bluuebunny/crossref_metadata_2025 huggingface dataset:
16. Compensatory remedies
Authors: Arvind TT
Published: August 2019

This chapter considers compensatory damages, the primary remedy for breach of contract which an affected party can seek in English law. It first examines how the courts assess and award damages based on two approaches: expectation interest and reliance interest. In particular, it looks at the various measures of damages such as the loss of profit measure, the ‘cost of cure’ and ‘difference in value’ measures, loss of amenity and disappointed expectations, and the loss of chance measure. The chapter also discusses the various ways in which compensatory remedies can be limited in law by focusing on the principles of causation, mitigation, and remoteness. Finally, it evaluates the role damages play in contract law and suggests that English law gives the parties a good deal of freedom to design remedies, which parties can use when designing contracts.
18. Privity and third parties
Authors: Arvind TT
Published: August 2019

This chapter examines how English law, through a doctrine known as privity of contract, deals with the problem posed by contracts whose performance involves third parties. According to the doctrine of privity, a contract ordinarily only affects persons who are party to it. Third parties are neither bound by the contract nor entitled to claim rights under the contract. However, the courts and Parliament developed a number of exceptions to the strict rule of privity, each of which gives third parties a right to sue under the contract in a certain type of situation. For example, the Contracts (Rights of Third Parties) Act 1999 gives third party beneficiaries a right to enforce contract terms. This chapter first considers the problem of third party rights in contracting before discussing the effects of privity and the provisions of the Contracts (Rights of Third Parties) Act 1999 in more detail.
1. Introduction
Authors: Horsey Kirsty , Rackley Erika
Published: August 2019

This introductory chapter begins with a definition of tort law and the interests that tort law protects. To say that the law of tort protects an individual’s rights or interests does not mean that a claimant will succeed simply by showing that the defendant harmed them or infringed their rights. Tort law lays down a set of rules stating when exactly a harm or infringement of one’s interest will give rise to legal liability. The chapter discusses the disparate functions of tort law and illustrates them through the case of Woodroffe-Hedley v Cuthbertson [1997]. The chapter then explains the significance of the Human Rights Act 1998 for tort law.
5. Special duty problems: psychiatric harm
Authors: Horsey Kirsty , Rackley Erika
Published: August 2019

This chapter begins by explaining the meaning of psychiatric harm. It then discusses the general exclusionary rule; the distinction between ‘primary’ and ‘secondary’ victims; and other circumstances where the law recognises victims of psychiatric harms as having a claim in negligence (rescuers, involuntary participants, communicators of shocking news, self-harm by the defendant and ‘assumption of responsibility’ cases). Though initially psychiatric harm was recoverable only if accompanied by physical injury, it is now clear that the claimant can recover for pure psychiatric harm so long as it is a recognised psychiatric illness. It is not, therefore, possible to recover in the tort of negligence for mere grief, anxiety or distress.
8. Breach of duty: the standard of care
Authors: Horsey Kirsty , Rackley Erika
Published: August 2019

This chapter focuses on the second of the requirements necessary to establish a claim in the tort of negligence—breach of duty. Breach occurs where a defendant has fallen below the particular standard of care demanded by the law. This is largely an objective test and is determined by comparing the actions of the defendant to those imagined to be done in the same circumstances by the so-called ‘reasonable man’. The questions to be answered are how the defendant ought to have behaved (what was the required standard of care) and how the defendant did behave (did they in fact fall below that standard).
13. Employers’ liability
Authors: Horsey Kirsty , Rackley Erika
Published: August 2019

This chapter discusses employers’ liability and, in particular, the non-delegable duty of care, which employers owe to their employees to ensure that they are reasonably safe when at work. The duty ensures that an employer remains responsible for key tasks even when their obligations have been delegated to another. The duty of care is typically said to have four components (building on Lord Wright’s statement in Wilsons & Clyde Coal Co Ltd [1938]) comprising the provision of: a competent workforce; adequate material and equipment; a safe system of working (including effective supervision); and a safe workplace.
16. Invasion of privacy
Authors: Horsey Kirsty , Rackley Erika
Published: August 2019

This chapter examines the nascent ‘tort’ of invasion of privacy. It first considers why no free-standing tort of invasion of privacy exists, before looking at breach of confidence—a legal concept straddling tort and equity and concerned with ‘secrets’ and judicially adapted to protect privacy by developing the new tort of misuse of private information. The chapter then asks whether developments in the law protecting privacy—particularly in the wake of the Human Rights Act 1998—threaten freedom of expression and therefore the general public’s ‘right’ to information, particularly about celebrities, including royalty and politicians.
19. Actions under the rule of Rylands v Fletcher
Authors: Horsey Kirsty , Rackley Erika
Published: August 2019

This chapter examines the rule from Rylands v Fletcher [1868]. The rule holds that where there has been an escape of a dangerous thing in the course of a non-natural use of land, the occupier of that land is liable for the damage to another caused as a result of the escape, irrespective of fault. The rule today is best understood through a trilogy of cases: Rylands v Fletcher, Cambridge Water Co Ltd v Eastern Counties Leather plc [1994] and Transco v Stockport Metropolitan Borough Council [2004]. The development of the rule has led to an increased overlap with ideas from nuisance and negligence.
20. Vicarious liability
Authors: Horsey Kirsty , Rackley Erika
Published: August 2019

