bluuebunny/crossref_metadata_2025 huggingface dataset:
Meaningfulness, Conventions, and Rules
Authors: REILAND INDREK
Published: January 2025

In the middle of the 20th century, it was a common Wittgenstein-inspired idea in philosophy that languages are analogous to games and for a linguistic expression to have a meaning in a language is for it to be governed by a rule of use. However, due to the influence of David Lewis’s work it is now standard to understand meaningfulness in terms of conventional regularities in use instead (Lewis 1969, 1975).

In this paper I will present a simplified Lewis-inspired Conventions view which embodies the basic idea and argue that it is inferior to the older Rules view. Every theory of meaningfulness in a language must yield a plausible story of what it is to speak the language, that is, of what it is to use an expression with its meaning. Those who have adopted something like the Conventions view standardly take use with meaning to consist in trying to use the expression in the conventionally regular way (Lewis 1969, Davis 2003, Loar 1981). I argue that this proposal fails since use with meaning is compatible with intentional misuses. In contrast, on the Rules view we can take use with meaning to be analogous to making a move in the game and to consist in using it while the rule is in force for one which is compatible with intentionally breaking it. And nothing structurally analogous can be found on the Conventions view without inflating it into the Rules view, which completes the case against it.
On the optimality of linear residual risk sharing
Authors: Yang Jiajie , Wei Wei
Published: January 2025

In this paper, we explore the optimal risk sharing problem in the context of peer-to-peer insurance. Using the criterion of minimizing total variance, we find that the optimal risk sharing strategy should take a linear form. Although linear risk sharing strategies have been examined in the literature, our study uncovers a significant finding: to minimize total variance, the linear strategy should be applied to the residual risks rather than the original risks, as commonly adopted in existing studies. By comparing with the existing models, we demonstrate the advantage of the linear residual risk sharing model in variance reduction and robustness. Furthermore, we develop and study a number of new models by incorporating some constraints, to reflect desirable properties required by the market. With those constraints, the optimal strategies turn out to favor market development, such as incentivize participation and guarantee fairness. A relevant model is considered at last, which establishes the connection among multiple optimization problems and provides insights on how to extend the models into a more general setup.
Why Does Possessing Standing to Blame Matter?
Authors: Yaure Philip
Published: January 2025

I argue that moral dialogue concerning an agent’s standing to blame facilitates moral understanding about the purported wrongdoing that her blame targets. Challenges to a blamer’s standing serve a communicative function: they initiate dialogue or reflection meant to align the moral understanding of the blamer and challenger. On standard accounts of standing to blame, challenges to standing facilitate shared moral understanding about the blamer herself: it matters per se whether the blamer has a stake in the purported wrongdoing at issue, is blaming hypocritically, or is complicit in the wrongdoing at issue. In contrast, I argue that three widely recognized conditions on standing to blame—the business, non-hypocrisy, and non-complicity conditions—serve as epistemically tractable proxies through which we evaluate the accuracy and proportionality of blame. Standing matters because, and to the extent that, it indirectly informs our understanding of the purported wrongdoing that an act of blaming targets.
Mental Health Status and Related Factors of Citizens 6 Months after Mass Death and Injury Due to Crowd Crush Incident: Focused on the Itaewon Disaster in 2022
Authors: Choi Yun-Jung , Song Heewon , Namgung Hae-In , Lee Na rae
Published: January 2025

Objective

Crowd crush disasters result in psychological risks such as anxiety, depression, and post-traumatic stress disorder (PTSD). This descriptive research study identified the mental health status of Koreans after the Itaewon crowd crush disaster and explored related factors.

Methods

Data were collected May 2-9, 2023 using an online survey. Participants included 205 adults aged 19-69 years recruited through South Korean local and online university communities. Their mental health and related factors were measured at 6 months post-disaster. Data were analyzed using IBM® SPSS® Statistics 26.0. and R 3.4.2.

Results

Significant differences in anxiety, depression, and PTSD among participants who experienced the disaster as victims; changes in drinking frequency and alcohol consumption; and differences in anxiety and PTSD according to family type were observed. Comparing the 3 and 6 month surveys, there were no significant changes in anxiety, depression, PTSD, general mental health, or mental well-being. When mental health severity was divided according to victimization, a significant difference in the severity of anxiety, depression, and PTSD was observed.

