bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pentateuch Outside the Pentateuch
Authors: Achenbach Reinhard
Published: May 2021

This essay examines the representation of major pentateuchal traditions (patriarchs, Exodus, law) in non-pentateuchal biblical texts (the Prophets and writings). Some prophetic texts exhibit evidence of interaction with pentateuchal legal material, and there is evidence of Deuteronomistic editing in biblical prophetic materials. Late biblical (e.g. Chronicles, wisdom texts) and other Persian and Hellenistic period texts mark the beginning of interpretive rewritings of both pentateuchal laws and narratives.
The Economics and Politics of Preferential Trade Agreements
Authors: Baccini Leonardo
Published: May 2021

The proliferation of preferential trade agreements (PTAs) is a key feature of this current wave of globalization. This chapter surveys the literature related to determinants of PTAs and their consequences. The key findings of the literature are two-fold. First, the expansion of global value chains is the main driver of the formation of PTAs. Second, PTAs generate stark distributional consequences among firms with large productive firms reaping the lion’s share of the gains from trade. Given that the welfare effect of preferential liberalization is generally small, forming PTAs is likely to remain a controversial trade policy among politicians and voters.
Foreign Aid
Authors: Bermeo Sarah Blodgett
Published: May 2021

This chapter reviews scholarship on the political economy of foreign aid, identifies key gaps in the current literature, and offers suggestions for bridging across dividing lines to advance future research agendas. It highlights potential synergies between the study of foreign aid allocation and aid effectiveness. The analysis draws attention to the need to synthesize across studies of micro-level and macro-level outcomes to understand the full political and economic impacts of aid. Reviewing the literature on differences across types of aid donors shows the need to better understand the relationship between democratic and non-democratic donors and to further study optimal design of development institutions to help meet global challenges addressed through foreign aid, such as climate change and pandemic disease.
Economic Coercion
Authors: McLean Elena V.
Published: May 2021

Economic coercion is a threatened or actual imposition of economic costs on one state by another with the objective of extracting a policy concession. While the first wave of research on economic coercion focused primarily on its effectiveness, more recently scholars broadened the scope of inquiry to include states’ motivations for using economic coercion, their choice of coercive instruments, and the scale of coercive efforts. In addition, scholars have evaluated a broad range of indirect and unintended outcomes of economic coercion. Overall, this field of International Political Economy (IPE) research is problem-driven; consequently, the shared focus on the use and outcomes of economic coercion results in a significant degree of engagement and collaboration among sanction scholars.
International Trade and Conflict
Authors: Mansfield Edward D.
Published: May 2021

This chapter surveys the empirical literature on the effects of foreign trade on political-military conflict. There have been three “waves” of work on this topic since 1980. It is argued that the most recent wave differs from earlier waves in various important respects. First, it has made significant headway in addressing the causal mechanisms underlying the relationship between trade and conflict. Second, this wave has addressed a wider variety of aspects of trade, including trade policy and trade agreements. Third, a variety of recent studies have shed new light on the effects of trade on the outbreak of war, as well as the effects of war on the trade ties of combatants. Finally, the third wave of research on trade and conflict has addressed whether the effects of trade stem from market capitalism more generally and whether a simultaneous relationship exists between trade and conflict.
Open Economy Politics Revisited
Authors: Rickard Stephanie J.
Published: May 2021

Scholars of International Political Economy (IPE) working in the open economy politics (OEP) tradition use interests, institutions and international bargaining to explain economic policies, as well as international economic relations. A large amount of research in IPE today fits squarely within the OEP paradigm, which makes OEP itself an expedient subject for investigation. This chapter describes the OEP framework and discusses recent developments that have challenged it, including the behavioral revolution and the growing importance of economic geography. An evaluation of how the paradigm has evolved in response to these challenges is undertaken. The chapter concludes with a discussion of emerging issues that confront the OEP paradigm going forward, including the rise of China and the growing political backlash against globalization and the liberal international order.
State-dependent studies on perception and cognition
Authors: Silvanto Juha
Published: May 2021

Neuronal response to an external stimulus is affected not only by stimulus properties, but also by the baseline activation state; this is referred to as state-dependency. Leveraging this principle helps to enhance the specificity and reduce the variability of brain stimulation effects. State-dependent paradigms have proven to be successful in enhancing the functional resolution of brain stimulation to the extent that the tuning of neuronal representations can be revealed, and they have also enhanced clinical benefits in the treatment of disorders such as depression. Furthermore, state-dependent approach has been applied in various brain stimulation protocols, including online and offline transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial random noise stimulation (tRNS), and paired-pulse associative stimulation. This chapter describes the principles and mechanisms of state-dependent brain stimulation and summarizes its contribution to cognitive neuroscience.
Architecture, Town Planning, and Large-Scale Housing Estates
Authors: Störtkuhl Beate
Published: May 2021

