bluuebunny/crossref_metadata_2025 huggingface dataset:
Relativistic global solutions of neutrino-dominated accretion flows with magnetic coupling
Authors: She Jiao-Zhen , Liu Tong , Xue Li
Published: April 2022

A Kerr black hole (BH) surrounded by a neutrino-dominated accretion flow (NDAF) is one of plausible candidates of the central engine in gamma-ray bursts. The accretion material might inherit and restructure strong magnetic fields from the compact object mergers or massive collapsars. The magnetic coupling (MC) process between a rapid rotating BH and an accretion disc is one of possible magnetic configurations that transfers the energy and angular momentum from the BH to the disc. In this paper, we investigate one-dimensional global solutions of NDAFs with MC (MCNDAFs), taking into account general relativistic effects, detailed neutrino physics, different MC geometries, and reasonable nucleosynthesis processes. Six cases with different accretion rates and power-law indices of magnetic fields are presented and compared with NDAFs without MC. Our results indict that the MC process can prominently impact the structure, thermal properties, and microphysics of MCNDAFs, increase luminosities of neutrinos and their annihilations, result in the changing of radial distributions of nucleons, and push the region of heavy nuclei synthesis to a larger radius than counterparts in NDAFs.
A holistic approach to understand helium enrichment in interplanetary coronal mass ejections: new insights
Authors: Yogesh  , Chakrabarty D , Srivastava N
Published: April 2022

Despite helium abundance [AHe = (nH/nHe) × 100] being ∼8 per cent at the solar photospheric/chromospheric heights, AHe can be found to exceed 8 per cent in interplanetary coronal mass ejections (ICMEs) on many occasions. Although various factors like interplanetary shocks, chromospheric evaporation, and ‘sludge removal’ have been separately invoked in the past to address the AHe enhancements in ICMEs, none of these processes could explain the variability of AHe in ICMEs comprehensively. Based on an extensive analysis of 275 ICME events, we show that there is a solar activity variation of ICME averaged AHe values. We also found that the first ionization potential effect and localized coronal heating due to magnetic reconnection are not the major contributing factors for AHe enhancements in ICMEs. Investigation on concurrent solar flares and ICME events for 63 cases reveals that chromospheric evaporation in tandem with gravitational settling determines the AHe enhancements and variabilities beyond 8 per cent in ICMEs. While chromospheric evaporation releases the helium from chromosphere into the corona, the gravitationally settled helium is thrown out during the ICMEs. We show that the intensity and timing of the preceding flares from the same active region from where the CME erupts are important factors to understand the AHe enhancements in ICMEs.
Consciousness matters: phenomenal experience has functional value
Authors: Cleeremans Axel , Tallon-Baudry Catherine
Published: April 2022

‘Why would we do anything at all if the doing was not doing something to us?’ In other words: What is consciousness good for? Here, reversing classical views, according to many of which subjective experience is a mere epiphenomenon that affords no functional advantage, we propose that subject-level experience—‘What it feels like’—is endowed with intrinsic value, and it is precisely the value agents associate with their experiences that explains why they do certain things and avoid others. Because experiences have value and guide behaviour, consciousness has a function. Under this hypothesis of ‘phenomenal worthiness’, we argue that it is only in virtue of the fact that conscious agents ‘experience’ things and ‘care’ about those experiences that they are ‘motivated’ to act in certain ways and that they ‘prefer’ some states of affairs vs. others. Overviewing how the concept of value has been approached in decision-making, emotion research and consciousness research, we argue that phenomenal consciousness has intrinsic value and conclude that if this is indeed the case, then it must have a function. Phenomenal experience might act as a mental currency of sorts, which not only endows conscious mental states with intrinsic value but also makes it possible for conscious agents to compare vastly different experiences in a common subject-centred space—a feature that readily explains the fact that consciousness is ‘unified’. The phenomenal worthiness hypothesis, in turn, makes the ‘hard problem’ of consciousness more tractable, since it can then be reduced to a problem about function.
Decitabine increases neoantigen and cancer testis antigen expression to enhance T-cell–mediated toxicity against glioblastoma
Authors: Ma Ruichong , Rei Margarida , Woodhouse Isaac , Ferris Katherine , Kirschner Sophie , Chandran Anandhakumar , Gileadi Uzi , Chen Ji-Li , Pereira Pinho Mariana , Ariosa-Morejon Yoanna , Kriaucionis Skirmantas , Ternette Nicola , Koohy Hashem , Ansorge Olaf , Ogg Graham , Plaha Puneet , Cerundolo Vincenzo
Published: April 2022

Background

Glioblastoma (GBM) is the most common and malignant primary brain tumor in adults. Despite maximal treatment, median survival remains dismal at 14–24 months. Immunotherapies, such as checkpoint inhibition, have revolutionized management of some cancers but have little benefit for GBM patients. This is, in part, due to the low mutational and neoantigen burden in this immunogenically “cold” tumor.