Conclusions

Participants’ levels of anxiety, depression, and PTSD varied according to their direct and indirect experience of the disaster, with higher levels of PTSD even without direct experience with the disaster.
Damping of solitons by coastal vegetation
Authors: Mossa Michele , De Padova Diana , Onorato Miguel
Published: January 2025

Mangroves are a natural defence of the coastal strip against extreme waves. Furthermore, innovative techniques of naturally based coast defence are used increasingly, according to the canons of eco-hydraulics. Therefore, it is important to correctly evaluate the transmission of waves through cylinder arrays. In the present paper, the attenuation of solitary waves propagating through an array of rigid emergent and submerged cylindrical stems on a horizontal bottom is investigated theoretically, numerically and experimentally. The results of the theoretical model are compared with the numerical simulations obtained with the smoothed particle hydrodynamics meshless Lagrangian numerical code and with experimental laboratory data. In the latter case, solitary waves were tested on a background current, in order to reproduce more realistic sea conditions, since the absence of circulation currents is very rare in the sea. The comparison confirmed the validity of the theoretical model, allowing its use for the purposes indicated above. Furthermore, the present study allowed for an evaluation of the bulk drag coefficient of the rigid stem arrays used, as a function of their density, the stem diameter, and their submergence ratio.
The Downstream Effects of Certiorari: Agenda-Setting, Amicus Briefs, and Opinion Writing on the US Supreme Court
Authors: Abi-Hassan Sahar , Box-Steffensmeier Janet M. , Christenson Dino P.
Published: January 2025

The majority opinion of the Supreme Court establishes precedent, but separate opinion writing affords the justices the ability to expound upon it or express their disagreement with the ruling or its logic. We broaden the exploration of separate opinion writing to consider how decisions and case features at the moment of granting cert shape justices’ decisions to engage in nonconsensual behavior. We also sharpen the focus on external actors to consider the nature of amici curiae. Through an empirical study of Supreme Court cases between 1986 and 1993, we find that aspects of the agenda-setting stage affect justices’ decisions at the litigation stage. In addition, we find that the number of briefs and the diversity of organized interests impacted by the case is particularly relevant to justices. The decision to write a separate opinion is the product of internal and external factors over the full course of a case’s history.
Foreign Judges and Foreign Case Citations: A Study of the Hong Kong Court of Final Appeal
Authors: Garoupa Nuno , Rao Weijia
Published: January 2025

We study the value of foreign judges and foreign case citations for emerging courts in postcolonial democracies, with a specific focus on the Hong Kong Court of Final Appeals (HKCFA). The HKCFA, Hong Kong’s highest appellate court since the transfer of its sovereignty to China, features foreign judges as full members of the court. Using a novel dataset of all publicly available HKCFA decisions from 1997 to 2020, we show that there is a significantly higher number of foreign case citations in cases where foreign judges have participated. Further analyses show that this correlation is stronger where the Hong Kong government is a disputing party, and more specifically, where the court rules in favor of the Hong Kong government. The findings are consistent with the possibility that foreign judges’ expertise in foreign case law is relevant for upholding the perception of the court’s independence from the executive branch. This explanation is in line with existing theories on the role of foreign judges on domestic courts.
Oversight of the Legal System in an Authoritarian Regime: Police and Court Monitoring in Russia
Authors: McCarthy Lauren A.
Published: January 2025

How can citizens in authoritarian regimes exercise oversight of the legal system? I examine police and court monitoring, bottom-up oversight activities popular in pre-war Russia (2012–2022). Monitoring pushes the state to honor commitments it has made in its own laws, taking advantage of the authoritarian state’s need for information and legitimacy. Yet monitoring activities are not just about improving the state’s performance. Using interviews, participant observation and document analysis of monitoring campaigns in pre-war Russia, I argue that monitoring can empower citizens in a profoundly disempowering environment, perhaps its most important legacy in a closing authoritarian space.
High Courts, Endowments, and Support for Institutional Change: Evidence from Israel and the United States
Authors: Braman Eileen , Sommer Udi , Kamoun Olivier
Published: January 2025

Proposals to change the institutional features of national high courts have been on the agenda recently in the United States and Israel. Using insights about endowment effects and prospect theory from behavioral economics, we theorize about how citizens may think about benefits from high courts and how those views can influence their support for change to those institutions. Mindful of differences across these countries, we employ a comparative experimental design to explore how people think about personal and societal benefits emanating from the Israeli and United States Supreme Courts. We find interesting differences in how experimental participants think about benefits from courts and how those views shape feelings about recent proposals to alter judicial institutions in each national context.
Relationship between tea intake and cedar pollen allergy: a population-based cross-sectional study
Authors: Aoki Nozomi , Suzuki Mai , Sato Yuki , Yokokawa Hirohide , Naito Toshio
Published: January 2025

Tea intake has been associated with health benefits, including potential beneficial effects of catechin-containing teas on allergic symptoms. However, large-scale epidemiological studies on the relationship between tea intake and allergic symptoms have been limited. The present study aimed to examine the relationship between the frequency of tea intake and cedar pollen allergy, which is a major cause of seasonal hay fever in Japan, in a large Japanese epidemiological cohort. Data on cedar pollen antibody levels assessed by blood tests and frequency of tea intake (green tea, coarse tea, oolong tea, and black tea) by a self-administered questionnaire from 16,623 residents in the Tohoku region of Japan were used in this study. The association between frequency of tea intake (less than once a week, 1–6 times/week, and more than once a day) and serum levels of cedar pollen-specific IgE (lumicount, LC: negative, 0–1.39; positive, ≥1.40) was analysed using a logistic regression model. Green tea intake (≥vs. <1/day) was inversely associated with cedar pollen-specific IgE (adjusted OR = 0.81, 95% CI, 0.70, 0.94). No statistically significant association between cedar pollen-specific IgE and frequency of tea intake was found for other types of tea. Our results suggest that green tea intake may be associated with lower cedar pollen-specific IgE positivity.
Suitability Models of Ancient Maya Agriculture in the Upper Usumacinta River Basin of Mexico and Guatemala
Authors: Horseman Grace , Morell-Hart Shanti , Golden Charles , Scherer Andrew
Published: January 2025