Architecture and urban planning were facing great challenges during the Weimar Republic, given the difficult economic context of the time. The housing conditions in Germany had already been problematic prior to the First World War. In the Weimar Republic, their improvement was defined as a communal, not-for-profit task. New urban quarters emerged and a new urban infrastructure had to be created, while many historic urban cores changed into a ‘city centre’ dominated by business and consumerism. In the optimistic, euphoric situation of societal renewal after the war, many architects produced visionary projects. Yet at the same time, they had to develop pragmatic approaches for a cost-saving, industrialized type of housing construction. Large settlements in Berlin and in Frankfurt, or the experimental Weißenhof settlement in Stuttgart as well as the Bauhaus represented the ideas of an architectural avant-garde that was internationally connected. The protagonists of modernism, the so-called Neues Bauen, dominated contemporary coverage and contributed, once they had been forced into exile in 1933, to the global reach of this current. Yet in reality, architecture and housing construction in the Weimar Republic were not dominated by the Neues Bauen. They can rather be described as multiple modernity, which showed fluid boundaries and permeability between radical modernist forms and traditionalist elements.
Federalism, Regionalism, and the Construction of Spaces
Authors: Weichlein Siegfried
Published: May 2021

The Weimar Republic was a democratic and a federal state. The Reich had significantly more powers than it had had in Prussian-dominated Imperial Germany. Not only the Reich, but also the Länder (states) were structured democratically. Neither the plans for a reorganization of the Reich nor those for ending the dualism between the Reich and Prussia came to fruition. The unitarian leanings of the democrats ran against the will of the democratic state governments to assert themselves. The 1920 Reich Finance Reform reversed the course of fiscal federalism by creating a nationwide centralized system of taxation replacing the older Länder tax codes. The Reich and the Länder shared revenues which put the Länder at risk in the crisis after 1930. A range of economic, social, and cultural dynamics changed Germany’s spatial order. No longer were the Reich’s financial administration and unemployment-insurance system oriented toward state borders. The same applied to transport areas and tariff zones, which were oriented towards rationalization and optimization. The Heimat movement found the essence of the nation in an ethnically and culturally defined peoplehood, which brought it close to the völkisch movement. A sharp nationalism prevailed in the Heimat movement putting border regions more and more at the center of national imagination.
Spectral and timing properties of the black hole candidate X1755−338 observed in 1989–1995
Authors: Yamauchi Shigeo , Maeda Sakiho
Published: May 2021

We report results of an analysis of the black hole (BH) candidate source X1755−338 made in 1989, 1990, and 1991 with Ginga, and in 1995 with ASCA. The spectra were well represented by a model consisting of a soft thermal emission from an accretion disk and a hard X-ray tail. The normalization of the multi-color disk, related to the inner disk radius, was similar to each other. The unabsorbed X-ray fluxes from the disk component in the 0.01–10 keV band were estimated to be 1.3 × 10−9, 3.0 × 10−9, 9.8 × 10−10, and 2.4 × 10−9 erg s−1 cm−2 in 1989, 1990, 1991, and 1995, respectively, and are proportional to $kT_{\rm in}^4$, where kTin is a temperature at the inner disk radius. Based on the standard accretion disk model for a non-rotating BH, our results suggest either a small BH mass or a large inclination angle. Otherwise, X1755−338 is a rotating BH. The hard X-ray intensity was found to be variable, while the soft X-ray intensity was stable. Although previous work showed the existence of an iron line at 6.7 keV, no clear iron line feature was found in any of the spectra. We infer that most of the iron line flux reported in the previous work was due to contamination of the Galactic diffuse X-ray emission.
Spine-Adjusting Instrument (Impulse®) Attenuates Nociception and Modulates Oxidative Stress Markers in the Spinal Cord and Sciatic Nerve of a Rat Model of Neuropathic Pain
Authors: da Silva Francielle B O , Santos Maria do Carmo Q , da Silva Thaisla Cristiane Borella , Facchini Daniel , Kolberg Angela , Barros Rodrigo R , Silveira Elza M S , Kroth Adarly , Duarte Felipe C K , Vassoler Jakson M , Kolberg Carolina , Partata Wania A
Published: May 2021

Objective

Oxidative stress plays an important role in neuropathic pain (NP). Spinal manipulative therapy (SMT) can exert beneficial effects on pain outcomes in humans and in animal models. SMT can also modulate oxidative stress markers in both humans and animals. We aimed to determine the effect of Impulse®-assisted SMT (ISMT) on nociception and oxidative stress biomarkers in the spinal cords and sciatic nerves of rats with NP.

Methods

NP was induced by chronic constriction injury (CCI) of the sciatic nerve. Animals were randomly assigned to naive, sham (rats with sciatic nerve exposure but without ligatures), or CCI, with and without ISMT. ISMT was applied onto the skin area corresponding to the spinous process of L4–L5, three times per week for 2 weeks. Mechanical threshold, latency to paw withdrawal in response to thermal stimulus, and oxidative stress biomarkers in the spinal cord and sciatic nerve were the main outcomes evaluated.

Results

ISMT significantly increased mechanical threshold and withdrawal latency after CCI. In the spinal cord, ISMT prevented the increase of pro-oxidative superoxide anion generation and hydrogen peroxide levels. Lipid hydroperoxide levels both in the spinal cord and in the sciatic nerve were attenuated by ISMT. Total antioxidant capacity increased in the spinal cords and sciatic nerves of CCI rats with and without ISMT. CCI and ISMT did not significantly change the total thiol content of the spinal cord.