This chapter examines the principle of vicarious liability, a form of secondary liability through which employers may, in certain circumstances, be liable for the torts of their employees, even though the employer themselves may be entirely blameless. The imposition of vicarious liability is one of the most important exceptions to the general approach of the common law whereby liability for any wrongdoing is imposed on, and only on, the wrongdoer(s). A defendant will not be vicariously liable unless the following conditions are met: (a) there is an employer–employee relationship between the defendant and the person for whose actions they are being held liable; (b) the employee committed the tortious act while acting in the course of their employment.
1. Relevance and admissibility of evidence
Authors: Munday Roderick
Published: August 2019

Titles in the Core Text series take the reader straight to the heart of the subject, providing focused, concise, and reliable guides for students at all levels. The law of evidence regulates what evidence may be admitted at trial and under what conditions such admissible proofs are to be admitted. This chapter discusses the following: the respective functions of judge and jury; the concept of relevance; the so-called ‘best evidence principle’; matters of which proof is unnecessary; judicial findings as evidence; prejudicial evidence, unfairly obtained evidence, and suspect witnesses; and evidence excluded as a matter of public policy.
3. Witnesses: competence, compellability, and various privileges
Authors: Munday Roderick
Published: August 2019

Titles in the Core Text series take the reader straight to the heart of the subject, providing focused, concise, and reliable guides for students at all levels. This chapter discusses the following: the competence of witnesses in civil and criminal cases; the compellability of witnesses, and of the accused and the spouse or civil partner in criminal cases in particular; sworn and unsworn evidence; privileges enjoyed by certain categories of witness, focussing upon the privilege against self-incrimination, and legal professional privilege (in the form of both legal advice privilege and litigation privilege); and public interest immunity.
5. Witnesses’ previous consistent statements and the remnants of the rule against narrative
Authors: Munday Roderick
Published: August 2019

Titles in the Core Text series take the reader straight to the heart of the subject, providing focused, concise, and reliable guides for students at all levels. This chapter discusses the following: the rule against narrative that excludes evidence of previous consistent statements; the five exceptions to the rule against narrative; evidence of distress; the eventual introduction of evidence-in-chief delivered by video recording (Criminal Justice Act 2003, s 137); statements made by the accused when first taxed with incriminating facts; and statements made by the accused when incriminating articles are recovered.
Immunogenicity of High Dose Influenza Vaccine for Patients with Inflammatory Bowel Disease on Anti-TNF Monotherapy: A Randomized Clinical Trial
Authors: Caldera Freddy , Hillman Luke , Saha Sumona , Wald Arnold , Grimes Ian , Zhang Youqi , Sharpe Abigail R , Reichelderfer Mark , Hayney Mary S
Published: August 2019

Background

Patients with inflammatory bowel disease (IBD) on anti-tumor necrosis factor alpha (TNF) agents may have lower immune response to the influenza vaccine. We aimed to evaluate the immunogenicity of the high dose (HD) vs standard dose (SD) influenza vaccine in patients with IBD on anti-TNF monotherapy.

Methods

We performed a randomized clinical trial at a single academic center evaluating the immunogenicity of the HD vs SD influenza vaccine in patients with IBD on anti-TNF monotherapy. Influenza antibody concentration was measured at immunization, at 2 to 4 weeks postimmunization, and at 6 months.

Results

Sixty-nine patients with IBD were recruited into the study, 40 on anti-TNF monotherapy, and 19 on vedolizumab, along with 20 healthy controls (HC). Patients with IBD receiving the HD influenza vaccine had significantly higher H3N2 postimmunization antibodies compared with those who received the SD influenza vaccine (160 [interquartile range 80 to 320] vs 80 [interquartile range 40 to 160]; P = 0.003). The H1N1 postimmunization levels were not significantly higher in the HD influenza vaccine (320 [interquartile range 150 to 320] vs 160 [interquartile range 80 to 320]; P = 0.18). Patients with IBD receiving the HD influenza vaccine and those on vedolizumab who received SD had equivalent antibody concentrations to HC (H1N1 P = 0.85; H3N2 P = 0.23; B/Victoria P = 0.20 and H1N1 P = 0.46; H3N2 P = 0.21; B/Victoria P = 1.00, respectively).

Conclusions

Patients with IBD on anti-TNF monotherapy receiving the HD influenza vaccine had significantly higher postimmunization antibody levels compared with SD vaccine. Clinicaltrials.gov (#NCT02461758).
King tuna: Indian Ocean trade, offshore fishing, and coral reef resilience in the Maldives archipelago
Authors: Yadav Shreya , Abdulla Ameer , Bertz Ned , Mawyer Alexander
Published: August 2019