Recent archaeological and remote sensing research in the Maya Lowlands has demonstrated evidence for extensive modification of the landscape in the forms of channeled fields and upland terraces. Scholars often assume these measures were taken primarily to intensify maize production; however, paleoethnobotany highlights a greater diversity of crops grown by the precolonial Maya. This study combines the growth requirements of 18 crops cultivated by ancient Maya farmers with lidar and other geospatial data in a suitability model that maps optimal areas for growth. These 18 crops cluster into five groups of crops with similar growth requirements. Across the study region, different groupings of crops had different suitability in and around different ancient Maya centers and agricultural features. This spatial variation in suitability reflects the heterogeneity of land resources and adaptations and contributes to existing conversations about economic and settlement organization in the study area. The results of this study serve as a foundation for future field studies and more complex spatial models.
The Birth of East-Belgian Identity and the Treaty of Versailles: A Critical Legal Analysis
Authors: Vanhullebusch Matthias
Published: January 2025

In the former districts of Eupen and Malmedy, present-day East-Belgians, in particular academic and socio-political elites, draw their collective identity, amongst others, from the historical injustices inflicted upon them ever since the adoption of the Treaty of Versailles. The transfer of sovereignty from Germany to Belgium was then the subject of a popular consultation organised by the transitional Belgian authorities in those territories. Favouring national over popular sovereignty, those authorities de facto undermined the freedom of choice and imposed their annexation to Belgium which the League of Nations, despite criticisms, consecutively endorsed. Much has been said about this petite farce belge yet not from a legal point of view. Thus, this article sheds a different light on the historical accounts of those events which are instrumentalised to construct the contemporary collective identity of the German-speaking Community of Belgium.
Contested Narratives of the Alash Movement in Contemporary Kazakhstan
Authors: Dukeyev Berikbol
Published: January 2025

This article examines the discursive contestation of Alash movement narratives in post-1991 Kazakhstan by studying overlapping and diverse official and non-official narratives. By surveying textual content and conducting interviews with those who carry these narratives, including textbook authors, the article reveals that while both official and unofficial narratives converge on the subject of statehood for the Alash movement, the non-official narratives and textbook authors use its legacy to express dissatisfaction with post-1991 developments in Kazakhstan. This study sheds light on the differing perspectives and debates surrounding the Alash movement’s legacy in shaping post–1991 Kazakhstani society and politics.
Communicating Assistance to Ukrainian Refugees: Does Empathetic Communication Make a Difference?
Authors: Ringlerova Zuzana , Kotýnek Krotký Jan
Published: January 2025

European countries have been important supporters of Ukraine since the 2022 invasion by Russia. Responding to the invasion, however, was not the only challenge facing these countries in 2022. A tough domestic economic situation caused by high inflation and skyrocketing energy prices gave rise to public resentment accusing governments of favoring Ukraine and Ukrainian refugees over their own citizens. Yet, communicating governments’ policies on Ukraine efficiently and having the public on board matters because lack of public support may endanger the countries’ ability to help Ukraine in the war. Given the importance of political communication, we use the case of Czechia to explore the role of empathy in political communication between Ukraine and Ukrainian refugees. We build on existing studies which suggest that empathy in communication has the potential to decrease polarization of public opinion and that candidates using empathetic communication are viewed more positively. First, in a rhetorical analysis, we demonstrate that empathy with citizens’ concerns is not a part of the government’s defense of its refugee policy. Then, in an original survey experiment, we show that contrary to expectations, expressing empathy with citizens’ concerns does not significantly increase public support for help to refugees.
Vegetable consumption and promotion among school-age children and adolescents in West Africa: a systematic review and narrative synthesis
Authors: Igbokwe Kosisochukwu C. , Ejoh Shirley I. , Iheme Gideon O.
Published: January 2025