Conclusions

Our findings suggest that reduced oxidative stress in the spinal cord and/or nerve may be an important mechanism underlying a therapeutic effect of SMT to manage NP nonpharmacologically.
Gene Editing, Identity and Benefit
Authors: Douglas Thomas , Devolder Katrien
Published: May 2021

Some suggest that gene editing human embryos to prevent genetic disorders will be in one respect morally preferable to using genetic selection for the same purpose: gene editing will benefit particular future persons, while genetic selection would merely replace them. We first construct the most plausible defence of this suggestion—the benefit argument—and defend it against a possible objection. We then advance another objection: the benefit argument succeeds only when restricted to cases in which the gene-edited child would have been brought into existence even if gene editing had not been employed. Our argument relies on a standard account of comparative benefit which has recently been criticised on the grounds that it succumbs to the so-called ‘pre-emption problem’. We end by considering how our argument would be affected were the standard account revised in an attempt to evade this problem. We consider three revised accounts and argue that, on all three, our critique of the benefit argument stands.
Consumers as Financiers: Consumer Surplus, Crowdfunding, and Initial Coin Offerings
Authors: Lee Jeongmin , Parlour Christine A
Published: May 2021

We study the efficiency implications of funding directly provided by consumers. Intermediaries fail to finance all efficient projects, and crowdfunding can improve efficiency. Whereas intermediaries value projects based on cash flows, consumers also receive a consumption benefit. Unique to crowdfunding is the ability of consumers to commit to pay for the benefit, and the degree to which they can do so determines its efficiency. We discuss the implications of introducing a resale market for consumers’ claims, as in the case of initial coin offerings, and the speculation that necessarily accompanies such markets. We provide testable and policy-related implications.
Conflict, Displacement … and Peace? A Critical Review of Research Debates
Authors: Krause Ulrike , Segadlo Nadine
Published: May 2021

The nexus of violent conflict and forced migration has received continuous scholarly attention since the 1980s, but what are the focus areas and key strands in these research debates? Based on a semi-systematic review of research published between 1980 and 2020, this article examines debates about conflict, displacement, and peace. The review leads to the identification of three main strands that are closely connected: the structural links outlining how conflicts contribute to displacements; the various prevailing risks of violence; and the individual and collective strategies of displaced people to cope with dangers and experiences especially in host countries and regions. Despite this broad and still-growing body of literature, peace is found to have been insufficiently addressed in debates thus far. Only few studies attend to peace, and they mainly connect it to return to places of origin, peace(building) education by aid actors, or partly displaced people being potential destabilisers of peace processes. Hence, the roles of peace and displaced people’s practices to support peace constitute key areas requiring further research going forwards.
Self-dependent neural variability predicts recovery from depressive symptoms
Authors: Fan Leyi , Duan Qin , Luo Siyang
Published: May 2021

Researchers have increasingly paid attention to the neural dynamics of depression. This study examined whether self-dependent neural variability predicts recovery from depressive symptoms. Sixty adults with depressive symptoms who were not officially diagnosed with major depressive disorder participated in this study. Participants completed functional magnetic resonance imaging (fMRI) scanning, including a resting-state and a self-reflection task. The fMRI data were used to estimate neural variability, which refers to the temporal variability in regional functional connectivity patterns. Participants then completed the Self-Construal Scale and the Beck Depression Inventory (BDI). The change in BDI scores over 3 months indicated the degree of recovery from depressive symptoms. Self-construal moderated the effects of general neural variability on predicting recovery from depressive symptoms. Interdependent individuals became less depressive with higher general neural variability, but the relationship was not significant in independent individuals. The differences in neural variability between self-related and other-related conditions also predicted recovery from depressive symptoms. The regions contributing to the prediction were mainly distributed in the default-mode network. Based on these results, the harmony between individuals’ neural dynamics and self-concept is important for recovery from depressive symptoms, which might be a foundation for individualized treatment and counseling.
Pythium spp. Associated with Root Rot and Stunting of Winter Crops in North Carolina
Authors: Reeves Ella R. , Kerns James P. , Shew Barbara B.
Published: May 2021

Annual double-crop rotation systems that incorporate winter wheat, clary sage, or a cover crop are common in eastern North Carolina. Stunting and root rot of clary sage (Salvia sclarea L.) reduce yields of this crop, especially in wet soils. Stunting and reduced stand establishment also afflict winter cover crops, including rye, rapeseed, and winter pea. Pythium spp. are causal agents of root rot of winter wheat in this region, but their role in root rot and stunting of other winter crops is not understood. During the growing seasons of 2018 to 2019 and 2019 to 2020, samples of clary sage, rye, rapeseed, and winter pea displaying symptoms of stunting were collected across eastern North Carolina, resulting in the recovery of 420 isolates of Pythium from the roots of all hosts. Pythium irregulare, Pythium spinosum, and the complex Pythium sp. cluster B2A were the species most frequently isolated from clary sage. P. irregulare and P. spinosum were aggressive pathogens of clary sage at 18°C and caused moderate root rot at 28°C. Koch’s postulates confirmed that isolates belonging to Pythium sp. cluster B2A, Pythium sylvaticum, Pythium pachycaule, Pythium aphanidermatum, Pythium myriotylum, and Pythium oopapillum are pathogens of clary sage. P. irregulare (37% of all isolates) and members of the species complex Pythium sp. cluster B2A (28% of all isolates) constituted the majority of isolates collected from all hosts and were the species most frequently isolated from rye, rapeseed, and winter pea. In pathogenicity assays, isolates representing P. irregulare and P. spinosum caused slight to moderate root necrosis on rye, rapeseed, and winter pea. Isolates representing Pythium sp. cluster B2A caused slight to moderate root necrosis on rapeseed and clary sage, but no symptoms on rye or winter pea.
Commentary on “Civil Commitment for SUDs: A National Survey of Addiction Medicine Physicians”
Authors: Haning William
Published: May 2021