The traditional offshore pole-and-line tuna fishery of the Maldives has historically promoted low levels of reef fishing in this archipelago. While the tuna fishery is old and extensive—some evidence suggests it has been in place for over a thousand years—the reasons for its development have not been closely examined. Why did an offshore fishery develop in such small and isolated islands with abundant and easily accessible nearshore reefs? Why is tuna considered the “king of fish” in the Maldives, in contrast to many other islands across the globe where reef fish are prized for a wide variety of cultural and social reasons, often deeply rooted in community histories? In this article, we use a historical approach to uncover some of the drivers of this fishery, and the long-term consequences it has had for the resilience of this island chain. We trace the written accounts of travellers, voyagers, and traders, in addition to more recent research to gain an understanding of how early Indian Ocean trade networks may have shaped the development of this fishery over time. We propose that the early growth of the tuna fishery was likely tied to the trade in money cowries (Monetaria moneta), of which the Maldives was a major global supplier. A regional demand and market for dried tuna from the fourteenth century onwards contributed to the income of Maldivians and promoted and supported reef health by encouraging relatively low levels of reef fishing. However, the emergence and substantial growth of the Maldivian tourist industry in the past few decades are resulting in a shift in local consumption preferences and increased exploitation of reef fisheries. Exploring this history is important, not only to help contextualize the modern governance of the offshore tuna fishery, but also for a more nuanced understanding of the social, cultural, and ecological dynamics that have shaped Maldivian coral reefs in the past with implications for those that will do so in the future.
Riding the Shi: From Infection Barriers to the Microbial City
Authors: Voelkner Nadine
Published: August 2019

How can a microbial approach to global health security protect life? Contemporary infection control mechanisms set the human and the pathogenic microbe against each other, as the victim versus the menace. This biomedical polarization persistently runs through the contemporary dominant mode of thinking about public health and infectious disease governance. Taking its cue from the currently accepted germ theory of disease, such mechanisms render a global city like Hong Kong not only pervasively “on alert” and under threat of unpredictable and pathogenic viruses and other microbes, it also gives rise to a hygiene and antimicrobial politics that is never entirely able to control pathogenic circulation. The article draws on recent advances in medical microbiology, which depart from germ theory, to invoke an ecological understanding of the human-microbe relation. Here, while a small number of viruses are pathogenic, the majority are benign; some are even essential to human life. Disease is not just the outcome of a pathogenic microbe infecting a human host but emerges from socioeconomic relations, which exacerbate human-animal-microbial interactions. In a final step, the article draws on Daoist thought to reflect on the ways that such a microbial understanding translates into life and city dwelling.
Challenges to I-125 Seed Localization of Metastatic Axillary Lymph Nodes Following Neoadjuvant Chemotherapy
Authors: Hyde Brenda , Geske Jennifer , Lee Christine
Published: August 2019

Objective

The objective of this retrospective study is to characterize challenges with ultrasound (US)-guided localization of clipped metastatic axillary lymph nodes after neoadjuvant chemotherapy.

Methods

After institutional review board approval, our radiology database was searched for all radioactive seed localizations (RSLs), which use a low-dose radioactive isotope, Iodine-125, performed for clipped axillary lymph nodes between January 1, 2016, and December 31, 2018. The details of each procedure were reviewed. RSL was defined to be successful if US-guidance was used, and postlocalization imaging showed the seed was no more than 1 cm away from the target. Cause and subsequent management of unsuccessful localizations were documented.

Results

During the study period, 139 clipped axillary lymph nodes (in 138 women and 1 man) were scheduled for preoperative RSL. The overall success rate of RSL was 106/139 (76%). The number of unsuccessful localizations was 10/37 (27%) in 2016, 7/39 (18%) in 2017, and 16/63 (25%) in 2018, with a total unsuccessful case frequency of 33/139 (24%) over the entire study period. The mean time interval between marker placement and localization was 6.0 months (range 0.4–18.1 months). The coil biopsy marker was the most frequently used marker.

Conclusions

Preoperative US-guided I-125 seed localization of clipped metastatic axillary lymph nodes is suboptimal or unsuccessful 24% of the time. Other options for non-US imaging-guided localizations, such as tomosynthesis, are available for consideration when US detection is unsuccessful.
JEEA-FBBVA LECTURE 2017: The Dynamics of Environmental Politics and Values
Authors: Besley Timothy , Persson Torsten
Published: August 2019

This paper develops a framework to study environmentalism as a cultural phenomenon, namely as reflecting a process of social identification with certain values. The model is used to explain how the shares of environmentalists and materialists in society can coevolve with taxes on emissions to protect society against damages caused by environmental degradation. These policies are determined by electoral competition. However, even though politicians internalize the welfare of those currently alive and pick utilitarian optimal policies, the dynamic equilibrium paths of policies and evolving values may not converge to the steady state with the highest level of long-run welfare.
An Autopsy Case of Preclinical/Early Clinical Pick Disease
Authors: Okada Keitaro , Hata Yukiko , Takayanagi Yoichiro , Takahashi Tsutomu , Takayanagi Isao , Nishida Naoki
Published: August 2019