Methods

U87MG and patient-derived cell lines were treated with 5-aza-2′-deoxycytidine (DAC) and underwent whole-exome and transcriptome sequencing. Cell lines were then subjected to cellular assays with neoantigen and cancer testis antigen (CTA) specific T cells.

Results

We demonstrate that DAC increases neoantigen and CTA mRNA expression through DNA hypomethylation. This results in increased neoantigen presentation by MHC class I in tumor cells, leading to increased neoantigen- and CTA-specific T-cell activation and killing of DAC-treated cancer cells. In addition, we show that patients have endogenous cancer-specific T cells in both tumor and blood, which show increased tumor-specific activation in the presence of DAC-treated cells.

Conclusions

Our work shows that DAC increases GBM immunogenicity and consequent susceptibility to T-cell responses in vitro. Our results support a potential use of DAC as a sensitizing agent for immunotherapy.
Long-Term Effectiveness of a Clinician-Assisted Digital Cognitive Behavioral Therapy Intervention for Smoking Cessation: Secondary Outcomes From a Randomized Controlled Trial
Authors: Webb Jamie , Peerbux Sarrah , Ang Alfonso , Siddiqui Sarim , Sherwani Yusuf , Ahmed Maroof , MacRae Hannah , Puri Hannah , Majeed Azeem , Glasner Suzette
Published: April 2022

Introduction

This study evaluated the secondary effectiveness outcomes for Quit Genius, a digital clinician-assisted cognitive behavioral therapy (CBT) intervention for smoking cessation.

Methods

Adult smokers (N = 556) were randomly assigned to Quit Genius (n = 277), a digital, clinician-assisted CBT intervention or very brief advice (VBA) to stop smoking, an evidence-based, 30-s intervention designed to facilitate quit attempts, coupled with referral to a cessation service (n = 279). Participants were offered combination nicotine replacement therapy (patches and gum) tailored to individual nicotine dependence. Analyses (n = 530), by intention-to-treat, compared Quit Genius and VBA at 4, 26, and 52 weeks post-quit date (QD). The primary outcome was self-reported 7-day point prevalence abstinence (PPA) at 4 weeks post-QD. Consecutive 7-day point-prevalence abstinence, defined as abstinent at two or more consecutive timepoints, was examined at weeks 26 and 52 to indicate long-term effectiveness. Abstinence was verified using a random sample of participants with carbon monoxide breath testing of <5 parts per million (n = 280).

Results

Self-reported consecutive 7-day PPA at weeks 26 and 52 for Quit Genius was 27.2% and 22.6%, respectively, compared with VBA which was 16.6% and 13.2% (RR = 1.70, 95% CI, 1.22-2.37; p = .003, 26 weeks; RR = 1.71, 95% CI, 1.17–2.50; P = .005, 52 weeks). Biochemically verified abstinence was significantly different at 26- (p = .03) but not 52 weeks (p = .16). Quit Genius participants were more likely to remain abstinent than those who received VBA (RR = 1.71, 95% CI 1.17–2.50; p = .005).

Conclusions

This study provides secondary evidence for the long-term effectiveness of Quit Genius in comparison with VBA. Future trials of digital interventions without clinician support and comparisons with active treatment are needed.

Implications

The long-term effectiveness of clinician-assisted digital smoking cessation interventions has not been well studied. This study established the long-term effectiveness of an extended CBT-based intervention; results may inform implementation of scalable approaches to smoking cessation in the health system.
Social progress around the world: trends and convergence
Authors: Peiró-Palomino Jesús , Picazo-Tadeo Andrés J , Rios Vicente
Published: April 2022

This paper assesses social progress in 139 countries over the period 1995–2017 following the framework proposed by the Social Progress Imperative; a notable contribution is a composite index allowing for comparisons across countries and over time. The index considers 45 raw indicators covering three fundamental pillars of social progress: basic human needs, foundations of well-being, and opportunities. The results point to a marked improvement in social progress all over the world from the mid-1990s, although they also depict a highly polarized world. Cross-country convergence patterns are also investigated, revealing a reduction in the differences in social progress, largely driven by the narrowing of the gap in basic human needs. Conversely, sizeable cross-country disparities remain in foundations of well-being and opportunities.
Dugongs and Turtles as Kin
Authors: McNiven Ian J.
Published: April 2022

Indigenous Australia has a rich ethnographic record that provides opportunities for archaeology to better understand and appreciate past human–animal relationships and the worldviews in which they are based. These ethnographic accounts indicate that marine hunting of large prey such as dugongs and turtles was often highly ritualized. These rituals increased hunting success but also included fecundity rituals to increase and/or maintain the distribution and frequency of particular taxa. Such rituals were founded on an understanding of fundamental kin relationships between hunters and prey that were validated cosmologically, authorized by ancestral power, enabled by mutually understood sentience and dialogue, and operationalized by a social and moral contract of respect, trust, etiquette, social obligation, and reciprocity. The richness of the anthropological record for Torres Strait in northeastern Australia has provided an opportunity for archaeology to explore past dugong and turtle hunting rituals via shrines of mounded stone and bone dating to the past 500 years. These sites provide rare windows into human–animal ontologies and associated sentient worlds and kin-centric ecologies.
Ecological Hermeneutics
Authors: Horrell David G.
Published: April 2022