In this issue, authors Abhishek Jain and colleagues report the outcome of a survey of the physician membership of the American Society of Addiction Medicine, bearing on attitudes toward the use of civil commitment in the treatment of substance use disorders (SUDs). This comment considers the sources of the pejorative view in which civil commitment for SUD is often held, identifying several historical analogies with other illnesses. Resolution of the common confusion between toxidrome and addiction, with a renewed emphasis on the treatability of SUDs, may contribute to more productive treatment matching and outcomes.
Single-level Cervical Arthroplasty with Prodisc-C Vivo Artificial Disc
Authors: Cao Shuo , Zhao Yanbin , Sun Yu , Li Weishi , Zhou Feifei , Zhang Fengshan , Zhang Li , Pan Shengfa , Chen Xin , Diao Yinze , Xia Tian
Published: May 2021

Study Design.

Retrospective study.

Objective.

The aim of this study was to evaluate the long-term clinical and radiographic outcomes of cervical arthroplasty using the ProDisc-C Vivo prosthesis.

Summary of Background Data.

Previous reports have shown that cervical arthroplasty with ProDisc-C artificial disc has acceptable clinical outcomes at 5-year and 10-year follow-ups.

Methods.

Clinical and radiographic evaluations, including dynamic flexion-extension lateral images, were performed at baseline and at the 5-year follow-up.

Results.

Twenty-eight patients who underwent single-level ProDisc-C Vivo arthroplasty were followed-up for a mean period of 65 months. The range of motion at the operated level was 8.9° ± 2.3° at baseline and 8.3° ± 4.8° at the final follow-up (P 
= 0.494). Fourteen of 28 levels (50%) developed heterotopic ossification (HO). According to McAfee's classification, one level was classified as grade I, nine levels as grade II, two levels as grade III, and two levels as grade IV. Only four of 28 levels (14.3%) had severe HO. Among patients with cervical spondylotic myelopathy, mJOA score was 13.9 ± 2.5° at baseline and 15.9° ± 1.0° at the final follow-up (P 
= 0.001 < 0.05). Among patients with cervical spondylotic radiculopathy, Visual Analog Scale (VAS) neck and shoulder was 5.4 ± 1.4° at baseline and 0.7° ± 1.2° at the final follow-up (p = 0.000 < 0.05), VAS arm was 5.1 ± 2.8° at baseline and 0.5° ± 1.2° at the final follow-up (P 
= 0.000 < 0.05). A total of 49 adjacent segments were observed and 13 (26.5%) had adjacent segment degeneration. No patient developed recurrent cervical radiculopathy or myelopathy due to adjacent segment disease. No patient underwent re-operation.

Conclusion.

ProDisc-C Vivo arthroplasty had satisfactory clinical and radiographic outcomes at 5-year follow-up.

Level of Evidence: 4
Outcomes of Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome Following Traumatic Injury: A Propensity-Matched Analysis
Authors: Ahmed Nasim , Kuo Yen-Hong , Pratt Abimbola
Published: May 2021

OBJECTIVES:

The purpose of this study is to evaluate the overall occurrence of inhospital mortality in trauma patients who were placed on extracorporeal membrane oxygenation following the complication of the acute respiratory distress syndrome.

DESIGN:

Observational cohort study.

SETTING:

The data of all patients who were traumatically injured and developed the complication of acute respiratory distress syndrome were accessed from the Trauma Quality Improvement Program database from the calendar years of 2013 to 2016.

PATIENTS:

Patients 16 years old and less than 90 years old were included in the study. Variables included patient demography, Injury Severity Score, Glasgow Coma Scale score, Abbreviated Injury Scale score, and outcomes.

INTERVENTIONS:

Extracorporeal membrane oxygenation.

MEASUREMENTS AND MAIN RESULTS:

Propensity-matched analysis was performed between two groups: patients placed on extracorporeal membrane oxygenation and patients placed on conventional mode of ventilation. The primary outcome was inhospital mortality. Out of 6,121 patients who developed acute respiratory distress syndrome, 118 patients (1.93%) were placed on extracorporeal membrane oxygenation. The pair matched analysis showed significant difference between the two groups (extracorporeal membrane oxygenation vs conventional mode of ventilation) for overall inhospital mortality (35.6% vs 14.4%; p < 0.001). There were significant differences found between the two groups for the median hospital length of stay (41 [35–49] vs 27 [24–33]), ICU days (35 [30–41] vs 19 [17–24]), and ventilator days (30 [27–34] vs 15 [13–18]). All p values are less than 0.001.

