bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Care of Opioid use Disorder: The End of “the French Model”?
Authors: Dupouy Julie , Maumus-Robert Sandy , Mansiaux Yohann , Pariente Antoine , Lapeyre-Mestre Maryse
Published: March 2020

Background: In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a ‘French model’ facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. Objectives: Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. Materials and Methods: Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009–2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. Results: Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (n = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. Conclusions: Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.
Histopathology of Parasellar Neoplasms
Authors: Manojlovic-Gacic Emilija , Rostami Elham , Karavitaki Niki , Casar-Borota Olivera
Published: March 2020

The anatomical and histological complexity of the parasellar region as well as the presence of embryonic remnants determine the huge diversity of parasellar neoplasms. Some of them are only located in the parasellar region, whereas others can occur elsewhere, within or outside the central nervous system. Their spectrum ranges from histologically benign and low-grade malignant to high-grade malignant tumours. Although rare, metastases can pose differential diagnostic dilemmas. The severity of the clinical picture, the challenges of surgery and the risk of adverse sequelae related to surgery or radiotherapy make parasellar tumours interesting entities for the clinicians irrespective of their histological malignancy grade. Due to the different cell origins of parasellar tumours, the World Health Organization classification system does not categorise them as a distinct group. Detailed criteria for classification and malignancy grading are presented in the classification systems covering central nervous system tumours, haematological malignancies and tumours of the soft tissue and bone. In the last few years, molecular genetic features have been integrated into the diagnosis of several types of the parasellar tumours enhancing diagnostic accuracy and providing information of the value for targeting therapies. In this review, we will present histopathological and molecular genetic features, updated classification criteria and recent advances in the diagnostics and rationale for novel pharmacological therapies of selected types of parasellar neoplasms.
Ambulatory Blood Pressure in Relation to Plasma and Urinary Manganese
Authors: Zhang Zhen-Yu , Carmeli Cristian , Ponte Belen , Pruijm Menno , Ackermann Daniel , Ehret Georg , Guessous Idris , Petrović Dušan , Pechère-Bertschi Antoinette , Vogt Bruno , Martin Pierre-Yves , Burnier Michel , Lenglet Sébastien , Augsburger Marc , Thomas Aurelien , Bochud Murielle
Published: March 2020

The association of blood pressure (BP) with manganese—an essential trace element required for human health—remains poorly studied. In 734 randomly recruited Swiss participants (mean age, 47.5 years; 51.4% women), we related ambulatory BP to 2 biomarkers, plasma manganese (pMn) and the urinary manganese (uMn) excretion. To allow for diurnal variation, we assessed BP and uMn over 24 hours and during wakefulness and sleep, using split urine samples. Twenty-four-hour, daytime, and nighttime systolic/diastolic BPs averaged 119.8/78.1, 123.8/81.2, and 107.0/68.3 mm Hg; the corresponding median uMn were 199.5, 83.0, and 51.5 μmol and median pMn, 0.52 μg/L. In analyses dichotomized by the median of the biomarkers, greater pMn was associated with higher 24-hour systolic/diastolic BP (+4.1/+2.3 mm Hg;
P
≤0.0003), greater daytime uMn with lower daytime BP (−3.5/−1.9 mm Hg;
P
≤0.0067), and greater nighttime uMn with higher nighttime BP (+2.9/+1.2 mm Hg;
P
≤0.046). In multivariable-adjusted analyses, significance (
P
≤0.030) was retained for the positive association of 24-hour and daytime diastolic BP with pMn and for systolic BP in relation to uMn at night. The association sizes for a 2-fold increment in the biomarkers amounting to 0.77 mm Hg (95% CI, 0.08–1.47 mm Hg), 0.97 (CI, 0.20–1.76) and 1.33 (CI, 0.20–2.50 mm Hg), respectively. In conclusion, there were positive associations between diastolic BP and pMn over 24 hours and during daytime and between systolic BP and uMn at night.
Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension Unit
Authors: Burrello Jacopo , Monticone Silvia , Losano Isabel , Cavaglià Giovanni , Buffolo Fabrizio , Tetti Martina , Covella Michele , Rabbia Franco , Veglio Franco , Pasini Barbara , Williams Tracy Ann , Mulatero Paolo
Published: March 2020

Primary aldosteronism (PA) was considered a rare disorder almost always associated with hypokalemia. The widespread screening of patients with hypertension unveiled an increased prevalence of PA with normokalemic hypertension the prevailing phenotype. Many studies have reported the prevalence of hypokalemia in patients with PA; conversely, the prevalence of PA in patients with hypokalemia is unknown. In this retrospective observational study, we define the prevalence of hypokalemia in referred patients with hypertension and the prevalence of PA in patients with hypokalemia and hypertension. Hypokalemia was present in 15.8% of 5100 patients with hypertension, whereas 76.9% were normokalemic, and 7.3% hyperkalemic. The prevalence of PA in patients with hypokalemia was 28.1% and increased with decreasing potassium concentrations up to 88.5% of patients with spontaneous hypokalemia and potassium concentrations <2.5 mmol/L. A multivariate regression analysis demonstrated the association of hypokalemia with the occurrence of cardiovascular events independent of PA diagnosis. An association of PA with the occurrence of cardiovascular events and target organ damage independent of hypokalemia was also demonstrated. In conclusion, our results confirm that PA is a frequent cause of secondary hypertension in patients with hypokalemia, and the presence of hypertension and spontaneous hypokalemia are strong indications for PA diagnosis. Finally, we show that PA and hypokalemia are associated with an increased risk of cardiovascular events.
Risk of Developing Hypokalemia in Patients With Hypertension Treated With Combination Antihypertensive Therapy
Authors: Krogager Maria Lukács , Mortensen Rikke Nørmark , Lund Peter Enemark , Bøggild Henrik , Hansen Steen Møller , Kragholm Kristian , Aasbjerg Kristian , Søgaard Peter , Torp-Pedersen Christian
Published: March 2020