This chapter offers an overview of the various approaches developed in the field of what has come to be known as ecological hermeneutics. Noting the provocative early stimulus of Lynn White’s classic article, the survey first considers readings of recovery, which seek to defend the Bible against criticisms such as White’s and to show how the Bible can make a positive contribution to ecological theology and ethics. The chapter turns next to the Earth Bible Project, and its particular approach to the task of ecological hermeneutics, following the steps of suspicion, identification, and retrieval, guided by a set of ecojustice principles. The third approach surveyed is that of the Exeter Project, which seeks to develop a critical and constructive hermeneutic that is informed both by the Christian theological tradition and by contemporary science. Finally, the chapter considers some of the various new directions and developments in the field.
Reading from the Ground Up
Authors: Marlow Hilary
Published: April 2022

The Bible is full of references to the natural world, from descriptions of the geophysical landscape of ancient Israel to allegories, parables, and other figurative portrayals that focus specifically on a particular aspect of nature. In some instances, these descriptions set the scene for the various events that take place. But the extent of language about the natural world, and the very many forms in which it occurs, cautions us against regarding this as merely a backdrop to the human story. The book of Isaiah is no exception and the extent and richness of figurative references to the natural world in Isaiah merits particular attention. What does this plethora of imagery tell us about attitudes to the physical world in Isaiah? How did the Isaianic authors conceive of the relationship between humanity and nature, and why did they often use such vivid images to convey this? How might the answers to these questions inform our understanding of ecological sustainability in the modern world? These and other questions will underpin this exploration of nature imagery in Isaiah and will prompt us to think beyond the sheer preponderance of such material to the purposes and functions that lie beyond it.
God’s Good Land
Authors: Braaten Laurie J.
Published: April 2022

Israel’s agrarian setting is reflected throughout the Book of the Twelve, which refers often to divine and human interaction with Land. Israel’s relationship with God is articulated in terms of kinship relations in an agrarian setting, reflecting Israel’s dependence on Land and Yhwh. The Twelve asserts that Israel’s Land belongs ultimately to Yhwh, who demands that Land and all her inhabitants (including nonhumans) be treated with respect and justice. Environmental degradation is linked with the elites’ exploitation of agrarian households’ sustainable subsistence practices. These elite extracted the farmers’ necessary surpluses for their conspicuous consumption and exchange for luxury goods, resulting in the abuse of Land for an unsustainable maximum yield. Land and her inhabitants suffered, and Land (or Earth) addresses Yhwh in mourning. Under the monarchy, Land’s fertility is conceptualized as being dependent on Yhwh’s blessing, but conveyed through the king and God’s temple in Jerusalem. While the Twelve acknowledges this tradition, it asserts that Yhwh is the true king of all Earth, and the primary source of fertility. The Twelve also moves beyond an agrarian setting to indicate the intrinsic value of all creation.
Conceiving Religious Dreams and Mystical Experiences
Authors: Sears Robert E.
Published: April 2022

This chapter analyzes basic and higher-level features of religious dreams and mystical experiences through the complementary lenses of event cognition and hierarchical predictive coding, which explain cognitive processing in terms of prediction casting and error feedback associated with sensory intake. With regard to mystical experience, it suggests that sustained error feedback, resulting in “de-automatization” of hierarchical processing and “cognitive resource depletion,” may explain some basic features of extrovertive and introvertive varieties. With regard to religious dreams, it claims that reduced error feedback, due to sensory gating during sleep, enables an individual’s preexisting religious schemata to inform dream content in accordance with continuity theory. Further, the chapter argues that challenges forming or maintaining predictions relative to the underlying content of dreams and mystical experiences may entail searching for extrinsic event causes and using religious attributions. In this vein, it argues that complexity drops between expected and actual circumstances instigate agency detection, which may culminate in attribution of causality to a supernatural agent if nonsupernatural concept alternatives are unavailable or lack explanatory relevance. While the focus is on the processing of religious dreams and mystical experiences, the conclusion briefly discusses some of their possible functions and consequences with regard to the phenomenon of religion.
Extreme Rituals
Authors: Xygalatas Dimitris
Published: April 2022

Ritual behavior is a human universal. We know of no society, past or present, which does not have rituals, so much so that ritual might be seen as one of the defining characteristic of our species. This in itself is a great puzzle, because rituals can entail significant, even massive, expenditures of time and resources with no immediately apparent payoffs. Nowhere is this puzzle more pronounced than in the case of certain “extreme” rituals, which involve activities that are particularly painful, stressful, dangerous, and, in some cases, even life threatening. Social theorists have proposed various answers to the puzzle of extreme rituals by suggesting that these practices serve important functions for individual participants, as well for society at large. In recent years, the cognitive science of religion has explored these functions on the basis of empirical evidence, shinning new light on this age-old puzzle.
The Cultural and Developmental Niche of Religious Cognitions
Authors: Richert Rebekah A.
Published: April 2022