Here, we report a 74-year-old woman with a long history of schizophrenia but no clinical manifestation of dementia. Cause of death after autopsy was atherosclerotic heart disease. Although neuropathological investigation showed no significant brain atrophy, superficial microvacuolation with neuronal loss was restrictedly detected in the right anterior cingulate gyrus by microscopic examination. Pick bodies (PBs) positive for Bodian and Bielshowsky staining and 3-repeat-tau were detected in frontal and temporal lobes and limbic regions. Prevalence of PBs was most frequent in the right anterior cingulate gyrus and lateral base, followed by other neocortical regions of the frontal lobe, amygdala, and granular layer of the hippocampus. Although the number of glial inclusions was low, ramified astrocytes and various forms of astrocytes with AT8-positive inclusions were also found. Thus, the case may reflect preclinical or very early clinical Pick disease. Distribution of PBs does not necessarily have to be consistent with previously reported preclinical/early clinical Pick disease. These results show that tau pathology in the earlier stage of Pick disease may be heterogeneous, and the anterior cingulate gyrus may be initially affected in Pick disease. Neuropathological examination, including immunohistochemistry without case selection, is useful in identifying clinical and pathological manifestations of Pick disease.
The effect of heteroatoms in carbonaceous surfaces: computational analysis of H chemisorption on to a PANH and Si-doped PAH
Authors: Barrales-Martínez César , Gutiérrez-Oliva Soledad
Published: August 2019

In this work, we studied the effect of a heteroatom (nitrogen and silicon) inside the main skeleton of the carbonaceous surface in the H chemisorption reaction. The process taking place on to an N-doped polycyclic aromatic hydrocarbon (PAH), known as PANHs, shows differences in the energetic parameters only when the process is carried out on to the N atom. When N is located in an external site of the surface, the process is barrierless, whereas if N is in an internal position of the surface the activation energy drastically increases. The aromaticity of these N-doped systems does not change much concerning pristine coronene. In a Si-doped PAHs, the chemisorption on to the Si atom takes place in the absence of activation energy, regardless the position of Si on the surface. Moreover, the adsorption on to their neighbour carbon atoms is carried out with lower activation energies than those found in the reaction on to pristine PAH, indicating that the presence of silicon atoms in the surface favours H chemisorption. This might be due to a loss of aromaticity on the surface. In both cases, the reactions become significantly more exoenergetic. Finally, the presence of heteroatoms favours kinetically the reaction, where the rate coefficient of H2 formation process, calculated considering all of the sites of every PAH studied in this work, reaches a close value to the reported for diffuse interstellar medium and photodissociation regions ($R_{_{\mathrm{ H}\mathrm{ }_2}} = 1 \times 10^{-17}$ cm3 s−1 at 40 K).
Retrospective Review of Immediate Restoration of Lordosis in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison of Static and Expandable Interbody Cages
Authors: Vaishnav Avani S , Saville Philip , McAnany Steven , Kirnaz Sertac , Wipplinger Christoph , Navarro-Ramirez Rodrigo , Hartl Roger , Yang Jingyan , Gang Catherine Himo , Qureshi Sheeraz A
Published: August 2019

BACKGROUND

Sagittal alignment is an important consideration in spine surgery. The literature is conflicted regarding the effect of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) on sagittal parameters and the role of expandable cage technology.

OBJECTIVE

To compare lordosis generated by static and expandable cages and to determine what factors affect postoperative sagittal parameters.

METHODS

Preoperative regional lordosis (RL), segmental lordosis (SL), and posterior disc height (PDH) were compared to postoperative values in single-level MI-TLIF performed using expandable or static cages. Patients were stratified based on preoperative SL: low lordosis (<15 degrees), moderate lordosis (15-25 degrees), and high lordosis (>25 degrees). Regression analyses were conducted to determine factors associated with postoperative SL and PDH.

RESULTS

Of the 171 patients included, 111 were in the static and 60 in the expandable cohorts. Patients with low preoperative lordosis experienced an increase in SL and maintained RL regardless of cage type. Those with moderate to high preoperative lordosis experienced a decrease in SL and RL with the static cage, but maintained SL and RL with the expandable cage. Although both cohorts showed an increase in PDH, the increase in the expandable cohort was greater. Preoperative SL was predictive of postoperative SL; preoperative SL, preoperative PDH, and cage type were predictive of postoperative PDH.

CONCLUSION

Expandable cages showed favorable results in restoring disc height and maintaining lordosis in the immediate postoperative period. Preoperative SL was the most significant predictor of postoperative SL. Thus, preoperative radiographic parameters and goals of surgery should be important considerations in surgical planning.
Does Mixotrophy in ciliates compensate for poor-quality prey? Experiments with heterotrophic–mixotrophic species pairs
Authors: Wickham Stephen A , Wimmer Romana
Published: August 2019

Fatty acid and sterol profiles play a large role in determining the food quality of prey in aquatic food webs. Ciliates have limited ability to synthesize essential polyunsaturated fatty acids (PUFA) and sterols, and must obtain these from their food. Many mixotrophic ciliates, however, are in a symbiosis with Chlorella, and this may compensate for prey that is low in PUFA and sterols. Moreover, when PUFA-rich prey are P-limited, mixotrophs may be less dependent than heterotrophs on having the optimal mixture of PUFA-rich and P-rich prey. To test these hypotheses, experiments were conducted using heterotrophic-mixotrophic species pairs and prey mixes with varying proportions of good and poor quality prey. Prey proportions had clear effects on ciliate growth rates, often with a clear threshold. In only one species, however, did mixotrophy appeared to be advantageous, with growth independent of the proportion of PUFA-rich prey. In the other two species pairs, mixotrophy gave at best a small advantage over heterotrophy when there was a large proportion of PUFA-poor prey, independent of whether the PUFA-rich prey was P-limited or P-replete. While PUFA- and sterol-rich prey are important for heterotrophic ciliates, mixotrophy cannot be universally employed as an alternate source of these required nutrients.
Helping Pregnant Women and Clinicians Understand the Risk of Ondansetron for Nausea and Vomiting During Pregnancy
Authors: Haas D.M.
Published: August 2019