Little is known about the occurrence of hypokalemia due to combination therapy for hypertension. Using data from Danish administrative registries, we investigated the association between different combinations of antihypertensive therapy and risk of developing hypokalemia. Using incidence density matching, 2 patients without hypokalemia were matched to a patient with hypokalemia (K, <3.5 mmol/L) on age, sex, renal function, and time between index date and date of potassium measurement. Combination therapies were subdivided into 10 groups including β-blockers (BB)+thiazides (BB+thiazides), calcium channel blockers (CCB)+renin angiotensin system inhibitors (RASi)+thiazides (CCB+RASi+Thiazides), calcium channel blockers+thiazides (CCB+thiazides), and β-blockers+renin angiotensin system inhibitors+thiazides (BB+RASi+thiazides). We used conditional logistic regression to estimate the odds of developing hypokalemia for different combinations of antihypertensive drugs within 90 days of combination therapy initiation. We matched 463 patients with hypokalemia to 926 patients with normal potassium concentrations. The multivariable analysis showed 5.82× increased odds of developing hypokalemia if administered CCB+thiazides (95% CI, 3.06–11.08) compared with CCB+RASi. Other combinations significantly associated with increased hypokalemia odds were BB+thiazides (odds ratio, 3.34 [95% CI, 1.67–6.66]), CCB+RASi+thiazides (odds ratio, 3.07 [95% CI, 1.72–5.46]), and BB+RASi+thiazides (odds ratio, 2.78 [95% CI, 1.41–5.47]). Combinations of thiazides with CCB, RASi, or BB were strongly associated with increased hypokalemia risk within 90 days of treatment initiation.
Loss of
Arhgef11
in the Dahl Salt-Sensitive Rat Protects Against Hypertension-Induced Renal Injury
Authors: Johnson Ashley C. , Wu Wenjie , Attipoe Esinam M. , Sasser Jennifer M. , Taylor Erin B. , Showmaker Kurt C. , Kyle Patrick B. , Lindsey Merry L. , Garrett Michael R.
Published: March 2020

Arhgef11
is a Rho-guanine nucleotide exchange factor that was previously implicated in kidney injury in the Dahl salt-sensitive (SS) rat, a model of hypertension-related chronic kidney disease. Reduced
Arhgef11
expression in an SS-
Arhgef11
SHR
-minimal congenic strain (spontaneously hypertensive rat allele substituted for S allele) significantly decreased proteinuria, fibrosis, and improved renal hemodynamics, without impacting blood pressure compared with the control SS (SS-wild type). Here, SS-
Arhgef11
−/−
and SS-wild type rats were placed on either low or elevated salt (0.3% or 2% NaCl) from 4 to 12 weeks of age. On low salt, starting at week 6 and through week 12, SS-
Arhgef11
−/−
animals demonstrated a 3-fold decrease in proteinuria compared with SS-wild type. On high salt, beginning at week 6, SS-
Arhgef11
−/−
animals demonstrated >2-fold lower proteinuria from weeks 8 to 12 and 30 mm Hg lower BP compared with SS-wild type. To better understand the molecular mechanisms of the renal protection from loss of
Arhgef11
, both RNA sequencing and discovery proteomics were performed on kidneys from week 4 (before onset of renal injury/proteinuria between groups) and at week 12 (low salt). The omics data sets revealed loss of
Arhgef11
(SS-
Arhgef11
−/−
) initiates early transcriptome/protein changes in the cytoskeleton starting as early as week 4 that impact a number of cellular functions, including actin cytoskeletal regulation, mitochondrial metabolism, and solute carrier transporters. In summary, in vivo phenotyping coupled with a multi-omics approach provides strong evidence that increased
Arhgef11
expression in the Dahl SS rat leads to actin cytoskeleton-mediated changes in cell morphology and cell function that promote kidney injury, hypertension, and decline in kidney function.
Cardiovascular Regulation by the Neuronal BBSome
Authors: Guo Deng-Fu , Reho John J. , Morgan Donald A. , Rahmouni Kamal
Published: March 2020