This chapter outlines how cultural practices support the development of both intuitive and explicit cognitive processes relevant to religious thinking. Cultural beliefs influence children’s religious thinking at a variety of levels. Parents and educators guide children’s learning of religious concepts and beliefs through direct instruction about religious doctrines; through guided participation in shared religious activities, such as prayer and rituals; and through indirect information about their own intuitions about religion that is conveyed unintentionally in the adults’ language use. Each of these processes are guided by adults’ ethnotheories about where, how, and when to engage children in religious thinking and practices.
“That evening our men daunced with the Indians”
Authors: Carr Revell
Published: April 2022

The potential for musical performances, and musical instruments, to intersect with economic interests and activities, particularly in spaces of cross-cultural encounter, made music a powerful social and cultural force in the age of European maritime exploration Pacific. This chapter draws on archival as well as published sailors’ accounts of musical activities in the context of trade and commerce in early contact situations between Pacific Islanders and Euro-American seamen, with the intent of illustrating the uniquely cosmopolitan perspectives of deepwater seamen, and their drive to introduce western ideas of capitalism, commerce, and music to Oceania. This chapter recognizes music and dance not simply as forms of entertainment or abstract art, but as sources of power—valuable, flexible commodities useful in economic relations. Through this perspective the people of Oceania in the late eighteenth and early nineteenth centuries can be seen as active agents, able to utilize the strength of their expressive culture to creatively and profitably interact with outsiders.
On Some Impossibility Theorems in Population Ethics
Authors: Carlson Erik
Published: April 2022

At least since Derek Parfit presented his “Mere Addition Paradox,” the difficulties of formulating a viable population axiology have been widely recognized. Building on Parfit’s work, a number of philosophers have proved impossibility theorems, showing that certain plausible adequacy conditions are mutually inconsistent. The most impressive and important such results are due to Gustaf Arrhenius. His theorems involve more compelling adequacy conditions and weaker assumptions of measurement than earlier work in this area. On the basis of these theorems, Arrhenius is inclined to deny the existence of a satisfactory population axiology. The aim of this chapter is to show that Arrhenius’s impossibility results are not inescapable. It shall mainly focus on his “sixth” theorem, which he considers to be his strongest result. Arrhenius’s proof of this theorem requires a certain assumption, as regards the order of welfare levels, which is more contentious than he recognizes. This assumption rules out “non-Archimedean” theories of welfare. If such theories are not excluded, there are, as this chapter shall show, population axiologies that satisfy all the adequacy conditions of Arrhenius’s sixth theorem. In the penultimate section of the chapter it will be argued, moreover, that this objection pertains to all of Arrhenius’s axiological impossibility theorems. Since non-Archimedean theories of welfare are far from obviously false, Arrhenius’s results fail to show that there is no acceptable population axiology.
Exploring Cultural and Social Differences in Defining Films for Children
Authors: Parry Becky
Published: April 2022

Far from being a universal experience, childhood differs greatly from country to country and context to context. Indeed, childhood, as it appears in culture, can be understood as a social construct whose meaning varies according to changing values. This chapter advances understanding of the way these differences impact on defining a film as a children’s film. Rather than draw on existing distinctions made between family films and children’s film, it presents new research data from a survey of the European Children’s Film Association membership. This data demonstrates how those working in distribution, exhibition and education sectors across the children’s film industry define films as being appropriate, engaging, and meaningful to children and young people. These findings highlight the ways in which international differences in defining children’s film relate to distinctive issues raised by particular representations of gender, ethnicity, and class.
Growing Up on Scandinavian Screens
Authors: Lysne Anders
Published: April 2022

This chapter discusses the historical development of the youth film in Scandinavian cinema. Adopting a regional perspective, it identifies four major strands in the historical development of the youth film across Denmark, Norway, and Sweden: (a) the juvenile-delinquency film, (b) the coming-of-age film, (c) the medium-concept youth film, and finally, (d) the generic turn in the postmillennial era. With a dual focus on textual features and contextual factors, the article argues that the Scandinavian youth film has evolved from being primarily films about youth to increasingly becoming films for youth, all the while retaining an inherent ambiguity informed by a continuous negotiation of pedagogic, aesthetic, and commercial objectives.
Decolonizing Climate Adaptation by Reacquiring Fractionated Tribal Lands
Authors: Watkinson-Schutten Melissa
Published: April 2022