CONCLUSIONS:

Approximately 2% of acute respiratory distress syndrome patients were placed on extracorporeal membrane oxygenation. The overall inhospital mortality remained high despite patients being placed on extracorporeal membrane oxygenation.
Sleep disorders and prostate cancer prognosis: biology, epidemiology, and association with cancer development risk
Authors: Porcacchia Allan Saj , Câmara Diana Aparecida Dias , Andersen Monica Levy , Tufik Sergio
Published: May 2021

Sleep is crucial for the maintenance of health and well-being. Sleep disorders can result in physiological consequences and are associated with several health issues, including cancer. Cancer is one of the most significant health problems in the world. In Western countries, prostate cancer is the most prevalent noncutaneous cancer among men. Epidemiological studies showed that one in nine men will have this disease during their life. Many factors influence prostate cancer and the tumor niche, including endogenous hormones, family history, diet, and gene mutations. Disruption of the circadian cycle by sleep disorders or other factors has been suggested as a novel and important risk factor for prostate cancer and its tumorigenesis. This review presents information regarding the epidemiological and biological aspects of prostate cancer, and discusses the impact of sleep physiology and sleep disorders on this type of cancer, highlighting possible associations with risk of cancer development.
Cutaneous Manifestations of Castleman Disease: Histopathological Characteristics and Review of Literature
Authors: Zapata-Salazar Natalia A. , Gómez-Flores Minerva , Ocampo-Candiani Jorge , Chavez-Alvarez Sonia
Published: May 2021

Castleman disease (CD) is a poorly understood lymphoproliferative disorder characterized by enlarged lymph nodes. The spectrum of differential diagnoses is wide, and it is hard to differentiate from other diseases. Cutaneous involvement of CD is rare, and studies that describe cutaneous dermatopathology of CD are scarce. The aim of this study was to collect case reports of CD with cutaneous manifestations and identify potential relevant histopathological features. We found that cases of CD with cutaneous manifestations often exhibited dermal lymphoid follicles with follicle center infiltration of lymphocytes and plasma cells. These dermal follicles also had regressive or atrophic germinal centers and were penetrated by hyalinized vessels. Patients with CD also consistently exhibited perivascular and deep dermal inflammatory infiltrate, primarily composed of lymphocytes and plasma cells. We intend to raise awareness of this rare entity and provide more histopathological information regarding its dermatological manifestations.
Proficiency at Tick Identification by Pathologists and Clinicians Is Poor
Authors: Laga Alvaro C. , Granter Scott R. , Mather Thomas N.
Published: May 2021

Objectives:

Prompt accurate identification of tick species is required for appropriate administration of single dose antimicrobial prophylaxis for Lyme disease in selected patients. To determine the proficiency of clinicians at tick identification in the northeastern United States where Lyme disease has its highest incidence, we undertook a survey.

Methods:

We analyzed the results of a voluntary survey testing proficiency in identifying tick species using high-resolution photographs of ticks.

Results:

Only 35% of ticks were correctly identified. Although 60% of respondents could identify a nonengorged adult blacklegged tick, only 34% could correctly identify a partially engorged blacklegged tick. Participants performed even worse at classifying brown dog, American dog, and Lone Star ticks.

Conclusions:

Proficiency of tick identification by pathologists and clinicians is poor.
Prognostic Utility of a Modified HEART Score When Different Troponin Cut Points Are Used
Authors: Aurora Lindsey , McCord James , Nowak Richard , Giannitsis Evangelos , Christenson Robert , DeFilippi Christopher , Lindahl Bertil , Christ Michael , Body Richard , Jacobsen Gordon , Mueller Christian
Published: May 2021

Background:

Although the recommended cut point for cardiac troponin (cTn) is the 99th percentile, many institutions use cut points that are multiples higher than the 99th percentile for diagnosing acute myocardial infarction (AMI). Prior studies have shown that patients with a HEART score (HS) ≤ 3 and normal serial cTn values (modified HS) are at low risk for adverse events. This study aimed to evaluate the prognostic utility of the HS when various cTn cut points are used.

Methods:

This was a substudy of High Sensitivity Cardiac Troponin T assay for RAPID Rule-out of Acute Myocardial Infarction (TRAPID-AMI), a multicenter, international trial evaluating a rapid rule-out AMI study using high-sensitivity cardiac troponin T (hs-cTnT). One-thousand two-hundred eighty-two patients were evaluated for AMI from 12 centers in Europe, United States, and Australia from 2011 to 2013. Blood samples of hs-cTnT were collected at presentation and 2 hours, and each patient had a HS calculated. The US Food and Drug Administration approved 99th percentile for hs-cTnT (19 ng/L) was used.

Results:

There were 213 (17%) AMIs. Within 30 days, there were an additional 2 AMIs and 8 deaths. The adverse event rates at 30 days (death/AMI) for a HS ≤ 3 and nonelevated hs-cTnT over 2 hours using increasing hs-cTnT cut points ranged from 0.6% to 5.1%.

Conclusions:

Using the recommended 99th percentile cut point for hs-cTnT, the combination of a HS ≤ 3 with nonelevated hs-cTnT values over 2 hours identifies a low-risk cohort who can be considered for discharge from the emergency department without further testing. The prognostic utility of this strategy is greatly lessened as higher hs-cTnT cut points are used.
UTILIZATION OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY TO IDENTIFY POSTERIOR VITREOUS DETACHMENT IN PATIENTS WITH RETINAL DETACHMENT
Authors: Wagley Sushant , Belin Peter J. , Ryan Edwin H.
Published: May 2021

Purpose:

To compare posterior vitreous detachment (PVD) identification rate between clinical examination versus spectral domain optical coherence tomography in patients with retinal detachment (RD).

Methods:

Data from the Primary Retinal Detachment Outcomes Study were used for this retrospective cross-sectional study of 506 patients. Spectral domain optical coherence tomography scans were reviewed to detect the separation of the posterior hyaloid face from the retina and the optic nerve on all 31 raster cuts of a 30 × 30 scan. Statistical analysis was performed to compare spectral domain optical coherence tomography–identified PVD with PVD identified on slit-lamp biomicroscopy.