The BBSome, a complex of 8 BBS (Bardet-Biedl syndrome) proteins known for its role in the control of cilia function and other cellular processes, has been implicated in blood pressure control, but the underlying mechanisms are not fully understood. Here, we show that neuronal BBSome plays an important role in blood pressure regulation. Targeted inactivation of the BBSome in the nervous system through
Bbs1
gene deletion causes sympathetically mediated increase in blood pressure in mice. This phenotype is reproduced by selective ablation of the
Bbs1
gene from the LRb (leptin receptor)-expressing neurons. Strikingly, the well-known role of the BBSome in the regulation of cilia formation and function is unlikely to account for the prohypertensive effect of BBSome inactivation as disruption of the IFT (intraflagellar transport) machinery required for ciliogenesis by deleting the
Ift88
gene in LRb neurons had no effect on arterial pressure and sympathetic nerve activity. Furthermore, we found that
Bbs1
gene deletion from AgRP (agouti-related protein) neurons or POMC (proopiomelanocortin) neurons increased renal and splanchnic sympathetic nerve activity without altering blood pressure. This lack of blood pressure increase despite the sympathetic overdrive may be explained by vascular adrenergic desensitization as indicated by the reduced vascular contractile response evoked by phenylephrine and the decreased expression of adrenergic receptors. Our results identify the neuronal BBSome as a new player in hemodynamic, sympathetic, and vascular regulation, in a manner independent of cilia.
Aortic Stiffness and White Matter Microstructural Integrity Assessed by Diffusion Tensor Imaging: The ARIC‐NCS
Authors: Wei Jingkai , Palta Priya , Meyer Michelle L. , Kucharska‐Newton Anna , Pence Brian W. , Aiello Allison E. , Power Melinda C. , Walker Keenan A. , Sharrett A. Richey , Tanaka Hirofumi , Jack Clifford R. , Mosley Thomas H. , Reid Robert I. , Reyes Denise A. , Heiss Gerardo
Published: March 2020

Background

Changes in white matter microstructural integrity are detectable before appearance of white matter lesions on magnetic resonance imaging as a manifestation of cerebral small‐vessel disease. The information relating poor white matter microstructural integrity to aortic stiffness, a hallmark of aging, is limited. We aimed to examine the association between aortic stiffness and white matter microstructural integrity among older adults.

Methods and Results

We conducted a cross‐sectional study to examine the association between aortic stiffness and white matter microstructural integrity among 1484 men and women (mean age, 76 years) at the 2011 to 2013 examination of the ARIC‐NCS (Atherosclerosis Risk in Communities Neurocognitive Study). Aortic stiffness was measured as carotid‐femoral pulse wave velocity. Cerebral white matter microstructural integrity was measured as fractional anisotropy and mean diffusivity using diffusion tensor imaging. Multivariable linear regression was used to examine the associations of carotid‐femoral pulse wave velocity with fractional anisotropy and mean diffusivity of the overall cerebrum and at regions of interest. Each 1‐m/s higher carotid‐femoral pulse wave velocity was associated with lower overall fractional anisotropy (β=−0.03; 95%
CI
, −0.05 to −0.02) and higher overall mean diffusivity (β=0.03; 95%
CI
, 0.02–0.04). High carotid‐femoral pulse wave velocity (upper 25th percentile) was associated with lower fractional anisotropy (β=−0.40; 95%
CI
, −0.61 to −0.20) and higher overall mean diffusivity (β=0.27; 95%
CI
, 0.10–0.43). Similar associations were observed at individual regions of interest.

Conclusions

High aortic stiffness is associated with low cerebral white matter microstructural integrity among older adults. Aortic stiffness may serve as a target for the prevention of poor cerebral white matter microstructural integrity.
Role of Moral Values in Evaluation of the Use of Nonhuman Animals in Research
Authors: Botero Maria , Desforges Donna
Published: March 2020

One requirement for the formation of an Institutional Animal Care and Use Committee (IACUC) is that they include a community member who embodies the values of the general population. This study’s aim is to investigate whether community members use moral arguments when deliberating a case of nonhuman animals used in experimentation. To this end, we tested the responses of community members in a situation similar to those confronting members of IACUC. The participants’ evaluation of the protocol was consistent with the mandates of IACUC. We also found that overall no moral argument played a significant role in their evaluation of a protocol. Only arguments based on loyalty to the human species played a moderate role in the evaluation of using animals in experimental research, in a way similar to using some moral arguments regarding the importance of human welfare to justify the use of animals in experimental research.
Précis of The Illusion of Doubt
Authors: Schönbaumsfeld Genia
Published: March 2020

The Illusion of Doubt shows that radical scepticism is an illusion generated by a Cartesian picture of our evidential situation—the view that my epistemic grounds in both the ‘good’ and the ‘bad’ cases must be the same. It is this picture which issues both a standing invitation to radical scepticism and ensures that there is no way of getting out of it while agreeing to the sceptic’s terms. The sceptical problem cannot, therefore, be answered ‘directly’. Rather, the assumptions that give rise to it, need to be undermined. These include the notion that radical scepticism can be motivated by the ‘closure’ principle for knowledge, that the ‘Indistinguishability Argument’ renders the Cartesian conception compulsory, that the ‘New Evil Genius Thesis’ is coherent, and the demand for a ‘global validation’ of our epistemic practices makes sense. Once these dogmas are undermined, the path is clear for a ‘realism without empiricism’ that allows us to re-establish unmediated contact with the objects and persons in our environment which an illusion of doubt had threatened to put forever beyond our cognitive grasp.
A review of the genus Evonima Walker, 1865 from China with description of a new species (Lepidoptera, Nolidae, Nolinae)
Authors: HU YAN-QING , YU YONG , HUANG ZHEN-FU
Published: March 2020