Coastal tribes are experiencing loss of land due to the cumulative effects of climate change. However, decolonization in the form of reacquiring tribal lands can be used as a tool for adapting to climate change impacts. Guided by an Indigenous worldview and in partnership with a coastal tribe in Washington State, spatial analyses and interviews were conducted to determine the effectiveness of reacquiring fractionated land, such as through the Land Buy-Back (LBB) program, on tribes’ ability to adapt to climate impacts. Reacquiring and consolidating fractionated land through the LBB program can increase the adaptive capacity for tribes impacted by climate change. Additional programs and funding for land and consolidation should be made available to tribes as a tool for climate adaptation.
AI Challenges for Society and Ethics
Authors: Whittlestone Jess , Clarke Samuel
Published: April 2022

Artificial intelligence is already being applied in and impacting many important sectors in society, including healthcare, finance, and policing. These applications will increase as AI capabilities continue to progress, which has the potential to be highly beneficial for society, or to cause serious harm. The role of AI governance is ultimately to take practical steps to mitigate this risk of harm while enabling the benefits of innovation in AI. This requires answering challenging empirical questions about current and potential risks and benefits of AI: assessing impacts that are often widely distributed and indirect, and making predictions about a highly uncertain future. It also requires thinking through the normative question of what beneficial use of AI in society looks like, which is equally challenging. Though different groups may agree on high-level principles that uses of AI should respect (e.g., privacy, fairness, and autonomy), challenges arise when putting these principles into practice. For example, it is straightforward to say that AI systems must protect individual privacy, but there is presumably some amount or type of privacy that most people would be willing to give up to develop life-saving medical treatments. Despite these challenges, research can and has made progress on these questions. The aim of this chapter will be to give readers an understanding of this progress, and of the challenges that remain.
Governing AI to Advance Shared Prosperity
Authors: Klinova Katya
Published: April 2022

This chapter describes a governance approach to promoting AI research and development that creates jobs and advances shared prosperity. Concerns over the labor-saving focus of AI advancement are shared by a growing number of economists, technologists, and policymakers around the world. They warn about the risk of AI entrenching poverty and inequality globally. Yet, translating those concerns into proactive governance interventions that would steer AI away from generating excessive levels of automation remains difficult and largely unattempted. Key causes of this difficulty arise from two types of sources: (1) insufficiently deep understanding of the full composition of factors giving AI R&D its present emphasis on labor-saving applications; and (2) lack of tools and processes that would enable AI practitioners and policymakers to anticipate and assess the impact of AI technologies on employment, wages and job quality. This chapter argues that addressing (2) will require creating worker-participatory means of differentiating between genuinely worker-benefiting AI and worker-displacing or worker-exploiting AI. To contribute to tackling (1), this chapter reviews AI practitioners’ motivations and constraints, such as relevant laws, market incentives, as well as less tangible but still highly influential constraining and motivating factors, including explicit and implicit norms in the AI field, visions of future societal order popular among the field’s members and ways that AI practitioners define goals worth pursuing and measure success. I highlight how each of these factors contributes meaningfully to giving AI advancement its excessive labor-saving emphasis and describe opportunities for governance interventions that could correct that over emphasis.
The Nature and Significance of Blame
Authors: Brink David O. , Nelkin Dana Kay
Published: April 2022

This chapter examines the nature and significance of blame, including conceptions in terms of the cognitive or conative states of appraisers, the social functions of blame, and multi-dimensional clusters of psychological and social factors. It raises questions about the extensional and explanatory adequacy of these conceptions. The chapter defends a conception of the core and syndrome of blame. The core is an aversive attitude that an appraiser holds toward a target based on the belief that the target is blameworthy for some failure in attitude or conduct; the syndrome is a set of psychological and social factors that are normally, but not invariably, downstream from blame. The chapter argues that blame can presuppose blameworthiness without circularity and explores the significance of this conception of blame for the ethics of blame.
Punishment as Communication
Authors: Cushman Fiery , Sarin Arunima , Ho Mark
Published: April 2022

Punishment is traditionally modelled as a ‘constructed incentive’. Specifically, the person who punishes is constructing a set of incentives that will motivate the person being punished to change her behaviour. Yet, while this model captures something important about the logic of punishment, it also misses important contours of how humans punish and how they learn from punishment. We argue that, in addition to understanding punishment as a form of incentive, we must also understand it as a form of communication. According to the communication model, a person can learn from punishment by attempting to infer the punisher’s communicative intent. Meanwhile, the punisher can choose punishments that are maximally informative given the learner’s likely inferential stance. This coordinated communicative reasoning enables faster and more accurate learning during punishment and provides a better fit to empirical data on how people actually punish and learn from punishment.
Self-Deception and the Moral Self
Authors: Holton Richard
Published: April 2022

Self-deception is rife in moral thinking. Some have even argued that moral behaviour is fundamentally driven by self-signalling: we want to see ourselves as good, and we make use of self-deception to achieve it. What form does this self-deception take? A rough division is made between two sorts of account: the proactive, wherein the agent is seen as having in place a prior strategy to avoid unwanted knowledge; and the reactive, wherein the agent is held to initially register the unwanted knowledge before responding to block it. Refining this distinction takes us to the issue of whether there are ‘tension triggers’: states that serve to trigger a self-deceptive response that are in tension with the agent’s existing beliefs. The empirical literature does not conclusively show that there are tension triggers; but it provides plausible examples.
Two Ways to Adopt a Norm
Authors: Kelly Daniel
Published: April 2022