(JAMA. 2018;320 (23):2425–2426)

Nausea and vomiting during the first trimester of pregnancy is often unresponsive to conservative treatment and commonly requires antiemetic pharmacotherapy. First line agents, as per the American College of Obstetricians and Gynecologists’ treatment algorithm, are pyridoxine, alone or in combination with doxylamine. However, while the safety of pyridoxine has been well established, there remain concerns regarding potential effects of other antiemetic drugs on fetal development. In particular, the study by Huybrechts et al addressed concerns about potential associations between ondansetron, a serotonin receptor agonist and third-line agent, and fetal congenital malformations. The study found no significant associations between ondansetron and cardiac abnormalities [adjusted risk difference (aRR), −0.8; 95% confidence interval (CI), 0.92-1.06] and overall congenital anomalies. A small but significantly increased risk of oral clefts with first-trimester exposure to ondansetron was found (aRR, 1.24; 95% CI, 1.03-4.08).
Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial
Authors: Abdelaal Ahmed Mahmoud A. , Mansour A.Z. , Yassin H.M. , Hussein H.A. , Kamal A.M. , Elayashy M. , Elemady M.F. , Elkady H.W. , Mahmoud H.E. , Cusack B. , Hosny H. , Abdelhaq M.
Published: August 2019

(Anesth Analg. 2018;127(6):1434–1439)

Postdural puncture headache (PDPH), with the postulated etiology of meningeal traction from low cerebrospinal fluid (CSF) pressure or cerebral vasodilation, is often treated with an epidural blood patch (EBP). A patient with a PDPH received neostigmine and atropine for management of postoperative ileus. Interestingly, her PDPH also resolved with this medication. This case resulted in the authors conducting a randomized controlled trial to study the efficacy of neostigmine and atropine in the management of PDPH.
The Elements of a Nursing Malpractice Case, Part 2: Breach
Authors: Brous Edie
Published: August 2019

Nurses must show that their actions conformed with acceptable standards of practice.
Paracetamol is ineffective for acute low back pain even for patients who comply with treatment: complier average causal effect analysis of a randomized controlled trial
Authors: Schreijenberg Marco , Lin Chung-Wei Christine , Mclachlan Andrew J. , Williams Christopher M. , Kamper Steven J. , Koes Bart W. , Maher Christopher G. , Billot Laurent
Published: August 2019

In 2014, the Paracetamol for Acute Low Back Pain (PACE) trial demonstrated that paracetamol had no effect compared with placebo in acute low back pain (LBP). However, noncompliance was a potential limitation of this trial. The aim of this study was to investigate the efficacy of paracetamol in acute LBP among compliers. Using individual participant data from the PACE trial (ACTN12609000966291), complier average causal effect (CACE), intention-to-treat, and per protocol estimates were calculated for pain intensity (primary), disability, global rating of symptom change, and function (all secondary) after 2 weeks of follow-up. Compliance was defined as intake of an average of at least 4 of the prescribed 6 tablets of regular paracetamol per day (2660 mg in total) during the first 2 weeks after enrolment. Exploratory analyses using alternative time points and definitions of compliance were conducted. Mean between-group differences in pain intensity on a 0 to 10 scale using the primary time point and definition of compliance were not clinically relevant (propensity-weighted CACE 0.07 [−0.37 to 0.50] P = 0.76; joint modelling CACE 0.23 [−0.16 to 0.62] P = 0.24; intention-to-treat 0.11 [−0.20 to 0.42] P = 0.49; per protocol 0.29 [−0.07 to 0.65] P = 0.12); results for secondary outcomes and for exploratory analyses were similar. Paracetamol is ineffective for acute LBP even for patients who comply with treatment. This reinforces the notion that management of acute LBP should focus on providing patients advice and reassurance without the addition of paracetamol.
Auxiliary Kirschner wire technique in the closed reduction of children with Gartland Type III Supracondylar humerus fractures
Authors: Dong Liangchao , Wang Yichen , Qi Muyu , Wang Sun , Ying Hao , Shen Yang
Published: August 2019

This study aimed to investigate the effect of auxiliary Kirschner wire (K-wire) technique in the closed reduction of children with Gartland type III supracondylar humerus fractures by comparing with manual reduction alone.

Retrospective analysis was performed on the clinical data of 68 cases of supracondylar humerus fractures. Thirty-six patients received closed reduction and percutaneous fixation with auxiliary K-wire technique (group A). Thirty-two patients received conventional manual reduction and percutaneous pin fixation (Group B).

In group A, the average operation time was 20.5 ± 8.5 minutes, the average frequency of intraoperative radiographic observations was 4.3 ± 1.1, the average fracture healing time was 6.2 ± 1.8 weeks, and the complication rate was 3/36, 8.3%. The mean operation time was 36.1 ± 10.2 minutes, the average frequency of intraoperative radiography was 8.9 + 1.7 times, the average fracture healing time was (6.1 ± 1.6) weeks, and the complication rate was 2/32, 6.3%. The operation time in group A was significantly shorter than that in group B. The difference between the 2 groups was statistically significant (P = .012). The frequency of radiography in group A was significantly less than that in group B (P = .001).

