knowledge and new ways to commodify and sell goods. However, many intellectual property products and related rights owned by businesses that trade across borders exploit traditional knowledge. Utilizing traditional knowledge became common to create copyrighted works and prospect the knowledge that contributes to the creation of new products. The chapter mentions how the most common objection to the protection of traditional knowledge is the perceived overlap with the public domain, which is known to be the absence of intellectual property.
The Political Safeguards of EU Foreign Relations Federalism
Authors: Verellen Thomas
Published: May 2023

This chapter argues that the EU Treaties provide for both strong formal and informal safeguards of foreign relations federalism in the EU. Member States have a strong formal voice in the EU foreign policy-making process, and, because of this voice, EU institutions cannot easily encroach on the autonomy of Member States. The comparatively strong voice of the Member States in EU foreign policy-making flips the stakes: whereas in the US and Canada, a concern about the autonomy of member units explains the need for political safeguards, in the EU the presence of strong safeguards raises a concern about the autonomy of the EU institutions vis-à-vis the Member States. In light of the central role of the EU Member States in the EU foreign policy-making process, this chapter also looks at whether there are any checks on the two Councils.
General Conclusion
Authors: Verellen Thomas
Published: May 2023

In the introduction to the book, federalism was defined as a combination of self-rule and shared rule. Federalism thus understood has four components: power allocation, conflict resolution, political safeguards of federalism, and intergovernmental relations. Bringing together the findings with regard to these four components, this concluding chapter identifies four approaches to the quintessentially federal objective of striking a balance between unity and diversity in the foreign relations context. The US approach constitutes a ‘unity +’ approach, the Canadian approach an ‘external unity, internal diversity’ approach, and the Belgian approach a ‘diversity +’ approach. Compared with these three federations, the EU’s brand of foreign relations federalism represents a ‘diversity ++’ approach, characterized as it is by a balance between unity and diversity that tilts quite strongly—and arguably altogether too strongly—towards the pole of diversity. This negative assessment of the emphasis of the EU’s foreign affairs constitution on diversity is justified due to the democratic deficit that it entails. Diversity as it is understood in the EU foreign affairs constitution has a cost: the strong political safeguards of foreign relations federalism and the concomitantly weak checks on the two Councils shield EU foreign policy-making from the constraints imposed by representative democracy. The final section of this concluding chapter puts forward three proposals for reform that aim to put EU foreign relations on a firmer democratic footing.
The Evolution of Constitutional Adjudication in Europe
Authors: Villalón Pedro Cruz
Published: May 2023

The chapter outlines the evolution of constitutional adjudication in Europe over a period spawning from 1815 until 2009, considered from the perspective of the European legal space. It aims to present an overall concept of this evolution, in which developments described as purely national in earlier times can now be seen as European. The year 1918 marks the watershed in this long evolution. The long nineteenth century shows a variety of scattered and largely insignificant institutions (judicial review of legislation, constitutional conflicts, individual complaints) related to the judicial guarantee of mostly monarchical and substantively poor constitutions. Reversely, the first afterwar period witnessed the emergence of a consistent notion of the normative—now republican—constitution in Europe that is consequently accompanied by the first examples (Austria, Czechoslovakia, Spain) of a characteristic system of judicial review, embodied in singular constitutional courts. Nevertheless, it is only in the time after 1945 when these first experiments take root. The success of the German and Italian Courts leads to the gradual but unfailing spread of the model to the rest of Europe. Parallel to this, the notion of constitutional interpretation becomes the defining feature of constitutional adjudication. The end of this evolution is signalled by the emergence of a complex European judicial space, following the transfer of constitutional responsibilities to the EU Court of Justice and the European Court of Human Rights (judicial dialogue).
Constitutional Courts Securing Their Legitimacy : An Institutional-Procedural Analysis
Authors: De Visser Maartje
Published: May 2023

This chapter contributes to the ongoing discussion regarding the legitimacy of constitutional jurisprudence. It shows the multitude of techniques relied on by constitutional courts in Europe to navigate the law–politics–society divide, in particular the adoption of rulings that are less invasive than the annulment of legislation. Methods such as saving constructions, findings of temporary constitutionality, and declarations without or with delayed annulment, allow the courts to exercise their authority cautiously. The chapter analyses how the legitimacy of constitutional courts, and a potential backlash, is also related to the possibilities to access the court. If the procedural framework makes it easy to refer all manner of constitutional questions to the court, it becomes more important still for the latter to think carefully about the adjudication of such questions on their merits, in part to ensure that the political branches are not overly stymied in the realization of their mandate and objectives.
Estate Landscapes of the Learned
Authors: FitzPatrick Elizabeth
Published: May 2023

This chapter investigates the scale and organization of learned kindred estates, and their land-use and resources, within the framework of estates as landscapes. Field-based case studies, historical records, and place names are used to profile them. Certain estate naming styles served to generate a sense of deep roots and visibility in the lordships for kindreds of literati who were relative newcomers. Descriptions of estates and their land-use histories, combined with chronicle and bardic references to livestock, suggest that pastoral agriculture was dominant on estates. However, evidence of enclosure and kilns on some lands, the recovery of millstones and deposits of grain, and remarks by scribes about harvesting, imply that tillage was equally important and expected on learned kindred landholdings. Gaelic chiefs had parkland by the sixteenth century at least, within which secular literati were allocated estates. Later modern emparkment of these, within landed estates of the seventeenth to late nineteenth century, is a lens through which their previous histories as grazing for mixed herds, including deer, can be perceived. Attention is drawn to the occurrence of metal ores and quarriable stone in the environs of learned kindred estates, and to the incorporation of resources into boundaries of estate lands.