The two main aims of this chapter are to clarify a psychological distinction between internalized and avowed norms and to characterize key features of each type of norm in a way that might usefully guide future research. After discussing a number of different lines of research that address human norm-governed behaviour, I argue that the distinction between internalization and avowal cross cuts the categories that have organized much of this research. I then describe an account of the human capacity for self-regulation and use the account to argue that avowed norms at least initially draw on the slower, more deliberate cognitive machinery of self-regulation, while internalized norms are underpinned by a specialized psychological system. After highlighting the different motivational features associated with each kind of norm, I conclude by pointing to several philosophical issues that stand to be illuminated by a better developed and empirically grounded account of internalized and avowed norms.
Race and Moral Psychology
Authors: Zheng Robin
Published: April 2022

What effects does a racially stratified social world have on our individual psychologies, and our moral interactions with one another? In what ways do our psychologies hinder or enable us in working toward a more racially just society? This chapter surveys a range of moral psychological phenomena––broadly construed––using diverse philosophical and empirical approaches, including racial bias, discrimination, prejudice, stereotyping, intergroup dynamics, alienation, double consciousness, racial identity, and combating racism. More specifically, the chapter focuses on outlining the differential impact of racial categorization on racially dominant versus racially oppressed groups, as well as some core topics in moral psychology as they manifest in the context of a racially unjust society. Some recurring themes include the twin moral and epistemic quandaries generated by racism, the interaction between individual psychology and social structure, and intersections with other forms of oppression.
To sim or not to sim—choosing wisely for procedural skills training in paediatrics
Authors: Al Maawali Ali , Amin Harish , Baerg Krista , Feldman Mark , Gorodzinksy Fabian , Puran Allan , Dubrowski Adam , Bismilla Zia
Published: April 2022

Objectives

Simulation is a commonly used modality to teach paediatric procedural skills, however, it is resource intensive. Which paediatric skills are best taught using simulation is not known. This study aims to examine what skills to simulate, allowing for the best use of resources in ever expanding curricula.

Method

We administered a questionnaire to community and hospitalist general paediatricians in Canada asking them to rate the importance of maintaining competency in each paediatric procedural skill and the frequency with which they perform the skill in their practice.

Results

Skills that were rated as highly important and also high frequency were: bag-mask ventilation (BMV), lumbar puncture, neonatal cardiopulmonary resuscitation (CPR), specimen procurement for infectious diseases, immunization, and ear curettage. Skills that were rated as highly important but low frequency were: paediatric CPR, intraosseous needle insertion, neonatal intubation, defibrillation, gathering specimens for evidence of child maltreatment, paediatric intubation, cervical spine immobilization, and oral/nasogastric tube placement.

Conclusion

Paediatric procedural skills are rated variably in terms of importance and frequency of use in general paediatric practice. Eight skills of high importance are infrequently performed and should be targeted for teaching via simulation.
Changes in Opioid Dispensing by Medical Specialties After the Release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain
Authors: Salvatore Phillip P , Guy Gery P , Mikosz Christina A
Published: April 2022

Objective

To identify changes in opioid prescribing across a diverse array of medical specialties after the release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.

Design

Interrupted time-series analysis of data from a commercial prescribing database.

Subjects

De-identified recipients of opioid prescriptions dispensed at U.S. retail pharmacies between 2015 and 2019.

Methods

Opioid dispensing data were obtained from the IQVIA Longitudinal Prescription (LRx) database, representing more than 800 million opioid prescriptions. Monthly dispensing rates, dosage in morphine milligram equivalents (MME), and mean prescription duration were calculated across 29 medical specialties. Changes in dispensing after the release of the 2016 CDC Guideline were assessed through interrupted time-series analysis.

Results

Declining trends in opioid dispensing accelerated in 24 of 29 specialty groups after the release of the CDC Guideline (P < 0.05 for 15 groups). Decreases were greatest among family medicine clinicians, where declines accelerated by 4.4 prescriptions per month per 100,000 persons (P = 0.005), and surgeons, where declines accelerated by 3.6 prescriptions per month per 100,000 (P = 0.003).