Ten Chinese species of the genus Evonima Walker, 1865 are reviewed. A new species (Evonima tianmuensis sp. nov.) is described from Tianmushan Mt., Prov. Zhejiang. Adult and distribution of each species from China are illustrated. A key to species of the genus from China is provided.
A new species of the genus Rhachotropis from off Amamioshima Island, northwestern Pacific (Crustacea: Amphipoda: Eusiridae)
Authors: OKAZAKI MASAKUNI , OHTSUKA SUSUMU , TOMIKAWA KO
Published: March 2020

A new species of the eusirid amphipod, Rhachotropis reiwa is described from off Amamioshima Island, northwestern Pacific. The new species differs from its congeners in having large eyes, the middorsal tooth on pereonite 7, pleonite 3 and urosomite 1 without middorsal and dorsolateral teeth, the basis of pereopod 5 strongly produced posteriorly, and pereopod 6 with the triangular basis. A key to the species of Rhachotropis from Japanese and adjacent waters is provided. Additionally, a nucleotide sequence of mitochondrial cytochrome c oxidase subunit I from its holotype was determined for the future study.
Notes on the “Pinocchio-cobweb-spider” Craspedisia cornuta (Keyserling, 1891) from southeastern of Brazil (Theridiidae, Pholcommatinae)
Authors: BRESCOVIT ANTONIO D. , VASCONCELLOS-NETO JOÃO , VILLANUEVA-BONILLA GERMAN ANTONIO
Published: March 2020

Craspedisia cornuta (Keyserling, 1891), is redescribed on the basis of SEM data after more than fifty years after its last records. We also provide information on its natural history. SEM images for the proboscis, ventral plates of abdomen and male palp and epigynal plate are provided. Data on natural history using specimens collected in the Serra do Japi, from the state of São Paulo were analyzed and presented for the first time for this little-known species of Pholcommatinae theridiid spider.
Can Policy Facilitate Partial Retirement? Evidence from a Natural Experiment in Germany
Authors: Berg Peter , Hamman Mary K. , Piszczek Matthew , Ruhm Christopher J.
Published: March 2020

In 1996, Germany introduced the Altersteilzeit (ATZ) policy, which provided incentives for partial retirement. Using linked establishment survey and administrative employment data, the authors estimate changes in part-time employment rates and retirement after ATZ. Among men, part-time work increased and retirements were postponed by at least 0.6 years without any displacement of full-time work. For women, the increases in working lives appeared to be even larger. These estimates are based on a nationally representative sample of firms. When analysis is restricted to a subset of firms with collective agreements covering partial retirement, and when the staggered timing of those agreements is used to identify estimates, the authors find extensions of working life of more than 1 year. Overall, these findings suggest that policies encouraging partial retirement may have potential for increasing the duration of working life.
Jumping on the Bandwagon: Differentiation and Security Defection during Conflict
Authors: Dworschak Christoph
Published: March 2020

When confronted with mass uprisings, governments deploy their security forces for crowd control or repression. However, sometimes security agencies choose to side with the opposition movement. Recent work shows that “fragmentation” contributes to defection: fragmenting the security forces into parallel units leads to oversight problems and grievances among soldiers, which raises the risk of members of the security forces defecting to the opposition movement. However, I argue that the effect on defection is strongly moderated by the circumstances under which states choose to fragment their military: fragmentation for the purpose of security specialization, called “differentiation,” even decreases its risk. Employing Bayesian multilevel modeling, the findings corroborate this distinction. The study contributes to the fundamental discussion on civil–military relations, shedding light on why some conflict situations see security defections while others do not. Understanding this phenomenon is a pivotal element to explaining how conflicts develop, escalate, and end.
Modes of Ingroup Identification and Notions of Justice Provide Distinct Pathways to Normative and Nonnormative Collective Action in the Israeli–Palestinian Conflict
Authors: Selvanathan Hema Preya , Leidner Bernhard
Published: March 2020

People on both sides of an intergroup conflict undertake various forms of collective action to seek justice for their own group. Three studies investigated whether modes of ingroup identification promoted distinct preferences for justice, which subsequently shaped the form of collective action people supported. Among Arab (Study 1, n = 148) and Jewish Israelis (Study 2, n = 294), we found that ingroup glorification promoted a desire for retributive justice, which predicted support for nonnormative collective action, whereas ingroup attachment promoted a desire for restorative justice, which predicted support for normative collective action. Further, during a period of conflict escalation (i.e., Palestinian protests at the Gaza Strip), emphasizing retributive or restorative justice produced differential effects on the links from glorification and attachment to nonnormative and normative collective action (Study 3, n = 546). This research advances our understanding of when and how collective action can escalate intergroup conflict.
Dan Shall Judge: The Danites and Iron Age Israel’s Connection with the Denyen Sea People
Authors: Korpman Matthew J
Published: March 2020