Low vegetable consumption among school-age children and adolescents puts them at risk of micronutrient malnutrition and non-communicable diseases. There is a dearth of synthesised literature on vegetable intake and interventions to promote increased consumption among this age group in West Africa. This study pooled evidence on vegetable consumption and interventions to promote vegetable consumption among school-age children and adolescents (6–19 years) in West Africa. Quantitative and qualitative studies from 2002 to 2023 were electronically searched in PubMed, African Journals Online (AJOL) and Google Scholar databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system was adhered to in reporting this review (PROSPERO ID: CRD42023444444). The Joanna Briggs Institute critical evaluation tool was used to appraise the quality of studies. Forty (40) studies met the search criteria out of n 5080 non-duplicated records. Meta-analysis was not possible due to high heterogeneity. Low vegetable consumption expressed in frequency or amounts was recorded among school-age children and adolescents in the reviewed studies. Intervention studies were mostly among adolescents; the most common type of intervention was the use of nutrition education. Insufficient evidence and high heterogeneity of studies reflect the need for more high-quality interventions using globally identified standards but applied contextually. School-age children appear to be an under-served population in West Africa with regard to nutrition interventions to promote vegetable consumption. There is a need for multi-component intervention studies that encourage vegetable consumption as a food group. Gardening, parental involvement, gamification and goal setting are promising components that could improve the availability, accessibility and consumption of vegetables.
Energetic bounds on gyrokinetic instabilities. Part 4. Bounce-averaged electrons
Authors: Costello P.J. , Plunk G.G.
Published: January 2025

Upper bounds on the growth of instabilities in gyrokinetic systems have recently been derived by considering the optimal perturbations that maximise the growth of a chosen energy norm. This technique has previously been applied to two-species gyrokinetic systems with fully kinetic ions and electrons. However, in tokamaks and stellarators, the expectation from linear instability analyses is that the most important kinetic electron contribution to ion-scale modes often comes from the trapped electrons, which bounce faster than the time scale upon which instabilities evolve. As a result, a fully kinetic electron response is not required to describe unstable modes in many cases. Here, we apply the optimal mode analysis to a reduced two-species system consisting of fully gyrokinetic ions and bounce-averaged electrons, with the aim of finding a tighter bound on ion-scale instabilities in toroidal geometry. This analysis yields bounds that are greatly reduced in comparison with the earlier two-species result. Moreover, if the energy norm is properly chosen, wave–particle resonance effects can be captured, reproducing the stabilisation of density-gradient-driven instabilities in maximum-

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devices. The optimal mode analysis also reveals that the maximum-

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property has an additional stabilising effect on ion-temperature-gradient-driven instabilities, even in the absence of an electron free energy source. This effect is explained in terms of the concept of mode inertia, making it distinct from other mechanisms.
The efficacy and feasibility of lifestyle interventions on modifiable cardiovascular disease risk factors among people with inflammatory bowel disease
Authors: Yap J. M. , Wall C. L. , Schultz M. , Meredith-Jones K. , Osborne H.
Published: January 2025

This review aims to highlight the relative importance of cardiovascular disease (CVD) lifestyle-associated risk factors among individuals with inflammatory bowel disease (IBD) and examine the effectiveness of lifestyle interventions to improve these CVD risk factors. Adults with IBD are at higher risk of CVD due to systemic and gut inflammation. Besides that, tobacco smoking, dyslipidaemia, hypertension, obesity, physical inactivity and poor diet can also increase CVD risk. Typical IBD behavioural modification including food avoidance and reduced physical activity, as well as frequent corticosteroid use, can further increase CVD risk. We reviewed seven studies and found that there is insufficient evidence to conclude the effects of diet and/or physical activity interventions on CVD risk outcomes among populations with IBD. However, the limited findings suggest that people with IBD can adhere to a healthy diet or Mediterranean diet (for which there is most evidence) and safely participate in moderately intense aerobic and resistance training to potentially improve anthropometric risk factors. This review highlights the need for more robust controlled trials with larger sample sizes to assess and confirm the effects of lifestyle interventions to mitigate modifiable CVD risk factors among the IBD population.
Accurate kinematic and stiffness analysis of parallel cable-driven upper limb rehabilitation robot with spherical guide wheel cable-guiding mechanism
Authors: Zou Yupeng , Pan Keyu , Wang Mengfei , Lai Xiaojing , Lan Tianyu , Zhou Zhishen , Li Changsheng
Published: January 2025

Cable-guiding mechanisms (CGMs) and the stiffness characteristics directly influence the dynamic features of the cable-driven upper limb rehabilitation robot (PCUR), which will affect PCUR’s performance. This paper introduces a novel CGM design. Given the precision and movement stability considerations of the mechanism, an analytical model is developed. Using this model, we analyze the error of the CGM and derive velocity and acceleration mappings from the moving platform to the cables. Continuity of cable trajectory and tension is rigorously demonstrated. Subsequently, a mathematical model for PCUR stiffness is formulated. Utilizing MATLAB/Simscape Multibody, simulation models for the CGM and stiffness characteristics are constructed. The feasibility of the proposed CGM design is validated through simulation and experimentation, while the influence of stiffness characteristics on PCUR motion stability is comprehensively analyzed.
Hi and Mighty: On the Czech Theatre Showcases
Authors: Brown Mark
Published: January 2025