Compared with manual reduction, auxiliary K-wire technology can significantly shorten the operation time, reduce the radiant quantity of the surgeon, improve the efficiency of closed reduction of children with Gartland type III supracondylar humerus fractures, and reduce the risk of developing postoperative complications. And meanwhile, there is no significant effect on the imaging and functional outcomes of affected extremities, which is worthy of respect.
Impact of diagnostic bone biopsies on the management of non-vertebral osteomyelitis
Authors: Hirschfeld Cole B. , Kapadia Shashi N. , Bryan Joanna , Jannat-Khah Deanna P. , May Benjamin , Vielemeyer Ole , Esquivel Ernie L.
Published: August 2019

Optimal antibiotic management of patients with osteomyelitis remains a challenge for many clinicians. Although image-guided bone biopsy (IGB) remains the gold standard, its role in confirming diagnosis and guiding antibiotic management is not clear in patients with non-vertebral osteomyelitis.

To determine the diagnostic yield of IGB and its impact on antibiotic management in non-vertebral osteomyelitis.

Retrospective cohort study.

Urban academic medical center.

Patients admitted for non-vertebral osteomyelitis who underwent image-guided bone biopsy.

Primary outcomes were microbiologic and histopathological results. We evaluated the impact of IGB on clinician-initiated changes in antibiotic regimen before and after biopsy.

We evaluated 203 bone biopsies in 185 patients with clinical suspicion of osteomyelitis. 79% of patient received antibiotics prior to biopsy. Bone cultures were positive in 28% and histopathology confirmed osteomyelitis in 29%, but concordance was poor. Furthermore, clinical suspicion of infection was much higher, given that 68% received empiric antibiotics. Leukocytosis was significantly associated with positive cultures in multivariate analysis. There was no statistically significant correlation between antibiotic management and bone culture results. When culture yielded an organism, empiric regimens were kept the same, broadened or narrowed with equal frequency; targeted regimens were chosen only in 4 cases. Despite negative cultures in 98/138 cases having received empiric treatment, antibiotics were discontinued in only 8 cases. Even when empiric treatment was not given, negative cultures did not dissuade clinicians from eventual antibiotic use in a significant number of cases (17/48). In 46/71 patients whose final regimen included vancomycin, there was no evidence of current or past infection with MRSA.

In patients with non-vertebral osteomyelitis, the diagnostic yield of image-guided bone biopsy is low, and clinicians frequently make decisions regarding antibiotic management that are not aligned with culture results.
Validation of the mortality in emergency department sepsis (MEDS) score in a Singaporean cohort
Authors: Pong Jeremy Zhenwen , Koh Zhi Xiong , Samsudin Mas’uud Ibnu , Fook-Chong Stephanie , Liu Nan , Ong Marcus Eng Hock
Published: August 2019

The emergency department (ED) serves as the first point of hospital contact for most septic patients. Early mortality risk stratification using a quick and accurate triage tool would have great value in guiding management. The mortality in emergency department sepsis (MEDS) score was developed to risk stratify patients presenting to the ED with suspected sepsis, and its performance in the literature has been promising. We report in this study the first utilization of the MEDS score in a Singaporean cohort.

In this retrospective observational cohort study, adult patients presenting to the ED with suspected sepsis and fulfilling systemic inflammatory response syndrome (SIRS) criteria were recruited. Primary outcome was 30-day in-hospital mortality (IHM) and secondary outcome was 72-hour mortality. MEDS, acute physiology and chronic health evaluation II (APACHE II), and sequential organ failure assessment (SOFA) scores were compared for prediction of primary and secondary outcomes. Receiver operating characteristic (ROC) analysis was conducted to compare predictive performance.

Of the 249 patients included in the study, 46 patients (18.5%) met 30-day IHM. MEDS score achieved an area under the ROC curve (AUC) of 0.87 (95% confidence interval [CI], 0.82–0.93), outperforming the APACHE II score (0.77, 95% CI 0.69–0.85) and SOFA score (0.78, 95% CI 0.71–0.85). On secondary analysis, MEDS score was superior to both APACHE II and SOFA scores in predicting 72-hour mortality, with AUC of 0.88 (95% CI 0.82–0.95), 0.81 (95% CI 0.72–0.89), and 0.79 (95% CI 0.71–0.87), respectively. In predicting 30-day IHM, MEDS score ≥12, APACHE II score ≥23, and SOFA score ≥5 performed at sensitivities of 76.1%, 67.4%, and 76.1%, and specificities of 83.3%, 73.9%, and 65.0%, respectively.