Results:

There was a significant difference in the rate of PVD identification by clinical examination versus spectral domain optical coherence tomography in patients with RD. Clinical examination identified 51.58% of patients with PVD, whereas spectral domain optical coherence tomography identified 78.42% of patients with PVD. In patients with macula-on RD, 61.68% were found to have PVD on clinical examination versus 83.90% by imaging. Spectral domain optical coherence tomography identified larger number of PVD in patients with macula-off RD compared with clinical examination, 46.28% versus 75.43%, respectively. There was low agreement between the two methods (kappa score = 0.137). There was a significant difference in surgical procedure type chosen in those with versus without PVD.

Conclusion:

Knowledge about the posterior hyaloid anatomy is important before undergoing RD repair. Spectral domain optical coherence tomography can better identify PVD than clinical examination in patients with RD.
CATASTROPHIC, BILATERAL RETINAL VASCULAR OCCLUSION AFTER INTRAVITREAL BEVACIZUMAB INJECTION
Authors: Ng Caleb C. , Brill Daniel , Cunningham Emmett T. , Burckhard Braden A. , Jumper J. Michael , Heier Jeffrey , Rifkin Lana M. , Eliott Dean , McDonald H. Richard , Sobrin Lucia
Published: May 2021

Purpose:

To describe two cases of catastrophic, bilateral retinal vascular occlusion after intravitreal (IVT) bevacizumab injection.

Methods:

Case series. Main outcome measures included clinical and fluorescein angiography findings.

Results:

Case 1—A 65-year-old woman with calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis syndrome developed acute, severe, bilateral visual loss 2 weeks after bilateral IVT bevacizumab injection for proliferative diabetic retinopathy. Examination and fluorescein angiography revealed moderate anterior chamber inflammation, bilateral perivascular retinal hemorrhages, and near total retinal vascular occlusion. Extensive testing revealed moderately elevated anti-B2 glycoprotein (antiphospholipid) antibodies. Case 2—An 85-year-old man with polymyalgia rheumatica and left eye exudative age-related macular degeneration experienced severe, bilateral, sequential visual loss in the left eye and then right eye approximately 3 weeks after IVT bevacizumab left eye injection. Examination revealed bilateral panuveitis, diffuse perivascular exudates, and intraretinal hemorrhages. Fluorescein angiography showed diffuse venous leakage. Extensive testing revealed an elevated antinuclear antibody and mildly elevated anticardiolipin antibody.

Conclusion:

Patients with underlying retinal vascular vulnerabilities may be at increased risk of catastrophic, bilateral retinal vascular occlusion after treatment with IVT bevacizumab. The moderate-to-severe intraocular inflammation in both cases and the contralateral involvement after unilateral IVT injection in Case 2 suggest a possible delayed immune-mediated mechanism.
Physical Activity and Cardiovascular Fitness During Childhood and Adolescence: Association With Retinal Nerve Fibre Layer Thickness in Young Adulthood
Authors: Lee Samantha Sze-Yee , McVeigh Joanne , Straker Leon , Howie Erin K. , Yazar Seyhan , Haynes Andrew , Green Daniel J. , Hewitt Alex W. , Mackey David A.
Published: May 2021

Precis:

Higher physical working capacity (PWC) at age 17 was associated with thicker peripapillary retinal nerve fiber layer (pRNFL) at age 20, suggesting a mechanistic link between cardiovascular fitness and neuroretinal integrity.

Purpose:

Physical activity and cardiovascular fitness have been linked with lower odds of developing glaucoma. We tested the hypothesis that early beneficial effects of physical activity and cardiovascular fitness can be observed by measuring the pRNFL thickness in young healthy adults.

Methods:

The Raine Study is a longitudinal study that has followed a cohort since before their births in 1989-1992. Parent-reported physical activity was collected between 8 and 17 years, and latent class analysis was used to identify the participants’ physical activity trajectories. At the 20-year follow-up (participants’ mean age=20.1±0.4 y), participants’ metabolic equivalent of task-minutes/week was determined using self-reported physical activity data. Participants’ PWC was assessed at the 14- and 17-year follow-ups to estimate their level of cardiovascular fitness. An eye examination, which included spectral-domain optical coherence tomography imaging, was conducted at the 20-year follow-up for 1344 participants.

Results:

Parent-reported or participant-reported physical activity was not associated with pRNFL thickness. However, higher PWC at 17 years was associated with thicker pRNFL globally [by 0.3 µm; 95% confidence interval (CI)=0.2-0.6; P<0.001], superotemporally (by 0.4 µm; 95% CI=0.1-0.7; P=0.013), inferonasally (by 0.7 µm; 95% CI=0.1-0.9; P=0.002), and nasally (by 0.4 µm; 95% CI=0.1-0.7; P=0.006) per 10 Watt increase in PWC.

Conclusions:

The association between estimated cardiovascular fitness and pRNFL thickness suggests there may be overlapping mechanisms for cardiovascular health and retinal ganglion cell integrity. While the effect sizes were small, it is possible that larger effects and clinically significant associations may arise as we follow this cohort of participants through their later adulthood.
Comparison of Superior and Inferior Visual Field Asymmetry Between Normal-tension and High-tension Glaucoma
Authors: Park In Ki , Kim Kyoung Woo , Moon Nam Ju , Shin Jae-Ho , Chun Yeoun Sook
Published: May 2021

Precis:

Increased severity of glaucoma heightened the hemispherical asymmetry in normal-tension and high-tension glaucoma (NTG/HTG), especially NTG. NTG showed localized superior defects in the central and paracentral areas whereas HTG showed mild asymmetry with diffuse defects.