The Hi PerformanCZ visitor programmes, hosted regularly by the Czech Arts and Theatre Institute since 2018, have invited international theatre professionals, from directors and promoters to critics, to immerse themselves in the variety of theatre on the contemporary Czech stage. Showcased performances, themed in programmes dedicated to theatre for children and young people, puppet theatre, and text-based theatre, among other examples, are accompanied by symposia, meetings with Czech theatre-makers, theatre tours, and museum visits. In this article Mark Brown provides an overview of the Czech showcases from 2018 to 2024, while focusing particularly on four productions: Tomáš Dianiška’s The Magnificent 294 (2020, showcased 2023); Jan Jirků’s Zá-to-pek! (2019, showcased 2022); director Jan Mikulášek’s staging of Thomas Bernhard’s novel Woodcutters (2018, showcased 2022 and 2023); and Brno’s Goose on a String Theatre’s collectively devised piece Smokeout (2022, showcased 2024). These productions markedly represent the diverse strengths of Czech theatre in the twenty-first century.
The Nude in the renaissance: Unveiling the world and revealing human dignity
Authors: Séris Émilie
Published: January 2025

The humanist theory of the nude is one of the places where what can be called a ‘poor metaphysics’ developed during the Renaissance. To construct the concept of the nude as a representation of man in his own right, art theorists used common scholastic categories such as substance and accident, form and matter, potentiality and actuality, quantity and quality, whole and part, soul and body. Resolutely poor in its object – the human body, the work of art – and in its form – technical treatise, fictional dialogue, or simple working notes – this reflection is nonetheless rich and original because of what constitutes its very weakness: the contamination of the Aristotelian metaphysical tradition with Neoplatonism, Vitruvianism, elements of natural philosophy, musical theory, and even Kabbalah. It testifies less to the permanence of scholastic metaphysics during the Renaissance than to the ingenious adaptation of its tools to new, humbler, and more rebellious objects of thought.
Links between preschool inhibitory control and working memory and elementary school adjustment
Authors: Gagne Jeffrey R. , Chang Chi-Ning , Yu Fanyi , Kwok Oi-Man
Published: January 2025

The development of inhibitory control (IC) and working memory (WM) in preschool is linked to a multitude of cognitive, emotional, and social outcomes, including elementary school adjustment. Furthermore, there are both cognitive and socioemotional domains of IC and it is unclear if both are related to these outcomes in the same manner. Using a family study design, the present investigation examined preschoolers’ IC, WM and externalizing behavior problems, maternal depression and anxiety measured when the children were in preschool, and elementary school externalizing behaviors and child and family functioning. Families with two children between 2.5 and 5.5 years of age (n = 198; mean age = 3.88, SD = 1.04) completed online surveys and laboratory visits, as well as another online survey after the children entered elementary school. Both cognitive and emotional domains of preschool IC significantly predicted the externalizing and functioning aspects of adjustment in elementary school (but WM did not predict either). In addition, child age predicted functioning in elementary school, and maternal depression predicted externalizing in elementary school. These longitudinal results indicate that supporting both cognitive and emotional aspects of preschool IC can benefit adjustment in elementary school.
A Single-Arm Pivotal Trial to Assess the Efficacy of AKL-T01, a Novel Digital Intervention for Attention, in Adults Diagnosed with Attention Deficit Hyperactivity Disorder
Authors: Maple Amanda M. , Savarese Antonia , Stamatis Caitlin A. , Mercaldi Catherine , Kollins Scott H.
Published: January 2025

Objectives

Rates of attention deficit hyperactivity disorder (ADHD) have increased among adults, and barriers to treatment (e.g., medication shortages; inaccessibility of behavioral treatments) underscore need for novel, scalable interventions. There is a particular need for treatments for inattentive symptoms, which are the most frequently endorsed ADHD symptoms in adults. AKL-T01 (EndeavorRx®) is an FDA-authorized digital therapeutic, currently approved for attention in children ages 8-12 with inattentive or combined-type ADHD and a demonstrated attention issue. This study evaluated the efficacy and safety of AKL-T01 in adults.

Methods

STARS-ADHD-Adults (NCT05183919) was a multicenter, single-arm trial at 14 US sites. Enrolled patients were 18 or older, had a diagnosis of ADHD (combined or inattentive), and demonstrated attentional impairment with a Test of Variables of Attention (TOVA) Attention Comparison Score (ACS) ≤ -1.8. Treatment involved using AKL-T01 at home 25 minutes/day, 5 days/week, for 6 weeks. The primary endpoint was change in TOVA-ACS. Secondary endpoints were changes in the ADHD Rating Scale-IV (ADHD-RS-IV) inattention subscale and total score, and Adult ADHD Quality of Life (AAQoL) total score. Safety, tolerability, and compliance were assessed.

Results

Of 440 participants screened, 221 were enrolled, and 153 (M age = 39.9, 70% female; 39% current stimulant use) had sufficient data for analysis. TOVA-ACS significantly improved from baseline to study day 42, M change = 6.46, SD = 6.95, t(152) = 11.49, p <.0001. There was significant improvement across all secondary endpoints (ps <.0001). In exploratory responder analyses, 36.6% moved into the normative range on TOVA (ACS>0), and 27.1% had ADHD-RS-IV improvement ≥ 30%. The treatment was well-tolerated (5% reported ADEs; none serious), and compliance was high (M = 81.1%).