The MEDS score performed well in its ability for mortality risk stratification in a Singaporean ED cohort.
Influence of angiotensin-converting enzyme inhibition on reversibility of alterations in arterial wall and cognitive performance associated with early hypertension
Authors: Csikai Enikő , Andrejkovics Mónika , Balajthy-Hidegh Bernadett , Hofgárt Gergely , Kardos László , Diószegi Ágnes , Rostás Róbert , Czuriga-Kovács Katalin Réka , Csongrádi Éva , Csiba László
Published: August 2019

The importance of optimal blood pressure control for preventing or reducing the impairment of vascular and cognitive functions is well known. However, the reversibility of early alterations in vascular and cognitive functions through antihypertensive agents is under-investigated. In this study, we evaluated the influence of 3 months of angiotensin-converting enzyme (ACE) inhibition treatment on the morphological and functional arterial wall and cognitive performance changes in 30 newly diagnosed primary hypertensive patients.

Common carotid intima-media thickness (IMT) and brachial artery flow-mediated dilatation (FMD) were detected by ultrasonography. Arterial stiffness indicated by augmentation index (AIx) and pulse wave velocity (PWV) was assessed by arteriography. Cognitive functions were assessed by neuropsychological examination.

The executive function overall score was significantly higher at 3-month follow-up than at baseline (median, 0.233 (IQR, 0.447) vs –0.038 (0.936); P = .001). Three-month ACE inhibition did not produce significant improvement in IMT, FMD, AIx and PWV values. Significant negative associations were revealed between IMT and complex attention (r = –0.598, P = .0008), executive function (r = –0.617, P = .0005), and immediate memory (r = –0.420, P = .026) overall scores at follow-up. AIx had significant negative correlations with complex attention (r = –0.568, P = .001), executive function (r = –0.374, P = .046), and immediate memory (r = –0.507, P = .005). PWV correlated significantly and negatively with complex attention (r = –0.490, P = .007).

Timely and effective antihypertensive therapy with ACE inhibitors has significant beneficial effects on cognitive performance in as few as 3 months. Early ACE inhibition may have an important role in the reversal of initial impairments of cognitive function associated with hypertension-induced vascular alterations.
TRIAD XII: Are Patients Aware of and Agree With DNR or POLST Orders in Their Medical Records
Authors: Mirarchi Ferdinando L. , Juhasz Kristin , Cooney Timothy E. , Puller Justin , Kordes Tammy , Weissert Lynn , Lewis Mary Lynn , Intrieri Brandon , Cook Nathan
Published: August 2019

Objective

The aim of the study was to determine (1) whether do-not-resuscitate (DNR) orders created upon hospital admission or Physician Orders for Life-Sustaining Treatment (POLST) are consistent patient preferences for treatment and (2) patient/health care agent (HCA) awareness and agreement of these orders.

Methods

We identified patients with DNR and/or POLST orders after hospital admission from September 1, 2017, to September 30, 2018, documented demographics, relevant medical information, evaluated frailty, and interviewed the patient and when indicated the HCA.

Results

Of 114 eligible cases, 101 met inclusion criteria. Patients on average were 76 years old, 55% were female, and most white (85%). Physicians (85%) commonly created the orders. A living will was present in the record for 22% of cases and a POLST in 8%. The median frailty score of “4” (interquartile range = 2.5) suggested patients who require minimal assistance. Thirty percent of patients requested cardiopulmonary resuscitation and 63% wanted a trial attempt of aggressive treatment if in improvement is deemed likely. In 25% of the cases, patients/HCAs were unaware of the DNR order, 50% were unsure of their prognosis, and another 40% felt their condition was not terminal. Overall, 44% of the time, the existing DNR, and POLST were discordant with patient wishes and 38% were rescinded. Of the 6% not rescinded, further clarifications were required. Discordant orders were associated with younger, slightly less-frail patients.

Conclusions

Do-not-resuscitate and POLST orders can often be inaccurate, undisclosed, and discordant with patient wishes for medical care. Patient safety and quality initiatives should be adopted to prevent medical errors.
Practical Considerations for APOL1 Genotyping in the Living Kidney Donor Evaluation
Authors: Mena-Gutierrez Alejandra M. , Reeves-Daniel Amber M. , Jay Colleen L. , Freedman Barry I.
Published: August 2019

Background.

Association between the apolipoprotein L1 gene (APOL1) and nephropathy has altered the epidemiology of chronic kidney disease. In addition, donor APOL1 genotypes play important roles in the time to allograft failure in kidneys transplanted from deceased donors and the safety of living kidney donation.

Methods.

This article reviews genetic testing for inherited kidney disease in living kidney donors to improve donor safety. APOL1 genotyping in donors with recent African ancestry is considered.

Results.

Based on current data, transplant physicians should discuss APOL1 genotyping with potential living kidney donors self-reporting recent African ancestry. Until results from APOL1 Long-term Kidney Transplant Outcomes Network ancillary studies are available, we present practical approaches from our experience for considering APOL1 genotyping in the living donor evaluation.

Conclusions.