Conclusions

These results illustrate that clinicians likely to provide primary care exhibited the greatest decreases in opioid dispensing. However, specialties outside the scope of the CDC Guideline (e.g., surgery) also exhibited accelerated decreases in prescribing. These declines illustrate that specialties beyond primary care could have interest in evaluating opioid prescribing practices, supporting the importance of specialty-specific guidance that balances the individualized risks and benefits of opioids and the role of non-opioid treatments.
OA12 Autoantibodies are common in patients labelled as “idiopathic” interstitial lung disease suggesting a high prevalence of undiagnosed autoimmune connective tissue disease
Authors: Tansley Sarah L , Cotton Caroline V , McMorrow Fionnuala K , Lu Hui , Betteridge Zoe E , New Robert P , Spencer Lisa G , McHugh Neil J , Cooper Robert G ,   the UK-BILD Collaboration
Published: April 2022

Background/Aims

In some patients, interstitial lung disease (ILD) may be the dominant or even sole clinically overt manifestation of an otherwise unrecognised autoimmune connective tissue disease (CTD). Accurate diagnosis can be challenging given considerable overlap of the clinical, radiological and histological disease features. Distinguishing CTD-related ILD (CTD-ILD) from idiopathic ILD can avoid a lung biopsy, enables appropriate immunosuppressive treatment, informs prognosis and facilitates monitoring for other CTD-associated complications. Autoantibodies are a hallmark feature of CTD, are highly disease-specific and their presence is strongly suggestive of covert CTD-ILD. We investigated patients who had been labelled with “idiopathic” ILD by their local hospital teams for the presence of autoantibodies that may suggest misdiagnosis.

Methods

Serum from two groups of patients recruited to UK Biomarkers of Interstitial Lung Disease (BILD) were analysed: 183 with a local diagnosis of idiopathic non-specific interstitial pneumonia (iNSIP) and 34 with a local diagnosis of idiopathic or Cryptogenic Organising Pneumonia (COP). Autoantibody status was determined by radio-immunoprecipitation.

Results

Overall, CTD-autoantibodies were identified in 15% of patients with a prior label of “idiopathic” ILD. CTD autoantibodies were more common in those with a prior diagnosis of COP, where more than 1 in 5 patient samples contained a potentially relevant autoantibody, see table. The autoantibodies identified included those readily detectable e.g. anti-Jo1, in addition to rarer antibodies not included in standard assays e.g. anti-EIF2B. Nearly half of all autoantibodies detected were anti-synthetase autoantibodies.

Conclusion

Covert CTD-ILD is potentially being missed as a diagnosis in patients who have been labelled by local teams as having idiopathic forms of inflammatory ILD (COP or iNSIP). More specific guidance on autoantibody testing and the interpretation of these test results could improve diagnosis and ensure patients receive more appropriate management.

Disclosure

S.L. Tansley: None. C.V. Cotton: None. F.K. McMorrow: None. H. Lu: None. Z.E. Betteridge: None. R.P. New: None. L.G. Spencer: None. N.J. McHugh: None. R.G. Cooper: None.
OA41 Audit of the rheumatology PIFU pathway at the UHMB Trust
Authors: Achieng Sheilla , Gray Leanne , Ottewell Lesley
Published: April 2022

Background/Aims

Patient initiated follow up (PIFU) is an initiative that allows patients to access follow-up when required by initiating their own appointments. The disruptive impact of the COVID-19 pandemic has created significant capacity constraints on many services that were already experiencing pressures prior to the pandemic, piquing interest in PIFU as a sustainable model of care. The BSR has produced draft PIFU guidance to support rheumatology units to develop and deliver safe, robust and sustainable PIFU care models. We audited our PIFU pathway in line with the BSR’s recommended standards to establish its safety and efficacy since its implementation in 2018.

Methods

This was a retrospective analysis of patients transferred to an active PIFU access plan within UHMBT between February 2018 and November 2019. Patients were identified by the informatics team from the active PIFU access plans. We captured data to include treatments used. The electronic case notes were reviewed to establish reasons for appointment triggers in those who contacted the service, analyse waiting times for clinical review further to making contact and assess subsequent outcomes. Data were entered and analysed in Microsoft Excel 2016.

Results

We had a total of 420 patients on PIFU. We audited 100 of these. 56 were female. Mean age was 63.4 years (24-96). The most common diagnosis was inflammatory arthritis (n = 78). The majority of patients (n = 53) were on a single disease-modifying anti-rheumatic drug (DMARD). 17 patients were on > 1 DMARD and 5 patients were on prednisolone monotherapy, mean steroid dose 4.9 mg daily. 25 patients were not on any treatment. Of those on DMARDS, 63% (44) were on methotrexate, either as monotherapy or in combination with other DMARDs. 68% (30) of those on methotrexate were on a dose of ≤ 15mg weekly. Of the 100 patients, 9 triggered a review within the follow up period. This was usually via the nurse helpline (n = 7). Occasionally the GP triggered a review on behalf of the patient via the advice and guidance line (n = 2). The most common reason for a trigger was a flare of inflammatory arthritis (n = 7) and the remaining two appointments were due to side effects of DMARDs. Patients were contacted via nurse telephone call back within 48 hours of contacting the helpline (n = 8). One patient required an urgent face-to-face consultant review and was seen within 7 days. After contacting the service, all nine patients were reverted to regular follow-up.

Conclusion

Our results confirmed a robust PIFU pathway with appropriate safety nets ensuring prompt access to clinician input when needed. The use of PIFU pathway did not compromise care or result in any worsening clinical outcomes. After validation at 2 years, the majority of our patients on this pathway were onwardly managed through the PIFU model.