Conclusions

Results support the efficacy of AKL-T01 in adults, and the magnitude of TOVA change in adults was nearly 7x the change reported in pediatric trials. Given the increasing rates of ADHD in adults, the barriers to accessing evidence-based treatments, and the centrality of inattentive symptoms as ADHD patients develop into adulthood, AKL-T01 holds promise as a scalable, targeted treatment for attention in adult ADHD with impacts to real-world symptoms.

Funding

Akili Interactive
Cogwheel Rigidity in Subacute Combined Degeneration Unresponsive to Vitamin B12 Therapy
Authors: Ashwin Gnanabaskaran , Hirsch Alan R , Kondepati Ananda K , Pasumarthi Shalini D
Published: January 2025

Introduction

Parkinsonian symptoms seen with B12 deficiency have been described in five cases where B12 therapy has led to their elimination. Subacute combined degeneration (SCD) presenting with parkinsonian signs of cogwheel rigidity, unresponsive to B12 supplementation, has not heretofore been described.

Methods

Case Study: This 62-year-old right-handed woman with a past medical history of hypothyroidism presented with complaints of trouble with memory. Cogwheel rigidity and pernicious anemia with low intrinsic factor and B12 levels (165 pg/ml) were found. SCD was diagnosed and treated with monthly B12 injections over the past three years, providing symptomatic relief, yet the cogwheeling persisted. She described never developing trouble with gait, movement disorders, autonomic abnormalities, olfactory dysfunction, disorders of sleep, visual hallucinations, or other parkinsonian symptoms.

Results

Abnormalities in Neurologic Examination: Cranial Nerve (CN) Examination: CN I: Alcohol Sniff Test: 9 (hyposmia). CN III, IV, VI: Bilateral ptosis. Motor Examination: 1+ Cogwheel rigidity both upper extremities. Drift Testing: Right pronator drift with left abductor digiti minimi sign. Reflexes: 3+ throughout other than 4+ ankle jerks. Quadriceps femoris bilaterally pendular. Bilateral Hoffman and Babinski reflexes present. B12 Level: 394 pg/ml (normal).

Discussion

While predominantly affecting the posterior columns and the lateral corticospinal tract, the demyelination may further extend into adjacent fibers including the reticulospinal tract and the rubrospinal tract, the tracts which, in Parkinson’s Disease, have been cited for their role in maintenance of tone and thus cogwheeling. Additionally, low B12 and elevated homocysteine levels have been noted as potential contributory factors in the pathogenesis of Parkinson’s Disease. It is also possible that this is a violation of Occam’s razor, that this individual has two separate distinct diseases — the prominent subacute combined degeneration as well as a subclinical parkinsonism which was revealed on neurologic examination. The parkinsonian signs may have been present prior to the B12 deficiency, and if not for the examination findings, could have remained undiscovered for decades. In those that present with Subacute Combined Degeneration, evaluation for parkinsonism is warranted.

Funding

No Funding
Pseudo-Wellens Syndrome: Demonstrating the Importance of Electrocardiogram in Emergency Psychiatric Patients
Authors: Berhane Asmeret , Hashemi Ava , Imtiaz Ayyub , Elahi Adil , Zaidi Muhammad
Published: January 2025

Introduction

Pseudo-Wellens syndrome (PWS) is a rare but clinically significant condition characterized by electrocardiogram (ECG) abnormalities that mimic acute ST-segment elevation myocardial infarction (STEMI) in the absence of obstructive lesions on coronary angiography. The occurrence of PWS should be on the differential for any patient who visits the Emergency Room (ER) with known and/or suspected drug overdose. This will avoid the potential for inappropriate invasive diagnostic modalities in otherwise cardiac healthy individuals. This literature review aims to explore the ECG changes in patients diagnosed with PWS in the context of drug intoxication presenting to the ER.

Methods

Specific keywords such as "Pseudo-Wellens Syndrome," "ECG/EKG,” and "substance abuse," were used to search PubMed, Google Scholar, and PsycInfo. Articles on PWS that were not on patients presenting with substance use or not in English were removed. We extracted substance use history, ECG parameters, and their clinical presentations to the ER for review.

Results

We found cases of PWS in patients presenting with cannabis, PCP, methamphetamine, opioid, and cocaine intoxication, either in combination or singularly. The most common ECG finding across the cases was biphasic T wave inversion in V2 and V3 with involvement in the anterior leads. The authors were unable to find any characteristic ECG changes associated with individual substances. This might be attributed by the small number of patients in the studies and due to the use of multiple drugs by patients at presentation to the ER, especially with drugs known to cause ECG abnormalities such as opioids. While PWS typically resolves spontaneously in most cases, this review revealed a concerning trend. Patients who consumed cocaine were at a higher risk of developing life-threatening cardiac conditions, including myocardial infarction. This finding underscores the importance of considering the pretest probability of acute coronary syndromes and avoiding misinterpretation of PWS as a less severe entity. For those patients presenting with a suspicious diagnosis and high pretest probability indicating an interruption of coronary blood flow, a comprehensive work up should be done to investigate any other possible life-threatening cardiac conditions.