Transplant physicians should inform potential living kidney donors at risk for APOL1-associated nephropathy about the gene and possibility of genetic testing early in the donor evaluation, well before scheduling the donor nephrectomy. Transplant programs must weigh risks of performing a donor nephrectomy in those with 2 APOL1 renal risk variants (high-risk genotypes), particularly younger individuals. Our program counsels kidney donors with APOL1 high-risk genotypes in the same fashion as with risk genotypes in other nephropathy genes. Because most African American kidney donor candidates lacking hypertension, proteinuria and reduced kidney function after workup will not possess APOL1 high-risk genotypes, genetic testing is unlikely to markedly increase donor declines and may reassure donors with regard to their long-term kidney outcomes, potentially increasing the number of African American donors.
Gender bias in research teams and the underrepresentation of women in science
Authors: Dakin Roslyn , Ryder T. Brandt
Published: August 2019

Why are females still underrepresented in science? The social factors that affect career choices and trajectories are thought to be important but are poorly understood. We analyzed author gender in a sample of >61,000 scientific articles in the biological sciences to evaluate the factors that shape the formation of research teams. We find that authorship teams are more gender-assorted than expected by chance, with excess homotypic assortment accounting for up to 7% of published articles. One possible mechanism that could explain gender assortment and broader patterns of female representation is that women may focus on different research topics than men (i.e., the “topic preference” hypothesis). An alternative hypothesis is that researchers may consciously or unconsciously prefer to work within same-gender teams (the “gender homophily” hypothesis). Using network analysis, we find no evidence to support the topic preference hypothesis, because the topics of female-authored articles are no more similar to each other than expected within the broader research landscape. Instead, consistent with a model of moderate gender homophily, we find that the prevalence of matched-gender teams increases as a discipline moves towards gender parity. This can occur because latent preferences are more easily fulfilled in a gender-diverse environment. Finally, we show that female authors pay a substantial citation cost to work in gender-matched teams. Notably, the prevalence of homotypic assortment is predicted to increase in the future if more disciplines shift towards gender parity. These data indicate that social preferences can have important downstream consequences for the retention of women and other underrepresented groups in science.
Diffusion of DNA-binding species in the nucleus: A transient anomalous subdiffusion model
Authors: Saxton M. J.
Published: August 2019

Single-particle tracking experiments have measured the distribution of escape times of DNA-binding species diffusing in living cells: CRISPR-Cas9, TetR, and LacI. The observed distribution is a truncated power law. One important property of this distribution is that it is inconsistent with a Gaussian distribution of binding energies. Another is that it leads to transient anomalous subdiffusion, in which diffusion is anomalous at short times and normal at long times, here only mildly anomalous. Monte Carlo simulations are used to characterize the time-dependent diffusion coefficientD(t) in terms of the anomalous exponentα, the crossover timet(cross), and the limitsD(0) andD(∞), and to relate these quantities to the escape time distribution. The simplest interpretations identifSubdiffusion of DNA-binding speciesy the escape time as the actual binding time to DNA, or the period of 1D diffusion on DNA in the standard model combining 1D and 3D search, but a more complicated interpretation may be required. The model has several implications for cell biophysics. (a), The initial anomalous regime represents the search of the DNA-binding species for its target DNA sequence. (b), Non-target DNA sites have a significant effect on search kinetics. False positives in bioinformatic searches of the genome are potentially rate-determining in vivo. For simple binding, the search would be speeded if false-positive sequences were eliminated from the genome. (c), Both binding and obstruction affect diffusion. Obstruction ought to be measured directly, using as the primary probe the DNA-binding species with the binding site inactivated, and eGFP as a calibration standard among laboratories and cell types. (d), Overexpression of the DNA-binding species reduces anomalous subdiffusion because the deepest binding sites are occupied and unavailable. (e), The model provides a coarse-grained phenomenological description of diffusion of a DNA-binding species, useful in larger-scale modeling of kinetics, FCS, and FRAP.

SIGNIFICANCE

DNA-binding proteins such as transcription factors diffuse in the nucleus until they find their biological target and bind to it. A protein may bind to many false-positive sites before it reaches its target, and the search process is a research topic of considerable interest. Experimental results from the Dahan lab show a truncated power law distribution of escape times at these sites. We show by Monte Carlo simulations that this escape time distribution implies that the protein shows transient anomalous subdiffusion, defined as anomalous subdiffusion at short times and normal diffusion at long times. Implications of the model for experiments, controls, and interpretation of experiments are discussed.
SCDC: Bulk Gene Expression Deconvolution by Multiple Single-Cell RNA Sequencing References
Authors: Dong Meichen , Thennavan Aatish , Urrutia Eugene , Li Yun , Perou Charles M. , Zou Fei , Jiang Yuchao
Published: August 2019

Recent advances in single-cell RNA sequencing (scRNA-seq) enable characterization of transcriptomic profiles with single-cell resolution and circumvent averaging artifacts associated with traditional bulk RNA sequencing (RNA-seq) data. Here, we propose SCDC, a deconvolution method for bulk RNA-seq that leverages cell-type specific gene expression profiles from multiple scRNA-seq reference datasets. SCDC adopts an ENSEMBLE method to integrate deconvolution results from different scRNA-seq datasets that are produced in different laboratories and at different times, implicitly addressing the problem of batch-effect confounding. SCDC is benchmarked against existing methods using bothin silicogenerated pseudo-bulk samples and experimentally mixed cell lines, whose known cell-type compositions serve as ground truths. We show that SCDC outperforms existing methods with improved accuracy of cell-type decomposition under both settings. To illustrate how the ENSEMBLE framework performs in complex tissues under different scenarios, we further apply our method to a human pancreatic islet dataset and a mouse mammary gland dataset. SCDC returns results that are more consistent with experimental designs and that reproduce more significant associations between cell-type proportions and measured phenotypes.