Purpose:

The purpose of this study was to compare the patterns of visual field (VF) defects according to glaucoma severity in NTG and HTG.

Materials and Methods:

A total of 1458 eyes with NTG (936) and HTG (522) were classified by mean deviation values into mild, moderate, and severe. The mean total deviation (mTD) values for each nasal, central, paracentral, arcuate 1, and arcuate 2 region of the Glaucoma Hemifield Test (GHT) were calculated. The differences in mTD between the superior and inferior hemifields of NTG and HTG were compared, and the degree of hemifield asymmetry was plotted.

Results:

In NTG and HTG, the mTDs of the 5 regions of the superior GHT were significantly worse than those of the corresponding regions of the inferior GHT at all severity levels except for mild HTG. However, NTG showed significantly greater asymmetry than HTG in 2 regions at mild, 3 at moderate, and all 5 at severe. Moderate and severe NTG showed severe asymmetry with localized superior field defects concentrated at the central and paracentral areas with >8 dB asymmetry. However, in all HTG groups showed mild asymmetry with diffuse defects.

Conclusions:

The superior hemifield was more severely affected than the inferior hemifield in NTG and HTG. As the severity of glaucoma increased, so did the asymmetry in both groups, with NTG showing more profound asymmetric VF defects in the central and paracentral areas whereas HTG did not. Different VF patterns suggest differing pathologic mechanisms and possible need for different therapeutic strategies in NTG and HTG.
Patient Concerns Regarding Suspended Ophthalmic Care Due to COVID-19
Authors: Dar Salman , De Moraes Carlos G. , Karani Rabia , Khan Sabine , Chen Royce , Blumberg Dana , Harizman Noga , Krawitz Brian , Valenzuela Ives A. , Aliancy Joah , Tezel Tongalp , Horowitz Jason , Bearelly Srilaxmi , Coleman Donald Jackson , Chang Stanley , Cioffi George A. , Liebmann Jeffrey M.
Published: May 2021

Purpose:

The temporary cessation and profound changes in ophthalmic care delivery that occurred as a result of the coronavirus disease 2019 (COVID-19) pandemic have yet to be fully understood. Our objective is to assess patients’ self-reported impact of health care lockdown measures on their fears and anxieties during the crisis period of the COVID-19 pandemic in New York City.

Methods:

We conducted a digital, self-reported, patient care survey distributed by an e-mail at Columbia University’s Department of Ophthalmology outpatient faculty practice. Inclusion criteria were age greater than or equal to 18 years, a diagnosis of either retinal disease or glaucoma, and a canceled or rescheduled ophthalmology established patient appointment during the acute phase of the COVID-19 pandemic in New York City. Patients without an e-mail address listed in their electronic medical records were excluded. The survey occurred between March 2, 2020, to May 30, 2020. Primary measures were survey responses to assess key areas of patient anxiety or concern during the pandemic including the safety of care delivery in a COVID pandemic, difficulties contacting or being seen by their ophthalmologist, concern of vision loss or disease progression, and concern over missed or access to treatments. Secondary measures were correlating survey response to factors such as visual acuity, intraocular pressure, diagnosis, disease severity, follow-up urgency, recent treatments, and diagnostic testing data.

Results:

Of the 2594 surveys sent out, 510 (19.66%) were completed. Over 95% of patients were at least as concerned as in normal circumstances about their ocular health during the peak of the pandemic. Overall, 76% of respondents were more concerned than normal that they could not be seen by their ophthalmologist soon enough. Increased concern over ocular health, disease progression, and access to care all showed positive correlations (P<0.05) with worse disease severity as measured with testing such as visual fields and optical coherence tomography. In addition, 55% of patients were afraid of contracting COVID-19 during an office visit.

Conclusion and Relevance:

We found a majority of our patients were concerned about limitations in access to ophthalmic care and were fearful of disease progression. In addition, we found a number of demographic and clinical factors that correlated with increased anxiety in our patients.
Relationship Between Macular Vessel Density and Total Retinal Blood Flow in Primary Open-angle Glaucoma
Authors: Cano Jennifer , Rahimi Mansour , Xu Benjamin Y. , Richter Grace M. , Tan Ou , Huang David , Shahidi Mahnaz
Published: May 2021

Precis:

An association between macular vessel density (VD) and total retinal blood flow (TRBF) was demonstrated in subjects with primary open-angle glaucoma (POAG) and visual field (VF) loss.

Purpose:

The purpose of this study was to report relationships of macular VD metrics and TRBF in POAG.

Materials and Methods:

A total of 24 POAG and 19 healthy control subjects participated in the study. Subjects underwent optical coherence tomography and angiography for measurements of inner retinal thickness (IRT), VD, and spacing between large vessels (SLV) and small vessels (SSV). Doppler optical coherence tomography imaging was performed for TRBF measurement. In POAG subjects, automated perimetry was performed and VF loss expressed as mean deviation was measured.