The Tribe of Dan has always appeared to biblical scholars and archaeologists as something of an enigma. For decades, certain scholars, beginning with Yigael Yadin, have proposed a connection between the Denyen/Danaoi Sea People and the Danites of Ancient Israel, arguing that the former became the latter and were adopted into Israel at a later date than the other 11 tribes. Focusing on recent archaeological excavations at Tel Dan and the connections between Samson and Hercules, with special attention specifically given to Dan’s traditional paired imagery with serpents, this study seeks to present a coherent case for the possibility that Yadin’s theory may soon carry weight.
Impact of 24/7/365 Attending Radiologist Coverage on the Turnaround Time of Trauma-Related Imaging Studies Being Finalized Within 48 Hours in an Emergency Radiology Department, Offering a Perspective from a Tertiary Care Hospital
Authors: Jalal Sabeena , Ante Zharmaine , Ouellette Hugue , Peters Stephen , Munk Peter , Nicolaou Savvas
Published: March 2020

Objective:

To offer an evidence-based account of the effect of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma-related radiographs finalized within 48 hours of exam completion, drawing data from an emergency radiology department of a tertiary care hospital in Vancouver, British Columbia.

Materials and Methods:

This was a retrospective chart review, where TATs of imaging studies for a sample of trauma patients, who had visited the emergency department of the Vancouver General Hospital between two time periods, January 1 to September 30, 2013, and January 1 to September 30, 2017, were noted.

Results:

In models adjusted for patient’s age, sex, and seasonality, the 24/7/365 attending radiologist coverage was associated with an average of 19.1 (95% confidence interval [CI]: 18.7-19.4) hours of reduction in time from exam completion to report finalization by an attending radiologist. Approximately 11.3 (95% CI: 18.7-19.4) hours was due to reduction in time from exam completion to preliminary diagnosis of reports. When the impact of the increased number of radiology staff in 2017 was removed in the analysis, the overall TAT was reduced by 13.3 (95% CI: 13.0-13.6) hours and the time from exam completion to preliminary report was reduced by 7.8 (95% CI: 7.6-8.1) hours.

Limitation:

Since we have used a simple random sample (SRS) for this research, this study does not describe the burden of reports that are finalized in the emergency and trauma radiology department during the given time periods.

Conclusion:

Our pilot study demonstrates that the implementation of 24/7/365 attending radiology coverage significantly reduces TAT for finalized radiology reports of all modalities of trauma imaging studies in an emergency and trauma radiology department.

Policy implication:

This research serves the contemporary health-care administration, policymaking information needs by providing the evidence for significantly reduced TAT of finalized radiology reports from a Canadian perspective.
Percutaneous Image-Guided Biopsy of the Spleen: Experience at a Single Tertiary Care Center
Authors: John Susan , Shabana Wael , Salameh Jean-Paul , McInnes Matthew D. F.
Published: March 2020

Purpose:

The purpose of this study is to assess the complication rate of percutaneous image-guided biopsy of the spleen at our institution and to evaluate for variables associated with complication rate.

Methods:

This is a Research Ethics Board approved retrospective study of consecutive patients who underwent image-guided biopsy of the spleen at our institution from January 2010 to November 2019. Complications, imaging findings, and pathologic diagnosis were reviewed. Complications (major and minor) were classified per Society of Interventional Radiology Guidelines, and complication rate was calculated. Logistic regression was applied to determine factors associated with complications. Diagnostic yield was calculated.

Results:

In all, 55 patients (28 female) underwent splenic biopsy using ultrasound guidance. The most common indication was possible lymphoma in 41 (71.7%) patients followed by query metastasis 18 (31.5%) patients. Core biopsies (18 g/20 g) were done in 53 (92%) cases, and fine-needle aspiration (22 g) was performed in 4 (8%). The median number of samples collected was 4 (range: 2-9). The results were diagnostic in 54 cases (94.7%, 95% confidence interval [CI]: 88.7-100.0). There were 12 (21%, 95% CI: 10.1-31.9) patients with minor complications and 2 (3.5%, 95% CI: 0.0-8.4) with major complications (2 splenic bleeds requiring embolization, no splenectomy, or deaths). No variables (needle size, lesion size, and number of passes) were associated with complication rate.

Conclusion:

Percutaneous image-guided biopsy of the spleen at a single tertiary care institution demonstrates major complication rate comparable to that in the literature with no variables associated with complication rate; there were no cases of splenectomy or death.
The Role of Combined Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced MRI for Differentiating Malignant From Benign Breast Lesions Presenting Washout Curve
Authors: Tezcan Sehnaz , Ozturk Funda Ulu , Uslu Nihal , Akcay Eda Yilmaz
Published: March 2020

Purpose:

The aim of this study is to evaluate the diagnostic performance of combined breast magnetic resonance imaging (MRI) protocol including dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in patients with enhancing lesions that demonstrated washout curve and to determine whether applying apparent diffusion coefficient (ADC) cutoff value could improve the diagnostic value of breast MRI.

Methods:

The retrospective study included 116 patients with 116 suspicious breast lesions, which showed washout curve on DCE-MRI, who underwent subsequent biopsy. Morphologic characteristics on DCE-MRI and ADC values on DWI were evaluated. Apparent diffusion coefficient values and morphologic features of benign and malignant lesions were compared. Diagnostic values of DCE-MRI and combined MRI, including DCE-MRI and DWI (applying an ADC cutoff value) for distinguishing malignancy from benign lesions, were calculated.