Conclusions

PWS has ST segment and T wave abnormalities, which are ECG abnormalities that are already very common in psychiatric patients seen in-hospital. Recognizing the specific ECG findings in PWS is of utmost importance for clinicians to prevent unnecessary interventions and potential harm to patients. For further understanding, more comprehensive analysis of ECG findings with larger sample sizes while considering comorbid conditions and contributing factors to the patient presentation should be conducted.

Funding

No Funding
Pollock’s Abstract Images in Paintings Prior to His Drip Paintings
Authors: Morrissette Debbi Ann , Stahl Stephen M. , Gates Jon A.
Published: January 2025

Although Jackson Pollock is most famous for his drip drawings, these occurred late in his career, starting around 1947. Prior to that he produced some “surrealist inflected” paintings and “gestural abstraction.” Troubled Queen in 1945 is considered Pollock’s masterful transitional work from the regionalist figurative paintings of his early years to the passionate “drip paintings” for which he is best known. As stated by Elliot Bostwick Davis et al (mfashop.com/9020398034), “As Troubled Queen shows, Pollock had begun to work in a very large scale by this time; his paint was dragged over, dripped on, and flung at the canvas. His subject matter was no less highly wrought: emerging from the churning coils and jagged lines of this life-sized canvas are two facelike forms, one a leering mask, the other a one-eyed diamond shape. Their nightmarish presences reflect not only Pollock’s agitated psyche but also the years of violence that had torn the world apart through war.” Thus, Troubled Queen shows that Pollock included images in his painting prior to his “drip paintings,” rendering it feasible that he continued to include images in his “drip paintings” using that new technique. We have coined the term “Polloglyphs TM” to name the images that are encrypted in his “drip paintings” and that tell a story about Pollock’s inner being, camouflaged yet hiding in plain sight.

Here, in order to establish the basis for Polloglyphs in his later “drip paintings,” we have deconstructed the multiple images in Troubled Queen by first showing the image on a white background and then transposing it upon the painting. In this way, the observer can begin to see how images were incorporated into Pollock’s pre-drip paintings. These are not Rorschach ink blots with fractal edges that are fooling the eyes and only in the mind of the viewer, but images purposely put on canvas as the observer can see. Clearly, there is a “troubled queen” in Troubled Queen. Beyond that there are images of war possibly inspired by Picasso’s famous Guernica painted in 1937 and first seen by Pollock in 1939. A character is also seen to her left. Pollock had a trick that can be used to better visualize and uncover his images by rotating this painting 90 degrees counterclockwise. In this case, a small angel of mercy with her sword can be seen in the upper left quadrant. Another character, possibly a soldier with a hatchet and gun with bullet in the barrel can also be seen. Several other images can also be deciphered including a Picasso-like rooster and many others. Together, these images suggest a theme of war during the midst of World War II and may have triggered Pollock’s long standing feelings of inadequacy as his psychiatrist and his draft board found him unfit to serve as a soldier and he was exempted from serving. We encourage the observer to look carefully at Troubled Queen and to develop an opinion on which if any of the images are seen and to ponder as well what they may mean.

Funding

No Funding
IDgenetix-Guided Medication Management for Major Depressive Disorder: Confirmation of Randomized Controlled Trial Outcomes by Real-World Evidence
Authors: Cao Feng , Hanson Andrea , Cook Robert
Published: January 2025

Introduction

IDgenetix is an advanced multi-gene pharmacogenomic (PGx) test that incorporates drug-gene interactions, drug-drug interactions, and lifestyle factors to guide medication management for patients diagnosed with major depressive disorder (MDD), anxiety, or other mental illnesses. In a previously published randomized controlled trial (RCT), IDgenetix significantly improved patient response and remission rates (Bradley et al., 2018). In this analysis, we aimed to compare the clinical outcome results from the RCT with real-world evidence from an open-label study (Cao et al., 2023).

Methods

Subjects with moderate to severe MDD at baseline per their HAM-D17 or PHQ-9 scores were included in the analysis for the RCT (n=261) and real-world data (n=242). In both studies, 8-week response and remission rates were analyzed for patients using IDgenetix-guided medication management (Guided) compared to patients receiving standard of care (Unguided).

Results

Patient response and remission rates strongly aligned between both studies. Response rates for the IDgenetix-guided participants in the RCT were 49% compared to 58% in the real-world data. Remission rates in the Guided group were 31% in both the RCT and real-world study compared to 22% and 19%, respectively, for participants in the Unguided group.

Conclusions

Comparing the clinical outcome results from the RCT with real-world data demonstrated the consistent impact of IDgenetix on patient response and remission rates. This study provides robust evidence-based research that supports the clinical use of IDgenetix to guide medication management in patients with MDD.