Results:

Compared with the control group, POAG group had decreased VD, TRBF, IRT, and increased SLV (P<0.0001). Decreased VD (Pearson correlation, r=0.51; P<0.0001; N=43) and increased SLV (Spearman correlation, r
s=−0.47; P=0.001) were correlated with decreased TRBF. Decreased VD and SSV (r≥0.39; P≤0.001; N=43) and increased SLV (r
s=−0.71; P<0.0001) were associated with decreased IRT. Decreased VF mean deviation was correlated with decreased VD, SSV, IRT (r≥0.53; P≤0.001; N=24), and with increased SLV (r
s=−0.84; P<0.0001).

Conclusions:

The finding of an association between macular VD and TRBF supports the role of vascular factors in the pathophysiology of POAG and potential conduct of future studies aimed at identifying multiple image-based vascular metrics for disease diagnosis.
A qualitative trajectory analysis of patients' experiences tapering opioids for chronic pain
Authors: McNeilage Amy G. , Avery Nicholas S. , Holliday Simon , Glare Paul A. , Ashton-James Claire E.
Published: May 2021

Tapering opioids for chronic pain can be challenging for both patients and prescribers, both of whom may be unsure of what to expect in terms of pain, distress, activity interference, and withdrawal symptoms over the first few weeks and months of the taper. To better prepare clinicians to provide patient-centred tapering support, the current research used prospective longitudinal qualitative methods to capture individual-level variation in patients' experience over the first few months of a voluntary physician-guided taper. The research aimed to identify patterns in individuals' experience of tapering and explore whether patient characteristics, readiness to taper, opioid tapering self-efficacy, or psychosocial context were related to tapering trajectory. Twenty-one patients with chronic noncancer pain commencing tapering of long-term opioid therapy were recruited from a metropolitan tertiary pain clinic (n = 13) and a regional primary care practice (n = 8). Semistructured phone interviews were conducted a mean of 8 times per participant over a mean duration of 12 weeks (N = 173). Four opioid-tapering trajectories were identified, which we characterised as thriving, resilient, surviving, and distressed. High and low readiness to taper was a defining characteristic of thriving and distressed trajectories, respectively. Life adversity was a prominent theme of resilient and distressed trajectories, with supportive relationships buffering the effects of adversity for those who followed a resilient trajectory. Discussion focuses on the implications of these findings for the preparation and support of patients with chronic pain who are commencing opioid tapering.
Distinct synaptic mechanisms underlying the analgesic effects of γ-aminobutyric acid transporter subtypes 1 and 3 inhibitors in the spinal dorsal horn
Authors: Oyama Misa , Watanabe Shun , Iwai Takashi , Tanabe Mitsuo
Published: May 2021

Normalization of the excitatory and inhibitory balance by increasing the levels of endogenous inhibitory neurotransmitters by blocking their reuptake is a promising therapeutic strategy for relieving chronic pain. Pharmacological blockade of spinal γ-aminobutyric acid (GABA) transporter subtypes 1 and 3 (GAT1 and GAT3) has been reported to generate analgesic effects in animal models of neuropathic pain. Here, we explored the synaptic mechanisms underlying their analgesic effects in the spinal dorsal horn. Whole-cell recordings were made from dorsal horn neurons in spinal slices with attached dorsal roots from adult mice, and the effects of GAT inhibitors on miniature and evoked postsynaptic currents were examined. Behaviorally, GAT inhibitors were intrathecally applied to assess their effects on mechanical hypersensitivity in mice developing neuropathic pain after partial sciatic nerve ligation. The GAT1 inhibitor NNC-711 reduced the frequency of miniature excitatory postsynaptic currents (EPSCs) and the amplitude of C-fiber-mediated EPSCs, and the GAT3 inhibitor SNAP-5114 reduced the amplitude of A-fiber-mediated and C-fiber-mediated EPSCs. These effects were antagonized by the GABAB receptor antagonist CGP55845. Consistently, the analgesic effect of intrathecally injected NNC-711 and SNAP-5114 in mice developing mechanical hypersensitivity after partial sciatic nerve ligation was abolished by CGP55845. Thus, GAT1 and GAT3 inhibitors exert distinct GABAB receptor–mediated inhibitory effects on excitatory synaptic transmission in the spinal dorsal horn, which most likely contributes to their analgesic effects.
A Mixed-Methods Exploration of Adolescents' Lived Realities of HIV Stigma: “It's Something You Wear, Something That's Like a Shadow All Over Where You Go”
Authors: Crowley Talitha , van der Merwe Anita , Skinner Donald
Published: May 2021

This study aimed to explore how adolescents living with HIV experience stigma and the contextual factors influencing such. The authors used an exploratory, sequential, mixed-method design, including interpretive phenomenological individual interviews and focus groups with adolescents ages 13 to 18 years, their caregivers, and health care workers (n = 56) and a cross-sectional survey (n = 385) in health care facilities in the Western Cape, South Africa. Data were analyzed using an equal-status sequential mixed-methods analysis approach. Enacted, perceived, and anticipated stigma fueled fears of rejection and affected disclosure patterns of adolescents living with HIV. Experiencing HIV-related stigma was associated with being an older adolescent, being disclosed to after the age of 12 years, and residing with one's biological mother. Internalized stigma was associated with poor adherence and viral nonsuppression. Multifaceted interventions involving various individuals and groups across ecological systems are needed to interrupt the stigma process and mitigate its effects.