Results:

Of the 116 breast lesions, 79 were malignant and 37 were benign. The ADC value of malignant tumors (median ADC, 0.72 × 10−3 mm2/s) was significantly lower than that of benign lesions (median ADC, 1.03 × 10−3 mm2/s; P < .000). The sensitivity and specificity of an ADC cutoff value of 0.89 × 10−3 mm2/s were 92% and 95%, respectively. Dynamic contrast-enhanced MRI alone presented 100% sensitivity and 59.4% specificity. Adding an ADC cutoff value of 0.89 × 10−3 mm2/s provided 100% sensitivity and 81% specificity, which would have prevented biopsy for 21.6% of benign lesions without missing any malignancies.

Conclusion:

Applying an ADC cutoff value to DCE-MRI provides an improvement in the diagnostic value of breast MRI for differentiating among lesions presenting washout curve.
Does Honesty Require Time? Two Preregistered Direct Replications of Experiment 2 of Shalvi, Eldar, and Bereby-Meyer (2012)
Authors: Van der Cruyssen Ine , D’hondt Jonathan , Meijer Ewout , Verschuere Bruno
Published: March 2020

Shalvi, Eldar, and Bereby-Meyer (2012) found across two studies ( N = 72 for each) that time pressure increased cheating. These findings suggest that dishonesty comes naturally, whereas honesty requires overcoming the initial tendency to cheat. Although the study’s results were statistically significant, a Bayesian reanalysis indicates that they had low evidential strength. In a direct replication attempt of Shalvi et al.’s Experiment 2, we found that time pressure did not increase cheating, N = 428, point biserial correlation ( rpb) = .05, Bayes factor (BF)01 = 16.06. One important deviation from the original procedure, however, was the use of mass testing. In a second direct replication with small groups of participants, we found that time pressure also did not increase cheating, N = 297, rpb = .03, BF01 = 9.59. These findings indicate that the original study may have overestimated the true effect of time pressure on cheating and the generality of the effect beyond the original context.
Pseudo-melancholia
Authors: Parker Gordon
Published: March 2020

Objective:

An incorrect false positive diagnosis of melancholia can lead to inappropriate treatment and illness prolongation. This paper therefore seeks to introduce the concept of ‘pseudo-melancholia’ to capture such instances and provide clinical examples of contributing at-risk scenarios.

Methods:

The author draws on clinical experience to provide exemplars of circumstances most risking a false positive diagnosis of melancholia.

Results:

Pseudo-melancholia can result from invalid measures of melancholia and from several functional and organic conditions presenting with suggested melancholic features.

Conclusions:

Recognising high-risk pseudo-melancholia scenarios has the potential to advance a change in diagnostic formulation, provide a more diagnosis-specific intervention and so avert a secondary diagnosis of ‘treatment resistant depression’.
Counting the cost of denying assisted dying
Authors: Shaw David , Morton Alec
Published: March 2020

In this paper, we propose and defend three economic arguments for permitting assisted dying. These arguments are not intended to provide a rationale for legalising assisted suicide or euthanasia in and of themselves; rather, they are supplementary arguments that should not be neglected when considering the ethics of assisted dying. The first argument is that permitting assisted dying allows consenting patients to avoid negative quality-adjusted life years, enabling avoidance of suffering. The second argument is that the resources consumed by patients who are denied assisted dying could instead be used to provide additional (positive) quality-adjusted life years for patients elsewhere in the healthcare system who wish to continue living and to improve their quality of life. The third argument is that organ donation may be an additional potential source of quality-adjusted life years in this context. We also anticipate and provide counterarguments to several objections to our thesis. Taken together, the cumulative avoidance of negative quality-adjusted life years and gain in positive quality-adjusted life years suggest that permitting assisted dying would substantially benefit both the small population that seeks assisted suicide or euthanasia, and the larger general population. As such, denying assisted dying is a lose–lose situation for all patients.
An Initial Effort to Create a Superficial Femoral Artery Ultrasound Phantom Using 3-Dimensional Printing
Authors: Bishop Paul D. , Fultz Thomas , Smith Lisa , Klatte Ryan S. , Loth Francis , Lyden Sean P.
Published: March 2020

Three-dimensional (3D) printing of anatomical structures has yielded valuable models for simulation, education, and surgical planning applications. Applications for 3D printing have continued to expand to include some ultrasound applications. The goal of this effort was to evaluate if a 3D printed model of a superficial femoral artery (SFA) would have realistic ultrasound characteristics. A computed tomography scan was 3D reconstructed and segmented using TeraRecon Aquarius Intuition software (TeraRecon, Foster City, California) to obtain an atherosclerotic SFA geometry. Both the lumen geometry and calcified plaque geometry of the SFA were exported as a stereolithographic (STL) file. The STL file was printed with An Object350 Connex 3D System using 2 different materials selected based on published elastic modulus data. VeroWhite was selected for the calcified plaque and TangoPlus Clear was selected for the artery wall. After printing, the SFA model was imaged in a water bath with a Phillips IU22 duplex ultrasound console and L12-9 ultrasound probe. Ultrasound imaging of the SFA model yielded grayscale views of artery geometry. Lumen geometry of the SFA model was similar to the actual artery geometry. Ultrasound was able to discern between the 3D print materials and visualize regions with stenosis. Suboptimal ultrasound parameters of echogenicity and wave velocity noted to differ from biological tissue. Total 3D print material cost was estimated at below $20. Although the 3D printed model did not have fully accurate ultrasound characteristics, it still provided realistic imaging. With further research, 3D printed models may offer a low-cost alternative for ultrasound phantoms.
Restored and Regretted: A History of Staging Authenticity at the Dutch Palace Het Loo
Authors: Ronnes Hanneke , van Toor Bob
Published: March 2020