Disclosure

S. Achieng: None. L. Gray: None. L. Ottewell: None.
OA43 Development of a national across specialty multi-disciplinary team for management of hyper-inflammatory conditions during the SARS-CoV-2 pandemic
Authors: McLellan Kirsty , Reilly Liam , Pollock Louisa , Swann Olivia , Anderson Catriona , Martin Neil , Brennan Mary , Hague Rosie , Walsh Jo
Published: April 2022

Background/Aims

Effective multi-specialty team working is extremely beneficial in management of children with hyper-inflammatory conditions. With the recognition of paediatric inflammatory multisystem syndrome (PIMS) it became apparent a standardised process for discussion of patients would be beneficial. This includes urgent discussion, with access to multiple specialties, and sharing knowledge and experience in a novel condition. Delivering equitable healthcare including access to expertise, specific treatments and research is challenging in Scotland due to its geography. This is facilitated by successful clinical networks (Scottish Paediatric & Adolescent Rheumatology Network [SPARN] and Scottish Paediatric& Adolescent Infection & Immunology National Managed Clinical Network [SPAIIN]) and a well-established paediatric transport service (ScotSTAR). Our aim was to develop a multi-specialty multi-disciplinary team (MDT) for management of patients with hyper-inflammatory conditions.

Methods

Narrative account of MDT and service development

Results

We identified a core group of individuals with an interest in inflammatory disorders from different centres and specialties across Scotland including Rheumatology, Infectious Diseases, Cardiology, Intensive Care, Academic Paediatrics, Pharmacists and Clinical Nurse Specialists. Three priorities emerged from initial planning stages: urgent discussions around patient management, peer-to-peer learning and information sharing, and effective prioritisation of research. We designed a written framework and referral pathway, including criteria for acute cardiology involvement, ScotSTAR transfer and intensive care. An electronic proforma was designed to guide MDT discussion, medico-legal documentation and audit purposes. Table 1 describes characteristics of the first nine patients discussed. A particular strength was in diagnostics and consideration of differentials; among patients referred we identified those with haematological malignancy, systemic lupus erythematosus and non-accidental injury. Regular peer-review sessions were held, for reflection on cases and their management in both secondary and tertiary care settings. Clinicians throughout Scotland were encouraged to join via SPARN and SPAIIN networks.

Conclusion

This multi-specialty MDT has been and continues to be beneficial for management of hyper-inflammatory patients. We will review the process but hope the MDT will prove to continue to be beneficial for future patients. The authors would like to acknowledge all members of the MDT.

Disclosure

K. McLellan: None. L. Reilly: None. L. Pollock: None. O. Swann: None. C. Anderson: None. N. Martin: None. M. Brennan: None. R. Hague: None. J. Walsh: None.
P005 Performance of giant cell arteritis pre-test probability score in a tertiary care setting
Authors: Kadamban Premila , Pattapola Shyanthi , Alkoky Hoda , Jordan Natasha , Gupta Bhaskardas
Published: April 2022

Background/Aims

Giant cell arteritis (GCA) is a chronic, idiopathic, granulomatous vasculitis of medium and large arteries comprising overlapping phenotypes of cranial arteritis and extracranial GCA. Vascular complications are generally due to delay in diagnosis and initiation of effective treatment. Due to the imminent risk of visual loss and other ischaemic complications it is vital to secure the diagnosis and it is equally important to exclude the mimics as the treatment of GCA has it's own complications. The objective of this quality improvement project was to assess the performance of Southend GCA Pre-test Probability Score (GCA PS) in a cohort of patients who were referred urgently with suspected GCA to the Rheumatology Department of Addenbrooke’s Hospital.

Methods

We analysed the data of 50 new patients seen between Aug 2019 and Feb 2020. GCA PS were calculated based on the information from GPs (clinical and biochemical data). The likely hood of GCA was determined on review after 1 month, based on the clinical, biochemical, histopathological data and response to steroids.

Results

A total of 50 cases were included in the study. Thirty-eight (76%) of them were females while 12(24%) were males. The median age was 68.5. The median probability score was 12, it ranged between 0 to 24. Finally, 25 patients were diagnosed as likely to have GCA based on clinical, biochemical, histopathological findings and response to steroids. The lowest probability score among those who had a positive biopsy was 10. The p value for the likelihood of GCA when the probability score was 10 or higher was 0.0001 which was very significant.

Conclusion

GCA pre-test probability score is a very promising and utilitarian tool for risk stratification of patients with suspected GCA and prediction of the likelihood of GCA. It enables exclusion of GCA in cases with low probability score and to have a higher degree of scrutiny in those with intermediate and high probability scores. Clinical diagnostic algorithm based on the BSR guidelines could further be utilised for confirmation.

Disclosure

P. Kadamban: None. S. Pattapola: None. H. Alkoky: None. N. Jordan: None. B. Gupta: None.