Funding

Castle Biosciences (Friendswood, TX)
Centanafadine Sustained Release Is Efficacious in Patients with Adult ADHD, Regardless of Their Treatment History
Authors: Mattingly Greg , Cutler Andrew J , Zhang Zhen , Ward Caroline , McDonough Jessica
Published: January 2025

Introduction

Centanafadine (CTN) is a potential first-in-class norepinephrine/dopamine/serotonin triple reuptake inhibitor (NDSRI) that has demonstrated efficacy, safety, and tolerability vs placebo (PBO) in adults with ADHD in 2 pivotal phase 3 trials (Adler LA, et al. J Clin Psychopharmacol. 2022;42:429-39).

Methods

Pooled data from 2 double-blind, multicenter, PBO-controlled trials enrolling adults (18–55 years) meeting DSM-5 ADHD criteria were analyzed. Patients were randomized 1:1:1 to CTN sustained release (SR) 200 mg or 400 mg total daily dose (TDD) or matching PBO if Adult ADHD Investigator Symptom Rating Scale (AISRS) score was ≥28 at screening (if not receiving pharmacologic ADHD treatment) or ≥22 at screening and ≥28 at baseline (if receiving treatment). Having had no prior benefit from ≥2 ADHD therapies of different classes, use of prohibited medications, and positive alcohol/drug screens were exclusionary. Studies had 4 periods: (1) screening and washout (≤28 days), (2) single-blind PBO run-in (1 week), (3) double-blind treatment (6 weeks), and (4) follow-up (10 days after last dose). Patients with ≥30% Adult ADHD Self-report Scale (ASRS) improvement from start to end of screening were screen failures; those with ≥30% ASRS improvement from start to end of PBO run-in were terminated early. A mixed model for repeated measures analysis evaluated CTN SR vs PBO based on ADHD treatment history; least squares mean (LSM) change from baseline (BL) in AISRS at day 42 was the outcome of interest.

Results

In total, 859 patients were analyzed (CTN SR 200 mg TDD, n=287; 400 mg TDD, n=287; PBO, n=285). LSM change from BL in AISRS score was significant at day 42 for each CTN SR TDD group (both, P<0.001) in the overall population vs PBO. Among patients with prior stimulant/nonstimulant treatment (n=542), LSM change from BL was significant at day 42 vs PBO in the CTN SR 200 mg (P=0.016) and 400 mg (P=0.008) TDD groups. Although cohort size was limited (n=47), LSM change from baseline with CTN SR 400 mg TDD was significant (P<0.05) from days 14 to 42 in those who took 2 prior stimulant/nonstimulant treatments, with P=0.030 at day 42. In those with no prior stimulant/nonstimulant treatment (n=317), LSM change from BL was significant at day 42 for the CTN SR 200 mg (P=0.007) and 400 mg (P=0.008) TDD groups vs PBO. When analyzed by history of any past stimulant use, LSM change from BL was significant at day 42 for CTN 200 mg (n=179; P=0.013) and 400 mg (n=166; P=0.006), with significance (P<0.05) noted at day 7 (200 mg TDD) and at day 21 (400 mg TDD), remaining significant to day 42.

Conclusions

This pooled analysis suggests that CTN SR treatment is efficacious in adults with ADHD, regardless of prior treatments, an encouraging finding given reported adult ADHD treatment patterns.

Study Registration: NCT03605680, NCT03605836

Funding

Otsuka
The Use of Carbamazepine in the Management of Psychogenic Nonepileptic Seizures (PNES)
Authors: Golembeski Gregory , Kalaga Manisha , Said Khaled
Published: January 2025

Psychogenic nonepileptic seizures (PNES) is a conversion disorder subtype that cause motor, sensory, autonomic, and cognitive symptoms that superficially resemble ictal epileptiform activity but without the electroencephalographic (EEG) activity that defines epilepsy. While 10-20% of patients referred to epilepsy centers are estimated to have PNES (1), diagnosing the condition is labor intensive as it requires seizure-like behavior observed during EEG monitoring. However, accurate diagnosis is essential as psychopharmacologic interventions have been shown to have limited utility in reducing seizure-like activity in PNES (2). Instead, case reports and small randomized clinical control trials have shown cognitive behavioral therapy (CBT) effective (3), and it is considered main stay of treatment.

We present the case of a 37-year-old woman who presented to our clinic with symptoms of depression including hypersomnia and anhedonia. Her most distressing symptoms were episodes of abnormal movements and shaking without loss of consciousness. She has a past medical history notable for EEG-confirmed PNES, major depressive disorder with psychotic features, generalized anxiety disorder, clipped-intracranial aneurysm. She had been taking Duloxetine for major depressive disorder and fibromyalgia, and Carbamazepine was initiated to manage abnormal movements and her depressive symptoms. She reported improvement in the frequency and severity of abnormal movements after initiating Carbamazepine. Unfortunately, her depression worsened, and she was admitted to the inpatient unit for suicidal ideation and auditory and visual hallucinations commanding her to end her life. She was initiated on Aripiprazole. She was admitted for four days and was discharged after she demonstrated improvement in mood and severity of auditory hallucinations.

Funding

No Funding