With the coronation of King-Stadtholder William of Orange III and Mary II of England in 1689, palace Het Loo became the seat of the first kingly ruler the Dutch had seen in a century. Its physical biography demonstrates this symbolic weight and the dialogue between its presentation and reception since. In the early nineteenth century, its resident king Louis Bonaparte greatly altered both the house and the garden of Het Loo. In the 1970s, it was decided to recreate the seventeenth-century palace, despite fierce debates, which even reached the Dutch Parliament. Both supporters and opponents of the far-reaching renovation plans argued that the authenticity of the site was at stake. Since then, several other restoration programs have been carried out, a very extensive one is currently underway. This article takes the restorations of Het Loo in the twentieth and twenty-first centuries in light of its presentation history as its subject and case, discussing how authenticity at palace museum Het Loo is defined, contested, neglected, and defended.
Autonomous Vehicles: The Need for a Separate European Legal Framework
Authors: Punev Anastas
Published: March 2020

Regulating autonomous vehicles is not only a question of finding solutions in connection with the technical aspects of the legal framework. Rather, it involves making preliminary policy-based decisions that take all stakeholders into consideration. This article makes the case that efforts must focus on how to incentivise the use of autonomous vehicles without putting the burden on the shoulders of those who will ultimately make use of them. In that respect, the existing regulation (implemented on the basis of the Product Liability Directive and the Motor Insurance Directive) is insufficient, as there is a considerable mismatch between the current framework and the challenges posed by autonomous vehicles. There is a need to act urgently on the regulatory level.
Natural Selection of Melanism in Costa Rican Jaguar and Oncilla: A Test of Gloger’s Rule and the Temporal Segregation Hypothesis
Authors: Mooring Michael S. , Eppert Amy A. , Botts Ryan T.
Published: March 2020

The persistence of coat color polymorphisms—such as the coexistence of melanistic and “wild-type” coat color—is an ongoing evolutionary puzzle. We tested the predictions of Gloger’s rule and the Temporal Segregation hypothesis that propose that melanistic individuals will (a) occur more frequently in closed tropical forest versus open habitat due to camouflage and thermoregulation advantages and (b) be more active during brighter times of the circadian and lunar cycle because black pigmentation is cryptic under bright illumination. Based on 10 years of camera trap records of jaguar and oncilla from dense tropical forest in Costa Rica, we compared activity and relative abundance of non-melanistic wild-type morphs (rosetted or spotted) versus melanistic morphs. Twenty-five percent of jaguar records in dense forest were melanistic compared with the global average of 10% in both open and closed habitats; 32% of oncilla records were melanistic compared with 18% overall in Brazil. Overlap analysis indicated that melanistic jaguars were more active during daylight hours compared with non-melanistic jaguars, which were more nocturnal and crepuscular. Likewise, melanistic oncillas were significantly more diurnal than non-melanistic oncillas; melanistic oncillas were also more active during full moon, while non-melanistic oncillas were less active. These results imply that melanistic jaguar and oncilla enjoy the adaptive benefits of superior camouflage when inhabiting dense forest and accrue a fitness advantage when hunting during conditions of brighter illumination. If true, natural selection would ensure that melanistic individuals persist when dense forest is retained but may be threatened by deforestation and accelerating human presence.
Assessment of quality indicators for acute myocardial infarction management in 28 countries and use of composite quality indicators for benchmarking
Authors: Rossello Xavier , Medina Jesús , Pocock Stuart , Van de Werf Frans , Chin Chee Tang , Danchin Nicolas , Lee Stephen W-L , Huo Yong , Bueno Héctor
Published: March 2020

Background:

The European Society of Cardiology established a set of quality indicators for the management of acute myocardial infarction. Our aim was to evaluate their degree of attainment, prognostic value and potential use for centre benchmarking in a large international cohort.

Methods:

Quality indicators were extracted from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) (555 hospitals, 20 countries in Europe and Latin America, 2010–2011) and EPICOR Asia (218 hospitals, eight countries, 2011–2012) registries, including non-ST-segment elevation acute myocardial infarction (n=6558) and ST-segment elevation acute myocardial infarction (n=11,559) hospital survivors. The association between implementation rates for each quality indicator and two-year adjusted mortality was evaluated using adjusted Cox models. Composite quality indicators were categorized for benchmarking assessment at different levels.

Results:

The degree of attainment of the 17 evaluated quality indicators ranged from 13% to 100%. Attainment of most individual quality indicators was associated with two-year survival. A higher compliance with composite quality indicators was associated with lower mortality at centre-, country- and region-level. Moreover, the higher the risk for two-year mortality, the lower the compliance with composite quality indicators.

Conclusions:

When EPICOR and EPICOR Asia were conducted, the European Society of Cardiology quality indicators would have been attained to a limited extent, suggesting wide room for improvement in the management of acute myocardial infarction patients. After adjustment for confounding, most quality indicators were associated with reduced two-year mortality and their prognostic value should receive further attention. The two composite quality indicators can be used as a tool for benchmarking either at centre-, country- or world region-level.
Viscostretch: A Novel Surgical Technique for Refractory Macular Holes
Authors: Kovacs Kyle D. , Gonzalez Luis A. , Mahrous Abdallah , D’Amico Donald J.
Published: March 2020

Purpose:

We present a novel technique of subretinal viscodissection for addressing refractory macular holes (MHs).

Methods:

A case report and surgical technique description are provided.

Results:

In this technique, standard pars plana vitrectomy with internal limiting membrane peeling (unless previously peeled) is performed. A cohesive ophthalmic viscosurgical device (OVD) is injected through the MH, focally detaching the parafoveal retinal tissue around the hole. The OVD is removed at the conclusion of the air-fluid exchange. We provide an example of a recurrent 833-µm MH that was successfully closed despite failing initial surgery. There was no retention of subretinal OVD, and anatomic closure was achieved in this patient with a refractory MH.

Conclusions:

In refractory holes with adhesions at the MH base, this technique mobilizes the adjacent retinal tissue and uses the air’s surface tension to facilitate closure. Surgeons can consider using this technique as part of their MH arsenal.
Environmental injustices in immigrant detention: How absences are embedded in the National Environmental Policy Act process
Authors: Edwards Michelle L. , Luna Briana , Edwards Hannah
Published: March 2020

The United States’ National Environmental Policy Act is a knowledge production process required by federal government agencies to assist in their evaluation of the environmental (and social) impacts of proposed federal agency actions prior to their implementation. The U.S. Department of Homeland Security, which manages immigrant detention in the United States, is included among these federal agencies. Using Texas as a case study, we explore how the National Environmental Policy Act process, as it relates to immigrant detention, systematically produces ignorance while also producing knowledge. We identify four forms of absence: absence of process in Department of Homeland Security’s use of Categorical Exclusions and programmatic Environmental Assessments, absence of actors in the exclusion of people who are detained as an “affected” social group, absence of alternatives in how “meaningful alternatives” are identified in Environmental Assessments, and absence of discourse with the public in the Environmental Assessment process. In addition, we consider how these absences reflect and perpetuate existing social and environmental inequalities.
An integrative model of pathway convergence in genetically heterogeneous blast crisis chronic myeloid leukemia
Authors: Ko Tun Kiat , Javed Asif , Lee Kian Leong , Pathiraja Thushangi N. , Liu Xingliang , Malik Simeen , Soh Sheila Xinxuan , Heng Xiu Ting , Takahashi Naoto , Tan Joanna H. J. , Bhatia Ravi , Khng Alexis J. , Chng Wee-Joo , Sia Yee Yen , Fruman David A. , Ng King Pan , Chan Zhu En , Xie Kim Jiajing , Hoi Qiangze , Chan Cheryl Xueli , Teo Audrey S. M. , Velazquez Camacho Oscar , Meah Wee Yang , Khor Chiea Chuen , Ong Chin Thing J. , Soon Wei Jia W. , Tan Patrick , Ng Pauline C. , Chuah Charles , Hillmer Axel M. , Ong S. Tiong
Published: March 2020

Targeted therapies against the BCR-ABL1 kinase have revolutionized treatment of chronic phase (CP) chronic myeloid leukemia (CML). In contrast, management of blast crisis (BC) CML remains challenging because BC cells acquire complex molecular alterations that confer stemness features to progenitor populations and resistance to BCR-ABL1 tyrosine kinase inhibitors. Comprehensive models of BC transformation have proved elusive because of the rarity and genetic heterogeneity of BC, but are important for developing biomarkers predicting BC progression and effective therapies. To better understand BC, we performed an integrated multiomics analysis of 74 CP and BC samples using whole-genome and exome sequencing, transcriptome and methylome profiling, and chromatin immunoprecipitation followed by high-throughput sequencing. Employing pathway-based analysis, we found the BC genome was significantly enriched for mutations affecting components of the polycomb repressive complex (PRC) pathway. While transcriptomically, BC progenitors were enriched and depleted for PRC1- and PRC2-related gene sets respectively. By integrating our data sets, we determined that BC progenitors undergo PRC-driven epigenetic reprogramming toward a convergent transcriptomic state. Specifically, PRC2 directs BC DNA hypermethylation, which in turn silences key genes involved in myeloid differentiation and tumor suppressor function via so-called epigenetic switching, whereas PRC1 represses an overlapping and distinct set of genes, including novel BC tumor suppressors. On the basis of these observations, we developed an integrated model of BC that facilitated the identification of combinatorial therapies capable of reversing BC reprogramming (decitabine+PRC1 inhibitors), novel PRC-silenced tumor suppressor genes (NR4A2), and gene expression signatures predictive of disease progression and drug resistance in CP.